Practical Considerations Research Articles

Open Notes Experiences of Parents in the Pediatric ICU.

We examined how parents experience and navigate open access to clinical notes ("open notes") in their child's electronic health record and explored their interactions with clinicians during an ICU admission. We performed a qualitative analysis using semistructured interviews of English-speaking parents who accessed their child's clinical notes during a pediatric ICU (general or cardiac) admission. We included patient-parent dyads with an ICU admission ≥48 hours between April 2021 and December 2022, note access by proxy timestamp during the ICU course, and either patient age <12 years or incapacitated adolescent ages 12 to 21 years. Purposive sampling was based on sociodemographic and clinical characteristics. Phone interviews were audio-recorded, transcribed, and analyzed using inductive thematic codebook analysis. We interviewed 20 parents and identified 2 thematic categories, outcomes and interactions, in parents accessing clinical notes. Themes of outcomes included applied benefits, psychosocial and emotional value, and negative consequences. Themes of interactions included practical limitations and parental approach and appraisal. The ICU context and power dynamics were a meta-theme, influencing multiple themes. All parents reported positive qualities of note access despite negative consequences related to content, language, burdens, and lack of support. Parents suggested practice and design improvements surrounding open note access. Parental experiences with open notes reveal new, unaddressed considerations for documentation access, practices, and purpose. Parents leverage open notes by negotiating between the power dynamics in the ICU and the uncertain boundaries of their role and authority in the electronic health record.

Identifying Important Areas for the Release of Five Endemic Species in a Mountainous Landscape: Inference from Spatial Modeling Techniques

Efforts to release animals resulting from evacuation and rehabilitation into their natural habitats are important practices in wildlife conservation. Before releasing the animals, it is important to assess the habitat suitability of the areas to support the existence of the animals in the long run. Yet, there is limited study of habitat suitability assessment on national parks as release locations for wild animals. This study aimed to assess the suitable habitat of five charismatic animal species, i.e., Panthera pardus melas, Hylobates moloch, Prinonailurus bengalensis, Nycticebus javanicus, and Nisaetus bartelsi, in Gunung Halimun Salak National Park using Maxent, and to determine potential locations for releasing animal’s species. Models for the P. p. melas show 47,619 ha and 21,391 ha, respectively, suitable as habitat and potential release location, for H. moloch, each is 57,537 ha and 33,471 ha, for P. bengalensis, each is 25,460 ha and 17.189 ha, for N. javanicus, each is 29,848 ha and 15,578 ha, and for N. bartelsi, each is 44,426 ha and 25,660 ha. Our study shows that a suitable habitat can be critical in choosing a wildlife release site. Further consideration of conflict mitigation and practicalities is required to achieve the long-term existence of released species.

What is good thinking? Comments on Mona Simion’s Shifty Speech and Independent Thought

ABSTRACT Mona Simion's Shifty Speech and Independent Thought argues for epistemic independence—the independence of good thinking from practical considerations. Along the way, she argues against “shifty” views of knowledge and knowledge ascriptions, as well as against those who have tried to preserve the independence of knowledge from practical considerations by accepting the dependence of the epistemic normativity of assertion on practical considerations. In my discussion, I start by highlighting some of Simion's main claims and reconstructing her main lines of argument. I then raise some minor concerns about her underlying methodology and some bigger picture concerns about some of her background theoretical assumptions and her argument for epistemic independence.

Supplemental Material for Putting Conceptions and Considerations of Culture Into Practice: A Qualitative Evaluation of a Cultural Competence Training

Supplemental Material for Putting Conceptions and Considerations of Culture Into Practice: A Qualitative Evaluation of a Cultural Competence Training

Efficient Malware Analysis Using Metric Embeddings

Real-world malware analysis consists of a complex pipeline of classifiers and data analysis—from detection to classification of capabilities to retrieval of unique training samples from user systems. In this article, we aim to reduce the complexity of these pipelines through the use of low-dimensional metric embeddings of Windows PE files, which can be used in a variety of downstream applications, including malware detection, family classification, and malware attribute tagging. Specifically, we enrich labeling of malicious and benign PE files with computationally-expensive, disassembly-based malicious capabilities information. Using this enhanced labeling, we derive several different types of efficient metric embeddings utilizing an embedding neural network trained via contrastive loss, Spearman rank correlation, and combinations thereof. Our evaluation examines performance on a variety of transfer tasks performed on the EMBER and SOREL datasets, demonstrating that low-dimensional, computationally-efficient metric embeddings maintain performance with little decay. This offers the potential to quickly retrain for a variety of transfer tasks at significantly reduced overhead and complexity. We conclude with an examination of practical considerations for the use of our proposed embedding approach, such as robustness to adversarial evasion and introduction of task-specific auxiliary objectives to improve performance on mission critical tasks.

The concept and grounds of medical professional liability

The relevance of the study is due to many social and legal factors. In modern conditions of the development and functioning of various systems for the protection of medical professionals and their patients, the concepts and grounds of medical professional liability are undergoing significant changes. The research of the conditions for the implementation of professional activities by medical professionals and their professional liability is determined by both scientific and practical considerations, since society needs orderliness and predictability of relations in areas of life directly related to the life and health of the patient on the one hand, and the business reputation of the medical professional on the other hand. With the emergence and expansion of professional activities types as integral attributes of social, economic and legal relations, a number of questions have arisen regarding a) improving the legal regulation of the professional activities of medical professionals; b) determining the goals of the medical professional liability; c) determining the medical professional liability grounds.&#x0D; The source base for the research is the valid legislation of Ukraine, laws and by-laws, research and comparison of which requires a systematic approach and various research methods, such as: dialectical, logical-legal, system-structural, forecasting and comparative law methods, as well as materials judicial practice.&#x0D; The article, first of all, concludes that the medical professional liability is applied to an individual entrepreneur (private practitioner) or a legal entity (health care institution) that provides medical services to the population, in accordance with a business license activities in medical practice, in case of causing harm to patients due to non-performance or improper performance of their professional duties, measures of government coercion in the form of sanctions (additional encumbrances) aimed at restoring the violated rights and interests of the patient. Secondly, it has been set that the medical professional liability shall arise only under the following grounds: wrongfulness of the medical professional, damage caused to the patient, causation and regardless of the medical professional guilt.

Unlocking Pathways to Employment: Understanding Factors Influencing Youth Employability in Tanzania's Informal Sector

This study investigates the determinants of employability in the informal sector among youth in Tanzania using data from the Integrated Labor Force Survey (ILFS) conducted in 2020–2021, utilizing probity regression analysis. The model, statistically significant at a 1% level, indicates that variables including sex, capital access, income tax, social security, technical and computer skills, literacy and numeracy skills, physical skills, business registration, ownership, age, marital status, readiness for work, and education level collectively account for 4.4% of variations in youth employability. Positive impacts on employability are associated with capital access, numeracy and computer skills, paid employment, and level of education. The negative impacts are being male, income tax, social security coverage, literacy skills, physical skills, registered and owned businesses, married individuals, age, and readiness for work. The study suggests that attending school and possessing computer skills increases the likelihood of informal sector employment, while being male, subjected to income tax, covered by social security, having literacy skills, physical skills, registered or owned businesses, being married, aging, and being ready for work decrease the probability. The findings emphasize the importance of targeted interventions to enhance employability for youth in the informal sector, with considerations for gender, skills development, and business practices. The research recommended that enhancing access to education, programs in skill development, and improving numeracy and computer skills for youth will foster employability.

Experiences With Mobile Health-Enabled Ambulatory Monitoring Among Stroke Survivors: A Qualitative Study.

Inquiring into the experiences of stroke survivors toward ambulatory monitoring is crucial for optimizing user adoption, design, implementation, and sustainability of ambulatory monitoring in the stroke population. This study was aimed to identify facilitators and barriers for ambulatory monitoring among stroke survivors, as well as their suggestions for development and implementation of ambulatory monitoring. We conducted individual semi-structured interviews with 40 stroke survivors who received ambulatory monitoring. The interviews were analyzed using thematic content analysis. Six themes about facilitators associated with ambulatory monitoring emerged: (1) user support, (2) technological features, (3) convenience, (4) personal strategies, (5)social influence, and (6)time commitment. Three themes about barriers to using ambulatory monitoring emerged: (1) personal factors, (2) functionality, (3) study design. Three themes about suggestions emerged: (1) personalization, (2) functionality, and (3) interactive feedback. As mobile health technology is becoming more popular, the findings of this study provide timely implications and practical considerations for ambulatory monitoring in the stroke population.

Existential Risk, Astronomical Waste, and the Reasonableness of a Pure Time Preference for Well-Being

Abstract In this paper, we argue that our moral concern for future well-being should reduce over time due to important practical considerations about how humans interact with spacetime. After surveying several of these considerations (around equality, special duties, existential contingency, and overlapping moral concern) we develop a set of core principles that can both explain their moral significance and highlight why this is inherently bound up with our relationship with spacetime. These relate to the equitable distribution of (1) moral concern in a universe that we can only causally affect in one temporal direction; (2) access to the benefits from using spacetime as a resource; and (3) the burdens of care given (1) and (2). We conclude by considering the practical implications of our argument and find that, while it is often assumed that a preference for present over future well-being weakens the case for existential risk mitigation, this likely is not the case.

Meta-analysis of central and peripheral cannulation for type A aortic dissection.

Acute type A aortic dissection necessitates rapid and effective arterial cannulation techniques for optimal outcomes. This meta-analysis compares the safety and effectiveness of direct aortic cannulation (AoC) with peripheral cannulation (PC) via the femoral or axillary arteries in aortic surgery for acute type A aortic dissection. A systematic review following PRISMA guidelines identified 10 retrospective studies encompassing 2518 patients (961 AoC, 1557 PC). Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to analyze perioperative characteristics, short-term mortality rates, and postoperative complications including stroke and acute kidney injury. Short-term mortality did not significantly differ between AoC and PC (OR [95% CI] = 0.78 [0.61-1.01], p = .06). Likewise, postoperative stroke (OR [95% CI] = 0.86 [0.63-1.17], p = .33) nor acute kidney injury (OR [95% CI] = 1.11 [0.89-1.37], p = .35) showed no significant differences. AoC exhibited shorter operation time whereas there were no significant differences in aortic cross clamp time and cardiopulmonary bypass time between both groups. Our meta-regression analysis, considering the distal extent of aortic replacement, indicated that variations in aortic replacement rates did not significantly impact the observed outcomes. AoC is a viable alternative to PC for acute type A aortic dissection. While both approaches offer comparable outcomes, AoC's advantage in shorter operation time warrants thoughtful consideration in clinical practice.

Exploring Seed Production Techniques for Flowering Annuals: A Comprehensive Overview

This comprehensive overview delves into the intricate techniques involved in seed production for flowering annuals. From selecting suitable varieties to understanding pollination dynamics, harvesting, and storage, this review provides valuable insights into the complex process of seed production. Drawing upon the latest research and practical considerations, it highlights the importance of proper management practices for maintaining genetic purity and seed viability. By exploring the various methodologies and considerations, this abstract aims to provide a foundational understanding for both home gardeners and commercial growers seeking to optimize seed production in flowering annuals. This paper presents a thorough examination of seed production methodologies tailored for flowering annuals. By addressing key aspects such as variety selection, pollination strategies, harvesting techniques, and storage protocols, it offers a comprehensive guide for both novice gardeners and seasoned professionals. Through a synthesis of empirical research and practical insights, it underscores the significance of meticulous management in ensuring the quality and sustainability of seed stocks. With a focus on enhancing understanding and proficiency, this abstract serves as a valuable resource for individuals seeking to maximize the yield and diversity of flowering annuals in their cultivation endeavors.

Is Economic Evaluation and Care Commissioning Focused on Achieving the Same Outcomes? Resource-Allocation Considerations and Challenges Using England as a Case Study.

Commissioning describes the process of contracting appropriate care services to address pre-identified needs through pre-agreed payment structures. Outcomes-based commissioning (i.e., paying services for pre-agreed outcomes) shares a common goal with economic evaluation: achieving value for money for relevant outcomes (e.g., health) achieved from a finite budget. We describe considerations and challenges as to the practical role of relevant outcomes for evaluation and commissioning, seeking to bridge a gap between economic evaluation evidence and care commissioning. We describe conceptual (e.g., what are 'relevant' outcomes) alongside practical considerations (e.g., quantifying and using relevant endpoint or surrogate outcomes) and pertinent issues when linking outcomes to commissioning-based payment mechanisms, using England as a case study. Economic evaluation often focuses on a single endpoint health-focused maximand, e.g., quality-adjusted life-years (QALYs), whereas commissioning often focuses on activity-based surrogate outcomes (e.g., health monitoring), as easier-to-measure key performance indicators that are more acceptable (e.g., by clinicians) and amenable to being linked with payment structures. However, payments linked to endpoint and/or surrogate outcomes can lead to market inefficiencies; for example, when surrogates do not have the intended causal effect on endpoint outcomes or when service activity focuses on only people who can achieve prespecified payment-linked outcomes. Accounting for and explaining direct links from commissioners' payment structures to surrogate and then endpoint economic outcomes is a vital step to bridging a gap between economic evaluation approaches and commissioning. Decision-analytic models could aid this but they must be designed to account for relevant surrogate and endpoint outcomes, the payments assigned to such outcomes, and their interaction with the system commissioners purport to influence.

Automating the Analysis of Negative Test Verdicts: A Future-Forward Approach Supported by Augmented Intelligence Algorithms

In the epoch characterized by the anticipation of autonomous vehicles, the quality of the embedded system software, its reliability, safety, and security is significant. The testing of embedded software is an increasingly significant element of the development process. The application of artificial intelligence (AI) algorithms in the process of testing embedded software in vehicles constitutes a significant area of both research and practical consideration, arising from the escalating complexity of these systems. This paper presents the preliminary development of the AVESYS framework which facilitates the application of open-source artificial intelligence algorithms in the embedded system testing process. The aim of this work is to evaluate its effectiveness in identifying anomalies in the test environment that could potentially affect testing results. The raw data from the test environment, mainly communication signals and readings from temperature, as well as current and voltage sensors are pre-processed and used to train machine learning models. A verification study is carried out, proving the high practical potential of the application of AI algorithms in embedded software testing.

Primary-school-aged children inspire their peers and families to eat more vegetables in the KiiDSAY project: a qualitative descriptive study

BackgroundWhile vegetable intakes in Australia remain sub-optimal across all age groups, children are rarely consulted about their ideas on how to increase consumption. Qualitative research involving children provides an opportunity to consider their views. The aim of the Kids initiative inspires Dietary Success in Adults and Youth (KiiDSAY) project was to explore the views of school-aged children, who had participated in a school-based nutrition education program, about inspiring their peers and families to eat more vegetables.MethodsA total of 26 children (15 boys) aged 10–12 years from four primary schools in New South Wales, Australia, participated in seven focus group interviews. Purposeful sampling was used to recruit participants. The study involved open-ended semi-structured questions conducted via Zoom that were audio-recorded, transcribed verbatim and analysed using thematic analysis with deductive and inductive coding in NVivo.ResultsFour major themes emerged: (i) taste; (ii) family environment; (iii) healthy eating; and (iv) change makers; with subthemes that were embedded within Social Cognitive Theory and Ecological Model of Health Behaviour theoretical frameworks.ConclusionsChildren’s inputs hold great potential for informing future interventions, particularly when designing or refining school-based nutrition programs. Children offered suggestions on how to inspire increased vegetable consumption among their peers and families that could be taken into consideration for future research and practice. These included: cooking activities in the home and school settings using recipes that creatively hide/mask/enhance the flavour of vegetables, involving positive role models and supportive school environments. Additionally, children recommended a sequential approach to the delivery of recipes starting from fruit-based and transitioning to vegetable-based recipes. Given the challenges faced in increasing children’s vegetable consumption, particular focus on future research in this area is warranted.Trial registrationFEAST Trial registered 14th December 2020 with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001347954).

OMR Sheet Evaluation using Image Processing

Optical Mark Recognition (OMR) technology has revolutionized the grading and assessment processes in educational institutions, surveys, and various other fields. OMR sheets, designed with predefined bubbles or checkboxes, are scanned and processed to extract relevant data. This paper presents a comprehensive review of the methodologies and advancements in OMR sheet evaluation using image processing techniques. The review begins with an overview of traditional OMR systems and their limitations, such as susceptibility to errors due to variations in scanning quality, paper orientation, and noise interference. Subsequently, it delves into the evolution of image processing algorithms tailored for OMR sheet evaluation. Several key components of OMR sheet evaluation are discussed, including image pre-processing techniques for enhancing readability, segmentation methods for isolating individual marks, feature extraction algorithms for capturing relevant data, and classification techniques for accurate identification of marked responses. The review highlights recent trends and innovations in OMR sheet evaluation, such as the integration of machine learning and deep learning algorithms for improved accuracy and robustness. Additionally, it addresses challenges such as handling skewed or distorted images, multi-page OMR sheets, and real-time processing requirements. Furthermore, the paper discusses benchmark datasets and evaluation metrics commonly used to assess the performance of OMR systems. It also examines practical considerations such as scalability, cost-effectiveness, and usability in diverse settings..

Creativity Through Embodied Movement in Expressive Activities: Conceptualising a New Pedagogical Model

ABSTRACT This work aimed to outline the first stages for the development of a pedagogical model for teaching-learning of expressive content within physical education (creative body movement). Drawing on several suggestions from previous models’ conceptualizations, we explore and present the theoretical foundations, practical considerations, and assumptions that align and support their core features. The major theme of the model is that students explore new expressive movements and develop capabilities through expressive games or tasks that nurture their creativity and ease their embodied movements. This implies that teachers should provide students with several resources and stimuli to nurture their creativity. Also, teachers should promote students’ embodiment through the exploration of new movements that allow knowing themselves in different movement situations. The affective and cognitive domains will be prominent in this model. The teachers’ and students’ assumptions, implementation needs, and enactment about how to apply this model are also proposed.

Energy‐Efficient Synthesis of Haloquinazolines and Their Suzuki Cross‐Coupling Reactions in Propylene Carbonate

AbstractComparative synthesis of some new quinazoline derivatives via tetrakis(triphenylphosphine)palladium(0) catalysed Suzuki‐Miyaura cross‐coupling reaction in “green” propylene carbonate (PC) and dimethoxyethane. Three haloquinazolines were synthesised for Suzuki‐cross‐coupling from 5‐bromoanthranilic acid. Sufficient and easy method for the elimination of PC is developed, thus the optimization of the synthesis of some quinazoline derivatives was carried out. Reactions with 2‐chloro‐6‐bromo‐3‐phenylquinazolin‐4(3H)‐one proceeded faster and with a higher yield in PC than in dimethoxyethane, thus for some reactants PC is a good choice for greener synthesis. Practical considerations for using PC include shorter reaction times, improved yields, and the elimination of unnecessary solvent distillation, leading to significant energy savings. This facilitates the execution of energy‐efficient reactions in a notably environmentally friendly solvent. In contrast to DME, the use of PC does not necessitate special pre‐treatments. Moreover, less PC is required due to its high boiling point and low volatility. Considering these properties, coupled with the consistent need for chromatographic purification, the use of PC in the Suzuki‐Miyaura cross‐coupling reaction emerges as a superior and greener alternative compared to DME.

PET/CT-Guided Tumor Ablation, From the AJR "How We Do It" Special Series.

PET/CT guidance during percutaneous tumor ablation procedures combines metabolic and anatomic imaging, providing a powerful approach that can improve intraprocedural tumor visibility and ablation margin evaluation for a variety of cancers. This article reviews key advantages of the use of PET/CT as guidance for tumor ablation and describes the authors' technique for performing such procedures, highlighting the application of PET/CT for each procedural stage, including planning, targeting, monitoring, and assessment of results. Practical considerations in establishing and operating an interventional PET/CT practice are discussed. Suggestions for overcoming logistical challenges that have historically limited procedural PET/CT adoption are proposed. Several emerging procedural approaches relating to PET/CT and other molecular or anatomic imaging technologies are briefly explored.

Anatomic Subtype Differences in Extramammary Paget Disease

Extramammary Paget disease (EMPD) is a rare, highly recurrent cutaneous malignant neoplasm of unclear origin. EMPD arises most commonly on the vulvar and penoscrotal skin. It is not presently known how anatomic subtype of EMPD affects disease presentation and management. To compare demographic and tumor characteristics and treatment approaches for different EMPD subtypes. Recommendations for diagnosis and treatment are presented. MEDLINE, Embase, Web of Science Core Collection, and Cochrane Reviews CENTRAL from December 1, 1990, to October 24, 2022. Articles were excluded if they were not in English, reported fewer than 3 patients, did not specify information by anatomic subtype, or contained no case-level data. Metastatic cases on presentation were also excluded. Abstracts of 1295 eligible articles were independently reviewed by 5 coauthors, and 135 articles retained. Reporting was in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. The analysis was cunducted in August 2019 and updated in November 2022. Most vulvar EMPD cases were asymptomatic, and diagnosis was relatively delayed (mean, 25.1 months). Although most vulvar EMPD cases were intraepidermal (1247/1773 [70.3%]), radical surgeries were still performed in almost one-third of cases. Despite this aggressive surgical approach, 481 of 1423 (34%) recurred, commonly confined to the skin and mucosa (177/198 [89.4%]). By contrast, 152 of 1101 penoscrotal EMPD cases (14%) recurred, but more than one-third of these recurrences were regional or associated with distant metastases (54 of 152 [35.5%]). Perianal EMPD cases recurred in one-third of cases (74/218 [33.9%]), with one-third of these recurrences being regional or associated with distant metastasis (20 of 74 [27.0%]). Perianal EMPD also had the highest rate of invasive disease (50% of cases). The diagnosis and treatment of EMPD should differ based on anatomic subtypes. Considerations for updated practice may include less morbid treatments for vulvar EMPD, which is primarily epidermal, and close surveillance for local recurrence in vulvar EMPD and metastatic recurrence in perianal EMPD. Recurrences in penoscrotal subtype were less common, and selective surveillance in this subtype may be considered. Limitations of this study include the lack of replication cohorts and the exclusion of studies that did not stratify outcomes by anatomic subtype.

The Forcible Transfer of Children from Ukraine as Genocide

Abstract On 17 March 2023, Pre-Trial Chamber ii of the International Criminal Court (icc) issued secret warrants of arrest for President Putin and the Commissioner for Children’s Rights in the Office of the President of the Russian Federation, Ms. Lvova-Belova, for the commission of the war crime of forcible transfer of children. This article argues that there are “reasonable grounds to believe”, as the icc Statute requires for the arrest warrant stage, that both Putin and Lvova-Belova bear individual criminal responsibility for the forcible transfer of Ukrainian children as a crime of genocide; however, two types of considerations – general and particular – prevented the issuing of arrest warrants for genocide crimes. In Section 2, after a short historical-legal review of the formulation of Article 2(e) of the Genocide Convention (gc), the article notes that despite the significant number of cases of children being transferred and removed from their families that have taken place since the gc was adopted, the provision has been dormant and considered anachronistic and was rarely applied by an international or a local court. Section 3 proceeds with a legal analysis of the elements of the crime of the forced transfer of children and the genocidal special intent. Section 4 parses the case study of the forcible transfer of children from Ukraine as a crime of genocide. Section 5 analyses the litigation of the crime of genocide in the icc through the only case of genocide the court has addressed so far: the arrest warrant for Sudan’s former president, Omar al-Bashir. Section 6 concludes with a forecast that despite the sufficient legal basis for issuing arrest warrants for Putin and Lvova-Belova, practical and political considerations would impede the icc from doing so.