Ranking Questions Research Articles

Australian Dentists' Knowledge of the Consequences of Interpretive Errors in Dental Radiographs and Potential Mitigation Measures.

Dental radiographs, typically taken and interpreted by dentists, are essential for diagnosis and effective treatment planning. Interpretive errors in dental radiographs, stemming from failures of visual and cognitive processes, can affect both patients and clinicians. This survey aimed to assess the dental practitioners' perceptions of the consequences of these errors and potential measures to minimize them. This online anonymized survey assessed Australian dental practitioners' perceptions of the consequences of these errors and potential mitigation measures using ranking, Likert scale, and open-ended questions. The data were analyzed using descriptive statistics and bivariate analysis. Participants identified undertreatment (72%) and legal implications (82%) as the most significant consequences of interpretive errors, whereas severe harm to patients was deemed the least likely. Dental practitioners placed a greater emphasis on maintaining a high level of competence and the well-being of their patients. Utilizing high-quality images (63.9%) and appropriate radiographs (59.7%) were identified as the most effective measures to minimize interpretive errors. Participants showed hesitancy regarding the reliance on machine learning as a clinical decision-making tool. The survey provides valuable practical insights into the consequences and targeted measures to minimize the occurrence of interpretive errors. Efforts to minimize interpretive errors should address patient safety and practitioners' concerns about professional reputation and business viability. The study also suggests further research into the role of machine learning algorithms in reducing interpretive errors in dentistry.

Analyzing Ballot Order Effects When Voters Rank Candidates

Abstract How does candidate order on the ballot affect voting behavior when voters rank candidates? I extend the analysis of ballot order effects to electoral systems with ordinal ballots, where voters rank candidates, including ranked-choice voting (RCV). First, I discuss two types of ballot order effects, including “position effects”—voters vote for specific candidates because of their ballot positions—and “pattern ranking”—voters rank candidates geometrically given their grid-style ballots. Next, I discuss experimental designs for identifying and estimating these effects based on ballot order randomization. Moreover, I illustrate the proposed methods by using survey and natural experiments based on mayoral and congressional RCV elections in 2022. I find that while voters seem less susceptible to specific ballot positions, ballot design can still impact voters’ ranking behavior via pattern ranking. This work has several implications for ballot design, survey research, and ranking data analysis. First, it shows that pattern ranking may affect electoral outcomes in RCV and other systems even when ballot order is fully randomized. Consequently, it may be worth considering an alternative solution to ballot order effects, which does not solely depend on randomization or rotation. Second, similar effects may impact any survey research using ranking questions. Future research must investigate the statistical consequences of pattern ranking for survey research. Finally, ranking data allow researchers to study diverse quantities of interest while targeting many different substantive questions. However, this flexibility also implies that analyzing ranking data can be prone to arbitrary analysis.

Co-creating a global shared research agenda on violence against women in low- and middle-income countries

BackgroundDespite a large growth in evidence on violence against women (VAW) over the last 25 years, VAW persists, as do gaps in the field’s knowledge of how to prevent and respond to it. To ensure that research on VAW in low- and middle-income countries (LIMCs) is addressing the most significant gaps in knowledge, and to prioritise evidence needs to reduce VAW and better support victims/survivors, the Sexual Violence Research Initiative (SVRI) and Equality Institute (EQI) led a process of developing a global shared research agenda (GSRA) on VAW in LMICs.MethodsThe GSRA was developed through a six-stage adaptation of the Child Health and Nutrition Research Initiative (CHNRI) method, which draws on the principle of the ‘wisdom of the crowd’. These steps included: a review of the literature on VAW in LMICs and development of domains; the generation of research questions within four domains by an Advisory Group; the consolidation of research questions; scoring of research questions by a Global Expert Group and the Advisory Group according to three criteria (applicability, effectiveness and equity); consultation and validation of the findings with the Advisory Group; and wide dissemination of the findings.ResultsThe highest ranked research questions in the GSRA pertain to the domain of Intervention research, with some highly ranked questions also pertaining to the domain of Understanding VAW in its multiple forms. Questions under the other two domains, Improving existing interventions, and Methodological and measurement gaps, were not prioritised as highly by experts. There was strong consistency in top ranked research questions according to experts’ characteristics, albeit with some important differences according to experts’ gender, occupation and geographical location.ConclusionsThe GSRA findings suggest that currently the VAW field is shifting towards intervention research after several decades of building evidence on understanding VAW, including prevalence, drivers and impacts of violence. The findings also suggest a strong emphasis on under-served populations, and under-researched forms of VAW. Future priority setting exercises in LMICs that seek to decolonise knowledge should ensure that methodologies, and modalities of engagement, put diverse voices at the centre of engagement.Trial registration Not applicable

Monitoring and integrated care coordination of patients with alpha-mannosidosis: A global Delphi consensus study

IntroductionCurrent literature lacks consensus on initial assessments and routine follow-up care of patients with alpha-mannosidosis (AM). A Delphi panel was conducted to generate and validate recommendations on best practices for initial assessment, routine follow-up care, and integrated care coordination of patients with AM. MethodsA modified Delphi method involving 3 rounds of online surveys was used. An independent administrator and 2 nonvoting physician co-chairs managed survey development, anonymous data collection, and analysis. A multidisciplinary panel comprising 20 physicians from 12 countries responded to 57 open-ended questions in the first survey. Round 2 consisted of 11 ranking questions and 44 voting statements. In round 3, panelists voted to validate 60 consensus statements. The panel response rate was ≥95% in all 3 rounds. Panelists used 5-point Likert scales to indicate importance (score of ≥3) or agreement (score of ≥4). Consensus was defined a priori as ≥75% agreement with ≥75% of panelists voting. ResultsConsensus was reached on 60 statements, encompassing 3 key areas: initial assessments, routine follow-up care, and treatment-related follow-up. The panel agreed on the type and frequency of assessments related to genetic testing, baseline evaluations, quality of life, biochemical measures, affected body systems, treatment received, and integrated care coordination in patients with AM. Forty-nine statements reached 90% to 100% consensus, 8 statements reached 80% to 85% consensus, and 1 statement reached 75% consensus. Two statements each reached consensus on 15 baseline assessments to be conducted at the initial follow-up visit after diagnosis in pediatric and adult patients. ConclusionThis is the first Delphi study providing internationally applicable, best-practice recommendations for monitoring patients with AM that may improve their care and well-being.

Communication and collaboration skills training in radiation oncology: A quantitative validation survey.

Communication and collaboration are integral in radiation oncology practice. A recently published qualitative study identified several deficiencies in skills development for Australian/New Zealand trainees. We aim to validate these findings to guide curriculum development. A quantitative survey was developed through an iterative process, using themes identified in the previous qualitative investigation. This survey was distributed to radiation oncologists and trainees across Australia and New Zealand via email. Data collection and management utilised the REDCap system. Question types varied to maximise richness of data, including ranking, likert-scales and free-text questions. Results are primarily reported descriptively. Totally 35 participants submitted completed survey responses with broad representation across geography, gender and clinician seniority. To learn communication, participants reported strong preferences towards informal observation (60% agreement) and self-reflection (49% agreement), and against online learning (77% disagreement) methodologies. Nearly 35% acknowledge poor communication at least weekly, with time pressure being a major barrier (63% agreement). Clinical uncertainty and existing patient/family assumptions (both 74% agreement) contribute to difficulties in breaking bad news, with online learning being the only negatively perceived training modality (23% agreement). No participants reported any formal training/mentoring in multi-disciplinary team (MDT) engagement. Conflict was commonly witnessed/experienced (97%) and 26% of participants avoid MDTs due to difficulties experienced. This study validates the themes previously identified. We identified a strong preference for informal learning methodologies and against online modules, discordant to published literature. Effective collaboration within MDTs is identified as a particular area of need. We recommend future curriculum modification considers these results to maximise efficacy.

Gateway community stakeholders’ perceived impacts of protected area management actions: The case of North Carolina (U.S.) state parks

Many protected area managers contend with increasing demand and insufficient funding (e.g., overcrowding, overuse, maintenance shortfalls, and staffing shortages). To combat these challenges, managers are exploring management actions (i.e., differential pricing, amenity pricing, reservation systems, and demand-based pricing) to increase revenue and distribute or reduce visitor use during peak times. However, implementation of these management actions may displace visitors, affecting gateway community stakeholders (e.g., park staff, affiliated nonprofits, tourism operators, destination management/marketing organizations (DMO), and elected officials) who benefit from state parks. Therefore, it is crucial to understand the effects these actions may have on gateway community stakeholders. Utilizing Weber's theory of formal and substantive rationality (WTFSR) coupled with the triple bottom line (economic, environmental, and social impacts), we conducted a concurrent, nested mixed methods study with 25 gateway community stakeholders of North Carolina State Parks (NCSP). Analysis of 25 semi-structured interviews and embedded rating and ranking questions provided a deeper understanding of stakeholders' preferred management actions, motivations for those preferences, and perceived impacts of NCSP management actions. Apart from demand-based pricing, gateway community stakeholders expressed overall positive economic, environmental, and social sentiments towards the proposed management actions, suggesting a suite of actions may be ideal for increasing revenue and distributing or reducing visitor use during peak times in protected areas. Management implications•Gateway community stakeholders can effectively differentiate between suites of management options to enhance environmental protections, community benefits, and profits.•State resident discounts, amenity pricing, and reservation systems were all highly ranked across multiple stakeholder groups, suggesting NCSP has multiple options to increase revenue and distribute or reduce visitor use during peak times. However, demand-based pricing had limited support from stakeholders suggesting NCSP should prioritize other management actions. The varying levels of support for management actions makes it crucial for NCSP to communicate their management action decisions with stakeholders.•Protected area managers must sustain relationships with gateway community stakeholders to be able to understand stakeholders' perspectives on the impacts of management actions.•Beyond NC, this study provides a strategy for protected areas facing similar challenges to assess how management actions may impact gateway community stakeholders or other key stakeholders (e.g., park users, underserved communities).

Prospective randomized multicenter phase III trial comparing perioperative chemotherapy (FLOT protocol) to neoadjuvant chemoradiation (CROSS protocol) in patients with adenocarcinoma of the esophagus (ESOPEC trial).

LBA1 Background: The most effective multimodal approach for treatment of resectable locally advanced esophageal adenocarcinoma (EAC) is under debate. A prior ranking question is if neoadjuvant chemoradiation therapy or perioperative chemotherapy is superior. ESOPEC (NCT02509286) is a multicenter prospective randomized trial comparing neoadjuvant CROSS (41.4Gy plus carboplatin/paclitaxel) followed by surgery versus perioperative FLOT (5-FU/ leucovorin/oxaliplatin/docetaxel) and surgery for the curative treatment of EAC. Methods: Patients with cT1 cN+ cM0 or cT2-4a cNany cM0 resectable EAC were eligible. The primary endpoint is overall survival (OS; 90% power; hazard ratio [HR] 0.645, 218 events needed; one sided significance level of 2.5%). Analysis is by intention-to-treat in all randomized patients. The effect of treatment on OS is estimated using Cox regression stratified by study site, and including N stage (N0, N+), and age as covariates. Results: Between Feb 2016 and Apr 2020, 438 patients from 25 sites in Germany were randomly assigned to two treatment groups (221 FLOT; 217 CROSS). Baseline characteristics (male sex 89.3%, median age 63 [range 30-86], cT3/4 80.5%; cN+ 79.7%) were well balanced between both arms. Neoadjuvant treatment was started in 403 patients (207 FLOT; 196 CROSS). Surgery was done in 371 patients (191 FLOT; 180 CROSS). R0 resection was achieved in 351 patients (180 FLOT; 171 CROSS). 90 days postsurgical mortality was 4.3% (3.2% FLOT; 5.6% CROSS). After a median follow up of 55 months, 218 patients had died (97 FLOT; 121 CROSS). Median OS was 66 (95% CI 36 – not estimable) months in the FLOT arm, and 37 (95% CI 28 – 43) months in the CROSS arm. The 3-year OS rates were 57.4% (95% CI 50.1 – 64.0%) for FLOT and 50.7% (95% CI 43.5 – 57.5%) for CROSS (HR 0.70, 95% CI 0.53-0.92, p=0.012). In 359 patients with available tumor regression status, pathological complete response was achieved in 35 (19.3%, 95%-CI 13.9 – 25.9%) in FLOT and in 24 (13.5%, 95%-CI 8.8 – 19.4%) in CROSS. Conclusions: Perioperative FLOT improves survival in resectable EAC compared to neoadjuvant CROSS. Funding: The trial was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation), project number 264590883. Clinical trial information: NCT02509286 .

Abstract PO5-05-10: Analysis of Trends in Funding of Metastatic Breast Cancer Research

Abstract Introduction To inform funding strategies for research in metastatic breast cancer (MBC), knowledge of the current research landscape and identification of potential gap areas requiring additional research are essential. In 2014, the Metastatic Breast Cancer Alliance (MBCA) published an analysis that showed that between 2000 and 2013, only 7% of all funds for breast cancer research were devoted to metastasis. As more people are living with MBC, addressing research priorities for those living with the disease is important, as is understanding gaps in the current funding landscape of MBC research to appropriately target investment. Methods A collaborative effort between funders and patients was undertaken to analyze breast cancer projects funded between 2014 and 2020 from the International Cancer Research Partnership database, the Health Resource Alliance database, and MBCA members, representing grants from 83 non-profit organizations worldwide. Project titles, abstracts, and classifications of these grants were extracted from these databases. Next, to identify research projects in the databases that are related to metastasis, a classification tool that uses a machine learning algorithm was built, trained on manually coded grants from the 2000-2013 analysis, and validated by expert coders. Projects were then coded according to a pre-established metastasis classification policy to categories such as type of research (e.g., treatment), genes or proteins studied, site of metastasis, breast cancer subtype, and patient priority questions. In terms of the latter, MBCA members living with MBC were surveyed about research priorities. Member advocates ranked survey questions according to highest patient priority, and these were converted to language that could be queried with the tool. Results Investment in MBC research nearly doubled from 2014 to 2020. Research into understanding and overcoming treatment resistance, which was the highest patient priority question, increased from 15% in 2014 to 26% of the MBC portfolio in 2020; this was a statistically significant increase above the rate of inflation. In terms of treatment resistance according to subtype, the highest number of projects focused on triple-negative MBC (>300). By contrast, < 20 projects were focused on overcoming treatment resistance in metastatic invasive lobular breast cancer. Of the six categories evaluated (e.g. biology and detection/diagnosis/prognosis), the largest increase in investment was for treatments. Discussion The coding tool allows for ongoing complex queries such as identification of funded research relevant to areas identified as important by MBC advocates (Table) and provides a funders’ ‘dashboard’ to identify gap areas in need of further research funding. This collaborative effort between funders and patient advocates, and the resulting current and future analyses, can be used to focus advocacy efforts to drive research funding of priorities and understudied areas of MBC. Despite the increase in funding, the investment in metastatic research–the primary cause of death from breast cancer–remains insufficient. Table. Research Priorities of MBC Patient Advocates Citation Format: Margaret Flowers, Teri Pollastro, Kari Wojtanik, Katherine McKenzie, Kimberly Badovinac, Medha Deoras-Sutliff, Lynne Davies. Analysis of Trends in Funding of Metastatic Breast Cancer Research [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-05-10.

Telesupervision in genetic counseling education during COVID-19 and beyond.

The COVID-19 pandemic led healthcare organizations to pivot to telemedicine, precipitating the shift to telesupervision, defined as supervision over video-conferencing platforms and telephone, for genetic counseling students. This study aimed to (1) characterize the impact of the COVID-19 pandemic on genetic counseling supervision, (2) ascertain genetic counseling supervisor experiences with telesupervision, and (3) examine the association between years of genetic counseling experience and preferences related to supervision modality. Certified genetic counselors were recruited through the National Society of Genetic Counselors (NSGC), Pennsylvania Association of Genetic Counselors (PAGC), and Association of Genetic Counseling Program Directors (AGCPD) listservs and by purposive sampling via emails to Genetic Counseling Program Directors in program-rich regions. An investigator-created survey was administered online to elicit descriptions of supervision during the pandemic, including modifications to rotations, changes to the number of students supervised, and mode of supervision preference. The survey was completed by 122 genetic counselors. The 54-question survey included multiple-choice, ranking, and open-ended questions. The majority (95.9%) of the participants were female, with an average age of 32 years. Most (86%) of participants reported changes in their supervision practices due to COVID-19, including sole use of telesupervision (54.4%), decreases in rotation lengths (25.4%), and delays in rotation start dates (24.6%). Interestingly, 19.3% (22/114) supervised more students than before the pandemic, and 18.4% (21/114) of participants supervised fewer students. Approximately two thirds (67.5%) of supervisors preferred supervising students in-person, while 2.6% preferred telesupervision, and 29.8% had no preference. Those who preferred to supervise in-person had fewer years of experience than those who had no preference (median = 4 years vs. median = 7 years respectively, Wilcoxonp-value = 0.0418, effect size rpb = 0.19, small). Given the persistence of telemedicine beyond the pandemic, telesupervision may be necessary to train genetic counseling students. However, additional research is needed to determine the effectiveness of telesupervision in facilitating student skill development and attainment of the Accreditation Council for Genetic Counseling (ACGC) Practice-Based Competencies (PBCs).

Stakeholder perspectives on ethical and trustworthy voice AI in health care.

Voice as a health biomarker using artificial intelligence (AI) is gaining momentum in research. The noninvasiveness of voice data collection through accessible technology (such as smartphones, telehealth, and ambient recordings) or within clinical contexts means voice AI may help address health disparities and promote the inclusion of marginalized communities. However, the development of AI-ready voice datasets free from bias and discrimination is a complex task. The objective of this study is to better understand the perspectives of engaged and interested stakeholders regarding ethical and trustworthy voice AI, to inform both further ethical inquiry and technology innovation. A questionnaire was administered to voice AI experts, clinicians, scholars, patients, trainees, and policy-makers who participated at the 2023 Voice AI Symposium organized by the Bridge2AI-Voice AI Consortium. The survey used a mix of Likert scale, ranking and open-ended questions. A total of 27 stakeholders participated in the study. The main results of the study are the identification of priorities in terms of ethical issues, an initial definition of ethically sourced data for voice AI, insights into the use of synthetic voice data, and proposals for acting on the trustworthiness of voice AI. The study shows a diversity of perspectives and adds nuance to the planning and development of ethical and trustworthy voice AI. This study represents the first stakeholder survey related to voice as a biomarker of health published to date. This study sheds light on the critical importance of ethics and trustworthiness in the development of voice AI technologies for health applications.

Latina immigrants' breast and colon cancer causal attributions: genetics is key.

Latinos in the US suffer health disparities including stage of disease at time of breast or colon cancer diagnosis. Understanding Latinas' causal attributions of breast and colon cancer may provide insight into some of the individual level determinants of cancer disparities in this population. Cultural consensus analysis (CCA) is one way to study causal beliefs. The objective of this study was to describe Latina immigrants' causal attributions of breast and colon cancer. We conducted Spanish-language interviews with 22 Latina immigrants using a qualitative exploratory design comprised of freelisting, ranking, and open-ended questions. Participants freelisted causes and risk factors for breast and colon cancer then ranked risk factors according to their perceived role in the development of each cancer. CCA was conducted on rank orders to identify whether a cultural consensus model was present. Participants answered semi-structured, open-ended questions regarding the risk factors and rankings. Interviews were transcribed and subjected to thematic analysis. CCA showed no consensus around rank of causes for either cancer, and residual agreement analysis suggested the presence of two subcultural groups. "Genetics" and "hereditary factors" ranked first and second on average across participants for both cancers. Based on interview data, participants were less aware of colon cancer than breast cancer. Participants' endorsement of heredity as a cause of breast and colon cancer was similar to beliefs reported in studies of primarily non-Latina populations.

Assessing Parental Perceptions of Meaningful Outcomes for Children with Autism Spectrum Disorder.

Outcomes of children diagnosed with autism spectrum disorder (ASD) generally focus on cognition, language, behavioral, and adaptive functioning, yet it is unknown whether this reflects patient and caregiver priorities. Identify parental perceptions of ASD outcomes and identify whether health care providers are currently addressing these concerns. Participant were 60 parents of school-aged children previously diagnosed with ASD participating in a larger autism outcomes study. Parents answered the open-ended question, "What aspect of your child's functioning matters most for your child at this time?" They also ranked a list of outcome categories (thinking and reasoning skills, daily living skills, etc). Parents answered a second open-ended question, "What should healthcare providers be asking about how your child is doing, that they may not be currently asking?" Open-ended independent coding and thematic analysis were used to identify themes for the open-ended questions. The most common themes identified with "what aspect of your child's functioning matters most" were "Social," "Communication," "Emotional," and "Behavior." These were similar to the results of a ranking question in which parents ranked "Communicating with and understanding others," "Social skills," and "Behavior" as most important. "Emotional" was a unique theme, although there is potential overlap between this and the theme of "Behavior." The most common theme identified with the question about what health care providers should be asking was "Social," followed by "Nothing." This study demonstrates that parental concerns largely match previous outcome categories, with the exception of a theme identified as "Emotional" which may overlap with "Behavior."

THU006 Exploring Primary Care Resident Perspectives On Diabetes Education In Training

Abstract Disclosure: N. Francis: None. S. Cardillo: None. D.R. Nandiwada: None. Background: The training residents gain in Family Medicine (FM) and Internal Medicine (IM) residency programs provide a critical foundation for their knowledge in diabetes (DM) management. It is one of the most common diagnoses physicians-in-training will encounter in their residency training programs and in clinical settings. However, a 2012 study compared diabetes care in resident clinics versus private physicians and found significant decrease in patient satisfaction (56.5% vs. 71.3%) in resident clinics. A 2020 study surveying primary care (PC) residency program directors showed that most FM and IM residency training programs focus on the core diabetes care and management topics with much less focus on emerging topics, such as 2nd generation insulin analogs and digital health technologies. The purpose of our survey was to better assess current resident perceptions and attitudes towards their DM education and their perceived comfort level in comprehensive DM counseling, evaluation, and management. Methods: A 12 item survey was designed using the Qualtrics program. The survey link was sent via email to IM- PC and FM residents at a major academic medical center. Data was collected from September 13th, 2022 to present. The survey included a combination of multiple choice, Likert scale and ranking questions. Results: 14 residents responded to the survey to date with the majority (71%) belonging to the IM-PC group and the remainder (29%) family medicine. Residents felt most comfortable managing diabetes related complications and counseling on foot and eye care and hypoglycemia. Respondents reported being most uncomfortable in prescribing non-insulin medication (50%) and initiating an insulin regimen (43%) and less comfortable counseling patients on continuous glucose monitoring systems (83%) and insulin administration (66%). While majority of residents (72%) found their DM curriculum clinically relevant, 85% of residents reported there was not enough time allotted. Respondents felt a more longitudinal lecture series, with increased access to treatment frameworks and on-site feedback on their DM counseling and care would best supplement their DM curriculum. Conclusion: This survey data explores specific areas that residents have identified as being least comfortable and also expresses what they identified as the most preferable ways to modify and design an educational intervention. This information allows for tailored curricular intervention highlighting diabetes technologies, insulin and non-insulin prescribing practice in a longitudinal lecture style format that provides access to DM treatment frameworks and incorporates direct on-site feedback to the residents. This provides evidence for the development of a novel clinically integrated DM curriculum. Presentation: Thursday, June 15, 2023

Expert Consensus on Comprehensive Early Rhythm Control in Addition to Guideline-Based Care for Atrial Fibrillation: A Modified Delphi Survey

Atrial fibrillation (AF) practice guidelines recommend a rhythm-control strategy to improve symptoms and quality of life, noting the side effects of antiarrhythmic drugs and catheter ablation. Emerging evidence indicates that comprehensive early rhythm control with antiarrhythmic drugs or catheter ablation is associated with a lower risk of adverse cardiovascular outcomes versus the usual care. Using an online modified Delphi survey approach, perspectives and expert consensus among electrophysiologists were examined through a series of ranking and likelihood questions around treatment decision-making on (1) the use of comprehensive early rhythm-control strategies in patients with AF based on guidelines and emerging research and (2) treatment selection factors. A panel of 17 electrophysiologists reached a consensus on using early rhythm control (median 90, interquartile range 14) based on the view that early intervention improved cardiovascular outcomes (mean rank 1.6 of 3, 82% within 1 SD) and symptoms (1.8 of 3, 41%). AF-related symptoms were identified as the most important in making a treatment initiation decision (1.1 of 7, 88%), followed by AF type (2.5 of 7, 82%). Participants were most likely to initiate treatment at AF symptom onset (median 80; interquartile range 6). In making treatment selection decisions, participants ranked short-term/long-term safety (1.9 of 7, 88%) and efficacy (1.8 of 7, 53%) as the top 2 considerations. In conclusion, experts were in favor of early rhythm control; however, additional research is needed to address the role that early rhythm-control strategies play in current AF treatment management algorithms.

Towards a Holistic Understanding of Mathematical Questions with Contrastive Pre-training

Understanding mathematical questions effectively is a crucial task, which can benefit many applications, such as difficulty estimation. Researchers have drawn much attention to designing pre-training models for question representations due to the scarcity of human annotations (e.g., labeling difficulty). However, unlike general free-format texts (e.g., user comments), mathematical questions are generally designed with explicit purposes and mathematical logic, and usually consist of more complex content, such as formulas, and related mathematical knowledge (e.g., Function). Therefore, the problem of holistically representing mathematical questions remains underexplored. To this end, in this paper, we propose a novel contrastive pre-training approach for mathematical question representations, namely QuesCo, which attempts to bring questions with more similar purposes closer. Specifically, we first design two-level question augmentations, including content-level and structure-level, which generate literally diverse question pairs with similar purposes. Then, to fully exploit hierarchical information of knowledge concepts, we propose a knowledge hierarchy-aware rank strategy (KHAR), which ranks the similarities between questions in a fine-grained manner. Next, we adopt a ranking contrastive learning task to optimize our model based on the augmented and ranked questions. We conduct extensive experiments on two real-world mathematical datasets. The experimental results demonstrate the effectiveness of our model.

Clinician satisfaction and preference for central venous catheter systems promoting patient safety, ease-of-use and reduced clinician error

ABSTRACT Objectives Central venous catheters (CVC) are frequently utilized with limited data on user preferences. A simulation/survey-based study was conducted among anesthesia providers to evaluate attitudes toward general CVC system attributes, and satisfaction with elements of the most-commonly used and a novel CVC system. Methods Forty providers completed a simulation using both CVC systems and a 29-item questionnaire, including multiple-choice, free-text, ranking, and Likert-like questions. Ranking scores were reported using a scale of 0 (least important/satisfactory) to 100 (most important/satisfactory). Statistical significances were evaluated via Wilcoxon signed-rank sum test. Results Participants chose (mean±SD) patient safety (83.9 ± 25.3), ease-of-use (64.6 ± 26.1), and reduced risk for error (61.1 ± 26.7) as the most important attributes when considering a CVC system. Satisfaction levels were significantly higher for the novel system: overall (p < 0.001), its ease-of-use (p < 0.001), tray layout/design (p < 0.001), and safety (p = 0.012). Mean satisfaction scores were significantly higher for the novel system’s potential to reduce 5 of 7 common issues, including clinician error (p < 0.001), and contamination/infection (p < 0.001). Conclusion Anesthesia providers preferred CVC systems promoting patient safety, ease-of-use and reduce clinician error. Significantly higher (p < 0.05) satisfaction scores were awarded to a novel system featuring a sequentially organized tray, enhanced labeling, and a guidewire funnel.

A mixed method analysis of student satisfaction with active learning techniques in an online graduate anatomy course: Consideration of demographics and previous course enrollment.

Online learning has become an essential part of mainstream higher education. With increasing enrollments in online anatomy courses, a better understanding of effective teaching techniques for the online learning environment is critical. Active learning has previously shown many benefits in face-to-face anatomy courses, including increases in student satisfaction. Currently, no research has measured student satisfaction with active learning techniques implemented in an online graduate anatomy course. This study compares student satisfaction across four different active learning techniques (jigsaw, team-learning module, concept mapping, and question constructing), with consideration of demographics and previous enrollment in anatomy and/or online courses. Survey questions consisted of Likert-style, multiple-choice, ranking, and open-ended questions that asked students to indicate their level of satisfaction with the active learning techniques. One hundred seventy Medical Science master's students completed the online anatomy course and all seven surveys. Results showed that students were significantly more satisfied with question constructing and jigsaw than with concept mapping and team-learning module. Additionally, historically excluded groups (underrepresented racial minorities) were generally more satisfied with active learning than non-minority groups. Age, gender, and previous experience with anatomy did not influence the level of satisfaction. However, students with a higher-grade point average (GPA), those with only a bachelor's degree, and those with no previous online course experience were more satisfied with active learning than students who had a lower GPA, those holding a graduate/professional degree, and those with previous online course experience. Cumulatively, these findings support the beneficial use of active learning in online anatomy courses.

Constructing Faithful Homomorphisms over Fields of Finite Characteristic

We study the question of algebraic rank or transcendence degree preserving homomorphisms over finite fields. This concept was first introduced by Beecken et al. [ 3 ] and exploited by them, and Agrawal et al. [ 2 ] to design algebraic independence–based identity tests using the Jacobian criterion over characteristic zero fields. An analogue of such constructions over finite characteristic fields was unknown due to the failure of the Jacobian criterion over finite characteristic fields. Building on a recent criterion of Pandey et al. [ 15 ], we construct explicit faithful maps for some natural classes of polynomials in the positive characteristic field setting, when a certain parameter called the inseparable degree of the underlying polynomials is bounded (this parameter is always 1 in fields of characteristic zero). This presents the first generalisation of some of the results of Beecken et al. [ 3 ] and Agrawal et al. [ 2 ] in the positive characteristic setting.

Updating the Military Unique Curriculum for a Ready Medical Force.

Previous conflicts have demonstrated the impact of physician readiness on early battlefield mortality rates. To prepare for the lethal nature of today's threat environment and the rapid speed with which conflict develops, our medical force needs to sustain a high level of readiness in order to be ready to "fight tonight." Previous approaches that have relied on on-the-job training, just-in-time predeployment training, or follow-on courses after residency are unlikely to satisfy these readiness requirements. Sustaining the successes in battlefield care achieved in Iraq and Afghanistan requires the introduction of effective combat casualty care earlier and more often in physician training. This needs assessment seeks to better understand the requirements, challenges, and opportunities to include the Military Unique Curriculum (MUC) during graduate medical education. This needs assessment used a multifaceted methodology. First, a literature review was performed to assess how Military Unique Curricula have evolved since their initial conception in 1988. Next, to determine their current state, a needs-based assessment survey was designed for trainees and program directors (PDs), each consisting of 18 questions with a mixture of multiple choice, ranking, Likert scale, and free-text questions. Cognitive interviewing and expert review were employed to refine the survey before distribution. The Housestaff Survey was administered using an online format and deployed to Internal Medicine trainees at the Walter Reed National Military Medical Center (WRNMMC). The Program Director Survey was sent to all Army and Navy Internal Medicine Program Directors. This project was deemed to not meet the definition of research in accordance with 32 Code of Federal Regulation 219.102 and Department of Defense Instruction 3216.02 and was therefore registered with the WRNMMC Quality Management Division. Out of 64 Walter Reed Internal Medicine trainees who received the survey, 32 responses were received. Seven of nine PDs completed their survey. Only 12.5% of trainees felt significantly confident that they would be adequately prepared for a combat deployment upon graduation from residency with the current curriculum. Similarly, only 14.29% of PDs felt that no additional training was needed. A majority of trainees were not satisfied with the amount of training being received on any MUC topic. When incorporating additional training on MUC topics, respondents largely agreed that simulation and small group exercises were the most effective modalities to employ, with greater than 50% of both trainees and PDs rating these as most or second most preferred among seven options. Additionally, there was a consensus that training should be integrated into the existing curriculum/rotations as much as possible. Current Military Unique Curricula do not meet the expected requirements of future battlefields. Several solutions to incorporate more robust military unique training without creating any significant additional time burdens for trainees do exist. Despite the limitation of these results being limited to a single institution, this needs assessment provides a starting point for improvement to help ensure that we limit the impact of any "peacetime effect."

Prerequisites, barriers and opportunities in care for Q-fever patients: a Delphi study among healthcare workers

BackgroundQ-fever is a zoonotic disease that can lead to illness, disability and death. This study aimed to provide insight into the perspectives of healthcare workers (HCWs) on prerequisites, barriers and opportunities in care for Q-fever patients.MethodsA two-round online Delphi study was conducted among 94 Dutch HCWs involved in care for Q-fever patients. The questionnaires contained questions on prerequisites for high quality, barriers and facilitators in care, knowledge of Q-fever, and optimization of care. For multiple choice, ranking and Likert scale questions, frequencies were reported, while for rating and numerical questions, the median and interquartile range (IQR) were reported.ResultsThe panel rated the care for Q-fever patients at a median score of 6/10 (IQR = 2). Sufficient knowledge of Q-fever among HCWs (36%), financial compensation of care (30%) and recognition of the disease by HCWs (26%) were considered the most important prerequisites for high quality care. A lack of knowledge was identified as the most important barrier (76%) and continuing medical education as the primary method for improving HCWs’ knowledge (76%). HCWs rated their own knowledge at a median score of 8/10 (IQR = 1) and the general knowledge of other HCWs at a 5/10 (IQR = 2). According to HCWs, a median of eight healthcare providers (IQR = 4) should be involved in the care for Q-fever fatigue syndrome (QFS) and a median of seven (IQR = 5) in chronic Q-fever care.ConclusionsTen years after the Dutch Q-fever epidemic, HCWs indicate that the long-term care for Q-fever patients leaves much room for improvement. Facilitation of reported prerequisites for high quality care, improved knowledge among HCWs, clearly defined roles and responsibilities, and guidance on how to support patients could possibly improve quality of care. These prerequisites may also improve care for patients with persisting symptoms due to other infectious diseases, such as COVID-19.