Senior Ones Research Articles

Development and Validation of Deep Learning Model for Diagnosis and Subtypes Differentiation of Myeloproliferative Neoplasms Using Clinical Data and Digital Pathology

Bone marrow histology was the indispensable tool for the differential diagnosis of classic myeloproliferative neoplasms (MPNs) and subtypes. However, the subjectivity of morphological assessment and markedly overlapping pathological features of different subtypes made accurate diagnosis challenging and controversial. In this study, we developed Clinical, deep learning (DL) and Fusion diagnosis models based on clinical parameters, whole slide images (WSI) based deep learning algorithm using hematoxylin-eosin (HE) staining bone marrow specimen and combination of both for the diagnosis and differentiation of MPNs (Figure 1). 1,051 MPN patients from seven medical centres were enrolled in this study and divided into training, internal testing, internal validation and two external validation cohorts (called combined validation cohort totally). In combined validation cohort, Fusion model performed best in distinguishing MPNs with non-MPN controls with the AUC 0.931 (95%CI: 0.891-0.971). For PV identification, Clinical model achieved the highest AUC with 0.975 (95%CI: 0.960-0.991). Fusion model made best performance in the identification of ET and prePMF, with the AUC 0.887 (95%CI: 0.850-0.925) for ET and 0.899 (95%CI: 0.851-0.947) for prePMF. Misclassified prePMF cases into ET group reduced from 26 (60.5%) in Clinical model to 5 (11.6%) in Fusion model. Consistently, the number of ET cases (N=70, 95.9%) who were misclassified into prePMF in Clinical model reduced to 4 (5.5%) in Fusion model. These results indicated that our Fusion model may have clinical utility in assisting to identify ET and prePMF. Moreover, Fusion model could distinguish overt PMF effectively with AUC 0.980 (95%CI: 0.961-0.999) even with prePMF, and only 3 (7.5%) prePMF cases misclassified into PMF group, suggesting that our machine learning model had high sensitivity in feature identification and extraction. Next, we compared the performances of the deep learning models with three junior hematopathologists with less than five years of clinical experience and three senior hematopathologists with more than 10 years of experience. 20 cases for each subtype and 20 non-MPN controls, in total 100 cases, were randomly selected from the pool of validation sets with truth label blinded. All the hematopathologists reviewed data and image of 100 patients independently, in parallel with model implementation. Clinical model achieved the highest AUC with 0.925 (0.843-1.000) for PV, which was equivalent with senior hematopathologists (0.929, 0.878-0.979) (difference, 0.004, P=0.8500), while higher than junior ones (0.850, 95%CI: 0.787-0.913) (difference, -0.075, P=0.0007). Fusion model (for ET, 0.806, 95%CI: 0.700-0.913; for prePMF, 0.860, 95%CI: 0.741-0.979) performed better than junior hematopathologists in ET and prePMF identification (for ET, 0.707, 95%CI: 0.539-0.876, P=0.0720; for prePMF, 0.694, 95%CI: 0.564-0.825, P=0.0203), and comparable with senior ones in prePMF and ET identification (for prePMF, 0.787, 95%CI: 0.591-0.984, P=0.2190; for ET, 0.877, 95%CI: 0.860-0.896, P=0.1719). In overt PMF diagnosis, Fusion model (0.952, 95%CI: 0.898-1.000) tended to achieve better performance than both junior (0.850, 95%: 0.774-0.926, P=0.1202) and senior observers (0.823, 95%CI: 0.581-1.000, P=0.0608). The effect sizes could inform future study design for validation. In conclusion, we developed and externally validated the deep learning models for MPNs diagnosis and subtype differentiation achieving the performances equivalent with senior hematopathologists and better than junior ones. Prospective validation and tool development were underwent to promote the accessibility and feasibility of the proposed models in clinical practice.

Framing Leadership Challenges in the Digital Age: The Role of Senior Leaders

The Digital Age innovations greatly change how people gain information, communicate,work, make decisions, solve problems and even how they spend their spare time.It certainly effects trust relations at workplace between leaders and followers posinggreat challenges for leaders, especially for senior ones who do not belong to the so-callediGeneration, those who were not born into the age of social media, automatization,artificial intelligence, and the jungle of millions of apps. As a result, we can observe awidening generational gap between junior and senior leaders. Nevertheless, how cansenior leaders drive the change in the Digital Age without having the necessary digitalmaturity? What are the implications and challenges for leadership? TransformationalLeadership is proven to be the most effective leadership approach but without mutualtrust, leaders will have no other choice than employ transactional leadershipapproaches which is less effective. Thus, the question how to maintain trustfulrelationship at workplace between trustee and trustor in the world of digitalization israther important. It is even more significant in military where people need to trusteach other with their lives. This paper aims to frame this problem and raise awarenessof this phenomena to initiate further research and discussions on the challenges ofsenior leaders in the Digital Age.

THE DIGITAL LEADERSHIP BEHAVIOURS OF X, Y, Z GENERATION NURSES IN THE DELIVERY OF HEALTH SERVICES

Younger nurses are more active and agile in nursing leadership comparing to as senior nurses are about to retirement. Digital era and technology forces nurses to be more dynamic and adaptive. Thus, they try to behave as digital leaders. The aim of this study to link the relationship between young digital nurse leaders’ organizational resilience and commitment in hospitals. To test this relationship, the data were collected from nurses in three groups: X, Y and Z generation. The data were collected by four scales and analysed by SPSS program. The results show that digital leadership has a positive effect on both organizational resilience and organizational commitment. Moreover, organizational resilience and organizational commitment is positively correlated. The young nurses have more digital leadership skills and behaviours comparing senior ones. But the perception of organizational resilience and commitment of the X generation nurses was higher than the Y and Z generations. The results of this study may guide to the managers of healthcare organization to pay attention young nurses in adapting technology and guide to senior nurses through applying digital leadership behaviours.

Effect of Aging on the Immune Response to Core Vaccines in Senior and Geriatric Dogs.

Elderly dogs are steadily increasing worldwide as well as veterinarians' and owners' interest in their health and wellness. Aging is not a disease, but a combination of changes negatively affecting the organism in general and the immune system in particular, resulting in a decline in protection over time. The aim of this study was to measure the specific serum antibody titers against the main dangerous and widespread viral diseases preventable by core vaccinations in senior and geriatric dogs using the in-practice test VacciCheck. A cohort of three hundred fifty elderly dogs was analyzed for Protective Antibody Titers (PATs) against CPV-2, CDV and CAdV-1. The age ranged from 5 to 19 years, with two hundred fifty-eight seniors (73.7%) and ninety-two geriatrics (26.3%), and 97.4% of them were vaccinated at least once in their lives. More than half of the entire study population (52.9%) had PATs simultaneously for all three diseases, with 80.5% seniors and 19.5% geriatrics. Specific PATs were found in 88.6% of aging dogs for CPV-2, 82.3% for CadV-1 and 66.0% for CDV, demonstrating that unprotected aging dogs represent a minority. Unexpectedly, the larger elderly dogs resulted as more protected than smaller ones for CPV-2. Protection then decreases over time, with geriatric dogs less protected than senior ones. Veterinary practitioners should therefore always consider whether to maintain core vaccinations in aging dogs as in adults on a three-year basis or opt instead for closer boosters (every 1 or 2 years). PATs for core vaccines could then represent a good biomarker of protection and their titration could become a standard of care, especially in such a sensitive period of the dogs' life.

Association of COVID-19-Related Restrictions With Changes in Functional Skills of Adults With Intellectual Disabilities in Day Programs of an Israeli Non-Profit Organization.

Intellectual disability (ID) is assumed to be a dynamic phenomenon influenced by personal and environmental factors. During the 18 months of the coronavirus disease (COVID-19) pandemic, most day centers remained open for adults with ID who lived with their families (most of them with severe/profound [S/P] ID) but were closed to those who lived in group homes (with moderate and mild ID). Owing to the fewer participants in day centers, adults with S/P ID received more hours of therapy than before the pandemic. Using a functional screening tool, functional and environmental changes were mapped and discussed in team meetings. As expected, the pandemic caused environmental and personnel changes that affected all groups. The moderate (n = 29) and mild (n = 31) groups deteriorated over the 18 months of the study, especially the senior ones. However, the functional state of the S/P group (n = 16) improved. These results support the understanding that ID is truly dynamic throughout the lifespan. Functional improvements for S/P ID can occur during adulthood with intense and individually adapted interventions.

Distilling experience into a physically interpretable recommender system for computational model selection

Model selection is a chronic issue in computational science. The conventional approach relies heavily on human experience. However, gaining experience takes years and is severely inefficient. To address this issue, we distill human experience into a recommender system. A trained recommender system tells whether a computational model does well or poorly in handling a physical process. It also tells if a physical process is important for a quantity of interest. By accumulating this knowledge, the system is able to make recommendations about computational models. We showcase the power of the system by considering Reynolds-averaged-Navier–Stokes (RANS) model selection in the field of computational fluid dynamics (CFD). Since turbulence is stochastic, there is no universal RANS model, and RANS model selection has always been an issue. A working model recommending system saves fluid engineers years and allows junior CFD practitioners to make sensible model choices like senior ones.

On the job training in the dissection room: from physical therapy graduates to junior anatomy instructors

Background The training of near-peer (NP) teachers and junior faculty instructors received major attention as a possible solution for the shortage of experienced anatomy instructors in faculties of medicine and health professions. Several studies described the training of NP teachers and junior instructors (≤ 2 years of teaching experience) using various methods. However, few publications include On the Job Training (OJT), which enables reflection and performance evaluation and encourages professionals to cope with their blind spots. Previous publications describing OJT did not include formal observation of the NP teacher or junior instructor. Therefore, this study aimed to present a novel approach to OJT inclusion during prosection laboratories based on the Lewinian experiential model.Methods Eight physical therapy (PT) graduates were recruited as junior anatomy instructors into the prosection laboratories. All participated in a unique training program during two consecutive academic years (2017, 2018) and received OJT during the teaching sessions. Two questionnaires were filled out to evaluate the educational impact of the training program. Eighty-three first-year PT students participated in prosection laboratories in anatomy taught by junior instructors, and filled out a questionnaire evaluating the performance of both junior and senior instructors. In addition, we compared the final grades in anatomy obtained by students taught by senior instructors to the grades of those taught by junior instructors.Results Each junior anatomy instructor participated in four OJT sessions. Based on self-reported measures, all professional and didactic aspects of the training program received a median score of 4.5 or higher on a five-point Likert scale. Students obtained similar grades in anatomy when taught by junior instructors compared with senior ones, and were similarly satisfied from the teaching performance of both senior and junior anatomy instructors.Conclusions OJT is applicable in a small-sized PT program facing a shortage of anatomy instructors. Including junior anatomy instructors in prosection laboratories for PT students is a viable solution to the shortage of experienced anatomy instructors. Further study, involving a larger cohort with a longer follow up will strengthen the preliminary results presented here.

How Do Socio-Demographic Patterns Define Digital Privacy Divide?

Digital privacy has become an essential component of information and communications technology (ICT) systems. There are many existing methods for digital privacy protection, including network security, cryptography, and access control. However, there is still a gap in the digital privacy protection levels available for users. This paper studies the digital privacy divide (DPD) problem in ICT systems. First, we introduce an online DPD study for understanding the DPD problem by collecting responses from 776 ICT users using crowdsourcing task assignments. Second, we propose a factor analysis-based statistical method for generating the DPD index from a set of observable DPD question variables. In particular, the DPD index provides one scaled measure for the DPD gap by exploring the dimensionality of the eight questions in the DPD survey. Third, we introduce a DPD proportional odds model for analyzing the relationship between the DPD status and the socio-demographic patterns of the users. Our results show that the DPD survey meets the internal consistency reliability with rigorous statistical measures, e.g., Cronbach's $\alpha=0.92$. Furthermore, the DPD index is shown to capture the underlying communality of all DPD variables. Finally, the DPD proportional odds model indicates a strong statistical correlation between the DPD status and the age groups of the ICT users. For example, we find that young users (15-32 years) are generally more concerned about their digital privacy than senior ones (33 years and over).

DEPRESSION AND ATTITUDESTO DEPRESSION AMONG STUDENTS OF A RUSSIAN MEDICAL UNIVERSITY DURING THE PANDEMIC CORONAVIRUS

The paper analyzes the attitude towards depression and the level of depression among medical students. Astrakhan State Medical University (Astrakhan, Russia) conducted a survey of students on their attitude towards depression, whether they consider depression a dangerous disease and whether they believe that it is necessary to consult a specialist in the presence of depression. The data of the depression level research and coping strategies among medical students are presented. In the course of study, it was found out that students know the symptoms of depression and the majority of them assess the effect of depression on their health correctly, however, they are not sufficiently informed about the treatment of depression and are biased against antidepressants. More symptoms of depression were diagnosed among junior students than that among senior ones. We identified that the students cannot adequately assess their mental condition and determine whether they have depression or not. It should be noted that students are practically not informed about such a disease as depression and it is necessary to carry out psychoeducational work with student youth.

Professional identity construction of EFL teachers as autonomous learners

Teacher Professional Development (TPD) is exponential for English teachers to the success of teaching and learning process in the classroom. Teachers with professional identity are deemed to have good quality in teaching. As stipulated by Rodgers & Scott (2008) teachers with professional identity are deemed to have good quality in teaching. The efforts to do this can be accomplished through such ways as participating in conferences, seminars, workshops, and non-degree training, or even pursuing their further studies to master’ s degree and doctorate program. Also, they can conduct research and publish articles. This article is intended to provide evidence how novice, mid-career, and senior EFL teachers construct their identity professionally and autonomously. To arrive at the purpose of the study, an explorative survey was carried out to 129 EFL teachers throughout the Province of East Java via online questionnaire with 37 close-ended items. The findings revealed that (1) EFL teachers, be they junior, mid-career or senior ones involved in the present study, have tried to professionalize themselves via a number of corridors from self-directed ones to the ones imposed by other professional development providers; (2) teachers perceive their professional status and areas in diverse ways, and (3) they have various professional and pedagogical knowledge and skills related to becoming professional EFL teachers. In conclusion, EFL novice, mid-career or senior teachers have manifested their professional identity with a number of corridors as professional autonomous learners.

The impact of the second victim phenomenon in an Italian Academic Hospital: a cross-sectional study

Abstract Background Adverse patient safety events (AEs) can negatively impact on healthcare workers (HCWs) by causing emotional distress and affecting professional ability. The challenge of healthcare organizations is to support HCWs involved in AEs. This study aims to investigate the second victim phenomenon in a large Italian Academic Hospital (AH). Methods A cross sectional survey was conducted from June to November 2019 involving all HCWs working at the AH of Udine. HCWs' demographic characteristics and answers to the Second Victim Experience and Support Tool, Italian version (IT-SVEST; 29 items representing 7 dimensions and 2 outcome variables; Likert-scale: 1-5) were collected. Higher scores indicated a greater negative impact of the AEs and a perceived inadequacy of support resources. Median (M) and interquartile range (IQR) were assessed for each item. The agreement (AGR) (respondents with a mean score ≥4) was assessed for each dimension. Relationship between items score and demographic aspects was analyzed with non-parametric tests. Results A total of 349 HCWs joined the survey. Women were 79.4% and mean age was 39.4±10.7 years. 58.7% of respondents referred to be involved in a AEs. Lots of HCWs expressed feelings of psychological distress (AGR=26.9%) and less experienced HCWs were more affected by feelings of shame than senior ones (M = 4, IQR=1.5 vs M = 3, IQR=2; p < 0.01). Physical distress (AGR=10.9%) and professional self-efficacy (AGR=11.8%) did not had a great impact on HCWs, but younger (M = 3, IQR=2 vs M = 2, IQR=2; p < 0.01) and female (M = 3, IQR=2 vs M = 2, IQR=2; p < 0.01) HCWs were more inclined to question their skills. Support services offered by Hospital organization may be improved (AGR 8,9%). Conclusions Psychological impact of the AEs is relevant in our cohort and less experienced and female HCWs resulted more inclined to doubt their professional abilities when involved. Improvements in support resources should be desirable to create a safer working environment. Key messages HCWs’ psychological dimension and perceived professional self-esteem can be negatively affected by adverse events, especially for less experienced and female professionals. Healthcare organizations need to develop and to implement a second victim support program designed to provide emotional, psychological and professional support for HCWs.

The contribution of resident physicians to hospital productivity

Resident physicians play a double role in hospital activity. They participate in medical practices and thus, on the one hand, they should be considered as an input. Also, they are medical staff in training and, on the other hand, must be considered as an output. The net effect on hospital activities should therefore be empirically determined. Additionally, when considering their role as active physicians, a natural hypothesis is that resident physicians are not more productive than senior ones. This is a property that standard logarithmic production functions (including Cobb–Douglas and Translog functional forms) cannot verify for the whole technology set. Our main contribution is the development of a Translog modification, which implies the definition of the input “doctors” as a weighted sum of senior and resident physicians, where the weights are estimated from the empirical application. This modification of the standard Translog is able, under suitable parameter restrictions, to verify our main hypothesis across the whole technology set while determining if the net effect of resident physicians in hospitals’ production should be associated to an output or to an input. We estimate the resulting output distance function frontier with a sample of Spanish hospitals. Our findings show that the overall contribution of resident physicians to hospitals’ production allows considering them as an input in most cases. In particular, their average productivity is around 37% of that corresponding to senior physicians.

Is language learning a feminine domain? Examining the content and stereotype threat effect of female-language stereotypes among EFL learners in China

In various societies, language domains are stereotypically associated with females. Yet, few studies have investigated the exact content of such female-language stereotypes, or whether they lead to stereotype threat effect among language learners. A questionnaire was distributed to 1,165 learners of English as a Foreign Language (EFL) from eight high schools in China, and participants were found to stereotypically regard female learners more positively in three aspects of English learning: aptitude, affect and achievement. Compared to boys or junior students, girls and more senior ones had stronger stereotypes. A subsequent field experiment was conducted on 427 students from a ninth school, revealing that priming female-language stereotypes prior to an English test impaired boys’ performance when English competence was controlled for. The studies suggest that male EFL learners were adversely portrayed and affected by the female-language stereotypes. Educational implications, particularly for language learners and educators, and policy-makers, are discussed.

Surgical Site Infections in General Surgery at the Regional Hospital of Thies (Senegal): Epidemiological, Bacteriological Aspects and Risk Factors

Introduction: Surgical Site Infections (SSIs) are frequent and lead to serious consequences and in terms of morbidity and mortality, with an increase in the length of hospitalization and health costs. Developing countries are the most affected. The aim of our study was to describe the epidemiological, clinical, and bacteriological aspects of SSIs in general surgery at the RH of Thies. Methods: This is a prospective study over a period of seven months (7 months) from September 1, 2018 to March 31, 2019 at the level of the general surgery department of the Regional Hospital of Thies. Bacteriological studies were carried out at the level of the Bacteriology unit of the National Public Health Laboratory of Senegal. Results: The incidence of SSIs in our study was 9.9%. The SSIs rate was 15.3% among resident surgeons, 10% among junior surgeons, 6.8% among senior ones. The surgical intervention was classified as Altemeier stage 1 in 3.4% of cases (n = 1), stage 2 in 27.6% of cases (n = 8), stage 3 in 24.1% of cases (n = 7) and stage 4 in 44.8% of cases (n = 13). Twenty-two of the isolated stems (73.3% of cases) were multidrug-resistant bacilli. The extended spectrum beta lactamase (ESBL) phenotype was found in 22 isolates and 1 stem of K. pneumoniae was resistant to all antibiotics. Conclusion: SSIs constitute a challenge because of their high frequency and the high resistance of germs to common antibiotics. Currently, the main mode of resistance of bacteria in SSIs is the secretion of ESBL. This phenomenon seems to be major in our regions where it is urgent to review the therapeutic protocols in practice in the services.

Effect of malpractice claims on orthopedic and traumatology physicians in Turkey: A survey study.

This study aimed to investigate the malpractice claims experienced by orthopedic and traumatology physicians and to determine their effects on burnout, job satisfaction, and clinical practice. A questionnaire survey was conducted on orthopedic and traumatology specialists between May 2019 and February 2020. Data collection was carried out via e-survey at "turk-ortopedi" mail group, which is an electronic communication network of orthopedic and traumatology physicians. For data collection, sociodemographic data forms were used including the general characteristics, working conditions, and the malpractice claim events along with the Maslach Burnout Inventory scale to evaluate burnout and the Minnesota Satisfaction Questionnaire to investigate job satisfaction. In total, 353 orthopedic and traumatology physicians (348 men, 5 women), including 37 professors, 41 associate professors, and 275 surgeons, completed the questionnaire. In total, 65.4% of the participants (231 physicians and 471 relevant dossiers) stated that they were currently facing a malpractice claim. Emotional burnout and hesitant behavior in medical practices were significantly higher among the physicians who had undergone an investigation/trial with the claim of malpractice (p<0.05), whereas intrinsic job satisfaction was significantly lower (p<0.05). It was determined that orthopedic and traumatology physicians dealing with arthroplasty, vertebral surgery, hand surgery, and foot/ankle surgeries had undergone significantly more trials (p<0.05). In the evaluation of the burnout levels and job satisfaction scores of the physicians according to the age, academic title, seniority, and institution, it was determined that burnout level decreased with age, those between the ages of 25 and 34 years were exhausted the most, and job satisfaction increased with age. It was also found that burnout level decreased and job satisfaction increased as the academic title became higher, and attending physicians were the most exhausted. Moreover, burnout level decreased as seniority increased, the most senior ones were the ones most exhausted, and job satisfaction increased with seniority. Evidence from this study has revealed that malpractice claims cause emotional burnout, low intrinsic job satisfaction, and a hesitant behavior in medical practice for the orthopedic and traumatology physicians. The concept of malpractice alone may result in unnecessary analyses/examinations for patients. Level IV, Diagnostic Study.

Sexual Feelings Toward Clients in the Psychotherapeutic Relationship: The Taboo Revealed.

Talking about sexual feelings toward clients is still difficult for many mental health professionals. This is unfortunate, because exploring and talking about these feelings with peers (especially senior ones) or supervisors can help professionals to recognize, acknowledge, accept, and handle these feelings well. This focus group study explores the various factors that contribute to psychotherapists' hesitancy to talk about these feelings. The analysis revealed two important impeding factors: the psychotherapists felt discomfortable and a safe environment was lacking. Young, less experienced psychotherapists and psychiatrists seemed to be most vulnerable. Furthermore, more profound sexual feelings were "disguised" in some cases by using a more acceptable narrative, such as " intimate feelings," which possibly also impeded acknowledgment and discussion of these feelings. These insights might help to open up the way for psychotherapists to explore and come forward with their sexual feelings and experiences.

The prevalence and mental comorbidity of internet-dependent behavior in adolescents of Central Siberia

To study the prevalence of Internet addiction (IA) in adolescents in Central Siberia and the association of IA with mental health problems. The study included 2950 adolescents (44.7% boys and 54.3% girls), aged 11-18 years (mean age 14.5±1.3). Younger adolescents (11-14 years old) accounted for 52.4%, senior ones (15-18 years old) did 47.6%. The Chen scale (CIAS) with a cutoff level of 65 points was used to evaluate IA. The overall CIAS value of 27-42 points was regarded to be adaptive Internet use (AIU); 43-64 points being non-adaptive Internet use (NIU); 65 points and above were considered to be IA. Mental health was assessed using SDQ, which includes five scales: 1) prosocial behavior; 2) emotional symptoms; 3) behavior problems; 4) hyperactivity; 5) peer problems. The prevalence of AIU is 50.3% (55.9% among boys and 45.6% among girls, p<0.01), NIU was found in 42.9% (38.9/46.3%, p<0.001), IA occurred in 6.8% (5.1/8.2%, p<0.001). The prevalence of IA among adolescents, aged 11-14 years old, was 5.9%, between the ages of 15-18 it was 7.8% (p=0.04). In the AIU group, emotional symptom** were observed in 5.1% of adolescents, behavior problems in 6.1%, hyperactivity in 3.6%; in the NIU group - in 14.9%, 11.7% and 9.4% of adolescents; in the IA group, there were 34%, 24% and 26% of adolescents, respectively. In terms of odds ratio (OR), the greatest effect size was observed for hyperactivity (OR=5.23, p<0.001) and emotional disorders (OR=4.85, p<0001). The prevalence of IA is 6.8%. IA is more common in girls and increases with age. IA is associated with mental health problems, the greatest effect size is observed for hyperactivity and emotional disorders. The incidence of psychopathological manifestations increases depending on the degree of impairment in network behavior.

Multicentric Atrial Strain COmparison between Two Different Modalities: MASCOT HIT Study.

Two methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume–pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference.

Personal perspectives: having a series of cardiac events.

It has never been clear to me whether being a medically qualified patient has positive or negative associations. In 2019, after a prostatectomy, where I had extended bleeding per urethra, I suffered two myocardial infarctions, underwent three coronary angiograms and eventually coronary stenting. Junior doctors never examined me at any point, while senior ones worried over the risk of stent placement in an actively bleeding patient. I report my views on how this seemed as a largely passive, but still actively thinking patient.

Applying Psychological Capital to Senior Management Development: A “Must” and Not “Nice to Have”

The purpose of this viewpoint is to describe the necessity to use psychological capital (which includes the attributes of self-efficacy, optimism, hope and resiliency) in order to develop managers, especially senior ones.&#x0D; &#x0D; The viewpoint includes an example of optional steps of micro-intervention for senior management. In the 21st-century VUCA world, managers need to invest in processes that strengthen their resistance to psychological pressures and negative outcomes, while enabling them to cope with confidence with instability, volatility and uncertainty. In this regard, Psychological Capital (PsyCap) can and will contribute to significant changes for the better in managers and organizations as a whole. This viewpoint offers a relatively new view for developing senior managers.