Specific Instructions Research Articles

Daily Life Management Guidelines for Diabetic Foot Patients

Diabetic foot ulcers are a significant complication of diabetes, often leading to hospitalization and, in severe cases, lower limb amputation, causing substantial medical costs and reduced quality of life. Approximately 15% of diabetic patients develop foot ulcers, with 15% of these cases progressing to amputation, highlighting the critical need for foot care in diabetes management. These ulcers have a high mortality rate and a high likelihood of recurrence, highlighting the need for both blood sugar control and foot care. In South Korea, around 2.9% of diabetic patients over the age of 20 were diagnosed with diabetic foot ulcers in 2011, affecting approximately 100,000 individuals. Globally, about one-third of diabetic patients will experience foot ulcers in their lifetime, with a high recurrence rate. Diabetic foot ulcers are prone to infections, potentially leading to amputation or even death, emphasizing the importance of prevention and proper treatment. Educating patients with diabetic foot ulcer about foot care can significantly enhance their knowledge and performance in caring for their feet, including the use of moisturizers. Providing specific and practical foot care instructions is crucial to improve self-foot care practices and to minimize the risk of complications.

Design And Construction Of A Web-Based Information System For Ordering Printing Services On Cv Multigraph

Designing a Web-Based Printing Service Ordering Information System for CV Multigraph is a project aimed at developing an efficient and practical information system for online printing service orders. CV Multigraph is a printing company that offers a variety of printing services to its customers. In this research, the author designed and implemented an information system that enables customers to easily place orders through the web platform. Utilizing modern web technology, the system harnesses the power of the internet to expedite and streamline the ordering process. The system allows customers to choose their desired printing services, upload design files, select print quantities and sizes, and provide specific instructions. Upon completion of the order, customers receive real-time order status updates and confirmations. Additionally, the system facilitates CV Multigraph in managing incoming orders. Printing staff can view the list of ongoing orders, schedule production, and send confirmation messages to customers, enhancing service effectiveness and responsiveness to customer needs. The methodology used is Extreme Programming, which encompasses analysis, planning, design, coding, and testing. The system development utilizes web technologies such as HTML, CSS, JavaScript, and PHP. The result is an efficient, practical, and user-friendly printing service ordering information system for CV Multigraph customers. The system is expected to enhance customer experience, expedite the ordering process, and improve operational efficiency and customer satisfaction for CV Multigraph. Keywords: information system, ordering, printing service, CV Multigraph, web- based.

Blended learning in English for specific purposes instruction: A systematic review

Due to Covid-19 pandemic, using ICT for teaching purposes has been the subject of a growing field of study in educational research. Thus, this systematic review aims to provide ESP practitioners with a current synthesis of the impact of blended learning on English for specific purposes (ESP) instruction. The current study systematically reviews and synthesizes studies related to blended learning and ESP with the aim of providing a comprehensive analysis of 28 research articles published across 2012-2022 and meeting selection criteria. Findings show that blended learning can foster university ESP students’ language skills. The majority of studies stress that blended learning brings considerable benefits to their ESP learning, namely flexibility, autonomy, and collaboration. The findings also revealed that few students faced some challenges such as demotivation, procrastination, and technical issues. In light of these results, the review ends up with implications for ESP teachers and researchers.

Prompted representation joint contrastive learning for aspect-based sentiment analysis

As a fine-grained and challenging subtask in the natural language processing (NLP) community, aspect-based sentiment analysis (ABSA) aims to predict the sentiment polarity towards a given aspect term. In previous ABSA research, most works utilized the pre-trained language model (PLM) as the backbone of their proposed methods, without any specific task-related instructions. Besides, some works focused on learning the dependency information or the external knowledge-enhanced dependency information separately, which lacked the exploitation of the mutual interaction between the normal dependency and knowledge-enhanced dependency. Therefore, we propose a novel ABSA method namely prompted representation joint contrastive learning enhanced graph convolutional networks (PRCL-GCN) to strengthen the robustness of the ABSA model. Specifically, to achieve the task-oriented contextual representation, we design the task-specific prompt template to guide the fine-tuning process of PLM in the ABSA task. And a biaffine attention mechanism is employed to further extract the essential sentiment feature from the prompted representation. Moreover, we introduce the syntax dependency graph as prior knowledge, and construct an affective syntactic dependency graph by injecting the affective knowledge from SenticNet into the graph. Then, we utilize the multi-layer GCNs to process the above two syntactic graphs independently, which aims to learn multi-granularity syntactic features. Subsequently, a novel designed attention variant is leveraged to integrate these syntax features with the guided contextual representation, separately. Eventually, through designing a Kullback–Leibler divergence-based contrastive learning to encourage the model’s learning, we improve the model’s accuracy in modeling contextual representation by integrating the designed dual-ways information. Extensive experiments are conducted on five benchmark datasets, and the outstanding experiment results validate the effectiveness of our proposed model.

An integrated, holistic, evidence-based, interdisciplinary approach to digital monitoring and remote care in patients with highly infectious diseases: TeleCovid.

During the first waves of the SARS-CoV-2 pandemic, hospitals were overrun with patients. To cope with this high influx of infectious patients, hospitals needed to postpone elective care. Additional ICU beds had to be opened, and the number of isolation units had to be increased. All of this placed considerable strain on the nursing and medical staff. At that time, the idea was launched to keep as many patients as possible at home and prevent their hospital admission through the use of a remote care program. Based on our previous experience with transmural care programs, we quickly developed a digital monitoring program to track the health status of Covid-19 infected patients at home.
 Patients could be registered for follow-up by their primary care physician or specialist. After registration, patients received access to a secured digital platform. They first had to complete an extensive survey in order to identify their medical and surgical history, as well as the symptoms present at that time. The severity of symptoms was also evaluated at the moment of the initiation of the digital monitoring. On the basis of the responses to the introductory questionnaire, a global personalized risk score was compiled. After this initial step was concluded, the patient was contacted by the medical monitoring team to arrange for the delivery of telemetric devices (such as peripheral oxygen saturation). Patients were monitored through a 4-layer system, consisting of diaries, validated surveys, telemonitoring of vital signs, and a digital communication system included in the digital platform. This resulted in close cooperation with GPs, home nurses, physiotherapists, and other caregivers. The remote care team monitored the condition of the patients on a 24/7 basis. If needed, they contacted the home caregivers with specific demands or instructions (e.g. administration of oxygen at home, blood sampling, administration of medication). 
 In the spring of 2022, Paxlovid became available in Belgium for ambulatory treatment of Covid-19 symptoms in high-risk patients. It was quickly decided that we would also include the follow-up of Paxlovid treatment regimens within our care pathway. This created an entirely new approach to our remote monitoring since we had to tackle specific problems like drug-drug interactions but also therapeutic monitoring of certain specific drugs.
 
 TeleCovid was perceived as an integrated, comprehensive remote care program for Covid-19 patients. At first, this digital care program was perceived in such a way that we could prevent the hospitalization of Covid-19 patients. But very soon after its activation, GPs started to include patients so that they focus their attention and time on other patients. They could rely on the remote care program to be notified when the medical conditions of their patients deteriorated. The care program provided support and guidance to the patients AND their families so they felt safe while staying at home. We provided all possible care right at the home of the patients. This was only possible through intensive and continuing cooperation between many different healthcare providers, such as nurses, physiotherapists, social workers, GPs, and hospital specialists.

Overreliance on inefficient computer-mediated information retrieval is countermanded by strategy advice that promotes memory-mediated retrieval

With ubiquitous computing, problems can be solved using more strategies than ever, though many strategies feature subpar performance. Here, we explored whether and how simple advice regarding when to use which strategy can improve performance. Specifically, we presented unfamiliar alphanumeric equations (e.g., A + 5 = F) and asked whether counting up the alphabet from the left letter by the indicated number resulted in the right letter. In an initial choice block, participants could engage in one of three cognitive strategies: (a) internal counting, (b) internal retrieval of previously generated solutions, or (c) computer-mediated external retrieval of solutions. Participants belonged to one of two groups: they were either instructed to first try internal retrieval before using external retrieval, or received no specific use instructions. In a subsequent internal block with identical instructions for both groups, external retrieval was made unavailable. The ‘try internal retrieval first’ instruction in the choice block led to pronounced benefits (d = .76) in the internal block. Benefits were due to facilitated creation and retrieval of internal memory traces and possibly also due to improved strategy choice. These results showcase how simple strategy advice can greatly help users navigate cognitive environments. More generally, our results also imply that uninformed use of external tools (i.e., technology) can bear the risk of not developing and using even more superior internal processing strategies.

Applying constructivism in driving teacher education: Analysis based on transcripts of videotaped lessons

Modern learning focuses heavily on theory and ideals, offering scant practical guidance on execution and outcome evaluation. This research paper aims to show that the integration, in 2018, of a contemporary educational approach into the driving teacher training program at Tallinn University, Estonia, with specific implementation and evaluation criteria, changes actual teaching behavior towards constructivist principles. This approach involved a change in which students began video recording their driving lessons and transcribing them using a web-based speech recognition tool while following specific instructions. This process allowed for feedback and self-analysis throughout the learning process.The study analyzed 145 videotaped driving lessons, which were submitted as final examinations in the driving teacher training curriculum at Tallinn University Haapsalu College between 2017 and 2021. The natural quasiexperimental study compared transcripts of recordings (N = 145; 115 males) before (n = 38) and after (n = 107) the methodology change.The findings reveal a significant increase in the implementation of constructivist principles within the lessons after methodology change in 2018: lesson objectives and evaluation criteria were formulated more often, leading to an increase in open-ended inquiries and a higher prevalence of feedback and analysis. Additional pilot analysis of data from 11 driving teacher certificate renewers in a brief education program supported the efficacy of revised approach: the exam lesson recordings exhibited significantly more constructivist elements compared to the initial stage of the program. There were variations in the length of training both pre and post methodology change. While longer training displayed more constructivist elements, the impact of the methodology shift was notably more pronounced.In summary, the utilization of specific expectations, evaluation criteria and assessment tool in the driving teacher training program promotes a shift in which graduating teachers independently use more constructivist and learning-centered methodology. This approach has the potential to shape more responsible drivers.

Importance of Long-Acting Injectable Antipsychotic Preparation, Administration, and Injection Site Tolerability: A Focus on Paliperidone Palmitate Once-Every-6-Months Formulation

Purpose. This post hoc analysis assessed the importance of proper paliperidone palmitate (PP) dose preparation prior to administration and evaluated injection site reactions after dorsogluteal injection of PP once-every-6-months (PP6M) and once-every-3-months (PP3M) formulations from a double-blind (DB) noninferiority study. Design and Methods. Clinically stable patients receiving moderate/high doses of PP once-monthly (PP1M) (156 mg/mL; 234 mg/1.5 mL) or PP3M (546 mg/1.75 mL; 819 mg/2.63 mL) were randomly assigned 2:1 to corresponding dorsogluteal injections of PP6M (1092 mg/3.5 mL; 1560 mg/5 mL) or PP3M (546 mg/1.75 mL; 819 mg/2.63 mL) during a 12-month DB phase. Patients receiving PP6M injections received alternating matching placebo injections every 3 months between active doses to maintain blinding. Prior to administration, each PP formulation was prepared per specific instructions to ensure complete resuspension of the medication. Findings. Of 895 PP6M injections, one of two incomplete injections was possibly related to insufficient shaking before administration; neither resulted in an adverse reaction. After dorsogluteal administration, 59 of 478 patients who received PP6M (12.3%) and 11 of 224 patients who received PP3M (4.9%) reported an injection site–related treatment-emergent adverse event (TEAE), with pain being the most commonly reported (7.7% and 4.0%, respectively). Patient-reported pain decreased from baseline to end point in both groups. During the DB phase, injection site-related TEAEs associated with PP6M injections up to 5 mL and PP3M injections up to 2.63 mL were mild to moderate in severity; none were reported as serious, resulted in treatment discontinuation, or required dermatological consultation. Practice Implications. These results inform provider and patient expectations of PP6M administration and reinforce the importance of proper PP dose preparation and administration; future work could assess safety data from real-world clinical practice. This trial is registered with NCT03345342.

The ability of typically developing 2–3 year olds to infer the control mechanism for eye-gaze technology and the impact of causal language instruction

Purpose Little is known about how children learn to control eye-gaze technology, and clinicians lack information to guide decision-making. This paper examines whether typically developing 2–3 year olds can infer for themselves the causal mechanisms by which eye-gaze technology is controlled, whether a teaching intervention based on causal language improves performance and how their performance compares to the same task accessed via a touchscreen. Methods and materials: Typically developing children’s (n = 9, Mean Age 28.7 months) performance on a cause and effect game presented on eye-gaze and touchscreen devices was compared. The game was presented first with no specific instruction on how to control the devices. This was followed by a subsequent presentation with explicit instruction about how the access methods worked, using a causal language approach. A final presentation examined whether children had retained any learning. Results Performance in the eye-gaze condition without instruction (42.5% successful trials) was significantly below performance in the corresponding touchscreen condition (75%). However, when causal language instruction was added, performance with both access methods rose to comparable levels (90.7% eye-gaze and 94.6% touchscreen success). Performance gains were not retained post-intervention. Conclusions Although 2–3 years in the study could make use of eye-gaze technology with support, this study found no evidence that these children could infer the causal mechanisms of control independently or intuitively. The lack of spatial contiguity and the comparative lack of feedback from eye-gaze devices are discussed as possible contributory factors.

TREE-GPT: MODULAR LARGE LANGUAGE MODEL EXPERT SYSTEM FOR FOREST REMOTE SENSING IMAGE UNDERSTANDING AND INTERACTIVE ANALYSIS

Abstract. This paper introduces a novel framework, Tree-GPT, which incorporates Large Language Models (LLMs) into the forestry remote sensing data workflow, thereby enhancing the efficiency of data analysis. Currently, LLMs are unable to extract or comprehend information from images and may generate inaccurate text due to a lack of domain knowledge, limiting their use in forestry data analysis. To address this issue, we propose a modular LLM expert system, Tree-GPT, that integrates image understanding modules, domain knowledge bases, and toolchains. This empowers LLMs with the ability to comprehend images, acquire accurate knowledge, generate code, and perform data analysis in a local environment. Specifically, the image understanding module extracts structured information from forest remote sensing images by utilizing automatic or interactive generation of prompts to guide the Segment Anything Model (SAM) in generating and selecting optimal tree segmentation results. The system then calculates tree structural parameters based on these results and stores them in a database. Upon receiving a specific natural language instruction, the LLM generates code based on a thought chain to accomplish the analysis task. The code is then executed by an LLM agent in a local environment and . For ecological parameter calculations, the system retrieves the corresponding knowledge from the knowledge base and inputs it into the LLM to guide the generation of accurate code. We tested this system on several tasks, including Search, Visualization, and Machine Learning Analysis. The prototype system performed well, demonstrating the potential for dynamic usage of LLMs in forestry research and environmental sciences.

A REVIEW OF TEACHING STRATEGIES FOR ENGLISH AS A FOREIGN LANGUAGE IN HEALTHCARE STUDIES

Teachers of English as a foreign language are faced with difficulties in selecting the proper teaching strategy for students learning English for academic and professional purposes. Fifteen research studies were included in the current study on teaching strategies for students with English as a foreign language in healthcare studies. The objective is to determine the most useful and effective teaching strategies for healthcare students learning English as a foreign language. The review study was conducted using Noblit and Hare methasynthesis and Dearholt and Dang’s Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines for evaluation, selection and analysis. Language teaching strategies play an important role in teaching English as a foreign language especially in specific professional environments such as healthcare and medicine. The study divides language teaching strategies for English in healthcare into two perspectives; those concerned with improving students’ language learning performance and those examining specific instruction strategies and their effects on students’ knowledge. Further it gives an outline of four general English language skills and most commonly used teaching strategies. The results of the study may be used by English language teachers and content creators for developing new teaching materials and courses to help students succeed. For healthcare as a profession, a future with newly educated professional who have skills in English and other foreign languages will be beneficial in helping their target population. Key words: teaching strategies, healthcare studies, EFL, nursing, medical English

Efficacy and Safty of Stem Cell Mobilization with Etoposide +Cytarabine Plus G-CSF in Patients with Lymphoma at High-Risk of Mobilizing Failure

Objective：Sufficient peripheral blood stem cell (PBSC) mobilization is important for performing successful autologous stem cell transplantation (ASCT) in patients with lymphoma. However, the optimal mobilization strategy remains a matter of debate in lymphoma.The aim of the study was to explore efficacy and safety of PBSC mobilization using etoposide combined with Cytarabine (EA) plus G-CSF in patients with lymphoma at high-risk of mobilizing failure. Methods：This retrospective study explored efficacy and safety of PBSC mobilization using EA (etoposide 50~100 mg/m2 , qd d1~3; AraC 0.5 g/m2 , q12h d1~3) plus G-CSF (5 µg/kg/day, from d5 until the day of apheresis) in 81 patients with lymphoma at high-risk of mobilizing failure. As previously reported, patients were defined at high-risk of mobilizing failure if (i) previous collection attempts failed (no special instructions); (ii) previous extensive radiotherapy or a complete course of treatment had affected stem cell activity; or (iii) any of these conditions: advanced disease (2 lines of chemotherapy), refractory disease, extensive bone marrow involvement or cellularity <30% at the time of mobilization or age 65 years. Results：The mean total and first apheresis trial CD34+ cells collection was 20.37(range 1.08~138.96) and 18.56(range 0.1~138.96)×10^6 CD34+ cells/kg, respectively. Overall, 79(97.5%) patents harvested adequate mobilization (≥2×10^6 CD34+ cells/kg), while 65(80.2%) patients achieved optimal mobilization(≥5×10^6 CD34+ cells/kg). A single apheresis was sufficient to reached the target yield of adequate apheresis in 67(82.7%) patients on median 15th day (range 11~19). We observed acceptable hematological toxicity and exposure of antibiotic usage in 57 patients with a median of 4 days. No severe infections or mobilization-related mortality were observed. Conclusion：Our resluts suggest that EA plus G-CSF is an effective and safe PBSC mobilization strategy for patients with lymphoma, including those predicted as poor mobilizers. The outcome should be evaluated in a randomized study.

Can ChatGPT Evaluate Plans?

Problem, research strategy, and findings Large language models, such as ChatGPT, have recently risen to prominence in producing human-like conversation and assisting with various tasks, particularly for analyzing high-dimensional textual materials. Because planning researchers and practitioners often need to evaluate planning documents that are long and complex, a first-ever possible question has emerged: Can ChatGPT evaluate plans? In this study we addressed this question by leveraging ChatGPT to evaluate the quality of plans and compare the results with those conducted by human coders. Through the evaluation of 10 climate change plans, we discovered that ChatGPT’s evaluation results coincided reasonably well (with an average of 68%) with those from the traditional content analysis approach. We further scrutinized the differences by conducting a more in-depth analysis of the results from ChatGPT and manual evaluation to uncover what might have contributed to the variance in results. Our findings indicate that ChatGPT struggled to comprehend planning-specific jargon, yet it could reduce human errors by capturing details in complex planning documents. Finally, we provide insights into leveraging this cutting-edge technology in future planning research and practice. Takeaway for practice ChatGPT cannot be used to replace humans in plan quality evaluation yet. However, it is an effective tool to complement human coders to minimize human errors by identifying discrepancies and fact-checking machine-generated responses. ChatGPT generally cannot understand planning jargon, so planners wanting to use this tool should use extra caution when planning terminologies are present in their prompts. Creating effective prompts for ChatGPT is an iterative process that requires specific instructions.

“DHUMAPANA: AYURVEDIC HERBAL SMOKE THERAPY”

Dhumapana is a unique practice in Ayurveda, the traditional Indian system of medicine. It involves inhaling herbal smoke for various health benefits. Dhumapana is about inhaling fragrant smoke from herbs, minerals, and other natural substances. This practice is designed to keep the sensory organs healthy and prevent Dosha imbalances in the parts above the clavicular region, mainly related to Kapha dosha. There are different types of Dhumapana, each with specific purposes. For instance, it can relieve headaches, respiratory issues, or eye problems and even help with emotional well-being. Dhoomanetra is a special instrument used to perform Dhumapana. This is designed in such a way that makes sure the smoke is inhaled properly. There are specific instructions to be followed based on the type of herbs and substances used for Dhumapana. However, it's crucial to be aware of the Dhumapana contraindications, such as being too young or old or suffering from specific Pitta-related health issues. Dhumapana can have negative effects if performed improperly or excessively, although these effects can be controlled using ayurvedic treatments. Dhumapana can be included into a daily schedule to assist maintain a healthy body, mind, and senses. It is both therapeutic and preventative measures.

Guiding pre-service teachers’ visual attention through instructional settings: an eye-tracking study

In complex classroom situations, pre-service teachers often struggle to identify relevant information. Consequently, classroom videos are widely used to support pre-service teachers’ professional vision. However, pre-service teachers need instructional guidance to attend to relevant information in classroom videos. Previous studies identified a specific task instruction and prompts as promising instructions to enhance pre-service teachers’ professional vision. This mixed-methods eye-tracking study aimed to compare pre-service teachers’ visual attention to information relevant for classroom management in one of three instructional conditions. Participants viewed two classroom videos and clicked a button whenever they identified situations relevant to classroom management in the videos. They got either (1) a specific task instruction before video viewing (n = 45), (2) attention-guiding prompts during video viewing (n = 45), or (3) a general task instruction (n = 45) before video viewing as a control group. We expected a specific task instruction and prompts to better guide participants’ visual attention compared to a general task instruction before video viewing because both experimental conditions contained informational cues to focus on specific dimensions of classroom management. As both a specific task and prompts were assumed to activate cognitive schemata, resulting in knowledge-based processing of visual information, we expected the specific task instruction to have a similar attention-guiding effect as prompts during video viewing. Measurements were conducted on an outcome level (mouse clicks) and on a process level (eye tracking). Findings confirmed our hypotheses on an outcome level and in part on a process level regarding participants’ gaze relational index. Nevertheless, in a disruptive classroom situation, participants of the prompting condition showed better attentional performance than participants of the other conditions regarding a higher number of fixation and a shorter time to first fixation on disruptive students. Further qualitative analyses revealed that, when observing classroom videos without instructional guidance, pre-service teachers were less likely to identify disruptive situations in the video and more likely to attend to other situations of classroom management concerning the teachers’ action. We discuss advantages of both attention-guiding instructions for pre-service teacher education in terms of the economy of implementation and the salience of situations.

Examining Teaching Strategies for Delivering English-Based Curriculum in Secondary Schools of Faisalabad City

English is now considered an international language which is used in almost every country. For teaching an English-based curriculum, teachers need to receive specific information and instruction so that teachers can provide adequate knowledge to students. English-based curriculum gives a lot of benefits, but teachers have to use specific teaching pedagogies. This study aimed to explore the prevalent teaching strategies, their effectiveness and relevant challenges teachers face during teaching English-based curriculum. In the sampled schools, there were 280 educators. Based on a 95% confidence level and a 5% confidence interval, the study's sample size was 162. This study's respondents' data were collected using a well-structured questionnaire. The study used a questionnaire to collect data for quantitative research. The instrument's reliability was determined using the Cronbach alpha coefficient. After modifying and coding, the collected data was entered into the Statistic Package for Social Sciences worksheet for analysis. It is concluded that the classroom management was poor for teaching English, and teachers are not well trained to teach English-based curriculum. It was observed that a lack of speaking fluency in English and the poor family background of students were also the major issues in teachers' proficiency. It is concluded that teachers lack confidence in relationships and reduce the students' speaking skills in an English-based curriculum. In light of the study findings, English teachers should speak slowly but continuously. Teachers should focus on words and basic grammar, and a teacher should pay particular attention to the structure of the English language.

From Ancient Mythology to Modern Technology: The Historical Evolution of Artificial Intelligence

Dear Editors, Recently, a fascinating article detailing the evolution of Artificial Intelligence (AI) was published, as the article describes it with the bronze creature Talos from ancient Greek myths and the groundbreaking DaVinci Si and DaVinci Xi surgical systems of the modern era [1]. The interaction of ancient myths and medical technology shows how far we have come but how deeply we remain connected to our past. As the article emphasizes, Talos, described in ancient Greek literature, may be the world's first recorded concept of an automaton with Artificial Intelligence capability. Talos, created by the god Hephaestus, used his bronze form and inner fire to patrol the coasts of Crete and deter invaders [2]. The story of a machine that moves independently, driven by an energy source and following specific instructions, is astoundingly pioneering [2]. It is interesting to think that robots, an idea we usually think of as a modern concept, were present in the imagination of ancient civilizations. Leonardo da Vinci's robot knight is a moving tribute to the versatile genius of the Renaissance [3]. However, since its operation depends on external intelligence, it is not a direct precursor to the AI we know today. The article makes this distinction. However, A claim that has been presented is open to discussion. Naming AI surgical tower da Vinci is misleading, article suggests. Although Leonardo's automaton was not autonomous, its extensive notebooks testify to a questioning and innovative mind that was always pushing boundaries. In this sense, it feels appropriate to mention the name of Da Vinci, a technological marvel. The underlying sentiment is concurred with. Hephaestus' creation of Talos offers a more direct line to the concept of autonomous machines and perhaps it deserves a more prominent position in the story of the history of Artificial Intelligence. Highlighting this overlooked intersection of mythology, history, and technology is commendable. Such discussions highlight the importance of understanding our past while understanding our rapidly evolving present and future. Sincerely yours,

Improving lung cancer screening starts with the primary care provider: Enhancing shared decision making for optimal patient outcomes.

306 Background: Despite the critical importance of lung cancer screening (LCS), its uptake remains dismally low, with only 5.8% of eligible individuals undergoing screening. To harness the potential benefits of LCS, there is an urgent need for shared decision making (SDM) between patients and primary care physicians (PCPs), who often serve as the initial point of contact. Recognizing this need, the Centers for Medicare and Medicaid Services endorse LCS through low-dose computed tomography (LDCT) following SDM. This study aims to enhance SDM and increase LCS utilization by providing PCPs with a comprehensive checklist to address key points and better utilize their time. Methods: A concise checklist was created, which included pertinent points to address during an SDM meeting. This checklist was then given to the PCPs. Fifty-eight (58) PCPs affiliated with two hospitals in the Indiana University Health system agreed to implement the LCS-SDM checklist during office visits with eligible patients. All participating PCPs had existing relationships with LCS-eligible patients, received specific instructions for implementing the LCS-SDM checklist, and agreed to allocate a portion of their visits for SDM. In total, 194 patients on Medicare participated in this study and were interviewed: 158 had no documented history of LCS discussions, while 36 had previously been offered and refused LDCT. Following SDM interviews, PCPs completed written surveys to evaluate the impact of the LCS-SDM checklist on their practice and the perceived effectiveness of SDM. The patients were also surveyed to assess their receptiveness to the SDM process. Results: The majority of the 58 PCPs expressed support for utilizing SDM in LCS; however, time constraints emerged as a significant limiting factor. Despite feeling rushed during the SDM sessions, the PCPs acknowledged the value of the checklist as a helpful reference tool. Among the 158 patients who had not previously discussed LCS, 91 out of 158 patients (57.6%) opted to undergo screening. Among the 36 patients who initially declined LDCT, 20 out of 36 patients (55.5%) chose to participate in LCS after revisiting the topic. Impressively, 192 out of 194 patients (98.9%) expressed appreciation for the opportunity to engage in SDM. Conclusions: The results underscore the significant benefits of SDM in LCS, demonstrating its potential to improve uptake and patient outcomes. While time constraints present challenges for PCPs, both patients and physicians generally respond positively to SDM sessions. By implementing comprehensive checklists and facilitating dedicated time for SDM, primary care providers can effectively enhance LCS utilization and empower patients to make informed decisions regarding their lung health.

대학생의 읽기 목적에 따른 위키 사이트의 이용 현황 및 인식 연구

This study conducted a survey of 286 college students to examine their perceptions and use of Wiki sites according to their reading purposes. First, we examined how university students searched for information by reading purpose and found that the most common response was to use search engines for both daily and academic information search. Wiki sites had a mean of 3.51 for daily reading but a statistically significant lower mean of 3.18 for academic reading. When asked how they used Wiki sites for academic purposes, the most common reason was to understand related concepts, and the most common reason for using Wikis was because they duly organized the information they needed and were the first to appear in portal searches. However, the most common reason given for not using Wiki sites for academic purposes is that they do not trust the information on the Wiki site. When asked about their professors’ and friends’ reactions to Wiki sites, it is clear that Wiki sites are not discussed much, and even when they are, they are viewed negatively. It is necessary to provide specific usage guidelines and instruction to help college students use online information and Wiki sites appropriately for their reading purposes.

The Reliability of the Modified Fels Knee Skeletal Maturity System.

The recently described Modified Fels knee skeletal maturity system (mFels) has proven utility in prediction of ultimate lower extremity length in modern pediatric patients. mFels users evaluate chronological age, sex, and 7 anteroposterior knee radiographic parameters to produce a skeletal age estimate. We developed a free mobile application to minimize the learning curve of mFels radiographic parameter evaluation. We sought to identify the reliability of mFels for new users. Five pediatric orthopaedic surgeons, 5 orthopaedic surgery residents, 3 pediatric orthopaedic nurse practitioners, and 5 medical students completely naïve to mFels each evaluated a set of 20 pediatric anteroposterior knee radiographs with the assistance of the (What's the Skeletal Maturity?) mobile application. They were not provided any guidance beyond the instructions and examples embedded in the app. The results of their radiographic evaluations and skeletal age estimates were compared with those of the mFels app developers. Averaging across participant groups, inter-rater reliability for each mFels parameter ranged from 0.73 to 0.91. Inter-rater reliability of skeletal age estimates was 0.98. Regardless of group, steady proficiency was reached by the seventh radiograph measured. mFels is a reliable means of skeletal maturity evaluation. No special instruction is necessary for first time users at any level to utilize the (What's the Skeletal Maturity?) mobile application, and proficiency in skeletal age estimation is obtained by the seventh radiograph. Level II.