Search

The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) conducted a one-year research study comparing performance on the traditional continued professional certification assessment, administered at a test center or online with remote proctoring, to a longitudinal assessment that required answering quarterly questions online on demand. A randomized controlled trial of 1,000 certified registered nurse anesthetists (500 randomly assigned to the traditional assessment group and longitudinal assessment group) aimed to 1) compare assessment performance between groups, 2) compare perceptions and user experience between groups; and 3) describe participant feedback about usability of the longitudinal assessment platform. The mean scaled score for the traditional assessment group exceeded that of the longitudinal assessment group when scoring the first responses; however, upon scoring the longitudinal assessment group's most recent responses on repeat questions previously answered incorrectly, the mean scaled score was higher than the traditional assessment group. Both groups were satisfied with their experience, with slightly higher feedback ratings for the longitudinal assessment group who also found the platform easy to use and navigate. Overall results suggest the longitudinal assessment is a feasible, acceptable, and usable format to assess specialized knowledge for continued healthcare professional certification.

Semiconductor heterojunctions have gained significant attention for efficient optoelectronic devices owing to their unique interfaces and synergistic effects. Interaction between charge carriers with the heterojunction plays a crucial role in determining device performance, while its spatial-temporal mapping remains lacking. In this study, we employ scanning ultrafast electron microscopy (SUEM), an emerging technique that combines high spatial-temporal resolution and surface sensitivity, to investigate photocarrier dynamics across a Si/Ge heterojunction. Charge dynamics are selectively examined across the junction and compared to far bulk areas, through which the impact of the built-in potential, band offsets, and surface effects is directly visualized. In particular, we find that the heterojunction drastically modifies the hot photocarrier diffusivities in both Si and Ge regions due to charge trapping. These findings are further elucidated with insights from the band structure and surface potential measured by complementary techniques. This work demonstrates the tremendous effect of heterointerfaces on hot photocarrier dynamics and showcases the potential of SUEM in characterizing realistic optoelectronic devices.

Wide field retinal imaging has emerged as a transformative technology over the last few decades, revolutionizing our ability to visualize the intricate landscape of the retina. By capturing expansive retinal areas, these techniques offer a panoramic view going beyond traditional imaging methods. In this review, we explore the significance of retinal imaging-based biomarkers to help diagnose ocular and systemic conditions. We discuss quantitative biomarkers, including ischemic index, nonperfusion area and more, and their application in diabetic retinopathy, central retinal vein occlusion, neurodegenerative diseases, and more. In addition, we outline qualitative biomarkers such as choroidal venous hyperpermeability and intervortex anastomoses. The role of wide field fundus autofluorescence in assessing hereditary retinal diseases is also emphasized. Standardized imaging procedures, professional collaboration, and validation across a range of clinical circumstances are necessary for the effective use of these biomarkers. They have the potential to transform disease identification, risk assessment, and customize therapy.

Objective: Female students consider physics a difficult subject and like physics less than chemistry and biology. Cooperative learning is considered as an effective student-centered teaching methodology. The jigsaw technique of cooperative learning is successfully used to improve students' academic achievement, knowledge retention, and students’ attitudes. The present study was conducted to compare the effectiveness of the jigsaw technique of cooperative learning with the traditional lecture-based teaching method for pre-medical female students. Methods: It was an experimental study in which Pretest-Posttest true experimental design was used. Fifty-six female pre-medical students of Federal Government Degree College for Women Bannu were divided into control and experimental groups. The experimental group was taught with the jigsaw technique of cooperative learning whereas the control group was taught with the traditional lecture method. Research tools to assess students' academic performance, retention of the knowledge, and attitude toward learning physics were developed and validated. Results: After three months of treatment, the performance of both groups was analyzed using an independent sample t-test. A statistically significant difference was noted between the post-test scores of the two groups. Conclusions: The jigsaw learning technique was found to be an effective technique and recommended as a proper method for teaching physics.

Aims: Steroid injections are used for subacromial pain syndrome and can be administered via the anterolateral or posterior approach to the subacromial space. It is not currently known which approach is superior in terms of improving clinical symptoms and function. This is the protocol for a randomized controlled trial (RCT) to compare the clinical effectiveness of a steroid injection given via the anterolateral or the posterior approach to the subacromial space. Methods: The Subacromial Approach Injection Trial (SAInT) study is a single-centre, parallel, two-arm RCT. Participants will be allocated on a 1:1 basis to a subacromial steroid injection via either the anterolateral or the posterior approach to the subacromial space. Participants in both trial arms will then receive physiotherapy as standard of care for subacromial pain syndrome. The primary analysis will compare the change in Oxford Shoulder Score (OSS) at three months after injection. Secondary outcomes include the change in OSS at six and 12 months, as well as the Pain Numeric Rating Scale (0 = no pain, 10 = worst pain), Disabilities of Arm, Shoulder and Hand questionnaire (DASH), and 36-Item Short-Form Health Survey (SF-36) (RAND) at three months, six months, and one year after injection. Assessment of pain experienced during the injection will also be determined. A minimum of 86 patients will be recruited to obtain an 80% power to detect a minimally important difference of six points on the OSS change between the groups at three months after injection. Conclusion: The results of this trial will demonstrate if there is a difference in shoulder pain and function after a subacromial space steroid injection between the anterolateral versus posterior approach in patients with subacromial pain syndrome. This will help to guide treatment for patients with subacromial pain syndrome. Cite this article: Bone Jt Open 2024;5(9):729–735.

PURPOSE: To assess the relationship between qualitative diabetic retinopathy (DR) scales with the precise numbers and surface area of DR lesions within the Early Treatment Diabetic Retinopathy Study (ETDRS) standard seven field (S7F) region on ultrawide-field (UWF) color fundus images. METHODS: In this study, we collected UWF images from adult patients with diabetes. Poor-quality images and eyes with any pathology precluding assessment of DR severity were excluded. The DR lesions were manually segmented. DR severity was graded according to the International Clinical Diabetic Retinopathy (ICDR) and AA protocol by two masked graders within the ETDRS S7F. These lesions numbers and surface area were computed and correlated against the DR scores using the Kruskal-Wallis H test. Cohens Kappa was performed to determine the agreement between two graders. RESULTS: One thousand five hundred and twenty eyes of 869 patients (294 females, 756 right eyes) with a mean age of 58.7 years were included. 47.4% were graded as no DR, 2.2% as mild non-proliferative DR (NPDR), 24.0% as moderate NPDR, 6.3% as severe NPDR, and 20.1% as proliferative DR (PDR). The area and number of DR lesions generally increased as the ICDR level increased up to severe NPDR, but decreased from severe NPDR to PDR. There was perfect intergrader agreement on the DR severity. CONCLUSION: A quantitative approach reveals that DR lesions number and area generally correlate with ICDR-based categorical DR severity levels with an increasing trend in the number and area of DR lesions from mild to severe NPDR and a decrease from severe NPDR to PDR.

BackgroundThere is evidence that cognitive training interventions can positively impact executive functions, and that some studies have demonstrated that athletes typically exhibit greater accuracy and faster response times on select cognitive tasks. While the engagement of executive functions is suggested to be part of high-level sporting activities, it is unclear whether such training approaches could directly benefit athletic performance. ObjectiveThe objective of this study was to evaluate the impact of a combined virtual reality (VR)– and tablet-based cognitive training intervention on adolescent tennis players’ performance. Here, we examined differences in Universal Tennis Rating (UTR) between players who supplemented their regular tennis training with a cognitive training intervention and a group that continued regular tennis training alone. This custom cognitive training program targeted specific cognitive control abilities including attention, working memory, and goal management. MethodsData were collected from a cohort of tennis players in a randomized controlled trial design led by the dedicated research team. Participants (N=23, age: mean 14.8, SD 2.4 years) from the Czech Lawn Tenis Klub (Prague, Czech Republic) were invited to participate in this study. These individuals were randomized into an intervention + training-as-usual group (n=13) or training-as-usual group (control group; n=10), with the change in UTR score being the primary metric of interest. ResultsThere was no difference in UTR between the 2 groups at baseline (intervention: mean 8.32, SD 2.7; control: mean 7.60, SD 2.3). Following the treatment period, individuals in the intervention group showed a significant improvement in their UTR (an increase of 0.5; t12=4.88, P

BackgroundType 2 diabetes (T2D) is a leading cause of premature morbidity and mortality globally and affects more than 100 million people in the world’s most populous country, India. Nutrition is a critical and evidence-based component of effective blood glucose control and most dietary advice emphasizes carbohydrate and calorie reduction. Emerging global evidence demonstrates marked interindividual differences in postprandial glucose response (PPGR) although no such data exists in India and previous studies have primarily evaluated PPGR variation in individuals without diabetes. ObjectiveThis prospective cohort study seeks to characterize the PPGR variability among individuals with diabetes living in India and to identify factors associated with these differences. MethodsAdults with T2D and a hemoglobin A1c of ≥7 are being enrolled from 14 sites around India. Participants wear a continuous glucose monitor, eat a series of standardized meals, and record all free-living foods, activities, and medication use for a 14-day period. The study’s primary outcome is PPGR, calculated as the incremental area under the curve 2 hours after each logged meal. ResultsData collection commenced in May 2022, and the results will be ready for publication by September 2025. Results from our study will generate data to facilitate the creation of machine learning models to predict individual PPGR responses and to facilitate the prescription of personalized diets for individuals with T2D. ConclusionsThis study will provide the first large scale examination variability in blood glucose responses to food in India and will be among the first to estimate PPGR variability for individuals with T2D in any jurisdiction. Trial RegistrationClinical Trials Registry-India CTRI/2022/02/040619; https://tinyurl.com/mrywf6bf International Registered Report Identifier (IRRID)DERR1-10.2196/59308

ABSTRACT Background and Aims An exploratory focus group study was conducted to better understand the needs of patients living with generalized myasthenia gravis (gMG). Methods US‐based adults with gMG and caregivers of patients with gMG participated in a Patient Engagement Research Council between August 2022 and January 2023. The study consisted of a 15‐min prework survey, followed by virtual focus groups facilitated using a semi‐structured interview guide. Data concepts were identified using conversational analysis and by direct observation. All transcripts were coded based on concepts using a qualitative research analysis program (MaxQDA). Results 16 participants (13 patients, three caregivers) were recruited. Participants reported impact on daily activities, fatigue, and psychosocial problems. Many participants experienced delayed diagnosis and difficulty accessing specialist care. Participants described multiple barriers related to their gMG, including barriers to treatment, access‐related issues, and communication disconnect between patients and healthcare professionals. Achieving stable disease was the most important goal. There was a preference for the autonomy of self‐administered medications at home versus infusions. Study insights led to recommendations to guide patient and healthcare professional education. Conclusion The study illustrates the need to improve access to specialist care, achieve earlier diagnosis, prioritize patients' preferences in disease management, and develop treatments that improve outcomes without additional burden. Patient or Public Contribution The data collected in this study was provided by the focus group participants, which included patients and caregivers of those with myasthenia gravis.