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The U.S. Food and Drug Administration (FDA) has launched Project Optimus to shift dose selection from the maximum tolerated dose (MTD) to the dose that produces the optimal risk-benefit tradeoff. One approach highlighted in the FDA's guidance involves conducting a randomized phase II trial following the completion of a phase I trial, where multiple doses (typically including the MTD and one or two doses lower than the MTD) are compared to identify the optimal dose that maximizes the benefit-risk tradeoff. This article focuses on the design of such a multiple-dose randomized trial, specifically the determination of the sample size. We generalized the standard definitions of type I error and power to accommodate the unique characteristics of dose optimization and derived a decision rule along with an algorithm to determine the optimal sample size. The resulting design is referred to as MERIT (Multiple-dosE RandomIzed Trial design for dose optimization based on toxicity and efficacy). Simulation studies demonstrate that MERIT has desirable operating characteristics, and a sample size between 20 and 40 per dosage arm often offers reasonable power and type I errors to ensure patient safety and benefit. To facilitate the implementation of the MERIT design, we provide software, available at https://www.trialdesign.org., (© 2024 John Wiley & Sons Ltd.)

Online program design is important for cross-cultural learning and cultural awareness and responsiveness. Because of the importance of these areas in journalism and similar fields, this research studies an intercultural "bridge" project with journalism and media-related students at a southwest U.S. university and four universities in Yemen. The paper presents an analysis of the students' experience of the cultural exchange on the platform, Slack, of journalism, and other types of media. Data demonstrated the impact of learning about each culture, and interculturally, through students' and instructors' perspectives versus news coverage provided by mainstream media. Intercultural bridge building and relationship development through collective activities and journalistic work also offered promise. The study also revealed impediments to seamless cultural exchanges and learning, and barriers to effective intercultural communication.

This review paper presents a systematic literature review on the use of Augmented Reality (AR) in engineering education, and specifically in student's spatial ability training, for the last decade. Researchers have explored the benefits of AR, and its application has been of increasing interest in all levels of education. Engineering students tend to have difficulties in acquiring visualization skills, and hence, AR is gaining momentum in enhancing students' learning achievements. This paper aims to present valuable information to researchers, tutors and software developers of learning technology systems concerning the advantages and limitations of AR in spatial ability training, the incorporation of adaptivity and personalization in AR applications as well as the aspects of spatial ability having been evaluated using AR and the prevalent evaluation methods for AR applications. To this direction, a total of thirty-two (32) studies were reviewed, having been published since 2010. The findings reveal an increase in the number of studies during the last three years. One major conclusion is the improvement of learners' spatial ability using AR in educational settings, and the noted challenge is the need for more learning content. One research gap that has been identified is the lack of personalization in the developed applications, offering space for future research. Concluding, this area is under-researched, and thus, there is scope for a lot of improvement.

Objectives: To evaluate AI biases and errors in estimating bone age (BA) by comparing AI and radiologists' clinical determinations of BA., Methods: We established three deep learning models from a Chinese private dataset (CHNm), an American public dataset (USAm), and a joint dataset combining the above two datasets (JOIm). The test data CHNt (n = 1246) were labeled by ten senior pediatric radiologists. The effects of data site differences, interpretation bias, and interobserver variability on BA assessment were evaluated. The differences between the AI models' and radiologists' clinical determinations of BA (normal, advanced, and delayed BA groups by using the Brush data) were evaluated by the chi-square test and Kappa values. The heatmaps of CHNm-CHNt were generated by using Grad-CAM., Results: We obtained an MAD value of 0.42 years on CHNm-CHNt; this result indicated an appropriate accuracy for the whole group but did not indicate an accurate estimation of individual BA because with a kappa value of 0.714, the agreement between AI and human clinical determinations of BA was significantly different. The features of the heatmaps were not fully consistent with the human vision on the X-ray films. Variable performance in BA estimation by different AI models and the disagreement between AI and radiologists' clinical determinations of BA may be caused by data biases, including patients' sex and age, institutions, and radiologists., Conclusions: The deep learning models outperform external validation in predicting BA on both internal and joint datasets. However, the biases and errors in the models' clinical determinations of child development should be carefully considered., Key Points: • With a kappa value of 0.714, clinical determinations of bone age by using AI did not accord well with clinical determinations by radiologists. • Several biases, including patients' sex and age, institutions, and radiologists, may cause variable performance by AI bone age models and disagreement between AI and radiologists' clinical determinations of bone age. • AI heatmaps of bone age were not fully consistent with human vision on X-ray films., (© 2022. The Author(s), under exclusive licence to European Society of Radiology.)

Surprisingly, distance education is quite an old concept. Its origins date back to the first correspondence-based course, which took place via the postal service in Boston, USA, in the 18th century. Rapid technological developments, especially in video and audio streaming, have increased the availability of such courses and moved learning into the virtual world. Due to the ongoing COVID-19 pandemic, we are witnessing an accelerated revolution in the learning process, as nearly all forms of education have been shifted online. Will this have a destructive effect on the human psyche? Is humanity sufficiently aware and ready for such a dramatic change? Will we return to physical in-classroom studies, or is remote distance education set to become the new norm? In particular, in medicine, computer science, fine arts, or architectural design, such a rapid change in the way students learn can be quite challenging. In this paper, we provide an overview of the history of distance learning, taking into account teachers' and students' points of view in both secondary and higher education.

Purpose: The purpose of this paper is to describe an example of how universities can develop unique synchronous educational opportunities to engage students in an online environment, especially since study abroad opportunities have slowed or halted due to the COVID-19 pandemic crisis. Design/methodology/approach: Two affiliated universities, in the United States and Scotland, selected a simulated root cause analysis (RCA) of a medical error for a collaborative activity. Findings: Together the students analyzed the event within assumed roles of healthcare professions in a systematic way using the "Swiss Cheese Model," identified opportunities for improvement, debriefed using the Promoting Excellence and Reflective Learning in Simulation (PEARLS) method and submitted a reflective assignment. The RCA resulted in several process improvement suggestions and positive feedback from the participants. Research limitations/implications: The approach was for graduate students from two affiliated universities, in the United States and Scotland, to simulate a RCA of a medical error as a collaborative activity. Practical implications: This example using simulation of healthcare roles demonstrates the application of international collaboration, problem-solving models and methodologies and recognition of the similarities and differences between the United Kingdom and the United States approaches to patient safety. Especially with the ongoing COVID-19 pandemic, the students' ability to internationally collaborate can be limited without such unique opportunities. Social implications: The students were provided with a side-by-side comparison of the patient safety efforts in each country and written and didactic material about an RCA and the Swiss cheese model. Originality/value: Students come from different perspectives of health services administration, nursing and nursing leadership from Scotland and the United States to solve patient safety problems.

Online and virtual teaching-learning has been a panacea that most educational institutions adopted from the dire need created by COVID-19. We provide a comprehensive bibliometric study of 9523 publications on virtual laboratories in higher education covering the years 1991 to 2021. Influential bibliometrics such as publications and citations, productive countries, contributing institutions, funders, journals, authors, and bibliographic couplings were studied using the Scientific Procedures and Rationales for Systematic Literature Reviews (SPAR-4-SLR) protocol. A new metric to complement citations called Field Weighted Citation Impact was introduced that considers the differences in research behavior across disciplines. Findings show that 72% of the research work was published between 2011-and 2021, most likely due to digitalization, with the highest number of publications in 2020-2021 highlighting the impact of the pandemic. Top contributing institutions were from the developed economies of Spain, Germany, and the United States. The citation impact from publications with international co-authors is the highest, highlighting the importance of co-authoring papers with different countries. For the first time, Altmetrics in the context of virtual labs were studied though a very low correlation was observed between citations and Altmetrics Attention Score. Still, the overall percentage of publications with attention showed linear growth. Our work also highlights that virtual laboratory could play a significant role in achieving the United Nations Sustainable Development Goals, specifically SDG4-Quality Education, which largely remains under-addressed.

This paper presents data from two international projects focused on the interaction between changemaking and digital making in university students. The data is drawn from the contributions of 63 university students located in the United States, Romania, Spain, Belgium, Norway, Denmark and England. Using a design thinking methodology and a thematic analysis of student responses, the aim was to understand how the creative use of immersive technologies, such as augmented and virtual reality, might create an environment for changemaking practices in an international context. Findings suggest that students demonstrated not only enhanced digital skills and student engagement but increased cultural competence and global mindfulness. International digital collaboration can create conditions for students to develop changemaker attributes and identify as changemakers within the spheres of entrepreneurship and education, preparing them to be a force for change in the world.

Large-span, post-tensioned (PT) beams play a crucial role in maximizing the benefits of post-tensioning techniques. Bonded and unbonded systems are prevalent, with the latter being more widespread in the United States. While bonded systems are advantageous for creating long spans when multiple tendons are grouped in ducts, limited studies in the literature exist on their demolition. With a case study, this paper addresses the unique challenge of demolishing large-span-bonded, post-tensioned beams that occurs due to a building's functional change. Emphasizing insights for engineers, it explores the use of cutting and dismantling methods, thereby considering the presence of prestressed cables. The demolition process is distinctive due to the presence of numerous prestressed cables along the beams, necessitating a specialized and cautious cutting approach. This is accomplished through the use of a drilling technique that selectively distresses the tendons, ensuring they are not all affected simultaneously. An intriguing observation discussed in this paper pertains to the occurrence of horizontal cracks accompanied by loud sounds following the drilling process, thereby offering insights from the design perspective of PT systems. This paper details an innovative method for safely demolishing large-span, bonded PT beams using ground-penetrating radar and computer models to navigate structural complexities and ensure nearby structures' safety. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present a comprehensive review of the present state and trends of smart education research. It addresses the need to have a systematic review of smart education to depict its research landscape in view of the growing volume of related publications. Design/methodology/approach: A bibliometric analysis of publications on smart education published in 2011 to 2020 was conducted, covering their patterns and trends in terms of collaboration, key publications, major topics and trends. A total of 1,317 publications with 29,317 cited references were collected from the Web of Science and Scopus for the bibliometric analysis. Findings: Research on smart education has been widely published in various sources. The most frequently cited references are all theoretical or discussion articles. Researchers in the USA, China, South Korea, India and Russia have been most active in research collaborations. However, international collaborations have remained infrequent except for those involving the USA. The research on smart education broadly covered smart technologies as well as teaching and learning. The emerging topics have addressed areas such as the Internet of Things, big data, flipped learning and gamification. Originality/value: This study depicts the intellectual landscape of smart education research, and illustrated the evolution and emerging trends in the field. The results highlight its latest developments and research needs, and suggest future work related to research collaborations on a larger scale and more studies on smart pedagogies.

Theoretical and practical implications of incorporating Quick Response (QR) codes in a traveling international art exhibition are addressed in this paper. Blending the physical and virtual dimensions, the exhibition undergirded a pilot study of the integration of technology into traditional museum settings in both China and the United States. The conceptual and methodical framework highlighted in this study included the participatory museum, informal education, and an array of evaluation research methods and techniques. Data collected for analysis comprised a set using Google Analytics, questionnaires completed by exhibition visitors, and other in-depth qualitative findings collected from participating artists from both cultures. This paper shows that the technological aspects of display can lead directly to participatory learning with the potential for new directions and avenues of inquiry.

Games have been successfully used in educational settings for many years. Still, it is not known in detail which factors influence the use and effectiveness of educational games. The game environment, its technology, and other game mechanics are factors directly linked to the game itself. The player's experience with the subject of the game and/or games in general, his or her motivation and expectations towards the gaming experience influence the outcome of a game-based learning experience. Some of the personal aspects, like age, were already addressed in earlier research. Cultural and gender differences though, were not a main object of study in educational gaming so far. This study started from certain assumptions about differences in game play, related to players' cultural backgrounds and gender. Literature suggests that gender plays a role when it comes to game performance. This paper introduces outcomes of a study with a so-called Microgame, a brief game used to raise the awareness of interdependent planning operations. It shows that in this game, gender and culture make a difference in relation to the learning experience of the players, measured by game performance.

This paper moves from the data collected during an ethnographic research conducted in Second Life, which focuses on the observation of different technological difficulties in educational experiences. The main research interests focused on the social dynamics of educational experiences in Second Life and the opportunity to develop a proper research methodology. The main goal is to evaluate the educational experience in such a particular context through the stories of participants; therefore, the most appropriate methodology for researching the subject has been considered to be ethnography. As result of the research, it is observed that an appropriate use of the available tools and the adoption of innovative teaching strategies can promote the improvement of the educational experience in online worlds. This paper suggests interesting elements from the analysis of the data collected, which may help to adopt an innovative point of view on ethnographic research in an online world in education.

[This paper is part of the Focused Collection on Curriculum Development: Theory into Design.] This manuscript discusses how learning theories have been applied to shape multiple aspects of the design of curricular activities combining interactive computer simulations and University of Washington style tutorials (so-called simulation-tutorials). When considering the curriculum goals (what to teach), we drew on theories of representational competence and learning with multiple representations. When considering how to teach, we drew on theories of constructivism and sketching to learn, leveraging the advantages of sketching as a constructive process that requires students to make their current understanding explicit in visual form, to make specific choices in order to make their ideas concrete, and to organize information to support deep processing. When considering when and why to sketch, we drew upon theories of representational competence, learning with multiple representations and inventing to prepare for future learning to describe six distinct purposes of sketching both prior to and while working with the simulation. This is illustrated by presenting specific sketching tasks to show how theory informed the design and the sequencing of the tasks. We followed a design-based research method, working at two institutions in two countries and with multiple cohorts of students to understand, and where necessary improve, the design of these activities, primarily basing our decisions on the sketches that students had created. The key message of this research is that the design and sequencing of sketching tasks needs to be carefully matched to the pedagogical rationale and that theory can shape these decisions in many ways.

Virtual classroom simulations can offer pre-service teachers unlimited opportunities for teaching practice that help them sensitize to classroom diversity. The purpose of this case study was to describe a collaborative simulation design studio initiated between two universities in South Korea and U.S.A. while American pre-service teachers visited South Korea for five days as part of the student exchange program. This paper presents the main components of the design studio program with detailed descriptions of design activities, in which South Korean and American pre-service teachers created four classroom management scenarios and corresponding virtual students/classrooms. We also shared how the design studio experiences helped participants understand different classroom cultures by analyzing their responses to the reflection questions, design outcomes, and the researchers' observation notes. The results showed that the design studio experiences were beneficial for participants to understand different classroom cultures. The analyses revealed two major themes emerged from participants' responses to cultural differences and similarities: classroom management and student attitude. In addition, participants shared perceived benefits of the collaborative design studio experiences: social engagement and tangible experiences.

The United States Environmental Protection Agency (USEPA) uses the lethal dose 50% (LD 50 ) value from in vivo rat acute oral toxicity studies for pesticide product label precautionary statements and environmental risk assessment (RA). The Collaborative Acute Toxicity Modeling Suite (CATMoS) is a quantitative structure-activity relationship (QSAR)-based in silico approach to predict rat acute oral toxicity that has the potential to reduce animal use when registering a new pesticide technical grade active ingredient (TGAI). This analysis compared LD 50 values predicted by CATMoS to empirical values from in vivo studies for the TGAIs of 177 conventional pesticides. The accuracy and reliability of the model predictions were assessed relative to the empirical data in terms of USEPA acute oral toxicity categories and discrete LD 50 values for each chemical. CATMoS was most reliable at placing pesticide TGAIs in acute toxicity categories III (>500-5000 mg/kg) and IV (>5000 mg/kg), with 88% categorical concordance for 165 chemicals with empirical in vivo LD 50 values ≥ 500 mg/kg. When considering an LD 50 for RA, CATMoS predictions of 2000 mg/kg and higher were found to agree with empirical values from limit tests (i.e., single, high-dose tests) or definitive results over 2000 mg/kg with few exceptions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

This paper shares the findings of a study conducted on a virtual inter-cultural global leadership development learning project. Mixed Methods analysis techniques were used to examine the interviews of U.S. and Uganda youth project participants. The study, based on cultural and social constructivist learning theories, investigated the effects of implementing the Global Intercultural Online Collaborative Learning (GIOCL) Model to guide educators in designing effective global intercultural online collaborative learning environments and experiences. Eighteen Ugandan and nineteen United States students participated in online discussions and presentations involving cultural and instructional topics. A mixed-method design involving the collection and analysis of both qualitative and quantitative data was used to assess students' global leadership aspirations and desires to expand knowledge of cultures quite distinct from their own country. Findings indicate that early introduction of global collaborative learning environments inspire desire of youth to develop early leadership competencies requiring them to transcend national boundaries.

The purpose of this research was to explore the relationships between design, learning, and translanguaging in a 3D collaborative virtual learning environment for adolescent learners of Chinese and English. We designed an open-ended space congruent with ecological and dialogical perspectives on second language acquisition. In such a space, sense-making is contingent on the relational dynamics of place, activities, and artefacts. These spaces encourage meaning-making in situ, manipulation of virtual objects within places, and coordination among players. Our investigation looked at how learners of Chinese and English collaborated on a project in which they decorated a virtual living room. The findings suggest that socioculturally bounded places afford unique learning opportunities. Firstly, learning occurred through "referencing", which is the mutual clarification of a virtual object's meaning, position, and function, in relatively stabilised places, such as a museum, and secondly, learning occurred through coordination between verbal instruction and object manipulation in more adaptive places, which we call eco-dialogical learning. We also found a strong relationship between translanguaging and object manipulation. We conclude the paper from the perspective of how the eco-dialogical model resulted in designs that promoted cognition and interactivity.

Background Study: Technology‐supported learning environments, act as significant observational and enabling indicators for evaluating and encouraging the digital revolution of education, are of vital importance in current educational research. Keeping track of the dynamics of technology‐supported learning environment research allows for the enrichment of theoretical studies and a prompt innovation of talent‐training environments. Objectives: The present study carried out a bibliometric analysis of the core collection of WoS database over the last two decades. Method: This study is a bibliometric research. We applied CiteSpace and VOSviewer for co‐occurrence and evolution analysis. In addition, we extracted the fundamental ideas and thoughts through reading and analysis. Results: First, the study found that technology‐supported learning environment research is in a growth phase, with core journals such as Interactive Learning Environments or Computers & Education. The findings show that a core research team comprised of such scholars as Hwang Gwo‐Jen, Lester James C. and Wong Lung‐Hsiang. Key nations of publishing and research strength are from China, the United States, the United Kingdom and the Netherlands. Second, the hot topics in research on technology‐supported learning environments were virtual learning environments, technology‐enabled learning environments and interactive learning environments. Nine study specifics were derived from these three topics such as moulding function, generating scenario, stimulating sensation, effect verification, design idea, research reflection, inquiry and research, virtual community, and mixed environment. Lastly, the frontier evolution offers a pattern of development from enhancing performance to changing mode to incorporating experience. Conclusion: Looking ahead, our research recommendations for the field of technology‐supported learning environments include a multifaceted approach. We should aim to enhance research designs and methodologies, develop contemporary guiding theories and strive for a balanced representation across various educational domains, expanding our scope to encompass all academic disciplines. In terms of practical application, it is imperative to focus on the design and implementation of technology‐supported learning environments from three critical perspectives: "change‐demand," "student‐learning" and "online‐offline." These approaches will collectively ensure that technology‐supported learning environments are both innovative and responsive to the diverse needs of the educational landscape. Lay Description: What is already known about this topic: Technology‐supported learning environments are currently a focal and hot research topic in the field of education.Although numerous studies have been conducted on the learning environment of technical support, there has yet to be a systematic and comprehensive review of the related research. What this paper adds: This study provides a comprehensive review of research on the technology‐supported learning environments over the past two decades.This study primarily presents an overview of research on the technology‐supported learning environments over the past two decades, focusing on main literature, research strength, hot topics and frontier evolution. Implications for practice and/or policy: Researchers need to further advance research on technology‐supported learning environments by enriching research designs and methods, constructing up‐to‐date guiding theories and achieving a balance across different educational domains while extending the reach to all disciplines.Educational practitioners need to pay attention to the design and implementation of technology‐supported learning environments from the three viewpoints of "change‐demand," "student‐learning" and "online‐offline." [ABSTRACT FROM AUTHOR]

The difference, average risk-neutral and physical volatility, is substantial and translates into a large return premium for sellers of index options. This paper studies a general equilibrium model based on long-run risk in an effort to explain the premium. In estimating the model using data on stock returns and volatility (VIX), the model captures the premium and also the large negative correlation between shocks to volatility and stock prices. Numerical simulations verify that writers of index options earn high rates of return in equilibrium and that the return patterns are similar to that seen in the S&P 500 index options data. [ABSTRACT FROM AUTHOR]

Competing Interests: Funding Support and Author Disclosures This research was supported by the American College of Cardiology’s National Cardiovascular Data Registry. The National Cardiovascular Data Registry is an initiative of the American College of Cardiology Foundation. Dr Waldo has received unrelated investigator-initiated research support from Abiomed, Cardiovascular Systems Incorporated, Janssen, Merck Pharmaceuticals, National Institutes of Health, and Veterans Affairs Health Services Research and Development. Dr Yeh has received grants from AstraZeneca; has received consulting fees from Teleflex; and has served on advisory boards for Abbott, Boston Scientific, and Medtronic. Dr Fanaroff has received a career development grant and honoraria from the American Heart Association; and has received research funding from Boston Scientific. Dr Wang has received research grants to the Duke Clinical Research Institute from AstraZeneca, Bristol Myers Squibb, Cryolife, Portola, and Regeneron; and has received consulting honoraria from AstraZeneca. Dr Giri has served on advisory boards for Boston Scientific, Inari Medical, and AstraZeneca; and has received research funds to the institution from Boston Scientific, Recor Medical, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

This case study demonstrates the application of an unsupervised topic modeling algorithm to 7,773 English-language articles published in the Library Quarterly from 1931 to 2015. The analysis of 85 years of the journal's output follows an exploratory data analysis framework to generate novel hypotheses about the history of LIS using topic modeling, a method for identifying clusters of co-occurring words within large collections of text. The paper closely examines two topics that suggest differences in gender representation in the journal to propose and support a new hypothesis regarding the historical inclusion of gendered objects of study in LIS literature. [ABSTRACT FROM AUTHOR]

In this paper, we demonstrate the application of MATLAB to develop a pandemic prediction system based on Simulink. The susceptible-exposed-asymptomatic but infectious-symptomatic and infectious (severe infected population + mild infected population)-recovered-deceased (SEAI( I 1 + I 2 )RD) physical model for unsupervised learning and two types of supervised learning, namely, fuzzy proportional-integral-derivative (PID) and wavelet neural-network PID learning, are used to build a predictive-control system model that enables self-learning artificial intelligence (AI)-based control. After parameter setting, the data entering the model are predicted, and the value of the data set at a future moment is calculated. PID controllers are added to ensure that the system does not diverge at the beginning of iterative learning. To adapt to complex system conditions and afford excellent control, a wavelet neural-network PID control strategy is developed that can be adjusted and corrected in real time, according to the output error., (© 2021 IOP Publishing Ltd.)

The reformed U.S. Corporate Average Fuel Economy (CAFE) standards have not only tightened the efficiency levels to be achieved by automakers, but also made substantial changes to the regulatory design and structure by introducing three new policy instruments (footprint-based targeting, intra-firm transferring of fuel economy credits across vehicle categories, and inter-firm trading of credits). While there are a number of economics studies on tightening CAFE standards, little attention has been paid to the design aspects. This paper uses policy simulation to evaluate the new policy instruments. First, I model and estimate vehicle purchase and utilization decisions by American households. Based on estimation results, I simulate the effects of four counterfactual CAFE policies with or without the three instruments. Simulation results suggest (1) footprint-based targeting has little impact at the aggregate market level, while at the individual automaker level it favors firms selling relatively large vehicles; (2) allowing intra-firm credit transferring (but not inter-firm credit trading) cuts aggregate gasoline consumption by 0.1-0.3%; and that (3) inter-firm credit trading significantly lowers the aggregate compliance costs (by $110-$140 million), and thus achieves the highest social welfare among the simulated policies. [ABSTRACT FROM AUTHOR]

To address the inadequacy of ambulance design standards, the Department of Homeland Security Science and Technology Directorate, the National Institute of Standards and Technology, the National Institute for Occupational Safety and Health, and BMT Designers and Planners have collaborated to develop new design standards for ambulance patient compartments. This paper presents a simulation-based approach to evaluate and guide improving patient compartment designs that conform to developed requirements for better performance and safety of ambulance users. Those requirements address hazards stemming from (1) the inability of providers to remain safely restrained while treating patients, and (2) the musculoskeletal damage from awkward body postures. An initial design was developed through the axiomatic design approach with inputs from stakeholders such as emergency medical service providers and ambulance manufacturers. The design was imported into a human task simulation tool. It was tested for performance to identify areas for further improvements, which resulted in a second design concept. This paper shows how computer simulation was used to evaluate the effectiveness of the two successive design concepts in enabling providers to perform a range of medical care tasks while remaining seated and restrained. We also evaluated the musculoskeletal effect of these designs on the providers. The results showed that using a simulation-based evaluation produced patient compartments that better meet user requirements when compared with traditional designs. This research produced a set of requirements and recommendations that we believe will lead to better design standards and guidelines for the next generation of ambulances. [ABSTRACT FROM AUTHOR]

This paper considers the problem of imputation model uncertainty in the context of missing data problems. We argue that so-called "Bayesianly proper" approaches to multiple imputation, although correctly accounting for uncertainty in imputation model parameters, ignore the uncertainty in the imputation model itself. We address imputation model uncertainty by implementing Bayesian model averaging as part of the imputation process. Bayesian model averaging accounts for both model and parameter uncertainty, and thus we argue is fully Bayesianly proper. We apply Bayesian model averaging to multiple imputation under the fully conditional specification approach. An extensive simulation study is conducted comparing our Bayesian model averaging approach against normal theory-based Bayesian imputation not accounting for model uncertainty. Across almost all conditions of the simulation study, the results reveal the extent of model uncertainty in multiple imputation and a consistent advantage to our Bayesian model averaging approach over normal-theory multiple imputation under missing-at-random and missing-completely-at random in terms of Kullback-Liebler divergence and mean squared prediction error. A small case study is also presented. Directions for future research are discussed.

Background and Aims: The focus of this paper is on the improvement of substance use disorder (SUD) screening and measurement. Using a multi-dimensional item response theory model, the bifactor model, we provide a psychometric harmonization between SUD, depression, anxiety, trauma, social isolation, functional impairment and risk-taking behavior symptom domains, providing a more balanced view of SUD. The aims are to (1) develop the item-bank, (2) calibrate the item-bank using a bifactor model that includes a primary dimension and symptom-specific subdomains, (3) administer using computerized adaptive testing (CAT) and (4) validate the CAT-SUD in Spanish and English in the United States and Spain., Design: Item bank construction, item calibration phase, CAT-SUD validation phase., Setting: Primary care, community clinics, emergency departments and patient-to-patient referrals in Spain (Barcelona and Madrid) and the United States (Boston and Los Angeles)., Participants/cases: Calibration phase: the CAT-SUD was developed via simulation from complete item responses in 513 participants. Validation phase: 297 participants received the Composite International Diagnostic Interview (CIDI) and the CAT-SUD., Measurements: A total of 252 items from five subdomains: (1) SUD, (2) psychological disorders, (3) risky behavior, (4) functional impairment and (5) social support. CAT-SUD scale scores and CIDI SUD diagnosis., Findings: Calibration: the bifactor model provided excellent fit to the multi-dimensional item bank; 168 items had high loadings (> 0.4 with the majority > 0.6) on the primary SUD dimension. Using an average of 11 items (four to 26), which represents a 94% reduction in respondent burden (average administration time of approximately 2 minutes), we found a correlation of 0.91 with the 168-item scale (precision of 5 points on a 100-point scale)., Validation: strong agreement was found between the primary CAT-SUD dimension estimate and the results of a structured clinical interview. There was a 20-fold increase in the likelihood of a CIDI SUD diagnosis across the range of the CAT-SUD (AUC = 0.85)., Conclusions: We have developed a new approach for the screening and measurement of SUD and related severity based on multi-dimensional item response theory. The bifactor model harmonized information from mental health, trauma, social support and traditional SUD items to provide a more complete characterization of SUD. The CAT-SUD is highly predictive of a current SUD diagnosis based on a structured clinical interview, and may be predictive of the development of SUD in the future., (© 2020 Society for the Study of Addiction.)

The American automobile industry is facing substantial environmental and energy challenges driving the pursuit of alternative powertrain technologies—“The intervening mechanism by which power is transmitted from an engine to a propeller or axle that it drives,” which nominally includes engine, transmission, drive shafts, differentials, and the final drive. Emerging alternative fuel vehicles are showing their potential to address these challenges. However, diffusion of new technologies has many complications. This paper uses system dynamics modeling to investigate the impacts of individual and organizational parameters. This model embeds two traditional modeling methods for technology adoption, the Bass diffusion model and multinomial logit regression method. Five types of powertrain systems and three major stakeholders are considered. Mathematical relationships among different variables are elaborated. The qualitative impacts of government feebate, manufacturer willingness, and consumer purchasing preferences on economic and environmental issues are addressed using scenario analysis. [ABSTRACT FROM AUTHOR]

Purpose: The United States' Food and Drug Administration (FDA) recommends that device manufacturers demonstrate 10 years of equivalent life duration for endovascular stents. Yet since the early 2000s clinical evidence of stent strut fracture defies the recommendations for these FDA approved devices. Stent strut fracture has been correlated with a higher incidence of adverse clinical events, such as in-stent thrombosis and in-stent restenosis., Methods: This paper reviews the current clinical evidence, computational modelling relating to fatigue lifetimes, experimental testing of coronary stents, and the related regulatory guidance and standards., Results: The scale of stent fracture is evident from the clinical data reviewed. In terms of model setups, either physical or computational the loadings, in particular, dictate the durability response., Conclusions: The full scale of stent fracture is most likely under-reported and its assessment is dependent on detection time and detection resolution. Within the event of SF it is not necessarily consequential; further research is warranted to distinguish when the event negatively impacts the patient.

Introduction. Applying computerized simulation education tool for learning in medical domains is widely used in many countries. This review is aimed at systematically investigating the computerized simulation tools developed to educate physiotherapy students and determine the effectiveness of these interventions. Methods. A comprehensive search was conducted in Medline (through PubMed) and Scopus databases from inception to Sept. 10, 2022. The studies that examined the effectiveness of computerized simulation-based interventions were included. Results. Sixteen studies were included in this systematic review. All included examinations were ranked "good" or "low risk of bias" based on the criteria utilized in the Joanna Briggs Institute (JBI) scale and the Effective Public Health Practice Project (EPHPP) tool. Most of the articles (43%) were conducted in the USA and 25% in Australia. In 43% of the total studies, the study population was only physiotherapy students, and in 12.5% of them, the scope of education was related to practical skills training. Three of the 16 reviewed articles presented positive qualitative results; thirteen quantitative investigations also declared statistically positive effects. Positive effects have been seen in areas such as improving professional and behavioral abilities, improving knowledge and self-confidence, and reducing stress. The sample size of the studies ranged from eight to 162 participants. The limited sample sizes in groups, lack of interaction, and short follow-up duration were the most consistent limitations evident within the included studies. Conclusion. Computerized simulation education approaches can help to improve physiotherapy students' skills and knowledge. They also have great potential to reduce learning costs and increase the quality of education. [ABSTRACT FROM AUTHOR]

Because influenza is a contagious respiratory illness that seriously threatens public health, accurate real-time prediction of influenza outbreaks may help save lives. In this paper, we use the Twitter data set and the United States Centers for Disease Control's influenza-like illness (ILI) data set to predict a nearly real-time regional unweighted percentage ILI in the United States by use of an artificial neural network optimized by the improved artificial tree algorithm. The results show that the proposed method is an efficient approach to real-time prediction.

Tumor-treating fields (TTFields) are a cancer treatment modality that uses alternating electric fields of intermediate frequency (∼100-500 kHz) and low intensity (1-3 V/cm) to disrupt cell division. TTFields are delivered by transducer arrays placed on the skin close to the tumor and act regionally and noninvasively to inhibit tumor growth. TTFields therapy is U.S. Food and Drug Administration approved for the treatment of glioblastoma multiforme, the most common and aggressive primary human brain cancer. Clinical trials testing the safety and efficacy of TTFields for other solid tumor types are underway. The objective of this paper is to review computational approaches used to characterize TTFields. The review covers studies of the macroscopic spatial distribution of TTFields generated in the human head, and of the microscopic field distribution in tumor cells. In addition, preclinical and clinical findings related to TTFields and principles of its operation are summarized. Particular emphasis is put on outlining the potential clinical value inferred from computational modeling.

Ethnoracial residential segregation is a complex, multiscalar phenomenon with immense moral and economic costs. Modeling the structure and dynamics of segregation is a pressing problem for sociology and urban planning, but existing methods have limitations. In this paper, we develop a suite of methods, grounded in information theory, for studying the spatial structure of segregation. We first advance existing profile and decomposition methods by posing two related regionalization methods, which allow for profile curves with nonconstant spatial scale and decomposition analysis with nonarbitrary areal units. We then formulate a measure of local spatial scale, which may be used for both detailed, within-city analysis and intercity comparisons. These methods highlight detailed insights in the structure and dynamics of urban segregation that would be otherwise easy to miss or difficult to quantify. They are computationally efficient, applicable to a broad range of study questions, and freely available in open source software., Competing Interests: The author declares no conflict of interest., (Published under the PNAS license.)

This paper develops a frequentist model averaging approach for threshold model specifications. The resulting estimator is proved to be asymptotically optimal in the sense of achieving the lowest possible squared errors. In particular, when combining estimators from threshold autoregressive models, this approach is also proved to be asymptotically optimal. Simulation results show that for the situation where the existing model averaging approach is not applicable, our proposed model averaging approach has a good performance; for the other situations, our proposed model averaging approach performs marginally better than other commonly used model selection and model averaging methods. An empirical application of our approach on the US unemployment data is given. [ABSTRACT FROM AUTHOR]

This paper describes environmental systems games developed for energy and water resource use designed to be adaptable from high school to undergraduate use. Two of the games are computer simulations with adjustable levels of difficulty that can be done in a computer lab or as a homework assignment. The third is a peer-to-peer roleplayer game designed for an immersive in-class simulation. For the energy and the peer-to-peer water games, we describe (1) the overall strategy or story line adopted, (2) the manner in which the game is played by students in a classroom setting, (3) the use of scientific literature in conceptualizing and parameterizing the game, and (4) possible game extensions. Preliminary data from use at the undergraduate level shows that the games are very well-received by students and, consistent with other research on quasi-experimental simulations, likely enhance learning outcomes. [ABSTRACT FROM AUTHOR]

Highlights • 3D models can be used to accurately predict flood wave propagation in natural environments. • 3D non-hydrostatic models can be used to study cases when flow becomes locally pressurized. • 3D models can be used to estimate effectiveness of flood protection measures. Abstract This paper discusses development and validation of a 3-D, non-hydrostatic, Reynolds-Averaged Navier–Stokes (RANS) model using the Volume of Fluid (VOF) approach to simulate flooding events in natural environments. A series of validation simulations in simple and complex geometries are performed to test the different modules of the flow solver. The paper also discusses the differences between simulation results obtained using the 3-D model and those obtained using a standard, 2-D hydrostatic, depth-averaged model. The predictions by the two models show fairly large differences in regions where 3-D effects are expected to be significant (e.g., in regions containing highly-curved river reaches and near hydraulic structures). Then, the validated 3-D model is employed to investigate the efficiency of using flood-protection walls to reduce adverse effects of flooding in the Iowa River near Iowa City, Iowa, USA. Finally, the propagation of a flood wave in a reach of the Iowa River containing a bridge is simulated and the effects of the flow becoming pressurized beneath the bridge deck are discussed. For such applications, in which the regime can change locally between open channel and pressurized flow, the use of fully 3-D, non-hydrostatic models may be the only viable option to accurately predict flow hydrodynamics and its effects on bed shear stresses and sediment entrainment potential, especially around locations where the flow becomes pressurized. [ABSTRACT FROM AUTHOR]

Drug-drug interactions (DDIs) are a common cause of adverse drug events (ADEs). The electronic medical record (EMR) database and the FDA's adverse event reporting system (FAERS) database are the major data sources for mining and testing the ADE associated DDI signals. Most DDI data mining methods focus on pair-wise drug interactions, and methods to detect high-dimensional DDIs in medical databases are lacking. In this paper, we propose 2 novel mixture drug-count response models for detecting high-dimensional drug combinations that induce myopathy. The "count" indicates the number of drugs in a combination. One model is called fixed probability mixture drug-count response model with a maximum risk threshold (FMDRM-MRT). The other model is called count-dependent probability mixture drug-count response model with a maximum risk threshold (CMDRM-MRT), in which the mixture probability is count dependent. Compared with the previous mixture drug-count response model (MDRM) developed by our group, these 2 new models show a better likelihood in detecting high-dimensional drug combinatory effects on myopathy. CMDRM-MRT identified and validated (54; 374; 637; 442; 131) 2-way to 6-way drug interactions, respectively, which induce myopathy in both EMR and FAERS databases. We further demonstrate FAERS data capture much higher maximum myopathy risk than EMR data do. The consistency of 2 mixture models' parameters and local false discovery rate estimates are evaluated through statistical simulation studies. [ABSTRACT FROM AUTHOR]