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OBJECTIVE This study examines the role of electronic learning platforms for medical knowledge acquisition in orthopedic surgery residency training. This study hypothesizes that all methods of medical knowledge acquisition will achieve similar levels of improvement in medical knowledge as measured by change in orthopedic in-training examination (OITE) percentile scores. Our secondary hypothesis is that residents will equally value all study resources for usefulness in acquisition of medical knowledge, preparation for the OITE, and preparation for surgical practice. DESIGN 9 ACGME accredited orthopedic surgery programs participated with 95% survey completion rate. Survey ranked sources of medical knowledge acquisition and study habits for OITE preparation. Survey results were compared to OITE percentile rank scores. PARTICIPANTS 386 orthopedic surgery residents SETTING 9 ACGME accredited orthopaedic surgery residency programs RESULTS 82% of participants were utilizing online learning resources (Orthobullets, ResStudy, or JBJS Clinical Classroom) as primary sources of learning. All primary resources showed a primary positive change in OITE score from 2018 to 2019. No specific primary source improved performance more than any other sources. JBJS clinical classroom rated highest for improved medical knowledge and becoming a better surgeon while journal reading was rated highest for OITE preparation. Orthopedic surgery residents’ expectation for OITE performance on the 2019 examination was a statistically significant predictor of their change (decrease, stay the same, improve) in OITE percentile scores (p CONCLUSIONS Our results showed that no specific preferred study source outperformed other sources. Significantly 82% of residents listed an online learning platform as their primary source which is a significant shift over the last decade. Further investigation into effectiveness of methodologies for electronic learning platforms in medical knowledge acquisition and in improving surgical competency is warranted.

Background The pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match. Methods This retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied. Results Lower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates. Conclusions Changes in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.

BACKGROUND: Several U.S. hospitals had surges in COVID-19 caseload, but their effect on COVID-19 survival rates remains unclear, especially independent of temporal changes in survival. OBJECTIVE: To determine the association between hospitals' severity-weighted COVID-19 caseload and COVID-19 mortality risk and identify effect modifiers of this relationship. DESIGN: Retrospective cohort study. (ClinicalTrials.gov: NCT04688372). SETTING: 558 U.S. hospitals in the Premier Healthcare Database. PARTICIPANTS: Adult COVID-19-coded inpatients admitted from March to August 2020 with discharge dispositions by October 2020. MEASUREMENTS: Each hospital-month was stratified by percentile rank on a surge index (a severity-weighted measure of COVID-19 caseload relative to pre-COVID-19 bed capacity). The effect of surge index on risk-adjusted odds ratio (aOR) of in-hospital mortality or discharge to hospice was calculated using hierarchical modeling; interaction by surge attributes was assessed. RESULTS: Of 144 116 inpatients with COVID-19 at 558 U.S. hospitals, 78 144 (54.2%) were admitted to hospitals in the top surge index decile. Overall, 25 344 (17.6%) died; crude COVID-19 mortality decreased over time across all surge index strata. However, compared with nonsurging (

Purpose Skin cancer is the most common, yet oftentimes preventable, cancer type in the United States. Exposure to ultraviolet radiation from sunlight is the most prominent environmental risk factor for skin cancer. Besides environmental exposure, demographic characteristics such as race, age, and socioeconomic status may make some groups more vulnerable. An exploratory spatial clustering method is described for identifying clusters of vulnerability to skin cancer incidence and mortality based on composite indices, which combine data from environmental and demographic risk factors. Methods Based on county-level ultraviolet data and demographic risk factors, two vulnerability indices for skin cancer were generated using an additive percentile rank approach. With these indices, univariate local Moran's I spatial autocorrelation identified significant clusters, or hotspots, of neighboring counties with high overall vulnerability indices. Clusters were identified separately for skin cancer incidence and mortality. Results Counties with high vulnerabilities were spatially distributed across the United States in a pattern that generally increased to the South and West. Clusters of counties with high skin cancer incidence vulnerability were mostly observed in Utah and Colorado, even with highly conservative levels of significance. Meanwhile, clusters for skin cancer mortality vulnerability were observed in southern Alabama and west Florida as well as across north Alabama, north Georgia and up through the Tennessee-North Carolina area. Conclusions Future skin cancer research and screening initiatives may use these innovative composite vulnerability indices and identified clusters to better target resources based on anticipated risk from underlying demographic and environmental factors.

Objective To determine the association between medical knowledge relevant to radiology practice (as measured by the Dutch radiology progress test [DRPT]) and clinical productivity during radiology residency. Methods This study analyzed the results of 6 DRPTs and time period–matched clinical production points of radiology residents affiliated to a tertiary care academic medical center between 2013 and 2016. The Spearman correlation analysis was performed to determine the association between DRPT percentile scores and average daily clinical production points. Linear regression analyses were performed to determine the association of DRPT percentile scores with average daily clinical production points, adjusted for age and gender of the radiology resident, and postgraduate year. Results Eighty-four DRPTs with time period–matched clinical production points were included. These 84 DRPTs were made by 29 radiology residents (18 males and 11 females) with a median age of 31 years (range: 26–38 years). The Spearman correlation coefficient between DRPT percentile scores and average daily clinical production points was 0.550 (95% confidence interval: 0.381–0.694) (p < 0.001), indicating a significant moderate positive association. On multivariate analysis, average daily clinical production points (β coefficient of 0.035, p = 0.003), female gender of the radiology resident (β coefficient of 12.690, p = 0.001), and postgraduate year (β coefficient of 10.179, p < 0.001) were significantly associated with DRPT percentile scores. These three independent variables achieved an adjusted R2 of 0.527. Conclusion Clinical productivity is independently associated with medical knowledge relevant to radiology practice during radiology residency. These findings indicate that clinical productivity of a resident could be a potentially relevant metric in a radiology training program. Key Points • There is a significant moderate correlation between medical knowledge relevant to radiology practice and clinical productivity during radiology residency. • Medical knowledge relevant to radiology practice remains independently associated with clinical productivity during radiology residency after adjustment for postgraduate year and gender. • Clinical productivity of a resident may be regarded as a potentially relevant metric in a radiology training program.

Background United States Medical Licensing Examination Step 1 (STEP 1) and Step 2 (STEP 2) scores are used in the selection of surgery residents. The American Board of Surgery In-Training Examination (ABSITE) is employed to assess resident knowledge. We sought to determine whether both STEP 1 and/or STEP 2 were predictive of ABSITE performance. Methods We performed a 10-year retrospective analysis of all PGY levels comparing STEP 1 and 2 scores with raw ABSITE scores and percentile rank. Additionally, we analyzed STEP 1 and 2 scores for the likelihood of scoring above the 20th percentile on the ABSITE. Results When STEP 1 and STEP 2 scores were evaluated separately, both were independent predictors of ABSITE performance. However, when STEP 1 and STEP 2 scores were evaluated together, only STEP 1 scores were predictive of ABSITE performance. Finally, only STEP 1 scores were predictive of scoring above the 20th percentile. Conclusion STEP 1 scores are a better predictor of ABSITE performance than STEP 2.

Diseases such as malaria, dengue, Zika and chikungunya remain endemic in many countries. Setting and deploying traps to capture the host/vector species are fundamental to understand their density and distributions. Human effort to manage the trap data accurately and timely is an exhaustive endeavour when the study area expands and period prolongs. One stop mobile app to manage and monitor the process of targeted species trapping, from field to laboratory level is still scarce. Toward this end, we developed a new mobile app named "PesTrapp" to acquire the vector density index based on the mobile updates of ovitraps and species information in field and laboratory. This study aimed to highlight the mobile app's development and design, elucidate the practical user experiences of using the app and evaluate the preliminary user assessment of the mobile app. The mobile app was developed using mobile framework and database. User evaluation of the mobile app was based on the adjusted Mobile App Rating Scale and Standardized User Experience Percentile Rank Questionnaire. The process flows of system design and detailed screen layouts were described. The user experiences with and without the app in a project to study Aedes surveillance in six study sites in Selangor, Malaysia were elucidated. The overall mean user evaluation score of the mobile app was 4.0 out of 5 (SD=0.6), reflects its acceptability of the users. The PesTrapp, a one-stop solution, is anticipated to improve the entomological surveillance work processes. This new mobile app can contribute as a tool in the vector control countermeasure strategies.

Monetary rewards granted on a per-publication basis to individual authors are an important policy instrument to stimulate scientific research. An inconsistent feature of many article reward schemes is that they use journal-level citation metrics. In this paper we assess the actual article-level citation impact of about 10,000 articles whose authors received financial rewards within the Romanian Program for Rewarding Research Results (PR3), an exemplary money-per-publication program that uses journal metrics to allocate rewards. We present PR3, offer a comprehensive empirical analysis of its results and a scientometric critique of its methodology. We first use a reference dataset of 1.9 million articles to compare the impact of each rewarded article from five consecutive PR3 editions to the impact of all the other articles published in the same journal and year. To determine the wider global impact of PR3 papers we then further benchmark their citation performance against the worldwide field baselines and percentile rank classes from the Clarivate Analytics Essential Science Indicators. We find that within their journals PR3 articles span the full range of citation impact almost uniformly. In the larger context of global broad fields of science almost two thirds of the rewarded papers are below the world average in their field and more than a third lie below the world median. Although desired by policymakers to exemplify excellence many PR3 articles are characterized by a rather commonplace individual citation performance and have not achieved the impact presumed and rewarded after publication based on journal metrics. Furthermore, identical rewards have been offered to articles with markedly different impact. Direct monetary incentives for articles may support productivity but they cannot guarantee impact.

Background: Informant-based measures are effective screening tools for cognitive impairment. The Alzheimer’s Questionnaire (AQ) is a subjective, informant-based measure that detects amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) with high sensitivity and specificity and has been shown to predict amyloid burden. Objective: To determine whether informant-based report of cognitive decline correlates with hippocampal volume changes in MCI and AD. Methods: Retrospective chart review of 139 clinically referred patients with clinical diagnoses of aMCI or mild dementia due to AD was conducted. Diagnostic status (clinical diagnosis made by a neurologist), NeuroQuant measured MRI brain with percentile rank hippocampal volume, Montreal Cognitive Assessment (MoCA) total, AQ-Total score, and demographic variables were extracted from medical records. Spearman correlation was used to assess the relationship between hippocampal volume and AQ-Total. The AQ was used to assign diagnostic status. Thus, the relationship between the AQ and diagnostic status was excluded. Results: The sample include 88 female and 51 male participants. The mean age was 74.37±9.45, mean MOCA was 22.65±4.18, mean education was 14.80±3.35, and mean AQ score was 10.54±5.22. Hippocampal volume and the AQ correlation was r = –0.33 [95%CI –0.47 to –0.17], p

Background Excessive media usage affects children’s health. This study investigated associations between children’s and mother’s media use, parent–child interactions, and early-childhood development outcomes. Methods Two hundred and ninety-six healthy 2–5-year-old preschoolers (52.4% male, mean age = 3.5 years) and 224 mothers from the LIFE Child cohort study were analyzed. Screen times and parent–child interactions were assessed using standardized parental questionnaires. Developmental skills were investigated using the standardized development test ET 6-6-R. Results High screen times in children (>1 h/day) were significantly associated with lower percentile ranks in cognition (b = −10.96, p b = −12.88, p b = −7.80, p = 0.05). High screen times in mothers (>5 h/day) were significantly associated with high media use by children (OR = 3.86, p b = 0.41, p = 0.05), cognition (b = 0.57, p b = 0.48, p = 0.02), and social–emotional outcomes (b = 0.80, p Conclusions Public health strategies should seek to educate caregivers as competent mediators for their children’s media habits, with focus on the need for children to have frequent parent–child interactions. Impact High media usage in children is related to poorer cognition, language, and social–emotional skills. More frequent parent–child interactions are associated with better body motor, cognition, language, and social–emotional skills in children. High level of media use in mothers is not directly related to children’s development outcomes but is directly related to high media usage of children. Public health strategies should seek to raise media awareness and management in both parents and children.

The moderating effects of motivation, social control, and self-regulation in predicting academic achievement were examined in Grades 11–12 for 3,281 seventh through nine graders. Standardized assessments of college readiness and student self-reported measures of psychosocial factors were used in the study. The results showed that females in Grades 7–9 scored higher than males for motivation and self-regulation. In predicting later achievement in Grades 11–12, motivation and social control moderated prior achievement, whereas self-regulation moderated both sex and prior achievement. Particularly among female students, effects of self-regulation were positive for high-achieving females (percentile rank ≥95) and negative for low-achieving females (percentile rank ≤5) in predicting achievement in Grades 11–12. The phenomenon known as the “Matthew Effect” and implications for classroom teachers and educational policymakers are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Background To determine objective resident characteristics that correlate with Ophthalmic Knowledge Assessment Program (OKAP) performance, as well as to correlate OKAP performance with Accreditation Council for Graduate Medical Education (ACGME) milestone assessments, written qualifying examination (WQE) scores, and oral board pass rates. Methods Review of administrative records at an ACGME-accredited ophthalmology residency training program at an urban, tertiary academic medical center. Results The study included data from a total of 50 resident physicians who completed training from 2012 to 2018. Mean (standard deviation) OKAP percentile performance was 60.90 (27.51), 60.46 (28.12), and 60.55 (27.43) for Years 1, 2, and 3 examinations, respectively. There were no statistically significant differences based on sex, marital status, having children, MD/PhD degree, other additional degree, number of publications, number of first author publications, or grades on medical school medicine and surgery rotations. OKAP percentile scores were significantly associated with United States Medical Licensing Examination (USMLE) Step 1 scores (linear regression coefficient 0.88 [0.54–1.18], p = 0.008). Finally, continuous OKAP scores were significantly correlated with WQE (r s = 0.292, p = 0.049) and oral board (r s = 0.49, p = 0.001) scores. Conclusion Higher OKAP performance is correlated with passage of both WQE and oral board examinations during the first attempt. USMLE Step 1 score is the preresidency academic factor with the strongest association with success on the OKAP examination. Programs can utilize this information to identify those who may benefit from additional OKAP, WQE, and oral board preparation assistance.

Background Birth by caesarean section has been shown to alter the composition of the early infant gut microbiota and postulated to influence cognitive outcomes via the gut-brain axis. Aims To determine whether birth by caesarean section is associated with secondary school educational achievement. Methods Whole-population administrative data were used from anonymised individual level linkage of birth records to educational and health information from the New Zealand Integrated Data Infrastructure (IDI). Participants were 111 843 children born between 1 January 1996 and 31 December 1998 for whom mode of delivery information was available from International Classification of Diseases 9th edition codes in maternal records. The National Certificate of Educational Achievement (NCEA) is the main secondary school qualification undertaken by New Zealand students. Multivariable linear regression models were used to examine the association between mode of delivery and educational achievement. A family fixed effect analysis compared educational achievement outcomes in sibling pairs where one sibling was delivered by caesarean section and one delivered vaginally. Results After adjustment for potential confounders, there was no significant association between mode of delivery and achievement of university entrance (odds ratio = 0.98, 95% CI: 0.94-1.02). NCEA percentile scores were lower in caesarean born infants (Estimate = -0.37, 95% CI: -0.69 to -0.06)). However, in the fixed effect sibling analysis caesarean section was no longer significantly associated with NCEA percentile scores. Conclusions We find that caesarean section is not related to educational outcomes, suggesting that even if the infant gut microbiota is altered in caesarean section, it does not appear to have a measurable impact on adolescent academic achievement.

Background Little information on gross motor function of congenital Zika syndrome (CZS) children is available. Objectives To evaluate gross motor function in CZS children aged up to 3 years, and its associated factors and changes in a minimum interval of 6 months. Methods One hundred children with CZS and cerebral palsy (36 with confirmed and 64 with presumed CZS) were evaluated with the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM-88/GMFM-66). Forty-six were reevaluated. Wilcoxon tests, Wilcoxon tests for paired samples, percentile scores, and score changes were performed. Results Clinical and socioeconomic characteristics (except maternal age), GMFM scores and GMFCS classification of confirmed and probable cases, which were analyzed together, were similar. The mean age was 25.6 months (±5.5); the median GMFM-88 score was 8.0 (5.4–10.8); and the median GMFM-66 score was 20.5 (14.8–23.1); 89% were classified as GMFCS level V. Low economic class, microcephaly at birth, epilepsy, and brain parenchymal volume loss were associated with low GMFM-66 scores. The median GMFM-66 percentile score was 40 (20–55). On the second assessment, the GMFM-66 scores in two GMFCS level I children and one GMFCS level IV child improved significantly. In one GMFCS level III child, one GMFCS level IV child, and the group of GMFCS level V children, no significant changes were observed. Conclusions Almost all CZS children had severe cerebral palsy; in the third year of life, most presented no improvement in gross motor function and were likely approaching their maximal gross motor function potential.

Background: Pediatric hypertension is the main cause of morbidity and mortality in pediatric populations.Purpose: To examine pediatric hypertension in a clinical setting, we used the percentile rank approach and defined hypertension as that above the 95th percentile.Methods: The present study was linked to the a national analytical cross-sectional community-based Iranian Children and Adolescents’ Psychiatric Disorders (IRCAP) survey. The survey was nationwide and funded by the National Institute of Medical Research Development. The IRCAP survey included 31,000 children and adolescents aged 6–18 years in all 31 Iran provinces. The current study included 1,035 children and adolescents and linked the data of the risk factors of cardiovascular disease only in Yazd province via random cluster sampling.Results: Of the total participants, 456 (44.1%) were male and 579 (55.9%) were female. The mean age was 11.2±3.8 years (11.7±3.7 years for males, 11.0±3.6 years for females), while mean height was 146±20.0 cm overall, 147.2±22.0 cm for males, and 144.6±17.0 cm for females (P=0.009). The blood pressure distributions and percentiles were evaluated.Conclusion: Here we determined age- and height-specific 50th, 90th, 95th, and 99th percentiles of systolic and diastolic blood pressures in Yazd boys and girls using 10-cm height intervals.

Introdução: O desenvolvimento motor do bebê tem influências cognitivas, socioemocionais e ambientais.Objetivo: verificar se existe associação dos escores do desenvolvimento motor grosso com as habilidades socioemocionais de bebês em seu primeiro trimestre de vida.Método: Estudo transversal, composto por 20 bebês provenientes de um hospital público de Porto Alegre, RS. Para a avaliação dos fatores de risco sociodemográficos foi utilizado um questionário elaborado pelas pesquisadoras. A Bayley III foi utilizada para avaliar o desenvolvimento motor grosso e habilidades socioemocionais.Resultados: Houve associação positiva estatisticamente significativa entre os escores brutos de motor grosso e socioemocional (r=0,665; p=0,001), como também nos escores bruto de motor grosso com os escores composto e percentil da socioemocional (r=0,571; p=0,008 e r=0,588; p=0,006, respectivamente). Houve associação positiva estatisticamente significativa entre idade gestacional (p=0,028), idade do bebê (p=0,003) e peso ao nascer (p=0,024) com o escore bruto motor grosso.Conclusão: Houve associação significativa positiva nos escores do desenvolvimento motor grosso e habilidades socioemocionais.

The current investigation reports on percentile normative values of college-aged men and women (18-25 years) for the YMCA bench press endurance test (YMCA-BPT). Previously reported normative values did not include the sample size or population specific information. Participants in this investigation were healthy, men and women who completed a standardized warm-up and then underwent the procedures for the YMCA-BPT. Demographic data are reported along with YMCA-BPT scores including averages of 34.18±12.51 for men, 25.26±10.20 for women and 29.69±12.26 for the combined group (repetitions±standard, respectively). Percentile scores by gender are also reported.

Background/Objectives: The Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy Phase 2 (CALERIE) study showed that individuals who are non-obese were able to undergo significant calorie restriction (CR), yet the time course changes in adherence, weight, and appetite are unknown. This analysis aimed to investigate the time course changes in adherence, body weight, and appetite during the CALERIE study. Subjects/Methods: Overall, 143 participants (body mass index: 21.9–28.0 kg/m2) were randomized to a CR group that aimed to achieve 25% CR for 2 years. Throughout the intervention, body weight was measured, and appetite was assessed through visual analogue scales. Algorithms were utilized with body weight measurements to calculate adherence percentile score. Participants targeted an adherence percentile score of 50, though being between 80 (lowest acceptable adherence) and 10 (highest acceptable adherence) was adequate. Polynomial regression analyses were used to assess time course changes. Results: Polynomials indicated that adherence percentile score increased above 50 after approximately week 20, although adherence remained acceptable (adherence percentile score less than 80) (R2 = 0.89; P < 0.001). Weight loss occurred until approximately week 60 and then plateaued (R2 ≥ 0.92; P < 0.001). Hunger and thirst increased (R2 ≥ 0.30; P < 0.001), but the total increase in scale scores were less than 10 mm throughout the intervention. Conclusions: In individuals who are non-obese, adherence to 25% CR declines after 20 weeks, but two years of CR that stimulates a meaningful reduction in weight, promotes aging-related benefits and negligibly affects appetite is viable.

BACKGROUND The American Board of Surgery In-training Examination (ABSITE) is an important marker of medical knowledge. It is unclear what factors predict or improve these scores. We evaluated demographics, United States Medical Licensing Examination (USMLE) step 1 and 2 scores, and surgical rotations during the intern year to determine if there were any correlations with the ABSITE performance. METHODS This was a multicenter retrospective review during a 6-y period, investigating the correlation and association of demographics, USMLE scores, and types of rotations on the ABSITE percentile score of interns. Demographics included age, gender, race/ethnicity, U.S. versus international/foreign medical graduate for stratified analyses. Descriptive analysis was performed with ANOVA, correlation was evaluated with 95% confidence interval, and significance was defined as P

The effects of complex Korean medicine treatment including acupotomy, on irritable bowel syndrome (IBS) are reported in this case study. A 54-year-old woman with diarrheal symptoms that alternatively improved and worsened for many years and worsening abdominal pain visited the emergency room and was diagnosed with IBS; she was admitted for approximately 2 weeks at the Acupuncture and Moxibustion Department of National Medical Center (NMC). Numerical rating scale (NRS), irritable bowel syndrome?quality of life (IBS-QOL), and gastrointestinal symptom rating scale (GSRS) scores were evaluated on the day of hospitalization, midway through the hospitalization period, and on the day of discharge. Abdominal pain was measured daily using NRS, and the score decreased from 8 at admission to 0 at discharge. The IBS-QOL percentile score improved from 42 points to 100 points. The total GSRS score also improved, from 30 points to 2 points. These results suggest that complex Korean medicine treatment with acupotomy, is useful for treating internal diseases, such as IBS, as well as musculoskeletal disorders.

Study objective Malpractice fear is a commonly cited cause for defensive medicine, but it is unclear whether being named in a malpractice claim changes physician practice patterns. We study whether there are changes in commonly used measures of emergency physician practice after being named in a malpractice claim. Methods We performed a retrospective difference-in-differences study comparing practice patterns of emergency physicians named in a malpractice claim and unnamed matched controls working contemporaneously in the same emergency departments (EDs), using data from a national emergency medicine management group (59 EDs in 11 US states from 2010 to 2015). We studied aggregate measures of care intensity (hospital admission rate and relative value units/visit), studied care speed (relative value units/hour and discharged patients' length of stay), and assessed patient experience (monthly physician Press Ganey percentile rank). Results A total of 65 emergency physicians named in at least 1 malpractice claim and 140 matched controls met inclusion criteria. After the malpractice claim filing date, there were no significant changes in measures of care intensity or speed. However, named emergency physicians' patient experience scores improved immediately after the malpractice claim filing date and showed sustained improvements by 6.52 Press Ganey percentile ranks (95% confidence interval 0.67 to 12.38), with the increase most prominent among those involved in the 46 failure-to-diagnose claims (10.52; 95% confidence interval 3.72 to 17.32). Conclusion We observed a temporal improvement in patient satisfaction scores for emergency physicians in this sample after their being named in a malpractice claim relative to matched controls. Measures of care intensity and speed did not significantly change.

Background: Physician denial of patient requests is associated with lower patient satisfaction. Our objective was to explore factors that influence physician request denial and patient satisfaction after request denial. Methods: Cross-sectional observational study of 1141 adult patients seen during 1319 outpatient visits with 56 primary care physicians. We measured patients9 postvisit self-report of requests and request fulfillment, visit satisfaction, sociodemographics, health status, symptom burden, life satisfaction, medical skepticism, and whether patients saw their usual physician and a faculty or resident physician. We used mixed-effects regression analyses to identify predictors of request denial and visit satisfaction among patients who had a request denied. Results: Patients made at least 1 request at 867 visits (65.7%) with at least 1 denied request reported at 182 visits (21.0%). Patients who saw their usual physician were less likely to report a request denial (adjusted Odds Ratio [aOR], 0.61; 95% CI, 0.42 to 0.88), and patients with the highest symptom burden (aOR, 2.21; 95% CI, 1.38 to 3.55) or greater medical skepticism (aOR, 1.35; 95% CI, 1.03 to 1.78) were more likely to report request denials. After request denials, patients seeing their usual physicians reported significantly greater visit satisfaction compared with not seeing their usual physician (adjusted percentile rank in visit satisfaction: 12.4%; 95% CI, 3.5% to 21.2%). Conclusions: Approximately one fifth of visits in primary care have a denied request. Having an office visit with one9s usual physician is associated with reduced likelihood of request denial and may mitigate the adverse impacts of request denial on patient visit satisfaction.

Purpose This study explores the effect of glaucomatous visual field defects on several neuropsychological tests that are often used in research and in clinical settings. Methods Nineteen glaucoma patients and nineteen healthy participants, which are current drivers and older than 65 years old were included. All participants completed the Montreal Cognitive Assessment (MoCA), the Trail Making Test (TMT), the Benton Visual Retention Test (BVRT), the Snellgrove Maze Task (SMT) and the Digit Span Test (DST). All participants were also tested on contrast sensitivity and near and far visual acuity. For the glaucoma patients, visual field tests were downloaded from hospital servers. Results On the MoCA test, glaucoma patients scored lower than the healthy group, but not significantly. On the MoCA-Blind, the difference was statistically significant. Glaucoma patients also had lower percentile scores on the TMT, with a significant difference in the TMT-A, but this difference largely disappeared in the calculated TMT B-A index, which isolates the cognitive component. The BVRT and SMT showed no significant differences between both groups. In the only non-visual test, the DST, glaucoma patients outperformed the healthy group. Glaucoma severity did not influence results, except for the BVRT on which the moderate/severe group has better scores. Conclusion Using visual items might lead to conclusions about cognition when it should be one about vision. Therefore, careful selection of tests is needed when examining cognition in glaucoma patients.

Social determinants of health (SDOH) impact patient outcomes in trauma. Census data are often used to account for SDOH; however, there is no consensus on which variables are most important. Social vulnerability indices offer the advantage of combining multiple constructs into a single variable. Our objective was to determine if incorporation of SDOH in patient-level risk-adjusted outcome modeling improved predictive performance.We evaluated two social vulnerability indices at the zip code level: Distressed Community Index (DCI) and National Risk Index (NRI). Individual variable combinations from Agency for Healthcare Research and Quality's SDOH data set were used for comparison. Patients were obtained from the Pennsylvania Trauma Outcomes Study 2000 to 2020. These measures were added to a validated base mortality prediction model with comparison of area under the curve and Bayesian information criterion. We performed center benchmarking using risk-standardized mortality ratios to evaluate change in rank and outlier status based on SDOH. Geospatial analysis identified geographic variation and autocorrelation.There were 449,541 patients included. The DCI and NRI were associated with an increase in mortality (adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.03 per 10% percentile rank increase; p0.01, respectively). The DCI, NRI, and seven Agency for Healthcare Research and Quality variables also improved base model fit but discrimination was similar. Two thirds of centers changed mortality ranking when accounting for SDOH compared with the base model alone. Outlier status changed in 7% of centers, most representing an improvement from worse-than-expected to nonoutlier or nonoutlier to better-than-expected. There was significant geographic variation and autocorrelation of the DCI and NRI (DCI; Moran's I 0.62, p = 0.01; NRI; Moran's I 0.34, p = 0.01).Social determinants of health are associated with an individual patient's risk of mortality after injury. Accounting for SDOH may be important in risk adjustment for trauma center benchmarking.Prognostic/Epidemiologic, level IV.

Objectives: This study aims to establish reference data for nondemented adults between 80 and 84 years of age based on the German version of the Consortium to Establish a Registry for Alzheimer’s disease Neuropsychological (CERAD-NP) test battery and to assess the possible influence of hearing and vision impairments on CERAD-NP performance. Methods: Two hundred one volunteers were examined with the German CERAD-NP test battery, and 18 test scores were calculated from the data. The sample included 99 men (49%), the mean age was 81.8 years (SD = 1.3), and the mean years of education were 13.9 (SD = 3.1). Percentiles for continuous and percentile ranks for discrete test scores were calculated separately for four norm groups. The groups were classified according to gender and education. Multiple regression analysis was used to predict cognitive performance from visual acuity and hearing ability. Results: The normative data obtained were consistent with other findings from younger and older age groups. Worse visual acuity predicted slower performance in the Trail Making Test (TMT). None of the other CERAD-NP tests were correlated to sensory functions. Conclusions: Using age-appropriate reference data, such as that established here for the 80–84 year age group can help to improve the detection of cognitive decline and prevent biases that arise when old-old adults are compared to younger old adults. Visual acuity should be considered an influencing factor on TMT performance.

ObjectiveTo describe normative values for blood pressure (BP) response to maximal exercise in children/adolescents undergoing a treadmill stress test.MethodsFrom a retrospective analysis of medical records, patients who had undergone a Bruce protocol exercise stress test, with (1) normal cardiovascular system and (2) a body mass index percentile rank below 95% were included for analysis. Sex, age, height, weight, resting and peak heart rate, resting and peak systolic blood pressure (SBP), test duration, stage of Bruce protocol at termination, reason for undergoing the test and reason for termination of test were collected. Percentiles for exercise-induced changes in SBP were constructed by age and height for each sex with the use of quantile regression models.Results648 patients with a median age of 12.4 years (range 6–18 years) were included. Typical indications for stress testing were investigation of potential rhythm abnormalities, syncope/dizziness and chest pain and were deemed healthy by an overseeing cardiologist. Mean test duration was 12.6±2.2 min. Reference percentiles for change in SBP by sex, age and height are presented.ConclusionThe presented reference percentiles for the change in SBP for normal children and adolescents will have utility for detecting abnormally high or low BP responses to exercise in these age groups.

Science, Technology, Engineering and Mathematics (STEM) jobs have grown in importance in the labor market in recent decades, and they are widely seen as the jobs of the future. Using data from the U.S. Census and American Community Survey, we first investigate the role of employment in STEM occupations when it comes to recent changes in the occupational employment distribution in the U.S. labor market. Next, with data from the High School and Beyond sophomore cohort (Class of 1982) recent midlife follow-up, we investigate the importance of high school students’ mathematics and science coursework, knowledge, and skills for midlife occupations. The Class of 1982 completed high school prior to technological changes altering the demand for labor. We find that individuals who took more advanced levels of high school mathematics coursework enjoyed occupations with a higher percentile rank in the average wage distribution and were more likely to hold STEM-related occupations. Findings suggest that the mathematics coursework enabled workers to adapt and navigate changing labor market demands.

Aim: Handgrip strength is considered an important health indicator. It is extremely important to establish normative values so that the handgrip strength is correctly interpreted in adolescents. The present study aims to establish normative values of handgrip strength (HGS) for adolescents, according to chronological age and sexual maturation. Methods: Data from three large projects carried out in Florianopolis and São José, Santa Catarina were used, corresponding to a sample of 2,637 adolescents aged 14 to 19 years old of both sexes (1,428 girls). The HGS of the right and left hands was measured by a manual dynamometer, and total HGS being defined by the sum of the left hand and the right-hand strength. Sexual maturation was determined by the development of pubic hair. The percentiles 3, 10, 15, 25, 50, 75, 85, 90, and 97 were calculated for the right, left, and total HGS. The percentile ranges < p15 (low), p15-p85 (normal) and > p85 (high) were used. ANOVA and Kruskal-Wallis tests were applied. Results: In boys, the mean total HGS ranged from 67.5 ± 16.5 to 86.9 ± 21.8 (p < 0.001) and 74.3 ± 17.5 to 82.2 ± 17.8 (p < 0.001) for age and sexual maturation, respectively, while in girls the mean HGS total ranged from 48.8 ± 11.3 to 56.4 ± 16.0 (p = 0.127) and 47.8 ± 10.6 to 54.3 ± 12.3 (p < 0.001). Conclusion: Reference values established by the percentile score, can be used to identify adolescents with better athletic condition and can be useful for prescribing exercises.

Objectives Emergency departments (EDs) patient satisfaction metrics are highly valued by hospitals, health systems, and payers, yet these metrics are challenging to analyze and interpret. Accurate interpretation involves selection of the most appropriate peer group for benchmark comparisons. We hypothesized that the selection of different benchmark peer groups would yield different interpretations of Press Ganey (PG) patient satisfaction scores. Methods Emergency department PG summary ratings of "doctors section" and "likelihood-to-recommend" raw scores and corresponding percentiles were derived for three benchmark peer groups from three academic years (2016, 2017, and 2018). The three benchmarks are: 1) the PG Large database; 2) the PG University HealthSystem Consortium (UHC) database; and 3) the Academy of Administrators in Academic Emergency Medicine (AAAEM) database, which is composed only of EDs from academic health centers with emergency medicine residency training programs. Raw scores were converted to percentile ranks for each distribution and then compared using Welch's ANOVA and Games-Howell pairwise comparisons. Results For both patient satisfaction raw scores evaluated, the AAAEM database was noted to have significantly higher percentile ranks when compared to the PG Large and PG UHC databases. These results were consistent for all three time frames assessed. Conclusions Benchmarking with different peer groups provides different results, with similar patient satisfaction raw scores resulting in higher percentile ranks using the AAAEM database compared to the two PG databases. The AAAEM database should be considered the most appropriate peer group for benchmarking academic EDs.

The criteria used by medical schools in the Philippines and the Adventist University of thePhilippines College of Medicine (AUPCOM) in admissions selection of future doctors aregenerally the same. These include academic ability, based on the cognitive Pre-Medical CourseGrade Point Average (Pre-Med GPA) and the National Medical Admission Test percentile rank(NMAT score). Other non-cognitive essential criteria are gleaned through personal interviewor written essays, such as insight into medicine, extracurricular activities and interests,personality, motivation, high work standards, and communication skills. Objective evidencejustifying the use of such criteria is an area that AUPCOM intended to investigate as basis forevaluating applicants to the medical school. This retrospective study utilized 153 students fromthe first four consecutive cohorts (from Batch 2019-2022) of medical students who wereaccepted in AUPCOM. The data taken from the COM records were strictly handled with utmostconfidentiality. Statistical analysis consisting of mean, standard deviation, percentage,correlation, and regression was employed. The NMAT percentile rank of the medicine studentshad an average of 72.01, with a Pre-Med GPA of 90.69 (B) and first year Medicine GPA of84.6 (C+). The bivariate correlation revealed significant positive relationship of NMAT scoreand Pre-Med grade to the first year Medicine GPA. Regression analysis revealed that PreMedicine course GPA and National Medical Admission Test Percentile Rank were bothpredictors of the first year medicine GPA among College of Medicine students. This result canbe an eye-opener to medical schools on the percentage weight given to NMAT percentile rankas one of the major criteria in the selection process of future doctors. Future research needs toinclude other predictors of performance in Medicine since Pre-Med GPA contributes only13.2% of the variance in medicine students’ first year Medicine GPA.

Background We report our experience in evaluating the severity of local influenza epidemics using the World Health Organization Pandemic Influenza Severity Assessment framework. Methods We assessed the severity of influenza by monitoring indicators of influenza transmissibility, seriousness of disease and impact on healthcare resource utilisation. Indicators were described by various parameters collected weekly from eight government hospitals, 20 government and 30 private primary care clinics, and the national public health laboratory. Transmissibility and seriousness of disease indicators were each represented by multiple parameters, and alert thresholds were set at the 70th and 90th percentile of a parameter's past 2‐year surveillance data. We derived a collective measure for each indicator using the average percentile rank of the related parameters. Alert thresholds for the single impact parameter were set at predefined values and evaluated for its sensitivity, specificity and positive predictive value. Results For the transmissibility and seriousness of disease parameters, calculation of the percentile rank was simple and independent of a parameter's underlying distribution. For the impact parameter, predefined alert thresholds had high sensitivity and specificity (>80%) but low positive predictive value (15%‐30%). Assessment scales were used to qualitatively classify the activity of an indicator as low, moderate or high together with a confidence level. Conclusion We applied different methods for threshold setting depending on the attributes of each parameter and indicator. For indicators represented by multiple parameters, an aggregated assessment of the indicator's level of activity and confidence level of the assessment was needed for effective reporting.

Introduction Physician burnout is of growing concern in the medical community and in emergency medicine (EM) in particular. It is unclear whether higher levels of burnout are associated with poorer academic or clinical performance. EM residency in military environments compared to civilian residencies has unique considerations related to additional military-specific training and operational requirements, which may contribute to burnout. The prevalence and effects of burnout on military EM resident physicians have not been investigated. Methods In this institutional review board-approved cross-sectional study, the prevalence of burnout and its effect on academic performance of 30 EM residents in a single 4-year military EM training program was examined. The primary instrument utilized to assess for burnout was the Maslach Burnout Inventory Health Services Survey (MBI-HSS). The primary definition of burnout utilized was a high score in both emotional exhaustion (EE) and depersonalization (DP), and a low score in personal achievement (PA). Additionally, at risk for burnout was defined as moderate or high scores in both EE and DP and low scores in PA. A secondary definition of burnout utilized was any high score in EE or DP, or a low score in PA. The findings in this cohort were compared with published reports of burnout in civilian EM resident and attending physicians as well as military orthopedic physicians. The annual American Board of Emergency Medicine In-Training Exam (ABEM-ITE) percentile ranks for each volunteer in that same academic year were collected as a measure of academic achievement. Results Thirty of the 40 eligible resident physicians consented to participate in this research project (75%). All 30 completed the MBI-HSS and ABEM-ITE. Burnout, using the primary definition, was found in 10% of residents with an additional 13% at risk for burnout. Using the secondary definition of burnout, 73% of residents demonstrated burnout. The prevalence of burnout as measured by the MBI-HSS was similar to that reported in civilian EM resident and practicing physician groups but 2.7 times the burnout rates found in a military orthopedic resident group. We found no relationship between any individual burnout measure in the MBI-HSS and the annual ABEM-ITE percentile scores. Conclusion In a small study of military EM resident physicians, level of burnout as measured by the MBI-HSS is similar to other EM populations including civilian residents and practicing physicians, though it was much higher than that of military orthopedic residents. No relationship between presence or absence of burnout and academic performance as measured by the ABEM-ITE was found.

The ABR Core Examination tests the comprehensive radiology curriculum. On first attempt, 10% of radiology residents fail. This study investigates factors that predict success or failure on the examination.An anonymous questionnaire was distributed to all accredited residency programs in diagnostic radiology. Residents who had recently taken the examination answered questions regarding demographics, program, preparation, learning methods, and examination results. Bivariate and multivariate analyses were performed.The study survey was completed by 273 residents. One-tenth of respondents failed or conditionally passed the examination. Residents were more likely to pass the examination if they had trained at an academic program, scored higher on the US Medical Licensing Examination Step 1 and Step 2, achieved higher in-training examination percentile score, completed more practice questions, practiced with both oral and multiple-choice practice questions, and slept longer per night (P.05 for all). Success was not associated with utilization of specific study resources or protected study time. Lower total number of months spent studying and lower total number of call-containing weeks before the examination were protective factors on multivariate analysis.Prior performance on standardized examinations predicts success. Training at an academic institution confers an advantage in performance. The ACR In-Training Examination is an appropriate readiness preparation tool. No specific preparation material or resource can guarantee success. Short-duration, high-quality studying is the most effective method of preparation.

OBJECTIVE. Since the American Board of Radiology (ABR) instituted its new board certification pathway, our residency program has had more residents fail the core examination than was typical with the prior pathway. We performed a single-center retrospective study to evaluate predictors of ABR core examination failure. MATERIALS AND METHODS. Data regarding U.S. Medical Licensing Examination (USMLE) steps 1 and 2, ACR diagnostic radiology in-training examinations, the number of image interpretations, academic degree (doctor of medicine or doctor of osteopathy), status as an American or foreign medical graduate, and Alpha Omega Alpha national medical honor society status were gathered and evaluated through logistic regression and generalized additive logistic regression. Data were gathered for all residents who took the ABR core examination from 2013 to 2017. RESULTS. Six of 30 residents (20%) failed the ABR core examination on the first attempt. The ACR in-training examination scores for 1st- and 3rd-year residents were significantly related to ABR core examination failure (p = 0.027 and p = 0.035, respectively), with significant nonlinearity (p = 0.037 and p = 0.033, respectively). The suggested baseline percentile score was the 30th percentile for 1st-year residents and the 20th percentile for 3rd-year residents. USMLE step 1 and 2 scores were significantly related to ABR core examination failure (p = 0.041 and p = 0.043, respectively), without significant nonlinearity (p = 0.35 and p = 0.09, respectively). However, residents with scores of less than 220 on USMLE steps 1 and 2 seemed to be at risk. CONCLUSION. Low scores on USMLE steps 1 and 2 and 1st- and 3rd-year ACR in-training examinations were associated with ABR core examination failure. If validated more broadly, these cutoffs may serve as predictors of ABR core examination failure and may facilitate identification and remediation of at-risk residents.

We examined the association between coupled and uncoupled acute:chronic workload ratios (ACWR) and injury risk in a cohort of 28 elite cricket fast bowlers (mean±SD age, 26±5 yr). Workloads were estimated using the session rating of perceived exertion (session-RPE). Coupled ACWRs were calculated using a 1-week acute workload and 4-week chronic workload (acute workload was included in the chronic workload calculation), whereas uncoupled ACWRs used the most recent 1-week acute workload and the prior 3-week chronic workload (acute workload was not included in the chronic workload calculation). A nearly perfect relationship (R2=0.99) was found between coupled and uncoupled ACWRs. Using a percentile rank method, no significant differences in injury risk were found between the coupled and uncoupled ACWR. Higher ACWRs were associated with increased injury likelihood for both coupled and uncoupled methods, however there were no significant differences in injury risk between coupled and uncoupled ACWRs. Our data demonstrates that both coupled and uncoupled ACWRs produce the same injury likelihoods. Furthermore, our results are consistent with previous studies: higher ACWRs are associated with greater risk, irrespective of whether acute and chronic workloads are coupled or uncoupled.

OBJECTIVES/HYPOTHESIS The objective of this study were to determine if any of the 10 attributes of the standardized letter of recommendation (SLOR) correlate significantly with objective measures of each applicant and to determine whether professor characteristics were associated with reported SLOR attributes. STUDY DESIGN Retrospective cohort study. METHODS We reviewed 339 SLORs from 187 otolaryngology residency applicants. The 10 SLOR attributes were converted into a percentile score and statistically analyzed. RESULTS All 10 SLOR attributes had a mean ± standard deviation above the 80th percentile (0.82-0.93 ± 0.08-0.52) and negative skewness. United States Medical Licensing Examination step 1 and 2 scores correlated most strongly with match potential (B = 93.1,P < .001 and B = 96.3, P = .002, respectively). Students from top 40 National Institutes of Health-funded institutions had a significant difference in length of relationship with their letter writer (B = -0.51, P = .02) and interpersonal communication skills (B = -12.9, P = .011). Alpha Omega Alpha (AOA) and non-AOA members differed in medical knowledge (B = 21.0, P = .007), research (B = -8.80, P = .036), and commitment to otolaryngology (B = -25.89, P = .020). Total number of research experiences correlated most strongly with medical knowledge (B = -16.55, P = .011). There was a significant difference in means between length of relationship and professorial rank (F[4, 339] = 3.61, P = .023), administrative position (F[5, 339] = 5.43, P = .002), and institution of the letter writer (P < .001). CONCLUSIONS Overall, the lack of correlation between SLOR attributes and objective measures suggests that the SLOR adds little to the residency application. Professor characteristics were similarly not associated with any of the 10 SLOR attributes; however, there were significant differences in the length of relationship between the professor and students with respect to professor rank, administrative rank, and institution of the letter writer. LEVEL OF EVIDENCE NA Laryngoscope, 130:603-608, 2020.

Bisphenol A (BPA) is a non-persistent chemical with endocrine disrupting abilities widely used in a variety of consumer products. The fetal brain is particularly sensitive to chemical exposures due to its rapid growth and complexity. Some studies have reported associationbetween maternal BPA exposure and behavior but few have assessed impact on cognitive development, and to our knowledge no studies have specifically assessed the impact on language development. We therefore assessed whether maternal urinary BPA concentration during pregnancy was associated with language development and attention-deficit and hyperactivity disorder (ADHD) symptoms in offspring aged 18–36 months in the prospective Odense Child Cohort. BPA was analyzed in 3rd trimester maternal fasting urine spot samples. Language development was addressed among 535 children using the Danish adaptation of the MacArthur-Bates Communicative Development Inventories at median age 21 months; ADHD traits were assessed by parents of 658 children using the Child Behavior Checklist for ages 1½-5 years at mean age 2.7 years. Associations were assessed using logistic regression models comparing children below the 15th percentile score for language and above the 85 percentiles score for ADHD with the other children while stratifying by sex and adjusting for maternal education, duration of breastfeeding and maternal urine phthalates. BPA was detected in 85.3% of the urine samples (median 1.2 ng/ml). Boys of mothers with BPA exposure in the highest tertile had an odds ratio of 3.70 (95% CI 1.34–10.21) of being in the lowest 15th percentile of vocabulary score compared to boys of mothers within the lowest tertile of BPA exposure after adjustment, whereas no association was found in girls. No clear dose-response relationship between maternal BPA and ADHD scores above the 85th percentile was found for either sex. Since early language development is a predictor of future reading skills and educational success, more epidemiological studies assessing BPA exposure and language skills are needed to confirm our findings.

Background Reading skills are crucial in medical school, where students are expected to absorb an onslaught of new and complex material. Studies on reading assessment in osteopathic medical education are lacking. Objective To address gaps in the literature related to reading assessment and to investigate the correlation of the Nelson-Denny Reading Test with various performance indicators in osteopathic medical education. Methods The West Virginia School of Osteopathic Medicine administered the Nelson-Denny Reading Test to first- and second-year students between 2015 and 2017. Raw scores were translated into the percentile rank, scale score, grade equivalent score, and stanine score based on guidelines supplied with the Nelson-Denny Reading Test. These translated scores were compared with Medical College Admission Test (MCAT) scores, first- and second-year performance on course examinations, Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 scores, and scores provided in a 2002 study by Haught and Walls. Results A total of 623 students took the first-year Nelson-Denny Reading Test, and 408 took both the first- and second-year Nelson-Denny Reading Test. Findings showed a large correlation between the Nelson-Denny Reading Test and the verbal reasoning section (r=0.56 for the class of 2020 and 0.46 for the class of 2021) of the old MCAT (before 2015) and the reasoning skills section (r=0.42 for the class of 2020 and 0.49 for the class of 2021) of the new MCAT (released in 2015). There were no correlations with first- and second-year course examination scores or COMLEX-USA Level 1 scores. The Nelson-Denny Reading Test scores reported by Haught and Walls for medical students and health professional students were slightly higher than those found for osteopathic medical students in this study. Conclusion The reasoning skills section of the new MCAT could serve as a good proxy for a reading test. There were no correlations between the Nelson-Denny Reading Test and performance in the first 2 years of medical school or COMLEX-USA Level 1 performance. Further research can strengthen the findings and determine whether correlations exist with clinical performance.

Tyrimo tikslas. Išanalizuoti išnešiotų vienvaisių naujagimių gimimo svorius ir ūgius pagal nėštumo laiką savaitėmis bei palyginti jų pokyčius per 20 metų. Tyrimo medžiaga ir metodai. Retrospektyviai išnagrinėti 2018 m. kovo 1 d. – 2019 m. gruodžio 31 d. laikotarpiu Lietuvos sveikatos mokslų universiteto ligoninėje Kauno klinikose (toliau – Kauno klinikos) 37–41 nėštumo savaitėmis iš vienvaisių nėštumų gimusių naujagimių ūgiai ir svoriai bei sudarytos procentilių lentelės pagal nėštumo laiką. Duomenys palyginti su kontroline grupe (2004 m. G. Mečėjaus publikuotomis vienvaisio nėštumo Lietuvos naujagimių fizinio brandumo lentelėmis). Rezultatai. Iš viso išnagrinėti 250 naujagimių duomenys. Statistiškai patikimo skirtumo tarp vidutinio moteriškosios ir vyriškosios lyčių naujagimių svorių ir ūgių negauta. Tiriamųjų grupėje rastas abiejų lyčių 3 ir 5, taip pat moteriškosios lyties 10 procentilio 37, 38 ir 39 nėštumo savaitę, vyriškosios lyties 37 nėštumo savaitę svorių padidėjimas. 90 procentilio svoris buvo mažesnis moteriškosios lyties naujagimių 40 ir 41 nėštumo savaitę bei vyriškosios lyties naujagimių 39 ir 40 nėštumo savaitę. Išvados. Abiejų lyčių naujagimių svorių ir ūgių pokyčiai nežymūs, tačiau gali būti pakankamai reikšmingi diagnozuojant vaisiaus augimo sulėtėjimą ir vaisiaus makrosomiją. Tam, kad būtų galima sudaryti naujas Lietuvos naujagimių svorio ir ūgio procentilių lenteles, reikėtų ištirti visos Lietuvos naujagimius.

Background At present, orthopedic surgery applicants do not universally include Step 2 Clinical Knowledge (Step 2 CK) scores on their applications and current inclusion rates are not yet reported. As Step 1 transitions to pass/fail scoring, we suspect more applicants will include Step 2 CK scores. We sought to identify what percentage of applications currently include Step 2 CK, if applicants who include Step 2 CK (Step 1+CK) score lower on Step 1 than those not including Step 2 CK (Step 1-CK), and what correlations exist between Step 1 and Step 2 CK scores among those who include the scores on their applications. Methodology Applicants to one residency program over two application cycles (2019-2020) were analyzed. The percentage including Step 1 and Step 2 scores was recorded. Step 1 scores were compared between Step 1+CK and Step 1-CK applicants. Differences between Step 2 CK and Step 1 scores were stratified by Step 1 score. Results A total of 1,688 applicants applied to our institution from 2019 to 2020. Of those reporting United States Medical Licensing Examination scores, 1,316/1,660 (79%) reported a Step 2 CK score. Step 1-CK applicants scored higher on Step 1 (250.7 ± 10.9) versus Step 1+CK applicants (244.3 ± 13.1) (p < 0.0001). More applicants who scored lower on Step 1 improved upon their percentile rank between Step 1 and Step 2 CK than those who scored higher on Step 1 (χ2 (8,1316) = 79.1, p < 0.0001). Conclusions From 2019 to 2020, 79% of applicants included Step 2 CK. Lower Step 1 scores were more likely to include Step 2 CK and improve upon their percentile score. It is unclear how Step 1 scoring change will affect current practice.

The purpose of the study was to find out whether a short 6-week intervention on motor competence can reduce the Relative Age Effect (RAE) of preschool children born in the first quarter, compared to those born in the fourth quarter of the same year. Seventy-six preschool children (5.20 ± 0.54 years) from Lugo (Spain) participated. A quasi-experimental pre-post-test design was used with an intervention group (n = 32) and a control group (n = 44). The Movement Assessment Battery for Children-2 (MABC-2) was used to collect data before and after the intervention. The data show that, before the intervention, there are significant differences between the control and the intervention group in favor of the former (born in the first quarter of the year) in manual dexterity (p = 0.011), balance (p = 0.002), total test score (p = 0.008), and total percentile score (p = 0.010). After the application of the specific intervention, statistically significant differences were found in aiming and catching (p &lt, 0.001), balance (p = 0.022), total test score (p = 0.001), and total percentile score (p &lt, 0.001) in favor of the intervention group (born in the last quarter of the year). The results obtained suggest that the application of a specific intervention on MC could positively influence the improvement of MC in preschool children (boys and girls) and reduce the differences produced by the RAE.

Purpose Surgical patients face unique challenges with discharge instructions and retention. The volume of information provided to patients, frequently combined with sedatives and opioids, leads to failure to retain this crucial information needed for home care. The purpose of this project was to implement a preoperative teaching intervention to provide written and verbal discharge instructions in the preoperative area before the administration of anesthetic agents to improve patient retention of information, and improve percentile ranking on the Outpatient Ambulatory Surgery- Consumer Assessment of Health Care Providers and Systems (OAS-CAHPS) survey. Design Cross-sectional descriptive Methods An additional educational intervention was implemented to provide discharge instructions in the preoperative area. Data was collected from the Press-Ganey database on patient responses to questions 13, 14, 15, 17, 19, and 21 and the global discharge domain scores of the OAS-CAHPS survey over a period of 12 weeks. This data was compared to the patient responses to the same questions over the same date range in the year time prior. Findings Statistical analysis demonstrated significant change in the percentile rank scores for the intervention period (P = .0024). Average percentile rank change on discharge domain questions was an increase by 50 points. Patient and staff feedback further demonstrated value to the intervention. Conclusions Providing discharge instructions in the preoperative area in addition to providing instructions immediately before discharge can improve the percentile rankings associated with OAS-CAHPS questions related to discharge.

The objective of this research was to analyze the impact of an intervention program performed by a specialist in physical education (PE) to contribute to the development of motor competence (MC) in pre-school children with motor development problems. The sample consisted of 28 children (12 from the intervention group and 16 from the control group) aged between 4.1 and 5.9 years (mean = 4.71 ± 0.54) who were in the fifth and sixth grades of pre-school education in two schools from Lugo, Spain. The Movement Assessment Battery for Children-2 (MABC-2) was used for data collection. The data revealed that, in the pre- and post-test intervention groups, there are statistically significant differences in manual dexterity (p < 0.001; d = 2.63), aiming and catching (p < 0.002; d = 1.13), balance (p < 0.001; d = 1.68), total test score (p < 0.001; d = 3.30) and total percentile score (p < 0.001; d = 1.88). Between the control and intervention post-test groups, significant differences were found in manual dexterity (p = 0.015; η2 = 0.22), aiming and catching (p = 0.003; η2 = 0.32), balance (p = 0.050; η2 = 0.15), total test score (p < 0.001; η2 = 0.47) and total percentile score (p < 0.001; η2 = 0.48). Based on the results obtained, a specific MC program implemented by a PE specialist contributed to the improvement of manual dexterity, aiming and catching and balance, as well as a better percentile in the general MC of pre-school children diagnosed with motor skill problems.

Zoonotic diseases such as malaria, dengue, Zika and chikungunya remain endemic in many countries. Setting and deploying trap to capture the host/vector species are fundamental to understand their density and distribution. Human effort to manage the trap data accurately and timely is an exhaustive endeavour when the study area expands and study period prolongs. One stop mobile app to manage and monitor the process of animal trapping, from field to laboratory level is still scarce. We developed a new mobile app named “PesTrapp” especially for medical entomologists to acquire the vector density index based on the mobile updates of ovitraps and species information in field and laboratory. This study aimed to highlight the mobile app’s development and design, describe the user experience and evaluate the preliminary user assessment of the mobile app. The mobile app was developed using mobile framework and database. User evaluation of the mobile app was based on the adjusted Mobile App Rating Scale and Standardized User Experience Percentile Rank Questionnaire. The process flows of system design and detailed screen layouts were described. The user experiences of using the app in a project to study Aedes surveillance in six study sites in Selangor, Malaysia were described. The overall mean user evaluation score of the mobile app was 4.0 (SD=0.6), which showed its acceptability by the users. The PesTrapp, a one-stop solution, is anticipated to improve the entomological surveillance work processes. This new mobile app can contribute as a tool in the vector control countermeasure strategies.

Author(s): Wilson, David; Laoteppitaks, Chaiya; Chandra, Shruti | Abstract: Introduction: Medical students pursuing an emergency medicine (EM) residency are advised to obtain at least two Standardized Letters of Evaluation (SLOE). Students often complete one rotation at their home institution and at least one “away” rotation at a program separate from their home institution. The SLOE was introduced as an objective evaluation tool. The aim of this study was to determine whether there was a difference in scores between home rotation and away rotation SLOEs.Methods: We retrospectively reviewed the SLOEs of all applicants to an urban, academic EM residency program. For each SLOE, we calculated a composite score from rankings in seven “Qualifications for EM” (CS7), and converted comparative rank score (CRS) and estimated rank list position (ERP) to percentile scores. The CS7, CRS, and ERP on the home rotation SLOE were compared to those of the away SLOE using a paired t-test.Results: An evaluation of 721 applicants with at least one home SLOE and one away SLOE demonstrated a significant increase in the ERP of home rotators (P = 0.003). The data did not demonstrate a statistically significant difference in the CS7 (P = 0.69), or CRS (P = 0.97).Conclusion: Our study demonstrated that the only difference in SLOEs is that students are likely to be given a slightly higher estimated placement on the rank order list on a home SLOE. We hope this will help residency leadership with reviewing applications.

Low motor competence (MC) can cause low participation in physical activities in preschool children, and together with a high caloric intake, it can lead to obesity. Interventions on motor skills are effective in the short term to improve MC, therefore the objectives of this study were (1) to investigate the effect of a short six-week program on levels of motor competence in preschool children, and (2) to examine the effects of gender-based intervention. A total of 156 preschool children (5.20 ± 0.54 years old) from Lugo (Spain) participated. A quasi-experimental pre–post-test design was used with a control group of 76 students. The Movement Assessment Battery for Children—2nd Edition (MABC-2) was used to collect the data. Significant differences between the control and experimental groups were found after the intervention program in aiming and catching (p &lt, 0.001), balance (p &lt, 0.001), the total score of eight tests (p &lt, 0.001), and total percentile score (p &lt, 0.001). The results regarding gender in the experimental group showed a reduction in differences with respect to the initial results except in aiming and catching, where scores were higher in boys. The data suggest that the application of specific intervention programs in MC could positively influence the improvement of MC in preschool children, thus reducing differences between genders.

Background: Prenatal exposure to organophosphate and pyrethroid insecticides has been associated with impaired neurodevelopment. Few longitudinal studies have investigated associations with early language development in populations with mainly low dietary exposure. Objective: To investigate associations between biomarkers of maternal gestational exposure to organophosphate and pyrethroid insecticides and the child & rsquo;s language development at age 20 & ndash;36 months in the prospective Odense Child Cohort. Methods: Metabolites of organophosphate and pyrethroid insecticides were measured in maternal urine samples collected at gestational week 28. Language development was assessed among 755 singletons at age 20 & ndash;36 months using the Vocabulary and Complexity scores of the MacArthur-Bates Communicative Development Inventories, standardized into age and sex specific percentile scores according to a Danish reference study. Multiple logistic regression models were used to estimate the odds of scoring below the 15th percentile scores in relation to maternal urinary insecticide metabolite concentrations after adjustment for confounders. Results: The generic pyrethroid metabolite 3-phenoxybenzoic acid (3-PBA) and the chlorpyrifos metabolite 3,5,6trichloro-2-pyridinol (TCPY) were detectable in more than 90% of the urine samples analyzed. Likewise, 82.2% had detectable concentrations of diethyl phosphates (DE) and 58.4% of dimethyl phosphates (DM), both of which are common metabolites of organophosphate insecticides. None of the metabolites was associated with higher odds of delayed results below the 15th percentile language scores. In contrast, reduced probability for scoring below the 15th percentile Vocabulary score was seen for the highest tertile of 3-PBA in boys and for the upper tertile of TCPY and DE in girls. Conclusion: In this prospective cohort, with predominantly dietary insecticide exposure, we found no evidence that gestational exposure to organophosphate or pyrethroid insecticides adversely affected early language development in the children. The observed indication of a positive effect of insecticides on language development may be explained by residual and unmeasured confounding from socioeconomic factors and dietary habits. Follow-up of these children should include assessment of more complex cognitive functions in later childhood, as well as associations with their own postnatal insecticide exposure.

The aim of this study was to evaluate the differences on motor competence between 5-year-old boys and girls and to investigate the existence of Relative Age Effect (RAE) on their motor competence. A total of 232 preschool children were evaluated of whom 134 (57.8%) were boys and 98 (42.2%) were girls. The Movement Assessment Battery for Children-2 (MABC-2) was used to collect data. The data show a main effect on gender factor, there was a main effect in total score of manual dexterity (MD, p = 0.010), in total score of balance (Bal, p &lt, 0.001), in total test score (TTS, 0.001), and in total percentile score (TPS, p &lt, 0.001). In the semester of birth factor, there were differences in aiming and catching (A&amp, C, p &lt, 0.001), in Bal (p = 0.029) and in total percentile score (TPS, p = 0.010). Girls perform better in MD, Bal, TTS, and TPS than boys. Preschool children born in the first semester obtain, in general, a higher percentage and a higher percentile than their peers born in the second one. RAE is present in A&amp, C, Bal, and TPS, with higher scores obtained by preschool children born in the first semester compared to those born in the second one.

IntroductionCaesarean section (C-section) is becoming increasingly prevalent worldwide. It can be a life-saving intervention when medical complications arise, but may cause adverse consequences for the mothers when it is not medically necessary. The upwards trend of C-section is becoming a general concern as it might be associated with a wide range of child outcomes such as immune diseases, respiratory diseases and developmental problems. One underlying mechanism of such association is through gut microbiota. Mode of delivery is a signification factor which determines the gut bacterial environment in early days of life. Gut microbiota can impact cognitive development via microbiota gut brain axis. Objectives and ApproachThis study investigated the association between mode of delivery and later educational outcomes of the children, using linked data from New Zealand Integrated Data Infrastructure. The participants consisted of children born in New Zealand between 1Jan1996 and 31Dec1998. All birth information were retrieved from Department of Internal Affairs and were linked to Ministry of Health data to obtain delivery methods from mothers’ diagnosis records. Once delivery modes were identified, the data was then linked to records from Ministry of Education to obtain children’s educational outcomes at secondary school. Three outcome variables were chosen: University Entrance, Highest Endorsement Level and National Certificate of Educational Achievement Level 2 Percentile Score. ResultsThe results have shown that C-section and assisted vaginal delivery were associated with better secondary school educational achievement, comparing to unassisted vaginal delivery. The results persisted after adjusting for sociodemographic factors such as household income, maternal education and deprivation index; infant factors such as birth weight, gestational age and ethnicity. However, when within family variation was further controlled for in the sibling fixed effects analysis, C-section was no longer associated with improved educational achievement. Conclusion / ImplicationsThis indicated that the impact of delivery mode might be negligible on later educational achievement.

Background PD-L1 immunohistochemistry (IHC) testing is suboptimal for predicting patient clinical benefit for checkpoint inhibition, while PD-L1 liquid biopsy is not clinically validated and lacks sensitivity, underscoring the need to include PD-L1 testing in more robust, tissue-efficient, comprehensive, scalable next generation sequencing (NGS) tests. Methods To assess comparability and efficacy of PD-L1 testing by NGS with IHC, we identified NSCLC patients treated by first-line pembrolizumab alone (n=54) or pembrolizumab + chemotherapy (n=49) whose tumors underwent companion diagnostic PD-L1 testing by IHC antibody 22C3 testing (high≥50%; low=1–49%, or negative=0% tissue proportion score), and also by RNA-seq, as part of a comprehensive immune profiling panel. PD-L1 expression by RNA-seq, was measured as a percentile rank, with ≥75 considered ‘high’, and Results More than 75% of IHC high cases were classified as high by RNA-Seq for both treatment groups (p Conclusions PD-L1 status by RNA-seq and IHC appear to be comparable. Unlike PD-L1 IHC however, PD-L1 RNA-seq high status versus not high status is associated with greater survival benefit, indicating PD-L1 by NGS may have utility for pembrolizumab selection.