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As institutions continuously strive to align with the standards set forth within competency-based medical education, there is an increased need to produce evidence of learner achievement in the form of observable behaviors. However, the complexity of healthcare education and clinical environments make it challenging to generate valid and reliable behavioral assessments. In this article, we utilize our interdisciplinary knowledge from the perspectives of experts in medical education, assessment, and academic administration to provide tips to successfully incorporate behavioral assessments into instructional designs. These include tips for identifying the best assessment methods fit for purpose, guiding instructors in establishing boundaries of assessment, managing instructors, selecting raters, generating behavioral assessment guides, training raters, ensuring logistics support assessment strategies, and fostering capacity for iteration. These can be used by institutions to improve planning and implementation for longitudinal behavioral assessments.

BackgroundThe aim of this study was to develop natural language processing (NLP) algorithms to conduct automated identification of incidental durotomy, wound drains, and the use of sutures or skin clips for wound closure, in free text operative notes of patients following lumbar surgery.MethodsA single-centre retrospective case series analysis was conducted between January 2015 and June 2022, analysing operative notes of patients aged >18 years who underwent a primary lumbar discectomy and/or decompression at any lumbar level. Extreme gradient-boosting NLP algorithms were developed and assessed on five performance metrics: accuracy, area under receiver-operating curve (AUC), positive predictive value (PPV), specificity, and Brier score.ResultsA total of 942 patients were used in the training set and 235 patients, in the testing set. The average age of the cohort was 53.900 ± 16.153 years, with a female predominance of 616 patients (52.3%). The models achieved an aggregate accuracy of >91%, a specificity of >91%, a PPV of >84%, an AUC of >0.933, and a Brier score loss of ≤0.082. The decision curve analysis also revealed that these NLP algorithms possessed great clinical net benefit at all possible threshold probabilities. Global and local model interpretation analyses further highlighted relevant clinically useful features (words) important in classifying the presence of each entity appropriately.ConclusionsThese NLP algorithms can help monitor surgical performance and complications in an automated fashion by identifying and classifying the presence of various intra-operative elements in lumbar spine surgery.

IntroductionFuture liver remnant volume (FLRV), a risk factor for liver failure (PHLF) after major hepatectomy (MH), is not routinely measured. This study aimed to evaluate the association between FLRV and PHLF.Patients and methodsAll patients undergoing MH (4 + segments) between 2011 and 2018 were identified from a prospectively maintained single-centre database. Perioperative data were collected for patients with PHLF, who were matched (1:2) with non-PHLF controls. FLRV and FLRV% (i.e., % of total liver volume) were calculated retrospectively from preoperative CT scans using Synapse-3D software, and compared between the PHLF and matched control groups.ResultsOf 711 patients undergoing MH, PHLF occurred in 27 (3.8%), of whom 24 had preoperative CT scans available. These patients were matched to 48 non-PHLF controls, 98% of whom were classified as being at high risk of PHLF on preoperative risk scoring. FLRV% was significantly lower in the PHLF group, compared to matched controls (median: 28.7 vs. 35.2%, p = 0.010), with FLRV%

A systematic compilation and evaluation of turbulent spray flame combustion data acquired from lab-scale spray-burners and CFD models validated with these are presented. Previous review studies have been limited to presentations of the progress with validation targets and modelling methods. This work expands these by presenting the details of lab-scale spray-burners and the characteristics of their datasets, the computational methodologies developed to capture the turbulent spray combustion processes acquired from the burners and their validation with the dataset. Additionally, by critically evaluating the spray and inflow boundary conditions, the reacting and non-reacting features and the main flame characteristics and data, direct correlations between the effectiveness of the dataset from the lab-scale spray burners and the outcomes from the computational methodologies using them for validation are clearly elucidated. The evaluation indicates that the turbulence modelling and validation of the swirling non-reacting flows before the application of the combustion models are important. A better representation of the multi-mode nature and the flame-turbulence-chemistry interactions in the combustion models are required. Also, a clearer experimental presentation of the flame structure and modes would help with the development of the modelling techniques. To plug these research needs, this paper reinforces the importance of developing improved numerical techniques that can be validated by selecting an appropriate lab-scale spray-burner with a robust database. Together these can be used to improve the development of and reduce emissions from combustors burning future green fuels.

Background: 69% of thoracic meningoceles are associated with Neurofibromatosis type 1(NF1). Pathology is debated between being a saccular protrusion of dysplastic meninges through a vertebral defect, or a forme fruste of neurofibroma, with no pathological evidence to the later. Treatment is usually conservative, however surgical intervention is sometimes indicated. Surgical options include thoracotomy, endoscopic plication of the cyst, or CSF diversion. After excision of the meningocele, watertight closure of the dura is difficult and meningoceles often reform, so dural reinforcement is indicated. Objective: A literature review on thoracic meningocele in NF1 patients: pathological hypothesis, presentation including rupture and hemothorax in large meningoceles, management strategies, and surgical challenges. The review also includes an illustrative case discussing the surgical challenges with giant meningoceles.Case presentation.A 46 year old male, NF1, with a known thoracic meningocele, presented with dyspnoea due to enlarging thoracic meningocele. The meningocele was successfully excised via thoracotomy in a challenging surgery with a novel surgical technique and unique insight on histology. Results: 10 cases of giant meningoceles in NF1 patients have been reported in literature, surgery was performed in 9 of them. 1 patient died, and there was recurrence or no change in 6 them. Histology in our illustrative case showed diffuse population of schwann cells. Also, Buttress plates achieved reinforced dural closure with no recurrence. Conclusion: Our study concluded that in in large thoracic meningocele(s) surgery via thoracotomy is advised , and dural reinforcement with buttress plates proved to be successful. Our study also concluded that meningoceles in NF1 patients is likely a forme fruste of neurofibroma, or a giant cystic neurofibroma rather than due to dysplastic dura.

Introduction Patients with major depressive disorder (MDD) with acute suicidal ideation or behavior (MDSI) require immediate intervention. Though oral antidepressants can be effective at reducing depressive symptoms, they can take 4–6 weeks to reach full effect. Objectives This study aimed to identify unmet needs in the treatment of patients with MDSI, specifically exploring the potential clinical benefits of rapid reduction of depressive symptoms. Methods A Delphi panel consisting of practicing psychiatrists (n=12) from the US, Canada and EU was conducted between December 2020–June 2021. Panelists were screened to ensure they had sufficient experience with managing patients with MDD and MDSI. Panelists completed two survey rounds, and a virtual consensus meeting. Results This research confirmed current unmet needs in the treatment of patients with MDSI. Hopelessness, functional impairment, worsening of MDD symptoms, recurrent hospitalization and higher risk of suicide attempt were considered as key consequences of the slow onset of action of oral antidepressants. Treatment with rapid acting antidepressant was anticipated by panelists to provide short-term benefit such as rapid reduction of core MDD symptoms which may contribute to shorter hospital stays and improved patient engagement/compliance, allowing for earlier interventions and improved patient outcomes. For long-term benefits, panelists agreed that improved daily functioning and increased trust/confidence in treatment options, constitute key benefits of rapid-acting treatments Conclusions There is need for rapid-acting treatments which may help address key unmet needs and provide clinically meaningful benefits driven by the rapid relief of depressive symptoms particularly in patients with MDSI. Disclosure SB, ED, KJ, MO’H, QZ, MM, MH, SR, JA and DZ are employees of Janssen and hold stock in Johnson & Johnson Inc. AN is currently employed by Neurocrine Biosciences Inc. RP is an employee of Adelphi Values PROVE hired by Janssen.

Background: Highways represent the most significant capital asset that any country’s public sector holds. A system of national highways with easy access to ambulance and trauma centers is termed emergency rescue ready and helps reduce the mortality due to road accidents. Given the rich impetus for road infrastructure development by the government of India, there is a need to consider emergency rescue readiness on highways. Previous research suggests that on typical Indian highways, an ambulance can reach the accident scene within 30 minutes; the remaining 30 minutes of golden hour is essential for saving the life of the injured by admitting to a healthcare facility with a trauma unit. Objective: To investigate the emergency rescue readiness for a stretch of highway between two cities in India. The main objective is to determine the possibility of transporting the injured due to the accident on the highway to the nearest available trauma center within 30 minutes. Methods: A Geographic Information System (GIS)-based network analysis method has been adopted to find the possibility of transporting the injured anywhere on the circuit of a national highway to the nearest healthcare unit within 30 minutes. Results: A map representing the status of emergency rescue readiness has been presented for the study area. For a circuit of national highway with a length of 805 km, in a stretch of 89.5% (718.5 km), the injured can be transported to the healthcare unit within 30 minutes. In the remaining 10.5% of the highway, the healthcare units are significantly far from the highways and may hamper the post-crash rescue operations. Conclusion: There exists a wide disparity in trauma care delivery in the study area. Currently, the healthcare units established to serve the areas with dense populations also serve as emergency rescues during accidents on the national highways. Using GIS techniques for highway stretches with difficulty reaching the trauma centers, a national-level assessment is highly recommended.

Soil salinity is a significant abiotic factor that impedes sustainable crop production in key agricultural regions worldwide. Saline cultivation adversely affects soil quality, whereas the use of saline water for irrigation disrupts the physiological and biochemical processes of plants. Continuous irrigation with high salt concentrations leads to a gradual buildup of soil salinity, thus hindering optimal plant growth and development. Consequently, there is a growing emphasis on breeding salinity-tolerant cultivars of various crops. In this study, 71 tomato accessions sourced from 20 countries and provided by the US Department of Agriculture were evaluated under controlled greenhouse conditions and subjected to saline stress (200 mM NaCl). The experiment used a split-plot design, with the salt treatment serving as the main plot and the tomato accession as the subplot, which were arranged in a completely randomized design with three replications. Results identified nine accessions (PI 109837, PI 127820, PI 270256, PI 634828, PI 636205, PI 636255, PI 647143, PI 647528, and PI 647556) as salt-tolerant. Additionally, high broad-sense heritability was observed for the leaf injury score and leaf chlorophyll content. Furthermore, positive correlations were found among parameters related to the leaf injury score and leaf chlorophyll content (soil plant analysis development value). These findings offer valuable insights for tomato breeding programs, particularly those focused on enhancing salt tolerance of elite cultivars of this crucial crop.

This research delves into the collective impacts of Hall-current, Soret-Dufour, magneto-hydrodynamics and Non-Darcy permeable medium on chemically reactive micropolar fluid flow over a stretching sheet. Employing advanced mathematical models and simulations, the study aims to elucidate these complex interactions. This study investigates micropolar fluid flow over a stretching sheet, accounting for the effects of melting and sliding. The subject is motivated by many industrial applications, such as metallurgical applications and polymer processing, where knowledge of fluid dynamics and heat transport is essential. The mathematical model includes the Navier-Stokes equations for micro-polar fluids and the Hall current effects with slip conditions. The problem is modelled based on the conservation of momentum with micropolar effects, energy, and species concentration. In addition, the energy calculation considers the melting effect on the stretching surfaces. The numerical solution to the problem is found by solving the partial differential equations using suitable techniques with the bvp4c tool in MATLAB. The investigation scrutinizes the impact of velocity slip, heat source, porosity, suction, volume fraction, chemical reaction, and viscous dissipation on velocity, heat transfer, and concentration profile. Results reveal notable influences, such as enhancements in velocity with increased porosity and nanoparticle volume fraction, while velocity slip and suction lead to velocity reduction. The findings offer valuable insights for optimising the efficiency of diverse technical applications.

A study on genetic diversity was conducted at Experimental Farm of Regional Horticultural Research and Training Station Dhaulakuan, District Sirmour (HP), Dr. YS Parmar University of Horticulture and Forestry, Nauni, Solan, Himachal Pradesh, India during kharif season, 2018 to assess the genetic diversity in 21 genotypes of chilli (Capsicum annuum L.) and to identify suitable donors for successful breeding programme in this crop.The twenty one (21) chilli genotypes were evaluated for seven horticultural traits viz., days to 50% flowering, days to first green fruit picking, fruit length (cm), fruit diameter (cm), number of fruits plant-1, fruit weight at edible maturity (g), green fruits yield plant-1 (g). The experiment was laid out in RCBD with three replications at spacing of 45×45 cm2. By estimating D2 values in all possible combinations of the genotypes, the 21 genotypes of chilli were grouped into 6 clusters based on green fruit characters, revealing the genetic diversity among the parents. Cluster IV had maximum (6) andCluster I with only one genotype. Average intra-cluster distance was maximum in cluster VI (19.56). The inter cluster distance was recorded maximum between cluster I and VI (207.49). Therefore, hybridization between the genotypes from cluster I and VI (green) can be utilized for getting superior recombinants/ transgressive segregants in segregating generations of chilli.