A National Survey of Hand Surgeons: Understanding the Rural Landscape

Background: Twenty percent of the US population is described as being rural and may have limited access to hand surgeons, especially on an emergency basis. Little is known about case type, call hours, employment status, and other relevant details of rural hand surgery. Methods: We surveyed members of the American Society of Surgery for the Hand to begin to describe the problem. Results: There were 471 responses from 2256 members surveyed with 387 completing 100% of questions asked. Ninety (19%) identified themselves as primarily located in a rural population and 381 (81%) in a metropolitan region. In our study, rural hand surgeons were more likely to be employed by a community hospital, followed by independent private practice, multispecialty group, academics, and then locum tenens. Rural surgeons’ practices were 80% solely hand surgery, while metropolitan surgeons’ practices were 89% ( P < .01). Metropolitan surgeons felt that of the transfers from rural facilities, 46% did not need emergency hand care and that 60% of the time, there was not actually a need for specialty hand surgery care. Conclusions: Our survey begins to shed light on the details of rural hand surgery practice. We found that rural surgeons are more likely to be employed in community hospitals and take more call. When available, hand surgery specialists could prevent unnecessary transfer of patients to metropolitan areas. More work needs to be done to describe the differences between rural and metropolitan hand surgery practices as well as create rural hand surgeons.

Procedural Risk in Congenital Cardiac Catheterization (PREDIC 3 T)

Background Advancements in the field, including novel procedures and multiple interventions, require an updated approach to accurately assess patient risk. This study aims to modernize patient hemodynamic and procedural risk classification through the creation of risk assessment tools to be used in congenital cardiac catheterization. Methods and Results Data were collected for all cases performed at sites participating in the C3PO (Congenital Cardiac Catheterization Project on Outcomes) multicenter registry. Between January 2014 and December 2017, 23 119 cases were recorded in 13 participating institutions, of which 88% of patients were <18 years of age and 25% <1 year of age; a high‐severity adverse event occurred in 1193 (5.2%). Case types were defined by procedure(s) performed and grouped on the basis of association with the outcome, high‐severity adverse event. Thirty‐four unique case types were determined and stratified into 6 risk categories. Six hemodynamic indicator variables were empirically assessed, and a novel hemodynamic vulnerability score was determined by the frequency of high‐severity adverse events. In a multivariable model, case‐type risk category (odds ratios for category: 0=0.46, 1=1.00, 2=1.40, 3=2.68, 4=3.64, and 5=5.25; all P ≤0.005) and hemodynamic vulnerability score (odds ratio for score: 0=1.00, 1=1.27, 2=1.89, and ≥3=2.03; all P ≤0.006) remained independent predictors of patient risk. Conclusions These case‐type risk categories and the weighted hemodynamic vulnerability score both serve as independent predictors of patient risk for high‐severity adverse events. This contemporary procedure‐type risk metric and weighted hemodynamic vulnerability score will improve our understanding of patient and procedural outcomes.

Constructing g-C3N4/Cd1−xZnxS-Based Heterostructures for Efficient Hydrogen Production under Visible Light

Two types of photocatalysts, 1%Pt/Cd1−xZnxS/g-C3N4 (x = 0.2–0.3) and Cd1−xZnxS/1%Pt/g-C3N4 (x = 0.2–0.3), were synthesized by varying the deposition order of platinum, and a solid solution of cadmium and zinc sulfides onto the surface of g-C3N4. The characterization of photocatalysts showed that, for 1%Pt/Cd1−xZnxS/g-C3N4, small platinum particles were deposited onto a solid solution of cadmium and zinc sulfides; in the case of Cd1−xZnxS/1%Pt/g-C3N4, enlarged platinum clusters were located on the surface of graphitic carbon nitride. Based on the structure of the photocatalysts, we assumed that, in the first case, type II heterojunctions and, in the latter case, S-scheme heterojunctions were realized. The activity of the synthesized samples was tested in hydrogen evolution from triethanolamine (TEOA) basic solution under visible light (λ = 450 nm). A remarkable increase in hydrogen evolution rate compared to single-phase platinized 1%Pt/Cd1−xZnxS photocatalysts was observed only in the case of ternary photocatalysts with platinum located on the g-C3N4 surface, Cd1−xZnxS/1%Pt/g-C3N4. Thus, we proved using kinetic experiments and characterization techniques that, for composite photocatalysts based on Cd1−xZnxS and g-C3N4, the formation of the S-scheme mechanism is more favorable than that for type II heterojunction. The highest activity, 2.5 mmol H2 g−1 h−1, with an apparent quantum efficiency equal to 6.0% at a wavelength of 450 nm was achieved by sample 20% Cd0.8Zn0.2S/1% Pt/g-C3N4.

DIGITAL TRANSFORMATION OF TOMSK REGIONAL SYSTEM OF GENERAL EDUCATION: PROFESSIONAL DEFICITS OF TEACHING STAFF

Рассматривается опыт реализации национального проекта «Образование», регионального проекта «Цифровая образовательная среда» на территории Томской области в части развития цифровых компетенций управленческого персонала и педагогических работников общеобразовательных организаций. Анализируются основополагающие федеральные и региональные нормативные правовые акты, определяющие стратегию развития региона по направлению цифровизации системы общего образования. Обозначены основные траектории цифровизации региональной системы общего образования, выделенные на основе мониторинга практики Томской области по развитию цифровой образовательной среды. Определены группы цифровых компетенций педагогических кадров системы общего образования, выявлены профессиональные дефициты педагогических работников и управленческого персонала общеобразовательных организаций Томской области путем использования авторских диагностических материалов на основе задач кейсового типа. The main directions of digital transformation and modernization of general education system in Tomsk region in the frame of implementation of “Education” national project and “Digital educational environment” local project are observered in the paper. The regional general education system is characterized. The practice and experience of its phased digitalization are described. Some fundamental federal and regional regulatory legal acts that determine the strategy to develop digitalization of the general education system are analyzed. The digital competencies of management personnel and pedagogical employees of educational organizations, which are necessary for effective cooperation and organization of the educational process in the context of creating a unified digital educational environment in the region, have been investigated. On the basis of the study, the groups of digital competencies for the teaching staff in general education system have been identified, and the qualitative characteristics of digital competencies necessary for the systemic and effective digital transformation of the general education system in the region have been formulated. The author’s diagnostic materials have been developed and described using case-type tasks, focused on identifying teachers’ professional deficiencies, corresponding to three groups of digital competencies. Examples of case-type tasks aimed at identifying professional deficits are given. Based on the data obtained, an analysis has been carried out, conclusions about the skills of mastering digital technologies, the ability to effectively use digital resources and services in the educational process have been described. Based on the results of the study, the tasks and prospects of the digital transformation of the general education system of Tomsk region have been identified.

Diagnosis and management of temporomandibular joint dysfunction before surgery: a case report

We present a case of colorectal cancer with temporomandibular joint dysfunction and discuss the management of the case. Type IIIb temporomandibular disorder involves anterior dislocation of the articular disk, trismus and difficult intubation. A 68-year-old woman was scheduled for colectomy. The day before surgery, the patient had temporomandibular pain. On examination, the mouth opening was 13 mm. We diagnosed type IIIb temporomandibular disorder. A simple splint was fabricated with gauze and she bit it. The mouth opening was 55 mm on the day of surgery. The pain disappeared, and intubation was uneventful. Temporomandibular disorders are generally treated by dentists. It is beneficial for general hospitals without a dentistry department to employ a dental anaesthesiologist to assist in potentially difficult intubations in patients with temporomandibular disorders.

Impact of Retail Case Type and Lighting Intensity on Instrumental Color Traits of Ground Beef Patties

The objective of this study was to determine the influence of retail case type and lighting intensity on color stability of ground beef patties. Ground 80:20 beef was procured from a local retail establishment between 7 and 10 d from the box date and ground through a 9.5 mm grinder plate, then formed into 150.25 g patties. Patties were then individually packaged in PVC-overwrap packages and randomly assigned into one of four treatments: open, multideck cases with 3000 K lighting (OPEN3000), open, 3500 K lighting (OPEN3500), enclosed, multideck cases with doors with 3000 K lighting (DOOR3000), and enclosed multideck at 3500 K lighting (DOOR3500). Patties were displayed for 7 d and instrumental color values (CIE L*, a*, and b*) were taken every 24 h. Data were analyzed as a 2 × 2 factorial arrangement with repeated measures, with case type, lighting intensity, and their interaction serving as fixed effects. Patties in DOOR cases possessed greater L* values (P &lt; 0.05) than OPEN cases on d 3 of display. A similar trend existed for a*, where DOOR patties were redder (P &lt; 0.05) than OPEN patties from d 2 to the end of display, and b* values were higher (P &lt; 0.05) in DOOR cases from d 1 to d 4 of display. Patties from the DOOR cases also possessed increased chroma values (P &lt; 0.05) from d 1 to 6 of display, and decreased (indicating more red) hue angle values from d 3 to the end of display. No differences were observed between lighting intensity for any trait evaluated (P ≥ 0.293). These results indicate patties placed in enclosed retail cases with doors are lighter, redder, and more intense in color during display compared to traditional open-front cases, which indicates greater color stability.

LabVIEW Software Platform for Kinematics Analyse in Robotics

The paper shown one new LabVIEW software platform for the Kinematics analyse in Robotics. This platform contents some more important type of robots and the positions, velocities and accelerations assisted analyse. The program contains a case-type structure with the various types of analysed robots, which also include related Cartesian systems applied in all joints. The front panel of the program contains a two-dimensional table with the input data of all relative position vectors between all joints, clusters for defining all robot modules and clusters for defining all parameters of the trapezoidal characteristics of relative motion in all robot’s joints. The clusters that define the robot modules contain information on the translation or rotation couple, the angular or linear home position and respectively the axes of movement by rotation or translation. The results are shown by 3D graphics of space trajectory, of space movement of the velocities and acceleration vectors. With this platform will be possible to quickly analyse some different variants of the movement like simultaneously, successive and complex combination between them and choose the best variant for one good dynamic behaviour without vibration, without pick of moments and forces. This software platform solves one small part of the complex problems of the robot’s kinematics.

Common diagnoses among pediatric attendances at emergency departments

Background Pediatric patients present to Emergency Departments (EDs) with a variety of medical conditions. An appreciation of the common presenting conditions can aid EDs in the provision of pediatric emergency care. In this study, we established the common pediatric diagnoses seen at the general EDs, with reference to a pediatric ED. Methods A retrospective review of medical records was performed for patients less than 16 years old at a pediatric ED and two general EDs from 1 January to 31 December 2018. Information including patient demographics, triage category, case type and diagnoses were collected. Results There were 159,040 pediatric attendances, of which 3477 (2.2%) were seen at the general EDs. Non-traumatic conditions were most prevalent at both general (N = 1933, 55.6%) and pediatric (N = 128,415, 82.5%) EDs. There was a higher proportion of trauma related conditions seen at the general EDs (N = 1544, 44.4%) compared to the pediatric ED (N = 27,148, 17.5%; p < 0.01). Across all EDs, upper respiratory tract infection, unspecified musculoskeletal pain and gastroenteritis were the three most common non-trauma related diagnoses, while fracture, wound and contusion were the three most common trauma related diagnoses. There was a greater proportion of emergent (P1) cases seen at the general EDs (N = 233, 6.7%) than the pediatric ED (N = 3821, 2.5%; p < 0.01). Respiratory conditions including bronchiolitis, asthma and bronchitis were the most common emergent (P1) diagnoses. Conclusions The common diagnoses among pediatric attendances varied between pediatric and general EDs. Therefore, general EDs should focus their efforts on these common diagnoses, especially the emergent (P1) ones, so that they can enhance their preparedness and work towards providing quality pediatric emergency care.