Prospective Clinical Feasibility Study for MRI-Only Brain Radiotherapy

ObjectivesMRI-only radiotherapy (RT) provides a workflow to decrease the geometric uncertainty introduced by the image registration process between MRI and CT data and to streamline the RT planning. Despite the recent availability of validated synthetic CT (sCT) methods for the head region, there are no clinical implementations reported for brain tumors. Based on a preceding validation study of sCT, this study aims to investigate MRI-only brain RT through a prospective clinical feasibility study with endpoints for dosimetry and patient setup.Material and MethodsTwenty-one glioma patients were included. MRI Dixon images were used to generate sCT images using a CE-marked deep learning-based software. RT treatment plans were generated based on MRI delineated anatomical structures and sCT for absorbed dose calculations. CT scans were acquired but strictly used for sCT quality assurance (QA). Prospective QA was performed prior to MRI-only treatment approval, comparing sCT and CT image characteristics and calculated dose distributions. Additional retrospective analysis of patient positioning and dose distribution gamma evaluation was performed.ResultsTwenty out of 21 patients were treated using the MRI-only workflow. A single patient was excluded due to an MRI artifact caused by a hemostatic substance injected near the target during surgery preceding radiotherapy. All other patients fulfilled the acceptance criteria. Dose deviations in target were within ±1% for all patients in the prospective analysis. Retrospective analysis yielded gamma pass rates (2%, 2 mm) above 99%. Patient positioning using CBCT images was within ± 1 mm for registrations with sCT compared to CT.ConclusionWe report a successful clinical study of MRI-only brain radiotherapy, conducted using both prospective and retrospective analysis. Synthetic CT images generated using the CE-marked deep learning-based software were clinically robust based on endpoints for dosimetry and patient positioning.

Technical performance analysis of different types of spirometers

Background The spirometer is an important element in lung function examinations, and its accuracy is directly related to the accuracy of the results of these examinations and to the diagnosis and treatment of diseases. Our aim was to conduct a performance analysis of the detection techniques of differential pressure and ultrasonic portable spirometers commonly used in China. Methods A standard flow/volume simulator was used to analyze the performance (accuracy, repeatability, linearity, impedance, and so on) of portable spirometers, 4 imported and 6 domestic, based on 13 curves generated by different air sources in the ISO 26782:2009 standard. A Bland–Altman diagram was used to evaluate the consistency between the values measured by the spirometers and the simulator. Results The pass rates for accuracy, repeatability, linearity, and impedance for the 10 different portable spirometers were 50%, 100%, 70%, and 70%, respectively. Only 30% (3/10) of the spirometers—2 domestic and 1 imported—met all standards of quality and performance evaluation, while the rest were partially up to standard. In the consistency evaluation, only 3 spirometers were within both the consistency standard range and the acceptability range. Conclusion The quality and performance of different types of portable spirometers commonly used in the clinic differ. The use of a standard flow/volume simulator is helpful for the standard evaluation of the technical performance of spirometers.

Launching PLTL for MATH: Building on the Foundation of Supplemental Instruction

The paper describes the launch of Peer-Led Team Learning for Precalculus Engineering and Math at the University of Texas at Arlington (UTA) and the results that PLTL has had on pass rates. Historically, students placed into Precalculus, instead of being Calculus ready, have experienced higher failure rates than any other student grouping. While UTA has invested in many studies, programs and techniques that aid these underprepared students, a few strategies have emerged as being effective. These strategies have included the previous implementation of Supplemental Instruction (SI), with separate sections devoted specifically to Precalculus co-enrolled engineering-course students, peer-based instruction, and active learning activities as opposed to additional lectures. As a result of these findings, in the Fall 2020 semester, UTA combined all these strategies into a learning course integrating these best practices into a required PLTL learning lab with problem-based activities and studying practices for the engineering course and a self-selected PLTL option for the math course. The goal was to aid in increasing success rates in these classes. The students engaged in effective “study habits” and problem-based learning practices with a Peer-Led Team Learning (PLTL) leader. What we have found is the positive impact that PLTL has on pass rates for at-risk populations in addition to positive satisfaction surveys. This paper will show the effectiveness of PLTL by discussing success rates for the Fall 2020 and Spring 2021 semesters versus the other singular implementations from previous semesters, in this case Supplemental Instruction.

Benchmarking educational quality – an independent analysis and alternative approach

In a ten-year study over thirty STEM units in seven nationally accredited institutions (two colleges, five universities, including a five-star teaching university) in two different countries were analyzed to evaluate their educational quality using a range of criteria and benchmarked against the finalists of the 2010 IEEE global award for academics. Unit content and teaching were found to be almost exclusively based on Constructivist based principles. However, Constructivism provides subjective guidelines open to different interpretations. The analyzed units demonstrated considerable variation in pass rates and educational standards. One unit consistently achieved circa 100% pass rates but at the expense of the standard of learning outcomes – far below any reasonable expectations. At the other extreme one unit achieved a higher standard of learning but with pass rates below 30%. This problem can potentially be addressed by using the new quantitative Cognitive Load Optimization learning theory and technology.

An 18-year Experience with an Innovative Geriatrics Training Model: Implications for the Workforce

Despite the growing population of older adults, the geriatrics workforce has not similarly expanded. The number of geriatrics fellows has declined by 14.3% from 2012-2017. Implementation of innovative training programs may improve this reality. In 2002, the Medical College of Wisconsin (MCW) created the first four-year combined medicine residency and geriatrics fellowship (Med-Ger). Similar programs are currently being developed. The aim of this study is to describe the outcomes of the MCW Med-Ger program. Primary endpoints: American Board of Internal Medicine (ABIM) pass rates, ABIM Geriatric Medicine Certification pass rates, fellowship completion rates, and geriatric-focused practice. Results: There was a Med-Ger program fill rate of 73.7% (n=38). There was equivalent ABIM pass rate of 100% between Med-Ger graduates (n=18) and traditional graduates (n=25). Med-Ger trainees were more likely to complete their geriatrics fellowship (94.4% vs. 88%) and practice in geriatric-focused careers (82.4% vs. 68.2%). These outcomes suggest the benefit of a combined program for training future geriatricians. The MCW Med-Ger fill rate exceeds the national geriatrics fellowship fill rate of under 50%. Additionally, graduates may be more likely to practice geriatric medicine. This may help address population needs for an increased geriatrics workforce. In 2020, the ACGME approved an Advancing Innovation in Residency Education (AIRE) Medicine-Geriatrics Integrated Residency and Fellowship national pilot program. Further investigation of why trainees choose Med-Ger training and are more likely to continue with careers in geriatrics is needed in order to replicate the success of the MCW Med-Ger program.

The Framing Preference for Large and Increasing Components in Static and Dynamic Descriptions

Describing sets in terms of a two-valued variable, either value can be chosen: exam results may be referred to by pass rates or fail rates. What determines such framing choices? Building on work by McKenzie and colleagues on reference points in the production and interpretation of framed information, we investigate two determinants of frame choice. One is that speakers tend to focus on the component that has increased vis-à-vis a previous state, the other is the tendency to choose the component larger than 50%. We propose to view reference points as pointing to different kinds of communicative relevance. Hence the use of the previous state and the 50% reference points by speakers is not just a function of the information, but is co-determined by a communicative cue in the context: the question being asked about this information. This line of thought is supported by two experiments containing items offering two-sided distribution information at two points in time. Our first experiment employs a static task, requiring a description of the most recent situation. The second experiment uses a dynamic task, asking participants to describe the development between the two time points. We hypothesize that in static tasks the component size is the strongest frame choice determinant, while in dynamic tasks frame choice is mainly driven by whether a component has increased. The experiments consist of 16 different scenarios, both with symmetrical contrasts (i.e., dogs vs. cats) and with asymmetrical ones (i.e., winning vs. losing). Both experiments support the hypotheses. In the static task, the size effect is the only consistent effect; in the dynamic task, the effect of direction of change is much larger than that of size. This pattern of differences between size and change effects applies across symmetrical and asymmetrical contrasts. Our experiments shed light on cognitive and communicative regularities involved in the production of framed messages: people do tend to prefer larger and increasing components when choosing a frame, but the relative strength of both these preferences depends on the communicative task.

Performance of Graduation Examination of Standardized Residency Training in Zhejiang Province, China

Background Standardized residency training is an important part of post-graduation medical education for medical students in China, and the graduation examination is a necessary part to test the effect of residency training and an important measure to guarantee the quality of residency training. This study analyzed the graduation examination results of standardized residency training in Zhejiang Province in 2020. Methods This study calculated the pass rates for the practical skills examination and written examination for 5555 examinees and analyzed the relationship between examinees' demographic characteristics and pass rates. Results The pass rates for practical skills examination and written examination were 91.8% and 96.5%, respectively. Gender, age, education, and type of organizations were significantly associated with the pass rates. Examinees who retook the examination were less likely to pass the practical skills examination (AOR = 0.266, 95% CI = 0.189-0.377) and the written examination (AOR = 0.043, 95% CI = 0.025-0.074) than examinees who took the examination for the first time. If an examinee did not pass the practical skills examination initially, he or she was less likely to pass the written examination (AOR = 0.172, 95% CI = 0.120-0.249) Conclusion The pass rate of graduation examination of standardized residency training was not only influenced by the individual characteristics of the examinees but also related to the level of training hospitals and lead teachers. Therefore, it is necessary to take comprehensive measures to further improve the system of standardized residency training.

College Comes to High School: Participation and Performance in Tennessee’s Innovative Wave of Dual-Credit Courses

We analyze the rollout of a Statewide Dual-Credit (SDC) program intended to expand access to college-level courses during high school. We find that SDC increased early postsecondary course-taking among students in the middle of the achievement distribution, especially through courses in vocational subjects, without decreasing participation in Advanced Placement (AP). However, SDC was mostly offered by schools already providing courses in similar subject areas and was less frequently offered in small relative to large schools, thus doing little to ameliorate placed-based gaps in course-taking opportunities. Furthermore, a majority of students failed the end-of-course exams necessary to secure college credit, and those who passed closely resemble students who pass AP exams. Low SDC exam pass rates predict school-level discontinuation of SDC courses over and above a range of other factors that reflect student demand and staffing capacity.

Analysis of Performance Trends from 2010–2019 on the American Board of Internal Medicine Nephrology Certifying Exam

BackgroundThe 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.MethodsThis 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.ResultsLower 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.ConclusionsChanges 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.