6-Year Follow-Up of a World Record Breaking Master Marathon Runner.

Endurance performance declines with advancing age. Of the three main physiological factors that determine endurance running performance (maximal oxygen consumption [V̇O2max], lactate threshold, and running economy [RE]), V̇O2max appears to be most affected by age. While endurance performance declines with age, recently, endurance performance has rapidly improved in master athletes as the number of master athletes competing in endurance events has increased. Master athletes represent an intriguing model to study healthy aging. In this case study, we reassessed the physiological profile of a 76-year-old distance runner who broke the marathon world record for men over 70 years of age in 2018. This runner was tested a few months before breaking the world record and retested in 2024. Between 2018 and 2024, his marathon running velocity decreased significantly. Therefore, the purpose of this case study was to determine the physiological changes that explain his performance decline. RE remained similar to 2018, and while there was not a clear breakpoint in blood lactate, he still likely runs marathons at a high percentage (~90%) of his V̇O2max. However, V̇O2max declined by 15.1%. HRmax declined by 3.2% and maximal O2 pulse declined by 12.4%, suggesting that maximal stroke volume and/or arteriovenous O2 difference decreased. Altogether, although this marathoner continues to compete at an elite level, his performance has declined since his record-breaking marathon due to a reduction in V̇O2max. This is likely caused by reductions in maximal stroke volume and/or arteriovenous O2 difference. We speculate that these changes reflect primarily age-related processes.

The hotspots and trends of nursing master's education in China: a bibliometric analysis from 2000 to 2022.

BACKGROUND: Graduate nursing education is the main way to train high-quality nursing personnel. Globally, the nursing education system has been gradually improved, forming a multi-level, multi-channel, and multi-specification education system including secondary, specialized, undergraduate, and postgraduate. OBJECTIVE: To analyze the research hotspots and trends of nursing postgraduate education in China by using bibliometric methods, and to provide reference for scholars at home and abroad to understand the current status of this field. METHODS: Literature related to graduate nursing education was searched in the Chinese full-text journal database (CNKI) from January 2000 to May 2022 and analyzed using CiteSpace software. RESULTS: A total of 998 kinds of literature were included, with a growing trend in the number of articles issued. The research hotspots and trends of nursing graduate education in China are clinical practice, cultivation mode, and core competence. CONCLUSION: Chinese nursing graduate education is improving. Foreign experience should be drawn upon, combined with the hotspots and trends summarized in this study, to promote the development of nursing graduate education in China.

Cloud-fog architecture-based control of smart island microgrid in master-slave organization using disturbance observer-based hybrid backstepping sliding mode controller.

Distributed control is an effective method to coordinate the microgrid with various components, and also in a smart microgrid, communication graph layouts are essential since changing the topology unexpectedly could disrupt the operation of the distributed controllers, and also an imbalance may occur between the production and load. Hence, reducing the exchanged data between units and system operator is essential in order to reduce the transmitted data volume and computational burden. For this purpose, an islanded microgrid with multiple agents which is using cloud-fog computing is proposed here, in order to reduce the computing burden on the central control unit as well as reducing data exchange among units. To balance the production power and loads in a smart island with a stable voltage/frequency, a hybrid backstepping sliding mode controller (BSMC) with disturbance observer (DO) is suggested to control voltage/frequency and current in the MG-based master-slave organization. Therefore, this paper proposes a DO-driven BSMC for controlling voltage/frequency, and power of energy sources within a Master-Slave organization; in addition, the study proposes a clod-fog computing for enhancing performance, reducing transferred data volume, and processing information on time. In the extensive simulations, the suggested controller shows a reduction in steady-state error, a fast response, and a lower total harmonic distortion (THD) for nonlinear and linear loads less than 0.33 %. The fog layer serves as a local processing level, so it reduces the exchanged data between cloud and fog nodes.

Axial length and keratometry characteristics of patients undergoing cataract surgery in Saudi Arabia.

Cataract surgery is one of the most successful surgical procedures, mainly due to the recent developments in surgical instruments and intraocular lens (IOL) measurements. Understanding the nature of axial length (AL) and keratometry readings (K) in patients with cataracts has significant implications for accurate postoperative IOL size selection. This study aimed to measure AL and K in patients undergoing cataract surgery in Saudi Arabia. This retrospective study included patients who underwent cataract surgery in Madinah, Saudi Arabia. The medical records of adult patients between May 2022 and May 2023 were reviewed, and those with a history of retinal detachment, refractive surgery, or trauma were excluded. The AL and K readings were obtained from the patient's IOL master results. A total of 691 eyes from 451 patients were included in the analysis. The mean age was 64.54 years old. Most of the patients were women (55%). The mean AL, K1, and K2 values were 23.27, 43.42, and 44.69, respectively. Linear regression analysis was used to measure the relationship between AL and K, revealing an inverse relationship in our findings. As AL increased by one unit, the mean K was estimated to decrease by 0.548, with a 95% confidence interval. Our results demonstrated an inverse relationship between AL and K, implying that when AL increases, K decreases, or the corneal curvature becomes flat. Further studies are needed to investigate the biomechanical mechanisms underlying this relationship.

Comparative Analysis of Refractive Outcomes Following Cataract Surgery Using IOL Master 500 and IOL Master 700 Biometry Devices: A Retrospective Analysis.

Background: This study aims to compare the refractive outcomes of cataract surgery using two different biometry devices, the IOL Master 500 and IOL Master 700, and to investigate the influence of patient-related factors on these outcomes. Methods: In this retrospective study, we analyzed data from 2994 eyes that underwent cataract surgery. Multiple linear regression analyses were performed to examine the impact of the biometry device (IOL Master 500 or IOL Master 700), patient age, time elapsed between biometry and surgery, gender, and insurance status, as well as biometric parameters (anterior chamber depth, axial length, and corneal curvature), on postoperative refractive outcomes, specifically the deviation from target refraction. Results: The choice of the IOL Master device did not result in a statistically significant difference between the two devices (p = 0.205). Age (p = 0.006) and gender (p = 0.001) were identified as significant predictors of refractive outcomes, with older patients and males experiencing slightly more hyperopic outcomes compared to younger patients and females, respectively. The time elapsed between biometry and surgery and insurance status did not significantly influence the refractive outcomes. Conclusions: Our study, supported by a large cohort and a diverse group of patients representing typical anatomical variants seen in cataract surgery, supports the thesis that the IOL Master 500 and IOL Master 700 can be regarded as equivalent and effective for biometry in cataract surgery. The differences between the devices were negligible. Therefore, switching between the devices is safe for bilateral patients.

Participant observation for inquiry-based learning: a document analysis of exam papers from an internship-course for master's students in health services research in Germany.

Inquiry-based learning (IBL) is a type of problem-based learning. While IBL aims at reflecting the work of practicing researchers, only some students will pursue an academic career. We therefore designed a course that provides opportunities for IBL by applying participant observation to internship work experience inside and outside academia. Using this internship course as an example, we investigated, how master's students in health science executed an IBL assignment regarding the application of participant observation and presentation of findings. In addition, the understanding of occupational fields provided through the IBL assignment was examined.To determine whether learning objectives were met, a document analysis of IBL assignments comprising presentation slides and field protocols was performed. Within content analysis, a category grid was used examining (a) suitability of chosen research objectives, (b) execution of field protocols, (c) sufficiency of reporting and (d) extent of reflection.49 IBL assignments from the years 2020-2022 were included. Sides of IBL observations were: (a) organizations providing health care (n = 28); (b) administrations of health care (n = 8); and (c) research institutes (n = 13). Within students' field protocols, the level of detail of descriptions differed. 30 assignments included reflection on the methods used and research experience. In about a third of IBL assignments, indication of observation type, theoretical background and data analysis was missing.Using participant observation of internship work-experience for IBL can serve as a teaching tool for students to develop methodological skills. For future courses, we developed a checklist to strengthen reporting, reflection and use of theory. As internships are often integrated in degree programs in health sciences similar courses could be implemented in different programs, given qualified methodological guidance.

Relationship between anterior segment biometry and primary angle-closure glaucoma in Hubei region: a retrospective case-control study.

Objective: To investigate the pathogenesis of Primary Angle-Closure Glaucoma (PACG) and its relationship with the anatomical structure of the anterior segment by obtaining biometric parameters using the IOL-Master 700. Methods: A retrospective case-control study was conducted. Clinical data from 39 PACG patients and 40 normal controls treated at the Aier Eye Hospital affiliated with Wuhan University from January to December 2022 were collected. Anterior chamber depth (AC), white-to-white (WTW), lens thickness (LT), central corneal thickness (CCT), axial length (AL), corneal curvature (K1), corneal curvature (K2), and lens position (LP) were measured using the IOL-Master 700 to analyze the characteristics and differences in the anterior segment structure of both groups. Statistical methods included independent sample t-tests and logistic regression analysis. Results: Significant differences were found in the anterior segment biometric parameters between PACG patients and normal controls (p < 0.05). Anterior chamber depth, white-to-white, lens thickness, central corneal thickness, axial length, and K2 were all related to the occurrence of PACG (p < 0.05). The occurrence of PACG was negatively correlated with ACD, CCT, and AL (OR = 0.12-0.64, p < 0.05), and positively correlated with LT. Conclusion: Compared to the normal control group, PACG patients in the Hubei region have a smaller anterior segment space, narrower angles, thicker lens, thinner cornea, shorter axial length, flatter cornea, and more anteriorly positioned lens.

Evaluating the Effectiveness of the Annual Physical Training Plan for Masters +45 Women Half Marathon Athletes: A Guideline Model for Good Practices for Programming Effort Volume and Intensity.

This study presents the implementation and results of the Annual Physical Training Program for Masters +45 Half Marathoners (PASm-12), focused on optimizing athletic performance through rigorous planning of training volume and intensity. PASm-12, structured over 12 mesocycles and 52 microcycles, was applied to 6 female runners with over 10 years of experience. The results indicate that the total running volume achieved (2347 km) was 90.2% of the volume proposed by PASm-12 (2603.2 km), with statistically significant differences in most mesocycles (Cohen's f2 = 6.24, t = -5.997, p = 0.002, indicating a large effect size). The training intensity was achieved at an average of 94.8% of what was proposed by PASm-12, with significant differences in several mesocycles (Cohen's f2 = 0.45, t = -1.972 to -3.984, p < 0.05, indicating a moderate to large effect size). The female runners' performances in field tests generally showed faster times than the maximum and average values proposed in PASm-12, with the exception of the final competition, where performance was slightly lower due to external competitive factors (Cohen's d = -0.53, t = -1.192, p = 0.3). This plan, demonstrating good practice, could serve as a guideline model for amateur runners who do not have specialist counseling. PASm-12 can reduce the risk of injury, prevent excessive fatigue, and support ongoing participation in sports activities. Additionally, the implementation of this plan could provide amateur runners with a safe and effective training structure, contributing to improved health and athletic performance.

S.3827 and a Systematic Review of State-Level Multisector Plans for Aging: How Incorporating Volunteer Caregiving Can Mitigate Service Gaps.

Recognizing the growing need to establish and enhance the necessary service infrastructure to better address the diverse needs of a rapidly aging US population, S.3827 (ie, Strategic Plan for Aging Act) seeks to provide federal support for the creation and implementation of Multisector Plans for Aging (MPAs). Passage of S.3827 can motivate states to strategically plan for a growing elder cohort, as only 8 states currently have developed and are implementing their own MPAs. In this policy brief, we detail the benefits of developing and implementing an MPA at the state level as well as the broad benefits of passing S.3827. We also conduct a systematic review of the 8 MPAs which have been developed and are currently being implemented, focusing on areas of significant overlap (eg, support for paid formal caregiving and support for informal family caregivers) and potential gaps. We conclude with a review of the volunteer caregiving movement and a discussion on how incorporating volunteer caregiving into an MPA can address local elder needs and mitigate service gaps, particularly among older adults who lack access to formal paid caregivers or informal family caregivers. Should S.3827 pass, we argue that state legislatures and stakeholders in eldercare should seriously consider incorporating the volunteer caregiving model into their strategic plans for aging.

Comparison of the IOL Master and Pentacam in the measurement of anterior segment parameters in patients with high myopia and cataracts.

PURPOSE: This study aimed to compare the differences between the Zeiss IOL Master and Oculus Pentacam in keratometry and central anterior chamber depth (ACD) measurements in patients with high myopia and cataracts. METHODS: Between January 2019 and December 2020, 89 patients (103 eyes) with cataracts and high myopia who underwent preoperative cataract evaluation at Nanchang First Hospital were selected for retrospective analysis. Keratometry (K1, K2) and ACD were measured with the IOL Master and Pentacam. Paired t-tests were performed to compare the differences, while the Bland-Altman method was used to evaluate the agreement. RESULTS: The K1 value was (43.15±2.44) D for the IOL Master and (42.98±2.47) D for the Pentacam, and the difference between the two instruments was statistically significant (P<0.01). The K2 value was (44.55±2.63) D for the IOL Master and (44.32±2.55) D for the Pentacam. The ACD was (3.44±0.33)mm for the IOL Master and (3.39±0.36)mm for the Pentacam. There were statistically significant differences between the two instruments in both keratometry and ACD (P<0.01). The absolute values of the maximum difference between the two instruments for K1 and K2 were 1.1 and 1.07; thus, the consistency of the two instruments with respect to this measurement was poor. However, the absolute value of the maximum difference between the two instruments for ACD was 0.34, so the consistency of the two instruments in relation to this measurement was good. CONCLUSIONS: Both the IOL Master and the Pentacam can be used in the measurement of keratometry and ACD in patients with high myopia and cataracts, but the keratometry measurements should be compared in clinical application.

Features of Gene Regulation in Violation of the Inflammatory Response of Monocyte-like Cells Bearing Mitochondrial Mutations Associated with Atherosclerosis.

Аims: This research aimed to study the features of gene regulation of the inflammatory response in cells carrying mitochondrial mutations associated with atherosclerosis. BACKGROUND: Inflammation plays an important, if not decisive, role in the occurrence of atherosclerotic lesions and then accompanies it throughout its further development. Thus, atherogenesis is a chronic inflammatory process. Chronification of inflammation is a consequence of disruption of the normal inflammatory response at the cell level of the vascular wall. OBJECTIVES: In this study, we used cytoplasmic hybrids or cybrids carrying atherosclerosis-associated mitochondrial mutations to study gene regulation of inflammatory response. The main goal of the study was to identify the key genes responsible for the impaired inflammatory response revealed for some cybrids. METHODS: Inflammatory stimulation of cybrids was induced with bacterial lipopolysaccharide, and assessed through secretion of pro-inflammatory cytokines CCL2, IL8, IL6, IL1b. A transcriptome analysis was performed to identify the key genes (master regulators) in the normal (tolerant) and intolerant response of cybrid cells. RESULTS: Normal inflammatory response after re-stimulation elicited a much smaller secretion of pro-inflammatory cytokines. In an intolerant response, the level of secretion upon re-stimulation was the same or even higher than after the first stimulation. Normal and intolerant responses differed significantly both in terms of the number of signaling pathways involved and qualitatively, since the signaling pathways for normal and intolerant responses are completely different. Master regulators controlling normal and intolerant inflammatory response were identified. For a normal response to the first inflammatory stimulation, no common master up-regulators and 3 master down-regulators were identified. The reverse situation was observed with the intolerant inflammatory response: 6 master up-regulators, and no master down regulators were identified. After the second inflammatory stimulation, no master regulator common to all studied cytokines was found. Thus, key genes involved in the development of intolerant inflammatory response have been identified. In addition, other key genes were identified that were initially associated with an intolerant inflammatory response and thus determine disorders of the inflammatory reaction leading to chronification of inflammation. CONCLUSION: We identified disturbances in gene associated with the development of intolerant immune response that may be relevant to atherosclerosis. Key genes responsible for the chronification of inflammation were discovered.

Master of nursing programs in Australia: A desktop analysis.

Background: Master of Nursing (MN) programs serve as an important structured pathway to prepare the nursing workforce to develop advanced capabilities. Little research has been done to examine the key characteristics of MN programs in Australia and their responsiveness to meeting the health needs of the community. Aim: The aim of this desktop analysis is to provide a detailed overview of the key characteristics of MN programs in Australia. Method: A desktop analysis of MN programs in Australia utilising content analysis of publicly available information gathered from program websites of Australian Universities. Results: A total of 70 MN programs were analysed from the 28 that offered these programs. Nine categories were developed that describe the key characteristics of these programs: nomenclature and program focus, program outcomes, regulation and professional recognition, structure, work integrated learning, delivery mode, admission, and tuition fees. Inconsistencies were identified across all categories. Discussion: While Australian universities offer a diverse range of MN programs, inconsistencies across the programs can impact quality and intent and have implications for students, employees, and universities. Conclusion: There is a pressing need to ensure the quality of MN education is maintained and adequate to meet healthcare needs. The benefits and risks of professional regulation of all MN programs should be considered as a mechanism for enhancing the quality of nursing education.

Open Digital Health Workshops - A Model for Mutual Contact and Knowledge Exchange with the Local Community.

The increasing percentage of elderly in our society is challenging the health care system. To meet the challenge, we have implemented an experience-based master's programme in digital health care. The 3-yrs 90 ECTS programme consists of physical sessions of three days duration and weekly 2-3-hour digital lectures and bi-weekly supervisions. A main goal of the program has been to involve the students in relevant local and regional health problems as well as inviting health care personnel to participate in the planning of the study program, present relevant health problems and challenges and follow our open digital health workshops. In this way we have managed to create a stimulating learning environment for both students on further education and local and regional health care personnel.

Canalizing kernel for cell fate determination.

The tendency for cell fate to be robust to most perturbations, yet sensitive to certain perturbations raises intriguing questions about the existence of a key path within the underlying molecular network that critically determines distinct cell fates. Reprogramming and trans-differentiation clearly show examples of cell fate change by regulating only a few or even a single molecular switch. However, it is still unknown how to identify such a switch, called a master regulator, and how cell fate is determined by its regulation. Here, we present CAESAR, a computational framework that can systematically identify master regulators and unravel the resulting canalizing kernel, a key substructure of interconnected feedbacks that is critical for cell fate determination. We demonstrate that CAESAR can successfully predict reprogramming factors for de-differentiation into mouse embryonic stem cells and trans-differentiation of hematopoietic stem cells, while unveiling the underlying essential mechanism through the canalizing kernel. CAESAR provides a system-level understanding of how complex molecular networks determine cell fates.

Solving the Mystery: A Case Study on Treating a Mandibular First Premolar With Multiple Canals.

The mandibular first premolar, which is the anteriormost tooth in the mandibular arch, differs from other teeth in that it typically has two roots and two to four canals. The current case involves treating a mandibular first premolar with two canals through endodontic therapy. The 42-year-old male patient's left mandibular first premolar was diagnosed with irreversible pulpitis. The lateral view X-ray depicted two canals. In the dental procedure, endodontic treatment involves working under an operating microscope and using magnification to treat the affected tooth. After canal shaping the tooth was treated with the crown after it had been cleaned and then adjusted for the bite. As aforementioned, no signs of periapical disease were observed when the tooth was rediscovered a year later. However, this case study indicates that any shift in the anatomy of the canal in premolars should be well monitored and controlled to improve endodontic treatment outcomes of such teeth as the mandibular first premolars.

Coordinated Multi-Scenario Optimization Strategy for Park Photovoltaic Storage Based on Master-Slave Game.

Optimizing the operation of photovoltaic (PV) storage systems is crucial for meeting the load demands of parks while minimizing curtailment and enhancing economic efficiency. This paper proposes a multi-scenario collaborative optimization strategy for PV storage systems based on a master-slave game model. Three types of energy storage system (ESS) application scenarios are designed to comprehensively stabilize PV fluctuations, compensate for load transfers, and participate in the frequency regulation (FR) market, thereby optimizing the overall operational strategy of PV storage systems in parks. The upper-level objective is to maximize the park operators' profit, while the lower-level objective is to minimize the user's power supply costs. Case studies demonstrate that this strategy can significantly increase the economic benefits for park operators by 25.8%, reduce user electricity expenditures by 5.27%, and lower curtailment through a load response mechanism, thereby promoting the development and construction of PV storage parks.

A systematic mapping of public health master's and structured doctoral programs in Germany.

BACKGROUND: Well-trained public health professionals are key to addressing both global and local public health challenges of the twenty-first century. Though availability of programs has increased, the population health science (PHS) and public health (PH) higher education landscape in Germany remains scattered. To date, no comprehensive overview of programs exists. OBJECTIVES: This study aimed to map PHS and PH master's and structured doctoral programs in Germany, including selected program characteristics, curricula and target competencies. METHODS: We conducted a systematic mapping of PHS and PH programs in Germany following a prospectively registered protocol ( https://doi.org/10.17605/OSF.IO/KTCBA ). Relevant master's and doctoral programs were identified by two study authors independently searching a comprehensive higher education database, which was, for doctoral programs, supplemented with a google search. For PHS programs, general characteristics were mapped and for the subset of PH programs, in-depth characteristics were extracted. RESULTS: Overall, 75 master's and 18 structured doctoral PHS programs were included. Of these, 23 master's and 8 doctoral programs focused specifically on PH. The majority of PHS master's programs awarded a Master of Science degree (55 out of 75 programs). The PH master's program curricula offered various courses, allowing for different specializations. Courses on topics like public health, epidemiology, health systems (research) and research methods were common for the majority of the master's programs, while courses on physical activity, behavioral science, nutrition, and mental health were offered less frequently. Structured PH doctoral programs were mainly offered by medical faculties (6 out of 8 programs) and awarded a doctorate of philosophy (Ph.D.) (6 out of 8 programs). PH doctoral programs were very heterogeneous regarding curricula, entry, and publication requirements. There was a broad geographical distribution of programs across Germany, with educational clusters in Munich, Berlin, Bielefeld and Düsseldorf. CONCLUSION: Germany offers a diverse landscape of PHS and PH master's programs, but only few structured doctoral programs. The variety of mandatory courses and competencies in these programs reflect Germany's higher education system's answer to the evolving demands of the PH sector. This review may aid in advancing PH education both in Germany and globally.

Characterizing the Perceived Need for Advanced Clinical Pharmacy Training in British Columbia.

Background: Currently in Canada there are limited opportunities for advanced clinical pharmacy training after a year 1 residency. Advanced training programs currently in existence are year 2 residencies, clinical Master's degrees, and Fellowships. Objectives: To characterize the perceived need for advanced clinical pharmacy training in British Columbia and to determine the desired educational competencies to be gained through advanced training. Methods: Current pharmacy residents (academic year 2021/22) and residency graduates of the past 5 years (2017-2021), together referred to as early career pharmacists or ECPs, were surveyed. Provincial health authority pharmacy leaders who hire clinical pharmacists were also surveyed and invited to participate in key informant interviews. Results: Eighty-four ECPs and 22 pharmacy leaders participated in the surveys (estimated response rates 26% and 35%, respectively). Eleven (13%) of the ECPs had already completed advanced clinical training, and an additional 24 (29%) planned to pursue such training within 5 years. Sixteen (73%) of the pharmacy leaders had experienced difficulties in filling advanced practice positions over the previous 3 years due to a lack of qualified applicants, and 21 (95%) believed that more advanced training positions should be offered. The majority of ECPs interested in advanced training (39/60, 65%) chose year 2 residency as their preferred program, and 20 (91%) of the pharmacy leaders agreed that British Columbia should offer year 2 residencies. Both ECPs and leaders rated clinical skills and knowledge as the most important educational competencies. Conclusions: Pharmacy leaders expressed a need for more pharmacists with advanced clinical pharmacy training, and many ECPs were interested in pursuing such advanced training. Most respondents preferred the year 2 residency, with the most common goal being to improve clinical competencies.

Contexte: Actuellement au Canada, les possibilités de formation avancée en pharmacie clinique après une première année de résidence sont limitées. Les programmes de formation avancée qui existent actuellement sont les résidences de deuxième année, les maîtrises cliniques et les programmes de bourses. Objectifs: Caractériser le besoin perçu de formation avancée en pharmacie clinique en Colombie-Britannique et déterminer les compétences pédagogiques souhaitées qui doivent être acquises grâce à la formation avancée. Méthodologie: Les résidents actuels en pharmacie (année universitaire 2021­2022) et les diplômés en résidence des 5 dernières années (2017­2021), appelés ensemble « pharmaciens en début de carrière ¼ (« PDC ¼), ont été interrogés. Les responsables de pharmacie des autorités sanitaires provinciales qui embauchent des pharmaciens cliniciens ont également été interrogés et invités à participer à des entrevues à titre d'informateurs clés. Résultats: Quatre-vingt-quatre PDC et 22 responsables de pharmacie ont participé aux sondages (taux de réponse estimés à 26 % et 35 %, respectivement). Onze PDC (13 %) avaient déjà suivi une formation clinique avancée et 24 autres (29 %) prévoyaient de le faire dans les cinq ans. Seize responsables de pharmacie (73 %) ont éprouvé des difficultés à pourvoir des postes de pratique avancée au cours des trois années précédentes en raison d'un manque de candidats qualifiés, et 21 (95 %) d'entre eux étaient d'avis que des postes de formation plus avancée devraient être offerts. La majorité des PDC intéressés par une formation avancée (39/60, 65 %) ont choisi la résidence de deuxième année comme programme de premier choix, et 20 responsables de pharmacie (91 %) convenaient que la Colombie-Britannique devrait offrir des résidences de deuxième année. Les PDC et les responsables ont évalué les compétences et les connaissances cliniques comme étant les compétences théoriques les plus importantes. Conclusions: Les chefs de file des pharmacies ont exprimé le besoin de disposer d'un plus grand nombre de pharmaciens ayant une formation avancée en pharmacie clinique, et de nombreux PDC souhaitaient poursuivre une telle formation. La plupart des répondants préféraient la résidence de deuxième année, l'objectif le plus couramment cité étant l'amélioration des compétences cliniques.

Paradoxes in the coevolution of contagions and institutions.

Epidemic models study the spread of undesired agents through populations, be it infectious diseases through a country, misinformation in social media or pests infesting a region. In combating these epidemics, we rely neither on global top-down interventions, nor solely on individual adaptations. Instead, interventions commonly come from local institutions such as public health departments, moderation teams on social media platforms or other forms of group governance. Classic models, which are often individual or agent-based, are ill-suited to capture local adaptations. We leverage developments of institutional dynamics based on cultural group selection to study how groups attempt local control of an epidemic by taking inspiration from the successes and failures of other groups. Incorporating institutional changes into epidemic dynamics reveals paradoxes: a higher transmission rate can result in smaller outbreaks as does decreasing the speed of institutional adaptation. When groups perceive a contagion as more worrisome, they can invest in improved policies and, if they maintain these policies long enough to have impact, lead to a reduction in endemicity. By looking at the interplay between the speed of institutions and the transmission rate of the contagions, we find rich coevolutionary dynamics that reflect the complexity of known biological and social contagions.

Tremor Estimation and Removal in Robot-Assisted Surgery Using Improved Enhanced Band-Limited Multiple Fourier Linear Combiner.

BACKGROUND: During a robot-assisted minimally invasive surgery, hand tremors in a surgeon's manipulation of the master manipulator can cause vibrations of the slave surgical instruments. METHODS: This letter addresses this problem by proposing an improved Enhanced Band-Limited Multiple Linear Fourier Combiner (E-BMFLC) algorithm for filtering the physiological tremor signals of a surgeon's hand. The proposed method uses the amplitude of the input signal to adapt the learning rate and a dense division of the combiner bands for the higher amplitude bands of the tremor signals. RESULTS: By using the proposed improved E-BMFLC algorithm, the compensation accuracy can be improved by 4.5%-8.9%, as well as a spatial position error of less than 1 mm. CONCLUSION: The results show that among all filtering methods, the improved E-BMFLC filtering method has the highest number of successful experiments and the lowest experimental time.