Administration of the American Board of Anesthesiology's virtual APPLIED Examination: successes, challenges, and lessons learned.

In response to the COVID-19 pandemic, the American Board of Anesthesiology transitioned from in-person to virtual administration of its APPLIED Examination, assessing more than 3000 candidates for certification purposes remotely in 2021. Four hundred examiners were involved in delivering and scoring Standardized Oral Examinations (SOEs) and Objective Structured Clinical Examinations (OSCEs). More than 80% of candidates started their exams on time and stayed connected throughout the exam without any problems. Only 74 (2.5%) SOE and 45 (1.5%) OSCE candidates required rescheduling due to technical difficulties. Of those who experienced "significant issues", concerns with OSCE technical stations (interpretation of monitors and interpretation of echocardiograms) were reported most frequently (6% of candidates). In contrast, 23% of examiners "sometimes" lost connectivity during their multiple exam sessions, on a continuum from minor inconvenience to inability to continue. 84% of SOE candidates and 89% of OSCE candidates described "smooth" interactions with examiners and standardized patients/standardized clinicians, respectively. However, only 71% of SOE candidates and 75% of OSCE candidates considered themselves to be able to demonstrate their knowledge and skills without obstacles. When compared with their in-person experiences, approximately 40% of SOE examiners considered virtual evaluation to be more difficult than in-person evaluation and believed the remote format negatively affected their development as an examiner. The virtual format was considered to be less secure by 56% and 40% of SOE and OSCE examiners, respectively. The retirement of exam materials used virtually due to concern for compromise had implications for subsequent exam development. The return to in-person exams in 2022 was prompted by multiple factors, especially concerns regarding standardization and security. The technology is not yet perfect, especially for testing in-person communication skills and displaying dynamic exam materials. Nevertheless, the American Board of Anesthesiology's experience demonstrated the feasibility of conducting large-scale, high-stakes oral and performance exams in a virtual format and highlighted the adaptability and dedication of candidates, examiners, and administering board staff.

Comparing characteristics and perspectives of U.S. anesthesiology fellows in training and anesthesiologists in their first year of practice.

BACKGROUND: The purpose of this study was to evaluate relationships between demographics, professional characteristics, and perceived challenges facing the specialty of anesthesiology among physicians who entered a fellowship and those who started independent practice immediately after finishing a U.S. anesthesiology residency. METHODS: Anesthesiologists in the year after their residency graduation were invited to take an online survey during the academic years of 2016-2017, 2017-2018, and 2018-2019, with questions about their personal characteristics, the nature of their professional lives, and their perceptions of the greatest challenge facing the profession of anesthesiology. RESULTS: A total of 884 fellows-in-training and 735 anesthesiologists starting independent practice right after the completion of their residency responded. Fellows were slightly younger (mean = 33.2 vs. 34.0 years old, p < 0.001), were more likely to have a spouse who works outside the home (63.9% vs. 57.0%, p = 0.002), had fewer children (mean = 0.69 vs. 0.88, p < 0.001), worked more hours per week (mean = 56.2 vs. 52.4, p < 0.001), and were less likely to report a personal and professional life balance (66.4% vs. 72.3% positive, p = 0.005) than direct-entry anesthesiologists. Fellows and direct-entry anesthesiologists identified similar challenges in three broad themes - workforce competition (80.3% and 71.8%), healthcare system changes (30.0% and 37.9%), and personal challenges (6.4% and 8.8%). Employment security issues posed by non-physician anesthesia providers and perceived lack of appreciation of anesthesiologists' value were commonly cited. Relative weighting of challenge concerns varied between fellows and direct-entry physicians, as well as within these groups based on gender, fellowship subspecialty, location or size of practice, and frequency of supervisory roles. CONCLUSIONS: Anesthesiology fellows and direct-entry anesthesiologists had largely similar demographics and perspectives on the challenges facing anesthesiology in the United States. Group differences found in some demographics and perspectives may reflect different motivations for choosing their professional paths and their diverse professional experiences.

Techno-economic analysis of biogas production from domestic organic wastes and locally sourced material: the moderating role of social media based-awareness.

Management of organic waste addresses the issue of cleanliness and sanitation in developing nations such as Pakistan, where improper waste management usually leads to significant health problems and early mortality. The control of organic waste in rural regions of Pakistan and other developing nations needs to be undertaken using effective solutions. This study contributes to satisfying local needs such as cooking, lighting, and maintaining a comfortable temperature in anaerobic locations and works as a guideline for converting to biogas. This research aims to ascertain households' most substantial challenges concerning biogas production using domestic organic waste and locally sourced materials. The analysis is conducted on data from 81 respondents gathered using a comprehensive questionnaire assessment. Respondents were carefully chosen with the purposive sampling process. Primary data were collected from a structured questionnaire and partial least squares structural equation modeling (PLS-SEM) to evaluate the formulated assumptions. The results indicate that managing organic waste positively influences the sustainable improvement of biogas using human organic waste and locally resourced materials. The selected variables and their moderating effect significantly and favorably influence this conceptual model. Furthermore, all manipulating influences are constructively connected with implementing biogas technology using organic waste and locally resourced material, minimizing household energy expenses, and satisfying local needs. This study concludes that the government's green energy policy and economic incentives encourage households to use biogas energy produced from organic waste and locally resourced material. The government should use modern technology, resident training, and expert methodological assistance to induce households into biogas production using domestic organic waste and locally resourced material. Finally, the study's limitations and suggestions for further research are also addressed.

Assessment of risk factors to Green, Lean, Six Sigma adoption in construction sector: Integrated ISM-MICMAC approach.

The construction industry consumes significant resources, emits considerable pollutants, and generates substantial waste. Green, Lean, Six Sigma (GLS) is an emerging paradigm to control waste, carbon footprint, resource conservation, non-value-added activities, and cost. However, limited focus has been given to the risks involved in GLS construction projects (GLSCPs). This research explored risk factors (RFs) to GLSCPs based on literature review and expert judgments. Brainstorming sessions were conducted to validate the RFs and establish mutual interactions among them through experts' opinions. A 4-level structural model was extracted through Interpretive structural modeling (ISM). The Matriced Impacts Croise's Multiplication Appliqée a UN Classement (MICMAC) was integrated to assess the 'driving' and 'dependence' power of the RFs. The results show that all RFs are crucial and impact GLSCPs, but the most critical are 'unstable inflation,' 'fluctuations in interest rate,' and 'fluctuations in exchange rate.' This study enhances managers' and policymakers' understanding of RFs associated with GLSCPs and supports effective risk management for successful GLS implementation in construction projects.

A Comparison of Psychometric Properties of the American Board of Anesthesiology's In-Person and Virtual Standardized Oral Examinations.

PURPOSE: The COVID-19 pandemic prompted training institutions and national credentialing organizations to administer examinations virtually. This study compared task difficulty, examiner grading, candidate performance, and other psychometric properties between in-person and virtual standardized oral examinations (SOEs) administered by the American Board of Anesthesiology. METHOD: This retrospective study included SOEs administered in person from March 2018 through March 2020 and virtually from December 2020 through November 2021. The in-person and virtual SOEs share the same structure, including 4 tasks of preoperative evaluation, intraoperative management, postoperative care, and additional topics. The Many-Facet Rasch Model was used to estimate candidate performance, examiner grading severity, and task difficulty for the in-person and virtual SOEs separately; the virtual SOE was equated to the in-person SOE by common examiners and all tasks. The independent-samples and partially overlapping-samples t tests were used to compare candidate performance and examiner grading severity between these 2 formats, respectively. RESULTS: In-person (n = 3,462) and virtual (n = 2,959) first-time candidates were comparable in age, sex, race and ethnicity, and whether they were U.S. medical school graduates. The mean (standard deviation [SD]) candidate performance was 2.96 (1.76) logits for the virtual SOE, which was statistically significantly better than that for the in-person SOE (mean [SD], 2.86 [1.75]; Welch independent-samples t test, P = .02); however, the effect size was negligible (Cohen d = 0.06). The difference in the grading severity of examiners who rated the in-person (n = 398; mean [SD], 0.00 [0.73]) vs virtual (n = 341; mean [SD], 0.07 [0.77]) SOE was not statistically significant (Welch partially overlapping-samples t test, P = .07). CONCLUSIONS: Candidate performance and examiner grading severity were comparable between the in-person and virtual SOEs, supporting the reliability and validity of the virtual oral exam in this large-volume, high-stakes setting.

Impact of internal metal ions in tea polysaccharides on antioxidant potential and suppression of cancer cell growth.

Four kinds of tea polysaccharides (MBTPS, MGTPS, ZBTPS, ZGTPS) were extracted from Maofeng black tea, Maofeng green tea,Ziyan black tea and Ziyan green tea, and then four tea polysaccharides (RMBTPS, RMGTPS, RZBTPS, RZGTPS) after metal removal were prepared. The physicochemical properties, antioxidant activity and inhibitory activity on cancer cell proliferation of the above polysaccharides were studied. The composition analysis shows that these tea polysaccharides were glycoproteins complexes, composed of a variety of monosaccharides, and the removal of metal ions did not lead to fundamental changes in the composition of polysaccharides. In vitro activity, after removing metal ions, the ABTS free radicals scavenging ability and reducing power of tea polysaccharides were decreased, and the inhibitory effect on proliferation of H22 cells weakened. There was a great correlation between metal elements Al and Ni and biological activity. The results showed that the metal ions in tea polysaccharides, especially Al and Ni, had positive effects on biological activity.