Does Game-Based Learning Promote Academic Engagement Among Millennial Oral and Maxillofacial Surgery Residents?

BACKGROUND: House staff participating in surgical residency programs are often comprised of adult learners from the millennial generation (Gen Y). With the increasing gap in both age and learning styles between these residents and their educators, their educators are struggling to keep them academically engaged. PURPOSE: The purpose of this study was to measure the association between implementing a digital online Jeopardy! (Sony Pictures Studios, Culver City, CA) style game (digital game) (Factile Solace Creative, LLC, Melbourne Beach, FL) into oral maxillofacial surgery (OMS) resident didactic training and Oral and Maxillofacial Surgery In-service Training Examination (OMSITE) scores. STUDY DESIGN, SETTING, SAMPLE: This study was a retrospective cohort study conducted at The New York Presbyterian Hospital/Weill Cornell Medicine. OMS residents who took the OMSITE examination were included in the study. Exclusion criteria included OMS residents who did not take the OMSITE in a given year. INDEPENDENT VARIABLE: The independent variable was the timing of the implementation of the digital game, divided into before and after implementation. MAIN OUTCOME VARIABLES: The primary outcome variable was OMSITE scores. COVARIATES: Covariates included demographics (age, gender, and race), year of training, and number of examination attempts. ANALYSES: Descriptive and bivariate statistics included Fisher's exact test and Wilcoxon rank sum test. Linear mixed modeling was performed to take into account multiple observations per participants. RESULTS: The sample composed of 14 resident subjects with a median age of 27.5 (27.0, 28.7) years. Females represented 29% of the cohort. Seventy-one percent of the participants were Post Graduate Year 1. The median (interquartile range) OMSITE score preimplementation: 61 (48, 71) and postimplementation: 79 (68, 87). On average, the OMSITE scores improved significantly following the implementation of this study modality (P < .001). CONCLUSION AND RELEVANCE: Digital games may be an effective learning tool to prepare residents for OMSITE by promoting academic engagement.

The Cost of Poor Mental Health in Total Joint Arthroplasty.

BACKGROUND: The purpose of this analysis was to evaluate (1) the impact of depression on resource utilization and financial outcomes in bundled total joint arthroplasty (TJA) and (2) whether similar effects are seen using baseline patient-reported outcome scores. METHODS: All elective bundled TJA cases from 2017 to 2018 at an academic system in the New York City area were included. We analyzed variables associated with cost differences seen between patients with and without depression, and between patients with low (<40th percentile) and high baseline (>60th percentile) Veterans RAND 12-Item Health Survey mental component scores (MCSs). We also analyzed whether depression or low MCS could predict worse financial outcomes. RESULTS: Our population included 825 patients, 418 with patient-reported outcome scores data. Depression was associated with higher rates of skilled nursing facility (SNF) discharge (42.7% vs 36.5%, P = .04), SNF payments ($16,200 vs $12,100, P = .0002), and average total episode costs ($31,000 vs $27,000, P = .04). Depression predicted bundle cost to be greater than target price (OR 1.82, 95% CI: 1.04-.16; P = .04) and SNF payment greater than 75th percentile (OR: 1.91; 95% CI: 1.00-3.65; P < .05). Similar effects were not seen using MCS. CONCLUSION: This is the first study to determine that depression predicts bundle cost greater than target price and SNF payment greater than 75th percentile. Our results emphasize the importance of accurate preoperative assessment of mental health in optimization of care, focusing on attenuating the increased SNF payments associated with depression. As similar effects were not seen using MCS, future studies should analyze the use of validated screening tools for depression, such as the PHQ-9, for more accurate assessments of patient mental health in TJA.

Electronic health records and blockchain interoperability requirements: a scoping review.

Objective: The purpose of this study was to conduct a scoping review of publications that explored blockchain technology in the context of interoperability and challenges of electronic health record (EHR) implementations. We synthesize the literature regarding standards and security, specifically regulation, regulatory operability, and conformance to standards. We review open practitioner questions that were not addressed in the studies as directions for further research. Materials and Methods: We conducted a literature search in the OVID databases (Medline and Embase) on terms blockchain, implementation, interoperability, EHRs, security, and standards. The search resulted in 152 nonduplicate, peer-reviewed manuscripts, of which 15 were relevant to our objective and included for synthesis. Results: Based on the search results, we analyzed the adoption of blockchain technology in the healthcare systems and challenges to EHR implementation of blockchain. From the synthesized research, we categorized and reported compelling factors of blockchain for EHR integration using current knowledge on blockchain research standardization and architectural challenges. Discussion: Our research showed promise in implementing blockchain technology associated with EHRs, especially with Health Information Exchanges. The studies relevant for both EHR (n = 5) and blockchain (n = 10) reported compelling factors and limitations of the architecture. Security (n = 4) and interoperability (n = 4) features were reported as compelling requirements with lingering challenges. Standardization literature (n = 3) reported implementation challenges. Conclusion: This study shows promise in implementing blockchain technology within EHR systems. The adoption is increasing; however, multiple implementation challenges remain from architectural perspectives (eg, scalability and performance), to security challenges (eg, legal requirements), and standard perspectives including patient-matching problems.

Roundup negatively impacts the behavior and nerve function of the Madagascar hissing cockroach (Gromphadorhina portentosa).

Glyphosate is the active ingredient in Roundup formulations. Glyphosate-based herbicides are used globally in agriculture, forestry, horticulture, and in urban settings. Glyphosate can persist for years in our soil, potentially impacting the soil-dwelling arthropods that are primary drivers of a suite of ecosystem services. Furthermore, although glyphosate is not generally classified as neurotoxic to insects, evidence suggests that it may cause nerve damage in other organisms. In a series of experiments, we used food to deliver environmentally realistic amounts of Roundup ready-to-use III, a common 2% glyphosate-based herbicide formulation that lists isopropylamine salt as its active ingredient, to Madagascar hissing cockroaches. We then assessed the impact of contamination on body mass, nerve health, and behavior. Contaminated food contained both 30.6 mg glyphosate and so-called inert ingredients. Food was refreshed weekly for 26-60 days, depending on the experiment. We found that consumption of contaminated food did not impact adult and juvenile survivorship or body weight. However, consumption of contaminated food decreased ventral nerve cord action-potential velocity by 32%, caused a 29% increase in respiration rate, and caused a 74.4% decrease in time spent on a motorized exercise wheel. Such changes in behavior may make cockroaches less capable of fulfilling their ecological service, such as pollinating or decomposing litter. Furthermore, their lack of coordination may make them more susceptible to predation, putting their population at risk. Given the decline of terrestrial insect abundance, understanding common risks to terrestrial insect populations has never been more critical. Results from our experiments add to the growing body of literature suggesting that this popular herbicide can act as a neurotoxin.