Imprecise Clinical Assessments and Inaccurate Grades: Family Medicine Clerkship Director Perspectives.

BACKGROUND AND OBJECTIVES: As application to residency programs becomes increasingly competitive, educational leaders face growing student concern about imprecise clinical assessments and clerkship grades. METHODS: As part of a large annual survey of family medicine clerkship directors (FMCDs), 10 questions were disseminated in May 2023 about perceived levels of imprecise assessments by faculty. We aimed to determine to what extent respondents felt their institution's evaluation system propagated inaccurate grading. RESULTS: A total of 52% of 169 FMCDs responded to the survey. Of these, 7% of respondents were completely confident that their preceptors would give two students of identical competence the same clinical evaluation rating. FMCDs estimated that an average of 38% of their preceptors inaccurately rate student performance. Most clerkships use an Honors/High Pass/Pass/Fail grading system. We found that 51% of FMCDs prefer to use a different grading paradigm than they currently use. We asked FMCDs to estimate the percentage of students that expressed concern over inaccurate preceptor ratings. Grading systems with more tiers were associated with a higher percentage of concerned students. CONCLUSIONS: Clerkship grades are widely used by residency program directors to classify and differentiate student applicants. We identified a significant concern from FMCDs that clinical evaluation ratings can vary greatly. Given the high stakes and perceived inaccuracy of clerkship grading, we recommend continued investigation into the appropriate weighing and usage of clinical evaluations. Continued exploration is recommended to develop grading paradigms centered on criterion-based assessment.

An Overview of Hereditary Angioedema for the Primary Care Physician.

Hereditary angioedema is a rare autosomal dominant condition characterized by episodes of swelling of the upper airway, intestines, and skin. The disorder is characterized by deficiency in C1 esterase inhibitor (C1-INH) or a decrease in functional C1-INH. Treatment options include on demand therapy (treatment of acute attacks), long-term prophylaxis, and short-term prophylaxis. Corticosteroids, epinephrine, and antihistamines are not effective for this form of angioedema. The high mortality in patients undiagnosed underscores a need for broader physician awareness to identify these patients and initiate therapy.

Empowering Low-Income Patients with Home Blood Pressure Monitors to Improve Hypertension Control.

INTRODUCTION: Effective management of hypertension (HTN) is a priority in primary care. With telehealth now considered a staple care delivery method, uninsured and low-income patients without home blood pressure (BP) monitors may need additional attention and resources to achieve successful HTN control. METHODS: This prospective study at an underserved community clinic assessed the impact of distributing free BP monitors on patients' HTN control and therapy adherence. Enrollees were randomized into 2 groups, both completing 4 primary care physician (PCP) visits over a 6-month study period. Intervention participants collected home BP readings to report to their PCP and comparison participants completed an equivalent number of visits without having home BP data available for their PCP to review. Both groups completed an initial and final Therapy Adherence Scale (TAS) questionnaire. RESULTS: 263 patients were invited and 200 participants (mean age 50, 60% female, 19% Black, 67% Hispanic) completed the study. Intervention and comparison subjects featured comparable initial BP levels and TAS scores. After adjusting for age, race, ethnicity, sex, presence of diabetes and therapy adherence, intervention participants experienced higher odds of controlled HTN (OR 4.0; 95% Confidence Interval 2.1 to 7.7). A greater proportion of participants achieved BP control in the intervention arm compared with the comparison arm (82% vs 54% of participants, P < .001). TAS scores were higher in the intervention group (Mean = 44.1 vs 41.1; P < .001). DISCUSSION: The provision of free home BP monitors to low-income patients may feasibly and effectively improve BP control and therapy adherence.

Climate Change as a Social Determinant of Health: An Interactive Case-Based Learning Activity.

Introduction: Despite consensus on climate change's impact on humans, medical schools have not widely adopted inclusion of environmental topics into their mandatory curriculum. This educational activity explicitly addresses climate change as one of the environmental determinants of health (EDH). Methods: We developed a required, 1-hour module for all first-year medical students. This interactive, case-based, small-group activity was incorporated into a curriculum within an advising program but could be run independently. Before and after the session, participants completed evaluations assessing knowledge gains and attitude shifts. Results: Of 183 first-year students, 155 completed both pre- and postmodule surveys. Participants' rating increased on the postmodule survey item "priority should be given to the discussion of EDH in medical education." The Wilcoxon signed rank test determined this difference in priority was statistically significant (p < .001). Reported strengths of this activity included the cases, informative content on EDH, the video, the discussion, and highlighted EDH resources. Suggested areas for improvement included more information on how to apply concepts to clinical contexts, guidance on how to engage in EDH concepts, and more discussion time. As a result of the module, students planned to engage in recycling, reduced consumption, advocacy, and changes to mode of transportation. Discussion: Climate change remains the greatest global threat to human health, and future physicians must be equipped to educate patients and policymakers on the harms of environmental hazards. This brief yet effective module offers one approach to incorporating this topic into medical school curricula.

Hereditary Angioedema: A Disease Often Misdiagnosed and Mistreated.

Hereditary angioedema is a rare autosomal dominant condition characterized by episodes of swelling of the upper airway, intestines, and skin. The disorder is characterized by deficiency in C1 esterase inhibitor (C1-INH) or a decrease in functional C1-INH. Treatment options include on demand therapy (treatment of acute attacks), long-term prophylaxis, and short-term prophylaxis. Corticosteroids, epinephrine, and antihistamines are not effective for this form of angioedema. The high mortality in patients undiagnosed underscores a need for broader physician awareness to identify these patients and initiate therapy.

Metaheuristic secured transmission in Telecare Medical Information System (TMIS) in the face of post-COVID-19.

The outbreak of novel corona virus had led the entire world to make severe changes. A secured healthcare data transmission has been proposed through Telecare Medical Information System (TMIS) based on metaheuristic salp swarm. Patients need proper medical remote treatments in this Post-COVID-19 time from their quarantines. Secured transmission of medical data is a significant challenge of digitally overwhelmed environment. The objective is to impart the patients' data by encryption with confidentiality and integrity. Eavesdroppers can carry sniffing and spoofing in order to deluge the data. In this paper, a novel scheme on metaheuristic salp swarm based intelligence has been sculptured to encrypt electrocardiograms (ECG) for data privacy. Metaheuristic approach has been blended in cryptographic engineering to address the TMIS security issues. Session key has been derived from the weight vector of the fittest salp from the salp population. The exploration and exploitation control the movements of the salps. The proposed technique baffles the eavesdroppers by the key strength and other robustness factors. The results, thus obtained, were compared with some existing classical techniques with benchmark results. The proposed MSE and RMSE were 28,967.85, and 81.17 respectively. The time needed to decode 128 bits proposed session key was 8.66 × 1052 years. The proposed cryptographic time was 8.8 s.

Comfort With Uncertainty in Medical Students and Their Residency Choice: A Residency Research Network of Texas Study.

BACKGROUND AND OBJECTIVES: Little is known about how comfort with uncertainty (CwU) influences career choice in medical students. The authors of this study examined the correlation between CwU and primary care career choice. METHODS: In academic years 2017-2018 and 2018-2019, the authors distributed surveys to third-year medical students from eight US medical schools, seven in Texas. The survey tool included two CwU scales and one comfort with ambiguity scale. Other questions covered career plans, family and personal background, and student debt. In the subjects' fourth year of medical school, authors obtained match data from the medical schools and the authors further communicated with the students where indicated. The primary outcome was the composite score of the three scales correlated to career choice, with a focus on primary care and family medicine. RESULTS: Among 642 participants, there was no difference in CwU scores between students who matched into primary care versus specialty fields (3.39 vs 3.37 average of three scales, P=.65, each individual scale NS) or family medicine (FM) vs all other fields (3.39 vs 3.37 average of three scales, P=.81). Other bivariate predictors of FM choice were more similar than different to previous studies, such as osteopathic more likely than allopathic, lower family income, planning to care for underserved populations, and had a primary care role model. Logistic regression found the two biggest predictors of FM were osteopathic training and the importance of educating patients about health promotion and disease prevention. CONCLUSIONS: We found no correlation between CwU and medical student career choice for primary care or FM. We discuss confounding factors that may impact results, as well as recommendations for medication education and public policy.

A Novel Allosteric Inhibitor Targets PLK1 in Triple Negative Breast Cancer Cells.

While Polo-like kinase 1 (PLK1) inhibitors have shown promise in clinical settings for treating triple-negative breast cancer tumors and other solid tumors, they are limited by their ability to bind non-selectively to the ATP kinase domain. Therefore, we sought to develop a PLK1 allosteric inhibitor targeting the PLK1 T-loop (a switch responsible for activation) and evaluate its effects in triple-negative breast cancer cells. A novel compound, RK-10, was developed based on an in silico model, and its effects on specificity, viability, migration, and cell cycle regulation in MCF-10A and MDA-MB 231 cells were evaluated. When MDA-MB 231 cells were treated with 0−50 µg/mL RK-10, phospho-PLK1 (Thr-210) was decreased in cells cultured adherently and cells cultured as mammospheres. RK-10 significantly inhibited viability after 24 h; however, by 48 h, 25−50 µM RK-10 caused >50% reduction. RK-10 attenuated wound healing by up to 99.7% and caused S and G2/M cell cycle arrest, which was associated with increased p21 expression. We developed a novel allosteric inhibitor which mediates anti-proliferative and anti-migratory properties through targeting phospho-PLK1 (Thr-210) in mammospheres and causing S phase and G2/M cell cycle arrest. Further development of PLK1 allosteric inhibitors may be a promising approach for TNBC treatment.

Information Fusion in Autonomous Vehicle Using Artificial Neural Group Key Synchronization.

Information fusion in automated vehicle for various datatypes emanating from many resources is the foundation for making choices in intelligent transportation autonomous cars. To facilitate data sharing, a variety of communication methods have been integrated to build a diverse V2X infrastructure. However, information fusion security frameworks are currently intended for specific application instances, that are insufficient to fulfill the overall requirements of Mutual Intelligent Transportation Systems (MITS). In this work, a data fusion security infrastructure has been developed with varying degrees of trust. Furthermore, in the V2X heterogeneous networks, this paper offers an efficient and effective information fusion security mechanism for multiple sources and multiple type data sharing. An area-based PKI architecture with speed provided by a Graphic Processing Unit (GPU) is given in especially for artificial neural synchronization-based quick group key exchange. A parametric test is performed to ensure that the proposed data fusion trust solution meets the stringent delay requirements of V2X systems. The efficiency of the suggested method is tested, and the results show that it surpasses similar strategies already in use.

Cryptographic Engineering on COVID-19 Telemedicine: An Intelligent Transmission Through Recurrent Relation Based Session Key.

Constraints imposed due to the cameo of the novel corona virus has abruptly changed the operative mode of medical sciences. Most of the hospitals have migrated towards the telemedicine mode of services for the non-invasive and non-emergency patients during the COVID-19 time. The advent of telemedicine services has remotely rendered health services to different types of patients from their isolates. Here, the patients' medical data has to be transmitted to different physicians/doctors in a safe manner. Such data are to be secured with a view to restore its privacy clause. Cardio vascular diseases (CVDs) are a kind of cardiac disease related to blockage of arteries and veins. Cardiac patients are more susceptible to the COVID-19 attacks. They are advised to be treated though cardiac telemedicine services. This paper presents an intelligent and secured transmission of clinical cardiac reports of the patients through recurrence relation based session key. Such reports were made through the following confusion matrix operations. The beauty of this technique is that confusion matrices are transferred to specified number of cardiologists with additional secret shares encapsulation. The case of robustness checking, transparency and cryptographic engineering has been tested under different set of inputs. The total cryptographic time observed here was noted as 469.92  ms, 3 ms 74.45 , 502.88 ms, 361.38 ms, 493.12 ms, and 660.16 ms, which is acceptable when compared with other classical techniques. The estimation of correlation coefficient in proposed variables has been recorded as - 0.362 . Different types of result and its analysis proves the efficiency of the proposed technique. It will provide more security in medical data transmission, especially in the needy hours of COVID-19 pandemic.

Episode of COVID-19 Telepsychiatry Session Key Origination Upon Swarm-Based Metaheuristic and Neural Perceptron Blend.

Current pandemic has immensely disrupted the entire world in the field of medical science. The novel corona virus has not only brought physical sufferings but also huge psychiatric complications on the patients. Treating the psychiatric issues from remote locations can be best done through telepsychiatry. Patients can virtually consult with psychiatrists from their quarantines. However, during this COVID-19 era of excessive digital transactions, patients' data security mechanism is a challenging issue to prevent from intruding. Efficient cryptographic algorithms are used depending on the transmission key. This paper deals with the episode of transmission key origination with the help of salp swarm algorithm and neural perceptron. Threshold cryptography provides the generation of the partial shares of the E-prescriptions, which can be restructured on the threshold set of shares. The property of lossless theory has been implemented on the proposed set of telepsychiatry shares. A mask matrix has been proposed to diffuse the E-prescription shares into the specified group of users. The transmission key validation has been carried out in this paper based on myriad statistical tests. Chi Square test, χ 2 = 17.04 has been observed under 5% level of significance. Thus, there exists no similarity between the bit patterns of the transmission key. A correlation coefficient between the average encryption and decryption time and the functional time has been estimated as 0.92076 and 0.72340, respectively. Also, it confirms the data resistance against the opponents in terms of different mathematical and statistical methods.

ICT-Guided Glycemic Information Sharing Through Artificial Neural Telecare Network.

The revolutionary and retrospective changes in the use of ICT have propelled the introduction of telecare health services in the crucial corona virus pandemic times. There have been revolutionary changes that happened with the advent of this novel corona virus. The proposed technique is based on secured glycemic information sharing between the server and users using artificial neural computational learning suite. Using symmetric Tree Parity Machines (TPMs) at the server and user ends, salp swarm-based session key has been generated for the proposed glycemic information modular encryption. The added taste of this paper is that without exchanging the entire session key, both TPMs will get full synchronized in terms of their weight vectors. With rise in the intake of highly rated Glycemic Indexed (GI) foods in today's COVID-19 lockdown lifestyle, it contributes a lot in the formation of cavities inside the periodontium, and several other diseases likes of COPD, Type I and Type II DM. GI-based food pyramid depicts the merit of the food in the top to bottom spread up approach. High GI food items helps in more co-morbid diseases in patients. It is recommended to have foods from the lower radars of the food pyramid. The proposed encryption with salp swarm-generated key has been more resistant to Man-In-The-Middle attacks. Different mathematical tests were carried on this proposed technique. The outcomes of those tests have proved its efficacy, an acceptance of the proposed technique. The total cryptographic time observed on four GI modules was 0.956 ms, 0.468 ms, 0.643 ms, and 0.771 ms.

Improving Student Confidence With Electronic Health Record Order Entry.

INTRODUCTION: Despite near-universal utilization of electronic health records (EHRs) by physicians in practice, medical students in most ambulatory settings gain limited experience with placing EHR orders. In this study, an individual preceptor site investigated the usefulness of a targeted curriculum in improving students' EHR confidence and clinical reasoning skills. METHODS: Family medicine clerkship students assigned to one community health center were invited to participate in this prospective, survey-based study. In their first week, students observed a preceptor performing EHR tasks. For the remainder of the 4-week clerkship, students utilized decision support tools, assigned a working diagnosis, entered unsigned orders in the EHR, proposed an assessment, and discussed a plan with a preceptor. Students completed weekly questionnaires to self-report confidence across several EHR domains while preceptors synchronously evaluated students' accuracy with entering orders correctly. RESULTS: From February 2017 to March 2020, all 49 eligible students completed the study. One hundred percent of students reported that placing EHR orders was beneficial to their medical education. The difference over time in learner confidence with placing EHR orders was statistically significant across every domain (eg, writing prescriptions, ordering labs and imaging). Preceptors' evaluations of students' accuracy with placing orders also showed significant improvement between each week. CONCLUSION: Clerkship-wide EHR training may be limited by multiple sites with multiple EHR products. This pilot study suggests that committed faculty at an individual preceptor site can offer a targeted curriculum to help students develop EHR confidence. We propose other preceptors similarly offer students this opportunity to maximize clerkship education.

Replacing winter rice in non-traditional areas by strawberry reduces arsenic bioaccumulation, and improves water productivity and profitability.

Use of huge amount (1450-1650 mm) of arsenic contaminated (14.0-24.5 mg l-1) ground water to irrigate winter rice resulted in high deposition of arsenic (As) in the topsoil and in rice grains, posing a serious threat to soil and human health of the Bengal basin. Strawberry (Fragaria × ananassa Duch.) requires 250 mm irrigation and fetches 3.5 times more net return over the winter rice, and can be grown as an alternate crop in place of winter rice to save the environment. In comparison to rice As load in edible parts of strawberry reduced from 865 to 39 µg kg-1. Deficit irrigation (0.8 and 0.6 crop evapotranspiration, ETc) to strawberry further reduced total as well as different As species load in fruits. Jute and straw mulches recorded lower As in fruits over other mulches. Drip irrigation to recharge full or 80% of ETc loss and use of jute agrotextile surface mulch maximized root growth and yield in strawberry, benefit:cost ratio, and energy efficiency and productivity. Results demonstrate that strawberry cultivation in non-traditional winter rice growing areas of Bengal basin can potentially benefit millions of people by reducing As load in food chains, ensuring higher returns, and aid in reviving the local jute agrotextile industry.