Metal-Mediated Catalytic Polarization Transfer from para Hydrogen to 3,5-Dihalogenated Pyridines.

The neutral catalysts [IrCl(H)2(NHC)(substrate)2] or [IrCl(H)2(NHC)(substrate)(sulfoxide)] are used to transfer polarization from para hydrogen (pH2) to 3,5-dichloropyridine and 3,5-dibromopyridine substrates. This is achieved in a rapid, reversible, and low-cost process that relies on ligand exchange within the active catalyst. Notably, the sulfoxide-containing catalyst systems produced NMR signal enhancements between 1 and 2 orders of magnitude larger than its unmodified counterpart. Consequently, this signal amplification by reversible exchange hyperpolarization method can boost the 1H, 13C, and 15N nuclear magnetic resonance (NMR) signal intensities by factors up to 4350, 1550, and 46,600, respectively (14.0, 1.3, and 15.4% polarization). In this paper, NMR and X-ray crystallography are used to map the evolution of catalytically important species and provide mechanistic rational for catalytic efficiency. Furthermore, applications in spontaneous radiofrequency amplification by stimulated emission and NMR reaction monitoring are also shown.

Developing Ethics and Equity Principles, Terms, and Engagement Tools to Advance Health Equity and Researcher Diversity in AI and Machine Learning: Modified Delphi Approach.

BACKGROUND: Artificial intelligence (AI) and machine learning (ML) technology design and development continues to be rapid, despite major limitations in its current form as a practice and discipline to address all sociohumanitarian issues and complexities. From these limitations emerges an imperative to strengthen AI and ML literacy in underserved communities and build a more diverse AI and ML design and development workforce engaged in health research. OBJECTIVE: AI and ML has the potential to account for and assess a variety of factors that contribute to health and disease and to improve prevention, diagnosis, and therapy. Here, we describe recent activities within the Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity (AIM-AHEAD) Ethics and Equity Workgroup (EEWG) that led to the development of deliverables that will help put ethics and fairness at the forefront of AI and ML applications to build equity in biomedical research, education, and health care. METHODS: The AIM-AHEAD EEWG was created in 2021 with 3 cochairs and 51 members in year 1 and 2 cochairs and ~40 members in year 2. Members in both years included AIM-AHEAD principal investigators, coinvestigators, leadership fellows, and research fellows. The EEWG used a modified Delphi approach using polling, ranking, and other exercises to facilitate discussions around tangible steps, key terms, and definitions needed to ensure that ethics and fairness are at the forefront of AI and ML applications to build equity in biomedical research, education, and health care. RESULTS: The EEWG developed a set of ethics and equity principles, a glossary, and an interview guide. The ethics and equity principles comprise 5 core principles, each with subparts, which articulate best practices for working with stakeholders from historically and presently underrepresented communities. The glossary contains 12 terms and definitions, with particular emphasis on optimal development, refinement, and implementation of AI and ML in health equity research. To accompany the glossary, the EEWG developed a concept relationship diagram that describes the logical flow of and relationship between the definitional concepts. Lastly, the interview guide provides questions that can be used or adapted to garner stakeholder and community perspectives on the principles and glossary. CONCLUSIONS: Ongoing engagement is needed around our principles and glossary to identify and predict potential limitations in their uses in AI and ML research settings, especially for institutions with limited resources. This requires time, careful consideration, and honest discussions around what classifies an engagement incentive as meaningful to support and sustain their full engagement. By slowing down to meet historically and presently underresourced institutions and communities where they are and where they are capable of engaging and competing, there is higher potential to achieve needed diversity, ethics, and equity in AI and ML implementation in health research.

From Veld to Coast: Towards an Understanding of the Diverse Landscapes' Uses by Past Foragers in Southern Africa.

In this brief contribution, we outline the aims of a collection entitled "From veld to coast: towards an understanding of the diverse landscapes' uses by past foragers in southern Africa," and we define its chronological, geographic and thematic framework.

Rivalries for attention: insights from a realist evaluation of a postgraduate competency-based medical education implementation in Canada.

BACKGROUND: Implementing competency-based medical education (CBME) in post-graduate medical education (PGME) is a complex process that requires multiple systemic changes in a complex system that is simultaneously engaged in multiple initiatives. These initiatives often compete for attention during the implementation of CBME and produce unintended and unanticipated consequences. Understanding the impact of this context is necessary for evaluating the effectiveness of CBME. The purpose of the study was to identify factors, such as contexts and processes, that contribute to the implementation of CBME. METHODS: We conducted a realist evaluation using data collected from 15 programs through focus groups with residents (2 groups, n = 16) and faculty (one group, n = 8), and semi-structured interviews with program directors (n = 18), and program administrators (n = 12) from 2018 to 2021. Data were analyzed using a template analysis based on a coding framework that was developed from a sample of transcripts, the context-mechanism-outcomes framework for realist evaluations, and the core components of CBME. RESULTS: The findings demonstrate that simultaneous initiatives in the academic health sciences system creates a key context for CBME implementation - rivalries for attention - and specifically, the introduction of curricular management systems (CMS) concurrent to, but separate from, the implementation of CBME. This context influenced participants' participation, communication, and adaptation during CBME implementation, which led to change fatigue and unmet expectations for the collection and use of assessment data. CONCLUSIONS: Rival initiatives, such as the concurrent implementation of a new CMS, can have an impact on how programs implement CBME and greatly affect the outcomes of CBME. Mitigating the effects of rivals for attention with flexibility, clear communication, and training can facilitate effective implementation of CBME.

Ostrich eggshell beads from Ga-Mohana Hill North Rockshelter, southern Kalahari, and the implications for understanding social networks during Marine Isotope Stage 2.

Ostrich eggshell (OES) beads from southern African archaeological contexts shed light on past traditions of personal ornamentation, and they are also argued to provide a proxy for understanding past social networks. However, OES beads are often understudied and not reported on in detail. In particular, there has been little research on OES bead variation during Marine Isotope Stage 2 (29,000-12,000 years ago) which includes the Last Glacial Maximum when changing climatic conditions are hypothesized to have significant impact on forager social networks. Here, we present the first technological analysis of terminal Pleistocene OES beads and fragments in the Kalahari from the ~15 ka levels at Ga-Mohana Hill North Rockshelter. We contextualise these findings through comparison with coeval OES bead assemblages across southern Africa during MIS 2. Results indicate that OES beads were manufactured at Ga-Mohana Hill North during the terminal Pleistocene occupation, based on the presence of most stages of bead manufacture. The review shows that OES beads were present across southern Africa through MIS 2, suggesting that culturing of the body was an embodied and persistent practice during that time. While the importance of OES beads as decorative objects was shared by populations across southern Africa, variation in bead diameters indicate that there was stylistic variation.

Clinical photography processes (ClinPhoto) study for photo diversity.

Although clinical photography serves an important role in the education of clinicians, there is still a disparity of darker skin tones in the photographs used for medical education. This disparity results in a skill deficit for clinicians because the differences in skin pigmentation change the appearance of visible diseases so that it is essential for students and trainees to have examples of clinical photographs on varying skin tones. To effectively address the problem, we need to understand the complex sociotechnical processes involved in clinical photography, which is more than simply the act of taking a photograph. Therefore, we conducted semi-structured interviews on clinical photography with 10 clinicians, 1 medical photographer, and 1 clinical administrator at a tertiary academic medical centre. The interviews revealed 5 deductive themes based on the questions and 19 inductive codes within those themes on how clinical photography is conducted. Analysis of the themes through a lens of critical theory showed how simple awareness of the disparity has not led to interventions for the poor representation of varying skin tones in photographs for medical education and also suggests initial next steps.

A Rapid Realist Review of Effective Mental Health Interventions for Individuals with Chronic Physical Health Conditions during the COVID-19 Pandemic Using a Systems-Level Mental Health Promotion Framework.

The 2020 global outbreak of COVID-19 exposed and heightened threats to mental health across societies. Research has indicated that individuals with chronic physical health conditions are at high risk for suffering from severe COVID-19 illness and from the adverse consequences of public health responses to COVID-19, such as social isolation. This paper reports on the findings of a rapid realist review conducted alongside a scoping review to explore contextual factors and underlying mechanisms or drivers associated with effective mental health interventions within and across macro-meso-micro systems levels for individuals with chronic physical health conditions. This rapid realist review extracted 14 qualified studies across 11 countries and identified four key mechanisms from COVID-19 literature-trust, social connectedness, accountability, and resilience. These mechanisms are discussed in relation to contextual factors and outcomes reported in the COVID literature. Realist reviews include iterative searches to refine their program theories and context-mechanism-outcome explanations. A purposive search of pre-COVID realist reviews on the study topic was undertaken, looking for evidence of the robustness of these mechanisms. There were differences in some of the pre-COVID mechanisms due to contextual factors. Importantly, an additional mechanism-power-sharing-was highlighted in the pre-COVID literature, but absent in the COVID literature. Pre-existing realist reviews were used to identify potential substantive theories and models associated with key mechanisms. Based on the overall findings, implications are provided for mental health promotion policy, practice, and research.

Interventions to Support Mental Health among Those with Health Conditions That Present Risk for Severe Infection from Coronavirus Disease 2019 (COVID-19): A Scoping Review of English and Chinese-Language Literature.

This study aimed to address knowledge gaps related to the prevention and management of mental health responses among those with a condition that presents risk of severe COVID-19 infection. A scoping review that mapped English and Chinese-language studies (2019-2020) located in MEDLINE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Sociological Abstracts, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Airiti Library was undertaken. Search terms related to COVID-19, mental health, and physical health were used and articles that included all three of these factors were extracted (n = 77). With the exception of one hospital-based pilot study, there were no intervention studies targeting mental health in those at risk of severe COVID-19 infection. Promising practices such as integrated care models that appropriately screen for mental health issues, address health determinants, and include use of digital resources were highlighted. Patient navigator programs, group online medical visits, peer support, and social prescribing may also support those with complex needs. Future policies need to address digital health access inequities and the implementation of multi-integrated health and social care. Furthermore, research is needed to comprehensively assess multi-integrated interventions that are resilient to public health crises.

Innovative Homo sapiens behaviours 105,000 years ago in a wetter Kalahari.

The archaeological record of Africa provides the earliest evidence for the emergence of the complex symbolic and technological behaviours that characterize Homo sapiens1-7. The coastal setting of many archaeological sites of the Late Pleistocene epoch, and the abundant shellfish remains recovered from them, has led to a dominant narrative in which modern human origins in southern Africa are intrinsically tied to the coast and marine resources8-12, and behavioural innovations in the interior lag behind. However, stratified Late Pleistocene sites with good preservation and robust chronologies are rare in the interior of southern Africa, and the coastal hypothesis therefore remains untested. Here we show that early human innovations that are similar to those dated to around 105 thousand years ago (ka) in coastal southern Africa existed at around the same time among humans who lived over 600 km inland. We report evidence for the intentional collection of non-utilitarian objects (calcite crystals) and ostrich eggshell from excavations of a stratified rockshelter deposit in the southern Kalahari Basin, which we date by optically stimulated luminescence to around 105 ka. Uranium-thorium dating of relict tufa deposits indicates sporadic periods of substantial volumes of fresh, flowing water; the oldest of these episodes is dated to between 110 and 100 ka and is coeval with the archaeological deposit. Our results suggest that behavioural innovations among humans in the interior of southern Africa did not lag behind those of populations near the coast, and that these innovations may have developed within a wet savannah environment. Models that tie the emergence of behavioural innovations to the exploitation of coastal resources by our species may therefore require revision.

Twelve tips for designing assignments that foster independence in learning.

Independent learning refers to opportunities in which responsibility for learning shifts to learners. Providing health professions learners with independent learning opportunities can be challenging because of the often highly structured curricula of health professions education. Structured independent learning assignments that give learners the opportunity to begin developing the skills and strategies to take on self-directed opportunities in the future may lend themselves to these contexts. However, in health professions education contexts, few guidelines exist for designing effective assignments that foster independence in learning. These twelve tips provide recommendations for how to improve structured independent learning assignments for health professions learners and help them develop the skills and experience required for more self-directed opportunities and for lifelong learning.

COVID-19 and 'immune boosting' on the internet: a content analysis of Google search results.

OBJECTIVE: The spread of misinformation has accompanied the coronavirus pandemic, including topics such as immune boosting to prevent COVID-19. This study explores how immune boosting is portrayed on the internet during the COVID-19 pandemic. DESIGN: Content analysis. METHODS: We compiled a dataset of 227 webpages from Google searches in Canada and the USA using the phrase 'boost immunity' AND 'coronavirus' on 1 April 2020. We coded webpages for typology and portrayal of immune boosting and supplements. We recorded mentions of microbiome, whether the webpage was selling or advertising an immune boosting product or service, and suggested strategies for boosting immunity. RESULTS: No significant differences were found between webpages that appeared in the searches in Canada and the USA. The most common types of webpages were from news (40.5%) and commercial (24.7%) websites. The concept of immune boosting was portrayed as beneficial for avoiding COVID-19 in 85.5% of webpages and supplements were portrayed as beneficial in 40% of the webpages, but commercial sites were more likely to have these portrayals. The top immune boosting strategies were vitamin C (34.8%), diet (34.4%), sleep (34.4%), exercise (30.8%) and zinc (26.9%). Less than 10% of the webpages provide any critique of the concept of immune boosting. CONCLUSIONS: Pairing evidence-based advice for maintaining one's health (eg, healthy diet, exercise, sleep) with the phrase immune boosting and strategies lacking in evidence may inadvertently help to legitimise the concept, making it a powerful marketing tool. Results demonstrate how the spread of misinformation is complex and often more subtle than blatant fraudulent claims.

12 Tips for Pivoting to Teaching in a Virtual Environment.

This article was migrated. The article was marked as recommended. COVID-19 has necessitated a rapid shift to teaching in virtual environments across the educational spectrum. In this respect, instructors previously unfamiliar, or under-familiar, with virtual teaching environments need to learn quickly and effectively how these environments work and how they can be used to successfully deliver courses, especially within health professions education contexts. These twelve tips provide insight on the practice of teaching in virtual environments, from course design, to student engagement, to assessment practices, to maximising the potential that technology can provide for both the instructor and the students. Moreover, these tips inform virtual pedagogical practices in the health professions for all levels of experience.

Mapping session learning objectives to exam questions: How to do it and how to apply the results.

Background: The undergraduate pre-clerkship Population Health courses for University of Manitoba medical students underwent a mapping exercise to improve alignment between session learning objectives and the multiple choice questions (MCQs) used for learner assessment.Methods: Each learning objective was mapped to all related MCQs in the exam bank. Learning objectives not linked to any specific MCQs were identified. All MCQs in the exam bank were mapped back to the learning objectives and all MCQs not corresponding to a learning objective were identified. In total, 536 MCQ were mapped to 358 learning objectives.Results: Mapping results were shared with course leadership and instructors to affect practical changes in the Population Health courses, such as revisions and improvements to session learning objectives, and targeted development of new MCQs. Following the implementation of changes post-mapping exercise, our findings indicate a significant improvement in student satisfaction with the Population Health courses, although they did not have a discernable impact on exam performance.Conclusions: The mapping exercise required an initial investment of resources, but produced an MCQ database that can be regularly maintained to ensure alignment between learning objectives and assessment, thereby contributing to ongoing curriculum quality and improvement, and improved exam reliability and validity.

What Can Determine the Length of an Open Nonendoscopic Thyroidectomy Incision?

Objectives Surgeons are now utilizing small incisions when performing thyroidectomy. This study evaluated the association between patient weight, nodule size, and maximum thyroid diameter and the length of an open thyroidectomy incision. Study Design Retrospective analysis of 32 consecutive patients. Subjects and Methods Patient demographics, clinical exam, ultrasound findings, operative findings, and pathology were recorded. Results Of the 32 patients (81% women), 27 underwent a hemithyroidectomy. The mean patient weight was 194 lbs. The mean clinical nodule diameter was 3.46 cm, and the mean maximum thyroid diameter was 5.91 cm. The mean incision size was 5.13 cm. Independently, patient weight, maximum thyroid diameter, and maximum nodule diameter were shown in regression models to be statistically significant predictors of incision size. In stepwise regression analysis that included all three listed variables, maximum thyroid diameter was the most significant predictor of incision size ( p < 0.0001). Conclusions Surgeons may determine the length of the incision using clinical and radiologic parameters, but most probably use their subconscious clinical judgment and the challenge of utilizing a very small incision for this operation. This study has shown that maximum thyroid diameter is the most significant determinant for the incision but that nodule size and patient weight are also significant factors. This study is evidence-based medicine level III.

Identification of Eastern United States Reticulitermes Termite Species via PCR-RFLP, Assessed Using Training and Test Data.

Reticulitermes termites play key roles in dead wood decomposition and nutrient cycling in forests. They also damage man-made structures, resulting in considerable economic loss. In the eastern United States, five species (R. flavipes, R. virginicus, R. nelsonae, R. hageni and R. malletei) have overlapping ranges and are difficult to distinguish morphologically. Here we present a molecular tool for species identification. It is based on polymerase chain reaction (PCR) amplification of a section of the mitochondrial cytochrome oxidase subunit II gene, followed by a three-enzyme restriction fragment length polymorphism (RFLP) assay, with banding patterns resolved via agarose gel electrophoresis. The assay was designed using a large set of training data obtained from a public DNA sequence database, then evaluated using an independent test panel of Reticulitermes from the Southern Appalachian Mountains, for which species assignments were determined via phylogenetic comparison to reference sequences. After refining the interpretive framework, the PCR-RFLP assay was shown to provide accurate identification of four co-occurring species (the fifth species, R. hageni, was absent from the test panel, so accuracy cannot yet be extended to training data). The assay is cost- and time-efficient, and will help improve knowledge of Reticulitermes species distributions.

Head and neck skin cancer in the immunocompromised patient: a quantitative analysis.

BACKGROUND: Non-melanoma skin cancers (NMSC) are especially prone to develop in the immunosuppressed population. There is insufficient data regarding outcomes and mortality for immunosuppressed individuals with NMSC of the head and neck. CLINICAL QUESTION: What are the mortality indicators for immunosuppressed subjects with head and neck NMSC? METHODS: This retrospective chart review analyzes all immunosuppressed patients diagnosed with any stage NMSC at an academic tertiary care institution from 2006-2011. RESULTS: Thirty four patients are analyzed. Odds of mortality is significantly increased for patients who required multiple surgeries (adjusted odds ratio (aOR)=23.98, 95%CI=(1.411, 407.599)) and those who were immunocompromised secondary to leukemia (aOR=28.27, 95%CI=(1.838, 434.73)). CONCLUSION: Patients with leukemia and NMSC may have an increased risk of mortality compared to other immunocompromised patients with NMSC. Immunocompromised patients with NMSC may have a worse prognosis if multiple surgeries are required. Knowledge of mortality indicators may aid in the management of these immunocompromised patients.