AI-powered real-time annotations during urologic surgery: The future of training and quality metrics.

INTRODUCTION AND OBJECTIVE: Real-time artificial intelligence (AI) annotation of the surgical field has the potential to automatically extract information from surgical videos, helping to create a robust surgical atlas. This content can be used for surgical education and qualitative initiatives. We demonstrate the first use of AI in urologic robotic surgery to capture live surgical video and annotate key surgical steps and safety milestones in real-time. SUMMARY BACKGROUND DATA: While AI models possess the capability to generate automated annotations based on a collection of video images, the real-time implementation of such technology in urological robotic surgery to aid surgeon and training staff it is still pending to be studied. METHODS: We conducted an educational symposium, which broadcasted 2 live procedures, a robotic-assisted radical prostatectomy (RARP) and a robotic-assisted partial nephrectomy (RAPN). A surgical AI platform system (Theator, Palo Alto, CA) generated real-time annotations and identified operative safety milestones. This was achieved through trained algorithms, conventional video recognition, and novel Video Transfer Network technology which captures clips in full context, enabling automatic recognition and surgical mapping in real-time. RESULTS: Real-time AI annotations for procedure #1, RARP, are found in Table 1. The safety milestone annotations included the apical safety maneuver and deliberate views of structures such as the external iliac vessels and the obturator nerve. Real-time AI annotations for procedure #2, RAPN, are found in Table 1. Safety milestones included deliberate views of structures such as the gonadal vessels and the ureter. AI annotated surgical events included intraoperative ultrasound, temporary clip application and removal, hemostatic powder application, and notable hemorrhage. CONCLUSIONS: For the first time, surgical intelligence successfully showcased real-time AI annotations of 2 separate urologic robotic procedures during a live telecast. These annotations may provide the technological framework for send automatic notifications to clinical or operational stakeholders. This technology is a first step in real-time intraoperative decision support, leveraging big data to improve the quality of surgical care, potentially improve surgical outcomes, and support training and education.

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Abstract Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO Registration: CRD42021291707.

A comparative study of vision-related quality of life (VRQoL) among glaucoma and nonglaucoma patients at a tertiary care center of North India.

Purpose: Glaucoma influences vision-related quality of life (VRQoL) of an individual in various ways. There are very limited studies on the Indian population and the northern part of India. Therefore, we conducted the present study to evaluate VRQoL in glaucoma patients as well as the association between the severity of glaucoma and VRQoL. Methods: An institution-based, cross-sectional, analytical study was conducted from August 2022 to October 2022 involving 190 participants (95 glaucoma patients and 95 controls). The glaucoma quality of life-15 (GQL-15) questionnaire was explained in their vernacular language by the interviewer. The scoring was given according to the validated scoring algorithm for the questionnaire. Results: Mean GQL score in the control group was 19.66 ± 5.5 and in glaucoma cases was 32.8 ± 10.2, whereas the mean score of mild glaucoma cases was 22.3 ± 4.83, moderate glaucoma cases was 36.3 ± 4.09, and severe glaucoma cases was 47.24 ± 3.03. Therefore, as the severity of glaucoma increases, the GQL score also increases, indicating poorer quality of life. Visual field loss was strongly positively correlated (correlation coefficient = 0.759, P < 0.01) with the GQL-15 score, while a weaker positive correlation was found with best corrected visual acuity (BCVA), cup disc ratio, and duration of treatment. Conclusion: Besides controlling or reducing intraocular pressure (IOP) to the target level, the goal of glaucoma treatment should be to provide an individual with good functional vision to maintain an acceptable quality of life. It would also help in providing patients with the best possible treatment, not only in terms of good vision but also in maintaining or improving their overall quality of life.

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials.

OBJECTIVE: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. METHODS: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. RESULTS: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. CONCLUSION: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO REGISTRATION: CRD42021291707.

Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a meta-analysis of randomised controlled trials.

OBJECTIVE: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and clonidine as an adjuvant to local anesthetics in BPBs. METHODS: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. RESULTS: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02‒208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55‒185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25‒238.58; I2 = 99%; GRADE approach evidence- high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60‒2.41; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63‒10.66; I2 = %). CONCLUSION: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than clonidine.

No reason to leave: The effects of CEO diversity-valuing behavior on psychological safety and turnover for female executives.

An extensive body of research has shed light on the structural challenges and stereotypic barriers that lead female leaders to exit their organizations. However, we know little about the factors that mitigate these exits. In this study, we advance the literature by examining how the chief executive officers (CEO's) diversity-valuing behavior relates to female executives' likelihood of turnover. We integrate insights from the literature on gender inclusive leadership, turnover, and psychological safety to propose psychological safety as a key underlying mechanism for this outcome. We test and find support for our theory and hypotheses using a unique data set that combines primary survey data and archival data on turnover for a sample of 365 male and female executives from large U.S. public firms. Our findings show that CEO diversity-valuing behavior is associated with psychological safety for female executives and that psychological safety, in turn, mediates the effect on female executive turnover. We do not find these effects in men. Our study contributes to the literature on gender diversity and female leadership by shifting the conversation from discussing barriers constraining women's longevity to how CEOs enable female executives' retention through diversity-valuing behaviors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact of suspected adverse drug reactions on mortality and length of hospital stay in the hospitalised patients: a meta-analysis.

PURPOSE: To estimate the risk of mortality and length of stay in hospitalised patients who have experienced suspected adverse drug reactions (ADRs) as compared to patients who did not experience suspected ADRs. METHODS: A systematic literature search was conducted on databases for observational and randomised controlled studies conducted in any inpatient setting that reported deaths and/or length of hospital stay in patients who had suspected ADRs and did not have suspected ADRs during hospitalisation. PRISMA guidelines were strictly followed during the review. The methodological quality of included studies was assessed using a tool designed by Smyth et al. for the studies of adverse drug reactions. The meta-analytic summary of all-cause mortality was estimated using odds ratio-OR (95% CI) and length of stay using mean difference-MD (95% CI). Both outcomes were pooled using a random effect model (DerSimonian and Laird method). Subgroup and meta-regression were performed based on study variables: study design, age group, study ward, study region, types of suspected ADRs (ADRAd-suspected ADRs that lead to hospitalisation and ADRIn-suspected ADRs that occur following hospitalisation), study duration, sample size and study period. The statistical analysis was conducted through the 'Review manager software version 5.4.1 and JASP (Version 0.14.1)'. RESULTS: After screening 475 relevant articles, 55 studies were included in this meta-analysis. Patients having suspected ADRs had reported significantly higher odds of all-cause mortality [OR: 1.50 (95% CI: 1.21-1.86; I2 = 100%) than those patients who did not have suspected ADRs during hospitalisation. Study wards, types of suspected ADRs and sample size were observed as significant predictors of all-cause mortality (p < 0.05). Patients having suspected ADRs had reported significantly higher mean difference in hospital stay [MD: 3.98 (95% CI: 2.91, 5.05; I2 = 99%) than those patients who did not have suspected ADRs during hospitalisation. Types of suspected ADRs and study periods were observed as significant predictors of length of stay (p < 0.05). CONCLUSION: Suspected ADRs significantly increase the risk of mortality and length of stay in hospitalised patients. SYSTEMATIC REVIEW REGISTRATION: CRD42020176320.

Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a metaanalysis of randomised controlled trials

Abstract Objective: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. Methods: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. Results: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to Clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02-208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55-185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25-238.58; I2 = 99%; GRADE approach evidence-high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60-2.41 ; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63-10.66; I2 = %). Conclusion: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than Clonidine.

Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: To compare the efficacy and safety of intranasal ketamine with intranasal dexmedetomidine as a premedication in pediatric patients undergoing general anesthesia for elective surgery or other procedures. SOURCE: We conducted a systematic literature search in PubMed, PubMed Central, Scopus, LILACS, Google Scholar, the Cochrane Database of Systematic Reviews, and trial registries for randomized controlled trials (RCTs) comparing intranasal ketamine with intranasal dexmedetomidine as preanesthetic medication in elective surgery or other procedures in pediatric patients. We used Review Manager software version 5.4.1 for statistical analysis and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed the methodological quality of the included studies with the RoB 2 risk of bias tool. All outcomes were pooled using the Mantle-Haenszel method and a random-effects model. The quality of evidence was assessed using the GRADE approach. PRINCIPAL FINDINGS: Out of 2,445 full texts assessed, we included ten RCTs in the analysis. The efficacy outcomes did not fulfill the comparability criteria between intranasal ketamine and intranasal dexmedetomidine for sedation at parental separation (risk ratio [RR], 0.90; 95% confidence interval [CI], 0.79 to 1.04; I2 = 89%; GRADE evidence, low), mask acceptance (RR, 0.86; 95% CI, 0.66 to 1.13; I2 = 50%; GRADE evidence, low), and iv canulation (RR, 1.16; 95% CI, 0.79 to 1.69; I2 = 69%; GRADE evidence, very low). Intranasal ketamine-treated patients showed a higher incidence of nausea and vomiting (RR, 2.47; 95% CI, 1.24 to 4.91; I2 = 0; GRADE evidence, moderate). Significantly more bradycardia was observed in the intranasal dexmedetomidine group (RR, 0.16; 95% CI, 0.04 to 0.70; I2 = 40%; GRADE evidence, moderate) than in the ketamine group. CONCLUSION: The low to very low-quality evidence in this systematic review and meta-analysis of RCTs neither confirmed nor refuted comparable premedication efficacy of intranasal ketamine and dexmedetomidine in terms of parental separation, mask acceptance, and iv cannulation in a pediatric population. Clinical decision-making is likely to be influenced by differences in gastrointestinal and cardiovascular safety profiles. STUDY REGISTRATION: PROSPERO (CRD42021262516); registered 22 July 2021.

RéSUMé: OBJECTIF: Comparer l'efficacité et l'innocuité de la kétamine intranasale à la dexmédétomidine intranasale comme prémédication chez les patients pédiatriques bénéficiant d'une anesthésie générale pour une chirurgie élective ou d'autres interventions. SOURCES: Nous avons réalisé une recherche documentaire systématique dans les bases de données PubMed, PubMed Central, Scopus, LILACS, Google Scholar, ainsi que dans la base de données Cochrane des revues systématiques et dans les registres d'études pour en tirer les études randomisées contrôlées (ERC) comparant la kétamine intranasale à la dexmédétomidine intranasale comme médicament préanesthésique en chirurgie élective ou pour d'autres interventions chez les patients pédiatriques. Nous avons utilisé la version 5.4.1 du logiciel Review Manager pour l'analyse statistique et nous nous sommes conformés aux lignes directrices PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Nous avons évalué la qualité méthodologique des études incluses à l'aide de l'outil d'évaluation du risque de biais RoB 2. Tous les résultats ont été regroupés à l'aide de la méthode Mantle-Haenszel et d'un modèle à effets aléatoires. La qualité des données probantes a été évaluée à l'aide de l'approche GRADE. CONSTATATIONS PRINCIPALES: Sur les 2445 textes intégraux évalués, nous avons inclus dix ERC dans l'analyse. Les critères d'efficacité ne remplissaient pas les critères de comparabilité entre la kétamine intranasale et la dexmédétomidine intranasale pour la sédation lors de la séparation des parents (risque relatif [RR], 0,90; intervalle de confiance [IC] à 95 %, 0,79 à 1,04; I2 = 89 %; qualité des données probantes selon GRADE, faible), acceptation du masque (RR, 0,86; IC 95 %, 0,66 à 1,13; I2 = 50 %; qualité des données probantes selon GRADE, faible) et canulation IV (RR, 1,16; IC 95 %, 0,79 à 1,69; I2 = 69 %; qualité des données probantes selon GRADE, très faible). Les patients traités par kétamine intranasale ont montré une incidence plus élevée de nausées et vomissements (RR, 2,47; IC 95%, 1,24 à 4,91; I2 = 0; qualité des données probantes selon GRADE, modérée). Une proportion significativement plus élevée de cas de bradycardie a été observée dans le groupe dexmédétomidine intranasale (RR, 0,16; IC 95%, 0,04 à 0,70; I2 = 40 %; qualité des données probantes selon GRADE, modérée) comparativement au groupe kétamine. CONCLUSION: Les données probantes de qualité faible à très faible de cette revue systématique et méta-analyse des ERC n'ont ni confirmé ni infirmé l'efficacité comparable de la prémédication par kétamine ou dexmédétomidine intranasale, que ce soit en termes de séparation parentale, d'acceptation du masque ou de canulation IV dans une population pédiatrique. La prise de décision clinique est susceptible d'être influencée par les différences dans les profils d'innocuité gastro-intestinale et cardiovasculaire. ENREGISTREMENT DE L'éTUDE: PROSPERO (CRD42021262516); enregistrée le 22 juillet 2021.

Stress Classification and Vital Signs Forecasting for IoT-Health Monitoring.

Health monitoring embedded with intelligence is the demand of the day. In this era of a large population with the emergence of a variety of diseases, the demand for healthcare facilities is high. Yet there is scarcity of medical experts, technicians for providing healthcare to the people affected with some medical problem. This paper presents an Internet of Things (IoT) system architecture for health monitoring and how data analytics can be applied in the health sector. IoT is employed to integrate the sensor information, data analytics, machine intelligence and user interface to continuously track and monitor the health condition of the patient. Considering data analytics as the major part, we focused on the implementation of stress classification and forecasted the future values from the recorded data using sensors. Physiological vitals like Pulse, oxygen level percentage (SpO2), temperature, arterial blood pressure along with the patients age, height, weight and movement are considered. Various traditional and ensemble machine learning methods are applied to stress classification data. The experimental results have shown that a hypertuned random forest algorithm has given a better performance with an accuracy of 94.3%. In a view that knowing the future values in prior helps in quick decision making, critical vitals like pulse, oxygen level percentage and blood pressure have been forecasted. The data is trained with ML and neural network models. GRU model has given better performance with lower error rates of 1.76, 0.27, 5.62 RMSE values and 0.845, 0.13, 2.01 MAE values for pulse, SpO2 and blood pressure respectively.

Undiagnosed Accidental Blister Pack Pill Ingestion in Elderly.

Ingestion of foreign body is a common occurrence in children. Most of these foreign bodies pass through gastrointestinal tract without causing any symptom or complication. Sharp edgy objects have propensity to cause tear or damage to the mucosal linings of gastrointestinal tract. Here is an interesting case of unintentional ingestion of blister pack pill in an elderly, whose initial presentation was intestinal obstruction and later on developed intestinal perforation.

Molecular Breeding for Improving Productivity of Oryza sativa L. cv. Pusa 44 under Reproductive Stage Drought Stress through Introgression of a Major QTL, qDTY12.1.

Increasing rice production is quintessential to the task of sustaining global food security, as a majority of the global population is dependent on rice as its staple dietary cereal. Among the various constraints affecting rice production, reproductive stage drought stress (RSDS) is a major challenge, due to its direct impact on grain yield. Several quantitative trait loci (QTLs) conferring RSDS tolerance have been identified in rice, and qDTY12.1 is one of the major QTLs reported. We report the successful introgression of qDTY12.1 into Pusa 44, a drought sensitive mega rice variety of the northwestern Indian plains. Marker-assisted backcross breeding (MABB) was adopted to transfer qDTY12.1 into Pusa 44 in three backcrosses followed by four generations of pedigree selection, leading to development of improved near isogenic lines (NILs). Having a recurrent parent genome (RPG) recovery ranging from 94.7-98.7%, the improved NILs performed 6.5 times better than Pusa 44 under RSDS, coupled with high yield under normal irrigated conditions. The MABB program has been modified so as to defer background selection until BC3F4 to accelerate generational advancements. Deploying phenotypic selection alone in the early backcross generations could help in the successful recovery of RPG. In addition, the grain quality could be recovered in the improved NILs, leading to superior selections. Owing to their improved adaptation to drought, the release of improved NILs for regions prone to intermittent drought can help enhance rice productivity and production.

"Burnt by the spotlight": How leadership endorsements impact the longevity of female leaders.

Women entering leadership positions such as the Chief Executive Officer (CEO) role face barriers in the form of pervasive stereotypic expectations by which stakeholders implicitly evaluate their effectiveness. In this study, we examine the effects that a widely used organizational practice-leadership endorsements in the CEO succession announcement-has on female CEOs' longevity in the CEO role. In particular, we theorize that the leadership endorsements of incoming female CEOs that highlight their past achievements and competence violate stakeholders' prescriptive stereotypes, thereby increasing the likelihood of stakeholders viewing the female leaders through a stereotypical lens. Therefore, though well intentioned, leadership endorsements in female CEOs' succession announcements foment a stereotype threat situation that is likely to have long-term negative consequences for female leaders. We investigate and find support for this relationship using archival data for a sample of 91 female CEO successions among S&P 1500 and Fortune 500 firms between 1995 and 2012. Several post hoc analyses, including in-depth interviews with 31 female executives, further strengthen our findings and show that this effect does not occur among male CEO succession events. We also find that two key facets of the succession context work to ameliorate this negative relationship: the insider status of the female CEO and the number of female executives at the focal firm. Our findings suggest that ostensibly gender-neutral practices can have unintended negative consequences for female leaders. We conclude with a discussion of the theoretical and practical implications of our findings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Drought Tolerant Near Isogenic Lines of Pusa 44 Pyramided With qDTY2.1 and qDTY3.1, Show Accelerated Recovery Response in a High Throughput Phenomics Based Phenotyping.

Reproductive stage drought stress (RSDS) is a major challenge in rice production worldwide. Cultivar development with drought tolerance has been slow due to the lack of precise high throughput phenotyping tools to quantify drought stress-induced effects. Most of the available techniques are based on destructive sampling and do not assess the progress of the plant's response to drought. In this study, we have used state-of-the-art image-based phenotyping in a phenomics platform that offers a controlled environment, non-invasive phenotyping, high accuracy, speed, and continuity. In rice, several quantitative trait loci (QTLs) which govern grain yield under drought determine RSDS tolerance. Among these, qDTY2.1 and qDTY3.1 were used for marker-assisted breeding. A set of 35 near-isogenic lines (NILs), introgressed with these QTLs in the popular variety, Pusa 44 were used to assess the efficiency of image-based phenotyping for RSDS tolerance. NILs offered the most reliable contrast since they differed from Pusa 44 only for the QTLs. Four traits, namely, the projected shoot area (PSA), water use (WU), transpiration rate (TR), and red-green-blue (RGB) and near-infrared (NIR) values were used. Differential temporal responses could be seen under drought, but not under unstressed conditions. NILs showed significant level of RSDS tolerance as compared to Pusa 44. Among the traits, PSA showed strong association with yield (80%) as well as with two drought tolerances indices, stress susceptibility index (SSI) and tolerance index (TOL), establishing its ability in identifying the best drought tolerant NILs. The results revealed that the introgression of QTLs helped minimize the mean WU per unit of biomass per day, suggesting the potential role of these QTLs in improving WU-efficiency (WUE). We identified 11 NILs based on phenomics traits as well as performance under imposed drought in the field. The study emphasizes the use of phenomics traits as selection criteria for RSDS tolerance at an early stage, and is the first report of using phenomics parameters in RSDS selection in rice.

Anesthesia Learning in the Digital Age: Are Program Directors and Residents on the Same Page?

BACKGROUND: In our current digital age, textbooks have been supplemented or supplanted by multiple online modalities for knowledge acquisition. Trainees, often from a younger generation than their program directors (PDs), prefer asynchronous options such as podcasts, videos, and question banks. We sought to identify whether an educational gap exists between PDs and trainees regarding what is assigned and what is used. METHODS: A national cross-sectional survey was conducted in the United States in 2018-2019 to characterize anesthesiology resident and PD perceptions of academic knowledge acquisition. RESULTS: Of the 149 PDs, 85 completed the survey (57%). Of the 85 PDs, 36 forwarded the survey to residents. Of the 1414 residents who received the survey, 503 residents responded to the survey (36%). The PDs thought residents used didactics, assigned reading, and scheduled simulations more than residents reported (P < .001). Residents reported using self-directed learning more (P = .004). Most residents (74.1%) reported using textbooks or online reading materials. Those residents reporting >70th percentile on the In-Training Exam used textbooks or online materials more than those who reported low scores (<30th percentile; P = .001). CONCLUSIONS: There is a discrepancy between PD and resident views on where and how knowledge acquisition occurs. Asynchronous forms of education (especially podcasts) are popular, but they are rarely assigned by programs. Although residents have a wide variety of learning preferences, textbook and online reading may be associated with higher In-Training Exam scores (a common way that knowledge acquisition is measured). The PDs should consider providing multiple options for optimizing knowledge acquisition, including textbook reading, to meet resident preferences and maximize testing success.

Uncorrected Tetralogy of Fallot's: Anesthetic Challenges.

Tetrology of Fallot's (TOF) is the most common cause of cyanotic congenital heart disease, and accounts for 10% of all congenital heart diseases. Right to left shunting and hyperviscosity of blood predisposes these patients to brain abscess. Perioperative management of these patients with uncorrected TOF for noncardiac surgery is a challenge for the anesthesiologists owing to the long-term effects of hypoxia and decreased pulmonary blood flow, resulting in considerable modification of the physiology and neurological complications. We are hereby reporting the anaesthetic management of an 8 year old child with uncorrected TOF presenting with multiple brain abscesses who underwent craniotomy with uneventful recovery.

Quality Control for Residency Applicant Scores.

BACKGROUND: The residency program selection process incorporates application review and candidate interviews to create an ordered rank list. Though this is the single most important process for determining the department's future trainees, the system lacks a quality control mechanism by which faculty ratings are scrutinized. This study used many-facet Rasch measurement (MFRM) to establish a quality control system for the candidate selection process. METHODS: This study took place from October 2017 to January 2018 at a large anesthesiology residency program with 25 available spots. Every candidate received scores from 3 faculty judges across 3 occasions: application review, interview, and interviewer group discussion. MFRM with 3 facets-faculty judges, candidates, and occasions-was used to identify sources of measurement error and produce fair averages for each candidate. RESULTS: A total of 1378 observations from 158 candidates were used in the MFRM model, explaining 58.42% of the variance in the data. Fit indices indicated that 1 of the 5 judges inconsistently applied the rating scale. MFRM output also flagged some scores as unexpected based on standardized residual values. This helped identify specific instances where inconsistent observations occurred. CONCLUSIONS: MFRM is a relatively low-cost, efficient way to test the quality of the scores that are used to make a rank list and to investigate noise that represents outlier scores. When these outlier scores are due to biased factors such as particularly stringent or lenient interviewers, they may be unfairly influencing the rank list, and program directors may choose to adjust for them.

Development of a scale to measure intrapersonal factors influencing speaking up in the operating room.

INTRODUCTION: This paper reports on the development of a scale to measure intrapersonal factors (IPF) that may influence speaking up behaviour in the operating room. METHODS: Participants were postgraduate year 2, 3, and 4 anaesthesiology residents and practising faculty anaesthesiologists at a large quaternary care academic hospital. Based on a literature review, the authors constructed the initial scale. Exploratory factor analysis was conducted to identify the underlying factor structure for the scale. A set of one-way ANOVAs and multiple ordinal regressions were carried out to provide additional validity evidence for the new scale. RESULTS: Exploratory factor analysis indicated a three-factor solution accounting for 73% of the variance. The self-efficacy subscale included four items (Cronbach's α = 0.86), and the social outcome expectations (Cronbach's α = 0.86) and assertive attitude (Cronbach's α = 0.67) subscales contained three items each. The effect of training level was significantly associated with self-efficacy (p < 0.001) and assertive attitude subscale scores (p < 0.001). Multiple ordinal regressions indicated that IPF predicted participants' likelihood of speaking up in various hypothetical scenarios. DISCUSSION: Our analyses provided initial evidence for the validity and reliability of a 10-item IPF scale. This instrument needs to be validated in other cohorts.

Faculty Underestimate Resident Desire for Constructive Feedback and Overestimate Retaliation.

BACKGROUND: Constructive feedback from faculty to trainees is essential to promoting trainees' learning yet is rarely provided. Resident physicians want more feedback than they receive but it is unclear whether faculty know this. We explored faculty and resident impressions of constructive feedback and the barriers to giving more. We hypothesized that residents want more constructive feedback; however, faculty believe that residents do not want constructive feedback and would retaliate against faculty who give it. METHODS: Between January and March 2019, we performed a cross-sectional survey study of anesthesiology residents and teaching faculty at two large academic centers. All residents and faculty were eligible to participate. The survey assessed satisfaction with written and in-person feedback and predicted responses to specific examples, in addition to perceived barriers. RESULTS: The survey was distributed to 156 residents and 260 faculty across the two institutions: 116 residents (74% response rate) and 127 faculty (49% response rate) responded. Eighty-eight percent of residents would want to receive feedback similar to the examples, whereas only 60% of faculty responded that they thought residents would want feedback. Ninety-eight percent of residents said they would not retaliate. Barriers to providing feedback included time constraints, insufficient confidence/training, fear of retaliation, and feelings of futility. CONCLUSIONS: Residents were significantly more likely to want to receive constructive feedback than the faculty members had predicted. Further, residents are unlikely to retaliate against faculty who provide feedback. Addressing barriers may help increase the amount of constructive feedback that faculty provide and resident satisfaction with feedback received.