Unleashing surgical skills: Ultra-high fidelity trauma thoracotomy training on knowledge donor platform.

BACKGROUND: Resuscitative thoracotomies are a time-sensitive emergency surgical procedure with an immediate risk of mortality. We hypothesize that a high-fidelity whole-body donor simulation model, referred to as a Knowledge Donor (KD), with mechanical lung ventilation and expired human blood perfusion could increase learner confidence in performing this critical procedure. METHODS: General surgery residents and faculty were invited to participate in KD training. Surveys were collected to track participation and confidence. RESULTS: Simulated resuscitative thoracotomies were performed involving PGY levels I-IV. Mean confidence was highest for residents with both KD and Live Patient experience (5.6 â€‹± â€‹1.7), followed by Live Patient only (4.3 â€‹± â€‹2.5), and KD only (2.6 â€‹± â€‹1.3). The mean confidence rating for residents with neither training opportunity was 1.4 â€‹± â€‹1.0. CONCLUSIONS: The KD platform is a hyper-realistic training modality that closely replicates live surgery. This platform allows residents to practice complex surgical procedures in a safe environment, without risking patient safety. This pilot program yielded early results in improving resident procedural confidence for high-risk surgical procedures, specifically resuscitative thoracotomies.

How Students Learn during the Pre-Briefing and Observation of Facilitation in a High-Fidelity Patient Simulation: A Narrative Analysis.

The rapid development of technology has led to the emergence of innovative teaching approaches, such as high-fidelity patient simulation (HFPS). HFPSs have been shown to significantly enhance students' decision-making and intellectual skills. This study aimed to investigate how students learn from the pre-briefing to observation period of the facilitation of the HFPS based on the original quasi-experimental studies. This study analyzed the narratives from 92 students in the intervention group about their learning during the pre-briefing and observation of facilitation. The results indicated that the students learned more independently, received better support and resources for learning, were provided with more appropriate and safe care for the simulated case, and developed higher-level intellectual skills, such as self-directed learning, critical thinking, and clinical reasoning. Importantly, the structured guidelines provided roles and responsibilities and guiding questions or aspects for observation that directed the students to learn more actively and effectively while performing their roles in the HFPS. The structured guidelines serve as a roadmap to instruct students on learning during pre-briefing and applying what they have learned during the facilitation of the HFPS. This roadmap includes the learning journey from novice to competence in knowledge and skills and also from knowing to application. Therefore, this study's results have contributed important knowledge about well-structured HFPS guidelines for all stages of the HFPS, addressing the need for adequate guidance and learning support during the pre-briefing and observation of facilitation. The elements identified during the pre-briefing and observation of facilitation are crucial for directing students to learn and significantly enhance their understanding and application of knowledge and skills, ultimately promoting the development of higher-level intellectual skills, professionalism, and engagement. Nurse educators can incorporate these elements into HFPS training in curricula to enhance students' involvement and optimize the HFPS as an effective teaching tool with structured guidelines providing guidance and support throughout various stages of HFPS training.

Structural variation discovery in wheat using PacBio high-fidelity sequencing.

Structural variations (SVs) pervade plant genomes and contribute substantially to the phenotypic diversity. However, most SVs were ineffectively assayed due to their complex nature and the limitations of early genomic technologies. By applying the PacBio high-fidelity (HiFi) sequencing for wheat genomes, we performed a comprehensive evaluation of mainstream long-read aligners and SV callers in SV detection. The results indicated that the accuracy of deletion discovery is markedly influenced by callers, accounting for 87.73% of the variance, whereas both aligners (38.25%) and callers (49.32%) contributed substantially to the accuracy variance for insertions. Among the aligners, Winnowmap2 and NGMLR excelled in detecting deletions and insertions, respectively. For SV callers, SVIM achieved the best performance. We demonstrated that combining the aligners and callers mentioned above is optimal for SV detection. Furthermore, we evaluated the effect of sequencing depth on the accuracy of SV detection, revealing that low-coverage HiFi sequencing is sufficiently robust for high-quality SV discovery. This study thoroughly evaluated SV discovery approaches and established optimal workflows for investigating structural variations using low-coverage HiFi sequencing in the wheat genome, which will advance SV discovery and decipher the biological functions of SVs in wheat and many other plants.

Optoelectronics Interfaces for a VLC System for UHD Audio-Visual Content Transmission in a Passenger Van: HW Design.

This work aims to provide the hardware (HW) design of the optoelectronics interfaces for a visible-light communication (VLC) system that can be employed for several use cases. Potential applications include the transmission of ultra-high-definition (UHD) streaming video through existing reading lamps installed in passenger vans. In this use case, visible light is employed for the downlink, while infrared light is used for the uplink channel, acting as a remote controller. Two primary components -a Light Fidelity (LiFi) router and a USB dongle-were designed and implemented. The 'LiFi Router', handling the downlink channel, comprises components such as a visible Light-Emitting Diode (LED) and an infrared receiver. Operating at a supply voltage of 12 V and consuming current at 920 mA, it is compatible with standard voltage buses found in transport vehicles. The 'USB dongle', responsible for the uplink, incorporates an infrared LED and a receiver optimized for visible light. The USB dongle works at a supply voltage of 5 V and shows a current consumption of 1.12 A, making it well suited for direct connection to a universal serial bus (USB) port. The bandwidth achieved for the downlink is 11.66 MHz, while the uplink's bandwidth is 12.27 MHz. A system competent at streaming UHD video with the feature of being single-input multiple-output (SIMO) was successfully implemented via the custom hardware design of the optical transceivers and optoelectronics interfaces. To ensure the system's correct performance at a distance of 110 cm, the minimum signal-to-noise ratio (SNRmin) for both optical links was maintained at 10.74 dB. We conducted a proof-of-concept test of the VLC system in a passenger van and verified its optimal operation, effectively illustrating its performance in a real operating environment. Exemplifying potential implementations possible with the hardware system designed in this work, a bit rate of 15.2 Mbps was reached with On-Off Keying (OOK), and 11.25 Mbps was obtained with Quadrature Phase Shift Keying (QPSK) using Orthogonal Frequency-Division Multiplexing (OFDM) obtaining a bit-error rate (BER) of 3.3259 × 10-5 in a passenger van at a distance of 72.5 cm between the LiFi router and the USB dongle. As a final addition, a solar panel was installed on the passenger van's roof to power the user's laptop and the USB dongle via a power bank battery. It took 13.4 h to charge the battery, yielding a battery life of 22.3 h. This characteristic renders the user's side of the system entirely self-powered.

Procedural simulators for teaching and learning vasectomy techniques: a scoping review.

Background: Procedural simulators can facilitate teaching and improve learning vasectomy surgical techniques. The objectives of this scoping review were to identify available vasectomy simulators (scrotal models), and to assess their characteristics and potential suitability for optimal transfer of surgical skills of most recommended techniques in clinical practice. Methods: We performed searches up to December 2023 using PubMed and Google search engines to identify existing vasectomy simulators. Articles and Web pages reporting vasectomy simulators were also examined using a snowball strategy. In addition, we asked members of the Vasectomy Network, an international Google discussion group, if they knew any other simulators. Two members of the research team performed the initial evaluations of the physical and functional characteristics of retrieved simulators. All team members made consensus on final evaluations. Results: We retrieved 10 relevant scrotal models through PubMed (n=2), Google (n=4), and the Vasectomy Network (n=4). Three were commercially available simulators produced by Gaumard® in the USA and seven were homemade models. All had limited visual and haptic realism of internal and external structures. Most, however, were suitable for simulating some basic skills of the no-scalpel technique to deliver the vas deferens. Fascial interposition could not be simulated with any model. Commercially available models had no advantage over homemade models. Conclusions: Most vasectomy simulators currently available allow learning some basic surgical skills of the procedure but have limitations for optimal learning of the recommended techniques and skill transfer in clinical practice. There appears to be a need to develop and evaluate new simulators with enhance visual and haptic characteristics for teaching and learning vasectomy techniques.

The Effects of Artificial Intelligence on Implementors' Fidelity of Instructional Strategies During Handwashing Acquisition in Children with Autism.

Handwashing is a vital skill for maintaining health and hygiene. For individuals with intellectual and developmental disabilities (IDD), such as autism spectrum disorder, evidence-based strategies, such as prompting and task analysis, may be effective in teaching these skills. Due to the shortage of experts who teach individuals with IDD skills such as handwashing, staff working with children need a means of ensuring these instructional strategies are implemented with fidelity. This study examined the effects of a tablet-based application that used artificial intelligence (GAINS®) on four behavior technicians' implementation of least-to-most prompting, total task chaining, and time delay during an acquisition of handwashing program with young children with autism. All four technicians increased fidelity immediately upon using GAINS and all four technicians reached mastery criteria within the shortest number of sessions possible. One child participant met mastery criteria, two showed some gains, and one demonstrated a high degree of variability across sessions. Limitations of the least-to-most prompting procedure, user design, considerations and directions for future research and practice are discussed.

Comparative Analysis of Independent Reviewer-Rated and Self-Rated Fidelity Scores in Individual Placement and Support Programs: Repeated Cross-Sectional Surveys.

Fidelity assessments can contribute to maintaining the adherence to the individual placement and support (IPS) model, which enhances vocational outcomes for individuals with mental illness worldwide. While independent reviews are standard, self-assessments could broaden the implementation of IPS. This study aimed to evaluate reviewer-rated and self-rated fidelity assessments using the Japanese version of the Individualized Supported Employment Fidelity Scale (JiSEF), and to compare the two assessment methods in terms of their correlations with employment outcomes in Japan. Over the 3-year research period, fidelity assessments were conducted by independent reviewers and trained program staff members across 26 programs, totaling 58 assessments. Analyses involved kappa statistics for item-level comparison, the intra-class correlation coefficient (ICC) and paired t-test for the overall fidelity scores, and Pearson's correlations to examine the relationship between the fidelity scores and program-level employment outcomes. Most individual JiSEF items demonstrated fair to good reliability between reviewer-rated and self-rated assessments. The ICC for the overall JiSEF scores between the two assessment methods was 0.756, yet the distribution of self-rated scores was more scattered compared with that of reviewer-rated scores. The mean total scores from self-assessments were significantly lower than those from reviewer assessments (t = 2.072, P = 0.043). While both sets of scores correlated significantly with employment rates (r = 0.640, P < 0.001 for reviewer assessments; r = 0.325, P = 0.013 for self-assessments), the correlation was stronger for reviewer ratings (z = 2.207, P = 0.027). Self-rated fidelity assessments offer several benefits. However, since independent reviews had a more normal distribution and higher correlation with employment outcome, they should remain the priority in fidelity assessments within the Japanese IPS framework.

Non-invasive methods characterise the world's largest tiger shark aggregation in Fuvahmulah, Maldives.

Tiger sharks are apex predators with a circumglobal tropical and warm-temperate distribution, with a general lack of population data for the central Indian Ocean. In Fuvahmulah, Maldives, tiger sharks display frequent use of the harbour area, attracted by discarded fish waste. Here, we document the population structure, residency, and reproductive characteristics of the world's largest known tiger shark aggregation in a geographically-restricted area. Using non-invasive methods, photo identification and laser photogrammetry, we identified 239 individual tiger sharks over a 7-year study period. The aggregation was female-dominated (84.5%), with both large juveniles and adults present. Adult females were resighted over the entire study period displaying strong inter- and intra-annual site fidelity. Modelled residency using maximum likelihood methods suggests they spent 60.7 ± S.E. 7.5 days in Fuvahmulah, with a larger aggregation size, shorter residence periods and longer absence periods compared to juvenile females. Prolonged abdominal distensions of adult females indicate they likely stay near Fuvahmulah during gestation and reproduce biennially. Fuvahmulah seems to provide suitable conditions for gestation given the year-round provision of food and warm waters, exhibited by strong site fidelity and temporal residency. Our results show indications of a thriving population within the confines of protected waters.

Medical Students' Confidence After "CardioSim": A Low-Fidelity, Peer Role-Play Simulation.

INTRODUCTION: Plans to increase medical student numbers will increase costs and potentially reduce clinical exposure. Simulation can be utilised to fill that gap. Low-fidelity simulation with peer role-play (PRP) provides reduced costs and standardisation of experience compared to high-fidelity or simulated patient RP simulation. This study aimed to assess changes in confidence in common graduate-level skills following a low-fidelity PRP scenario. METHODS: Forty-three fourth-year medical students were divided into groups of three and five students. A Likert-scale questionnaire was completed at the start of the session. During the simulation, they had the opportunity to be the doctor and the patient and observe the remaining scenarios. Finally, the same questionnaire was answered. RESULTS: All students gained confidence in at least two aspects. All students were confident in history taking and ST-elevation myocardial infarction (STEMI) management at the end of the session. The biggest improvement in overall confidence was in the management of non-ST-elevation myocardial infarction (NSTEMI) (62.8%) and Situation-Background-Assessment-Recommendation (SBAR) handover (60.5%). Six students improved their confidence by at least one ranking in every question, and one student improved their confidence by three rankings in four questions. SBAR handover and management of pneumothorax had the biggest improvements. CONCLUSION: Low-fidelity RP simulation allows the development of confidence in technical and non-technical skills. Given increasing student numbers and increasing medical education costs, it can be utilised effectively as part of a simulation syllabus that helps prepare students for clinical practice. Areas of further research include focus groups, knowledge tests and comparisons to other forms of simulation.

Enhancing EEG Data Quality and Precision for Cloud-Based Clinical Applications: An Evaluation of the SLOG Framework.

Automation is revamping our preprocessing pipelines, and accelerating the delivery of personalized digital medicine. It improves efficiency, reduces costs, and allows clinicians to treat patients without significant delays. However, the influx of multimodal data highlights the need to protect sensitive information, such as clinical data, and safeguard data fidelity. One of the neuroimaging modalities that produces large amounts of time-series data is Electroencephalography (EEG). It captures the neural dynamics in a task or resting brain state with high temporal resolution. EEG electrodes placed on the scalp acquire electrical activity from the brain. These electrical potentials attenuate as they cross multiple layers of brain tissue and fluid yielding relatively weaker signals than noise - low signal-to-noise ratio. EEG signals are further distorted by internal physiological artifacts, such as eye movements (EOG) or heartbeat (ECG), and external noise, such as line noise 50 Hz. EOG artefacts, due to their proximity to the frontal brain regions, are particularly challenging to eliminate. Therefore, a widely used EOG rejection method, independent component analysis (ICA), demands manual inspection of the marked EOG components before they are rejected from the EEG data. We underscore the inaccuracy of automatized ICA rejection and provide an auxiliary algorithm - Second Layer Inspection for EOG (SLOG) in the clinical environment. SLOG based on spatial and temporal patterns of eye movements, re-examines the already marked EOG artifacts and confirms no EEG-related activity is mistakenly eliminated in this artifact rejection step. SLOG achieved a 99% precision rate on the simulated dataset while 85% precision on the real EEG dataset. One of the primary considerations for cloud-based applications are operational costs, including computing power. Algorithms like SLOG allow us to maintain data fidelity and precision without overloading the cloud platforms and maxing out our budgets.

Efficient Plantlet Regeneration from Branches in Mangifera indica L.

Mango (Mangifera indica L.) is one of the most significant tropical and subtropical fruit species, with high ecological and economic value. However, research on the in vitro culture of mangoes is relatively weak, so establishing an efficient and stable mango plant regeneration system is of great significance. In this study, a preliminary mango regeneration system was established with Mangifera indica L. cv. Keitt from young branches as the starting explants. The results showed that the optimal plant growth regulator (PGR) formula for direct adventitious shoot induction on the branches was 1 mg/L 6-benzylaminopurine (6-BA) + 0.1 mg/L a-naphthaleneacetic acid (NAA), with an adventitious shoot induction rate of 73.63% and an average of 6.76 adventitious shoots. The optimal basal medium for adventitious shoot induction was wood plant medium (WPM), with an adventitious shoot induction rate of 63.87% and an average of 5.21 adventitious shoots. The optimal culture medium for adventitious shoot elongation was WPM + 1 mg/L 6-BA + 0.5 mg/L NAA, with an adventitious shoot elongation rate of 89.33% and an average length of 5.17 cm. The optimal formula for the induction of mango rooting was Douglas fir cotyledon revised medium (DCR) + 3 mg/L indole-3-butyric acid (IBA), with a maximum rooting rate of 66.13% and an average rooting quantity of 6.43. The genetic fidelity of the in vitro-regenerated plants was evaluated using inter-simple sequence repeat (ISSR) molecular markers. There was no difference between the in vitro-regenerated plants and the parent plant. This study provides an efficient and stable propagation system for Mangifera indica L., laying the foundation for its rapid propagation and genetic improvement.

Physical extraction of antigen and information.

To respond and adapt, cells use surface receptors to sense environmental cues. While biochemical signal processing inside the cell is studied in depth, less is known about how physical processes during cell-cell contact impact signal acquisition. New experiments found that fast-evolving immune B cells in germinal centers (GCs) apply force to acquire antigen clusters prior to internalization, suggesting adaptive benefits of physical information extraction. We present a theory of stochastic antigen transfer and show that maximizing information gain via physical extraction can explain the dramatic phenotypic transition from naive to GC B cells-attenuated receptor signaling, enhanced force usage, and decentralized contact architecture. Our model suggests that binding-lifetime measurement and physical extraction serve as complementary modes of antigen recognition, greatly extending the dynamic range of affinity discrimination when combined. This physical-information framework further predicts that the optimal size of receptor clusters decreases as affinity improves, rationalizing the use of a multifocal synaptic pattern seen in GC B cells. By linking extraction dynamics to selection fidelity via discriminatory performance, we propose that cells may physically enhance information acquisition to sustain adaptive evolution.

Treatment fidelity in clinical trials.

In the context of clinical trials, treatment fidelity (TF) has traditionally referred to the extent to which an intervention or treatment is implemented by the clinicians as intended by the researchers who designed the trial. Updated definitions of TF have included an appropriate design of the intervention that was performed in a way that is known to be therapeutically beneficial. This requires careful attention to three key components: (1) protocol and dosage adherence, (2) quality of delivery, and (3) participant adherence. In this viewpoint, we describe several cases in which TF was lacking in clinical trials and give opportunities to improve the deficits encountered in those trials. We feel that along with quality, risk of bias, and certainty of evidence, TF should be considered an essential element of the veracity of clinical trial.

Exploring ambulance clinicians' clinical reasoning when training mass casualty incidents using virtual reality: a qualitative study.

BACKGROUND: How ambulance clinicians (ACs) handle a mass casualty incident (MCI) is essential for the suffered, but the training and learning for the ACs are sparse and they don't have the possibility to learn without realistic simulation training. In addition, it is unclear what type of dilemmas ACs process in their clinical reasoning during an MCI. With virtual reality (VR) simulation, the ACs clinical reasoning can be explored in a systematic way. Therefore, the objective was to explore ambulance clinicians' clinical reasoning when simulating a mass casualty incident using virtual reality. METHODS: This study was conducted as an explorative interview study design using chart- stimulated recall technique for data collection. A qualitative content analysis was done, using the clinical reasoning cycle as a deductive matrix. A high-fidelity VR simulation with MCI scenarios was used and participants eligible for inclusion were 11 senior ACs. RESULTS/CONCLUSION: All phases of the clinical reasoning cycle were found to be reflected upon by the participants during the interviews, however with a varying richness of analytic reflectivity. Non-analytic reasoning predominated when work tasks followed specific clinical guidelines, but analytical reasoning appeared when the guidelines were unclear or non-existent. Using VR simulation led to training and reflection on action in a safe and systematic way and increased self-awareness amongst the ACs regarding their preparedness for MCIs. This study increases knowledge both regarding ACs clinical reasoning in MCIs, and insights regarding the use of VR for simulation training.

Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospital Patients: Formative Acceptability Evaluation of an eLearning Continuing Education Training.

BACKGROUND: Suicide is the 12th leading cause of death in the United States. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill building are resource intensive and difficult to implement. Novel computer technologies harnessing artificial intelligence are now available, which hold promise for increasing the feasibility of providing trainees opportunities across a range of continuing education contexts to engage in skills practice with constructive feedback on performance. OBJECTIVE: This pilot study aims to evaluate the feasibility and acceptability of an eLearning training in suicide safety planning among nurses serving patients admitted to a US level 1 trauma center for acute or intensive care. The training included a didactic portion with demonstration, practice of microcounseling skills with a web-based virtual patient (Client Bot Emily), role-play with a patient actor, and automated coding and feedback on general counseling skills based on the role-play via a web-based platform (Lyssn Advisor). Secondarily, we examined learning outcomes of knowledge, confidence, and skills in suicide safety planning descriptively. METHODS: Acute and intensive care nurses were recruited between November 1, 2021, and May 31, 2022, to participate in a formative evaluation using pretraining, posttraining, and 6-month follow-up surveys, as well as observation of the nurses' performance in delivering suicide safety planning via standardized patient role-plays over 6 months and rated using the Safety Plan Intervention Rating Scale. Nurses completed the System Usability Scale after interacting with Client Bot Emily and reviewing general counseling scores based on their role-play via Lyssn Advisor. RESULTS: A total of 18 nurses participated in the study; the majority identified as female (n=17, 94%) and White (n=13, 72%). Of the 17 nurses who started the training, 82% (n=14) completed it. On average, the System Usability Scale score for Client Bot Emily was 70.3 (SD 19.7) and for Lyssn Advisor was 65.4 (SD 16.3). On average, nurses endorsed a good bit of knowledge (mean 3.1, SD 0.5) and confidence (mean 2.9, SD 0.5) after the training. After completing the training, none of the nurses scored above the expert-derived cutoff for proficiency on the Safety Plan Intervention Rating Scale (≥14); however, on average, nurses were above the cutoffs for general counseling skills per Lyssn Advisor (empathy: mean 4.1, SD 0.6; collaboration: mean 3.6, SD 0.7). CONCLUSIONS: Findings suggest the completion of the training activities and use of novel technologies within this context are feasible. Technologic modifications may enhance the training acceptability and utility, such as increasing the virtual patient conversational abilities and adding automated coding capability for specific suicide safety planning skills. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/33695.

Undergraduate Nursing Students' Attitude and Perception Toward High-Fidelity Simulation-Based Education in a Middle Eastern Country.

Introduction: Rapid use of technologically driven simulation environment in teaching-learning has caused mixed feelings among students. High-fidelity simulation-based education is superior in cultivating the knowledge, skills, caring, learning interest, and collaboration among nursing students. However, the nursing students' attitudes and perceptions toward high-fidelity simulation-based education are unexplored. Objectives: The present study aims to explore the attitude and perception of undergraduate nursing students toward high-fidelity simulation-based education. Methods: Cross-sectional survey research design was adopted. We used self-administered Education Practices Questionnaire (student version) and Attitude Scale toward Simulation-Based Education to collect the data. A total of 109 nursing students were recruited. Results: Nursing student's attitude shows (mean = 68.26); perception on educational practices of high-fidelity simulation-based education demonstrates (M = 39.33 ± 7.87) and the importance of high-fidelity simulation-based education shows (M = 37.73 ± 7.45). However, no significant difference observed between the male and female student's attitude (t = -0.286 [0.78]) and perception (t [107] = 0.960 [0.34]). Similarly, no significant difference was observed among the different levels of students p > .005 on perception and attitude toward high-fidelity simulation-based education. Conclusion: The study proposed to have high-fidelity simulation-based education as an integral part of teaching in clinical training of students at all levels of nursing program.

A Validation Study of the Mindfulness-Based Interventions Teaching Assessment Criteria for Assessing Mindfulness-Based Intervention Teacher Skill: Inter-Rater Reliability and Predictive Validity.

Background: Prior data suggests the Mindfulness-Based Interventions: (MBI) Teaching Assessment Criteria (MBI:TAC) has good inter-rater reliability, but many raters knew teacher experience level. Objective: We sought to further evaluate the MBI-TAC's inter-rater reliability and obtain preliminary data on predictive validity. Methods: We videorecorded 21 MBSR teachers from academic and community settings. We trained 19 experienced MBI teachers in using the MBI:TAC. MBSR teachers were rated by three assessors; teachers and their assessors did not know one another. To assess predictive validity, MBSR students in courses taught by 18 of the MBSR teachers were invited to complete PROMIS-29 measures before the MBSR course, at the end of the course (month 2), and month 4. Results: Intraclass correlation coefficients (ICCs) representing a single rater ranged from 0.33 to 0.56 on the 6 MBI:TAC domains. Using an average of two raters, ICC estimates ranged from 0.48 to 0.71 and ICCs generalizing to an average of three raters ranged from 0.6 to 0.8. Among n = 152 participating MBSR students, we found improvements from baseline to 2 months and 4 months in PROMIS measures of Anxiety, Depression, Fatigue, Sleep, and Social Role function (range in improvement 2.3 to 6.3, P < 0.0001 for all comparisons except Social Role at 2 months, P = 0.007). Higher MBI:TAC ratings were associated with greater improvements in anxiety among MBSR students from baseline to 2 months, with a -0.31 lower participant anxiety score per 1 unit increase in MBI:TAC composite teaching rating (95% CI -0.58, -0.05, P = 0.019), but we did not find statistically significant relationships with improvements in other PROMIS-29 domains. Conclusions: ICCs indicated good reliability using an average of three ratings, but inter-rater reliability was only fair using a single rater. We found initial validation that higher MBI:TAC ratings predicted greater improvements in anxiety symptoms in MBSR participants.

The Evolution of Mate Attachment.

AbstractWhether natural selection leads to attachment in monogamous pair bonds has seldom been addressed. Operationally defining attachment as a behavioral modifier that decreases divorce probability with pair duration, we develop a model for the evolution of attachment. If divorce (the ending of a pair bond when both individuals survive to the next breeding season) is more likely to occur out of poor-quality reproductive opportunities (i.e., poor territory or low-quality mate), individuals in experienced pairs are more likely to be found in high-quality opportunities. Consequently, when divorce decisions occur using imperfect information from reproductive success, pair duration provides individuals with information about the quality of their reproductive opportunity and attachment can evolve. We show that high survival rates, divorce propensities, and probabilities of nest failure favor the evolution of attachment. Attachment is also more likely to evolve when individuals can directly assess the quality of their reproductive opportunity (as opposed to relying on imperfect information from reproductive success), when the quality of the reproductive opportunity has adult survival ramifications, and when divorce coevolves with attachment. We show that our core conclusions are robust to a variety of assumptions using individual-based simulations. Our results clarify how attachment can be adaptive and suggest that studying pair bonds as dynamic entities is a promising avenue for future work.

Evidence that DNA polymerase δ proofreads errors made by DNA polymerase α across the Saccharomyces cerevisiae nuclear genome.

We show that the rates of single base substitutions, additions, and deletions across the nuclear genome are strongly increased in a strain harboring a mutator variant of DNA polymerase α combined with a mutation that inactivates the 3´-5´ exonuclease activity of DNA polymerase δ. Moreover, tetrad dissections attempting to produce a haploid triple mutant lacking Msh6, which is essential for DNA mismatch repair (MMR) of base•base mismatches made during replication, result in tiny colonies that grow very slowly and appear to be aneuploid and/or defective in oxidative metabolism. These observations are consistent with the hypothesis that during initiation of nuclear DNA replication, single-base mismatches made by naturally exonuclease-deficient DNA polymerase α are extrinsically proofread by DNA polymerase δ, such that in the absence of this proofreading, the mutation rate is strongly elevated. Several implications of these data are discussed, including that the mutational signature of defective extrinsic proofreading in yeast could appear in human tumors.

Survey of Voice-Focused Speech-Language Pathologists' Usage of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V).

PURPOSE: As part of the process of developing specific recommendations for modifying certain elements of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) to promote end-user fidelity, the authors sought input from voice clinicians who regularly use the CAPE-V to assess voice quality. METHOD: At an academic meeting focusing on voice disorders, we presented a poster briefly reviewing the CAPE-V protocol and describing several sources of variability that have been reported in its current use. Interested viewers were directed to a QR code linking to a brief, anonymous survey on how individuals currently use the CAPE-V and how they might improve it. A link to the survey was also distributed on the conference discussion board. RESULTS: Fifty-nine participants responded to the survey: 49 completed it. The median respondent reported 8years of experience conducting voice evaluations, with 50% of their current practice in voice, and about eight voice evaluations per week. Key findings from this survey were that fewer than half of respondents reported audio recording any components of in-person or virtual voice evaluations, and that most respondents reported changing some aspect of the CAPE-V tasks and stimuli in practice. CONCLUSION: This exploratory study revealed a wide range of idiosyncratic practices by clinicians when administering and scoring the CAPE-V. The findings support planned revisions to the CAPE-V protocol and form involving the tasks, stimuli, and rating procedures.