To prove or improve? Examining how paradoxical tensions shape evaluation practices in accreditation contexts.

INTRODUCTION: Although programme evaluation is increasingly routinised across the academic health sciences, there is scant research on the factors that shape the scope and quality of evaluation work in health professions education. Our research addresses this gap, by studying how the context in which evaluation is practised influences the type of evaluation that can be conducted. Focusing on the context of accreditation, we critically examine the types of paradoxical tensions that surface as evaluation-leads consider evaluation ideals or best practices in relation to contextual demands associated with accreditation seeking. METHODS: Our methods were qualitative and situated within a critical realist paradigm. Study participants were 29 individuals with roles requiring responsibility and oversight on evaluation work. They worked across 4 regions, within 26 academic health science institutions. Data were collected using semi-structured interviews and analysed using framework and matrix analyses. RESULTS: We identified three overarching themes: (i) absence of collective coherence about evaluation practice, (ii) disempowerment of expertise and (iii) tensions as routine practice. Examples of these latter tensions in evaluation work included (i) resourcing accreditation versus resourcing robust evaluation strategy (performing paradox), (ii) evaluation designs to secure accreditation versus design to spur renewal and transformation (performing-learning paradox) and (iii) public dissemination of evaluation findings versus restricted or selective access (publicising paradox). Sub-themes and illustrative data are presented. DISCUSSION: Our study demonstrates how the high-stakes context of accreditation seeking surfaces tensions that can risk the quality and credibility of evaluation practices. To mitigate these risks, those who commission or execute evaluation work must be able to identify and reconcile these tensions. We propose strategies that may help optimise the quality of evaluation work alongside accreditation-seeking efforts. Critically, our research highlights the limitations of continually positioning evaluation purely as a method versus as a socio-technical practice that is highly vulnerable to contextual influences.

Acute Effects of Sprint Interval Training and Blood Flow Restriction on Neuromuscular and Muscle Function.

BFR) applied during sprint interval training (SIT) on performance and neuromuscular function. METHODS: Fifteen men completed a randomized bout of SIT with CBFR, IBFR, and without BFR (No-BFR), consisting of 2, 30-s maximal sprints on a cycle ergometer with a resistance of 7.5% of body mass. Concentric peak torque (CPT), maximal voluntary isometric contraction (MVIC) torque, and muscle thickness (MT) were measured before and after SIT, including surface electromyography (sEMG) recorded during the strength assessments. Peak and mean revolutions per minute (RPM) were measured during SIT and power output was examined relative to physical working capacity at the fatigue threshold (PWCFT). RESULTS: CPT and MVIC torque decreased from pre-SIT (220.3±47.6 Nm and 355.1±72.5 Nm, respectively) to post-SIT (147.9±27.7 Nm and 252.2±45.5 Nm, respectively, all P<0.05), while MT increased (1.77±0.31 cm to 1.96±0.30 cm). sEMG mean power frequency decreased during CPT (-12.8±10.5%) and MVIC (-8.7±10.2%) muscle actions. %PWCFT was greater during No-BFR (414.2±121.9%) than CBFR (375.9±121.9%). CONCLUSION: SIT with or without BFR induced comparable alterations in neuromuscular fatigue and sprint performance across all conditions, without affecting neuromuscular function.

Progression and perceptual responses to blood flow restriction resistance training among people with multiple sclerosis.

PURPOSE: Resistance exercise can attenuate muscular impairments associated with multiple sclerosis (MS), and blood flow restriction (BFR) may provide a viable alternative to prescribing heavy training loads. The purpose of this investigation was to examine the progression of upper and lower body low-load (30% of one-repetition maximum [1RM]) resistance training (RT) with BFR applied intermittently during the exercise intervals (RT + BFR) versus volume-matched heavy-load (65% of 1RM) RT. METHODS: Men and women with MS (n = 16) were randomly assigned to low-load RT + BFR (applied intermittently) or heavy-load RT and completed 12 weeks (2 × /week) of RT that consisted of bilateral chest press, seated row, shoulder press, leg press, leg extension, and leg curl exercises. Exercise load, tonnage, and rating of perceived exertion were assessed at baseline and every 6 weeks. RESULTS: Training load increased to a greater extent and sometimes earlier for RT + BFR (57.7-106.3%) than heavy-load RT (42.3-54.3%) during chest press, seated row, and leg curl exercises, while there were similar increases (63.5-101.1%) for shoulder press, leg extension, and leg press exercises. Exercise tonnage was greater across all exercises for RT + BFR than heavy-load RT, although tonnage only increased during the chest press (70.7-80.0%) and leg extension (89.1%) exercises. Perceptions of exertion (4.8-7.2 au) and compliance (97.9-99.0%) were similar for both interventions. CONCLUSION: The training-induced increases in load, high compliance, and moderate levels of exertion suggested that RT + BFR and heavy-load RT are viable interventions among people with MS. RT + BFR may be a preferred modality if heavy loads are not well tolerated and/or to promote early-phase training responses.

Standing on shoulder of giants: the incredible legacy of the Judet family in orthopaedic surgery.

In orthopaedic surgery, as well as other areas in medicine, it is common for a surgical technique to carry the original authors' name describing the procedure. The Judet family represents a unique history, since several orthopaedic procedures are known as "Judet's technique". The aim of this historic review is to outline the genealogy of the orthopaedic arm of the Judet family, while crediting each surgical procedure to the specific family member that described the technique.

[The SCATTER project: computer-based simulation in the strategic transfer of intensive care patients]. / Das SCATTER-Projekt: Computerbasierte Simulation zur Unterstützung bei der strategischen Verlegung von Intensivpatienten.

BACKGROUND: The need for a concept for the nationwide strategic transfer of critical care patients in Germany was highlighted during the COVID-19 (coronavirus disease 2019) pandemic. Despite the cloverleaf concept developed specifically for this purpose, the transfer of large numbers of critical care patients represents a major challenge. With the help of a computer simulation, the SCATTER research project uses a fictitious example to test, develop, and recommend transfer strategies. METHOD: The simulation was programmed after collecting procedural and structural data on critical care transports within Germany. The simulation allows altering various parameters and testing different transfer scenarios. In a fictitious scenario, nationwide transfers starting from Schleswig-Holstein were simulated and evaluated using predetermined criteria. RESULTS: In the case of ground-based transfers, it became apparent that, depending on the selected target region, not all patients could be transferred due to the limited range of ground-based vehicles. Although a higher number of patients can be transferred by air, this is associated with additional gurney changes and potential risk to the patient. A distance-dependent transport strategy led to the identical results as purely air-bound transport, since air-bound transport was always chosen due to the long distances. DISCUSSION: The simulation can be used to develop recommendations and to draw important conclusions from different transfer strategies.

The development and evaluation of a virtual, asynchronous, trauma-focused treatment program for adult survivors of childhood interpersonal trauma.

BACKGROUND: The long-term mental and physical health implications of childhood interpersonal trauma on adult survivors is immense, however, there is a lack of available trauma-focused treatment services that are widely accessible. This study, utilizing a user-centered design process, sought feedback on the initial design and development of a novel, self-paced psychoeducation and skills-based treatment intervention for this population. AIMS: To explore the views and perspectives of adult survivors of childhood interpersonal trauma on the first two modules of an asynchronous trauma-focused treatment program. METHODS: Fourteen participants from our outpatient hospital service who completed the modules consented to provide feedback on their user experience. A thematic analysis of the three focus groups was conducted. RESULTS: Four major themes emerged from the focus groups: (1) technology utilization, (2) module content, (3) asynchronous delivery, and (4) opportunity for interactivity. Participants noted the convenience of the platform and the use of multimedia content to increase engagement and did not find the modules to be emotionally overwhelming. CONCLUSIONS: Our research findings suggest that an asynchronous virtual intervention for childhood interpersonal trauma survivors may be a safe and acceptable way to provide a stabilization-focused intervention on a wider scale.

Power/knowledge: A sociomaterial perspective on a new accreditation process during COVID-19.

INTRODUCTION: The COVID-19 pandemic had significant impacts on many aspects of health care and education, including the accreditation of medical education programmes. As a community of international educators, it is important that we study changes that resulted from the pandemic to help us understand educational processes more broadly. As COVID-19 unfolded in Canada, a revised format of undergraduate medical accreditation was implemented, including a shift to virtual site visits, a two-stage visit schedule, a focused approach to reviewing standards and the addition of a field secretary to the visit team. Our case study research aimed to evaluate the sociomaterial implications of these changes in format on the process of accreditation at two schools. METHODS: We interviewed key informants to understand the impacts, strengths and limitations of changes made to the accreditation format. We used an abductive approach to analyse transcripts and applied a sociomaterial lens in looking for interconnections between the material and social changes that were experienced within the accreditation system. RESULTS: Stakeholders within the accreditation system did not anticipate that changes to the accreditation format would have significant impacts on how accreditation functioned or on its overall outcomes. However, key informants described how the revised format of accreditation reconstructed how power was distributed and how knowledge was produced. The revised format contributed to changes in who held power within each of the programmes, within each of the visiting teams and between site members and visiting team members. As power shifted across stakeholders in response to material changes to the accreditation format, key informants described changes in how knowledge was produced. CONCLUSIONS: Our findings suggest that the most powerful knowledge about any given programme might best be obtained through individualised tools, technologies and voices that are most meaningful to the unique context of each programme. Deliberate attention to how knowledge and power are influenced by the interactions between material and social processes within accreditation may help educators and leaders see the effects of change.

Acute effects of low load blood flow restricted and non restricted exercise on muscle excitation, neuromuscular efficiency, and average torque.

OBJECTIVES: The purpose of this investigation was to examine the acute effects of low-load blood flow restriction (LLBFR) and low-load (LL) resistance exercise on muscle excitation, neuromuscular efficiency, and average torque. METHODS: Eleven men (age±SD=22±3yrs) randomly performed LLBFR and LL that consisted of 30 unilateral leg extensions at 30% of one-repetition maximum while surface electromyography (sEMG) and torque were simultaneously assessed. Polynomial regression analyses and slope comparisons were performed to examine patterns of responses and rates of change. RESULTS: sEMG amplitude increased for LLBFR (9 of 11) and LL (8 of 11) and between composite responses (R2=0.939-0.981). For LLBFR, sEMG amplitude increased to a greater extent for 5 of the 11 individual and for the composite responses. Similarly, neuromuscular efficiency decreased for LLBFR (8 of 11) and LL (5 of 11) as well as the composite responses r2=0.902-0.929, but the decrease was larger for LLBFR than LL for the individual (4 of 11) responses. For average submaximal concentric torque, there were individual increases, decreases, and no changes for the composite responses (R2=0.198-0.325). CONCLUSION: LLBFR elicited greater fatigue-induced increases in muscle excitation and decreases in neuromuscular efficiency than LL, but neither LLBFR nor LL affected average submaximal concentric torque.

Highly Sensitive Self-Actuated Zinc Oxide Resonant Microcantilever Humidity Sensor.

A resonant microcantilever sensor is fabricated from a zinc oxide (ZnO) thin film, which serves as both the structural and sensing layers. An open-air spatial atomic layer deposition technique is used to deposit the ZnO layer to achieve a ∼200 nm thickness, an order of magnitude lower than the thicknesses of conventional microcantilever sensors. The reduction in the number of layers, in the cantilever dimensions, and its overall lower mass lead to an ultrahigh sensitivity, demonstrated by detection of low humidity levels. A maximum sensitivity of 23649 ppm/% RH at 5.8% RH is observed, which is several orders of magnitude larger than those reported for other resonant humidity sensors. Furthermore, the ZnO cantilever sensor is self-actuated in air, an advantageous detection mode that enables simpler and lower-power-consumption sensors.

Acute Effects of Continuous and Intermittent Blood Flow Restriction on Sprint Interval Performance and Muscle Oxygen Responses.

ABSTRACT: Wizenberg, AM, Gonzalez-Rojas, D, Rivera, PM, Proppe, CE, Laurel, KP, Stout, JR, Fukuda, DH, Billaut, F, Keller, JL, and Hill, EC. Acute effects of continuous and intermittent blood flow restriction on sprint interval performance and muscle oxygen responses. J Strength Cond Res 37(10): e546-e554, 2023-This investigation aimed to examine the acute effects of continuous and intermittent blood flow restriction (CBFR and IBFR, respectively) during sprint interval training (SIT) on muscle oxygenation, sprint performance, and ratings of perceived exertion (RPE). Fifteen men (22.6 ± 2.4 years; 176 ± 6.3 cm; 80.0 ± 12.6 kg) completed in random order a SIT session with CBFR, IBFR (applied during rest), and no blood flow restriction (NoBFR). Each SIT session consisted of two 30-second all-out sprint tests separated by 2 minutes. Peak power (PP), total work (TW), sprint decrement score (S dec ), RPE, and muscle oxygenation were measured during each sprint. A p value ≤0.05 was considered statistically significant. PP decreased to a greater extent from sprint 1 to sprint 2 during CBFR (25.5 ± 11.9%) and IBFR (23.4 ± 9.3%) compared with NoBFR (13.4 ± 8.6%). TW was reduced similarly (17,835.6 ± 966.2 to 12,687.2 ± 675.2 J) from sprint 1 to sprint 2 for all 3 conditions, but TW was lower (collapsed across time) for CBFR (14,320.7 ± 769.1 J) than IBFR (15,548.0 ± 840.5 J) and NoBFR (15,915.4 ± 771.5 J). There were no differences in S dec (84.3 ± 1.7%, 86.1 ± 1.5%, and 87.2 ± 1.1% for CBFR, IBFR, and NoBFR, respectively) or RPE, which increased from sprint 1 (8.5 ± 0.3) to sprint 2 (9.7 ± 0.1). Collective muscle oxygenation responses increased across time and were similar among conditions, whereas increases in deoxy[heme] and total[heme] were greatest for CBFR. Applying BFR during SIT induced greater decrements in PP, and CBFR resulted in greater decrements in work across repeated sprints. The larger increases in deoxy[heme] and total[heme] for CBFR suggested it may induce greater metabolite accumulation than IBFR and NoBFR when combined with SIT.

Greater neuromuscular fatigue following low-load blood flow restriction than non-blood flow restriction resistance exercise among recreationally active men.

The purpose of this study was to examine the acute effects of low-load blood flow restriction (LLBFR) and low-load non-BFR (LL) on neuromuscular function after a bout of standardized fatiguing leg extension muscle actions. Fourteen men (mean age ± SD = 23 ± 4 yr) volunteered to participate in this investigation and randomly performed LLBFR and LL on separate days. Resistance exercise consisted of 75 isotonic unilateral leg extension muscle actions performed at 30% of one-repetition maximum. Before (pretest) and after (posttest) performance of each bout of exercise, strength and neural assessments were determined. There were no pretest to posttest differences between LLBFR and LL for maximal voluntary isometric contraction (MVIC) torque or V wave/M wave responses (muscle compound action potentials assessed during a superimposed MVIC muscle action), which exhibited decreases (collapsed across condition) of 41.2% and 26.2%, respectively. There were pretest to posttest decreases in peak twitch torque (36.0%) and surface electromyography amplitude (sEMG) (29.5%) for LLBFR but not LL and larger decreases in voluntary activation for LLBFR (11.3%) than for LL (4.5%). These findings suggested that LLBFR elicited greater fatigue-induced decreases in several indexes of neuromuscular function relative to LL. Despite this, both LLBFR and LL resulted in similar decrements in performance as assessed by maximal strength.NEW & NOTEWORTHY The application of blood flow restriction induces greater acute neuromuscular fatigue relative to nonrestricted conditions. Resistance exercise with blood flow restriction elicited a greater reduction in twitch responses. These neuromuscular differences might explain the more favorable adaptations achieved with blood flow restriction that are likely a function of metabolic stress and subsequent changes in efferent neural drive.

Advances in Flexible Metallic Transparent Electrodes.

Transparent electrodes (TEs) are pivotal components in many modern devices such as solar cells, light-emitting diodes, touch screens, wearable electronic devices, smart windows, and transparent heaters. Recently, the high demand for flexibility and low cost in TEs requires a new class of transparent conductive materials (TCMs), serving as substitutes for the conventional indium tin oxide (ITO). So far, ITO has been the most used TCM despite its brittleness and high cost. Among the different emerging alternative materials to ITO, metallic nanomaterials have received much interest due to their remarkable optical-electrical properties, low cost, ease of manufacturing, flexibility, and widespread applicability. These involve metal grids, thin oxide/metal/oxide multilayers, metal nanowire percolating networks, or nanocomposites based on metallic nanostructures. In this review, a comparison between TCMs based on metallic nanomaterials and other TCM technologies is discussed. Next, the different types of metal-based TCMs developed so far and the fabrication technologies used are presented. Then, the challenges that these TCMs face toward integration in functional devices are discussed. Finally, the various fields in which metal-based TCMs have been successfully applied, as well as emerging and potential applications, are summarized.

State Estimation for Coupled Reaction-Diffusion PDE Systems Using Modulating Functions.

Many systems with distributed dynamics are described by partial differential equations (PDEs). Coupled reaction-diffusion equations are a particular type of these systems. The measurement of the state over the entire spatial domain is usually required for their control. However, it is often impossible to obtain full state information with physical sensors only. For this problem, observers are developed to estimate the state based on boundary measurements. The method presented applies the so-called modulating function method, relying on an orthonormal function basis representation. Auxiliary systems are generated from the original system by applying modulating functions and formulating annihilation conditions. It is extended by a decoupling matrix step. The calculated kernels are utilized for modulating the input and output signals over a receding time window to obtain the coefficients for the basis expansion for the desired state estimation. The developed algorithm and its real-time functionality are verified via simulation of an example system related to the dynamics of chemical tubular reactors and compared to the conventional backstepping observer. The method achieves a successful state reconstruction of the system while mitigating white noise induced by the sensor. Ultimately, the modulating function approach represents a solution for the distributed state estimation problem without solving a PDE online.

Bilateral subtrochanteric stress riser fractures following percutaneous screw fixation of femoral neck stress fractures: a literature review and case report.

Hip and groin pain in patients at-risk for femoral neck stress fracture demand a careful workup including advanced imaging in the setting of normal radiographs. A delay in diagnosis can lead to fracture displacement, which negatively impacts outcomes. Non-displaced tension-sided fractures and displaced fractures warrant operative fixation, while non-displaced compression-side fractures can be managed conservatively. Fixation with a sliding hip screw or cephalomedullary nail is recommended over cannulated screws. In addition, all patients should undergo a metabolic workup to identify correctable parameters. We present a rare case of bilateral compression-sided basicervical femoral neck stress fractures in a non-compliant osteoporotic patient who was treated with cannulated screws. The postoperative course was complicated by bilateral subtrochanteric stress riser fractures requiring revision fixation, which could have been prevented with use of a different implant.

Planar and Transparent Memristive Devices Based on Titanium Oxide Coated Silver Nanowire Networks with Tunable Switching Voltage.

Threshold switching devices are fundamental active elements in more than Moore approaches, integrating the new generation of non-volatile memory devices. Here, the authors report an in-plane threshold resistive switching device with an on/off ratio above 106 , a low resistance state of 10 to 100 kΩ and a high resistance state of 10 to 100 GΩ. Our devices are based on nanocomposites of silver nanowire networks and titanium oxide, where volatile unipolar threshold switching takes place across the gap left by partially spheroidized nanowires. Device reversibility depends on the titanium oxide thickness, while nanowire network density determines the threshold voltage, which can reach as low as 0.16 V. The switching mechanism is explained through percolation between metal-semiconductor islands, in a combined tunneling conduction mechanism, followed by a Schottky emission generated via Joule heating. The devices are prepared by low-cost, atmospheric pressure, and scalable techniques, enabling their application in printable, flexible, and transparent electronics.

Effects of non-homogeneity and oxide coating on silver nanowire networks under electrical stress: comparison between experiment and modeling.

Silver nanowire (AgNW) networks are among the most promising indium-free, flexible transparent electrodes for energy, lighting and heating devices. However, the lack of stability of such networks is a key factor that limits their industrial application. While applications require homogeneous networks, non-homogeneous AgNW networks are intentionally prepared in the present work to probe the mechanisms leading to failure under electrical stress. We show that induced non-homogeneities have a strong impact both on the spatial distribution of temperature (measured by IR imaging) and the current density throughout the electrode (as deduced from modeling). Regions with higher current density under elevated electrical stress are correlated to the origin of degradation. Furthermore, the influence of a zinc oxide (ZnO) layer on electrical performances of non-homogeneous specimens is studied. Thanks to ZnO coating, the tortuosity of electrical potential lines measured by the one-probe mapping technique is much lower than for bare networks. Additionally, coated network electrical failure occurs at 40% higher voltage compared to bare network, over 18 V, while reaching superior power-induced heating of 360 °C. The results presented here will contribute to the design and fabrication of more robust nanowire networks, particularly for application in transparent heaters.

Effect of preoperative vitamin D deficiency on functional outcomes after high tibial osteotomy: a retrospective case control study.

BACKGROUND: This study aimed to evaluate the effects of vitamin D deficiency on the functional outcomes following a high tibial osteotomy (HTO). METHODS: Clinical data of 209 patients (327 knees) who underwent HTO done by a single surgeon were retrospectively registered for the study. Ninety-four patients (94 knees) who underwent HTO were analyzed. Patients were assigned into two groups according to their preoperative serum vitamin D levels (D- Deficiency and S- Sufficient); < 20 ng/ml (group D, N = 48) and ≥ 20 ng/ml (group S, N = 46) respectively. A subjective form of International Knee Documentation Committee (IKDC) score, mechanical alignment, and cartilage status before and 1 year following HTO were studied between groups. RESULTS: The mean postoperative IKDC score was significantly higher in group S (p = 0.012). Moreover, the difference of IKDC score between pre- and post- HTO was also significantly higher in group S (p = 0.006). Preoperative vitamin D level and IKDC score did not show a significant correlation. Serum vitamin D level was found to be moderately correlated to postoperative IKDC score (r = 0.342 and, p = 0.001). A moderately positive correlation between serum vitamin D level and improvement of IKDC score following osteotomy was appreciated (r = 0.381 and, p < 0.001). CONCLUSION: Patients with vitamin D deficiency had less satisfactory functional outcomes within 1 year from HTO surgery. Our results suggest that preoperative serum vitamin D level is one of the factors affecting the outcome after HTO. We recommended analyzing serum vitamin D levels as part of the routine workup in patients undergoing HTO.

Laves Phase in a 12% Cr Martensitic/Ferritic Steel: Evolution and Characterization of Nanoparticles at 650 °C.

A 12% Cr martensitic/ferritic with tailor-made microstructure was characterized by HRTEM after tempering (780 °C/2 h) and isothermal aging at 650 °C during 2 months and 1 year. The investigation was focused on the precipitation behavior of Laves phase nanoparticles and its contribution to creep response at 650 °C. Although, dense precipitation of Laves phase occurs during the heat treatment (196 nm), addition of 3.8% tungsten (W) promotes a high growth rate of this particle at 650 °C. The excessive addition of W induces a high driving force for the growth of this particle reaching a mean size of 300 nm at 2 months and 400 nm at 1 year. However, some small Laves phase nanoparticles inside the grain were detected at 1 year of isothermal aging, suggesting a low coarsening rate maybe due to low diffusion of W in the matrix. Results of creep test at 650 °C suggest most of the precipitation hardening is granted by fine dispersion of Ta-rich carbonitrides (Ta-MX), i.e., Laves phase is too coarse to contribute to the pinning force of the subgrain structure in the designed alloy.

Occult injuries of the contralateral sacroiliac joint in operatively treated pelvis fractures: incidence, root cause analysis, and proposal of treatment algorithm.

PURPOSE: To determine the most common injury patterns, root cause, and the frequency with which unrecognized contralateral posterior ring injury occurs in patients presenting with surgically treated pelvic fractures. METHODS: The medical records of 73 patients presenting to our level I trauma center (52 male and 21 female patients; mean age 41.8 years; range 18-89 years) with surgically treated pelvic ring fractures between January 1, 2016 and January 1, 2018 were reviewed. Patient demographics, mechanism of injury, associated injuries, imaging prior to binder or external fixation, use of temporary stabilization with pre-peritoneal pelvic packing (PPP) and anterior pelvic external fixation, and fracture pattern were recorded and analyzed to identify independent risk factors contributing to occult contralateral missed posterior ring injury. RESULTS: Occult contralateral pelvic ring injuries occurred in 6/72 patients (8.2% incidence). Pelvis fractures in multiply traumatized patients with associated orthopaedic injuries were associated with higher prevalence of occult contralateral pelvic ring injury (relative risk 1.85, 95% CI 1.13-3.02) as compared to patients with isolated pelvic fractures. CONCLUSIONS: There is an 8.2% incidence of unrecognized contralateral SI joint instability in patients presenting with unstable pelvic ring injuries. Multiply traumatized patients with multiple orthopaedic injuries were an independent risk factor for this injury pattern.