摘要： As the coronavirus disease 2019 (COVID-19) pandemic hit the United States in March 2020, there was widespread disruption of clinical medical education: Hospital clerkships were suspended nationwide and students were moved out of the hospital and continued their studies remotely through virtual learning systems. Frustrated by not being able to directly care for patients, medical students across the country formed diverse volunteer initiatives to help frontline clinicians. In this article, the authors describe the essential role of medical students at Weill Cornell Medicine in quickly designing and building a large registry of COVID-19 patients who presented at 3 New York City hospitals. The Cornell COVID-19 Registry, which contains granular clinical information on more than 4,000 patients, informed hospital operations and guided clinical management during the first wave of the pandemic. One month after its creation, the registry led to the first published description of the clinical characteristics of a U.S.-based cohort of hospitalized COVID-19 patients. Using their experience as a model, the authors propose that students who cannot participate in their clinical clerkships because of the pandemic can augment their traditional medical education by contributing to COVID-19 research. In the case described in this article, students reviewed the management of COVID-19 patients, followed inpatients throughout their hospitalization (much like students would on clinical rotations), and refined their interpersonal skills through discussions with patients and patients' families during follow-up calls. The authors conclude that medical students who are displaced from their hospital rotations can further their education and provide an invaluable contribution to the fight against COVID-19 by serving as essential frontline researchers.

摘要： PurposeTo explore validity evidence for the use of entrustable professional activities (EPAs) as an assessment framework in medical education. MethodFormative assessments on the 13 Core EPAs for entering residency were collected for 4 cohorts of students over a 9- to 12-month longitudinal integrated clerkship as part of the Education in Pediatrics Across the Continuum pilot at the University of Minnesota Medical School. The students requested assessments from clinical supervisors based on direct observation while engaging in patient care together. Based on each observation, the faculty member rated the student on a 9-point scale corresponding to levels of supervision required. Six EPAs were included in the present analyses. Student ratings were depicted as curves describing their performance over time;regression models were employed to fit the curves. The unit of analyses for the learning curves was observations rather than individual students. Results(1) Frequent assessments on EPAs provided a developmental picture of competence consistent with the negative exponential learning curve theory;(2) This finding was true across a variety of EPAs and across students;and (3) The time to attain the threshold level of performance on the EPA for entrustment varied by student and EPA. ConclusionsThe results provide validity evidence for an EPA-based program of assessment. Students assessed using multiple observations performing the Core EPAs for entering residency demonstrate classic developmental progression toward the desired level of competence resulting in entrustment decisions. Future work with larger data samples will allow further psychometric analyses of assessment of EPAs.

关键词： Biosurfactants   Sophorolipids   Rhamnolipids   Solid-phase extraction   UHPLC-MS   MS  

摘要： Biosurfactants have been investigated as potential alternatives for synthetic surfactants in several areas, for example, in environmental and pharmaceutical fields. In that regard, extensive research has been carried out with sophorolipids and rhamnolipids that also present various biological properties with therapeutic significance. These biosurfactants are obtained as complex mixtures of slightly different molecules, and thus when studying these microbial glycolipids, the ability to identify and purify the produced compounds is of extreme importance. This study aimed to develop improved methodologies for the identification, separation, and purification of sophorolipids and rhamnolipids. Therefore, an ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method was modified to ensure faster characterization of both sophorolipids and rhamnolipids, enabling the identification and fragmentation pattern description of 10 and 13 congeners, respectively. The separation and purification of these biosurfactants was achieved with novel reversed-phase solid-phase extraction methods guaranteeing the isolation of different glycolipids, including those considered for their significant biological activity (e.g. antimicrobial, anticancer). It was possible to isolate sophorolipids and rhamnolipids with purity of 94% and 99%, respectively. The methods presented herein can be easily implemented and are expected to make purification of these biosurfactants easier, facilitating the study of their individual properties in further works.

关键词： Higg MSI   Textile   Apparel   Decision support   Interpretation   Aggregation   Sustainability   LCA  

摘要： Purpose The Higg Materials Sustainability Index (MSI) consists of five life cycle indicators to help the apparel industry inform material selection at the design stage. Until 2020, the Higg MSI applied a single score and after much debate, in 2021, indicators will no longer be aggregated. The problem of tradeoffs remains, and so this study evaluates potential aggregation approaches to help decision makers deal with tradeoffs that solve previous issues and allow for an integrated view. Methods Aggregation can be compensatory such as in the case of the weighted sum in the previous Higg MSI, or partially compensatory, and this relates as to how tradeoffs are managed. This study compares aggregation in the Higg MSI to four other aggregation methods via a comparative application using six textile materials (cotton, wool, PET, nylon 6, lyocell, and viscose) that, while not functionally equivalent on a mass basis, serve as an illustration of the effects of aggregation. This paper compares three compensatory aggregation methods to results from the Higg MSI-internal normalization of division by maximum, global normalization, monetization-and one partially compensatory method-stochastic multi-attribute analysis (SMAA). Methods were chosen to ensure a broad coverage according to their applicability to the Higg MSI. Results and discussion The comparison of raw materials using the impact categories used in the MSI Higg show tradeoffs, particularly for two materials which are the best performing materials in two impact categories and worse performing materials in the other two impact categories (out of four categories). For materials presenting tradeoffs, results show a distinct pattern between compensatory methods and SMAA. Compensatory single score methods place these materials in the lowest ranks, even lower than a material which is not the best performing material in any category. In SMAA, these same two materials rank above the mediocre material. There is a difference in how

摘要： Machine learning (ML) algorithms are powerful prediction tools with immense potential in the clinical setting. There are a number of existing clinical tools that use ML, and many more are in development. Physicians are important stakeholders in the health care system, but most are not equipped to make informed decisions regarding deployment and application of ML technologies in patient care. It is of paramount importance that ML concepts are integrated into medical curricula to position physicians to become informed consumers of the emerging tools employing ML. This paradigm shift is similar to the evidence-based medicine (EBM) movement of the 1990s. At that time, EBM was a novel concept;now, EBM is considered an essential component of medical curricula and critical to the provision of high-quality patient care. ML has the potential to have a similar, if not greater, impact on the practice of medicine. As this technology continues its inexorable march forward, educators must continue to evaluate medical curricula to ensure that physicians are trained to be informed stakeholders in the health care of tomorrow.

关键词： Endometriosis   Complementary and alternative medicine    CAM  

摘要： Objective: This study aimed to provide an overview of the extent to which women with endometriosis are informed about, interested in, and make use of CAM, and to evaluate which of the methods are most often applied. Study Design: A retrospective, two-center cohort study was conducted using a validated questionnaire among women with laparoscopically confirmed endometriosis at two urban teaching hospitals, certified as endometriosis centres. Results: A total of 592 patients were included in the study and received the questionnaire;114 (19.3 %) were included in the data analysis. Most of the women were not receiving hormone therapy at the time of the study (n = 60, 52.6 %). Most (n = 75, 65.8 %) were interested in CAM, but only a minority (n = 12, 10.5 %) had detailed knowledge about it. A total of 81 patients (71.1 %) had used at least one CAM method for disease management;the five most frequently used CAM methods were exercise (n = 55, 48.2 %), vitamins (n = 40, 35.1 %), yoga (n = 38, 33.3 %), homeopathy (n = 32, 28.1 %), and trace elements (n = 27, 23.7 %). Conclusions: In our study population, women with endometriosis are strongly interested in using CAM, but have only limited information about it. Nevertheless, a majority of the patients had used at least one CAM method to relieve symptoms associated with the disease and the most often used was exercise. (c) 2021 Elsevier B.V. All rights reserved.

关键词： Economic analysis  

摘要： Abstract: A mass-economic assessment of replacement of aviation kerosene with cryogenic fuel is carried out based on the analysis of the mass sensitivity to the initial change in the aircraft parameters and on an example of transferring the Tu-204 aircraft to liquefied natural gas (Tu-206 project). © 2021, Allerton Press, Inc.

摘要： The Core EPAs for Entering Residency Pilot project aimed to test the feasibility of implementing 13 entrustable professional activities (EPAs) at 10 U.S. medical schools and to gauge whether the use of the Core EPAs could improve graduates' performance early in residency. In this manuscript, the authors (members of the pilot institutions and Association of American Medical Colleges staff supporting the project evaluation) describe the schools' capacity to collect multimodal evidence about their students' performance in each of the Core EPAs and the ability of faculty committees to use those data to make decisions regarding learners' readiness for entrustment. In reviewing data for each of the Core EPAs, the authors reflected on how each activity performed as an EPA informed by how well it could be assessed and entrusted. For EPAs that did not perform well, the authors examined whether there are underlying practical and/or theoretical issues limiting its utility as a measure of student performance in medical school.