Review: update on performance assessment and monitoring systems for ophthalmologists

Performance assessment and monitoring systems are the process by which ophthalmologists demonstrate they are fit to continue practicing.Revalidation is the process by which licensed doctors are legally required to demonstrate to medical regulators that they are up to date and fit to practice in order to maintain their medical license,and began in the United Kingdom(UK)in 2012 following well-publicized events.Recertification is a different process which began in North America and demonstrates doctors have maintained competence,without involvement of external stakeholders.Arguments for and against the concept of performance assessment are reviewed.Stakeholders in performance assessment,whether part of the process or not,are doctors themselves,peers and other health care providers,patients,hospitals and health systems,medical regulators,and health policy makers.Early models of performance assessment included portfolios,credit accumulation,and closed-book examinations.Models are in evolution with the value of formative rather than summative assessments,and the need for methods of assessing procedural competency increasingly recognized.Emerging methods of performance assessment of practicing ophthalmologists include use of performance indicators,simulation,and workplace-based assessments.Alternate methods of assuring the public by improved detection of outliers are discussed.Despite weak evidence supporting performance assessments in demonstrating continuing competency to practice,the process is gradually being accepted worldwide.Further research into optimum methods of performance assessment and monitoring processes is required,along with cost-benefit analysis.

EXISTENCE OF POSITIVE PERIODIC SOLUTIONS TO A DISCRETE TIME NON-AUTONOMOUS COMPETING SYSTEM WITH FEEDBACK CONTROLS

In this paper,a class of discrete time non-autonomous competing system with feedback controls is considered. With the help of differential equations with piecewise constant arguments,we first propose a discrete model of a continuous non-autonomous competing system with feedback controls. Then,using the coincidence degree and the related continuation theorem as well as some priori estimations,a suficient condition for the existence of positive solutions to difference equations is obtained.

Health evaluation method for degrading systems subject to dependent competing risks

This paper proposes a health evaluation method for degrading systems subject to competing risks of dependent soft and hard failures. To characterize the time-varying degradation rate, the degradation process is determined by a non-stationary Gamma process and the soft failure is encountered when it exceeds a predefined critical level. For the hard failure, a Cox’s proportional hazard model is applied to describe the hazard rate of the time to system failure. The dependent relationship is modeled by incorporating the degradation process as a time-varying covariate into the Cox’s proportional hazard model. To facilitate the health characteristics evaluation, a discretization technique is applied both to the degradation process and the monitoring time.All health characteristics can be obtained in the explicit form using the transition probability matrix, which is computationally attractive for practical applications. Finally, a numerical analysis is carried out to show the effectiveness and the performance of the proposed health evaluation method.

Permanence and Positive Periodic Solutions for Kolmogorov Competing Species Systems with Periodic Forced Terms

In this paper，we consider the Kolmogorov type n-species competition systems with forced terms．We prove that this system is permanent in the case of which there are positive forced terms in this system;and if there are several negative forced terms in this system，it has at least two positive periodic solutions.

Inference for accelerated bivariate dependent competing risks model based on Archimedean copulas under progressive censoring

Dependent competing risks model is a practical model in the analysis of lifetime and failure modes.The dependence can be captured using a statistical tool to explore the re-lationship among failure causes.In this paper,an Archimedean copula is chosen to describe the dependence in a constant-stress accelerated life test.We study the Archimedean copula based dependent competing risks model using parametric and nonparametric methods.The parametric likelihood inference is presented by deriving the general expression of likelihood function based on assumed survival Archimedean copula associated with the model parameter estimation.Combining the nonparametric estimation with progressive censoring and the non-parametric copula estimation,we introduce a nonparametric reliability estimation method given competing risks data.A simulation study and a real data analysis are conducted to show the performance of the estimation methods.

Flux pinning evolution in multilayer Pb/Ge/Pb/Ge/Pb superconducting systems

Multicomponent superconductors exhibit nontrivial vortex behaviors due to the various vortex–vortex interactions,including the competing one in the recently proposed type-1.5 superconductor.However,potential candidate that can be used to study the multicomponent superconductivity is rare.Here,we prepared an artificial superconducting multilayer to act as an alternative approach to study multicomponent superconductivity.The additional repulsive length and the coupling strength among superconducting films were regulated by changing the thickness of the insulting layer.The magnetization measurements were performed to clarify the effect of the competition between the repulsive vortex interactions on the macroscopic superconductivity.The vortex phase diagram and the optimum critical current density have been determined.Furthermore,a second magnetization effect is observed,and is attributed to the upper layer,which provides the weak pinning sites to localize the flux lines.The pinning behaviors switches to the mixed type with the increase of the insulting layer thicknesses.Our results open a new perspective to the study and related applications of the multilayer superconducting systems.

Identification and characterization of noncoding RNAs-associated competing endogenous RNA networks in major depressive disorder

BACKGROUND Major depressive disorder(MDD)is a common and serious mental illness.Many novel genes in MDD have been characterized by high-throughput methods such as microarrays or sequencing.Recently,noncoding RNAs(ncRNAs)were suggested to be involved in the complicated environmental-genetic regulatory network of MDD occurrence;however,the interplay among RNA species,including protein-coding RNAs and ncRNAs,in MDD remains unclear.AIM To investigate the RNA expression datasets downloaded from a public database and construct a network based on differentially expressed long noncoding RNA(lncRNAs),microRNAs(miRNAs),and mRNAs between MDD and controls.METHODS Gene expression data were searched in NCBI Gene Expression Omnibus using the search term“major depressive disorder.”Six array datasets from humans were related to the search term:GSE19738,GSE32280,GSE38206,GSE52790,GSE76826,and GSE81152.These datasets were processed for initial assessment and subjected to quality control and differential expression analysis.Differentially expressed lncRNAs,miRNAs,and mRNAs were determined,Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed,and protein-protein interaction network was generated.The results were analyzed for their association with MDD.RESULTS After analysis,3 miRNAs,12 lncRNAs,and 33 mRNAs were identified in the competing endogenous RNA network.Two of these miRNAs were earlier shown to be involved in psychiatric disorders,and differentially expressed mRNAs were found to be highly enriched in pathways related to neurogenesis and neuroplasticity as per Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses.The expression of hub gene fatty acid 2-hydroxylase was enriched,and the encoded protein was found to be involved in myelin formation,indicating that neurological development and signal transduction are involved in MDD pathogenesis.CONCLUSION The present study presents candidate nc RNAs involved in the neurogenesis and neuroplasticity pathways related to MDD.

Stenting as a bridge to surgery in obstructing colon cancer:Longterm recurrence pattern and competing risk of mortality

BACKGROUND Stenting as a bridge to curative surgery(SBTS)for obstructing colon cancer(OCC)has been associated with possibly worse oncological outcomes.AIM To evaluate the recurrence patterns,survival outcomes,and colorectal cancer(CRC)-specific death in patients undergoing SBTS for OCC.METHODS Data from 62 patients undergoing SBTS at a single tertiary centre over ten years between 2007 and 2016 were retrospectively examined.Primary outcomes were recurrence patterns,overall survival(OS),cancer-specific survival(CSS),and CRC-specific death.OS and CSS were estimated using the Kaplan-Meier curves.Competing risk analysis with cumulative incidence function(CIF)was used to estimate CRC-specific mortality with other cause-specific death as a competing event.Fine-Gray regressions were performed to determine prognostic factors of CRC-specific death.Univariate and multivariate subdistribution hazard ratios and their corresponding Wald test P values were calculated.RESULTS 28 patients(45.2%)developed metastases after a median period of 16 mo.Among the 18 patients with single-site metastases:Four had lung-only metastases(14.3%),four had liver-only metastases(14.3%),and 10 had peritoneum-only metastases(35.7%),while 10 patients had two or more sites of metastatic disease(35.7%).The peritoneum was the most prevalent(60.7%)site of metastatic involvement(17/28).The median follow-up duration was 46 mo.26(41.9%)of the 62 patients died,of which 16(61.5%)were CRC-specific deaths and 10(38.5%)were deaths owing to other causes. The 1-, 3-, and 5-year OS probabilities were 88%, 74%, and 59%;1-, 3-, and5-year CSS probabilities were 97%, 83%, and 67%. The highest CIF for CRC-specific death at 60 mowas liver-only recurrence (0.69). Liver-only recurrence, peritoneum-only recurrence, and two ormore recurrence sites were predictive of CRC-specific death.CONCLUSIONThe peritoneum was the most common metastatic site among patients undergoing SBTS. Liveronlyrecurrence, peritoneum-only recurrence, and two or more recurrence sites were predictors ofCRC-specific death.

Competing Patterns in Bernoulli Sequence of Trials

Consider performing a sequence of Bernoulli trials (each resulting in either a success, denoted S, or a failure F, with a probability of p and q := 1 - p respectively) until one of m specific strings (or patterns) of consecutive outcomes is generated. This can be seen as a game where m players select one such pattern each and the one whose pattern occurs first wins. We present symbolic formulas for the m probabilities of winning, and for the mean number of trials and the corresponding standard deviation to complete this game. Several numerical examples are presented, including a search for optimal strategy.

Transcriptomic and bioinformatics analysis of the mechanism by which erythropoietin promotes recovery from traumatic brain injury in mice

Recent studies have found that erythropoietin promotes the recovery of neurological function after traumatic brain injury.However,the precise mechanism of action remains unclea r.In this study,we induced moderate traumatic brain injury in mice by intrape ritoneal injection of erythro poietin for 3 consecutive days.RNA sequencing detected a total of 4065 differentially expressed RNAs,including 1059 mRNAs,92 microRNAs,799 long non-coding RNAs,and 2115circular RNAs.Kyoto Encyclopedia of Genes and Genomes and Gene Ontology analyses revealed that the coding and non-coding RNAs that were differentially expressed after traumatic brain injury and treatment with erythropoietin play roles in the axon guidance pathway,Wnt pathway,and MAPK pathway.Constructing competing endogenous RNA networks showed that regulatory relationship between the differentially expressed non-coding RNAs and mRNAs.Because the axon guidance pathway was repeatedly enriched,the expression of Wnt5a and Ephb6,key factors in the axonal guidance pathway,was assessed.Ephb6 expression decreased and Wnt5a expression increased after traumatic brain injury,and these effects were reversed by treatment with erythro poietin.These findings suggest that erythro poietin can promote recove ry of nerve function after traumatic brain injury through the axon guidance pathway.

Long noncoding RNA protein-disulfide isomerase-associated 3 regulated high glucose-induced podocyte apoptosis in diabetic nephropathy through targeting miR-139-3p

BACKGROUND Podocyte apoptosis plays a vital role in proteinuria pathogenesis in diabetic nephropathy(DN).The regulatory relationship between long noncoding RNAs(lncRNAs)and podocyte apoptosis has recently become another research hot spot in the DN field.AIM To investigate whether lncRNA protein-disulfide isomerase-associated 3(Pdia3)could regulate podocyte apoptosis through miR-139-3p and revealed the underlying mechanism.METHODS Using normal glucose or high glucose(HG)-cultured podocytes,the cellular functions and exact mechanisms underlying the regulatory effects of lncRNA Pdia3 on podocyte apoptosis and endoplasmic reticulum stress(ERS)were explored.LncRNA Pdia3 and miR-139-3p expression were measured through quantitative real-time polymerase chain reaction.Relative cell viability was detected through the cell counting kit-8 colorimetric assay.The podocyte apoptosis rate in each group was measured through flow cytometry.The interaction between lncRNA Pdia3 and miR-139-3p was examined through the dual luciferase reporter assay.Finally,western blotting was performed to detect the effect of lncRNA Pdia3 on podocyte apoptosis and ERS via miR-139-3p.RESULTS The expression of lncRNA Pdia3 was significantly downregulated in HG-cultured podocytes.Next,lncRNA Pdia3 was involved in HG-induced podocyte apoptosis.Furthermore,the dual luciferase reporter assay confirmed the direct interaction between lncRNA Pdia3 and miR-139-3p.LncRNA Pdia3 overexpression attenuated podocyte apoptosis and ERS through miR-139-3p in HG-cultured podocytes.CONCLUSION Taken together,this study demonstrated that lncRNA Pdia3 overexpression could attenuate HG-induced podocyte apoptosis and ERS by acting as a competing endogenous RNA of miR-139-3p,which might provide a potential therapeutic target for DN.

Implementation of an international medical student pen-pal club:survey outcomes of perceptions in cultural competency and global health

Background:Pen-pal clubs(PPC)are used worldwide for students to learn about different cultures and other skillsets without the need for travel.Many medical students are interested in global health opportunities abroad but costs,scheduling,and other barriers allow few to participate in such experiences.It is important that medical students have nuanced global medical perspectives and can contribute to the global medical community.Objective:The purpose of this study is to demonstrate that an international medical student PPC improves medical students'perspectives of cultural competency and global health engagement.Methods:In 2021,a novel medical student PPC was established that began between an American and Japanese medical school.Following a shareholders meeting,it was decided that the number of medical schools involved globally be expanded through previous institutional affiliations and online presences.In total,the club connected 50 American medical students and 52 medical students from 17 high-and middle-income countries.The primary form of communication was online;pen-pals were encouraged to communicate monthly using provided topics,although frequency and way of communication was their discretion.In February 2022,American PPC members were emailed a qualitative survey to assess the PPC's impact.Results:The survey was completed by 42%of American PPC members,95%of which were 22-26 years.Participants were preclinical medical students,60%whom were female and the majority either white(47%)or Asian(43%).Overall,the PPC positively influenced American medical students'perception of global medicine,medical education,and their cultural competency after joining the PPC compared to prior(P=0.004).Conclusion:PPCs encourage medical students to think from a global perspective and foster open-mindedness within varying social and cultural contexts.Having a global communication platform for students during medical school education may be an additional way to train aspiring global leaders.

How Emotion Nurtures Mentality:The Influencing Mechanism of Social-Emotional Competency on the Mental Health of University Students

Social-Emotional Competency(SEC),regarded as a critical psychological resource for individuals to adapt to social environments,is an effective protective factor for students’mental health,impacting their future success and well-being.Analyzing the impact of SEC on university students’mental health can offer valuable insights for nurturing talents with healthy psychological and physical development.Based on data from two large-scale surveys of Chinese university students,this study designed two comprehensive Multiple Mediation Models involving SEC,stress,coping strategies,and stress reaction to explore the pathway of emotion nurturing mentality.Study 1 utilized a parallel mediation model to examine the relationships between SEC,academic stress,interpersonal stress,and stress reactions.The results indicated that SEC negatively predicted academic stress,interpersonal stress,and stress reactions.Additionally,academic and interpersonal stress mediated the relationships between SEC and stress reactions in parallel.Extending these findings,Study 2 further investigated the role of coping strategies.By constructing a multiple-chain mediation model,it examined the predictive relationships among SEC,academic stress,interpersonal stress,three types of coping strategies,and stress reactions.The findings indicated that SEC negatively predicted stress,problemavoiding strategy,and stress reactions,while positively predicting problem-solving and assistant-seeking strategies.Furthermore,the two stress types and three coping strategies significantly mediated the relationship between SEC and stress reactions.This indicated that higher SEC was associated with reduced stress and more adaptive coping strategies and subsequently contributed to more favorable stress reactions.This research explored the impact of university students’SEC on mental health and its relational mechanisms,aiming to provide theoretical reference and practical insights for future efforts in cultivating SEC among university students to adjust academic and interpersonal stress,to enhance problem-solving and stress resistance capabilities,and to maintain their mental health.

From Theoretical Grammar to Grammatical Competence:An Empirical Study

In China,English teachers usually take a three-step approach to grammar teaching,namely,the presentation—practice—production principle(3P Principle).This method consists of both“morphology”and“syntax.”It adopts the traditional mode of grammar teaching,including knowledge presentation,grammar exercises,and grammatical competence production,which will inevitably lead to time consumption and low efficiency in grammar learning.This study is about cultivating English majors'grammatical competence through the theoretical mode of grammar teaching.The research results show that the theoretical mode of grammar teaching helps cultivate learners'grammatical competence.

Ultrasound Scanning Competencies in Midwifery Education in Zambia: Findings from a Desk Review and Needs Assessment

Introduction: Ultrasound is an essential component of antenatal care. Midwives provide most of the antenatal care but they do not perform ultrasound as it has been beyond their scope of practice. This leaves many women in Low and Middle-Income Countries without access to ultrasound scanning. The aim of this study was to identify competencies in ultrasound scanning in midwifery education. Methods: A desk review and needs assessment were conducted between July and October 2023. Articles and curricula on the internet, Google scholar and PubMed were searched for content on ultrasound scanning competencies. A Google form consisting of 20 questions was administered via email and WhatsApp to 135 participants. Descriptive statistics were used to analyse data. Results: The desk review showed that it is feasible to train midwives in ultrasound scanning. The training programs for midwives in obstetric ultrasound were conducted for 1 week to 3 months with most of them running for 4 weeks. Content included introduction to general principles of ultrasound, physics, basic knowledge in embryology, obstetrics, anatomy, measuring foetal biometry, estimating amniotic fluid and gestational age. Experts like sonographers trained midwives. Theory and hands on were the teaching methods used. Written and practical assessments were conducted. Needs assessment revealed that majority of participants 71 (53%) knew about basic ultrasound training for midwives. All participants (100%) said it is necessary to train midwives in basic ultrasound scan in Zambia. Some content should include, anatomy, measuring foetal biometry, assessing amniotic fluid level, and gestational age determination. Most participants 91 (67%) suggested that the appropriate duration of training is 4 - 6 weeks. Conclusion: Empowering every midwife with ultrasound scanning skills will enable early detection of any abnormality among pregnant women and prompt intervention to save lives.

Community Needs Assessment for a Professional University Health Counselling Course in Cambodia

Developing health and counselling professionals remains an important part of supporting mental health services in Cambodia.This paper aims to identify how the key stakeholders and mental health experts in Cambodia consider how a university level health counselling course could contribute to addressing the needs/treatment gap for mental health services in Cambodia.In order to do this,the study consists of semi-structured interviews with stakeholders,community needs assessment,and community resource mapping.The data were drawn from 15 NGOs,various profit and not-for-profit organizations as well as two key government stakeholders.The participants were invited to take part in a stakeholders/expert semi-structured interview that lasted between 30-60 minutes at the participants’organizations.The findings revealed that all participants believe that a university level health counseling course was crucial in Cambodia to address pressing mental health issues in the country.Most participants believed that a graduate or post-graduate level program such as a B.A.or M.A.was necessary to train qualified counsellors.The program should be internationally benchmarked,with a Cambodian context.Topics should include psychopathology,professional ethics and competencies,counselling theories and interventions,trauma treatment,as well as emotional intelligence and addiction.Other topics might need to include parenting,support system for suicidal patients,self-care,staff wellbeing programs,and school counselor programs.

New Nurse Perceptions of Preparedness: Elements of Academic-Practice Gap

The education-practice gap, also known as the academic-practice gap is recognized as the difference between what a nursing student is taught and what the new nurse will experience in practice. This study evaluated specific education outcomes of schools of nursing in New Hampshire through surveys of new nurses and their employers. The responses were explored in relation to identified factors such as curriculum and clinical hours. The findings suggest that the new nurses felt prepared for practice, except in relationship to provision of care and medication administration for six or more patients. Of note is that 61% percent of participants were involved in errors and of these, 37.5% indicated that their education did not prepare them to administer medications to large groups. Evaluation of employer responses points to at least one and sometimes two levels of lower perception of perceived preparedness by the employer. The results highlight the differences between perceptions of preparedness of new nurse and employer, differences in perception of preparedness based on program type for specific gap elements, and the high rate of errors among new nurses. These results underscore the need for further research regarding the education practice gap, error factors, perceptions of preparedness for practice, and practice-readiness expectations of employers.

Attitudes and Practices of Lumbar Puncture among Students, Interns, and Residents of the Pediatric Department of the Mohammed VI University Hospital Center of Oujda, Morocco

Introduction: Even though lumbar puncture (LP) represents an important tool in the diagnosis of certain neurological diseases, this procedure is little practiced by our students. We aimed to evaluate the attitudes and practices of students, interns, and residents about LP, and to assess their feelings about how this procedure is taught. Materials and Methods: We conducted a cross-sectional study of 160 participants, using an anonymous questionnaire, to evaluate the attitudes and practices of students, interns and residents in the pediatrics department concerning lumbar puncture. Results: Half of the participants had never performed LP, usually because of the risk involved or lack of confidence, while 20% had performed it more than 4 times. None of the participants had learned to perform the procedure through simulation sessions, while (42%) had learned it under the supervision of a senior physician and had not been able to perform it successfully the first time. Most participants inform the patient about the procedure before performing it. Only 44% of participants acknowledged that LP can be performed under local anesthetic. The sitting position (60%) was by far the most commonly used. Most LPs were performed for diagnostic purposes. Most participants stated that the pediatric ward and the pediatric emergency department are among the departments that perform LP most frequently, and that they would be interested in taking part in simulated lumbar puncture sessions in children in the future. Conclusion: The results of our study show that LP is perceived by students as a risky procedure that is difficult to perform. Teachers should reconsider how this technical procedure is taught, by integrating simulation on mannequins into student training.

Cultural Linguistics and Intercultural Communication

The relationship between language and culture is the core issue in intercultural communication.For native language learners,their native language and local culture are in perfect harmony;while for foreign language learners,they often unconsciously separate the two,resulting in the phenomenon of“half-cooked rice”in foreign language education.This phenomenon makes us reflect on the purpose,content,and methods of foreign language education and seek theoretical guidance.Foreign language teaching aims to improve intercultural competencies,so it must face language and culture in intercultural communication.As a branch of cultural linguistics with multidisciplinary origins,intercultural linguistics focuses on the relationship between language and culture in intercultural communication.In the process of exploring how to apply linguistic theories in second language acquisition,it shows that intercultural linguistics not only has important enlightenment and application value,but also needs further studies.

College English Teaching Based on the Theory of Core Competencies

The core competencies of college students can influence their further learning,employment,and personal development.This paper explores college English teaching from the three aspects of core competencies:cultural foundation,self-development,and social participation.Adapting to the challenges posed by the new era for the cultivation of foreign language talents,the paper aims to improve students’cultural literacy,independent learning,the ability of problem discovery and problem solving,and critical cultural thinking,so as to make them more competitive in employment and entrepreneurship.