BACKGROUND: Foreign body (FB) inhalation, ingestion, and insertion account for 11% of emergency admissions for ear, nose, and throat conditions. Children are disproportionately affected, and urgent intervention may be needed to maintain airway patency and prevent blood vessel occlusion. High-quality, readable online information could help reduce poor outcomes from FBs.
OBJECTIVE: We aim to evaluate the quality and readability of available online health information relating to FBs.
METHODS: In total, 6 search phrases were queried using the Google search engine. For each search term, the first 30 results were captured. Websites in the English language and displaying health information were included. The provider and country of origin were recorded. The modified 36-item Ensuring Quality Information for Patients tool was used to assess information quality. Readability was assessed using a combination of tools: Flesch Reading Ease score, Flesch-Kincaid Grade Level, Gunning-Fog Index, and Simple Measure of Gobbledygook.
RESULTS: After the removal of duplicates, 73 websites were assessed, with the majority originating from the United States (n=46, 63%). Overall, the quality of the content was of moderate quality, with a median Ensuring Quality Information for Patients score of 21 (IQR 18-25, maximum 29) out of a maximum possible score of 36. Precautionary measures were not mentioned on 41% (n=30) of websites and 30% (n=22) did not identify disk batteries as a risky FB. Red flags necessitating urgent care were identified on 95% (n=69) of websites, with 89% (n=65) advising patients to seek medical attention and 38% (n=28) advising on safe FB removal. Readability scores (Flesch Reading Ease score=12.4, Flesch-Kincaid Grade Level=6.2, Gunning-Fog Index=6.5, and Simple Measure of Gobbledygook=5.9 years) showed most websites (56%) were below the recommended sixth-grade level.
CONCLUSIONS: The current quality and readability of information regarding FBs is inadequate. More than half of the websites were above the recommended sixth-grade reading level, and important information regarding high-risk FBs such as disk batteries and magnets was frequently excluded. Strategies should be developed to improve access to high-quality information that informs patients and parents about risks and when to seek medical help. Strategies to promote high-quality websites in search results also have the potential to improve outcomes.

BACKGROUND: Thyroid thermoablative techniques have been developed as an alternative to surgery for the treatment of symptomatic benign nodes, with the advantage of being minimally invasive, repeatable, with a minimal complication rate, and avoiding the perioperative risks and irreversible consequences of surgery.
METHODS: A series of patients undergoing laser thermoablation by the same team of endocrinologists operating in 2 centers from May 2016 to December 2022 is presented. The procedure was performed in patients with compressive symptomatology determined by a thyroid node typed TIR 2, or TIR 3A with rejection of the surgical option. We analyzed cases that required surgery because of persistent compressive symptoms, reduction failure, or increase in volume.
RESULTS: From May 2016 to December 2022, 207 thermoablative procedures were performed (187 patients). Single ablative session was unresolved in 28 patients (15%). The proportion of nodes with TIR 3A cytology was significantly higher (21.4 vs 7.0%). In this group, the response in terms of volumetric reduction 6 months after the procedure was significantly lower (5.7% vs 50%). Ten patients (5.3%) underwent surgery, whose histological outcome demonstrated malignancy in 50% of cases.
CONCLUSIONS: Data show the importance of timely re-evaluation with referral to surgical treatment for patients presenting a less than 20% volume reduction 6 months after thermoablation, in order to ensure promptly effective treatment of misrecognized malignancies.

UNASSIGNED: A robust Health Technology Assessment (HTA) framework is crucial to address the rising burden of healthcare costs and to inform decision-making to promote high-quality health systems. This research aims to describe the HTA methods and mechanisms for the successful implementation of HTA in the WHO South-East Asia region, and contextualize the synthesized evidence relevant to Indian settings.
UNASSIGNED: Realist review involves developing a program theory by conducting a systematic search strategy, screening, study selection, data extraction, and data synthesis. A systematic search for literature will be conducted on PubMed (NCBI), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate), and ProQuest Central for identifying the methods used for HTA of health technology interventions. Stakeholder consultations will be conducted to develop a program theory following the Context-Mechanism-Outcome configurations (CMOcs) framework. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. The proposed realist review will be reported as per the Realist and MEta-narrative Evidence Syntheses: Evolving Standards [RAMESES II] guidelines.
UNASSIGNED: To our knowledge, there has been no comprehensive review conducted to understand the mechanisms of HTA methods in the WHO South-East Asia region. The findings from the realist review will help us understand the mechanisms through which the HTA could work in WHO South-East Asian countries. We will then contextualize the findings obtained from evidence to Indian settings, based on program theory development through stakeholder consultation. A framework will be developed that can be used by policymakers/HTA experts in India for effective implementation of the same.

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The European and global dairy breeding industry has benefited enormously from collaboration and sharing of data. The new era of genomics has disrupted the information flow due to the requirement to protect commercial investments. New trait phenotypes, evaluation models, and breeding goals continue to evolve and will impact the way national and proprietary data are shared and presented to the dairy industry. The global nature of cattle breeding will, however, continue to require some form of collaboration, even under the new ways of working.

BACKGROUND: Deep learning (DL) CT denoising models have the potential to improve image quality for lower radiation dose exams. These models are generally trained with large quantities of adult patient image data. However, CT, and increasingly DL denoising methods, are used in both adult and pediatric populations. Pediatric body habitus and size can differ significantly from adults and vary dramatically from newborns to adolescents. Ensuring that pediatric subgroups of different body sizes are not disadvantaged by DL methods requires evaluations capable of assessing performance in each subgroup.
OBJECTIVE: To assess DL CT denoising in pediatric and adult-sized patients, we built a framework of computer simulated image quality (IQ) control phantoms and evaluation methodology.
METHODS: The computer simulated IQ phantoms in the framework featured pediatric-sized versions of standard CatPhan 600 and MITA-LCD phantoms with a range of diameters matching the mean effective diameters of pediatric patients ranging from newborns to 18 years old. These phantoms were used in simulating CT images that were then inputs for a DL denoiser to evaluate performance in different sized patients. Adult CT test images were simulated using standard-sized phantoms scanned with adult scan protocols. Pediatric CT test images were simulated with pediatric-sized phantoms and adjusted pediatric protocols. The framework\'s evaluation methodology consisted of denoising both adult and pediatric test images then assessing changes in image quality, including noise, image sharpness, CT number accuracy, and low contrast detectability. To demonstrate the use of the framework, a REDCNN denoising model trained on adult patient images was evaluated. To validate that the DL model performance measured with the proposed pediatric IQ phantoms was representative of performance in more realistic patient anatomy, anthropomorphic pediatric XCAT phantoms of the same age range were also used to compare noise reduction performance.
RESULTS: Using the proposed pediatric-sized IQ phantom framework, size differences between adult and pediatric-sized phantoms were observed to substantially influence the adult trained DL denoising model\'s performance. When applied to adult images, the DL model achieved a 60% reduction in noise standard deviation without substantial loss in sharpness in mid or high spatial frequencies. However, in smaller phantoms the denoising performance dropped due to different image noise textures resulting from the smaller field of view (FOV) between adult and pediatric protocols. In the validation study, noise reduction trends in the pediatric-sized IQ phantoms were found to be consistent with those found in anthropomorphic phantoms.
CONCLUSIONS: We developed a framework of using pediatric-sized IQ phantoms for pediatric subgroup evaluation of DL denoising models. Using the framework, we found the performance of an adult trained DL denoiser did not generalize well in the smaller diameter phantoms corresponding to younger pediatric patient sizes. Our work suggests noise texture differences from FOV changes between adult and pediatric protocols can contribute to poor generalizability in DL denoising and that the proposed framework is an effective means to identify these performance disparities for a given model.

This article was migrated. The article was marked as recommended. There has long been an underrepresentation of women in medicine and biomedical research; this is often described as a \"leaky pipeline,\" as the more senior the level of rank, the fewer women are appointed. In evaluating a faculty member for promotion, student evaluations of faculty teaching are often considered; therefore, if gender biases are reinforced by student evaluations of teaching, the gender gap in faculty promotion could remain or increase. In this study, we examine student evaluations of faculty teaching in a graduate biomedical research training program, using data gathered during two academic years. While female faculty received higher quantitative ratings of teaching, subtle gender differences in language existed in the student comments, indicating that implicit biases about women may be present in student evaluations of faculty teaching.

OBJECTIVE: Useful feedback and evaluation are critical to a medical trainee\'s development. While most academic physicians understand that giving feedback to learners is essential, many do not consider the components of feedback to be truly useful, and there are barriers to implementation. We sought to use a quick reader (QR) system to solicit feedback for trainees in two pediatric subspecialties (pediatric critical care and neonatal-perinatal medicine) at one institution to increase the quality and quantity of feedback received.
METHODS: New valuations were modified from the existing evaluations and imported into online systems with QR code capability. Each fellow was given a QR code linking to evaluations and encouraged to solicit feedback and evaluations in a variety of clinical settings and scenarios. Evaluation numbers and quality of evaluations were assessed and compared both pre- and post-intervention.
RESULTS: There were increases in the number of evaluations completed for both the pediatric critical care fellows and the neonatal-perinatal medicine fellows. There was no overall change in the quality of written evaluations received. Satisfaction with the evaluation system improved for both faculty and fellows of both training programs.
CONCLUSIONS: In our critical care units, we were successfully able to implement a QR code-driven evaluation for our fellows that improved access for the faculty and offered the ability of the learner to solicit evaluations, without compromising the number or quality of evaluations. What\'s new: Quick reader (QR) codes can be used by learners to solicit evaluations and feedback from faculty. They can increase the quantity of written evaluations received without affecting their quality.

Although evaluative judgments are a central component of everyday decision making little is known about the temporal dynamics of the processes used to make them. The present study used the high temporal resolution of event-related brain potentials (ERPs) to test Cunningham and Zelazo\'s (2007) posited differences in the timing of attitude tag retrieval relative to stimulus categorization for \'attitudes\' and \'evaluations,\' as well as tenets of their Iterative Reprocessing (IR) loop model. Participants made agree/disagree decisions about their attitudes and You/Not You decisions about their autobiographical memories in separate reaction time (RT) tasks while brain activity was recorded from 32 scalp sites. A median-split analysis on RT was used to separate fast and slow decisions. Decisions about autobiographical stimuli produced the typical results in which retrieval and stimulus categorization occurred together just before the response regardless of decision difficulty. By contrast, the relative timing of tag retrieval and categorization differed with difficulty for attitude decisions as predicted by the model. Fast attitude decisions were processed similarly to fast You decisions with retrieval and categorization timing coupled to the response. Slow attitude decisions, however, differed because, while tag retrieval timing was the same as for fast attitude decisions, post-retrieval processing delayed stimulus categorization and a response by 450 msec. ERP activity over dorsolateral prefrontal cortex (DLPFC) in the pre-response interval was asymmetrical, with greater activity for attitude and autobiographical decisions over left and right hemispheres, respectively, while amplitude and duration increased with decision difficulty for both. Slow attitude decisions alone elicited a reduced pre-response positivity, a correlate of goal-directed response selection. The results provide empirical support for key aspects of Cunningham and Zelazo\'s (2007) attitude-evaluation dichotomy and the timing of the posited component processes in their IR model as well as novel information about the roles of stored tags and reflective processes in different attitude decisions.

Background: Little research to date has examined the quality of data obtained from resident performance evaluations. This study sought to address this need and compared inter-rater reliability obtained from norm-referenced and criterion-referenced evaluation scaling approaches for faculty completing resident performance evaluations. Methods: Resident performance evaluation data were examined from 2 institutions (3 programs, 2 internal medicine and 1 surgery; 426 residents in total), with 4 evaluation forms: 2 criterion-referenced (1 with an additional norm-referenced item) and 2 norm-referenced. Faculty inter-rater reliability was calculated with intraclass correlation coefficients (ICCs) (1,10) for each competency area within the form. ICCs were transformed to z-scores, and 95% CIs were computed. Reliabilities for each evaluation form and competency, averages within competency, and averages within scaling type were examined. Results: Inter-rater reliability averages were higher for all competencies that used criterion-referenced scaling relative to those that used norm-referenced scaling. Aggregate scores of all independent categories (competencies and the items assessing overall competence) for criterion-referenced scaling demonstrated higher reliability (z=1.37, CI 1.26-1.48) than norm-referenced scaling (z=0.88, CI 0.77-0.99). Moreover, examination of the distributions of composite scores (average of all competencies and raters for each individual being rated) suggested that the criterion-referenced evaluations better represented the performance continuum. Conclusion: Criterion-referenced evaluation approaches appear to provide superior inter-rater reliability relative to norm-referenced evaluation scaling approaches. Although more research is needed to identify resident evaluation best practices, using criterion-referenced scaling may provide more valid data than norm-referenced scaling.