Audio podcast and procedural video use in anaesthesiology and intensive care: A nationwide survey of Swedish anaesthetists

BACKGROUND

Digital modalities which enable asynchronous learning, such as audio podcasts and videos demonstrating procedures, may benefit acquisition and retention of knowledge and clinical skills. The main objective of this nationwide cross-sectional survey study was to evaluate key aspects and factors related to usage of audio podcasts and procedural videos in anaesthesiology and intensive care.

METHODS

A 20-item multiple-choice-question online survey was created through a consensus process including pilot testing among residents and consultants. Data were collected over a 3-month period, September-November 2023.

RESULTS

The survey was completed by 466 anaesthetists. More than a third reported using procedural videos ≥1 time per week, whereas fewer than one in four participants used audio podcasts at least once per week. Multivariable logistic regression analysis showed that working at a university hospital, male sex, and younger age were independently associated with podcast use ≥1 time per week, with the highest odds ratio (OR) for younger age (<40 years vs. ≥40 years old; OR 5.86 (95% confidence interval 3.55-9.67), p < .001). Younger age was also significantly associated with higher frequency of video use (OR 1.71 (1.13-2.58), p = .011), while working predominantly in intensive care was associated with a lower frequency of video use. Podcasts were often used during commuting (42.3%), household work (30.7%), and exercise (24.9%), indicating a role in multi-tasking. Approximately half of respondents expressed that audio podcast-based learning has a moderate to very large positive impact on acquisition of theoretical knowledge, as well as practical skills. A vast majority, 85.2%, reported that procedural videos have a moderate to very large impact on development of clinical skills.

CONCLUSION

Audio podcasts and procedural videos are appreciated tools with potential to supplement more traditional didactic techniques in anaesthesiology and intensive care. Procedural video use is common, with perceived large effects on development of clinical skills. Further data are needed to fully understand learning outcomes, quality of peer-review processes, and potential sex-differences.

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.

Descriptive Analysis of Patients Receiving Outpatient eConsults for Neurological Disorders in the United States

Introduction: Interprofessional consultations ("eConsults"), which facilitate asynchronous specialist consultations, remain understudied in neurological disorders. We aimed to describe the patient population receiving eConsult services for neurological disorders nationwide and to conduct a comparative analysis between rural and urban patients within this eConsult cohort. Methods: We analyzed a dataset of U.S. outpatient claims from employer-sponsored commercial and Medicare plans. Using standardized mean differences, we compared clinical and sociodemographic patient characteristics between urban and rural patients within the eConsult group. Results: We identified 1,374 patients who had an eConsult order for a neurological disorder. Overall eConsult volume increased by 548.5% between 2019 and 2021. A majority of the cohort were aged 65 years or older (23.7%), had an eConsult order in 2021 (52.4%), and live in an urban area (90.4%). The primary diagnosis for our cohort was likely to be a sleep-wake disorder (21.9%), cerebrovascular disease (14.3%), neurological sign or symptom (14.2%), or headache (13.7%). In the secondary analysis, rural eConsult patients exhibited higher rates of primary diagnoses for traumatic brain injury, neuroophthalmic disorders, or neuropathy than their urban counterparts. Discussion: In this national sample of commercially insured patients, the utilization of eConsults for neurological conditions increased nationwide since 2019, especially for patients living in rural areas.

Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study

BACKGROUND

Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups.

OBJECTIVE

We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals.

METHODS

We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients' first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups.

RESULTS

Among all 95 patients, the average HbA1c decreased by -1.0 (from 8.2% to 7.2%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8%, the average HbA1c decreased by -2.1 (from 10.2% to 8.1%; P<.001), and in those with a baseline HbA1c >9%, the average HbA1c decreased by -2.8 (from 11% to 8.2%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by -1.2 (from 8.6% to 7.4%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg).

CONCLUSIONS

A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible.

Validity and intra- and inter-rater reliability of the Tinetti performance-oriented mobility assessment balance subscale using different tele-assessment methods in patients with chronic stroke

INTRODUCTION

Balance assessments are an important component of rehabilitation. Considering the increasing use of telemedicine to meet rehabilitation needs, it is important to examine the feasibility of such assessments. This study aimed to examine the reliability and validity of the Tinetti Performance-Oriented Mobility Assessment Balance Subscale (POMA-B) when applied via synchronous and asynchronous tele-assessment.

METHODS

Twenty-five patients with chronic stroke were included in the study. The first physiotherapist assessed the patients on the first day in a face-to-face clinical setting. Synchronous or asynchronous tele-assessment was applied the next day. The assessments were performed in the same time zone, with an interval of one day. The synchronous tele-assessment was done online in real time by the first and second physiotherapists. A reference assessment video was sent to the patients for asynchronous tele-assessment. They were asked to make a video recording while performing the evaluation activities according to the reference video. Then the first and second physiotherapists assessed these video recordings separately. All the tests were repeated 10 days later to determine the intra-rater reliability of the tele-assessment methods.

RESULTS

The intra-class correlation coefficients ranged from 0.96 to 0.98 for inter-rater reliability and from 0.97 to 0.98 for intra-rater reliability for both tele-assessment methods. Both asynchronous and asynchronous tele-assessment methods were medium correlated with the face-to-face versions.

CONCLUSIONS

We demonstrated the validity and reliability of the POMA-B in chronic stroke patients with different tele-assessment methods, typically using the internet and available devices.

Chip-In-Loop SNN Proxy Learning: a new method for efficient training of spiking neural networks

The primary approaches used to train spiking neural networks (SNNs) involve either training artificial neural networks (ANNs) first and then transforming them into SNNs, or directly training SNNs using surrogate gradient techniques. Nevertheless, both of these methods encounter a shared challenge: they rely on frame-based methodologies, where asynchronous events are gathered into synchronous frames for computation. This strays from the authentic asynchronous, event-driven nature of SNNs, resulting in notable performance degradation when deploying the trained models on SNN simulators or hardware chips for real-time asynchronous computation. To eliminate this performance degradation, we propose a hardware-based SNN proxy learning method that is called Chip-In-Loop SNN Proxy Learning (CIL-SPL). This approach effectively eliminates the performance degradation caused by the mismatch between synchronous and asynchronous computations. To demonstrate the effectiveness of our method, we trained models using public datasets such as N-MNIST and tested them on the SNN simulator or hardware chip, comparing our results to those classical training methods.

Descriptive and Concordance Data for Asynchronous Teledermatology Consultations for Dermatitis: A Retrospective Study

Background: Implementation of teledermatology for assessing dermatitis patients provides comparable diagnostic and management outcomes to in-person visits, but studies on consumer to physician asynchronous teledermatology (eDerm) consults submitted by patients in large dermatitis cohorts are limited. The objective of this study was to retrospectively assess associations of eDerm consults with diagnostic accuracy, management, and follow-up in a large cohort of dermatitis patients. Methods: One thousand forty-five eDerm encounters between April 1, 2020, and October 29, 2021, recorded in the University of Pittsburgh Medical Center Health System Epic electronic medical record were reviewed. Descriptive statistics and concordance were analyzed using chi-square. Results: Asynchronous teledermatology modified/changed treatment in 97.6% of cases and had the same diagnosis between teledermatology and in-person follow-up in 78.3% of cases. Patients following up in the time line requested were more likely to follow-up in person (61.2% vs. 43.8%) than those who did not. Patients with intertriginous dermatitis (p = 0.003), preexisting conditions (p = 0.002), who required follow-ups (<0.0001), and moderate-high severity scores of 4-7 (p = 0.019) were more likely to follow up in the time line requested. Limitations: Lack of similar in-person visit data did not allow us to compare descriptive and concordance data between eDerm and clinic visits. Conclusions: eDerm offers a quick accessible solution to provide comparable dermatologic care for patients with dermatitis.

Framing asynchronous interprofessional education: a qualitative study on medical, physiotherapy and nursing students

Objectives

To explore how virtual, asynchronous modules can be used in interprofessional health education curricula and to identify any advantages and shortcomings of asynchronous interprofessional education.

Methods

A sample of 27 health professional students who attended in-person interprofessional education workshops at the McMaster Centre for Simulation-Based Learning from 2019-2020 were recruited through email discourse. Participants were asked to complete an asynchronous interprofessional education module and take part in a semi-structured interview that was recorded and transcribed verbatim. Techniques of direct content analysis were used to analyze the qualitative data from recorded transcripts.

Results

The following emergent themes from participants' responses were identified: 1) the modules, as well as the features interspersed throughout, taught strategies for conflict resolution and interprofessional communication, 2) the modules have utility in preparing students for future interprofessional learning, 3) the convenience of virtual asynchronous modules introduces a sense of learner safety, and 4) a sense of isolation and fatigue was identified as a consequence of the lack of face-to-face interaction in these modules.

Conclusion

Asynchronous interprofessional education modules may be best suited to prepare students for future interprofessional learning in a synchronous setting. Asynchronous modules effectively provide an introduction to interprofessional objectives such as conflict resolution and role clarification, yet the competency of team functioning is more difficult to achieve in an asynchronous environment. Future studies may focus on establishing a sequence of completing asynchronous modules for ideal development of interprofessional competencies in health professions learners.

New Construction of Asynchronous Channel Hopping Sequences in Cognitive Radio Networks

The channel-hopping-based rendezvous is essential to alleviate the problem of under-utilization and scarcity of the spectrum in cognitive radio networks. It dynamically allows unlicensed secondary users to schedule rendezvous channels using the assigned hopping sequence to guarantee the self-organization property in a limited time. In this paper, we use the interleaving technique to cleverly construct a set of asynchronous channel-hopping sequences consisting of d sequences of period xN2 with flexible parameters, which can generate sequences of different lengths. By this advantage, the new designed CHSs can be used to adapt to the demands of various communication scenarios. Furthermore, we focus on the improved maximum-time-to-rendezvous and maximum-first-time-to-rendezvous performance of the new construction compared to the prior research at the same sequence length. The new channel-hopping sequences ensure that rendezvous occurs between any two sequences and the rendezvous times are random and unpredictable when using licensed channels under asynchronous access, although the full degree-of-rendezvous is not satisfied. Our simulation results show that the new construction is more balanced and unpredictable between the maximum-time-to-rendezvous and the mean and variance of time-to-rendezvous.

Signatures of cross-modal alignment in children's early concepts

Whether supervised or unsupervised, human and machine learning is usually characterized as event-based. However, learning may also proceed by systems alignment in which mappings are inferred between entire systems, such as visual and linguistic systems. Systems alignment is possible because items that share similar visual contexts, such as a car and a truck, will also tend to share similar linguistic contexts. Because of the mirrored similarity relationships across systems, the visual and linguistic systems can be aligned at some later time absent either input. In a series of simulation studies, we considered whether children's early concepts support systems alignment. We found that children's early concepts are close to optimal for inferring novel concepts through systems alignment, enabling agents to correctly infer more than 85% of visual-word mappings absent supervision. One possible explanation for why children's early concepts support systems alignment is that they are distinguished structurally by their dense semantic neighborhoods. Artificial agents using these structural features to select concepts proved highly effective, both in environments mirroring children's conceptual world and those that exclude the concepts that children commonly acquire. For children, systems alignment and event-based learning likely complement one another. Likewise, artificial systems can benefit from incorporating these developmental principles.

Rapid Expansion of a Teledermatology Web Application for Digital Dermatology Assessment Necessitated by the COVID-19 Pandemic: Retrospective Evaluation

BACKGROUND

The COVID-19 pandemic necessitated a change in the provision of outpatient care in dermatology.

OBJECTIVE

A novel, asynchronous, digital consultation platform was codeveloped with 2 National Health Service dermatology teams to improve access and enhance choice in outpatient care.

METHODS

The rollout of the platform was accelerated during the initial COVID-19 lockdown, and its wider use across 2 Scottish health boards was retrospectively evaluated. Integrated with the hospital booking system and electronic patient record, the platform provides an alternative to face-to-face consultations, using information and images submitted by the patients.

RESULTS

In total, 297 new patient consultations and 108 return patient consultations were assessed, and 80% (324/405) of the images submitted were of satisfactory quality. The consultations were, on average, 3 minutes shorter than equivalent face-to-face interactions, and a total of 5758 km of patient travel was avoided. Outcomes included web-based reviews (66/405, 16.3%), face-to-face reviews (190/405, 46.9%), biopsies (46/405, 11.4%), discharge (89/405, 22%), and other treatments or investigations (14/405, 3.5%). High levels of patient satisfaction (92/112, 82.1%) were reported.

CONCLUSIONS

Digital dermatology assessments are now included in the choices for consultation types that are available to patients, helping to augment service capacity during pandemic recovery.

Reproductive asynchrony within social groups of female eastern wild turkeys

Coordination in timing of reproduction is driven by multiple ecological and sociobiological processes for a wide array of species. Eastern wild turkeys (Meleagris gallopavo silvestris) use a male dominance polygynous mating system, where males communicate with females via elaborate courtship displays and vocalizations at display sites. Most females prefer to mate with dominant males; therefore, asynchronous breeding and nesting may occur which can disproportionately influence individual fitness within breeding groups. For female wild turkeys, there are reproductive advantages associated with earlier nesting. As such, we evaluated reproductive asynchrony within and between groups of GPS-tagged female eastern wild turkeys based on timing of nest initiation. We examined 30 social groups with an average of seven females per group (range 2-15) during 2014-2019 in west central Louisiana. We found that the estimated number of days between first nest initiation across females within groups varied between 3 and 7 days across years, although we expected 1-2 days to occur between successive nesting attempts of females within groups based on observations of captive wild turkeys in the extant literature. The number of days between successive nest attempts across females within groups was lower for successful than failed attempts, and nests with an average of 2.8 days between initiation of another nest were more likely to hatch. Our findings suggest that asynchronous reproduction may influence reproductive success in female wild turkeys.

An Asynchronous Curriculum: Learner Perspectives on Incorporating Asynchronous Learning Into In-Person and Virtual Emergency Residency Didactics

Background  Didactic education in emergency medicine (EM) residencies has been impacted both by the advent of asynchronous learning and by the shift toward virtual, web-based conference education due to coronavirus disease 2019 (COVID-19). Studies have demonstrated the efficacy of asynchronous education, but few have explored resident opinions about how asynchronous and virtual modifications on conference impact their educational experience.  Objective This study aimed to evaluate resident perceptions of both asynchronous and virtual modifications to a historically in-person didactic curriculum. Methods This was a cross-sectional study of residents of a three-year EM program at a large academic center where a 20% asynchronous curriculum was implemented in January 2020. A questionnaire was administered online with questions assessing how residents perceived their didactic curriculum with regard to convenience, retention of information, work/life balance, enjoyability, and overall preference. Questions compared resident opinions of in-person vs. virtual learning, as well as how the substitution of one hour of asynchronous learning impacted residents' perception of their didactics. Responses were reported on a five-point Likert-type scale.  Results A total of 32 out of 48 residents (67%) completed the questionnaire. When virtual conference was compared to in-person conference, residents favored virtual conference with regard to convenience (78.1%), work-life balance (78.1%), and overall preference (68.8%). They favored in-person conference (40.6%) or felt that the modalities were equivalent (40.6%) with regard to retention of information and favored in-person conference with regard to enjoyability (53.1%). Residents felt that the addition of asynchronous learning to their curriculum increased subjective convenience, work-life balance, enjoyability, retention of information, and overall preference, regardless of whether synchronous conference was virtual or in-person. All 32 responding residents were interested in seeing the asynchronous curriculum continue. Conclusion EM residents value the addition of asynchronous learning to both in-person and virtual didactic curricula. Additionally, virtual conference was favored over in-person conference with regard to work/life balance, convenience, and overall preference. As social distancing restrictions continue to ease post-COVID-19 pandemic, EM residencies may consider adding or maintaining asynchronous or virtual components to their synchronous conference schedule as a means to support resident wellness.

Teachers’ CALL professional development in synchronous, asynchronous, and bichronous online learning through project-oriented tasks: developing CALL pedagogical knowledge

The popularity of online education has prompted computer-assisted language learning (CALL) teachers to attend online teacher professional development (OTPD) courses. Online education has necessitated a deeper look into online delivery in professional development courses. Hence, an exploratory qualitative case study was conducted to investigate how synchronous, asynchronous, or the blend of both, called bichronous online learning, could develop teachers’ CALL pedagogical knowledge through project-oriented tasks. In light of data from technology-review projects and discussions, it was revealed that bichronous online learning benefited teachers significantly in acquiring CALL pedagogical knowledge, specifically in selecting, developing, and evaluating CALL materials. Bichronous online learning incorporates the best affordances of synchronous and asynchronous modalities. The findings showed that synchronous and asynchronous modalities complement each other and should not be substituted for each other. This study could be considered a contribution on account of informing the community of inquiry about the pedagogical affordances of bichronous online learning and proving that bichronous online learning is an ideal learning setting to aid CALL teacher education programs.

Field-programmable encoding for address-event representation

In conventional frame-based image sensors, every pixel records brightness information and sends this information to a receiver serially in a scanning fashion. This full-frame readout approach suffers from high bandwidth requirements and increased power consumption with the increasing size of the pixel array. Event-based image sensors are gaining popularity for reducing the bandwidth and power requirements by sending only meaningful data in an event-driven approach with the help of address-event representation (AER) communication protocol. However, the event-based readout suffers from increased latency and timing error when the number of pixels with an event increase. In this paper, we introduce a new field-programmable AER (FP-AER) encoding scheme which offers benefits of both frame-based and event-based approaches. The readout design can be configured "in the field" using configuration bits. We also compare the performance of the proposed design against existing AER-based approaches for imaging applications and show that FP-AER performs best in both scanning and event-based readout.

Fluctuating fortunes: Stressor synchronicity and fluctuating intensity influence biological impacts

Ecosystems remain under enormous pressure from multiple anthropogenic stressors. Manipulative experiments evaluating stressor interactions and impacts mostly apply stressors under static conditions without considering how variable stressor intensity (i.e. fluctuations) and synchronicity (i.e. timing of fluctuations) affect biological responses. We ask how variable stressor intensity and synchronicity, and interaction type, can influence how multiple stressors affect seagrass. At the highest intensities, fluctuating stressors applied asynchronously reduced seagrass biomass 36% more than for static stressors, yet no such difference occurred for photosynthetic capacity. Testing three separate hypotheses to predict underlying drivers of differences in biological responses highlighted alternative modes of action dependent on how stressors fluctuated over time. Given that environmental conditions are constantly changing, assessing static stressors may lead to inaccurate predictions of cumulative effects. Translating multiple stressor experiments to the real world, therefore, requires considering variability in stressor intensity and the synchronicity of fluctuations.

Asynchronous Space-Time-Coding Digital Metasurface

Recent progress in space-time-coding digital metasurface (STCM) manifests itself a powerful tool to engineer the properties of electromagnetic (EM) waves in both space and time domains, and greatly expands its capabilities from the physical manipulation to information processing. However, the current studies on STCM are focused under the synchrony frame, namely, all meta-atoms follow the same variation frequency. Here, an asynchronous STCM is proposed, where the meta-atoms are modulated by different time-coding periods. In the proposed asynchronous STCM, the phase discontinuities on traditional metasurface are replaced with the frequency discontinuities. It is shown that dynamic wavefronts can be automatically realized for both fundamental and high-order harmonics by elaborately arranging the spatial distribution of meta-atoms with various time-coding periods. The physics insight is due to the accumulated rapidly changing phase difference with time, which offers an additional degree of freedom during the wave-matter interactions. As a proof-of-principle example, an asynchronous STCM for automatic spatial scanning and dynamic scattering control is investigated. From the theory, numerical simulations, and experiments, it can be found that the proposed STCM exhibits significant potentials for applications in radars and wireless communications.

Deep versus Shallow Processing: A Learning and Memory Experiment for Asynchronous and Synchronous Online Platforms

Processing of words can be meaning-based (deep processing) or appearance/sound-based (shallow processing). A simple experiment that can be conducted online, asynchronously or synchronously, demonstrates that the number of words recalled from a list of 24 words read aloud depends on the instructions given to students beforehand. Students in the deep processing group were asked to write 'yes' or 'no' - is the word likeable/pleasant, while students in the shallow processing group were asked to write 'yes' or 'no' - does the word contain an E or G. After a one-minute delay in which students performed a backward calculation task, they had two minutes to recall as many words as possible from the list. Regardless of how the online experiment was conducted, asynchronously or synchronously, the deep processing group recalled an average of 11-14 words compared to the shallow processing group, which recalled an average of 8-10 words. The deep processing group consistently recalled 3-6 more words on average than the shallow processing group. After debriefing the students about the experiment, the instructor can focus class discussion on topics that include experimental design, methodology, reproducibility, data analysis, as well as using these data as an evidence-based starting point for best learning practices.

Adapting Case Studies for Synchronous and Asynchronous Online Courses

Case studies are an effective active learning method that increases student engagement and are readily adaptable from in-person to online learning environments. In this perspective, Neuroscience Case Network fellows (NeuroCaseNet; NSF-RCN-UBE Grant #1624104) provide specific examples of how case studies were successfully adapted for synchronous and asynchronous online learning, including general strategies and best practices for adapting case studies into both online learning environments.

Redesigning a face-to-face course to an asynchronous online format: a look at teaching pathophysiology with software that enhances student engagement

The COVID-19 pandemic, while disruptive and abrupt, provided instructors opportunities to redesign face-to-face (F2F) lecture courses to an online asynchronous delivery mode. Asynchronous course delivery is often synonymous with recorded lectures, discussion boards, and standardized assessments, yet this mode can be student-centered, include active learning, and engage students. Our undergraduate clinical pathophysiology course was redesigned with Understanding Your Physiology (Lt by ADInstruments) lessons with video case studies in place of a textbook. Most students (72.7%) found the Lt activities effective in helping them learn the material as well as a cost-effective replacement for a traditional textbook (50%). In addition, the course design focused on different types of Lt activities to deliver the course content in an interactive way. Specifically, students (82%) appreciated the opportunity to select an answer without penalty and make another selection if needed. The type of activity that students selected as most effective in helping them learn and understand the content was the ability to determine which statements were correct/incorrect (32%). Students enjoyed the video case studies of patients because they were directly related to course content, were visually engaging, and used real patients who told their personal story. All these factors contributed to the success in achieving the study's goals of redesigning a F2F lecture course to an asynchronous online format. The online course led to verifiable pedagogical outcomes of using the Lt platform to engage students in learning. This course was offered again in 2021, filled quickly, and will continue to be offered each year.

Educating Online Students in Laboratory Safety

Understanding laboratory biosafety is essential for any student in biology courses. With the switch to remote instruction, it became imperative to continue to relay the importance of laboratory biosafety even for online, asynchronous science courses. Here, we present exercises used to teach students the importance of understanding, not just memorizing, laboratory biosafety guidelines, rules, protocols, and requirements. The incorporation of universal design for learning (UDL) principles allowed for multimodal approaches to incorporate content and attempt to provide a flexible, equitable, and engaging experience. Continuing to educate students on proper laboratory safety even in an online modality is especially critical for students that will eventually return to in-person laboratory courses where they will be expected to follow laboratory safety policies and procedures.

Synchronous and asynchronous teledermatology: A narrative review of strengths and limitations

The policy changes prompted by the COVID-19 pandemic caused synchronous models (primarily video visits) to supplant asynchronous models (store-and-forward or shared digital photographs) as the default and predominant modality of teledermatology care. Here, we call attention to the unique strengths and limitations of these models in terms of clinical utility, accessibility, and cost-effectiveness. Strengths of synchronous visits include direct physician-patient interaction and current reimbursement parity; limitations include variable video image quality, technological difficulties, and accessibility barriers. Strengths of asynchronous visits include greater convenience, especially for clinicians, and potential for image quality superior to video; limitations include less direct physician-patient communication, barriers to follow-up, and limited reimbursement. Both synchronous and asynchronous models have been shown to be cost-effective. Teledermatology is positioned to play a prominent role in patient care post-pandemic. Moving forward, dermatologists are challenged to optimize teledermatology use in order to improve outcomes, efficiency, and workflows to meet diverse patient needs. Future directions will depend on sustainable reimbursement of both teledermatology formats by government and private payers.

Dynamic Asynchronous Anti Poisoning Federated Deep Learning with Blockchain-Based Reputation-Aware Solutions

As promising privacy-preserving machine learning technology, federated learning enables multiple clients to train the joint global model via sharing model parameters. However, inefficiency and vulnerability to poisoning attacks significantly reduce federated learning performance. To solve the aforementioned issues, we propose a dynamic asynchronous anti poisoning federated deep learning framework to pursue both efficiency and security. This paper proposes a lightweight dynamic asynchronous algorithm considering the averaging frequency control and parameter selection for federated learning to speed up model averaging and improve efficiency, which enables federated learning to adaptively remove the stragglers with low computing power, bad channel conditions, or anomalous parameters. In addition, a novel local reliability mutual evaluation mechanism is presented to enhance the security of poisoning attacks, which enables federated learning to detect the anomalous parameter of poisoning attacks and adjust the weight proportion of in model aggregation based on evaluation score. The experiment results on three datasets illustrate that our design can reduce the training time by 30% and is robust to the representative poisoning attacks significantly, confirming the applicability of our scheme.

Point-of-Care Ultrasound for Physicians in Practice - A Training Model for Specialty Specific and Clinically Relevant Skill Development

Point-of-care Ultrasound (POCUS) skills are required competencies for emergency medicine and paediatric emergency medicine training [1,2,3,4]. Over time, more specialties will require these skills of their graduates. Experienced physicians who completed their training before POCUS requirements may ask: How can I gain POCUS skills training and competency? In this perspective piece we describe in-person and asynchronous training programs available to these clinicians in practice. We highlight these programs due to their person-centred design: they maximise the needs of the learner, provide personalised education, and expose them to respected and established POCUS faculty and training centers.

Asynchronous and Synchronous Delivery Models for Home-Based Cardiac Rehabilitation: A SCIENTIFIC REVIEW

PURPOSE

To review the principles, advantages, and disadvantages of asynchronous and synchronous delivery models of home-based cardiac rehabilitation (HBCR).

METHODS

We reviewed recently published systematic reviews and other publications of randomized studies of asynchronous and synchronous HBCR to assess principles, outcomes, and limitations of those delivery methods compared with center-based cardiac rehabilitation (CBCR).

SUMMARY

While most studies prior to 2016 involved asynchronous HBCR approaches to care, studies since 2016 have included asynchronous or synchronous delivery models. Both delivery models have been shown to help provide core components of cardiac rehabilitation (CR). Studies using either method have been shown to have similar short-term patient outcomes as CBCR, at least in low- to moderate-risk patients who have been studied. Asynchronous HBCR offers greater flexibility for patients and CR staff, while synchronous HBCR provides greater real-time oversight and feedback to patients.Asynchronous and synchronous HBCR is an option to consider for patients eligible for CR. Additional research is needed for both delivery models, applied separately or in combination, to compare their impact on shorter- and longer-term patient outcomes and to assess their impact in patient subgroups (referral diagnosis, women, elderly, underrepresented racial and ethnic minority groups, patients at a higher cardiovascular disease risk, patients with multiple comorbid conditions, etc).

Implications of a Remote Study of Children With Cerebral Visual Impairment for Conducting Virtual Pediatric Eye Care Research: Virtual Assessment Is Possible for Children With CVI

The Pandemic of 2020 impacted conducting in-person research. Our proposed project already had an asynchronous online component but was later morphed to add a synchronous online component, thereby eliminating the need for in-person assessment. The project compares the results of various tests between a group of children with Cerebral Visual Impairments (CVI) (N = 4) and an age-matched sample of children without CVI (N = 3) from a pediatric low vision clinic. This model was trialed with a small convenient sample of typically developing children in the same age range (N = 4). Given the positive feedback, recruitment for the larger study was done via encrypted e-mail rather than through traditional mailing. The asynchronous components included recruitment, pre-assessment information, the Flemish CVI questionnaire, Vineland-3 comprehensive parent questionnaire for assessment of age equivalent, and vision function tests, such as contrast sensitivity. The synchronous components were administered via Zoom telehealth provided by necoeyecare.org and included assessment of visual acuity via the Freiburg Visual Acuity and Contrast Test (FrACT) electronic software and assessment of visual perceptual batteries via the Children’s Visual Impairment Test for developmental ages 3–6-years (CVIT 3–6). Our virtual testing protocol was successful in the seven participants tested. This paper reviews and critiques the model that we utilized and discusses ways in which this model can be improved. Aside from public health considerations during the pandemic, this approach is more convenient for many families. In a broader perspective, this approach can be scaled for larger N studies of rare conditions, such as CVI without being confined by proximity to the researcher.

Conducting Online Healthcare Research With Open-Ended Questions in the Age of COVID-19: A Critical Review

BACKGROUND

Worldwide, there is a remarkable increase in Internet use, with a current penetration rate of 62%. This widespread Internet use and the global coronavirus disease (COVID-19) preventive measures provide opportunities for data collection using the Internet in healthcare research. No recent studies have been conducted regarding the methodological issues of asynchronous Internet research that employed opened-ended questions to explore providers' and patients' experiences.

PURPOSE

This study utilizes prior research to explore methodological issues that affect online research using open-ended questions to obtain health data.

METHODS

The electronic databases searched were PubMed, CINAHL, and full-text Ovid. Reference lists and the Journal of Medical Internet Research were manually searched. The search strategy was based on the PRISMA flow diagram. Articles published between January 2003 and May 2020 were searched. Inclusion criteria were asynchronous online researcher-led studies that used open-ended questions to explore healthcare issues. Methodological issues were extracted from the selected studies.

RESULTS

The evidence suggests that factors such as technical/website study/survey design issues, smartphone study applications, use of reminders, incentives, overrecruiting participants, using a combination of asynchronous and synchronous methods, trustworthiness, ethical and security issues affect the quality of data obtained in online health research.

IMPLICATIONS FOR PRACTICE

Asynchronous online research methods with open-ended questions could be used to collect high-quality data from patients, healthcare providers, and other participants in self-isolation, quarantine, and in diverse locations. However, researchers should be aware of the identified methodological issues. Future research could explore methodological issues and data quality in combined asynchronous and synchronous data collection methods.

Keeping environmental physiology education up and running during the COVID-19 pandemic

The COVID-19 pandemic provoked a need for rapid adaptation of teaching strategies and learning environments. Thus novel approaches, predominantly based on online/virtual platforms are needed to minimize the negative effects of the pandemic on teaching (and learning). Herein we describe our recent web-based symposium series on environmental physiology and ergonomics initiative as an example of such a strategy. We outline the ideas behind this series and its implementation, which could serve as an example of a useful joint interactive virtual educational environment that could be applied to any physiology subspecialty. Based on the feedback received from all stakeholders involved in the process, we strongly believe that such an approach can provide an excellent platform for all educational levels from undergraduate students up to seasoned academics. Importantly, the unrestricted availability (free registration and publication of recordings and student handouts) is an important consideration for the democratization of science and the inclusion of financially less well-supported students and academics.

Spatio-temporal equalization multi-window algorithm for asynchronous SSVEP-based BCI

Objective.Asynchronous brain-computer interfaces (BCIs) show significant advantages in many practical application scenarios. Compared with the rapid development of synchronous BCIs technology, the progress of asynchronous BCI research, in terms of containing multiple targets and training-free detection, is still relatively slow. In order to improve the practicability of the BCI, a spatio-temporal equalization multi-window algorithm (STE-MW) was proposed for asynchronous detection of steady-state visual evoked potential (SSVEP) without the need for acquiring calibration data.Approach.The algorithm used SIE strategy to intercept EEG signals of different lengths through multiple stacked time windows and statistical decisions-making based on Bayesian risk decision-making. Different from the traditional asynchronous algorithms based on the 'non-control state detection' methods, this algorithm was based on the 'statistical inspection-rejection decision' mode and did not require a separate classification of non-control states, so it can be effectively applied to detections for large-scale candidates.Main results.Online experimental results involving 14 healthy subjects showed that, in the continuously input experiments of 40 targets, the algorithm achieved the average recognition accuracy of97.2±2.6%and the average information transfer rate (ITR) of106.3±32.0 bitsmin-1. At the same time, the average false alarm rate in the 240 s resting state test was0.607±0.602 min-1. In the free spelling experiments involving patients with severe amyotrophic lateral sclerosis, the subjects achieved an accuracy of 92.7% and an average ITR of 43.65 bits min^-1in two free spelling experiments.Significance.This algorithm can achieve high-performance, high-precision, and asynchronous detection of SSVEP signals with low algorithm complexity and false alarm rate under multi-targets and training-free conditions, which is helpful for the development of asynchronous BCI systems.

Dental education during the pandemic: Cross-sectional evaluation of four different teaching concepts

Objectives

To evaluate the advantages of student satisfaction with and functionality of three digital teaching concepts during the SARS‐CoV‐2 pandemic compared to a conventional lecture setup.

Methods

This cross‐sectional study was a survey‐based e‐learning research among dental students in the clinical study phase of a department of prosthetic dentistry at a German university hospital. A total of 44 questions were answered in four main sections: 1. general technical components; 2. acceptance; 3. evaluation and functionality; and 4. overall evaluation and grades of the various digital concepts. The use of Zoom conference, livestream, and prerecorded PowerPoint was compared to the conventional lecture setup (control group/CG). Data were analyzed using the Kolmogorov‐Smirnov test, followed by an exploratory data analysis and Cronbach's alpha test (α = 0.05).

Results

Students were very satisfied with the provision, quality, and benefit of the digital concepts. The asynchronous concept was significantly more satisfying than the synchronous concepts in many aspects but was less successful in interactions. In the overall evaluation and grading, the asynchronous concept was rated significantly better than the other synchronous concepts (p ≤ 0.007), followed by Zoom conference, conventional lecture (CG), and livestream, while Zoom conference and the conventional lecture showed no significant difference (p = 0.784).

Conclusions

Students significantly preferred the asynchronous concept to the synchronous concepts. The results suggested that asynchronous concepts are an effective and functional form of distance education during a pandemic. In general, digital teaching concepts are currently widely accepted for maintaining university education.

An Asynchronous Real-Time Corner Extraction and Tracking Algorithm for Event Camera

Event cameras have many advantages over conventional frame-based cameras, such as high temporal resolution, low latency and high dynamic range. However, state-of-the-art event- based algorithms either require too much computation time or have poor accuracy performance. In this paper, we propose an asynchronous real-time corner extraction and tracking algorithm for an event camera. Our primary motivation focuses on enhancing the accuracy of corner detection and tracking while ensuring computational efficiency. Firstly, according to the polarities of the events, a simple yet effective filter is applied to construct two restrictive Surface of Active Events (SAEs), named as RSAE+ and RSAE−, which can accurately represent high contrast patterns; meanwhile it filters noises and redundant events. Afterwards, a new coarse-to-fine corner extractor is proposed to extract corner events efficiently and accurately. Finally, a space, time and velocity direction constrained data association method is presented to realize corner event tracking, and we associate a new arriving corner event with the latest active corner that satisfies the velocity direction constraint in its neighborhood. The experiments are run on a standard event camera dataset, and the experimental results indicate that our method achieves excellent corner detection and tracking performance. Moreover, the proposed method can process more than 4.5 million events per second, showing promising potential in real-time computer vision applications.

Asynchronous Telepsychiatry Interviewer Training Recommendations: A Model for Interdisciplinary, Integrated Behavioral Health Care

Objective: Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlines the development of a training model for ATP clinician skills. Methods: Clinical and procedural training for ATP clinicians (n = 5) was provided by master's-level, clinical mental health providers developed by three experienced telepsychiatrists (P.Y. D.H., and J.S) and supervised by a tele-psychiatrist (PY, GX, DL) through seminar, case supervision, and case discussions. A training manual and one-on-one sessions were employed for initial training. Unstructured expert discussion and feedback sessions were conducted in the training phase of the study in year 1 and annually thereafter over the remaining 4 years of the study. The notes gathered during those sessions were synthesized into themes to gain a summary of the study telepsychiatrist training recommendations for ATP interviewers. Results: Expert feedback and discussion revealed three overarching themes of recommended skill sets for ATP interviewers: (1) comprehensive skills in brief psychiatric interviewing, (2) adequate knowledge base of behavioral health conditions and therapeutic techniques, and (3) clinical documentation, integrated care/consultation practices, and e-competency skill sets. The model of training and skill requirements from expert feedback sessions included these three skill sets. Technology training recommendations were also identified and included: (1) awareness of privacy/confidentiality for electronic data gathering, storage, management, and sharing; (2) technology troubleshooting; and (3) video filming/retrieval. Conclusions: We describe and provide a suggested training model for the use of ATP integrated behavioral health. The training needs for ATP clinicians were assessed on a limited convenience sample of experts and clinicians, and more rigorous studies of training for ATP and other technology-focused, behavioral health services are needed. Clinical Trials number: NCT03538860.

Teledentistry applications for mitigating risk and balancing the clinical schedule

The upheaval of providers and their patients has led to many changes in the way people live and work. In addition to the changes in Personal Protective Equipment (PPE) guidelines, there has been evidence of rapid adoption of telehealth services. In April of 2020, the American Dental Association's Health Policy Institute released a report stating that 1 in 4 dentists nationally were utilizing teledentistry to perform limited evaluations. Many of these dentists are new to teledentistry, and unfortunately, direct-to-patient consultations yield limited clinical outcomes. The more traditional methods of using teledentistry have been extending the reach of dental care for over a decade, using an allied team member such as a dental hygienist or expanded-function dental assistant. As dentistry adapts to this new environment, it is important that there be adequate awareness of the diverse uses of teledentistry to meet the needs of the population. This brief, outlines one dental clinic's attempt at providing a broad use of teledentistry.

The Attraction of Synchrony: A Hip-Hop Dance Study

This study investigated an evolutionary-adaptive explanation for the cultural ubiquity of choreographed synchronous dance: that it evolved to increase interpersonal aesthetic appreciation and/or attractiveness. In turn, it is assumed that this may have facilitated social bonding and therefore procreation between individuals within larger groups. In this dual-dancer study, individuals performed fast or slow hip-hop choreography to fast-, medium-, or slow-tempo music; when paired laterally, this gave rise to split-screen video stimuli in which there were four basic categories of dancer and music synchrony: (1) synchronous dancers, synchronous music; (2) synchronous dancers, asynchronous music; (3) asynchronous dancers, one dancer synchronous with music; and (4) asynchronous dancers, asynchronous music. Participants' pupil dilations and aesthetic appreciation of the dancing were recorded for each video, with the expectation that these measures would covary with levels of synchronization. While results were largely consistent with the hypothesis, the findings also indicated that interpersonal aesthetic appreciation was driven by a hierarchy of synchrony between the dancers: stimuli in which only one dancer was synchronous with the music were rated lower than stimuli in which the dancers were asynchronous with each other and with the music; i.e., stimuli in which the dancers were unequal were judged less favorably than those in which the dancers were equal, albeit asynchronously. Stimuli in which all elements were synchronous, dancers and music, were rated highest and, in general, elicited greater pupil dilations.

Providing an Online Nursing Journal Club and Ensuring the Rigor of the Experience

Participation in nursing journal clubs has been correlated with increased familiarity among nurses with research processes and outcomes, as well as improved ability to critique research studies and apply evidence from the literature to practice. For nurses who are direct care providers, time and accessibility are barriers to participation in journal clubs. Providing a journal club using an online, asynchronous format increased participation. This article describes the inception of a nursing journal club and the steps taken to alter the format to increase participation.

Feasibility of Asynchronous and Automated Telemedicine in Otolaryngology: Prospective Cross-Sectional Study

BACKGROUND

COVID-19 often causes respiratory symptoms, making otolaryngology offices one of the most susceptible places for community transmission of the virus. Thus, telemedicine may benefit both patients and physicians.

OBJECTIVE

This study aims to explore the feasibility of telemedicine for the diagnosis of all otologic disease types.

METHODS

A total of 177 patients were prospectively enrolled, and the patient's clinical manifestations with otoendoscopic images were written in the electrical medical records. Asynchronous diagnoses were made for each patient to assess Top-1 and Top-2 accuracy, and we selected 20 cases to conduct a survey among four different otolaryngologists to assess the accuracy, interrater agreement, and diagnostic speed. We also constructed an experimental automated diagnosis system and assessed Top-1 accuracy and diagnostic speed.

RESULTS

Asynchronous diagnosis showed Top-1 and Top-2 accuracies of 77.40% and 86.44%, respectively. In the selected 20 cases, the Top-2 accuracy of the four otolaryngologists was on average 91.25% (SD 7.50%), with an almost perfect agreement between them (Cohen kappa=0.91). The automated diagnostic model system showed 69.50% Top-1 accuracy. Otolaryngologists could diagnose an average of 1.55 (SD 0.48) patients per minute, while the machine learning model was capable of diagnosing on average 667.90 (SD 8.3) patients per minute.

CONCLUSIONS

Asynchronous telemedicine in otology is feasible owing to the reasonable Top-2 accuracy when assessed by experienced otolaryngologists. Moreover, enhanced diagnostic speed while sustaining the accuracy shows the possibility of optimizing medical resources to provide expertise in areas short of physicians.

Perception Understanding Action: Adding Understanding to the Perception Action Cycle With Spiking Segmentation

Traditionally the Perception Action cycle is the first stage of building an autonomous robotic system and a practical way to implement a low latency reactive system within a low Size, Weight and Power (SWaP) package. However, within complex scenarios, this method can lack contextual understanding about the scene, such as object recognition-based tracking or system attention. Object detection, identification and tracking along with semantic segmentation and attention are all modern computer vision tasks in which Convolutional Neural Networks (CNN) have shown significant success, although such networks often have a large computational overhead and power requirements, which are not ideal in smaller robotics tasks. Furthermore, cloud computing and massively parallel processing like in Graphic Processing Units (GPUs) are outside the specification of many tasks due to their respective latency and SWaP constraints. In response to this, Spiking Convolutional Neural Networks (SCNNs) look to provide the feature extraction benefits of CNNs, while maintaining low latency and power overhead thanks to their asynchronous spiking event-based processing. A novel Neuromorphic Perception Understanding Action (PUA) system is presented, that aims to combine the feature extraction benefits of CNNs with low latency processing of SCNNs. The PUA utilizes a Neuromorphic Vision Sensor for Perception that facilitates asynchronous processing within a Spiking fully Convolutional Neural Network (SpikeCNN) to provide semantic segmentation and Understanding of the scene. The output is fed to a spiking control system providing Actions. With this approach, the aim is to bring features of deep learning into the lower levels of autonomous robotics, while maintaining a biologically plausible STDP rule throughout the learned encoding part of the network. The network will be shown to provide a more robust and predictable management of spiking activity with an improved thresholding response. The reported experiments show that this system can deliver robust results of over 96 and 81% for accuracy and Intersection over Union, ensuring such a system can be successfully used within object recognition, classification and tracking problem. This demonstrates that the attention of the system can be tracked accurately, while the asynchronous processing means the controller can give precise track updates with minimal latency.

Mechanistic Insights into C(sp2 )-C(sp)N Reductive Elimination from Gold(III) Cyanide Complexes

A new family of phosphine-ligated dicyanoarylgold(III) complexes has been prepared and their reactivity towards reductive elimination has been studied in detail. Both, a highly positive entropy of activation and a primary ^12/13 C KIE suggest a late concerted transition state while Hammett analysis and DFT calculations indicate that the process is asynchronous. As a result, a distinct mechanism involving an asynchronous concerted reductive elimination for the overall C(sp² )-C(sp)N bond forming reaction is characterized herein, for the first time, complementing previous studies reported for C(sp³ )-C(sp³ ), C(sp² )-C(sp² ), and C(sp³ )-C(sp² ) bond formation processes taking place on gold(III) species.

Telemedicine Proof of Concept and Cost Savings During Underway Naval Operations

Objectives: With military service members stationed around the world aboard ships and remote fixed facilities, subspecialty care frequently occurs outside of the TRICARE network, the health care program of the United States Department of Defense Military Health System, including foreign hospitals. Furthermore, usage aboard U.S. Navy ships has been limited in scope. This has direct costs associated with the medical care rendered and indirect costs such as difficulty navigating medical systems, access to records, and appropriate follow-up. Telemedicine has expanded access to otolaryngologic care where coverage has been deficient, with overall costs that are not well defined. This study aims to demonstrate the ability of consult management aboard a deployed U.S. Navy ship and to determine the direct costs associated with the use of an HIPAA-compliant, store-and-forward telemedicine system available to overseas medical providers to obtain specialty consultation at a tertiary care military treatment facility. Study Design: Retrospective case series. Methods: We reviewed consults submitted through the system from February 2018 to May 2018. Consult management was performed remotely by a deployed otolaryngologist in various locations underway and in port in the Pacific Rim. The direct cost associated with each consult was compared with the cost had the patient been treated in the host nation. Results: During the deployment, there were eight consults submitted and directed to a neurotologist/skull base surgeon for an opinion. The estimated cost for treating these patients overseas was $124,037, while the estimated cost of retaining the patients in the Military Health System was $27,330. Extrapolated to a 12-month period, the cost savings of this program could be over $400,000. Conclusions: Telemedicine consultation has the ability to be initiated and managed remotely-expanding access to subspecialty physicians by service members stationed around the world. Furthermore, it has the potential for substantial cost savings within the military health care system along with intangible benefits that sustain the military health care system downstream.

Temporal and latitudinal comparisons of reproductive parameters in a heavily exploited shark, the bonnethead, Sphyrna tiburo (L. 1758), in the southern Gulf of Mexico

In the southern Gulf of Mexico, the bonnethead shark, Sphyrna tiburo, is one of the most frequently captured species in landings of small-scale fisheries. Based on the analysis of two fishery-dependent sampling periods (1993-1994 and 2007-2014), this study aimed to determine reproductive parameters and identify temporal differences between the two time periods. In the first sampling period, 776 males and 352 females with a size range of 28.0-120.0 cm total stretched length (L_T ) were analysed, and in the second sampling period, 387 males and 432 females with a size range of 28.0-122.0 cm L_T were analysed. The size at 50% maturity in the second sampling period was significantly different between sexes, 82.6 cm L_T for females and 73.8 cm L_T for males (no estimation was possible for the first sampling period). The size at 50% maternity was not different between sampling periods, 97.3 cm L_T for the first sampling period and 99.0 cm L_T for the second sampling period. Litter size varied from 3 to 19 embryos and the average was not statistically different in both periods, 10.1 (S.D. = 3.8) for the first sampling period and 11.3 (S.D. = 3.5) for the second sampling period. The female reproductive cycle is asynchronous, and it seems to be annual, with a gestation period of 5-6 months, and a consecutive ovarian cycle and gestation period. Temporal (between sampling periods) and latitudinal (southern Gulf versus northern regions) variations occur in the synchronicity of the reproductive cycle, temporal variation in the relationship between maternal length and litter size, and latitudinal variation in average size of mature sharks.

Development and Dissemination of an Interprofessional Online Dementia Training Curriculum

OBJECTIVES

Despite the growing number of individuals with dementia, clinicians skilled in caring for people with dementia, especially in rural areas, are lacking. The Program for Advancing Cognitive Disorders Education for Rural Staff (PACERS) was designed to improve clinician competency and comfort when caring for individuals with dementia. Based on an interprofessional needs assessment, six 1-hour training modules were created: (1) Dementia and Delirium, (2) Identifying and Assessing for Dementia, (3) Treating Dementia: Case Studies, (4) Normal Cognitive Aging and Dementia Caregiving, (5) Addressing Decision Making and Safety in Dementia, and (6) Dementia and Driving. Each module is available for free on the Department of Veterans Affairs Talent Management System (TMS) for employees and the free TrainingFinder Real-time Affiliate Integrated Network (TRAIN) platform for clinicians in the community. One continuing education unit is earned upon completion of each module.

DESIGN

Posttest.

SETTING

Online training at VA TMS and TRAIN.

PARTICIPANTS

To date, more than 3000 modules have been completed by interprofessional healthcare learners (eg, nurses, physicians, psychologists, and social workers).

MEASUREMENTS

Satisfaction, perceived utility of training, knowledge, skills, and attitudes were assessed.

RESULTS

The learners reported high satisfaction (mean [M] > 4) and ability to apply the knowledge and skills learned from the module to their job (M > 4) on a Likert scale (1 = Strongly disagree to 5 = Strongly agree).

CONCLUSION

Learners also reported perceived impact on both direct patient care (eg, ability to provide education and support to individuals with dementia and their caregivers) and system-level care (eg, more appropriate referrals). Given the number of users and their evaluation data, PACERS can serve as a model curriculum for online interprofessional dementia training. J Am Geriatr Soc 68:192-197, 2019.

Case-Based Asynchronous Interactive Modules in Undergraduate Medical Education

Undergraduate medical education traditionally consists of 2 years of lecture-based courses followed by 2 years of clinical clerkships. However, over the past couple decades, undergraduate medical education has been evolving toward non-lecture-based integrated curriculums, requiring a collaborative curriculum. Additionally, e-learning platforms have become efficacious and essential to delivering education asynchronously to students. At Thomas Jefferson University, the Pathology and Obstetrics and Gynecology departments collaborated to create a pilot series of case-based asynchronous interactive modules to teach gynecologic pathology in a clinical context, while interweaving other educational components, such as evidence-based medicine, clinical skills, and basic sciences. The case-based asynchronous interactive modules were given to third-year medical students during their obstetrics and gynecology clerkship. Students interpreted histologic and clinical images while being evaluated on clinical management skills, gynecologic diagnoses, general principles of population health and pathology. Sixty-eight students from 3 blocks completed a pre and posttest. All participants showed improvement in interpreting gynecologic pathology in routine clinical scenarios as well as improved case-based decision-making, with an average score increase by 5.7%. Learner feedback was positive, with suggestions to apply this method to other medical specialties, particularly radiology. Asynchronous interactive modules are an efficacious and popular method of pathology education.

Asynchronous telepsychiatry: A systematic review

INTRODUCTION

Healthcare providers and systems increasingly utilize telehealth modalities to address barriers and challenges for healthcare delivery. Specialties, such as psychiatry, are testing asynchronous methods for telehealth delivery. The National Quality Forum (NQF) developed a framework with which to assess the quality of telemedicine according to measures and measure concepts within four domains. This review assesses existing asynchronous telepsychiatry (ATP) research according to the telehealth domains established by NQF, evaluates the prevalence and quality of ATP, and identifies the areas in which more research must be conducted.

METHODS

A systematic review of ATP methods was conducted according to PRISMA guidelines. Studies were categorized according to NQF telehealth domains and subdomains to further examine study outcomes.

RESULTS

The review initially identified 205 studies that were narrowed down to a final sample of 11 articles. Of the final articles, most studies addressed the effectiveness of ATP or users' experience with ATP.

DISCUSSION

The initial investigation of published ATP literature suggests promising results. ATP studies suggest that these services improve access to care, can be feasibly implemented by the clinical team, maintain patient/family satisfaction, and potentially reduce the cost of services. The limited sample of published literature necessitates further study of the practice in order to assess ATP according to the quality domains identified by NQF, especially access to care for patients and caregivers, the financial costs incurred by both providers and patients, and barriers to uptake.

Asynchronous Bilateral Obturator Hernias: A Suggested Approach to Reduce Morbidity of Obturator Hernias

Obturator hernias (OHs) are rare pelvic hernias that involve the protrusion of intraperitoneal or extraperitoneal organs or tissues through the obturator foramen. Risk factors for OH patients include female gender, chronic disease, age, malnourishment, history of multiple pregnancies, anatomical enlargement of obturator foramen, increased intraabdominal pressure, and defective collagen metabolism. Since OHs have the highest mortality rate of all abdominal hernias, prompt diagnosis and treatment are critical. Prior research has demonstrated an increased likelihood of bilateral OHs relative to unilateral. We present the case of a 79-year-old female who presented with an obstructed OH six months after an operation for an OH on the contralateral side. Due to the potential morbidity and mortality associated with OHs and delay in discovery, we suggest evaluation and treatment of the contralateral side in patients who present with unilateral OHs.

Accuracy Analysis in Sensor Networks for Asynchronous Positioning Methods

The accuracy requirements for sensor network positioning have grown over the last few years due to the high precision demanded in activities related with vehicles and robots. Such systems involve a wide range of specifications which must be met through positioning devices based on time measurement. These systems have been traditionally designed with the synchronization of their sensors in order to compute the position estimation. However, this synchronization introduces an error in the time determination which can be avoided through the centralization of the measurements in a single clock in a coordinate sensor. This can be found in typical architectures such as Asynchronous Time Difference of Arrival (A-TDOA) and Difference-Time Difference of Arrival (D-TDOA) systems. In this paper, a study of the suitability of these new systems based on a Cramér-Rao Lower Bound (CRLB) evaluation was performed for the first time under different 3D real environments for multiple sensor locations. The analysis was carried out through a new heteroscedastic noise variance modelling with a distance-dependent Log-normal path loss propagation model. Results showed that A-TDOA provided less uncertainty in the root mean square error (RMSE) in the positioning, while D-TDOA reduced the standard deviation and increased stability all over the domain.

Facilitators' teaching and social presence in online asynchronous interprofessional education discussion

Asynchronous discussion boards have been increasingly used to engage teams of interprofessional learners in interactive and reflective discourse. Facilitation of this interprofessional discourse is critical, yet largely unexplored. The Community of Inquiry (CoI) framework provides a lens through which facilitators' contributions on asynchronous discussion boards can be explored. The aim of this study was to apply the CoI framework teaching and social presence indicators to an online asynchronous IPE facilitation environment to determine if they comprehensively describe the kind of contributions made by IPE facilitators in two types of interprofessional team discussions. Directed content analysis based on the teaching and social presence indicators from the CoI framework was used to analyse seven facilitators' contributions to four asynchronous team discussion points (two key dimensions and two case study discussions). Sixteen of the 31 teaching and social presence indicators, along with a new indicator (feedback on assessment tasks), comprehensively described the facilitators' contributions. Many of the teaching presence indicators were used in a greater proportion of the key dimension discussions than in the case study discussions. This study demonstrates that the teaching and social presence indicators of the CoI framework are a valuable way to describe the contributions made by facilitators to asynchronous interprofessional team discussions.

Neuromodulation influences synchronization and intrinsic read-out

Background: The roles of neuromodulation in a neural network, such as in a cortical microcolumn, are still incompletely understood. Neuromodulation influences neural processing by presynaptic and postsynaptic regulation of synaptic efficacy. Neuromodulation also affects ion channels and intrinsic excitability.

Methods: Synaptic efficacy modulation is an effective way to rapidly alter network density and topology. We alter network topology and density to measure the effect on spike synchronization. We also operate with differently parameterized neuron models which alter the neuron's intrinsic excitability, i.e., activation function.

Results: We find that (a) fast synaptic efficacy modulation influences the amount of correlated spiking in a network. Also, (b) synchronization in a network influences the read-out of intrinsic properties. Highly synchronous input drives neurons, such that differences in intrinsic properties disappear, while asynchronous input lets intrinsic properties determine output behavior. Thus, altering network topology can alter the balance between intrinsically vs. synaptically driven network activity.

Conclusion: We conclude that neuromodulation may allow a network to shift between a more synchronized transmission mode and a more asynchronous intrinsic read-out mode. This has significant implications for our understanding of the flexibility of cortical computations.

Neuromodulation influences synchronization and intrinsic read-out

Background: The roles of neuromodulation in a neural network, such as in a cortical microcolumn, are still incompletely understood. Neuromodulation influences neural processing by presynaptic and postsynaptic regulation of synaptic efficacy. Neuromodulation also affects ion channels and intrinsic excitability. Methods: Synaptic efficacy modulation is an effective way to rapidly alter network density and topology. We alter network topology and density to measure the effect on spike synchronization. We also operate with differently parameterized neuron models which alter the neuron's intrinsic excitability, i.e., activation function. Results: We find that (a) fast synaptic efficacy modulation influences the amount of correlated spiking in a network. Also, (b) synchronization in a network influences the read-out of intrinsic properties. Highly synchronous input drives neurons, such that differences in intrinsic properties disappear, while asynchronous input lets intrinsic properties determine output behavior. Thus, altering network topology can alter the balance between intrinsically vs. synaptically driven network activity. Conclusion: We conclude that neuromodulation may allow a network to shift between a more synchronized transmission mode and a more asynchronous intrinsic read-out mode. This has significant implications for our understanding of the flexibility of cortical computations.

Sensory feedback and coordinating asymmetrical landing in toads

Coordinated landing requires anticipating the timing and magnitude of impact, which in turn requires sensory input. To better understand how cane toads, well known for coordinated landing, prioritize visual versus vestibular feedback during hopping, we recorded forelimb joint angle patterns and electromyographic data from five animals hopping under two conditions that were designed to force animals to land with one forelimb well before the other. In one condition, landing asymmetry was due to mid-air rolling, created by an unstable takeoff surface. In this condition, visual, vestibular and proprioceptive information could be used to predict asymmetric landing. In the other, animals took off normally, but landed asymmetrically because of a sloped landing surface. In this condition, sensory feedback provided conflicting information, and only visual feedback could appropriately predict the asymmetrical landing. During the roll treatment, when all sensory feedback could be used to predict an asymmetrical landing, pre-landing forelimb muscle activity and movement began earlier in the limb that landed first. However, no such asymmetries in forelimb preparation were apparent during hops onto sloped landings when only visual information could be used to predict landing asymmetry. These data suggest that toads prioritize vestibular or proprioceptive information over visual feedback to coordinate landing.