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Comparison of Program-centric vs Student-centric National Resident Matching Algorithms
The current program-centric algorithm for the National Resident Matching Program (NRMP) primarily uses the program's ranking of students to determine a match. Concerns that the existing algorithm favors programs over students, recent findings that the program's ranking of applicants is not associated with resident performance, and disruptions of existing screening methods and metrics have prompted reevaluation of the current algorithm relative to a student-centric algorithm, in which student ranking of programs is primary and program ranking of students is secondary.
To compare program-centric and student-centric algorithms for the NRMP participants.
This cross-sectional study used randomized computer-generated data reflecting the NRMP match for 2018, 2019, and 2020, capturing more than 50 000 students and more than 4000 programs in 23 specialties, to compare the 2 algorithms.
The same simulated students, programs, and rankings were exposed to the 2 algorithms, running 2300 simulations in the overall analysis and 1000 simulations in each of 23 specialties.
The percentage of students who did and did not match, the percentage of students who matched to their top-ranked and top-5-ranked programs, and the program's rank of the last student matched per position were examined.
The 2 algorithms were not different in percentage of students matched overall (eg, for 2020, program-centric: 59% [95% CI, 57%-61%]; student-centric: 58% [95% CI, 56%-60%]; P = .73). The student-centric algorithm, relative to the program-centric algorithm, matched a significantly higher percentage of students to their first-ranked program (eg, for 2020, 50% [95% CI, 48%-52%] vs 14% [95% CI, 13%-15%]; P < .001) and to their top-5-ranked programs (eg, for 2020, 60% [95% CI, 58%-62%] vs 46% [95% CI, 44%-48%]; P < .001). However, the last position was filled with students who had lower program rankings in the student-centric algorithm vs the program-centric algorithm (2 [95% CI, 1-2] vs 8 [95% CI, 6-10]; P < .001).
In this study, the 2 algorithms were not different in the percentage of students matched overall. However, the student-centric algorithm matched a significantly higher percentage of students to their preferred programs. The program-centric algorithm was associated with a lower program's last matched student rank. Further research is needed on the algorithms' associations with cost and time demands in the match, postmatch resident and program performance, and fit with a changing environment.
Journal Article
Development and Testing of a Mobile App for Pain Management Among Cancer Patients Discharged From Hospital Treatment: Randomized Controlled Trial
The incidence of cancer pain increases in discharged patients because of discontinued standard treatments and reductions in medication adherence. Motivated by the need for better pain management in discharged patients, we developed a mobile phone app (Pain Guard) to provide continuous treatment information and feedback to discharged cancer patients suffering from pain.
The aim was to design, construct, and test the Pain Guard app in patients managing cancer pain, evaluate the total remission rate of pain and the improvement in quality of life (QoL) to improve pain management for cancer pain patients, and assess patient acceptance of the app.
This randomized controlled double-arm study involved 58 patients with cancer pain symptoms. Participants were randomly assigned to a group receiving care through the Pain Guard app (n=31) or to a control group (n=27) who received only traditional pharmaceutical care. In a pretest, participants were rated using a baseline cancer pain assessment and QoL evaluation. During treatment, the consumption levels of analgesic drugs were recorded every week. After a 4-week study period, another round of cancer pain assessment and QoL evaluation was conducted. The system's usability, feasibility, app compliance, and satisfaction were also assessed. Our primary outcome was remission rate of pain, and secondary outcomes were medication adherence, improvements in QoL, frequency of breakthrough cancer pain (BTcP), incidence of adverse reactions, and satisfaction of patients.
All participants (N=58) successfully completed the study. There were no significant differences in baseline pain scores or baseline QoL scores between groups. At the end of the study, the rate of pain remission in the trial group was significantly higher than that in the control group (P<.001). The frequency of BTcP in the app group was considerably lower than that in the control group (P<.001). The rate of medication adherence in the trial group was considerably higher than that in the control group (P<.001). Improvements in global QoL scores in the trial group were also significantly higher than those in the control group (P<.001). The incidence of adverse reactions in the trial group (7/31) was lower than that in the control group (12/27), especially constipation, with significant differences (P=.01). The 31 participants in the trial group completed a satisfaction survey regarding Pain Guard: 23 (74%) indicated that they were satisfied with receiving pharmaceutical care by Pain Guard, 5 (16%) indicated that they were somewhat satisfied, 2 (6%) indicated neutral feelings, and 1 (3%) indicated that they were somewhat dissatisfied; no participants indicated that they were very dissatisfied.
Pain Guard was effective for the management of pain in discharged patients with cancer pain, and its operability was effective and easily accepted by patients.
Chinese Clinical Trials Registry ChiCTR1800016066; http://www.chictr.org.cn/showproj.aspx?proj=27153.
Journal Article
Reactive application development
Mission-critical applications have to respond instantly to changes in load, recover gracefully from failure, and satisfy exacting requirements for performance, cost, and reliability. That's no small task! Reactive designs make it easier to meet these demands through modular, message-driven architecture, innovative tooling, and cloud-based infrastructure. Reactive Application Development teaches you how to build reliable enterprise applications using reactive design patterns. This hands-on guide begins by exposing you to the reactive mental model, along with a survey of core technologies like the Akka actors framework. Then, you'll build a proof-of-concept system in Scala, and learn to use patterns like CQRS and Event Sourcing. You'll master the principles of reactive design as you implement elasticity and resilience, integrate with traditional architectures, and learn powerful testing techniques.
Book
Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial
Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD.
In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels.
From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up.
The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.
Journal Article
Programming TypeScript : making your JavaScript applications scale
Any programmer working with a dynamically typed language will tell you how hard it is to scale to more lines of code and more engineers. That's why Facebook, Google, and Microsoft invented gradual static type layers for their dynamically typed JavaScript and Python code. This practical book shows you how one such type layer, TypeScript, is unique among them: it makes programming fun with its powerful static type system. If you're a programmer with intermediate JavaScript experience, author Boris Cherny will teach you how to master the TypeScript language. You'll understand how TypeScript can help you eliminate bugs in your code and enable you to scale your code across more engineers than you could before. In this book, you'll: Start with the basics: Learn about TypeScript's different types and type operators, including what they're for and how they're used. Explore advanced topics: Understand TypeScript's sophisticated type system, including how to safely handle errors and build asynchronous programs. Dive in hands-on: Use TypeScript with your favorite frontend and backend frameworks, migrate your existing JavaScript project to TypeScript, and run your TypeScript application in production.
Book
An innovative pedagogic course combining video and simulation to teach medical students about pediatric cardiopulmonary arrest: a prospective controlled study
Compliance by residents in pediatrics to pediatric resuscitation guidelines is low. In many French faculties, a 1-h traditional lecture is still used to educate medical students about pediatric cardiopulmonary arrest (CPA). We developed an innovative pedagogic course combining a 23-min video and 3-h simulation exercises to improve knowledge and skills of medical students. A prospective controlled study was conducted. Medical student knowledge was tested before, just after, and 6–12 months after the innovative course and compared to that of a cohort who attended the traditional lecture. A high-fidelity mannequin simulator simulating cardiopulmonary arrest was used to assess and compare the skills of the study and control groups. Costs of the courses were evaluated; 809 of 860 (94 %) medical students were assessed for knowledge. Six to 12 months after the courses, the median score was significantly higher for the innovative group than that for the traditional lecture group (
p
< 0.001). In terms of skills, student in the innovative group scored higher on the performance score than the control group (
p
< 0.01). The innovative course was 24 times more expensive.
Conclusion
: Combination of video and simulation allows better retention of knowledge than a traditional lecture and leads to better compliance to resuscitation guidelines.
What is known:
• Compliance by residents to pediatric resuscitation guidelines is low.
• We developed an innovative pedagogic course combining an educational video and simulation.
What is new:
• Knowledge retention after the innovative course was better than after a traditional lecture.
• Sixty-six students tested on their skills demonstrated better compliance to resuscitation guidelines.
Journal Article
Accelerating progress in obesity prevention
One-third of adults are now obese, and children's obesity rates have climbed from 5 to 17 percent in the past 30 years. The causes of the nation's obesity epidemic are multi-factorial, having much more to do with the absence of sidewalks and the limited availability of healthy and affordable foods than a lack of personal responsibility. The broad societal changes that are needed to prevent obesity will inevitably affect activity and eating environments and settings for all ages. Many aspects of the obesity problem have been identified and discussed; however, there has not been complete agreement on what needs to be done to accelerate progress.
Accelerating Progress in Obesity Prevention reviews previous studies and their recommendations and presents five key recommendations to accelerate meaningful change on a societal level during the next decade. The report suggests recommendations and strategies that, independently, can accelerate progress, but urges a systems approach of many strategies working in concert to maximize progress in accelerating obesity prevention.
The recommendations in Accelerating Progress in Obesity Prevention include major reforms in access to and opportunities for physical activity; widespread reductions in the availability of unhealthy foods and beverages and increases in access to healthier options at affordable, competitive prices; an overhaul of the messages that surround Americans through marketing and education with respect to physical activity and food consumption; expansion of the obesity prevention support structure provided by health care providers, insurers, and employers; and schools as a major national focal point for obesity prevention. The report calls on all individuals, organizations, agencies, and sectors that do or can influence physical activity and nutrition environments to assess and begin to act on their potential roles as leaders in obesity prevention.
eBook