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AbstractOver the course of training, physicians develop significant knowledge and expertise. We review dual-process theory, the dominant theory in explaining medical decision making: physicians use both heuristics from accumulated experience (System 1) and logical deduction (System 2). We then discuss how the accumulation of System 1 clinical experience can have both positive effects (e.g., quick and accurate pattern recognition) and negative ones (e.g., gaps and biases in knowledge from physicians’ idiosyncratic clinical experience). These idiosyncrasies, biases, and knowledge gaps indicate a need for individuals to engage in appropriate training and study to keep these cognitive skills current lest they decline over time. Indeed, we review converging evidence that physicians further out from training tend to perform worse on tests of medical knowledge and provide poorer patient care. This may reflect a variety of factors, such as specialization of a physician’s practice, but is likely to stem at least in part from cognitive factors. Acquired knowledge or skills gained may not always be readily accessible to physicians for a number of reasons, including an absence of study, cognitive changes with age, and the presence of other similar knowledge or skills that compete in what is brought to mind. Lastly, we discuss the cognitive challenges of keeping up with standards of care that continuously evolve over time.

<p>Differentially abundant microbial enzyme classes (EC) and metabolic pathways (MaAsLin2).</p>

BACKGROUND Anthropometric measurements are vital for safe care in pediatric intensive care units. OBJECTIVE To identify barriers to anthropometric measurements and determine if perceptions of barriers differ between ordering providers and nurses. METHODS A 21-item survey to elicit perceptions of barriers to obtaining anthropometric measurements was distributed via e-mail to societies with members who provide care in pediatric intensive care units. RESULTS Most of the 258 eligible respondents (46% ordering providers) were from North America (90%). Although 84% agreed that anthropometric measurements are important, only 3% knew if these measurements were obtained upon admission to their unit. Estimates of patients' measurements by parents or caregivers were commonly used (72%) when actual measurements were not obtained. Leading barriers were presence of medical devices (57%), use of extracorporeal life support (54%), and unstable hemodynamic status (52%). More ordering providers than nurses considered osteopenia/fragile bones as a barrier to weight measurement (46% vs 29%; P = .007) and traumatic brain injury a barrier to measurement of head circumference (42% vs 24%; P = .002). More nurses than ordering providers perceived dialysis (21% vs 9%; P = .01) and obesity (26% vs 15%; P = .04) as barriers to measurement of stature. Ordering providers more than nurses perceived nurses' workload (51% vs 33%; P < .001) and lack of importance (43% vs 20%; P < .001) as barriers. CONCLUSIONS Barriers to obtaining anthropometric measurements exist in pediatric intensive care units; ordering providers and nurses have different perceptions of what constitutes a barrier.

Relationships between bacteria, microphytobenthos and extracellular polymeric substances (EPS) that make up microbial biofilms over bare mudflats were investigated at an hourly frequency during two 14-day spring– neap cycles in winter and summer 2008. Bacterial abundance and total chl a concentration were lower in summer (0.78 × 108 ± SD 0.39 × 108 cell.m−2 and 59.0 ± SD 10.42 mgchla.m−2) than in winter (3.7 × 108 ± SD 1.9 × 108 cell.m−2 and 106.64 ± SD 11.29 mgchla.m−2), coinciding with a high abundance of the gastropod Peringia ulvae in summer, which subsequently impacted 1st-cm chl a concentration by intense grazing. Bound and colloidal EPS carbohydrate temporal patterns were similar in winter (5.71 ± SD 3.95 and 4.67 ± SD 3.45 μg.g−1, respectively) butwere different in summer (14.9±SD 4.05 and 5.60±SD 4.50 μg.g−1, respectively). Carbohydrate colloidal EPS appeared to be related to light and salinity, while 1st-mm chl a concentration was negatively affected by strong salinities and predation pressure by P. ulvae. The fluctuations of colloidal carbohydrates were remarkably similar in the two seasons with peaks just after spring tideswhen the highest irradiance was received by microphytobenthic cells. Apparently, colloidal EPS carbohydrates can protect cells against the high salinity values ranging from 32.3 to 50.4 PSU. The presence of bound EPS carbohydrates may be linked to sediment colonization and resistance of biofilm activity. Proteins in EPS were absent in winter and represented a small proportion in summer (10%), but they appeared to be a good indicator of potential synergistic effects between MPB and bacteria in summer. Conversely, bound EPS carbohydrates reached high levels in winter, while the number of bacteria decreased simultaneously, suggesting a negative effect on bacterial growth in the absence of proteins in EPS. There was a lower proportion (31%) of low molecular weight EPS in summer than in winter (83%), possibly in relation to desiccation.

International audience; Recurrence properties of systems and associated sets of integers that suffice for recurrence are classical objects in topological dynamics. We describe relations between recurrence in different sorts of systems, study ways to formulate finite versions of recurrence, and describe connections to combinatorial problems. In particular, we show that sets of Bohr recurrence (meaning sets of recurrence for rotations) suffice for recurrence in nilsystems. Additionally, we prove an extension of this property for multiple recurrence in affine systems.

BACKGROUND: Current data regarding the risk of malignancy in a large thyroid nodule with benign fine-needle aspiration biopsy(FNAB) is conflicting. We investigated the impact of patient age on the risk of malignancy in nodules≥4cm with benign cytology. METHODS: We performed a single-institution retrospective review of patients who underwent surgery from 07/2008-08/2019 for a cytologically benign thyroid nodule ≥4cm. The relationship between malignant histopathology and patient and ultrasound features was assessed with multivariable logistic regression. RESULTS: Of 474 nodules identified, 25(5.3%) were malignant on final pathology. In patients 4cm and high-risk ultrasound features were not associated with risk of malignancy(OR:1.0,95%CI:0.7-1.4,p=0.980, and OR:9.6,95%CI:0.9-107.8,p=0.066, respectively). CONCLUSIONS: Patients <55 years old are 3.7-fold more likely to have a falsely benign FNA biopsy in a nodule≥4cm.

Les epanchements pleuraux parapneumoniques representent la principale etiologie des pleuresies infectieuses. Leur incidence est en constante augmentation. Bien qu’ils soient qualifies de « parapneumoniques », l’epidemiologie microbienne est differente de celle des pneumonies avec notamment une plus grande frequence des germes anaerobies. La ponction pleurale exploratrice represente l’etape diagnostique centrale qui permet de distinguer les epanchements parapneumoniques compliques et non compliques. Seuls les epanchements parapneumoniques compliques doivent faire l’objet d’un traitement evacuateur reposant sur la mise en œuvre de ponctions pleurales repetees (PPR), d’un drainage thoracique ou d’une prise en charge chirurgicale. Le choix de la technique evacuatrice premiere reste debattu car il existe peu d’etudes prospectives comparatives. L’utilisation d’agents fibrinolytiques n’a pas fait la preuve de son efficacite sauf lorsqu’ils sont utilises en association a la DNAse. L’antibiotherapie doit etre systematique, precoce et couvrir les germes anaerobies, sauf en cas d’infection a pneumocoque. Il existe peu de donnees sur la place de la kinesitherapie qui reste largement utilisee. La mortalite est elevee et directement influencee par les comorbidites sous-jacentes.

With the aim to alleviate the increasing plastic burden and carbon footprint on Earth, the role of certain microbes that are capable of capturing and sequestering excess carbon dioxide (CO2) generated by various anthropogenic means was studied. Cyanobacteria, which are photosynthetic prokaryotes, are promising alternative for carbon sequestration as well as biofuel and bioplastic production because of their minimal growth requirements, higher efficiency of photosynthesis and growth rates, presence of considerable amounts of lipids in thylakoid membranes, and cosmopolitan nature. These microbes could prove beneficial to future generations in achieving sustainable environmental goals. Their role in the production of polyhydroxyalkanoates (PHAs) as a source of intracellular energy and carbon sink is being utilized for bioplastic production. PHAs have emerged as well-suited alternatives for conventional plastics and are a parallel competitor to petrochemical-based plastics. Although a lot of studies have been conducted where plants and crops are used as sources of energy and bioplastics, cyanobacteria have been reported to have a more efficient photosynthetic process strongly responsible for increased production with limited land input along with an acceptable cost. The biodiesel production from cyanobacteria is an unconventional choice for a sustainable future as it curtails toxic sulfur release and checks the addition of aromatic hydrocarbons having efficient oxygen content, with promising combustion potential, thus making them a better choice. Here, we aim at reporting the application of cyanobacteria for biofuel production and their competent biotechnological potential, along with achievements and constraints in its pathway toward commercial benefits. This review article also highlights the role of various cyanobacterial species that are a source of green and clean energy along with their high potential in the production of biodegradable plastics.