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Subtle skills: Using objective structured clinical examinations to assess gastroenterology fellow performance in system based practice milestones

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World Journal of Gastroenterology 2020年第11期26卷 1221-1230页

作者： marianna Papademetriou Gabriel Perrault Max Pitman Colleen Gillespie Sondra Zabar Elizabeth Weinshel Renee Williams Division of Gastroenterology Georgetown University Medical CenterWashingtonDC 20007United States Division of Gastroenterology Washington DC VA Medical CenterWashingtonDC 20422United States Department of Medicine New York University Medical CenterNew YorkNY 10016United States Division of Gastroenterology New York University Medical CenterNew YorkNY 10016United States Department of Medicine New York University School of MedicineNew YorkNY 10016United States Department of Gastroenterology VA New York Harbor Healthcare SystemNew YorkNY 10010United States

BACKGROUND System based practice(SBP) milestones require trainees to effectively navigate the larger health care system for optimal patient care. In gastroenterology training programs, the assessment of SBP is difficult due to high volume, high acuity inpatient care, as well as inconsistent direct supervision. Nevertheless,structured assessment is required for training programs. We hypothesized that objective structured clinical examination(OSCE) would be an effective tool for assessment of *** To develop a novel method for SBP milestone assessment of gastroenterology fellows using the *** For this observational study, we created 4 OSCE stations: Counseling an impaired colleague, handoff after overnight call, a feeding tube placement discussion, and giving feedback to a medical student on a progress note. Twentysix first year fellows from 7 programs participated. All fellows encountered identical case presentations. Checklists were completed by trained standardized patients who interacted with each fellow participant. A report with individual and composite scores was generated and forwarded to program directors to utilize in formative assessment. Fellows also received immediate feedback from a faculty observer and completed a post-session program evaluation *** Survey response rate was 100%. The average composite score across SBP milestones for all cases were 6.22(SBP1), 4.34(SBP2), 3.35(SBP3), and 6.42(SBP4)out of 9. The lowest composite score was in SBP 3, which asks fellows to advocate for cost effective care. This highest score was in patient care 2, which asks fellows to develop comprehensive management plans. Discrepancies were identified between the fellows’ perceived performance in their self-assessments and Standardized Patient checklist evaluations for each case. Eighty-seven percent of fellows agreed that OSCEs are an important component of their clinical training,and 83% stated that the cases were similar to actual clinical encoun

关键词： Objective structured clinical exams Medical education Medical error System based practice Milestones Gastroenterology

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Development of deep-learning-based autonomous agents for low-speed maneuvering in Unity

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Journal of Intelligent and Connected Vehicles 2024年第3期7卷 229-244页

作者： Riccardo Berta Luca Lazzaroni Alessio Capello marianna Cossu Luca Forneris Alessandro Pighetti Francesco Bellotti Electrical Electronics and Telecommunication Engineering and Naval Architecture Department(DITEN)University of GenoaGenoa 16145Italy

This study provides a systematic analysis of the resource-consuming training of deep reinforcement-learning (DRL) agents for simulated low-speed automated driving (AD). In Unity, this study established two case studies: garage parking and navigating an obstacle-dense area. Our analysis involves training a path-planning agent with real-time-only sensor information. This study addresses research questions insufficiently covered in the literature, exploring curriculum learning (CL), agent generalization (knowledge transfer), computation distribution (CPU vs. GPU), and mapless navigation. CL proved necessary for the garage scenario and beneficial for obstacle avoidance. It involved adjustments at different stages, including terminal conditions, environment complexity, and reward function hyperparameters, guided by their evolution in multiple training attempts. Fine-tuning the simulation tick and decision period parameters was crucial for effective training. The abstraction of high-level concepts (e.g., obstacle avoidance) necessitates training the agent in sufficiently complex environments in terms of the number of obstacles. While blogs and forums discuss training machine learning models in Unity, a lack of scientific articles on DRL agents for AD persists. However, since agent development requires considerable training time and difficult procedures, there is a growing need to support such research through scientific means. In addition to our findings, we contribute to the R&D community by providing our environment with open sources.

关键词： automated driving autonomous agents deep reinforcement learning curriculum learning modeling and simulation

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Sedation and analgesia in children with cerebral palsy:a narrative review

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World Journal of Pediatrics 2019年第5期15卷 432-440页

作者： Ingrid Rabach Francesca Peri Marta Minute Emanuela Aru marianna Lucafò Alberto Di Mascio Giorgio Cozzi Egidio Barbi Institute for Maternal and Child Health IRCCS'Burlo Garofolo'Via dell'Istria 65/134100 TriesteItaly University of Trieste TriesteItaly Department of Medicine Surgery and Health SciencesUniversity of TriesteTriesteItaly

Background Patients with cognitive impairment due to cerebral palsy experience pain more often than healthy peers and frequently require diagnostic and therapeutic painful *** and procedural sedation outside the operating room are often required,but they may not adequately be provided because of the inability to accurately recognize and classify the state of pain and for the perceived higher risk of *** sources We reviewed the available literature to highlight the specific risk factors and area of criticism,that should be further *** searched the Cochrane Library,Medline,Pubmed from 1987 to September 2018 using key words such as'cerebral palsy and children and pain'or'sedation and cerebral palsy and children'.Results While different pain scales are useful in recognizing pain expressions,anxiety scales are not ***,studies on non-pharmacological techniques do not always have comparable *** risk factors,from anatomic abnormalities to liver and kidney functioning,should be kept in mind before proceeding with *** Large trials are needed to assess the impact of non-pharmacological techniques and to evaluate which pain control strategy(pharmacological and non-pharmacological)should be used in different settings.

关键词： Analgesia Cerebral palsy Intellectual disability Pain Procedural sedation

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THE I MELESS WISS WILL THE SUN EVER SET ON ROGER FEDERER?

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城市漫步（上海版、英文） 2015年第10期 56-63页

作者： marianna CERNI 不详

A few years ago,Roger Federer was *** you believe what you might have read in pretty much every sports site,newspaper and magazine,anyway."My guess is all Federer's fans will find themselves here[saying goodbye]in 2012,"mourned Pranav Gandhi in GQ India in 2011."The real achievement for Federer going forward will be to retain his spot in the top five,"suggested Eurosport in 2013."Is it the end for Roger Federer?"asked The Telegraph in *** article carried a whiff of *** suggestion that the magic Swiss was nearing the final years of his career held a haunting promise of nostalgia for his play,his tricks,his persona.

关键词： saying themselves guess

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DIY NATION The Fast-Growing World of China's Hackerspace Communities

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城市漫步（上海版、英文） 2015年第2期 54-65页

作者： marianna CERINI 不详

It is a chilly December afternoon in Shanghafs Jing'an district and some 30 people are huddled together in a former office building,listening attentively to a presentation on how to build an Insect Bot-a small,spider-... 详细信息

关键词： DIY robot district

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SHE'S IN ogue

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城市漫步（上海版、英文） 2015年第10期 24-29页

作者： marianna CERINI 不详

If American Vogue editor Anna Wintour has a reputation for being intimidating,then Angelica Cheung should be doubly *** the editor-in-chief of Vogue China(the youngest to cover such a role for CondéNast’s glossy title),Cheung presides over a publication whose readership is greater than British,French,Italian and German Vogue combined.

关键词： doubly editor Italian

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Determination of Methadone and Eight New Psychoactive Substances in Hair Samples by Gas Chromatography/Mass Spectrometry

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Journal of Forensic Science and Medicine 2018年第4期4卷 184-191页

作者： Luca Anzillotti Luca Cald marianna Giacalone Antonio Banchini Rossana Cecchi Department of Medicine and Surgery Institute of Legal MedicineUniversity of ParmaParmaItaly

Many new psychoactive substances(NPSs)with different chemical structures have emerged in the illicit drug market in the last *** present work was aimed at the development of a simple method in gas chromatography/mass spectrometry(MS)for the determination of NPS of different classes,the use of cannabinoids,and,at the same time,the evaluation of methadone therapy in hair matrix,within our routine analysis control for methadone treatment or from autopsy *** determination of synthetic cannabinoids and methadone therapy used an extraction method based on incubation in concentrated sodium hydroxide(NaOH)solution,providing a dissolution of the keratin *** described method was applied on 15 authentic specimens from our cases:five showed the presence of methadone and 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine(EDDP).The described method can be useful not only in the forensic investigation of NPS-related addiction histories but also in epidemiological and retrospective studies on the spread of NPS among specific safety-sensitive social *** GC instrument was an Agilent 7820A(Agilent Technologies,Santa Clara,CA,USA),and the detection system was an Agilent 5977B single quadrupole MS operating in selective ion monitoring *** parameters such as limit of detections(LODs),limit of quantifications(LOQs),repeatability,accuracy,and linearity were satisfactory for its application on real ***,LOQs,2?2,%CY standard deviation,and the mean concentration for the analyzed compounds are reported in Table *** and repeatability were acceptable for all the analytes at their respective *** experiments varied from 58.3%to 103.0%,thus allowing the application on authentic *** described method can be useful not only in the forensic investigation ofNPS-related addiction histories but also in epidemiological and retrospective studies on the spread of NPS among specific safety-sensitive social workers,such as drivers.

关键词： Drugs of abuse forensic gas chromatography/mass spectrometry hair new psychoactive substance toxicology

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SHARING IS CARING How social networks are driving what you buy

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城市漫步（上海版、英文） 2015年第6期 58-67页

作者： marianna Cerini 不详

S ocial commerce”sounds like an internet buzzword,concocted in one of those brightly-colored Silicon Valley offices by a dot-com worker at his standing *** it may be,but social commerce is a big deal–the term involves,in one way or another,90 percent of all consumer purchases *** the uninitiated,here’s how it works:*** buys toilet paper,multi-vitamin tablets and a bottle of baijiu on Tmall,one of China’s largest online retailers.

关键词： networks driving colored

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Fulminant ulcerative colitis in a healthy pregnant woman

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World Journal of Gastroenterology 2015年第19期21卷 6060-6064页

作者： Rossana Orabona Adriana Valcamonico marianna Salemme Stefania Manenti Guido AM Tiberio Tiziana Frusca Maternal Fetal Medicine Unit Department of Obstetrics and Gynecology University of Brescia Pathology Department University of Brescia Surgical Clinic Department of Clinical and Experimental Sciences University of Brescia

This case report concerns a 25-year-old patient with6-7 bloody stools/d, abdominal pain, tachycardia,and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory.

关键词： Ulcerative colitis Toxic megacolon Pregnancy Cesarean section Colonoscopy

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The Evolving Nature of Hepatic Abscess:A Review

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Journal of Clinical and Translational Hepatology 2016年第2期4卷 158-168页

作者： marianna G.Mavilia Marco Molina George Y.Wu University of New England College of Osteopathic Medicine BiddefordMEUSA Department of Radiology UCONN HealthFarmingtonCTUSA Department of Medicine Division of Gastroenterology-HepatologyUCONN HealthFarmingtonCTUSA

Hepatic abscess (HA) remains a serious and often difficult to diagnose *** can be divided into three main categories based on the underlying conditions:infectious,malignant,and *** abscesses include those secondary to direct extension from local infection,systemic bacteremia,and intra-abdominal infections that seed the portal ***,over the years,the etiologies and risks factors for HA have continued to *** recognition is important for instituting effective management and obtaining good outcomes.

关键词： Liver abscess Liver neoplasms Iatrogenic disease Risk factors

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