Geriatric Telehealth: A Standardized Patient Case for Medical Students.

Introduction: The COVID-19 pandemic has necessitated the rapid expansion of telemedicine. However, there has been minimal coverage of telemedicine in traditional undergraduate medicine curricula. Telemedicine presents specific challenges in the geriatric population, including unfamiliarity with technology, cognitive and sensory barriers, inclusion of family and/or caregivers, multimorbidity, and a high degree of medical complexity. Methods: We developed a workshop to allow rising third-year medical students to practice a telemedicine patient encounter while developing skills for assessing and communicating with geriatric patients. This 90-minute workshop consisted of an introductory didactic presentation and a standardized patient activity for small groups of two to five students. Students' level of comfort with telemedicine for assessment of geriatric patients was evaluated with a pre- and postsurvey. Results: Fifty-eight students participated in the workshop and completed the surveys (presurvey = 58, postsurvey = 40), with roughly half (52%) reporting prior experience with telemedicine. A 5-point Likert-type scale (1 = very uncomfortable, 5 = very comfortable) was used. Students reported statistically significant increases in comfort using telemedicine (presurvey = 3.1, postsurvey = 3.9, p < .001) and using telemedicine for patients ≥65 years (presurvey = 2.8, postsurvey = 3.9, p < .001) after completing the workshop. Discussion: Medical students' comfort levels using telemedicine and caring for patients ages 65 and older with a telehealth visit improved after participating in this workshop. To help prepare students for telehealth practice in their future careers, educators should provide them with opportunities to practice and develop this critical skill set.

Deep Learning With Electronic Health Records for Short-Term Fracture Risk Identification: Crystal Bone Algorithm Development and Validation.

BACKGROUND: Fractures as a result of osteoporosis and low bone mass are common and give rise to significant clinical, personal, and economic burden. Even after a fracture occurs, high fracture risk remains widely underdiagnosed and undertreated. Common fracture risk assessment tools utilize a subset of clinical risk factors for prediction, and often require manual data entry. Furthermore, these tools predict risk over the long term and do not explicitly provide short-term risk estimates necessary to identify patients likely to experience a fracture in the next 1-2 years. OBJECTIVE: The goal of this study was to develop and evaluate an algorithm for the identification of patients at risk of fracture in a subsequent 1- to 2-year period. In order to address the aforementioned limitations of current prediction tools, this approach focused on a short-term timeframe, automated data entry, and the use of longitudinal data to inform the predictions. METHODS: Using retrospective electronic health record data from over 1,000,000 patients, we developed Crystal Bone, an algorithm that applies machine learning techniques from natural language processing to the temporal nature of patient histories to generate short-term fracture risk predictions. Similar to how language models predict the next word in a given sentence or the topic of a document, Crystal Bone predicts whether a patient's future trajectory might contain a fracture event, or whether the signature of the patient's journey is similar to that of a typical future fracture patient. A holdout set with 192,590 patients was used to validate accuracy. Experimental baseline models and human-level performance were used for comparison. RESULTS: The model accurately predicted 1- to 2-year fracture risk for patients aged over 50 years (area under the receiver operating characteristics curve [AUROC] 0.81). These algorithms outperformed the experimental baselines (AUROC 0.67) and showed meaningful improvements when compared to retrospective approximation of human-level performance by correctly identifying 9649 of 13,765 (70%) at-risk patients who did not receive any preventative bone-health-related medical interventions from their physicians. CONCLUSIONS: These findings indicate that it is possible to use a patient's unique medical history as it changes over time to predict the risk of short-term fracture. Validating and applying such a tool within the health care system could enable automated and widespread prediction of this risk and may help with identification of patients at very high risk of fracture.

The marine geological imprint of Antarctic ice shelves.

Reductions in the thickness and extent of Antarctic ice shelves are triggering increased discharge of marine-terminating glaciers. While the impacts of recent changes are well documented, their role in modulating past ice-sheet dynamics remains poorly constrained. This reflects two persistent issues; first, the effective discrimination of sediments and landforms solely attributable to sub-ice-shelf deposition, and second, challenges in dating these records. Recent progress in deciphering the geological imprint of Antarctic ice shelves is summarised, including advances in dating methods and proxies to reconstruct drivers of change. Finally, we identify several challenges to overcome to fully exploit the paleo record.

Technologies for retrieving sediment cores in Antarctic subglacial settings.

Accumulations of sediment beneath the Antarctic Ice Sheet contain a range of physical and chemical proxies with the potential to document changes in ice sheet history and to identify and characterize life in subglacial settings. Retrieving subglacial sediments and sediment cores presents several unique challenges to existing technologies. This paper briefly reviews the history of sediment sampling in subglacial environments. It then outlines some of the technological challenges and constraints in developing the corers being used in sub-ice shelf settings (e.g. George VI Ice Shelf and Larsen Ice Shelf), under ice streams (e.g. Rutford Ice Stream), at or close to the grounding line (e.g. Whillans Ice Stream) and in subglacial lakes deep under the ice sheet (e.g. Lake Ellsworth). The key features of the corers designed to operate in each of these subglacial settings are described and illustrated together with comments on their deployment procedures.

Antarctic and Southern Ocean influences on Late Pliocene global cooling.

The influence of Antarctica and the Southern Ocean on Late Pliocene global climate reconstructions has remained ambiguous due to a lack of well-dated Antarctic-proximal, paleoenvironmental records. Here we present ice sheet, sea-surface temperature, and sea ice reconstructions from the ANDRILL AND-1B sediment core recovered from beneath the Ross Ice Shelf. We provide evidence for a major expansion of an ice sheet in the Ross Sea that began at ∼3.3 Ma, followed by a coastal sea surface temperature cooling of ∼2.5 °C, a stepwise expansion of sea ice, and polynya-style deep mixing in the Ross Sea between 3.3 and 2.5 Ma. The intensification of Antarctic cooling resulted in strengthened westerly winds and invigorated ocean circulation. The associated northward migration of Southern Ocean fronts has been linked with reduced Atlantic Meridional Overturning Circulation by restricting surface water connectivity between the ocean basins, with implications for heat transport to the high latitudes of the North Atlantic. While our results do not exclude low-latitude mechanisms as drivers for Pliocene cooling, they indicate an additional role played by southern high-latitude cooling during development of the bipolar world.

Polymeric core-shell nanoparticles for therapeutics.

1. Nanobiotechnologies have recently attracted significant attention from chemists, biologists, engineers and pharmaceutical scientists. In particular, they have been widely applied to improve drug, protein/peptide and gene delivery. 2. This review presents recent advances in the field of drug, protein/peptide and gene delivery using natural and synthetic polymer nanoparticles and explains how polymeric nanoparticles are specifically designed to suit the needs for targeted delivery of small molecular drugs, proteins/peptides and genes. In addition, some of the challenges and prospects for these technologies are discussed.