How physicians manage medical uncertainty: A qualitative study and conceptual taxonomy

Background - Medical uncertainty is a pervasive and important problem, but the strategies physicians use to manage it have not been systematically described. Objectives - To explore the uncertainty management strategies employed by physicians practicing in acute-care hospital settings and to organize these strategies within a conceptual taxonomy that can guide further efforts to understand and improve physicians’ tolerance of medical uncertainty. Design - Qualitative study using individual in-depth interviews. Participants - Convenience sample of 22 physicians and trainees (11 attending physicians, 7 residents [postgraduate years 1–3), 4 fourth-year medical students), working within 3 medical specialties (emergency medicine, internal medicine, internal medicine–pediatrics), at a single large US teaching hospital. Measurements - Semistructured interviews explored participants’ strategies for managing medical uncertainty and temporal changes in their uncertainty tolerance. Inductive qualitative analysis of audio-recorded interview transcripts was conducted to identify and categorize key themes and to develop a coherent conceptual taxonomy of uncertainty management strategies. Results - Participants identified various uncertainty management strategies that differed in their primary focus: 1) ignorance-focused, 2) uncertainty-focused, 3) response-focused, and 4) relationship-focused. Ignorance- and uncertainty-focused strategies were primarily curative (aimed at reducing uncertainty), while response- and relationship-focused strategies were primarily palliative (aimed at ameliorating aversive effects of uncertainty). Several participants described a temporal evolution in their tolerance of uncertainty, which coincided with the development of greater epistemic maturity, humility, flexibility, and openness. Conclusions - Physicians and physician-trainees employ a variety of uncertainty management strategies focused on different goals, and their tolerance of uncertainty evolves with the development of several key capacities. More work is needed to understand and improve the management of medical uncertainty by physicians, and a conceptual taxonomy can provide a useful organizing framework for this work

Interactive translation prediction versus conventional post-editing in practice: a study with the CasMaCat workbench

[EN] We conducted a field trial in computer-assisted professional translation to compare interactive translation prediction (ITP) against conventional post-editing (PE) of machine translation (MT) output. In contrast to the conventional PE set-up, where an MT system first produces a static translation hypothesis that is then edited by a professional (hence "post-editing"), ITP constantly updates the translation hypothesis in real time in response to user edits. Our study involved nine professional translators and four reviewers working with the web-based CasMaCat workbench. Various new interactive features aiming to assist the post-editor/translator were also tested in this trial. Our results show that even with little training, ITP can be as productive as conventional PE in terms of the total time required to produce the final translation. Moreover, translation editors working with ITP require fewer key strokes to arrive at the final version of their translation.This work was supported by the European Union’s 7th Framework Programme (FP7/2007–2013) under grant agreement No 287576 (CasMaCat ).Sanchis Trilles, G.; Alabau, V.; Buck, C.; Carl, M.; Casacuberta Nolla, F.; Garcia Martinez, MM.; Germann, U.... (2014). Interactive translation prediction versus conventional post-editing in practice: a study with the CasMaCat workbench. Machine Translation. 28(3-4):217-235. https://doi.org/10.1007/s10590-014-9157-9S217235283-4Alabau V, Leiva LA, Ortiz-Martínez D, Casacuberta F (2012) User evaluation of interactive machine translation systems. In: Proceedings of the 16th Annual Conference of the European Association for Machine Translation, pp 20–23Alabau V, Buck C, Carl M, Casacuberta F, García-Martínez M, Germann U, González-Rubio J, Hill R, Koehn P, Leiva L, Mesa-Lao B, Ortiz-Martínez D, Saint-Amand H, Sanchis-Trilles G, Tsoukala C (2014) Casmacat: A computer-assisted translation workbench. In: Proceedings of the 14th Conference of the European Chapter of the Association for Computational Linguistics, pp 25–28Alves F, Vale D (2009) Probing the unit of translation in time: aspects of the design and development of a web application for storing, annotating, and querying translation process data. Across Lang Cultures 10(2):251–273Bach N, Huang F, Al-Onaizan Y (2011) Goodness: A method for measuring machine translation confidence. In: Proceedings of the Annual Meeting of the Association for Computational Linguistics, pp 211–219Barrachina S, Bender O, Casacuberta F, Civera J, Cubel E, Khadivi S, Lagarda AL, Ney H, Tomás J, Vidal E, Vilar JM (2009) Statistical approaches to computer-assisted translation. Comput Linguist 35(1):3–28Brown PF, Della Pietra SA, Della Pietra VJ (1993) The mathematics of statistical machine translation: parameter estimation. Comput Linguist 19(2):263–311Callison-Burch C, Koehn P, Monz C, Post M, Soricut R, Specia L (2012) Findings of the 2012 workshop on statistical machine translation. In: Proceedings of the Seventh Workshop on Statistical Machine Translation, pp 10–51Carl M (2012a) The CRITT TPR-DB 1.0: A database for empirical human translation process research. In: Proceedings of the AMTA 2012 Workshop on Post-Editing Technology and Practice, pp 1–10Carl M (2012b) Translog-II: a program for recording user activity data for empirical reading and writing research. In: Proceedings of the Eighth International Conference on Language Resources and Evaluation, pp 4108–4112Carl M (2014) Produkt- und Prozesseinheiten in der CRITT Translation Process Research Database. In: Ahrens B (ed) Translationswissenschaftliches Kolloquium III: Beiträge zur Übersetzungs- und Dolmetschwissenschaft (Köln/Germersheim). Peter Lang, Frankfurt am Main, pp 247–266Carl M, Kay M (2011) Gazing and typing activities during translation : a comparative study of translation units of professional and student translators. Meta 56(4):952–975Doherty S, O’Brien S, Carl M (2010) Eye tracking as an MT evaluation technique. Mach Transl 24(1):1–13Elming J, Carl M, Balling LW (2014) Investigating user behaviour in post-editing and translation using the Casmacat workbench. In: O’Brien S, Winther Balling L, Carl M, Simard M, Specia L (eds) Post-editing of machine translation: processes and applications. Cambridge Scholar Publishing, Newcastle upon Tyne, pp 147–169Federico M, Cattelan A, Trombetti M (2012) Measuring user productivity in machine translation enhanced computer assisted translation. In: Proceedings of the Tenth Biennial Conference of the Association for Machine Translation in the AmericasFlournoy R, Duran C (2009) Machine translation and document localization at adobe: From pilot to production. In: Proceedings of MT Summit XIIGreen S, Heer J, Manning CD (2013) The efficacy of human post-editing for language translation. In: Proceedings of SIGCHI Conference on Human Factors in Computing Systems, pp 439–448Guerberof A (2009) Productivity and quality in mt post-editing. In: Proceedings of MT Summit XII-Workshop: Beyond Translation Memories: New Tools for Translators MTGuerberof A (2012) Productivity and quality in the post-editing of outputs from translation memories and machine translation. Ph.D. ThesisJust MA, Carpenter PA (1980) A theory of reading: from eye fixations to comprehension. Psychol Rev 87(4):329Koehn P (2009a) A process study of computer-aided translation. Mach Transl 23(4):241–263Koehn P (2009b) A web-based interactive computer aided translation tool. In: Proceedings of ACL-IJCNLP 2009 Software Demonstrations, pp 17–20Krings HP (2001) Repairing texts: empirical investigations of machine translation post-editing processes, vol 5. Kent State University Press, KentLacruz I, Shreve GM, Angelone E (2012) Average pause ratio as an indicator of cognitive effort in post-editing: a case study. In: Proceedings of the AMTA 2012 Workshop on Post-Editing Technology and Practice, pp 21–30Langlais P, Foster G, Lapalme G (2000) Transtype: A computer-aided translation typing system. In: Proceedings of the 2000 NAACL-ANLP Workshop on Embedded Machine Translation Systems, pp 46–51Leiva LA, Alabau V, Vidal E (2013) Error-proof, high-performance, and context-aware gestures for interactive text edition. In: Proceedings of the 2013 annual conference extended abstracts on Human factors in computing systems, pp 1227–1232Montgomery D (2004) Introduction to statistical quality control. Wiley, HobokenO’Brien S (2009) Eye tracking in translation process research: methodological challenges and solutions, Copenhagen Studies in Language, vol 38. Samfundslitteratur, Copenhagen, pp 251–266Ortiz-Martínez D, Casacuberta F (2014) The new Thot toolkit for fully automatic and interactive statistical machine translation. In: Proceedings of the 14th Annual Meeting of the European Association for Computational Linguistics: System Demonstrations, pp 45–48Plitt M, Masselot F (2010) A productivity test of statistical machine translation post-editing in a typical localisation context. Prague Bulletin Math Linguist 93(1):7–16Sanchis-Trilles G, Ortiz-Martínez D, Civera J, Casacuberta F, Vidal E, Hoang H (2008) Improving interactive machine translation via mouse actions. In: Proceedings of the Conference on Empirical Methods in Natural Language Processing, pp 485–494Simard M, Foster G (2013) Pepr: Post-edit propagation using phrase-based statistical machine translation. In: Proceedings of MT Summit XIV, pp 191–198Skadiņš R, Puriņš M, Skadiņa I, Vasiļjevs A (2011) Evaluation of SMT in localization to under-resourced inflected language. In: Proceedings of the 15th International Conference of the European Association for Machine Translation, pp 35–4

CASMACAT: A Computer-assisted Translation Workbench

International audienceno abstrac

Temporada de quaresma del 1936

De cada obra s'ha digitalitzat un programa sencer. De la resta s'han digitalitzat les parts que són diferents.Direcció artística Empresa Joan Mestres CalvetOrquestra del Gran Teatre del Liceu. Direcció: Hans Knappertsbusch; Igor Stravisnky, Joan Lamote de GrignonPrograma general de la temporada de quaresma de 1936 per l'Orquestra del Gran Teatre del Liceu. Repertori: primera simfonia de Beethoven; novena simfonia de Beethoven; preludi i mort de Tristany i Isolda de Wagner; preludi d'Els mestres cantaires de Richard Wagner; preludi i escenda del Divendres Sant de Parsifal Richard Wagner; Don Joan de Richard Strauss; Simfonia en si bemoll major de Johann Christian Bach; Oberon de Weber; Divertimento per a orquestra d' Igor Stravinsky; Capriccio per a orquestra i piano d'Igor Stravinsky; concerto a dos pianos d'Igor Stravinsky; Simfonia dels Salsm d'Igor Stravinsky; Apollon d'Igor Stravinsky; l'Ocell de foc d'Igor Stravinsky i Le sacre du Printemps d'Igor Stravinsky; Obertura de Francesc Pujol; Simfonieta d'Alexandre Zelimsky; Tres preludis de Ricard Lamote de Grignon; Le tombeau de Couperin de Maurice Ravel; Tres danses mallorquines de Baltasar Samper; Allegro simfònic d'Antoni Marquès i La nit de Nada de Joan Lamote de Grignon.Amb la col·laboració de l'Orfeó Gracienc que dirigeix Joan Ballcells i l'Orfeó L'Eco de Catalunya sota la direcció de Josep M. Comell

Transition from Undergraduate to Postgraduate Medical Education: A Scoping Review

The purpose of this scoping review was to explore the published literature and identify potential future educational research questions and activities regarding senior year curriculum in United States (U.S.) medical schools. In particular, we focus on the transition between final year of medical school and residency, identifying trends in competency-based practices. A structured, five-step approach was used to conduct this scoping review. Electronic searches of PubMed, ERIC, Scopus, MedEdPortal and eight medical education journals were conducted to identify relevant articles published in 2006-2017. Among 6,485 articles retrieved, 817 articles were included in the study. From 2007-2011 to 2012-2016, articles addressing the final year of medical school increased 93%, whereas articles describing internship preparatory courses increased 218%. While the majority of articles did not use a competency-based medical education (CBME) framework (572/817, 70%), the frequency of its description increased 268% from 2007-2011 to 2012-2016. Nearly three- quarters of preparatory course-related papers included use of or direct reference to a CBME framework (37/50, 74%). Most of articles did not associate with a single discipline (481/817; 59%). This scoping review identified substantial increase in recent publications on the final year and transition between medical school and residency. These results reflect a recent curricular paradigm shift in medical education from a traditional to competency-based education model

Risk management and avoiding legal pitfalls in the emergency treatment of high-risk orthopedic injuries.

Avoiding legal pitfalls of orthopedic injuries in the emergency department (ED) requires an understanding of certain high-risk injuries, their presentation, evaluation, and disposition. Various pitfalls pertaining to both upper and lower extremity injuries are discussed in detail, with recommendations regarding the history, physical examination, and radiographic techniques that minimize the risk inherent in these injuries. When approaching these injuries in the ED, a high level of suspicion coupled with appropriate evaluation and management will allow the practitioner to avoid mismanagement of these potential pitfall cases

Myocardial infarction in the setting of anaphylaxis to celecoxib: a case of Kounis syndrome.

BACKGROUND: Acute coronary syndromes in the setting of an allergic or hypersensitivity reaction are known as Kounis syndrome. The syndrome involves release of inflammatory mediators after an allergen exposure that leads to coronary artery vasospasm or platelet activation. A variety of foods, drugs, and environmental exposures have been implicated in this condition. CASE REPORT: The case involves a 62-year-old woman with dyspnea, chest pain, and transient ST-segment elevation after ingesting celecoxib. Her symptoms resolved with treatment for a suspected allergic reaction. Although she did have mild elevation of serum cardiac biomarkers, subsequent cardiac catheterization demonstrated normal coronary arteries. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This is the first reported case of ST-segment elevation myocardial infarction after allergy to celecoxib. Knowledge of Kounis syndrome will better prepare physicians in both its identification and clinical management

The Research Escape Hunt: An Escape Room-Scavenger Hunt for Resident Education

Background: Research and evidence-based medicine (EBM) education are important parts of residency training in Emergency Medicine (EM), however curricular time is limited and trainees are exposed to very large amounts of learning material in a short period of time. EM educators integrate novel strategies to engage learners and improve understanding and retention, including case-based strategies, flipped-classrooms, workshops, simulation, and traditional lecture-based methods. The escape-hunt, a hybrid escape room and scavenger hunt activity, presents an opportunity to integrate an active learning strategy that capitalizes on the benefits of improved engagement and collaborative learning in adults. Educational Objectives: We sought to develop, implement, and evaluate a novel research escape hunt educational experience to teach emergency medicine residents basic research and EBM skills. Goals included enhancing understanding of: test characteristics and predictive statistics (sensitivity, specificity, positive and negative predictive values); interpreting visual data displays (Kaplan-Meyer curves, receiver operating characteristic curves, forest plots); interpreting p-values and confidence intervals; qualitative and quantitative study designs; odds ratios, relative risk and prevalence estimates; power and sample size; the required elements of informed consent; and the Belmont Report ethical principles (beneficence, justice, respect for persons). Curricular Design: A nine-station escape room was developed around the educational content. Each station focused on one topic, for example, on understanding test characteristics. Stations required participants to use a variety of strategies (computation, multiple choice questions, crossword puzzles, blacklight activities) to solve a puzzle, with correct puzzle responses contributing to the station’s lock combination. Opening each station’s lock revealed the location of the team’s next station and provided the team with a station-completed ‘ticket’ and a small reward (chocolate). Teams worked together to solve each station’s puzzles, rotating through each station as the escape hunt progressed. Faculty were present to help guide teams through the stations and to re-set stations and locks with each successful completion. The first team to successfully complete all nine stations won the game. One week prior to the escape hunt event, participants were provided with preparatory educational materials including summary sheets and podcast links with instructions to review the material prior to the event. Following the event, learners participated in a debriefing, including a review of the rationale for all responses. Post-activity assessments were grounded in Kirkpatrick’s evaluation model and focused on participants’ reactions, learning, and behavior. Impact/Effectiveness: 21 EM resident physicians participated in the escape hunt event. Participants reported high levels of satisfaction and engagement with the activity, reported increased comfort with the research and EMB concepts covered, and demonstrated improvements in knowledge across each content area presented. In addition, participants reported that skills and strategies used during the escape hunt were similar to those used in clinical practice including working as a team, task switching, task delegation, brainstorming and solving complex problems together. Challenges included the time necessary to develop the escape hunt materials, costs associated with purchasing materials, limitations on the space required to optimize the event, and the number of faculty required to ensure flow game progression

The research escape hunt: An escape room-scavenger hunt for resident education

OBJECTIVES: Research and evidence-based medicine (EBM) education are important elements of emergency medicine (EM) residency training; however, curricular time is limited and integrating novel strategies to engage learners and improve understanding of complex concepts is challenging. We sought to develop a unique research escape hunt educational experience to teach EM residents basic research and EBM skills using an active-learning, team-based strategy. METHODS: A nine-station escape room-scavenger hunt was designed around educational content including (1) predictive statistics and diagnostic test characteristics, (2) interpretation of data and statistical analysis, (3) study design, (4) informed consent for research, and (5) the ethical principles guiding research. Stations required participants to use a variety of strategies to solve puzzles, with a correct response required to progress through the escape hunt. Teams worked together to solve each station\u27s puzzles, with opportunities to reinforce the content in real time. Subsequent sessions were presented in a virtual format using Zoom breakout rooms over the past 2 years. RESULTS: Postactivity assessments were grounded in Kirkpatrick\u27s model and focused on participants\u27 reactions, learning, and behavior. Participants reported high levels of satisfaction (100% [21/21] satisfied or extremely satisfied ) and engagement (95% [20/21] engaged or very engaged ) with the activity, as well as increased comfort with the research and EBM concepts covered (91% [19/21] agree or strongly agree increased comfort), and demonstrated improvements in knowledge across each content area presented (91% [19/21]). REFLECTIVE DISCUSSION: This practical, team-based curriculum was found to be a successful way to engage residents with research methodology and EBM content. This curriculum is feasible for both in-person and virtual formats and we will continue to use this as a component of our EM residency program moving forward