LF: a Foundational Higher-Order Logic

This paper presents a new system of logic, LF, that is intended to be used as the foundation of the formalization of science. That is, deductive validity according to LF is to be used as the criterion for assessing what follows from the verdicts, hypotheses, or conjectures of any science. In work currently in progress, we argue for the unique suitability of LF for the formalization of logic, mathematics, syntax, and semantics. The present document specifies the language and rules of LF, lays out some notational conventions, and states some basic technical facts about the system

A Three-dimensional Printed Low-cost Anterior Shoulder Dislocation Model for Ultrasound-guided Injection Training.

Anterior shoulder dislocations are the most common, large joint dislocations that present to the emergency department (ED). Numerous studies support the use of intraarticular local anesthetic injections for the safe, effective, and time-saving reduction of these dislocations. Simulation training is an alternative and effective method for training compared to bedside learning. There are no commercially available ultrasound-compatible shoulder dislocation models. We utilized a three-dimensional (3D) printer to print a model that allows the visualization of the ultrasound anatomy (sonoanatomy) of an anterior shoulder dislocation. We utilized an open-source file of a shoulder, available from embodi3D® (Bellevue, WA, US). After approximating the relative orientation of the humerus to the glenoid fossa in an anterior dislocation, the humerus and scapula model was printed with an Ultimaker-2 Extended+ 3D® (Ultimaker, Cambridge, MA, US) printer using polylactic acid filaments. A 3D model of the external shoulder anatomy of a live human model was then created using Structure Sensor®(Occipital, San Francisco, CA, US), a 3D scanner. We aligned the printed dislocation model of the humerus and scapula within the resultant external shoulder mold. A pourable ballistics gel solution was used to create the final shoulder phantom. The use of simulation in medicine is widespread and growing, given the restrictions on work hours and a renewed focus on patient safety. The adage of see one, do one, teach one is being replaced by deliberate practice. Simulation allows such training to occur in a safe teaching environment. The ballistic gel and polylactic acid structure effectively reproduced the sonoanatomy of an anterior shoulder dislocation. The 3D printed model was effective for practicing an in-plane ultrasound-guided intraarticular joint injection. 3D printing is effective in producing a low-cost, ultrasound-capable model simulating an anterior shoulder dislocation. Future research will determine whether provider confidence and the use of intraarticular anesthesia for the management of shoulder dislocations will improve after utilizing this model

The Effect of Display Size on Ultrasound Interpretation

Purpose: To assess how display size affects providers’ abilities to accurately interpret ultrasound (U/S) videos. U/S has become essential for patient evaluation in the emergency setting. Although newer devices that are smaller in size and affordable place the technology within the pockets of practitioners, it is necessary to assess how smaller size may impact image quality. Methods: The target learner population for this study includes all practitioners who perform point of care U/S. A prospective convenience sample of emergency providers were randomized to begin on either a phone-sized screen or a laptop-sized screen. Participants answered Yes or No in response to whether they identified free fluid, above and/or below the diaphragm on each of 50 unique right upper quadrant U/S videos, with 25 displayed per device. Researchers collected data on the speed of interpretation and participants\u27 experiences. Results and Conclusions: Prior to study initiation, 50% of participants felt display size would affect accuracy, 42.3% were unsure, and 7.7% felt it would not (n=52). The accuracy of interpretation for phone versus laptop display was 87.3% and 87.6%, respectively (p=0.84). Mean time spent with phone versus laptop display was 293s and 290s, respectively (p=0.66). Upon study completion, 48.1% of participants believed display size affected their ability to interpret the videos, 38.5% felt it did not, and 13.5% were unsure. The results of this study show no significant statistical difference in the accuracy of interpretation between screen sizes

The Clicker Study

Purpose: A recent study in orthopedics showed that clicker-based learning was more effective than traditional feedback when teaching procedures. We sought to determine whether this principle is applicable to ultrasound skills. Methods: Our prospective randomized control trial used a population of new ultrasound learners. Exclusion criteria included previous ultrasound experience of more than one hour. Students were shown an instructional video on the Focused Assessment with Sonography in Trauma (FAST) exam and randomized to receive clicker or scripted feedback. Each student performed the FAST exam once without feedback, then with either scripted or clicker-based feedback. They were timed and scored on 18 microskills. Results and Conclusions: 45 students were enrolled in the study, with 6 excluded from analysis. This included 24 premedical and 15 medical students. No significant differences were observed between groups for time or accuracy on the FAST exam. Among medical students, there was a trend toward faster results in the clicker group (mean=83 seconds) than the script group (mean=103 seconds) (p=0.22). Among undergraduates, there was a trend toward higher accuracy in the script group (mean=100%) than the clicker group (mean=95%) (p=0.068) and towards faster performance (mean=103 seconds) than the clicker group (mean=121 seconds) (p=0.38). Although no significant differences were observed, there seemed to be a trend toward faster performance with clicker feedback among medical students and faster and more accurate performance with scripted feedback among premedical students. This may be an area for future study