SummaryBackground: The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives: Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods: This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results: Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 -26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions: A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them.

Surface distress is an indication of poor or unfavorable pavement performance or signs of impending failure that can be classified into a fracture, distortion, or disintegration. To mitigate the risk of failing roadways, effective methods to detect road distress are needed. Recent studies associated with the detection of road distress using object detection algorithms are encouraging. Although current methodologies are favorable, some of them seem to be inefficient, time-consuming, and costly. For these reasons, the present study presents a methodology based on the mask regions with convolutional neural network model, which is coupled with the new object detection framework Detectron2 to train the model that utilizes roadway imagery acquired from an unmanned aerial system (UAS). For a comprehensive understanding of the performance of the proposed model, different settings are tested in the study. First, the deep learning models are trained based on both high- and low-resolution datasets. Second, three different backbone models are explored. Finally, a set of threshold values are tested. The corresponding experimental results suggest that the proposed methodology and UAS imagery can be used as efficient tools to detect road distress with an average precision score up to 95%.

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Objectives: Over time medical para-clinical subject teachers have felt that undergraduate students have difficulty in understanding immunological concepts of infections. The objectives of the study were to compare the effectiveness of traditional method of teaching with the flipped classroom teaching (FCT) model in Immunology and to assess the perception of students towards the flipped classroom teaching (FCT) model using semi-structured feedback.Methodology: In the study, the flipped classroom model was employed. This is a single centre study involving 100 students of second year MBBS where the students were required to learn and understand the supplied material before coming to the class. During the class, clinically applied aspects of Immunology topic including higher levels were discussed. Ten sessions were done on FCT. Pre class and post class student's knowledge of concept was assessed using MCQs on the given session. Also a theory test was conducted on the same topic at the end of completion of the Immunology topic and comparison was done with a topic in which teaching was done based on didactic lectures only. Feedback was taken from the students in the peer validated questionnaire provided having open ended question also. Similar feedback was taken from participating teachers. Results:The MCQ marks were categorized in three groups; students scoring <5, 6-8 and >8 out of 10. In the post class assessment significantly higher proportion of students secured score between 9 -10 (P<0.001). Overall scores of students was also significantly higher in post class assessment. However, summative assessment done by Theory test (having long answer questions and short answer questions) showed no statistical difference (P>0.10). Regarding feedback from the students; a positive attitude was seen for incorporating the flipped class teaching as assessment method showing a significant value (p=0.005). In terms of duration for the flipped class study, students disagreed that FCT takes longer time than routine lecture. Feedback from the teachers showed that this is a good method of teaching regards to some difficult topics but some preparation is required beforehand. Conclusions:There was a positive feedback by the students towards flipped classroom teaching method as understanding of the topics covered was much more. According to the assessment, Flipped teaching approach offered no additional benefits as compared to non-flipped traditional method.

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