The influence of students' prior clinical skills and context characteristics on mini-CEX scores in clerkships - a multilevel analysis.

BACKGROUND In contrast to objective structured clinical examinations (OSCEs), mini-clinical evaluation exercises (mini-CEXs) take place at the clinical workplace. As both mini-CEXs and OSCEs assess clinical skills, but within different contexts, this study aims at analyzing to which degree students' mini-CEX scores can be predicted by their recent OSCE scores and/or context characteristics. METHODS Medical students participated in an end of Year 3 OSCE and in 11 mini-CEXs during 5 different clerkships of Year 4. The students' mean scores of 9 clinical skills OSCE stations and mean 'overall' and 'domain' mini-CEX scores, averaged over all mini-CEXs of each student were computed. Linear regression analyses including random effects were used to predict mini-CEX scores by OSCE performance and characteristics of clinics, trainers, students and assessments. RESULTS A total of 512 trainers in 45 clinics provided 1783 mini-CEX ratings for 165 students; OSCE results were available for 144 students (87 %). Most influential for the prediction of 'overall' mini-CEX scores was the trainers' clinical position with a regression coefficient of 0.55 (95 %-CI: 0.26-0.84; p < .001) for residents compared to heads of department. Highly complex tasks and assessments taking place in large clinics significantly enhanced 'overall' mini-CEX scores, too. In contrast, high OSCE performance did not significantly increase 'overall' mini-CEX scores. CONCLUSION In our study, Mini-CEX scores depended rather on context characteristics than on students' clinical skills as demonstrated in an OSCE. Ways are discussed which focus on either to enhance the scores' validity or to use narrative comments only.

Circulating tumor cells as trigger to hematogenous spreads and potential biomarkers to predict the prognosis in ovarian cancer.

Despite several improvements in the surgical field and in the systemic treatment, ovarian cancer (OC) is still characterized by high recurrence rates and consequently poor survival. In OC, there is still a great lack of knowledge with regard to cancer behavior and mechanisms of recurrence, progression, and drug resistance. The OC metastatization process mostly occurs via intracoelomatic spread. Recent evidences show that tumor cells generate a favorable microenvironment consisting in T regulatory cells, T infiltrating lymphocytes, and cytokines which are able to establish an "immuno-tolerance mileau" in which a tumor cell can become a resistant clone. When the disease responds to treatment, immunoediting processes and cancer progression have been stopped. A similar inhibition of the immunosuppressive microenvironment has been observed after optimal cytoreductive surgery as well. In this scenario, the early identification of circulating tumor cells could represent a precocious signal of loss of the immune balance that precedes cancer immunoediting and relapse. Supporting this hypothesis, circulating tumor cells have been demonstrated to be a prognostic factor in several solid tumors such as colorectal, pancreatic, gastric, breast, and genitourinary cancer. In OC, the role of circulating tumor cells is still to be defined. However, as opposed to healthy women, circulating tumor cells have been demonstrated in peripheral blood of OC patients, opening a new research field in OC diagnosis, treatment monitoring, and follow-up.

A Review of General Physical and Chemical Processes Related to Plasma Sources and Losses for Solar System Magnetospheres

The aim of this paper is to provide a review of general processes related to plasma sources, their transport, energization, and losses in the planetary magnetospheres. We provide background information as well as the most up-to-date knowledge of the comparative studies of planetary magnetospheres, with a focus on the plasma supply to each region of the magnetospheres. This review also includes the basic equations and modeling methods commonly used to simulate the plasma sources of the planetary magnetospheres. In this paper, we will describe basic and common processes related to plasma supply to each region of the planetary magnetospheres in our solar system. First, we will describe source processes in Sect. 1. Then the transport and energization processes to supply those source plasmas to various regions of the magnetosphere are described in Sect. 2. Loss processes are also important to understand the plasma population in the magnetosphere and Sect. 3 is dedicated to the explanation of the loss processes. In Sect. 4, we also briefly summarize the basic equations and modeling methods with a focus on plasma supply processes for planetary magnetospheres.

Personality traits and the propensity to trust friends and strangers

Research on the foundations of social trust mainly concentrates on the evaluation of one's social environment. Empirical evidence focusing on the psychological origins of social trust is quite rare and the findings of these few studies remain inconclusive. Two innovations are proposed in order to systemize the knowledge about the foundations of social trust. First, we propose using a trust measure that is sensitive to different categories of trustees and refers to a realistic situation. Second, we argue for a broad conception of personality, rather than focusing only on selected attributes. Using data from a unique Swiss population survey, we show that the impact of personality traits on trust in strangers is stronger than on trust in friends. While conscientiousness and openness, in particular, are important traits for the development of both trust in friends and strangers, agreeableness is related to trust in strangers.

Domain Globalization: Using Languages to Support Technical and Social Coordination

When a project is realized in a globalized environment, multiple stakeholders from different organizations work on the same system. Depending on the stakeholders and their organizations, various (possibly overlapping) concerns are raised in the development of the system. In this context a Domain Specific Language (DSL) supports the work of a group of stakeholders who are responsible for addressing a specific set of concerns. This chapter identifies the open challenges arising from the coordination of globalized domain-specific languages. We identify two types of coordination: technical coordination and social coordination. After presenting an overview of the current state of the art, we discuss first the open challenges arising from the composition of multiple DSLs, and then the open challenges associated to the collaboration in a globalized environment.