Quality assurance of simulated patient feedback in communication training for fourth-year medical students

Introduction In our program, simulated patients (SPs) give feedback to medical students in the course of communication skills training. To ensure effective training, quality control of the SPs’ feedback should be implemented. At other institutions, medical students evaluate the SPs’ feedback for quality control (Bouter et al., 2012). Thinking about implementing quality control for SPs’ feedback in our program, we wondered whether the evaluation by students would result in the same scores as evaluation by experts. Methods Consultations simulated by 4th-year medical students with SPs were video taped including the SP’s feedback to the students (n=85). At the end of the training sessions students rated the SPs’ performance using a rating instrument called Bernese Assessment for Role-play and Feedback (BARF) containing 11 items concerning feedback quality. Additionally the videos were evaluated by 3 trained experts using the BARF. Results The experts showed a high interrater agreement when rating identical feedbacks (ICCunjust=0.953). Comparing the rating of students and experts, high agreement was found with regard to the following items: 1. The SP invited the student to reflect on the consultation first, Amin (= minimal agreement) 97% 2. The SP asked the student what he/she liked about the consultation, Amin = 88%. 3. The SP started with positive feedback, Amin = 91%. 4. The SP was comparing the student with other students, Amin = 92%. In contrast the following items showed differences between the rating of experts and students: 1. The SP used precise situations for feedback, Amax (=maximal agreement) 55%, Students rated 67 of SPs’ feedbacks to be perfect with regard to this item (highest rating on a 5 point Likert scale), while only 29 feedbacks were rated this way by the experts. 2. The SP gave precise suggestions for improvement, Amax 75%, 62 of SPs’ feedbacks obtained the highest rating from students, while only 44 of SPs’ feedbacks achieved the highest rating in the view of the experts. 3. The SP speaks about his/her role in the third person, Amax 60%. Students rated 77 feedbacks with the highest score, while experts judged only 43 feedbacks this way. Conclusion Although evaluation by the students was in agreement with that of experts concerning some items, students rated the SPs’ feedback more often with the optimal score than experts did. Moreover it seems difficult for students to notice when SPs talk about the role in the first instead of the third person. Since precision and talking about the role in the third person are important quality criteria of feedback, this result should be taken into account when thinking about students’ evaluation of SPs’ feedback for quality control. Bouter, S., E. van Weel-Baumgarten, and S. Bolhuis. 2012. Construction and Validation of the Nijmegen Evaluation of the Simulated Patient (NESP): Assessing Simulated Patients’ Ability to Role-Play and Provide Feedback to Students. Academic Medicine: Journal of the Association of American Medical Colleges

Alternative outcomes for the multiple breath washout in children with CF

BACKGROUND The lung clearance index (LCI) measured by multiple-breath washout (MBW) has been proposed as an outcome for clinical trials; however, MBW is time consuming and LCI can be affected by breathing pattern. We aimed to evaluate moment ratios and abbreviated LCI in school-aged children with mild-to-moderate CF lung disease. METHODS Using existing data from three studies we assessed the sensitivity of moment ratios and abbreviated LCIs to (i) detect mild-to-moderate CF lung disease and (ii) detect treatment effects after 4weeks of hypertonic saline or dornase alfa inhalation. MBW was measured by respiratory mass spectrometry using 4% "sulphur hexafluoride as a tracer gas. RESULTS Compared to the traditional LCI, moment ratios and abbreviated LCIs were similarly sensitive to detect CF lung disease. Moment ratios consistently demonstrated treatment effects, whereas abbreviated LCIs were less sensitive. CONCLUSIONS Both moment ratios and abbreviated LCI are suitable to differentiate health from disease. Sensitivity is decreased for abbreviated LCIs in interventional studies in mild CF lung disease.

People, protected areas and ecosystem services: a qualitative and quantitative analysis of local people's perception and preferences in Côte d'Ivoire

The long-term integrity of protected areas (PAs), and hence the maintenance of related ecosystem services (ES), are dependent on the support of local people. In the present study, local people's perceptions of ecosystem services from PAs and factors that govern local preferences for PAs are assessed. Fourteen study villages were randomly selected from three different protected forest areas and one control site along the southern coast of Côte d'Ivoire. Data was collected through a mixed-method approach, including qualitative semi-structured interviews and a household survey based on hypothetical choice scenarios. Local people's perceptions of ecosystem service provision was decrypted through qualitative content analysis, while the relation between people's preferences and potential factors that affect preferences were analyzed through multinomial models. This study shows that rural villagers do perceive a number of different ecosystem services as benefits from PAs in Côte d'Ivoire. The results based on quantitative data also suggest that local preferences for PAs and related ecosystem services are driven by PAs' management rules, age, and people's dependence on natural resources.

Spatial genomic heterogeneity within localized, multifocal prostate cancer

Herein we provide a detailed molecular analysis of the spatial heterogeneity of clinically localized, multifocal prostate cancer to delineate new oncogenes or tumor suppressors. We initially determined the copy number aberration (CNA) profiles of 74 patients with index tumors of Gleason score 7. Of these, 5 patients were subjected to whole-genome sequencing using DNA quantities achievable in diagnostic biopsies, with detailed spatial sampling of 23 distinct tumor regions to assess intraprostatic heterogeneity in focal genomics. Multifocal tumors are highly heterogeneous for single-nucleotide variants (SNVs), CNAs and genomic rearrangements. We identified and validated a new recurrent amplification of MYCL, which is associated with TP53 deletion and unique profiles of DNA damage and transcriptional dysregulation. Moreover, we demonstrate divergent tumor evolution in multifocal cancer and, in some cases, tumors of independent clonal origin. These data represent the first systematic relation of intraprostatic genomic heterogeneity to predicted clinical outcome and inform the development of novel biomarkers that reflect individual prognosis.

Lung clearance index in cystic fibrosis subjects treated for pulmonary exacerbations.

Pulmonary exacerbations are important clinical events for cystic fibrosis (CF) patients. Studies assessing the ability of the lung clearance index (LCI) to detect treatment response for pulmonary exacerbations have yielded heterogeneous results. Here, we conduct a retrospective analysis of pooled LCI data to assess treatment with intravenous antibiotics for pulmonary exacerbations and to understand factors explaining the heterogeneous response.A systematic literature search was performed to identify prospective observational studies. Factors predicting the relative change in LCI and spirometry were evaluated while adjusting for within-study clustering.Six previously reported studies and one unpublished study, which included 176 pulmonary exacerbations in both paediatric and adult patients, were included. Overall, LCI significantly decreased by 0.40 units (95% CI -0.60- -0.19, p=0.004) or 2.5% following treatment. The relative change in LCI was significantly correlated with the relative change in forced expiratory volume in 1 s (FEV1), but results were discordant in 42.5% of subjects (80 out of 188). Higher (worse) baseline LCI was associated with a greater improvement in LCI (slope: -0.9%, 95% CI -1.0- -0.4%).LCI response to therapy for pulmonary exacerbations is heterogeneous in CF patients; the overall effect size is small and results are often discordant with FEV1.

The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus.

OBJECTIVE We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. METHODS An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (vr*) (vr* = 0 indicating excellent agreement and vr* = 1 indicating poor agreement). RESULTS The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1-4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1-4.4) for panel members and 4.5 (95% CI 4.3-4.6) for external reviewers (p = 0.017). Mean Likert scores were 4.2 (95% CI 4.1-4.3) for interventional reviewers (n = 56) and 4.1 (95% CI 3.9-4.4) for noninterventional reviewers (n = 12) (p = 0.290). Overall IRA (vr*) for both cohorts was 0.026 (95% CI 0.019-0.033). CONCLUSIONS This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA.

Young medical educators' workshop: Finding the right mentor in Medical Education

Background: Finding the right mentor in medical education is challenging, especially if you are relatively new to the field. However, a mentor that is fit for purpose offers great potential. The workshop will explore strategies and pitfalls for successfully finding the best available mentor. Intended Outcomes: At the end of the workshop participants will be able to: (1) identify practical strategies for successfully finding the right mentor in medical education; (2) give feedback on a proposed idea of a platform for matching mentees and mentors within AMEE; (3) establish an electronic network for continued dialogue and support within the online platform of AMEE (MedEdWorld). Structure: After an introduction to mentorship in medical education and characteristics of effective mentors, participants will have the opportunity to develop their own concepts and questions and discuss them with other participants and facilitators. Senior mentors will give advice from their experience. Furthermore, a proposal of an online platform to help young medical educators find a mentor will be presented and discussed. Who Should Attend: Young medical educators interested in finding the right mentor and in exchanging ideas with colleagues in a similar situation. Level: Introductory

STAT3 activation by the ErbB2 receptor and development of peptide-based STAT3 inhibitors

Stats (s&barbelow;ignal t&barbelow;ransducer and a&barbelow;ctivator of t&barbelow;ranscription) are latent transcription factors that translocate from the cytoplasm to nucleus. Constitutive activation of Stat3α by upstream oncoproteins and receptor tyrosine kinases has been found in many human tumors and tumor-derived cell lines and it is often correlated with the activation of ErbB-2. In order to explore the involvement of ErbB-2 in the activation of Stat3 and the mechanisms underlying this event, an erbB-2 point mutant was used as a model of a constitutively activated receptor. Phenylalanine mutations (Y-F) were made in the receptor's autophosphorylation sites and their ability to activate Stat3α was evaluated. Our results suggest that Stat3α and Janus tyrosine kinase 2 associates with ErbB-2 prior to tyrosine phosphorylation of the receptor and that full activation of Stat3α by ErbB-2 requires the participation of other non-receptor tyrosine kinases. Both Src and Jak2 kinases contribute to the activation of Stat3α while only Src binds to ErbB-2 only when the receptor is tyrosine phosphorylated. Our results also suggest that tyrosine 1139 may be important for Src SH2 domain association since a mutant lacking this tyrosine reduces the ability of the Src SH2 domain to bind to ErbB-2 and significantly decreases its ability to activate Stat3α. ^ In order to disrupt aberrant STAT3α activation which contributes to tumorigenesis, we sought small molecules which can specifically bind to the STAT3 SH2 domain, thereby abolishing its ability of being recruited into receptors, and also blocking the dimer formation required for STAT3α activation. A phosphopeptide derived from gp130 was found to have a high affinity to STAT3 SH2 domain, and we decided to use this peptide as the base for further modifications. A series of peptide based compounds were designed and tested using electrophoretic mobility shift assay and fluorescence polarization assay to evaluate their affinity to the STAT3 SH2 domain. Two promising compounds, DRIV-73C and BisPOM, were used for blocking STAT3α activity in cell culture. Either can successfully impair STAT3α activation induced by IL-6 stimulation in HepG2 cells. BisPOM proved to be the more effective in blocking STAT3α tyrosine phosphorylation in induced cells and tumor cell lines, and was the more potent in inhibiting STAT3 dependent cell growth. ^

Gott mit Israel im Leide und in der Freiheit : Predigt, gehalten am Sabbath 5663 (2 Jänner 1903) im Leopoldstädter Tempel zu Wien

von A. Kaminka

A systematic review of the animal and human literature on the use of vaccines to prevent dental caries

Streptococcus mutans has been identified as the primary etiological agent of human dental caries. Since its identification, there has been research focused on the development of a vaccine to prevent this disease. Preliminary research has been conducted to test both active and passive vaccines for Streptococcus mutans in animals and humans. Although a vaccine for dental caries caused by Streptococcus mutans would most likely be administered to children, no testing of any type of dental caries vaccines has been conducted on children as of yet. The public health imperative for the development of a vaccine is great. Not only will a vaccine reduce the various consequences, but it would also improve quality of life for many individuals. Among the many possible vaccine antigen candidates, researchers have also been focusing on protein antigens, GTFs, and Gbps as possible candidates for a vaccine. There are also many routes of administration under research, with topical, oral, and intranasal showing a lot of promise. This review will provide an overview on the current state of research, present key factors influencing prevalence of caries, and summarize and discuss the results of animal and human studies on caries vaccines against Streptococcus mutans. The progress and obstacles facing the development of a vaccine to fight dental caries will also be discussed. ^

Obstáculos epistemológicos para la producción conceptual en Ciencias Sociales : : el caso del concepto de “sistema capitalista global"

Se intenta esclarecer cómo ciertos factores materiales, en determinados momentos históricos, influyen en el retraso del surgimiento de un corpus teórico que dé cuenta, con la mayor exactitud, de la realidad social. Más precisamente, se pretende evidenciar las condiciones materiales que obstaculizan el surgimiento del concepto de sistema capitalista global, considerando que su objeto real ya estaba plenamente presente hacia la segunda mitad del siglo XIX. Para esto se ilustraran algunos esbozos del concepto, elaborados desde la periferia del sistema global que, independientemente de su pertinente enunciación, fueron bloqueados en su desarrollo por condiciones políticas e ideológicas particulares.

La construcción de políticas durante el proceso de provincialización del Territorio Nacional de Chubut : 1954-1955

Los territorios nacionales constituyeron durante 70 años unidades político-administrativas que no gozaron de los derechos políticos que poseían para ese entonces el resto de las provincias argentinas. Los territorios patagónicos sufrieron especialmente el aislamiento que esta situación conllevaba, construyéndose en torno a éstos un discurso acerca de su inmadurez política y social. El presente trabajo apunta a una reflexión acerca del proceso de ruptura que implicó para los territorianos la irrupción del peronismo en términos de la construcción de identidades políticas. El objetivo general es indagar acerca de los discursos y prácticas que influyeron en la construcción de escenarios políticos específicos y sobredeterminaron procesos de identificación en estos espacios. En particular, proponemos un abordaje de la discursividad social que nos permita analizar el modo en que esos discursos condicionaron el devenir político-institucional de los territorios nacionales, y las características particulares que esta discursividad adquirió durante el proceso de provincialización del Territorio de Chubut. Nuestra hipótesis sostiene que la separación en 1944 de una parte del territorio, convertida en la Gobernación Militar de Comodoro Rivadavia, generó las pautas para procesos de identificación disímiles entre el norte y el sur del territorio que abrieron paso a una conflictividad que perdurará en la historia provincial

El análisis regional en la Argentina : Enfoque teórico-metodológico y aportes para su profundización

El artículo presenta los principales núcleos del enfoque de análisis regional en la Argentina, realizando distintos aportes a su desarrollo sobre las dinámicas de acumulación y hegemonía. En ese sentido, retomamos a autores como Rofman, de Jong y Levín, para comprender la relación entre territorio y sociedad. Partimos del planteo de construcción de conocimiento sintético y holístico, tratando de integrar las distintas escalas del análisis espacial con sus particularidades y sus interpenetraciones. La relación espacio/modo de producción nos lleva a la pregunta por las transformaciones orgánicas del capital como relación social y, así, al estudio del proceso de reproducción ampliada del capital a partir de conceptos como el de régimen y modelo de acumulación, a diferentes escalas, alcances y niveles de abstracción. Vemos las relaciones de fuerzas a nivel internacional a la luz de la disputa por distintos monopolios estratégicos, que señala Amín, y del lugar de las corporaciones transnacionales como agentes centrales de los regímenes de acumulación actual. En ese punto, continuamos desarrollando el plan de análisis de relaciones de fuerzas gramsciano, desde su nivel estructural hasta el momento de la hegemonía. De esta manera, la construcción del territorio dentro de una formación social nacional lleva a indagar la dinámica del proceso productivo, sus agentes, fracciones y clases, así como el rol del Estado y de la disputa entre distintos proyectos societarios. Estas dimensiones aparecen, asimismo, conjugadas, en una escala menor, en el análisis de los subsistemas espaciales de acumulación y de los circuitos productivos regionales que los constituyen. La explicitación de diversas claves teórico-metodológicas aparece atravesada por el debate en torno a repensar la planificación del espacio social, preguntándonos ¿qué territorio para qué sociedad?

La construcción de políticas durante el proceso de provincialización del Territorio Nacional de Chubut : 1954-1955

Los territorios nacionales constituyeron durante 70 años unidades político-administrativas que no gozaron de los derechos políticos que poseían para ese entonces el resto de las provincias argentinas. Los territorios patagónicos sufrieron especialmente el aislamiento que esta situación conllevaba, construyéndose en torno a éstos un discurso acerca de su inmadurez política y social. El presente trabajo apunta a una reflexión acerca del proceso de ruptura que implicó para los territorianos la irrupción del peronismo en términos de la construcción de identidades políticas. El objetivo general es indagar acerca de los discursos y prácticas que influyeron en la construcción de escenarios políticos específicos y sobredeterminaron procesos de identificación en estos espacios. En particular, proponemos un abordaje de la discursividad social que nos permita analizar el modo en que esos discursos condicionaron el devenir político-institucional de los territorios nacionales, y las características particulares que esta discursividad adquirió durante el proceso de provincialización del Territorio de Chubut. Nuestra hipótesis sostiene que la separación en 1944 de una parte del territorio, convertida en la Gobernación Militar de Comodoro Rivadavia, generó las pautas para procesos de identificación disímiles entre el norte y el sur del territorio que abrieron paso a una conflictividad que perdurará en la historia provincial

El análisis regional en la Argentina : Enfoque teórico-metodológico y aportes para su profundización

El artículo presenta los principales núcleos del enfoque de análisis regional en la Argentina, realizando distintos aportes a su desarrollo sobre las dinámicas de acumulación y hegemonía. En ese sentido, retomamos a autores como Rofman, de Jong y Levín, para comprender la relación entre territorio y sociedad. Partimos del planteo de construcción de conocimiento sintético y holístico, tratando de integrar las distintas escalas del análisis espacial con sus particularidades y sus interpenetraciones. La relación espacio/modo de producción nos lleva a la pregunta por las transformaciones orgánicas del capital como relación social y, así, al estudio del proceso de reproducción ampliada del capital a partir de conceptos como el de régimen y modelo de acumulación, a diferentes escalas, alcances y niveles de abstracción. Vemos las relaciones de fuerzas a nivel internacional a la luz de la disputa por distintos monopolios estratégicos, que señala Amín, y del lugar de las corporaciones transnacionales como agentes centrales de los regímenes de acumulación actual. En ese punto, continuamos desarrollando el plan de análisis de relaciones de fuerzas gramsciano, desde su nivel estructural hasta el momento de la hegemonía. De esta manera, la construcción del territorio dentro de una formación social nacional lleva a indagar la dinámica del proceso productivo, sus agentes, fracciones y clases, así como el rol del Estado y de la disputa entre distintos proyectos societarios. Estas dimensiones aparecen, asimismo, conjugadas, en una escala menor, en el análisis de los subsistemas espaciales de acumulación y de los circuitos productivos regionales que los constituyen. La explicitación de diversas claves teórico-metodológicas aparece atravesada por el debate en torno a repensar la planificación del espacio social, preguntándonos ¿qué territorio para qué sociedad?