In-training assessment - Its potential in enhancing clinical teaching

Context In-training assessment (ITA) has established its place alongside formative and summative assessment at both the undergraduate and postgraduate level. In this paper the authors aimed to identify those characteristics of ITA that could enhance clinical teaching. Methods A literature review and discussions by an expert working group at the Ninth Cambridge Conference identified the aspects of ITA that could enhance clinical teaching. Results The features of ITA identified included defining the specific benefits to the learner, teacher and institution, and highlighting the patient as the context for ITA and clinical teaching. The ‘mapping’ of a learner’s progress towards the clinical teaching objectives by using multiple assessments over time, by multiple observers in both a systematic and opportunistic way correlates with the incremental nature of reaching clinical competence. Conclusions The importance of ITA based on both direct and indirect evidence of what the learner actually does in the real clinical setting is emphasized. Particular attention is given to addressing concerns in the more controversial areas of assessor training, ratings and documentation for ITA. Areas for future research are also identified.

Assessment of In-House Natural Product and Synthetic Compound Libraries Based on In vitro Inhibition of Cholinesterases

The first line medication for mild to moderate Alzheimer s disease (AD) is based on cholinesterase inhibitors which prolong the effect of the neurotransmitter acetylcholine in cholinergic nerve synapses which relieves the symptoms of the disease. Implications of cholinesterases involvement in disease modifying processes has increased interest in this research area. The drug discovery and development process is a long and expensive process that takes on average 13.5 years and costs approximately 0.9 billion US dollars. Drug attritions in the clinical phases are common due to several reasons, e.g., poor bioavailability of compounds leading to low efficacy or toxic effects. Thus, improvements in the early drug discovery process are needed to create highly potent non-toxic compounds with predicted drug-like properties. Nature has been a good source for the discovery of new medicines accounting for around half of the new drugs approved to market during the last three decades. These compounds are direct isolates from the nature, their synthetic derivatives or natural mimics. Synthetic chemistry is an alternative way to produce compounds for drug discovery purposes. Both sources have pros and cons. The screening of new bioactive compounds in vitro is based on assaying compound libraries against targets. Assay set-up has to be adapted and validated for each screen to produce high quality data. Depending on the size of the library, miniaturization and automation are often requirements to reduce solvent and compound amounts and fasten the process. In this contribution, natural extract, natural pure compound and synthetic compound libraries were assessed as sources for new bioactive compounds. The libraries were screened primarily for acetylcholinesterase inhibitory effect and secondarily for butyrylcholinesterase inhibitory effect. To be able to screen the libraries, two assays were evaluated as screening tools and adapted to be compatible with special features of each library. The assays were validated to create high quality data. Cholinesterase inhibitors with various potencies and selectivity were found in natural product and synthetic compound libraries which indicates that the two sources complement each other. It is acknowledged that natural compounds differ structurally from compounds in synthetic compound libraries which further support the view of complementation especially if a high diversity of structures is the criterion for selection of compounds in a library.

Towed vehicles: undulating platforms as tools for maping coastal processes and water quality assessment, Seaside, California, February 5-7,2007. Workshop proceedings

The Alliance for Coastal Technologies (ACT) Workshop on Towed Vehicles: Undulating Platforms As Tools for Mapping Coastal Processes and Water Quality Assessment was convened February 5-7,2007 at The Embassy Suites Hotel, Seaside, California and sponsored by the ACT-Pacific Coast partnership at the Moss Landing Marine Laboratories (MLML). The TUV workshop was co-chaired by Richard Burt (Chelsea Technology Group) and Stewart Lamerdin (MLML Marine Operations). Invited participants were selected to provide a uniform representation of the academic researchers, private sector product developers, and existing and potential data product users from the resource management community to enable development of broad consensus opinions on the application of TUV platforms in coastal resource assessment and management. The workshop was organized to address recognized limitations of point-based monitoring programs, which, while providing valuable data, are incapable of describing the spatial heterogeneity and the extent of features distributed in the bulk solution. This is particularly true as surveys approach the coastal zone where tidal and estuarine influences result in spatially and temporally heterogeneous water masses and entrained biological components. Aerial or satellite based remote sensing can provide an assessment of the aerial extent of plumes and blooms, yet provide no information regarding the third dimension of these features. Towed vehicles offer a cost-effective solution to this problem by providing platforms, which can sample in the horizontal, vertical, and time-based domains. Towed undulating vehicles (henceforth TUVs) represent useful platforms for event-response characterization. This workshop reviewed the current status of towed vehicle technology focusing on limitations of depth, data telemetry, instrument power demands, and ship requirements in an attempt to identify means to incorporate such technology more routinely in monitoring and event-response programs. Specifically, the participants were charged to address the following: (1) Summarize the state of the art in TUV technologies; (2) Identify how TUV platforms are used and how they can assist coastal managers in fulfilling their regulatory and management responsibilities; (3) Identify barriers and challenges to the application of TUV technologies in management and research activities, and (4) Recommend a series of community actions to overcome identified barriers and challenges. A series of plenary presentation were provided to enhance subsequent breakout discussions by the participants. Dave Nelson (University of Rhode Island) provided extensive summaries and real-world assessment of the operational features of a variety of TUV platforms available in the UNOLs scientific fleet. Dr. Burke Hales (Oregon State University) described the modification of TUV to provide a novel sampling platform for high resolution mapping of chemical distributions in near real time. Dr. Sonia Batten (Sir Alister Hardy Foundation for Ocean Sciences) provided an overview on the deployment of specialized towed vehicles equipped with rugged continuous plankton recorders on ships of opportunity to obtain long-term, basin wide surveys of zooplankton community structure, enhancing our understanding of trends in secondary production in the upper ocean. [PDF contains 32 pages]

Methods and tools for the assessment of daylight transmittance through expanded metal meshes

306 p.

Assessment of existing information on Atlantic coastal fish habitats: development of a web-based spatial bibliography, query tools, and data summaries

The primary objective of this project, “the Assessment of Existing Information on Atlantic Coastal Fish Habitat”, is to inform conservation planning for the Atlantic Coastal Fish Habitat Partnership (ACFHP). ACFHP is recognized as a Partnership by the National Fish Habitat Action Plan (NFHAP), whose overall mission is to protect, restore, and enhance the nation’s fish and aquatic communities through partnerships that foster fish habitat conservation. This project is a cooperative effort of NOAA/NOS Center for Coastal Monitoring and Assessment (CCMA) Biogeography Branch and ACFHP. The Assessment includes three components; 1. a representative bibliographic and assessment database, 2. a Geographical Information System (GIS) spatial framework, and 3. a summary document with description of methods, analyses of habitat assessment information, and recommendations for further work. The spatial bibliography was created by linking the bibliographic table developed in Microsoft Excel and exported to SQL Server, with the spatial framework developed in ArcGIS and exported to GoogleMaps. The bibliography is a comprehensive, searchable database of over 500 selected documents and data sources on Atlantic coastal fish species and habitats. Key information captured for each entry includes basic bibliographic data, spatial footprint (e.g. waterbody or watershed), species and habitats covered, and electronic availability. Information on habitat condition indicators, threats, and conservation recommendations are extracted from each entry and recorded in a separate linked table. The spatial framework is a functional digital map based on polygon layers of watersheds, estuarine and marine waterbodies derived from NOAA’s Coastal Assessment Framework, MMS/NOAA’s Multipurpose Marine Cadastre, and other sources, providing spatial reference for all of the documents cited in the bibliography. Together, the bibliography and assessment tables and their spatial framework provide a powerful tool to query and assess available information through a publicly available web interface. They were designed to support the development of priorities for ACFHP’s conservation efforts within a geographic area extending from Maine to Florida, and from coastal watersheds seaward to the edge of the continental shelf. The Atlantic Coastal Fish Habitat Partnership has made initial use of the Assessment of Existing Information. Though it has not yet applied the AEI in a systematic or structured manner, it expects to find further uses as the draft conservation strategic plan is refined, and as regional action plans are developed. It also provides a means to move beyond an “assessment of existing information” towards an “assessment of fish habitat”, and is being applied towards the National Fish Habitat Action Plan (NFHAP) 2010 Assessment. Beyond the scope of the current project, there may be application to broader initiatives such as Integrated Ecosystem Assessments (IEAs), Ecosystem Based Management (EBM), and Marine Spatial Planning (MSP).

Pharmacotherapy optimization in older patients by a structured clinical pharmacist assessment and intervention

Introduction: Older individuals are particularly vulnerable to potentially inappropriate prescribing (PIP), drug related problems (DRPs) and adverse drug reactions (ADRs). A number of different interventions have been proposed to address these issues. However to-date there is a paucity of well-designed trials examining the impact of such interventions. Therefore the aims of this work were to: (i) establish a baseline PIP prevalence both nationally and internationally using the STOPP, Beers and PRISCUS criteria, (ii) identify the most comprehensive method of assessing PIP in older individuals, (iii) develop a structured pharmacist intervention supported by a computer decisions support system (CDSS) and (iv) examine the impact of this intervention on prescribing and incidence of ADRs. Results: This work identified high rates of PIP across all three healthcare settings in Ireland, 84.7% in the long term care, 70.7% in secondary care and 43.3% in primary care being reported. This work identified that for a comprehensive assessment of prescribing to be undertaken, an amalgamation of all three criteria should be deployed simultaneously. High prevalences of DRPs and PIP in older hospitalised individuals were identified. With 82.0% and 76.3% of patients reported to have at least one DRP or PIP instance respectively. The structured pharmacist intervention demonstrated a positive impact on prescribing, with a significant reduction MAI scores being reported. It also resulted in the intervention patients’ having a reduced risk of experiencing an ADR when compared to the control patients (absolute risk reduction of 6.8 (95% CI 1.5% - 12.3%)) and the number needed to treat = 15 (95% CI 8 - 68). However the intervention was found to have no significant effect on length of stay or mortality rate. Conclusion: This work shows that PIP is highly prevalent in older individuals across three healthcare settings in Ireland. This work also demonstrates that a structured pharmacist intervention support by a dedicated CDSS can significantly improve the appropriateness of prescribing and reduce the incidence of ADRs in older acutely ill hospitalised individuals.

Performance metrics of an optical spectral imaging system for intra-operative assessment of breast tumor margins.

As many as 20-70% of patients undergoing breast conserving surgery require repeat surgeries due to a close or positive surgical margin diagnosed post-operatively [1]. Currently there are no widely accepted tools for intra-operative margin assessment which is a significant unmet clinical need. Our group has developed a first-generation optical visible spectral imaging platform to image the molecular composition of breast tumor margins and has tested it clinically in 48 patients in a previously published study [2]. The goal of this paper is to report on the performance metrics of the system and compare it to clinical criteria for intra-operative tumor margin assessment. The system was found to have an average signal to noise ratio (SNR) >100 and <15% error in the extraction of optical properties indicating that there is sufficient SNR to leverage the differences in optical properties between negative and close/positive margins. The probe had a sensing depth of 0.5-2.2 mm over the wavelength range of 450-600 nm which is consistent with the pathologic criterion for clear margins of 0-2 mm. There was <1% cross-talk between adjacent channels of the multi-channel probe which shows that multiple sites can be measured simultaneously with negligible cross-talk between adjacent sites. Lastly, the system and measurement procedure were found to be reproducible when evaluated with repeated measures, with a low coefficient of variation (<0.11). The only aspect of the system not optimized for intra-operative use was the imaging time. The manuscript includes a discussion of how the speed of the system can be improved to work within the time constraints of an intra-operative setting.

Computer vision tools for low-cost and noninvasive measurement of autism-related behaviors in infants.

The early detection of developmental disorders is key to child outcome, allowing interventions to be initiated which promote development and improve prognosis. Research on autism spectrum disorder (ASD) suggests that behavioral signs can be observed late in the first year of life. Many of these studies involve extensive frame-by-frame video observation and analysis of a child's natural behavior. Although nonintrusive, these methods are extremely time-intensive and require a high level of observer training; thus, they are burdensome for clinical and large population research purposes. This work is a first milestone in a long-term project on non-invasive early observation of children in order to aid in risk detection and research of neurodevelopmental disorders. We focus on providing low-cost computer vision tools to measure and identify ASD behavioral signs based on components of the Autism Observation Scale for Infants (AOSI). In particular, we develop algorithms to measure responses to general ASD risk assessment tasks and activities outlined by the AOSI which assess visual attention by tracking facial features. We show results, including comparisons with expert and nonexpert clinicians, which demonstrate that the proposed computer vision tools can capture critical behavioral observations and potentially augment the clinician's behavioral observations obtained from real in-clinic assessments.

Clinical utility of a Web-enabled risk-assessment and clinical decision support program.

PURPOSE: Risk-stratified guidelines can improve quality of care and cost-effectiveness, but their uptake in primary care has been limited. MeTree, a Web-based, patient-facing risk-assessment and clinical decision support tool, is designed to facilitate uptake of risk-stratified guidelines. METHODS: A hybrid implementation-effectiveness trial of three clinics (two intervention, one control). PARTICIPANTS: consentable nonadopted adults with upcoming appointments. PRIMARY OUTCOME: agreement between patient risk level and risk management for those meeting evidence-based criteria for increased-risk risk-management strategies (increased risk) and those who do not (average risk) before MeTree and after. MEASURES: chart abstraction was used to identify risk management related to colon, breast, and ovarian cancer, hereditary cancer, and thrombosis. RESULTS: Participants = 488, female = 284 (58.2%), white = 411 (85.7%), mean age = 58.7 (SD = 12.3). Agreement between risk management and risk level for all conditions for each participant, except for colon cancer, which was limited to those <50 years of age, was (i) 1.1% (N = 2/174) for the increased-risk group before MeTree and 16.1% (N = 28/174) after and (ii) 99.2% (N = 2,125/2,142) for the average-risk group before MeTree and 99.5% (N = 2,131/2,142) after. Of those receiving increased-risk risk-management strategies at baseline, 10.5% (N = 2/19) met criteria for increased risk. After MeTree, 80.7% (N = 46/57) met criteria. CONCLUSION: MeTree integration into primary care can improve uptake of risk-stratified guidelines and potentially reduce "overuse" and "underuse" of increased-risk services.Genet Med 18 10, 1020-1028.

Assessment of fibronectin as a potential new clinical tool in andrology.

In this prospective clinical study, 892 patients with normal and impaired semen were examined in order to investigate the correlation between the concentration of fibronectin in seminal plasma and the motility of spermatozoa. The fibronectin concentration in seminal plasma, total sperm motility and linear sperm motility were measured. We report here a significant negative correlation between the fibronectin concentration in seminal plasma and total sperm motility (r=-0.3474). There was no link between varicocele and vasectomy, or between varicocele and variation in the concentration of fibronectin. It is concluded that higher concentrations of the acute-phase protein fibronectin may be a cause of severe reduction in sperm motility. The investigation of fibronectin concentrations in seminal fluid could be a new and helpful clinical tool in the assessment of male fertility.