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McDaniel, Charlotte. "Anonymous Grading." Nurse Educator 19, no. 5 (1994): 11–12. http://dx.doi.org/10.1097/00006223-199409000-00012.
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Dorsey, J. K., and J. A. Colliver. "Effect of anonymous test grading on passing rates as related to gender and race." Academic Medicine 70, no. 4 (1995): 321–3. http://dx.doi.org/10.1097/00001888-199504000-00017.
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Malouff, John M., Ashley J. Emmerton, and Nicola S. Schutte. "The Risk of a Halo Bias as a Reason to Keep Students Anonymous During Grading." Teaching of Psychology 40, no. 3 (2013): 233–37. http://dx.doi.org/10.1177/0098628313487425.
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Charlson, Robert, Joshua Herbert, and Ilya Kister. "Severity Grading in Multiple Sclerosis." International Journal of MS Care 18, no. 5 (2016): 265–70. http://dx.doi.org/10.7224/1537-2073.2015-097.
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CME/CNE Information Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org. Target Audience: The target audience for this activity is physicians, physician assistants, nursing professionals, and other health-care providers involved in the management of patients with multiple sclerosis (MS). Learning Objectives: Appropriately apply information learned in this activity to assign a severity grade to MS patients Recognize the limitations of the severity grading scheme and be able to address those limitations in both treating and educating patients Accreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Consortium of Multiple Sclerosis Centers (CMSC), Nurse Practitioner Alternatives (NPA), and Delaware Media Group. The CMSC is accredited by the ACCME to provide continuing medical education for physicians. The CMSC designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Practitioner Alternatives (NPA) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. NPA designates this enduring material for 1.0 Continuing Nursing Education credit (none of these credits are in the area of pharmacology). Disclosures: Francois Bethoux, MD, Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has disclosed no relevant financial relationships. Robert Charlson, MD, has served on an advisory board for Teva Pharmaceuticals. Joshua Herbert, BA, has disclosed no relevant financial relationships. Ilya Kister, MD, has served as a consultant for Biogen Idec and Genentech. Dr. Kister has also performed contracted research for Bayer, Genzyme, and Biogen Idec. Laurie Scudder, DNP, NP, has served as Nurse Planner for this activity. She has disclosed no relevant financial relationships. The anonymous peer reviewers for the IJMSC have disclosed no relevant financial relationships. The staff at the CMSC, NPA, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Method of Participation: Release Date: October 1, 2016 Valid for Credit Through: October 1, 2017 In order to receive CME/CNE credit, participants must:Review the CME/CNE information, including learning objectives and author disclosures.Study the educational content.Complete the post-test and evaluation, which are available at http://www.cmscscholar.org. Statements of Credit are awarded upon successful completion of the post-test with a passing score of >70% and the evaluation. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This CME/CNE activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. CMSC, NPA, and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of CMSC, NPA, or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health-care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.
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Dueck, Amylou C., Claus C. Becker, Lauren J. Rogak, et al. "Composite grading algorithm for National Cancer Institute’s PRO-CTCAE." Journal of Clinical Oncology 38, no. 15_suppl (2020): 7018. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.7018.
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7018 Background: Standard reporting of symptomatic adverse events (AEs) in oncology relies on clinicians to rate patient (pt) experience using CTCAE; each symptom is represented by a single graded item. To capture direct pt experience, NCI developed PRO-CTCAE to supplement CTCAE. In PRO-CTCAE, the pt answers up to 3 questions per AE about a symptom’s frequency, severity and interference with daily activities. To align PRO-CTCAE with CTCAE, we developed an algorithm for mapping sets of questions for an AE to a single composite numerical grade. Methods: We used a 5-step process. (1) All 187 possible PRO-CTCAE score permutations were presented to clinical investigators to subjectively map permutations to single numerical grades (range 0-3). (2) Permutations with < 75% agreement were presented to investigator committees at a National Clinical Trials Network meeting to gain majority consensus via anonymous voting. (3) The resulting algorithm was refined via graphical and tabular approaches to assure directional consistency. (4) Validity, reliability and sensitivity were assessed in a national study dataset. (5) Accuracy for delineating AEs between study arms was measured in 2 phase III clinical trials (Alliance for Clinical Trials in Oncology A091105 and Exelixis COMET-2). Results: (1) 12/187 score permutations had < 75% initial agreement. (2) Majority consensus was reached for all permutations. (3) 5 mappings were adjusted to assure directional consistency. (4) Composite grades for 46/59 (78%) AEs were higher in pts with ECOG performance status 2-4 vs 0-1 (median effect size 0.23 [range -0.49-0.73]; 32/59 effect size ≥0.2; 25/59 p< 0.05), similar to when conducting analysis on individual unmapped items. The test-retest reliability for 24 selected composite grades ranged from 0.57-0.96 (median intraclass correlation coefficient [ICC] 0.77) with 18/24 (75%) grades having ICC ≥0.7. Median (range) standardized response means in pts reporting worsening, no change, and improvement were 0.20 (0.03-0.34), -0.06 (-0.20-0.03) and -0.12 (-0.32-0.06). (5) Pattern, directionality and statistical significance of between-arm differences in both trials were preserved with composite grades as compared to individual unmapped items. Conclusions: A composite grading algorithm for PRO-CTCAE was rigorously developed and validated. PRO-CTCAE composite grades may be useful in analyses to provide a single metric for each pt-reported AE for trial and real-world reporting. Support: UG1CA189823; U01CA233046; HHSN261200800043C; Bayer (A091105); https://acknowledgments.alliancefound.org .
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Guilford, William H. "TEACHING PEER REVIEW AND THE PROCESS OF SCIENTIFIC WRITING." Advances in Physiology Education 25, no. 3 (2001): 167–75. http://dx.doi.org/10.1152/advances.2001.25.3.167.
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Many undergraduate and graduate students understand neither the process of scientific writing nor the significance of peer review. In response, some instructors have created writing assignments that teach or mimic parts of the scientific publishing process. However, none fully reproduced peer review and revision of papers together with the writing and publishing process from research to final, accepted draft. In addition, most have been instituted at the graduate rather than undergraduate level. We present a detailed method for teaching undergraduate students the full scientific publishing process, including anonymous peer review, during the process of writing a “term paper.” The result is a review article in the format for submission to a major scientific journal. This method has been implemented in the course Cell and Molecular Biology for Engineers at the University of Virginia. Use of this method resulted in improved grades, much higher quality in the final manuscript, greater objectivity in grading, and improved understanding of the importance of peer review.
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Barlet, Grace, Rosemary K. Sokas, and Eileen Betit. "Operating Engineers and the OSHA Silica Standard: A Survey of Union Trainers." NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy 29, no. 4 (2019): 530–35. http://dx.doi.org/10.1177/1048291119889006.
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Enclosed cabs with filtration systems, an engineering control preferred in the hierarchy of controls, may reduce heavy equipment operators’ silica exposure during demolition, grading, and excavation. We surveyed operating engineer trainers about silica training, familiarity with the Occupational Safety and Health Administration (OSHA) silica standard, and cab filtration systems. A voluntary and anonymous online survey was e-mailed to 437 trainers in January 2018. The response rate was 22.9 percent (n = 100). Most trainers (84 percent) covered health risks and silica exposure prevention in their courses. Of these, 59 percent discussed cab filtration as an engineering control. Trainers identified possible barriers to the use of cab filtration systems and a need for education to increase use, and raised concerns about other exposures associated with heavy equipment use. Education about selection, use, and maintenance of cab filtration systems to control silica exposure is needed. Engineering improvements to heavy equipment should address cab filtration, noise, heat, and vibration.
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Jaworska, Joanna, Anna Komorowska-Piotrowska, Andrzej Pomiećko, et al. "Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children." Diagnostics 10, no. 11 (2020): 935. http://dx.doi.org/10.3390/diagnostics10110935.
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This evidence-based consensus aims to establish the role of point-of-care lung ultrasound in the management of pneumonia and bronchiolitis in paediatric patients. A panel of thirteen experts form five Polish tertiary pediatric centres was involved in the development of this document. The literature search was done in PubMed database. Statements were established based on a review of full-text articles published in English up to December 2019. The development of this consensus was conducted according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluations)—adopted and Delphi method. Initially, 22 proposed statements were debated over 3 rounds of on-line discussion and anonymous voting sessions. A total of 17 statements were agreed upon, including four statements referring to general issues, nine referring to pneumonia and four to bronchiolitis. For five statements experts did not achieve an agreement. The evidence supporting each statement was evaluated to assess the strength of each statement. Overall, eight statements were rated strong, five statements moderate, and four statements weak. For each statement, experts provided their comments based on the literature review and their own experience. This consensus is the first to establish the role of lung ultrasound in the diagnosis and management of pneumonia and bronchiolitis in children as an evidence-based method of imaging.
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Murthy, Ananth S., and James A. Lehman. "Evaluation of Alveolar Bone Grafting: A Survey of ACPA Teams." Cleft Palate-Craniofacial Journal 42, no. 1 (2005): 99–101. http://dx.doi.org/10.1597/03-045.1.
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Objective To evaluate the management of alveolar clefts by cleft palate and craniofacial teams in North America. Design An anonymous survey was mailed to 240 American Cleft Palate– Craniofacial Association teams across North America regarding alveolar bone grafting. The questionnaire included multiple questions about each team's approach to alveolar bone grafting and options for the missing tooth. Results Consensus was achieved in three areas: 90% of centers performed secondary alveolar bone grafting, 78% performed grafting between ages 6 and 9 years, and iliac crest donor site was the most popular site (83%). There was no consensus with respect to dental criteria for the timing of grafting, follow-up x-rays, or the use of a grading system for evaluating results. In addition, there was no consensus on the management of the missing tooth. Conclusion There is wide acceptance of secondary bone grafting and there is a consensus for the age of grafting (6 to 9 years) and donor site (iliac crest). The disturbing finding was the lack of postoperative x-ray evaluation of the results. With so much variability in management, the use of a routine, standardized scale to measure postoperative results would allow for better outcome studies in alveolar bone grafting.
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Strong, Kay E. "CPRTM: Adopting An Out-Of-Discipline Innovation." College Teaching Methods & Styles Journal (CTMS) 4, no. 1 (2011): 65. http://dx.doi.org/10.19030/ctms.v4i1.5051.
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Calibrated Peer Review (CPR) is a web-based instructional tool that encourages writing gain for students without adding grading pain for the instructor! The use of CPR provides students frequent opportunities to hone both writing as well as peer review skills in a guided environment. And once an assignment is authored, instructors have little to do beside monitor progress and arbitrate possible grading complaints! The four phase process of the Calibrated Peer Review reinforces learning of the content material and provides immediate assessment feedback. Students access the assignment by logging into CPR. Phase one involves the preparation and submission of the students text response to the writing assignment. During phase two the student evaluates three instructor written calibrations (high quality, mid quality and low quality) of the same assignment using pre-specified rubrics assessing content and style. An unsuccessful outcome prompts a return to the calibrations and a retry. A successful outcome moves the student forward into phase three. The software randomly selects three anonymous peer assignments. Using the same evaluation criteria the student assesses each assignment. At phase four, the student is presented his/her own assignment for self-review. Time limits at each phase insure timely completion of the assignment in full. The CPR tool provides immediate feedback on student performance at each phase. At the conclusion the CPR tool produces a complete set of results corresponding to performance at each phase; a score for the text entry, a score for the three calibrations, a score for the three peer reviews, a self-assessment score and concluding overall score. To bypass problems commonly associated with students reviewing student work, CPR has built in a set of weighting factors based on standard deviations which are reflected in the students own scores. Given its discipline-independent nature, Calibrated Peer Review makes an excellent instructional management tool to encourage students to read for content, master the content, write-to-learn, as well as, critically review writing.
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Siau, Keith, Sarah Hearnshaw, Adrian J. Stanley, et al. "British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding." Frontline Gastroenterology 11, no. 4 (2020): 311–23. http://dx.doi.org/10.1136/flgastro-2019-101395.
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Medical care bundles improve standards of care and patient outcomes. Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency which has been consistently associated with suboptimal care. We aimed to develop a multisociety care bundle centred on the early management of AUGIB.Commissioned by the British Society of Gastroenterology (BSG), a UK multisociety task force was assembled to produce an evidence-based and consensus-based care bundle detailing key interventions to be performed within 24 hours of presentation with AUGIB. A modified Delphi process was conducted with stakeholder representation from BSG, Association of Upper Gastrointestinal Surgeons, Society for Acute Medicine and the National Blood Transfusion Service of the UK. A formal literature search was conducted and international AUGIB guidelines reviewed. Evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation tool and statements were formulated and subjected to anonymous electronic voting to achieve consensus. Accepted statements were eligible for incorporation into the final bundle after a separate round of voting. The final version of the care bundle was reviewed by the BSG Clinical Services and Standards Committee and approved by all stakeholder groups.Consensus was reached on 19 statements; these culminated in 14 corresponding care bundle items, contained within 6 management domains: Recognition, Resuscitation, Risk assessment, Rx (Treatment), Refer and Review.A multisociety care bundle for AUGIB has been developed to facilitate timely delivery of evidence-based interventions and drive quality improvement and patient outcomes in AUGIB.
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Uttl, Bob, and Dylan Smibert. "Student evaluations of teaching: teaching quantitative courses can be hazardous to one’s career." PeerJ 5 (May 9, 2017): e3299. http://dx.doi.org/10.7717/peerj.3299.
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Anonymous student evaluations of teaching (SETs) are used by colleges and universities to measure teaching effectiveness and to make decisions about faculty hiring, firing, re-appointment, promotion, tenure, and merit pay. Although numerous studies have found that SETs correlate with various teaching effectiveness irrelevant factors (TEIFs) such as subject, class size, and grading standards, it has been argued that such correlations are small and do not undermine the validity of SETs as measures of professors’ teaching effectiveness. However, previous research has generally used inappropriate parametric statistics and effect sizes to examine and to evaluate the significance of TEIFs on personnel decisions. Accordingly, we examined the influence of quantitative vs. non-quantitative courses on SET ratings and SET based personnel decisions using 14,872 publicly posted class evaluations where each evaluation represents a summary of SET ratings provided by individual students responding in each class. In total, 325,538 individual student evaluations from a US mid-size university contributed to theses class evaluations. The results demonstrate that class subject (math vs. English) is strongly associated with SET ratings, has a substantial impact on professors being labeled satisfactory vs. unsatisfactory and excellent vs. non-excellent, and the impact varies substantially depending on the criteria used to classify professors as satisfactory vs. unsatisfactory. Professors teaching quantitative courses are far more likely not to receive tenure, promotion, and/or merit pay when their performance is evaluated against common standards.
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Hegab, Marwa M., and Maha Abdelkawy. "Classification of Periodontal Diseases – Old is Gold or New is Bold? A Survey Study in Egypt." December 2020 4, no. 1 (2020): 11–23. http://dx.doi.org/10.26810/perioj.2020.a2.
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Background: A consensus was reached for a new classification system for periodontal and peri-implant diseases and conditions and was proposed by a group of world experts in 2017. Since then, there have been ongoing debates among periodontists regarding the application of the new classification. This study aims to shed light on the current understanding of the new classification among Egyptian periodontists. Methods: This cross-sectional survey study was performed using an anonymous manually distributed questionnaire in various universities in Egypt. The validated questionnaire included 15 questions – 13 multiple choice questions with a Likert scale and two open ended questions, in addition to demographic data of the participant. Qualitative data were presented as frequencies and percentages, and binary and ordinal logistic regression analyses were performed. Results: The clarity of the new classification was the only significant predictor for satisfaction. An increase in clarity scores was directly associated with an increase in satisfaction scores (odds ratio = 5.521, 95% CI = 2.198 – 8.844, P-value = 0.001). Only 24.2% of the participants actually applied the new classification. There was a high approval rate on the introduction of “health on reduced periodontium” and the classification of peri-implant conditions. However, there was a huge dissatisfaction with applying the staging and grading system as well as the omission of aggressive periodontitis. Conclusions: This survey has identified important gaps between theory and practice and bridging these gaps by revising the controversial points would help develop a clearer, simpler system for clinicians to improve patients’ oral health.
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Cui, David, Ingrid U. Scott, and Heidi Luise Wingert. "Ophthalmology Program Directors' Perspectives on the Impact of the United States Medical Licensing Examination Step 1 Change to Pass-Fail Scoring." Journal of Academic Ophthalmology 12, no. 02 (2020): e277-e283. http://dx.doi.org/10.1055/s-0040-1718569.
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Abstract Purpose This article investigates the perspectives of ophthalmology residency program directors (PDs) regarding the impact of the United States Medical Licensing Examination (USMLE) Step 1 change from graded to pass-fail scoring on ophthalmology resident selection and medical education. Methods The PDs of all United States ophthalmology residency programs accredited by the Accreditation Council for Graduate Medical Education were identified using a public, online database. An anonymous web-based survey constructed using REDCap was emailed to each PD in February 2020. Results Surveys were completed by 64 (54.2%) PDs, with the majority (81.2%) disagreeing with the change to pass-fail scoring. The majority of PDs believe this change will negatively impact the ability to evaluate residency applicants (92.1%) and achieve a fair and meritocratic match process (76.6%), and will decrease medical students' basic science knowledge (75.0%). The factors identified most frequently by PDs as becoming more important in evaluating residency applicants as a result of the Step 1 scoring change include clerkship grades (90.6%), USMLE Step 2 Clinical Knowledge score (84.4%), and a rotation in the PD's department (79.7%). The majority of PDs believe the Step 1 grading change to pass-fail will benefit applicants from elite medical schools (60.9%), and disadvantage applicants from nonelite allopathic schools (82.8%), international medical graduate applicants (76.6%), and osteopathic applicants (54.7%). Conclusion The majority of ophthalmology PDs disagree with the change in USMLE Step 1 scoring from graded to pass-fail and believe this change will negatively impact the ability to evaluate residency applicants and achieve a fair and meritocratic match process, and will decrease medical students' basic science knowledge.
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Matlin, Talitha Rosa, and Tricia Lantzy. "Maintaining Quality While Expanding Our Reach: Using Online Information Literacy Tutorials in the Sciences and Health Sciences." Evidence Based Library and Information Practice 12, no. 3 (2017): 95. http://dx.doi.org/10.18438/b8zd3q.
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Abstract
 
 Objective – This article aims to assess student achievement of higher-order information literacy learning outcomes from online tutorials as compared to in-person instruction in science and health science courses.
 
 Methods – Information literacy instruction via online tutorials or an in-person one-shot session was implemented in multiple sections of a biology (n=100) and a kinesiology course (n=54). After instruction, students in both instructional environments completed an identical library assignment to measure the achievement of higher-order learning outcomes and an anonymous student survey to measure the student experience of instruction. 
 
 Results – The data collected from library assignments revealed no statistically significant differences between the two instructional groups in total assignment scores or scores on specific questions related to higher-order learning outcomes. Student survey results indicated the student experience is comparable between instruction groups in terms of clarity of instruction, student confidence in completing the course assignment after library instruction, and comfort in asking a librarian for help after instruction.
 
 Conclusions – This study demonstrates that it is possible to replace one-shot information literacy instruction sessions with asynchronous online tutorials with no significant reduction in student learning in undergraduate science and health science courses. Replacing in-person instruction with online tutorials will allow librarians at this university to reach a greater number of students and maintain contact with certain courses that are transitioning to completely online environments. While the creation of online tutorials is initially time-intensive, over time implementing online instruction could free up librarian time to allow for the strategic integration of information literacy instruction into other courses. Additional time savings could be realized by incorporating auto-grading into the online tutorials.
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Zhou, Zhen, Loai Albarqouni, Monique Breslin, Andrea J. Curtis, and Mark Nelson. "Statin-associated muscle symptoms (SAMS) in primary prevention for cardiovascular disease in older adults: a protocol for a systematic review and meta-analysis of randomised controlled trials." BMJ Open 7, no. 9 (2017): e017587. http://dx.doi.org/10.1136/bmjopen-2017-017587.
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IntroductionAlthough statins are commonly used for prevention of cardiovascular disease, there is limited evidence about statin-related adverse effects in older people. Statin-related adverse events (AEs), especially the statin-associated muscle symptoms (SAMS), are the most common reasons for their discontinuation. Therefore, it is important to determine the risk of SAMS in the older population. We will undertake a systematic review and meta-analysis primarily focusing on the risk of SAMS and secondarily targeting myopathy, rhabdomyolysis, AEs and serious AEs, dropouts due to SAMS in run-in period, related permanent discontinuation rate of statins and creatine kinase level, among older people who received statins for primary prevention.Methods and analysisThis study has been developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. We will include randomised controlled trials in which statin was compared with placebo with at least 1 year follow-up among older adults aged ≥65. This review is an update of a Cochrane systematic review that included the articles published before 2012. Cochrane Central Register of Controlled Trials, Medline OvidSP and Embase electronic database searches will be performed to identify relevant articles, limiting the publication date from 1 January 2012 to 13 February 2017. There will be no language limitation. Two independent reviewers will screen titles and abstracts and full text in duplicate. Risk of bias and evidence quality will be assessed using the Cochrane Collaboration’s tool and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. A meta-analysis using pooled data will be undertaken, if appropriate. We will also perform metaregression and subgroup analyses to identify sources of heterogeneity.Ethics and disseminationThis study is exempt from ethics approval due to the anonymous and aggregated data used. The outcomes will be disseminated by conference presentations and published in a peer-reviewed journal.Trial registration numberCRD42017058436.
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Messenger, Louisa Alexandra, Joanna Furnival-Adams, Bethanie Pelloquin, and Mark Rowland. "Vector control for malaria prevention during humanitarian emergencies: protocol for a systematic review and meta-analysis." BMJ Open 11, no. 7 (2021): e046325. http://dx.doi.org/10.1136/bmjopen-2020-046325.
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IntroductionHumanitarian emergencies, of either natural or anthropogenic origins, are equivalent to major disasters, which can lead to population displacement, food insecurity and health system disruptions. Almost two-thirds of people affected by humanitarian emergencies inhabit malaria endemic regions, particularly the WHO African Region, which currently accounts for 93% and 94% of malaria cases and deaths, respectively. As of late 2020, the United Nations Refugee Agency estimates that there are globally 79.5 million forcibly displaced people, including 45.7 million internally displaced people, 26 million refugees, 4.2 million asylum-seekers and 3.6 million Venezuelans displaced abroad.Methods and analysesA systematic review and meta-analysis will be conducted to evaluate the impact of different vector control interventions on malaria disease burden during humanitarian emergencies. Published and grey literatures will be systematically retrieved from 10 electronic databases and 3 clinical trials registries. A systematic approach to screening, reviewing and data extraction will be applied based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Two review authors will independently assess full-text copies of potentially relevant articles based on inclusion criteria. Included studies will be assessed for risk of bias according to Cochrane and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Eligible studies with reported or measurable risk ratios or ORs with 95% CIs will be included in a meta-analysis. Subgroup analyses, including per study design, emergency phase and primary mode of intervention, may be performed if substantial heterogeneity is encountered.Ethics and disseminationEthical approval is not required by the London School of Hygiene and Tropical Medicine to perform secondary analyses of existing anonymous data. Study findings will be disseminated via open-access publications in peer-reviewed journals, presentations to stakeholders and international policy makers, and will contribute to the latest WHO guidelines for malaria control during humanitarian emergencies.PROSPERO registration numberCRD42020214961.
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Steinbrink, Julie M., Charles Burns, Jessica L. Seidelman, et al. "1115. A Longitudinal Medical Education Program for Infectious Diseases Fellows." Open Forum Infectious Diseases 7, Supplement_1 (2020): S588. http://dx.doi.org/10.1093/ofid/ofaa439.1301.
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Abstract Background Many Infectious Diseases (ID) fellows express interest in the education of future learners, yet there is little opportunity to develop these skills during training. We designed an immersive program to develop the teaching skills of ID fellows. We report our initial experiences and plans for future directions. Methods ID fellows were recruited to participate in the program after their first year. Enrollees had no changes to their clinical/research requirements. Faculty provided initial guidance on teaching techniques and instructed fellows on how to create a curriculum for medical student ID clinical rotations. This curriculum consisted of weekly teaching sessions led by the fellows and formatted to the fellows’ discretion. Teaching session goals were to provide education on high-yield topics at an appropriate level and in a separate environment from where student grading would be assigned. Fellows received faculty feedback on their teaching in real-time by direct observation and learner feedback by anonymous student survey. An annual survey also assessed the fellows’ experiences. Outcomes of interest included an evaluation of baseline teaching skills, experience designing a curriculum, and confidence teaching over time. Results Since its inception in 2017, 7 fellows have participated in the program. Teaching sessions consisted of various formats: lecture, roundtable discussion, case-based, and remote virtual conferences. Education sessions were well-received by students (Figure 1). 86% of enrollees reported only occasional lecturing experience prior to fellowship and requested additional training in design of an educational course (Table 1). After participation in the program, 57% rated their experience as better than expected and 100% agreed that fellow-led sessions should remain part of the rotation. After involvement, 57% reported strong interest in a career involving medical education. Figure1 Table1 Conclusion We developed a structured, longitudinal medical education program dedicated to improving fellows’ skills as academic teaching physicians. Thus far, it has been well received by ID fellows and students. The program is ongoing and continues to adapt to the fellows’ and learners’ needs as determined by routine quantitative and qualitative assessments. Disclosures All Authors: No reported disclosures
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Shayne, Michelle, Eva Culakova, Michael T. Milano, and Louis S. Constine. "Evidence table development as a novel teaching tool in cancer survivorship education." Journal of Clinical Oncology 34, no. 3_suppl (2016): 3. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.3.
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3 Background: We established a novel curriculum in Cancer Survivorship Education (CSE), as a collaborative effort between our accredited training programs in Hematology/Oncology and Radiation Oncology. The conceptual framework for all our coursework in cancer survivorship was grounded in the recommendations from the Institute of Medicine report from 2006. As a means of refining our CSE curriculum, we introduced Evidence Table (ET) development. ETs are formatted summaries of methods, data, and outcomes from related studies used to answer specific questions. ETs facilitate the development of recommendations and standards of care. ET development was proposed to enhance the CSE experience allowing trainees to: 1) understand data supporting survivorship recommendations, 2) practice grading the evidence, 3) become more critical in appraisal of published studies, and 4) discover areas where further research is needed to substantiate cancer survivorship care plans. Methods: A total of 19 trainees participated in academic year 2013-2014 and 18 trainees in 2014-2015. Trainees were required to define key questions pertaining to survivorship, probe the literature for available data addressing these questions, and develop ETs in which the evidence was then graded. To ascertain the value of this experience from the trainees’ perspectives, anonymous and voluntary pre- and post-Workshop surveys were administered. The course was modified after the first academic year based on results of a trainee feed-back. Results: Following course modification in 2014-2015, 92% of trainees responded that they used some of the learned course information in their clinics. This represents significant improvement from 45% the previous year (p = 0.02). Significant improvement was observed (from 18% to 67%) in the perception that the course influenced trainees' approach to the medical literature. Ninety-two percent responded that they learned more about survivorship as a result of the CSE Workshop. All trainees reported that, to some extent, CSE has helped to make them better oncologists. Conclusions: ET development is a feasible, meaningful, and novel approach to fostering independent learning in cancer survivorship.
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Guidon, Amanda C., Leeann B. Burton, Bart K. Chwalisz, et al. "Consensus disease definitions for neurologic immune-related adverse events of immune checkpoint inhibitors." Journal for ImmunoTherapy of Cancer 9, no. 7 (2021): e002890. http://dx.doi.org/10.1136/jitc-2021-002890.
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Expanding the US Food and Drug Administration–approved indications for immune checkpoint inhibitors in patients with cancer has resulted in therapeutic success and immune-related adverse events (irAEs). Neurologic irAEs (irAE-Ns) have an incidence of 1%–12% and a high fatality rate relative to other irAEs. Lack of standardized disease definitions and accurate phenotyping leads to syndrome misclassification and impedes development of evidence-based treatments and translational research. The objective of this study was to develop consensus guidance for an approach to irAE-Ns including disease definitions and severity grading. A working group of four neurologists drafted irAE-N consensus guidance and definitions, which were reviewed by the multidisciplinary Neuro irAE Disease Definition Panel including oncologists and irAE experts. A modified Delphi consensus process was used, with two rounds of anonymous ratings by panelists and two meetings to discuss areas of controversy. Panelists rated content for usability, appropriateness and accuracy on 9-point scales in electronic surveys and provided free text comments. Aggregated survey responses were incorporated into revised definitions. Consensus was based on numeric ratings using the RAND/University of California Los Angeles (UCLA) Appropriateness Method with prespecified definitions. 27 panelists from 15 academic medical centers voted on a total of 53 rating scales (6 general guidance, 24 central and 18 peripheral nervous system disease definition components, 3 severity criteria and 2 clinical trial adjudication statements); of these, 77% (41/53) received first round consensus. After revisions, all items received second round consensus. Consensus definitions were achieved for seven core disorders: irMeningitis, irEncephalitis, irDemyelinating disease, irVasculitis, irNeuropathy, irNeuromuscular junction disorders and irMyopathy. For each disorder, six descriptors of diagnostic components are used: disease subtype, diagnostic certainty, severity, autoantibody association, exacerbation of pre-existing disease or de novo presentation, and presence or absence of concurrent irAE(s). These disease definitions standardize irAE-N classification. Diagnostic certainty is not always directly linked to certainty to treat as an irAE-N (ie, one might treat events in the probable or possible category). Given consensus on accuracy and usability from a representative panel group, we anticipate that the definitions will be used broadly across clinical and research settings.
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Guidon, Amanda C., Leeann B. Burton, Bart K. Chwalisz, James M. Hillis, Teilo Schaller, and Kerry Lynn Reynolds. "Consensus disease definitions for the spectrum of neurologic immune related adverse events." Journal of Clinical Oncology 39, no. 15_suppl (2021): 2647. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.2647.
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2647 Background: Expanding FDA-approved indications for immune checkpoint inhibitors in patients with cancer has resulted in both therapeutic success and immune related adverse events (irAEs). Neurologic irAEs (irAE-Ns) have an incidence of 1-12% and a high fatality rate relative to other irAEs. Lack of standardized disease definitions and accurate phenotyping leads to syndrome misclassification and impedes evidence-based treatments and research progress. The objectives of this study were to develop consensus guidance for an approach to irAE-Ns including disease definitions and severity grading. Methods: A working group of 4 neurologists drafted irAE-N consensus guidance and definitions, which were reviewed by the Neuro irAE Disease Definition Panel, consisting of neurologists, oncologists, neuro-oncologists and irAE subspecialists. A modified Delphi consensus process was used, with 2 rounds of anonymous ratings by panelists and 2 virtual meetings to discuss areas of controversy. Panelists rated content for usability, appropriateness and accuracy on 9-point scales in electronic surveys and provided free text comments. The working group aggregated survey responses and incorporated them into revised definitions. Consensus was based on numeric ratings using the RAND/UCLA Appropriateness Method with prespecified definitions. Results: Twenty-seven panelists from 15 academic medical centers voted on a total of 53 rating scales (6 general guidance, 24 central and 18 peripheral nervous system disease definition components, 3 severity criteria and 2 clinical trial adjudication statements); of these, 77% (41/53) received first round consensus. After revisions, all items received second round consensus. Consensus definitions were achieved for 7 core disorders: irMeningitis, irEncephalitis/Encephalomyelitis, irDemyelinating disease, irVasculitis, irNeuropathy, irNeuromuscular junction disorders and irMyopathy. For each disorder, 6 sub-classifications are described: disease subtype, diagnostic certainty, severity, autoantibody association, exacerbation of pre-existing disease or de novo presentation and present or absent concurrent irAE. Conclusions: These disease definitions standardize irAE-N classification. They are being incorporated into a multi-institutional registry that our group has initiated to study irAEs. Given consensus on their accuracy and usability from a representative panel group, we anticipate that they can be used broadly across clinical and research settings.
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Shiraishi, Masahiko, Adam J. Oates, Xu Li, Ying H. Chuu, and Takao Sekiya. "Segregation of partly melted molecules: isolation of CpG islands by polyacrylamide gel electrophoresis." Biological Chemistry 385, no. 10 (2004): 967–73. http://dx.doi.org/10.1515/bc.2004.126.
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Abstract The technique of segregation of partly melted molecules (SPM) is a convenient and efficient method to isolate DNA fragments associated with CpG islands. The approach is conceptually simple and uses denaturant gradient gel electrophoresis to separate DNA molecules digested with restriction endonucleases. The SPM methodology has successfully been applied to the identification of genes from anonymous, unsequenced DNA fragments and CpG islands methylated in human cancer. In this article the theoretical background and practical application of the SPM method is reviewed.
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Evensen, Miriam. "Adolescent Mental Health Problems, Behaviour Penalties, and Distributional Variation in Educational Achievement." European Sociological Review 35, no. 4 (2019): 474–90. http://dx.doi.org/10.1093/esr/jcz015.
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Abstract Prior research shows that mental health problems are linked to worse student achievements in school, but few studies address whether the consequences of such problems vary by student achievement level and the role of teachers’ grading practices in these processes. In this study, I examine the relationship between mental health problems and grade achievement at the end of compulsory education using a population-based Norwegian health survey, the Young-HUNT study, matched with administrative data. The results show a robust negative influence of attention problems and conduct problems on average grade achievement, and a positive role of internalizing problems, in fixed-effects models controlling for unobserved characteristics of school context. Further, conduct problems are more strongly related with student achievement in the lower end of the grade distribution, indicating that low-achieving students are disproportionally affected by mental health problems. I also compare grades assigned by classroom teachers with anonymously graded exams, and find that part of the negative association between externalizing problems and achievement reflect a ‘behavioural penalty’ due to teacher-bias in grading practices.
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Mittal, Nupur, and Lewis L. Hsu. "A Survey of Resident Physicians' and Nurses' Knowledge of Severity Assessment of Acute Chest Syndrome and Role of Incentive Spirometry in Management." Blood 126, no. 23 (2015): 2064. http://dx.doi.org/10.1182/blood.v126.23.2064.2064.
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Abstract Background Acute chest syndrome (ACS) is the second most frequent reason for hospitalization in children and adults with sickle cell disease (SCD) and the most common cause of death. Physicians caring for SCD patients need to be aware of the early symptoms and signs of ACS, assessment of ACS severity to guide optimal therapy, and measures to prevent ACS. Recently there is some consensus on the definition of ACS, and an ACS severity assessment tool used in multicenter clinical research (Ballas et al. for the Investigators of the Comprehensive Sickle Cell Centers. Am J Hematol 2010) has been utilized but not validated in a real-world setting. Thus, existing guidelines and policy statements for the management of children with ACS do not provide a uniform system for grading of severity and management, and the new guidelines from NHLBI for sickle cell disease management by primary care physicians does not rectify this situation [2014 NIH guidelines]. In contrast, the evidence base for role of incentive spirometry in preventing ACS (Bellet et al, NEJM 1995)and decreasing severity of ACS is strong/moderate and accordingly incentive spirometry recommendations are included in guidelines [2014 NIH guidelines, Crabtree et al. Pediatrics 2011]. As a first step toward this quality improvement initiative at our institution our objective was to assess the current knowledge of resident physicians and nursing regarding these 2 aspects of ACS: Severity assessment and Incentive spirometry. Methods This tertiary care teaching hospital admits over 20 sickle cell patients per month on the pediatric ward. Pediatric house staff learns about ACS management and prevention as part of 2 formal didactic sessions on SCD per year and bedside teaching by rotating pediatric hematology-oncology faculty, fellows, and advanced-practice nurses. Pediatric ward nurses have 1 didactic session on SCD per year. An anonymous survey consisting of ten items regarding the use of a scoring system for ACS and incentive spirometry was administered to 40 pediatric resident physicians and 20 pediatric inpatient nurses who routinely engage in care of pediatric patients hospitalized with ACS. Descriptive statistics were employed for analysis. This was followed by an education session on ACS for the group. This study was approved by the institutional IRB. Results SEVERITY SCORING: We found that 15% of resident physicians and 5% of nurses had been educated on the use of a ACS severity assessment score in past (Fig 1a), however an overwhelming 92% felt that such a scoring system would be extremely useful for assessing their patient's condition and their management (Fig 1b). Only 5% of residents and 3% of nurses had used a severity scoring system for ACS in the past to guide their management decisions (Fig 1c). This was further confirmed by testing them on a clinical vignette based on ACS and a majority of the residents and nurses (58%) answered it incorrectly (Fig 1d). INCENTIVE SPIROMETRY: An impressive 91% responded they were aware that incentive spirometry during hospitalization can decrease the severity of and improve outcomes of acute chest syndrome (Fig 2a). Greater than 88% of resident physicians thought that incentive spirometry is almost always ordered for the patients but the same proportion felt that the patients are compliant less than 50% of the time with instructions regarding use (Fig 2b and 2c). Nurses' responses were more variable on the ordering of incentive spirometry for the patients but 95% thought that less than patients were compliant less than half the time with the orders (Fig 2b and 2c). Conclusions We conclude that the knowledge of resident physicians and nurses regarding severity assessment of acute chest syndrome is extremely limited and greater efforts are needed to educate and encourage them to include this assessment in their management decisions to improve their understanding of patient condition and optimize care. In addition, we found that importance of incentive spirometry is recognized by house staff, however, the patient compliance is far below desirable and stricter reinforcement will be needed by the physicians and nurses to potentially improve outcomes for hospitalized patients with ACS. This pilot study thus identifies room for quality improvement at several different steps in the process of care for SCD. Disclosures No relevant conflicts of interest to declare.
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Berger, M., M. Pillei, A. Giotakis, et al. "Pre-surgery planning tool for estimation of resection volume to improve nasal breathing based on lattice Boltzmann fluid flow simulations." International Journal of Computer Assisted Radiology and Surgery 16, no. 4 (2021): 567–78. http://dx.doi.org/10.1007/s11548-021-02342-z.
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Abstract Purpose State-of-the-art medical examination techniques (e.g., rhinomanometry and endoscopy) do not always lead to satisfactory postoperative outcome. A fully automatized optimization tool based on patient computer tomography (CT) data to calculate local pressure gradient regions to reshape pathological nasal cavity geometry is proposed. Methods Five anonymous pre- and postoperative CT datasets with nasal septum deviations were used to simulate the airflow through the nasal cavity with lattice Boltzmann (LB) simulations. Pressure gradient regions were detected by a streamline analysis. After shape optimization, the volumetric difference between the two shapes of the nasal cavity yields the estimated resection volume. Results At LB rhinomanometry boundary conditions (bilateral flow rate of 600 ml/s), the preliminary study shows a critical pressure gradient of −1.1 Pa/mm as optimization criterion. The maximum coronal airflow ΔA := cross-section ratio $$\frac{\mathrm{virtual surgery }}{\mathrm{post}-\mathrm{surgery}}$$ virtual surgery post - surgery found close to the nostrils is 1.15. For the patients a pressure drop ratio ΔΠ := (pre-surgery − virtual surgery)/(pre-surgery − post-surgery) between nostril and nasopharynx of 1.25, 1.72, −1.85, 0.79 and 1.02 is calculated. Conclusions LB fluid mechanics optimization of the nasal cavity can yield results similar to surgery for air-flow cross section and pressure drop between nostril and nasopharynx. The optimization is numerically stable in all five cases of the presented study. A limitation of this study is that anatomical constraints (e.g. mucosa) have not been considered.
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Nagoshi, Kira, Zareen Zaidi, Ashleigh Wright, and Carolyn Stalvey. "Peer-assisted feedback: a successful approach for providing feedback on United States Medical Licensing Exam-style clinical skills exam notes in the United States." Journal of Educational Evaluation for Health Professions 16 (October 8, 2019): 29. http://dx.doi.org/10.3352/jeehp.2019.16.29.
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Purpose: Peer-assisted learning (PAL) promotes the development of communication, facilitates improvements in clinical skills, and is a way to provide feedback to learners. We utilized PAL as a conceptual framework to explore the feasibility of peer-assisted feedback (PAF) to improve note-writing skills without requiring faculty time. The aim was to assess whether PAL was a successful method to provide feedback on the United States Medical Licensing Exams (USMLE)-style clinical skills exam notes by using student feedback on a survey in the United States.Methods: The University of Florida College of Medicine administers clinical skills examination (CSEs) that include USMLE-like note-writing. PAL, in which students support the learning of their peers, was utilized as an alternative to faculty feedback. Second-year (MS2) and third-year (MS3) medical students taking CSEs participated in faculty-run note-grading sessions immediately after testing, which included explanations of grading rubrics and the feedback process. Students graded an anonymized peer’s notes. The graded material was then forwarded anonymously to its student author to review. Students were surveyed on their perceived ability to provide feedback and the benefits derived from PAF using a Likert scale (1–6) and open-ended comments during the 2017–2018 academic year.Results: Students felt generally positively about the activity, with mean scores for items related to educational value of 4.49 for MS2s and 5.11 for MS3s (out of 6). MS3s perceived peer feedback as constructive, felt that evaluating each other’s notes was beneficial, and felt that the exercise would improve their future notes. While still positive, MS2 students gave lower scores than the MS3 students.Conclusion: PAF was a successful method of providing feedback on student CSE notes, especially for MS3s. MS2s commented that although they learned during the process, they might be more invested in improving their note-writing as they approach their own USMLE exam.
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Gauvin, Laetitia, Paolo Bajardi, Emanuele Pepe, Brennan Lake, Filippo Privitera, and Michele Tizzoni. "Socio-economic determinants of mobility responses during the first wave of COVID-19 in Italy: from provinces to neighbourhoods." Journal of The Royal Society Interface 18, no. 181 (2021): 20210092. http://dx.doi.org/10.1098/rsif.2021.0092.
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After more than 1 year into the COVID-19 pandemic, governments worldwide still face the challenge of adopting non-pharmaceutical interventions to mitigate the risks posed by the emergence of new SARS-CoV-2 variants and the lack of a worldwide equitable vaccine allocation. Thus, it becomes crucial to identify the drivers of mobility responses to mitigation efforts during different restriction regimes, for planning interventions that are both economically and socially sustainable while effective in controlling an outbreak. Here, using anonymous and privacy-enhanced cell phone data from Italy, we investigate the determinants of spatial variations of reductions in mobility and co-location in response to the adoption and the lift of restrictions, considering both provinces and city neighbourhoods. In large urban areas, our analysis uncovers the desertification of historic city centres, which persisted after the end of the lockdown. Such centre-periphery gradient was mainly associated with differences in educational attainment. At the province level, the local structure of the labour market mainly explained the variations in mobility responses, together with other demographic factors, such as the population’s age and sex composition. In the future, targeted interventions should take into account how the ability to comply with restrictions varies across geographical areas and socio-demographic groups.
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Precht, Helle, Jesper Thygesen, Oke Gerke, Kenneth Egstrup, Dag Waaler, and Jess Lambrechtsen. "Influence of adaptive statistical iterative reconstruction algorithm on image quality in coronary computed tomography angiography." Acta Radiologica Open 5, no. 12 (2016): 205846011668488. http://dx.doi.org/10.1177/2058460116684884.
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Background Coronary computed tomography angiography (CCTA) requires high spatial and temporal resolution, increased low contrast resolution for the assessment of coronary artery stenosis, plaque detection, and/or non-coronary pathology. Therefore, new reconstruction algorithms, particularly iterative reconstruction (IR) techniques, have been developed in an attempt to improve image quality with no cost in radiation exposure. Purpose To evaluate whether adaptive statistical iterative reconstruction (ASIR) enhances perceived image quality in CCTA compared to filtered back projection (FBP). Material and Methods Thirty patients underwent CCTA due to suspected coronary artery disease. Images were reconstructed using FBP, 30% ASIR, and 60% ASIR. Ninety image sets were evaluated by five observers using the subjective visual grading analysis (VGA) and assessed by proportional odds modeling. Objective quality assessment (contrast, noise, and the contrast-to-noise ratio [CNR]) was analyzed with linear mixed effects modeling on log-transformed data. The need for ethical approval was waived by the local ethics committee as the study only involved anonymously collected clinical data. Results VGA showed significant improvements in sharpness by comparing FBP with ASIR, resulting in odds ratios of 1.54 for 30% ASIR and 1.89 for 60% ASIR ( P = 0.004). The objective measures showed significant differences between FBP and 60% ASIR ( P < 0.0001) for noise, with an estimated ratio of 0.82, and for CNR, with an estimated ratio of 1.26. Conclusion ASIR improved the subjective image quality of parameter sharpness and, objectively, reduced noise and increased CNR.
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Šumskas, Linas, Apolinaras Zaborskis, and Vilius Grabauskas. "Social Determinants of Smoking, Alcohol and Drug Use Among Lithuanian School-Aged Children: Results From 5 Consecutive HBSC Surveys, 1994–2010." Medicina 48, no. 11 (2012): 87. http://dx.doi.org/10.3390/medicina48110087.
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The aim of this study was to analyze the changes in the prevalence of smoking, alcohol and drug use among Lithuanian school-aged children in relation to the place of residence, family affluence, and family structure. Material and Methods. National surveys (26 556 anonymous questionnaires analyzed) of schoolchildren aged 11, 13, and 15 years were conducted in 1994, 1998, 2002, 2006, and 2010 in the framework of the international Health Behaviour in School-aged Children (HBSC) study. Results. In 1994–2010, a significant increase in smoking prevalence was observed both among boys (11.3% to 21.5%, P<0.05) and girls (3.6% to 14.8%, P<0.05). Weekly alcohol consumption increased from 9.6% to 12.9% (P<0.05) among boys and from 4.3% to 7.9% (P<0.05) among girls. The prevalence of “ever use” of any psychoactive substance (data for 15-year-old group only) increased both in boys (14.6% to 33.5%) and girls (6.7% to 18.4%). Urban girls smoked more often than their rural peers. For both genders, such a residential gradient was observed in the use of alcohol and drugs. The respondents from intact families used drugs less frequently than the adolescents from not intact families. The adolescents from affluent families smoked less often, while the prevalence of alcohol and drug use was higher (except weekly alcohol use in girls). Conclusions. The study has demonstrated a significant increase in the prevalence of smoking, drinking, and drug use among Lithuanian school-aged children during the period of transition to market economy. This study provides some insight that should be addressed in equity-oriented control policies of substance use.
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El-Rayes, Nesreen, Ming Fang, Michael Smith, and Stephen M. Taylor. "Predicting employee attrition using tree-based models." International Journal of Organizational Analysis 28, no. 6 (2020): 1273–91. http://dx.doi.org/10.1108/ijoa-10-2019-1903.
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Purpose The purpose of this study is to develop tree-based binary classification models to predict the likelihood of employee attrition based on firm cultural and management attributes. Design/methodology/approach A data set of resumes anonymously submitted through Glassdoor’s online portal is used in tandem with public company review information to fit decision tree, random forest and gradient boosted tree models to predict the probability of an employee leaving a firm during a job transition. Findings Random forest and decision tree methods are found to be the strongest attrition prediction models. In addition, compensation, company culture and senior management performance play a primary role in an employee’s decision to leave a firm. Practical implications This study may be used by human resources staff to better understand factors which influence employee attrition. In addition, techniques developed in this study may be applied to company-specific data sets to construct customized attrition models. Originality/value This study contains several novel contributions which include exploratory studies such as industry job transition percentages, distributional comparisons between factors strongly contributing to employee attrition between those who left or stayed with the firm and the first comprehensive search over binary classification models to identify which provides the strongest predictive performance of employee attrition.
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Mbagwu, Smart Ikechukwu, Nils Lannes, Michael Walch, Luis Filgueira, and Pierre-Yves Mantel. "Human Microglia Respond to Malaria-Induced Extracellular Vesicles." Pathogens 9, no. 1 (2019): 21. http://dx.doi.org/10.3390/pathogens9010021.
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Microglia are the chief immune cells of the brain and have been reported to be activated in severe malaria. Their activation may drive towards neuroinflammation in cerebral malaria. Malaria-infected red blood cell derived-extracellular vesicles (MiREVs) are produced during the blood stage of malaria infection. They mediate intercellular communication and immune regulation, among other functions. During cerebral malaria, the breakdown of the blood–brain barrier can promote the migration of substances such as MiREVs from the periphery into the brain, targeting cells such as microglia. Microglia and extracellular vesicle interactions in different pathological conditions have been reported to induce neuroinflammation. Unlike in astrocytes, microglia–extracellular vesicle interaction has not yet been described in malaria infection. Therefore, in this study, we aimed to investigate the uptake of MiREVs by human microglia cells and their cytokine response. Human blood monocyte-derived microglia (MoMi) were generated from buffy coats of anonymous healthy donors using Ficoll-Paque density gradient centrifugation. The MiREVs were isolated from the Plasmodium falciparum cultures. They were purified by ultracentrifugation and labeled with PKH67 green fluorescent dye. The internalization of MiREVs by MoMi was observed after 4 h of co-incubation on coverslips placed in a 24-well plate at 37 °C using confocal microscopy. Cytokine-gene expression was investigated using rt-qPCR, following the stimulation of the MoMi cells with supernatants from the parasite cultures at 2, 4, and 24 h, respectively. MiREVs were internalized by the microglia and accumulated in the perinuclear region. MiREVs-treated cells increased gene expression of the inflammatory cytokine TNFα and reduced gene expression of the immune suppressive IL-10. Overall, the results indicate that MiREVs may act on microglia, which would contribute to enhanced inflammation in cerebral malaria.
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Panfili, Jacques, Jean-Dominique Durand, Khady Diop, Béatrice Gourène, and Monique Simier. "Fluctuating asymmetry in fish otoliths and heterozygosity in stressful estuarine environments (West Africa)." Marine and Freshwater Research 56, no. 5 (2005): 505. http://dx.doi.org/10.1071/mf04138.
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Fluctuating asymmetry (FA) is assumed to reflect the developmental instability caused by environmental or genetic stress. Fish otoliths represent a very good tool for investigating the consequence of different effects on FA. Otolith FA analysis, coupled with genetic analysis, has been undertaken on two common West African estuarine species, Ethmalosa fimbriata (EFI) and Sarotherodon melanotheron (SME), in two neighbouring estuaries, in order to highlight the impact of salinity on developmental stability. The Gambia estuary has a normal functioning and the Saloum estuary is inverse (saltier waters in the upper river), reaching extremely high salinities (>100 psu) and constituting severe environmental stress. Five sub-populations of EFI and six of SME were studied along a salinity gradient. The differences between right and left otoliths were estimated with image processing by measuring five dimensions (area, perimeter, diameter, rostrum and posterior radii). Analyses of genetic differentiation at three EPIC and one anonymous nuclear gene loci for EFI and six polymorphic enzymatic loci for SME were carried out to measure the level of heterozygosity. Absolute FA in all otolith traits examined was unaffected by gender but increased significantly with fish size. Size-corrected absolute FA did not show any significant difference among sites differing largely in salinity, although a higher asymmetry in otolith area was recorded in the saltiest site. These findings suggest that otolith asymmetry is a poor indicator of osmotic stress. The individual heterozygosity level did not seem to have an effect on otolith FA for either species, even though a slight correlation appeared with otolith area or perimeter. Otolith FA cannot be considered to be a useful indicator for estimating changes linked with environmental or genetic stress in these estuaries.
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Cole, Andrew, and Alan McMichael. "Audit of Dental Practice Record-Keeping: A PCT-Coordinated Clinical Audit by Worcestershire Dentists." Primary Dental Care os16, no. 3 (2009): 85–93. http://dx.doi.org/10.1308/135576109788634296.
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A collaborative audit of clinical record-keeping standards was performed among Worcestershire dentists. Aims Its aims were to improve the quality of National Health Service (NHS) patient care and to assist dentists to perform well during Dental Reference Service practice visits. Methods Worcestershire dentists with NHS contracts were invited to take part in this audit. Each dentist audited a random selection of 30 of their dental clinical records against a common framework comprising eight domains. Record-keeping, and the presence or absence of key diagnostic and treatment planning details were recorded. Grading was applied in four categories, in which grades 1 and 2 were good (1) and adequate (2), captured on data-collection sheets and centrally analysed for frequency of each grade. Results Out of a total of 184 Worcestershire general dental practitioners, 161 (87.5%) submitted usable responses. The audit revealed wide variation between dentists in clinical record-keeping. The recording of soft tissues (36% below grade 2), periodontal status (30%), radiographic review (27%), and note-taking (25%) all fell below the standard that had been set (brackets show proportion not meeting the standard). Conclusions The results provided baseline information about the standard of record-keeping in NHS dental practices in Worcestershire. The collaborative nature of the audit enabled dissemination of individual results to participants, to facilitate comparison (anonymously) against their peers. The audit provided impetus for the Primary Care Trust (PCT) to arrange postgraduate education on record-keeping and to raise awareness among local dentists about record-keeping. The subsequent report to dentists explored the record-keeping standards expected during practice inspections undertaken by the Dental Reference Service. Worcestershire PCT's method of collaborative dental audit could potentially replace the previous national programme of dental audit, formerly coordinated locally.
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Rabe, Sophie, Arash Azhand, Wolfgang Pommer, Swantje Müller, and Anika Steinert. "Descriptive Evaluation and Accuracy of a Mobile App to Assess Fall Risk in Seniors: Retrospective Case-Control Study." JMIR Aging 3, no. 1 (2020): e16131. http://dx.doi.org/10.2196/16131.
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Background Fall-risk assessment is complex. Based on current scientific evidence, a multifactorial approach, including the analysis of physical performance, gait parameters, and both extrinsic and intrinsic risk factors, is highly recommended. A smartphone-based app was designed to assess the individual risk of falling with a score that combines multiple fall-risk factors into one comprehensive metric using the previously listed determinants. Objective This study provides a descriptive evaluation of the designed fall-risk score as well as an analysis of the app’s discriminative ability based on real-world data. Methods Anonymous data from 242 seniors was analyzed retrospectively. Data was collected between June 2018 and May 2019 using the fall-risk assessment app. First, we provided a descriptive statistical analysis of the underlying dataset. Subsequently, multiple learning models (Logistic Regression, Gaussian Naive Bayes, Gradient Boosting, Support Vector Classification, and Random Forest Regression) were trained on the dataset to obtain optimal decision boundaries. The receiver operating curve with its corresponding area under the curve (AUC) and sensitivity were the primary performance metrics utilized to assess the fall-risk score's ability to discriminate fallers from nonfallers. For the sake of completeness, specificity, precision, and overall accuracy were also provided for each model. Results Out of 242 participants with a mean age of 84.6 years old (SD 6.7), 139 (57.4%) reported no previous falls (nonfaller), while 103 (42.5%) reported a previous fall (faller). The average fall risk was 29.5 points (SD 12.4). The performance metrics for the Logistic Regression Model were AUC=0.9, sensitivity=100%, specificity=52%, and accuracy=73%. The performance metrics for the Gaussian Naive Bayes Model were AUC=0.9, sensitivity=100%, specificity=52%, and accuracy=73%. The performance metrics for the Gradient Boosting Model were AUC=0.85, sensitivity=88%, specificity=62%, and accuracy=73%. The performance metrics for the Support Vector Classification Model were AUC=0.84, sensitivity=88%, specificity=67%, and accuracy=76%. The performance metrics for the Random Forest Model were AUC=0.84, sensitivity=88%, specificity=57%, and accuracy=70%. Conclusions Descriptive statistics for the dataset were provided as comparison and reference values. The fall-risk score exhibited a high discriminative ability to distinguish fallers from nonfallers, irrespective of the learning model evaluated. The models had an average AUC of 0.86, an average sensitivity of 93%, and an average specificity of 58%. Average overall accuracy was 73%. Thus, the fall-risk app has the potential to support caretakers in easily conducting a valid fall-risk assessment. The fall-risk score’s prospective accuracy will be further validated in a prospective trial.
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Armstrong, David, Alan Barkun, Ron Bridges, et al. "Canadian Association of Gastroenterology Consensus Guidelines on Safety and Quality Indicators in Endoscopy." Canadian Journal of Gastroenterology 26, no. 1 (2012): 17–31. http://dx.doi.org/10.1155/2012/173739.
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Several organizations worldwide have developed procedure-based guidelines and/or position statements regarding various aspects of quality and safety indicators, and credentialing for endoscopy. Although important, they do not specifically address patient needs or provide a framework for their adoption in the context of endoscopy services. The consensus guidelines reported in this article, however, aimed to identify processes and indicators relevant to the provision of high-quality endoscopy services that will support ongoing quality improvement across many jurisdictions, specifically in the areas of ethics, facility standards and policies, quality assurance, training and education, reporting standards and patient perceptions.BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy.OBJECTIVE: To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery.METHODS: A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants.RESULTS: Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), qual: 97% to 100%) and patient perceptions ( statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified.DISCUSSION: The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services.CONCLUSIONS: The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy.
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Jansson, Joakim, and Björn Tyrefors. "Gender Grading Bias at Stockholm University: Quasi-Experimental Evidence From an Anonymous Grading Reform." SSRN Electronic Journal, 2018. http://dx.doi.org/10.2139/ssrn.3334460.
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Geary, Amelia, Qing Wen, Rosa Adrianzén, et al. "The impact of distance cataract surgical wet laboratory training on cataract surgical competency of ophthalmology residents." BMC Medical Education 21, no. 1 (2021). http://dx.doi.org/10.1186/s12909-021-02659-y.
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Abstract Background This study assessed the impact of distance cataract surgical wet laboratory training on surgical competency of ophthalmology residents at a tertiary-level ophthalmic training center in Trujillo, Peru. Methods Three five-week distance wet lab courses were administered through Cybersight, Orbis International’s telemedicine platform. Weekly lectures and demonstrations addressed specific steps in phacoemulsification surgery. Each lecture had two accompanying wet lab assignments, which residents completed and recorded in their institution’s wet lab and uploaded to Cybersight for grading. Competency was assessed through anonymous grading of pre- and post-training surgical simulation videos, masked as to which occurred before and after training, using a standardized competency rubric adapted from the Ophthalmology Surgical Competency Assessment Rubric (OSCAR, scale of 0–32). Day one best-corrected post-operative visual acuity (BVCA) was assessed in the operative eye on the initial consecutive 4–6 surgeries conducted by the residents as per the norms of their residency training. An anonymous post-training satisfaction survey was administered to trainees’. Results In total, 21 ophthalmic residents participated in the courses, submitting a total of 210 surgical videos. Trainees’ average competency score increased 6.95 points (95%CI [4.28, 9.62], SD = 5.01, p < 0.0001, two sample t-test) from 19.3 (95%CI [17.2, 21.5], SD = 4.04) to 26.3 (95%CI [24.2, 28.3], SD = 3.93). Visual acuity for 92% of post-training resident surgeries (n = 100) was ≥20/60, meeting the World Health Organization’s criterion for good quality. Conclusions Structured distance wet lab courses in phacoemulsification resulted in significantly improved cataract surgical skills. This model could be applicable to locations where there are obstacles to traditional in-person training, such as the current COVID-19 pandemic.
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Olivera, Pablo A., Stephane Zuily, Paulo G. Kotze, et al. "International consensus on the prevention of venous and arterial thrombotic events in patients with inflammatory bowel disease." Nature Reviews Gastroenterology & Hepatology, August 27, 2021. http://dx.doi.org/10.1038/s41575-021-00492-8.
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AbstractPatients with inflammatory bowel disease (IBD) are at increased risk of thrombotic events. Therapies for IBD have the potential to modulate this risk. The aims of this Evidence-Based Guideline were to summarize available evidence and to provide practical recommendations regarding epidemiological aspects, prevention and drug-related risks of venous and arterial thrombotic events in patients with IBD. A virtual meeting took place in May 2020 involving 14 international IBD experts and 3 thrombosis experts from 12 countries. Proposed statements were voted upon in an anonymous manner. Agreement was defined as at least 75% of participants voting as ‘fully agree’ or ‘mostly agree’ with each statement. For each statement, the level of evidence was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) grading system. Consensus was reached for 19 statements. Patients with IBD harbour an increased risk of venous and arterial thrombotic events. Thromboprophylaxis is indicated during hospitalization of any cause in patients with IBD. Disease activity is a modifiable risk factor in patients with IBD, and physicians should aim to achieve deep remission to reduce the risk. Exposure to steroids should be limited. Antitumour necrosis factor agents might be associated with a reduced risk of thrombotic events.
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Basch, Ethan, Claus Becker, Lauren J. Rogak, et al. "Composite grading algorithm for the National Cancer Institute’s Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)." Clinical Trials, December 1, 2020, 174077452097512. http://dx.doi.org/10.1177/1740774520975120.
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Background: The Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events is an item library designed for eliciting patient-reported adverse events in oncology. For each adverse event, up to three individual items are scored for frequency, severity, and interference with daily activities. To align the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events with other standardized tools for adverse event assessment including the Common Terminology Criteria for Adverse Events, an algorithm for mapping individual items for any given adverse event to a single composite numerical grade was developed and tested. Methods: A five-step process was used: (1) All 179 possible Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events score combinations were presented to 20 clinical investigators to subjectively map combinations to single numerical grades ranging from 0 to 3. (2) Combinations with <75% agreement were presented to investigator committees at a National Clinical Trials Network cooperative group meeting to gain majority consensus via anonymous voting. (3) The resulting algorithm was refined via graphical and tabular approaches to assure directional consistency. (4) Validity, reliability, and sensitivity were assessed in a national study dataset. (5) Accuracy for delineating adverse events between study arms was measured in two Phase III clinical trials (NCT02066181 and NCT01522443). Results: In Step 1, 12/179 score combinations had <75% initial agreement. In Step 2, majority consensus was reached for all combinations. In Step 3, five grades were adjusted to assure directional consistency. In Steps 4 and 5, composite grades performed well and comparably to individual item scores on validity, reliability, sensitivity, and between-arm delineation. Conclusion: A composite grading algorithm has been developed and yields single numerical grades for adverse events assessed via the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events, and can be useful in analyses and reporting.
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Piccinni, G., and G. Putoto. "Clear proceedings as workplace health promotion. Supervision and management tools in rural Uganda." European Journal of Public Health 29, Supplement_4 (2019). http://dx.doi.org/10.1093/eurpub/ckz186.439.
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Abstract Health centres and supervision teams in rural/poor settings in developing countries are affected by limited resources, uneasy reporting to higher level of power and unclear proceedings to filling the gaps. Inconsistency in supervising visits lead to mistrust. Supervisees react with resistance or indifference. Supervisors react behaving as policemen. In Uganda, Oyam Health District, february-august 2018, actions were taken in order to solve conflicts, sustain quality, improve interactions. Sharing the concept and the implementing process could inspire colleagues engaged in workplace health promotion. Key points were informed by direct observations, talks with staffs, literature review, ugandan Ministry of Health official directives and tools, NGO’s adaptations. Selected issues were discussed during two workshops held in april ’18 involving all the concerned staff: 100 people. Agreement reached, based on a 3 (gap-act-resp) 5 (0-4 grading) algorithm, re-designed tools were able to reduce aléa during inspections, grade the gaps, guide actions and to address the appropriate level of responsability. User friendly reporting formats, database and unicode for linkage were designed ex novo. Information flow was agreed with the Health District Authorities. After the learning period, staffs felt empowered about resolving gaps and less stressed advocating higher authorities. Conflicts lost harshness. Satisfaction was captured by a self-filled anonymous questionnaire in june 2018 (n = 80, 12 core questions, 0-4 likert scale, mean &gt;3, SD &lt; 1, median= 4, open sentences positives). Quality improvements of health care services were measured by the Ugandan Ministry of Health independently. Unclear targets, shortage of means, ineffective communication flows reduce quality and trigger frustration. Sustaining transparency, organizing communication flows and proceedings, sourcing staff’s experience could enhance success both in reaching targets and promoting relational health at workplace. Key messages Transparency, shared decisions, clear communication, awareness of the aims and mastership are able to reduce conflicts and misunderstandings, sustaining a healthier workplace relational environment. People spend 60 to 80% of their active time at workplace. Well designed tools, policies and information flows, could be effective health enhancer as well. Work style is a lifestyle.
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Al Badarin, Firas, Juwairia Al Ali, Feras Bader, et al. "Abstract 16240: Knowledge of Clinical Presentation and Diagnostic Pathways for Cardiac Amyloidosis Among Physicians in the Middle East-Gulf Region: on Behalf of the Gulf Cardiac Amyloidosis Working Group." Circulation 142, Suppl_3 (2020). http://dx.doi.org/10.1161/circ.142.suppl_3.16240.
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Background: There is a growing interest in raising awareness about amyloidosis as an under-recognized cause of heart failure and preserved ejection fraction (HFpEF). Recently, the prevalence of cardiac amyloidosis in the United States has increased, which may partly be attributed to initiatives from major professional societies aimed to improve patient identification and disease detection. Whether this has also impacted physicians’ knowledge about cardiac amyloidosis in the Middle East-Gulf region is unknown but critical to assess, as it would identify a need for dedicated regional educational activities. Methods: Physicians practicing in 5 Gulf countries (UAE, Bahrain, Qatar, Oman and Kuwait) were invited to participate in this anonymous, online survey by receiving a unique survey link by email. We assessed awareness of cardiac amyloidosis, knowledge of disease manifestations and approach to diagnosis. Responses to the survey were recorded using a 4- or 5-point Likert scale. Results: A total of 272 physicians participated in the survey. Most participating physicians were men (82%) and have been practicing cardiology (71%) for >10 years (65%). Whereas 83% of responders considered themselves to be somewhat or extremely familiar with signs and symptoms of cardiac amyloidosis, only 63% would consider cardiac amyloidosis as a cause of HFpEF, 59% would consider it in patients with heart failure and orthostatic hypotension while only 39% consider cardiac amyloidosis in patients with low-flow, low-gradient severe aortic stenosis. Furthermore, cardiac MRI was found to be useful for diagnosis of cardiac amyloidosis by 92% of responders, while echocardiography, cardiac scintigraphy with bone-seeking radiotracers and biomarkers were felt to be useful by only 81%, 60% and 31% of survey participants, respectively. Conclusion: Despite perceived familiarity with cardiac amyloidosis among a group of mid-career cardiologists, there is need to raise awareness about the heterogenous manifestations of the disease and about the respective roles of testing modalities in making this diagnosis.
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Dang, Jun, Tao You, Wenzheng Sun, et al. "Fully Automatic Sliding Motion Compensated and Simultaneous 4D-CBCT via Bilateral Filtering." Frontiers in Oncology 10 (January 18, 2021). http://dx.doi.org/10.3389/fonc.2020.568627.
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PurposeTo incorporate the bilateral filtering into the Deformable Vector Field (DVF) based 4D-CBCT reconstruction for realizing a fully automatic sliding motion compensated 4D-CBCT.Materials and MethodsInitially, a motion compensated simultaneous algebraic reconstruction technique (mSART) is used to generate a high quality reference phase (e.g. 0% phase) by using all phase projections together with the initial 4D-DVFs. The initial 4D-DVF were generated via Demons registration between 0% phase and each other phase image. The 4D-DVF will then kept updating by matching the forward projection of the deformed high quality 0% phase with the measured projection of the target phase. The loss function during this optimization contains an projection intensity difference matching criterion plus a DVF smoothing constrain term. We introduce a bilateral filtering kernel into the DVF constrain term to estimate the sliding motion automatically. The bilateral filtering kernel contains three sub-kernels: 1) an spatial domain Guassian kernel; 2) an image intensity domain Guassian kernel; and 3) a DVF domain Guassian kernel. By choosing suitable kernel variances, the sliding motion can be extracted. A non-linear conjugate gradient optimizer was used. We validated the algorithm on a non-uniform rotational B-spline based cardiac-torso (NCAT) phantom and four anonymous patient data. For quantification, we used: 1) the Root-Mean-Square-Error (RMSE) together with the Maximum-Error (MaxE); 2) the Dice coefficient of the extracted lung contour from the final reconstructed images and 3) the relative reconstruction error (RE) to evaluate the algorithm's performance.ResultsFor NCAT phantom, the motion trajectory's RMSE/MaxE are 0.796/1.02 mm for bilateral filtering reconstruction; and 2.704/4.08 mm for original reconstruction. For patient pilot study, the 4D-Dice coefficient obtained with bilateral filtering are consistently higher than that without bilateral filtering. Meantime several image content such as the rib position, the heart edge definition, the fibrous structures all has been better corrected with bilateral filtering.ConclusionWe developed a bilateral filtering based fully automatic sliding motion compensated 4D-CBCT scheme. Both digital phantom and initial patient pilot studies confirmed the improved motion estimation and image reconstruction ability. It can be used as a 4D-CBCT image guidance tool for lung SBRT treatment.
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Zakaria, Hala, Hina Nasreen, and Ehab Basssam. "Assessment of Oral Health Care and Knowledge amongst University Students." Dental Research and Management, August 5, 2021, 26–32. http://dx.doi.org/10.33805/2572-6978.155.
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Objectives: Good oral heath not only promotes an individual to look and feel good, it also helps in preserving oral functions. The study was carried out to assess oral health knowledge and practices, attitudes as well as their oral hygiene habits among university students in the UAE. Method: A structured and revised questionnaire was distributed to 300 university students that were randomly sampled from the selected universities of the UAE. The questionnaires were answered anonymously by the students and paper consisted of questions to study and assess the prevalence of oral diseases amongst these students. The answers were then subjected to statistical analysis to determine if there is a significant correlation between oral health knowledge and attitude. Results: Data showed a positive correlation with a Pearson coefficient value of 0.4 given at a positive gradient when plotted as a linear graph. The students had good knowledge on the basic oral health measures but still students had poor oral health practices they brush their teeth once daily and brushed for less than the optimal time of two minutes. Lack of time and cost were reported to be the most common causes that prevented visiting the dental clinic. While some students reported no importance to visit the dentist if there is any pain as the second most common reason. Conclusion: Students had good knowledge on the basic oral health measures but efforts towards spreading proper dental education is very important to minimize and prevent the escalation of oral diseases that may develop due to lack of correct dental knowledge. Oral health education programs should be conducted with reinforcement to close the gap between knowledge and practice.