ACGME Case Log Reminder Does Not Improve Resident Accuracy in Logging Cases.

To assess competency of residents prior to graduation, the Accreditation Council for Graduate Medical Education (ACGME) maintains a case log system, where residents self-report cases they perform. This mechanism results in underreporting of resident involvement in patient care. To determine if an intraoperative case log reminder would increase the frequency of ACGME case logging amongst anesthesiology residents. An intraoperative ACGME case log reminder was implemented on March 13, 2019. The authors collected data for all 53 PGY2-4 anesthesiology residents at the authors' institution from July 14, 2018 to July 16, 2019 from the electronic medical record and ACGME system to calculate the proportion of cases logged and the "lag time" between case occurrence and logging. Data was analyzed for all residents, classes, and individuals. A total of 16,342 anesthetics were performed, and a total of 11,713 cases were logged. The reminder did not improve overall logging rates. Case-logging rates amongst PGY2 residents remained unchanged and declined for PGY3 and PGY4 residents. The lag time between case occurrence and logging increased. An automatic reminder did not improve logging frequency. This may be because residents are unable to log cases intraoperatively in many instances, or they may not feel as though they have participated enough in a case to log it. Additionally, senior residents may log cases less frequently once they have met required case minimums. An automatic case-logging system that transmits resident information directly to the ACGME may be the best way to increase logging accuracy.

Comparison of Two Learning Modalities on Continuing Medical Education Consumption and Knowledge Acquisition: A Pilot Randomized Controlled Trial.

BACKGROUND: Research has demonstrated that active learning, spaced education, and retrieval-based practice can improve knowledge acquisition, knowledge retention, and clinical practice. Furthermore, learners prefer active learning modalities that use the testing effect and spaced education as compared to passive, lecture-based education. However, most research has been performed with students and residents rather than practicing physicians. To date, most continuing medical education (CME) opportunities use passive learning models, such as face-to-face meetings with lecture-style didactic sessions. The aim of this study was to investigate learner engagement, as measured by the number of CME credits earned, via two different learning modalities. METHODS: Diplomates of the American Board of Anesthesiology or candidates for certification through the board (referred to colloquially and for the remainder of this article as board certified or board eligible) were provided an opportunity to enroll in the study. Participants were recruited via email. Once enrolled, they were randomized into 1 of 2 groups: web-app-based CME (Webapp CME) or an online interface that replicated online CME (Online CME). The intervention period lasted 6 weeks and participants were provided educational content using one of the two approaches. As an incentive for participation, CME credits could be earned (without cost) during the intervention period and for completion of the postintervention quiz. The same number of CME credits was available to each group. RESULTS: Fifty-four participants enrolled and completed the study. The mean number of CME credits earned was greater in the Webapp group compared to the Online group (12.3 ± 1.4 h versus 4.5 ± 2.3 h, P < .001). Concerning knowledge acquisition, the difference in postintervention quiz scores was not statistically significant (Webapp 70% ± 7% versus Online 60% ± 11%, P = .11). However, only 29% of the Online group completed the postintervention quiz, versus 77% of the Webapp group (P < .001), possibly showing a greater rate of learner engagement in the Webapp group. CONCLUSION: In this prospective, randomized controlled pilot study, we demonstrated that daily spaced education delivered to learners through a smartphone web app resulted in greater learner engagement than an online modality. Further research with larger trials is needed to confirm our findings.

Visualization of aggregate perioperative data improves anesthesia case planning: A randomized, cross-over trial.

STUDY OBJECTIVE: A challenge in reducing unwanted care variation is effectively managing the wide variety of performed surgical procedures. While an organization may perform thousands of types of cases, privacy and logistical constraints prevent review of previous cases to learn about prior practices. To bridge this gap, we developed a system for extracting key data from anesthesia records. Our objective was to determine whether usage of the system would improve case planning performance for anesthesia residents. DESIGN: Randomized, cross-over trial. SETTING: Vanderbilt University Medical Center. MEASUREMENTS: We developed a web-based, data visualization tool for reviewing de-identified anesthesia records. First year anesthesia residents were recruited and performed simulated case planning tasks (e.g., selecting an anesthetic type) across six case scenarios using a randomized, cross-over design after a baseline assessment. An algorithm scored case planning performance based on care components selected by residents occurring frequently among prior anesthetics, which was scored on a 0-4 point scale. Linear mixed effects regression quantified the tool effect on the average performance score, adjusting for potential confounders. MAIN RESULTS: We analyzed 516 survey questionnaires from 19 residents. The mean performance score was 2.55 ± SD 0.32. Utilization of the tool was associated with an average score improvement of 0.120 points (95% CI 0.060 to 0.179; p < 0.001). Additionally, a 0.055 point improvement due to the "learning effect" was observed from each assessment to the next (95% CI 0.034 to 0.077; p < 0.001). Assessment score was also significantly associated with specific case scenarios (p < 0.001). CONCLUSIONS: This study demonstrated the feasibility of developing of a clinical data visualization system that aggregated key anesthetic information and found that the usage of tools modestly improved residents' performance in simulated case planning.

Post-transcriptional adaptation of the aquatic plant Spirodela polyrhiza under stress and hormonal stimuli.

The Lemnaceae family comprises aquatic plants of angiosperms gaining attention due to their utility in wastewater treatment, and rapid production of biomass that can be used as feed, fuel, or food. Moreover, it can serve as a model species for neotenous growth and environmental adaptation. The latter properties are subject to post-transcriptional regulation of gene expression, meriting investigation of how miRNAs in Spirodela polyrhiza, the most basal and most thoroughly sequenced member of the family, are expressed under different growth conditions. To further scientific understanding of its capacity to adapt to environmental cues, we measured miRNA expression and processing of their target sequences under different temperatures, and in the presence of abscisic acid, copper, kinetin, nitrate, and sucrose. Using two small RNA sequencing experiments and one degradome sequencing experiment, we provide evidence for 108 miRNAs. Sequencing cleaved mRNAs validated 42 conserved miRNAs with 83 targets and 24 novel miRNAs regulating 66 targets and created a list of 575 predicted and verified targets. These analyses revealed condition-induced changes in miRNA expression and cleavage activity, and resulted in the addition of stringently reviewed miRNAs to miRBase. This combination of small RNA and degradome sequencing provided not only high confidence predictions of conserved and novel miRNAs and targets, but also a view of the post-transcriptional regulation of adaptations. A unique aspect is the role of miR156 and miR172 expression and activity in its clonal propagation and neoteny. Additionally, low levels of 24 nt sRNAs were observed, despite the lack of recent retrotransposition.

The Risk of Oxygen during Cardiac Surgery (ROCS) trial: study protocol for a randomized clinical trial.

BACKGROUND: Anesthesiologists administer excess supplemental oxygen (hyper-oxygenation) to patients during surgery to avoid hypoxia. Hyper-oxygenation, however, may increase the generation of reactive oxygen species and cause oxidative damage. In cardiac surgery, increased oxidative damage has been associated with postoperative kidney and brain injury. We hypothesize that maintenance of normoxia during cardiac surgery (physiologic oxygenation) decreases kidney injury and oxidative damage compared to hyper-oxygenation. METHODS/DESIGN: The Risk of Oxygen during Cardiac Surgery (ROCS) trial will randomly assign 200 cardiac surgery patients to receive physiologic oxygenation, defined as the lowest fraction of inspired oxygen (FIO2) necessary to maintain an arterial hemoglobin saturation of 95 to 97%, or hyper-oxygenation (FIO2 = 1.0) during surgery. The primary clinical endpoint is serum creatinine change from baseline to postoperative day 2, and the primary mechanism endpoint is change in plasma concentrations of F2-isoprostanes and isofurans. Secondary endpoints include superoxide production, clinical delirium, myocardial injury, and length of stay. An endothelial function substudy will examine the effects of oxygen treatment and oxidative stress on endothelial function, measured using flow mediated dilation, peripheral arterial tonometry, and wire tension myography of epicardial fat arterioles. DISCUSSION: The ROCS trial will test the hypothesis that intraoperative physiologic oxygenation decreases oxidative damage and organ injury compared to hyper-oxygenation in patients undergoing cardiac surgery. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02361944 . Registered on the 30th of January 2015.

Single Nucleotide Polymorphism Discovery in Bovine Pituitary Gland Using RNA-Seq Technology.

Examination of bovine pituitary gland transcriptome by strand-specific RNA-seq allows detection of putative single nucleotide polymorphisms (SNPs) within potential candidate genes (CGs) or QTLs regions as well as to understand the genomics variations that contribute to economic trait. Here we report a breed-specific model to successfully perform the detection of SNPs in the pituitary gland of young growing bulls representing Polish Holstein-Friesian (HF), Polish Red, and Hereford breeds at three developmental ages viz., six months, nine months, and twelve months. A total of 18 bovine pituitary gland polyA transcriptome libraries were prepared and sequenced using the Illumina NextSeq 500 platform. Sequenced FastQ databases of all 18 young bulls were submitted to NCBI-SRA database with NCBI-SRA accession numbers SRS1296732. For the investigated young bulls, a total of 113,882,3098 raw paired-end reads with a length of 156 bases were obtained, resulting in an approximately 63 million paired-end reads per library. Breed-wise, a total of 515.38, 215.39, and 408.04 million paired-end reads were obtained for Polish HF, Polish Red, and Hereford breeds, respectively. Burrows-Wheeler Aligner (BWA) read alignments showed 93.04%, 94.39%, and 83.46% of the mapped sequencing reads were properly paired to the Polish HF, Polish Red, and Hereford breeds, respectively. Constructed breed-specific SNP-db of three cattle breeds yielded at 13,775,885 SNPs. On an average 765,326 breed-specific SNPs per young bull were identified. Using two stringent filtering parameters, i.e., a minimum 10 SNP reads per base with an accuracy ≥ 90% and a minimum 10 SNP reads per base with an accuracy = 100%, SNP-db records were trimmed to construct a highly reliable SNP-db. This resulted in a reduction of 95,7% and 96,4% cut-off mark of constructed raw SNP-db. Finally, SNP discoveries using RNA-Seq data were validated by KASP™ SNP genotyping assay. The comprehensive QTLs/CGs analysis of 76 QTLs/CGs with RNA-seq data identified KCNIP4, CCSER1, DPP6, MAP3K5 and GHR CGs with highest SNPs hit loci in all three breeds and developmental ages. However, CAST CG with more than 100 SNPs hits were observed only in Polish HF and Hereford breeds.These findings are important for identification and construction of novel tissue specific SNP-db and breed specific SNP-db dataset by screening of putative SNPs according to QTL db and candidate genes for bovine growth and reproduction traits, one can develop genomic selection strategies for growth and reproductive traits.

A method for automating 3-dimensional proximal isovelocity surface area measurement.

OBJECTIVE: The proximal isovelocity surface area (PISA) is used for the echocardiographic quantification of effective orifice areas in valvular stenosis and regurgitation. Typically measured in 2 dimensions, the PISA relies on the geometric assumption that the shape of flow convergence is a hemisphere and that the orifice is a single circular point. Neither assumption is true. The objective was to develop a method for automating the measurement of the PISA in 3 dimensions and to illuminate the actual shape of the flow convergence pattern and how it changes over time. DESIGN: Retrospective, single-case study. SETTING: Major urban hospital. PARTICIPANTS: This study was based on a single patient undergoing mitral valve replacement. INTERVENTIONS: No additional interventions were performed in the patient. RESULTS: The effective orifice areas calculated from the serial hemispheric, hemi-elliptic, and 3-dimensional (3D) PISAs during diastole were compared with the corresponding planimetric anatomic mitral orifice area. The effective orifice areas based on the manual and automated measurements of 3D PISAs more closely approximated the anatomic orifice than the effective orifice areas calculated using hemispheric or hemi-elliptic PISAs. CONCLUSIONS: An automated analysis of 3D color Doppler data is feasible and allows a direct and accurate measurement of a 3D PISA, thus avoiding reliance on simplistic geometric assumptions. The dynamic aspect of cardiac orifices also must be considered in orifice analysis.

Regulated antisense transcription controls expression of cell-type-specific genes in yeast.

Transcriptome profiling studies have recently uncovered a large number of noncoding RNA transcripts (ncRNAs) in eukaryotic organisms, and there is growing interest in their role in the cell. For example, in haploid Saccharomyces cerevisiae cells, the expression of an overlapping antisense ncRNA, referred to here as RME2 (Regulator of Meiosis 2), prevents IME4 expression. In diploid cells, the a1-α2 complex represses the transcription of RME2, allowing IME4 to be induced during meiosis. In this study we show that antisense transcription across the IME4 promoter region does not block transcription factors from binding and is not required for repression. Mutational analyses found that sequences within the IME4 open reading frame (ORF) are required for the repression mediated by RME2 transcription. These results support a model where transcription of RME2 blocks the elongation of the full-length IME4 transcript but not its initiation. We have found that another antisense transcript, called RME3, represses ZIP2 in a cell-type-specific manner. These results suggest that regulated antisense transcription may be a widespread mechanism for the control of gene expression and may account for the roles of some of the previously uncharacterized ncRNAs in yeast.

Have personal statements become impersonal? An evaluation of personal statements in anesthesiology residency applications.

STUDY OBJECTIVE: To evaluate personal statements submitted to a major academic anesthesiology program to determine the prevalence of common features and overall subjective quality, and to survey anesthesiology program directors as to how they utilized these statements during the resident selection process. DESIGN: Structured analysis of de-identified personal statements and Internet-based survey of program directors. SETTING: Large academic anesthesiology training program. SUBJECTS: 670 applicant personal statements and academic anesthesiology program directors. MEASUREMENTS: Prevalence of 13 specific essay features and 8 quality ratings were calculated for the essays and correlated with other aspects of the residency application, as abstracted from the Electronic Residency Application Service (ERAS) files. A 6-question survey regarding use of personal statements was collected from program directors. MAIN RESULTS: 70 of 131 program directors queried responded to our survey. Interest in physiology and pharmacology, enjoyment of a hands-on specialty, and desire to comfort anxious patients were each mentioned in more than half of the essays. Candidates invited for an interview had essays that received higher quality ratings than essays of those not invited (P = 0.02 to P < 0.0001). Higher quality ratings were also strongly associated with graduation from a U.S. or Canadian medical school, applicant file screening score, female gender, and younger age. Interrater reliability was good (kappa 0.75-0.99 for structural features, and 0.45-0.65 for quality features). More than 90% of program directors found proper use of English to be a somewhat or very important feature of the essay. Only 41% found the personal statement to be very or somewhat important in selecting candidates for interview invitations. However, over 90% stated that they used the statements during actual interviews with invited applicants. CONCLUSION: The data showed a high prevalence of common features found within personal statements and a general ambivalence amongst those program directors for whom the statements were intended.

Plagiarism in residency application essays.

BACKGROUND: Anecdotal reports suggest that some residency application essays contain plagiarized content. OBJECTIVE: To determine the prevalence of plagiarism in a large cohort of residency application essays. DESIGN: Retrospective cohort study. SETTING: 4975 application essays submitted to residency programs at a single large academic medical center between 1 September 2005 and 22 March 2007. MEASUREMENTS: Specialized software was used to compare residency application essays with a database of Internet pages, published works, and previously submitted essays and the percentage of the submission matching another source was calculated. A match of more than 10% to an existing work was defined as evidence of plagiarism. RESULTS: Evidence of plagiarism was found in 5.2% (95% CI, 4.6% to 5.9%) of essays. The essays of non-U.S. citizens were more likely to demonstrate evidence of plagiarism. Other characteristics associated with the prevalence of plagiarism included medical school location outside the United States and Canada; previous residency or fellowship; lack of research experience, volunteer experience, or publications; a low United States Medical Licensing Examination Step 1 score; and non-membership in the Alpha Omega Alpha Honor Medical Society. LIMITATIONS: The software database is probably incomplete, the 10%-match threshold for defining plagiarism has not been statistically validated, and the study was confined to applicants to 1 institution. Evidence of matching content in an essay cannot be used to infer the applicant's intent and is not sensitive to variations in the cultural context of copying in some societies. CONCLUSION: Evidence of plagiarism in residency application essays is more common in international applicants but was found in those by applicants to all specialty programs, from all medical school types, and even among applicants with significant academic honors. PRIMARY FUNDING SOURCE: No external funding.