Development of a Formative Assessment Rubric for Peer Evaluation of Teaching (FARPET) and Pilot Use in Veterinary Online Teaching.

Peer evaluation of teaching (PET) serves an important role as a component of faculty development in the medical education field. With the emergence of COVID-19, the authors recognized the need for a flexible tool that could be used for a variety of lecture formats, including virtual instruction, and that could provide a framework for consistent and meaningful PET feedback. This teaching tip describes the creation and pilot use of a PET rubric, which includes six fixed core items (lesson structure, content organization, audiovisual facilitation, concept development, enthusiasm, and relevance) and items to be assessed separately for asynchronous lectures (cognitive engagement-asynchronous) and synchronous lectures (cognitive engagement-synchronous, discourse quality, collaborative learning, and check for understanding). The instrument packet comprises the rubric, instructions for use, definitions, and examples of each item, plus three training videos for users to compare with authors' consensus training scores; these serve as frame-of-reference training. The instrument was piloted among veterinary educators, and feedback was sought in a focus group setting. The instrument was well received, and training and use required a minimum time commitment. Inter-rater reliability within 1 Likert scale point (adjacent agreement) was assessed for each of the training videos, and consistency of scoring was demonstrated between focus group members using percent agreement (0.82, 0.85, 0.88) and between focus members and the authors' consensus training scores (all videos: 0.91). This instrument may serve as a helpful resource for institutions looking for a framework for PET. We intend to continually adjust the instrument in response to feedback from wider use.

Autologous reconstruction of massive enteroatmospheric fistulation with a pedicled subtotal lateral thigh flap.

BACKGROUND: Reconstruction of massive contaminated abdominal wall defects associated with enteroatmospheric fistulation represents a technical challenge. An effective technique that allows closure of intestinal fistulas and reconstruction of the abdominal wall, with a good functional and cosmetic result, has yet to be described. The present study is a retrospective review of simultaneous reconstruction of extensive gastrointestinal tract fistulation and large full-thickness abdominal wall defects, using a novel pedicled subtotal thigh flap. METHODS: The flap, based on branches of the lateral circumflex femoral artery, was used to reconstruct the abdominal wall in six patients who were dependent on artificial nutritional support, with a median (range) of 4·5 (3-23) separate intestinal fistulas, within open abdominal wounds with a surface area of 564·5 (204-792) cm2. Intestinal reconstruction was staged, with delayed closure of a loop jejunostomy. Median follow-up was 93·5 (10-174) weeks. RESULTS: Successful healing occurred in all patients, with no flap loss or gastrointestinal complications. One patient died from complications of sepsis unrelated to the surgical treatment. All surviving patients gained complete nutritional autonomy following closure of the loop jejunostomy. CONCLUSION: Replacement of almost the entire native abdominal wall in patients with massive contaminated abdominal wall defects is possible, without the need for prosthetic material or microvascular free flaps. The subtotal pedicled thigh flap is a safe and effective method of providing definitive treatment for patients with massive enteroatmospheric fistulation.

The microbe-mineral environment and gypsum neogenesis in a weathered polar evaporite.

Evaporitic deposits are a globally widespread habitat for micro-organisms. The microbe-mineral environment in weathered and remobilized gypsum from exposed mid-Ordovician marine evaporite beds in the polar desert of Devon Island, Nunavut, Canadian High Arctic was examined. The gypsum is characterized by internal green zones of cyanobacterial colonization (dominated by Gloeocapsa/Aphanothece and Chroococcidiopsis spp. morphotypes) and abundant black zones, visible from the surface, that contain pigmented cyanobacteria and fungi. Bioessential elements in the gypsum are primarily provided by allochthonous material from the present-day polar desert. The disruption, uplift and rotation of the evaporite beds by the Haughton meteorite impact 39 Ma have facilitated gypsum weathering and its accessibility as a habitat. No cultured cyanobacteria, bacteria and fungi were halophilic consistent with the expectation that halophily is not required to persist in gypsum habitats. Heterotrophic bacteria from the evaporite were slightly or moderately halotolerant, as were heterotrophs isolated from soil near the gypsum outcrop showing that halotolerance is common in arctic bacteria in this location. Psychrotolerant Arthrobacter species were isolated. No psychrophilic organisms were isolated. Two Arthrobacter isolates from the evaporite were used to mediate gypsum neogenesis in the laboratory, demonstrating a potential role for microbial biomineralization processes in polar environments.

Successful treatment of refractory joint contractures caused by sclerodermatous graft versus host disease.

Sclerodermatous or cutaneous chronic graft versus host disease is characterised by deposition of collagen in the skin and possibly other soft tissues, resulting in loss of range of motion and functional capabilities. A patient with refractory joint contractures caused by sclerodermatous graft versus host disease is presented, and the successful surgical management of the case described.

The analysis of flue gas treatment residues using non-destructive X-ray fluorescence as a regulatory compliance test.

Current and proposed European Union (EU) regulations require the residual material from municipal solid waste incineration to be characterised prior to disposal. X-Ray fluorescence (XRF) provides a rapid and non-destructive technique for analysing such materials.

An evaluation of the influence of practitioner-led hand clinics on rupture rates following primary tendon repair in the hand.

Practitioner-led hand clinics were introduced in our unit in the year 2000 as a response to the high and increasing number of postoperative hand trauma patients coming to consultant clinics. The aim of this study was to evaluate the influence of these clinics on rupture rates following primary tendon repair in the hand. The study specifically examined:zone II flexor tendon repairsflexor pollicis longus (FPL) tendon repairsextensor pollicis longus (EPL) tendon repairs. Prospective data collection were undertaken for these particular operations over a 17-month study period. Prior to the introduction of the practitioner-led hand clinics previous audits had demonstrated rupture rates of 30% zone II flexor tendon repairs, 16% for FPL repairs and 5% for EPL repairs. Rupture rates after the introduction of practitioner-led hand clinics fell in all of the study categories-to 17% for zone II flexor tendon repairs, 4% for FPL repairs and 0% for EPL repairs. It is suggested that improved continuity of care by experienced hand therapists may have contributed to the observed improvements in outcome.

Lessons learned from the management of complex intra-articular fractures at the base of the middle phalanges of fingers.

The use of dynamic traction splintage is established in the treatment of complex intra-articular phalangeal fractures. Several different systems have been used and we report our experience with one of these, the Pins and Rubber Traction System. A cohort of 14 patients with complex intra-articular fractures at the base of the middle phalanges of the fingers were treated and assessed prospectively over a 2.5-year period (mean, 20 months; range, 7-28 months). The mean active range of motion regained, at the proximal interphalangeal joint, was 74 degrees (range, 0-100 degrees ). The mean total active motion of the injured digit was 196 degrees (range, 40-275 degrees ). Refinements in the regime are suggested as a result of this investigation.

Genetic susceptibility to Dupuytren's disease: transforming growth factor beta receptor (TGFbetaR) gene polymorphisms and Dupuytren's disease.

Dupuytren's disease (DD) is a benign fibroproliferative disease of unknown cause. It is a familial condition that commonly affects Caucasians. Genetic studies have yet to identify the genes involved in DD. Transforming growth factor beta (TGFbeta) family members are multifunctional; some play a central role in wound healing and fibrosis. Previous studies have implicated TGFbeta cytokines and receptors in DD. In the light of this evidence, TGFbeta receptors represent candidate susceptibility genes for this condition. In this study, we investigated the association of single nucleotide polymorphisms (SNPs) in TGFbeta receptors one, two and three (TGFbetaRI, RII and RIII) with the risk of DD formation. A polymerase chain reaction-restriction fragment length polymorphism method was used for genotyping novel and known TGFbeta receptor polymorphisms. DNA samples from 183 DD patients and 181 controls were examined. There was a statistically significant difference (p<0.05) in genotype frequency distributions between cases and controls for TGFbetaRI polymorphisms in the recessive model. However, there were no significant difference in genotype or allele frequency distributions between cases and controls for the TGFbetaRII and TGFbetaRIII SNPs.

Efficacy of ADCON-T/N after primary flexor tendon repair in Zone II: a controlled clinical trial.

A prospective double-blind, randomized, controlled clinical trial was conducted to assess the use of ADCON-T/N after flexor tendon repair in Zone II. Forty-five patients with 82 flexor tendon repairs in 50 digits completed the study. ADCON-T/N was injected into the tendon sheath after tenorrhaphy in the experimental group while the control group was not treated with ADCON-T/N. ADCON-T/N had no statistically significant effect on total active motion at 3, 6 and 12 months but the time taken to achieve the final range of motion was significantly shorter in treated patients. ADCON-treated patients had a higher rupture rate but this was not significant.

Novel single nucleotide polymorphisms in the 3'-UTR of the TGFbetaRI and TGFbetaRIII genes.

Transforming growth factor beta (TGFbeta) family members are multifunctional cytokines that play a key role in cellular growth, proliferation and differentiation. Transmembrane signalling by TGFbeta occurs via a complex of the serine/threonine kinases TGFbeta type 1 (TGFbetaRI), type 2 (TGFbetaRII), and type 3 (TGFbetaRIII) receptors. Previous studies have implicated TGFbeta receptors (TGFbetaR) in a variety of important hereditary clinical disorders. Mutations of the TGFbetaR genes have been observed in several human cancers. The aim of this study was to identify and confirm novel single nucleotide polymorphisms (SNPs) in TGFbetaRI and RIII and to determine the relative allele and genotype frequencies of these SNPs. SNPs were identified from the examination of sequence alignments held in databases and were confirmed by DNA sequencing. A polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was devised for genotyping TGFbeta receptor polymorphisms. DNA samples from 91 controls were examined. The observed heterozygosities of TGFbetaRI and TGFbetaRIII gene polymorphisms in the control population were 43 and 33%, respectively, suggesting these SNPs could be useful markers in disease association studies.

Palmar resurfacing techniques: an "ideal" opportunity and the importance of long-term follow-up.

A case involving the accidental loss of all the skin of the palm and the palmar surfaces of all four fingers, and its replacement as a full-thickness graft, is presented. The importance of long-term follow-up to detect and correct palmar skin contractures is emphasized. The literature which relates to this difficult area of loss is reviewed.

Genetic susceptibility in Dupuytren's disease. TGF-beta1 polymorphisms and Dupuytren's disease.

Dupuytren's disease is a benign fibroproliferative disease of unknown aetiology. It is often familial and commonly affects Northern European Caucasian men, but genetic studies have yet to identify the relevant genes. Transforming growth factor beta one (TGF-beta1) is a multifunctional cytokine which plays a central role in wound healing and fibrosis. It stimulates the proliferation of fibroblasts and the deposition of extracellular matrix. Previous studies have implicated TGF-beta1 in Dupuytren's disease, suggesting that it may represent a candidate susceptibility gene for this condition. We have investigated the association of four common single nucleotide polymorphisms in TGF-beta1 with the risk of developing Dupuytren's disease. A polymerase chain reaction-restriction fragment length polymorphism method was used for genotyping TGF-beta1 polymorphisms. DNA samples from 135 patients with Dupuytren's disease and 200 control subjects were examined. There was no statistically significant difference in TGF-beta1 genotype or allele frequency distributions between the patients and controls for the codons 10, 25, -509 and -800 polymorphisms. Our observations suggest that common TGF-beta1 polymorphisms are not associated with a risk of developing Dupuytren's disease. These data should be interpreted with caution since the lack of association was shown in only one series of patients with only known, common polymorphisms of TGF-beta1. To our knowledge, this is the first report of a case-control association study in Dupuytren's disease using single nucleotide polymorphisms in TGF-beta1.

Genetic susceptibility in Dupuytren's disease: lack of association of a novel transforming growth factor beta(2) polymorphism in Dupuytren's disease.

The genes involved in the pathogenesis of Dupuytren's disease have yet to be identified. In this study, we tested for an association between Dupuytren's disease (DD) and a novel insertion polymorphism within the 5'-untranslated region (5'-UTR), of the TGFbeta(2) gene. DNA samples from 179 DD patients and 187 ethnically matched controls were examined. There was no statistically significant difference in TGFbeta(2) allele frequency distributions between cases and controls for the TGFbeta(2) polymorphism.

Distinguishing logic from association in the solution of an invisible displacement task by children (Homo sapiens) and dogs (Canis familiaris): using negation of disjunction.

Prior research on the ability to solve the Piagetian invisible displacement task has focused on prerequisite representational capacity. This study examines the additional prerequisite of deduction. As in other tasks (e.g., conservation and transitivity), it is difficult to distinguish between behavior that reflects logical inference from behavior that reflects associative generalization. Using the role of negation in logic whereby negative feedback about one belief increases the certainty of another (e.g., a disjunctive syllogism), task-naive dogs (Canis familiaris; n=19) and 4- to 6-year-old children (Homo sapiens; n=24) were given a task wherein a desirable object was shown to have disappeared from a container after it had passed behind 3 separate screens. As predicted, children (as per logic of negated disjunction) tended to increase their speed of checking the 3rd screen after failing to find the object behind the first 2 screens, whereas dogs (as per associative extinction) tended to significantly decrease their speed of checking the 3rd screen after failing to find the object behind the first 2 screens.

Contingency perception and misperception in infancy: some potential implications for attachment.

A theoretical analysis is presented in which the four major attachment patterns (A, B, C, and D) are viewed as adaptations to particular forms of early contingency experience. The author proposes that human infants analyze contingency experience on the basis of two computations of conditional probability, one prospective and one retrospective. Ideally, when these computations do not agree, the direction of disagreement provides information as to how the infant should adjust effective behavior and/or how potential contingent consequences should be redefined. The author also proposes that the specific patterns of insecure attachment (A, C, and D) are a result of parental responsiveness that is by nature inconsistent or out of balance and that the infant interprets this imbalance as his or her misperception of a balanced contingency. The observed symptoms of attachment insecurity are seen as consistent with specific attempts by infants to adjust behavior and/or discrimination according to the direction of imbalance in conditional probabilities they have experienced in interactions with their caretakers.

Social facilitation of object-oriented hand use in a Rett syndrome variant girl: implications for partial preservation of an hypothesized specialized cerebral network.

Partial preservation of object-oriented hand use (OOHU) was studied behaviorally in a 6-1/2-year-old girl with the preserved speech variant (PSV) of Rett syndrome (RS), associated with a T 158 missense MeCP2 mutation and favorably skewed X-inactivation. At home, OOHU was limited except for self-feeding. When examined, overall time invested in toy play was only 38% of that of healthy subjects, and also, by comparison with healthy subjects, less when autonomous than when socially-facilitated (13% vs 63%). Good interest in and responsiveness to people translated into better motivation for OOHU. She responded to others' requests for grasping and handling objects and used them to reinforce affiliations with people. Results were discussed in terms of a disruption of the formation of a specialized OOHU cerebral network in RS, partially compensated for by the favorably skewed X-inactivation, which among other effects permitted functional retention of the network segment incorporating social influence and motivation.

Determination of naphthenic acids in crude oils using nonaqueous ion exchange solid-phase extraction.

A method is presented for the routine, rapid, and quantitative analysis of aliphatic and naphthenic acids in crude oils, based on their isolation using nonaqueous ion exchange solid-phase extraction cartridges. The isolated acid fractions are methylated and analyzed by gas chromatography and gas chromatography/mass spectrometry. The method is effective on both light and heavy oils and is capable of providing mechanistic information of geochemical significance on the origin of the acids in the oils. Analysis of oils that were solvent extracted from laboratory and field mesocosm marine sediment oil degradation studies indicate that this new method of analyzing the products of hydrocarbon biodegradation may be a useful tool for monitoring the progress of bioremediation of oil spills in the environment.

Nail fold creation in complete syndactyly using Buck-Gramcko pulp flaps.

We have used the double pulp flap technique described by Buck-Gramcko for nail fold creation in 75 fingertips after separation of 38 complete syndactyly webs in 27 patients. The operative technique is described and the results are discussed. Nail patterns in these complex syndactyly webs are analysed and a classification is proposed.

A comparative study of two methods of controlled mobilization of flexor tendon repairs in zone 2.

This prospective study compares subjects following primary repair of flexor tendons in zone 2 using either controlled active motion or a modified Kleinert regime. A matched pairs design was employed, subjects being matched for gender, age and injury characteristics. Twenty-six pairs of subjects with 92 tendon injuries in 52 digits were assessed 12 weeks postoperatively in respect of range of motion and dehiscence. Outcomes were defined using the Strickland criteria. No statistically significant differences in respect of range of motion were demonstrated between the groups. Incidence of rupture, however, was significantly less in the modified Kleinert group (7.7%) than in the controlled active motion group (46%).