Quality Control for Residency Applicant Scores.

BACKGROUND: The residency program selection process incorporates application review and candidate interviews to create an ordered rank list. Though this is the single most important process for determining the department's future trainees, the system lacks a quality control mechanism by which faculty ratings are scrutinized. This study used many-facet Rasch measurement (MFRM) to establish a quality control system for the candidate selection process. METHODS: This study took place from October 2017 to January 2018 at a large anesthesiology residency program with 25 available spots. Every candidate received scores from 3 faculty judges across 3 occasions: application review, interview, and interviewer group discussion. MFRM with 3 facets-faculty judges, candidates, and occasions-was used to identify sources of measurement error and produce fair averages for each candidate. RESULTS: A total of 1378 observations from 158 candidates were used in the MFRM model, explaining 58.42% of the variance in the data. Fit indices indicated that 1 of the 5 judges inconsistently applied the rating scale. MFRM output also flagged some scores as unexpected based on standardized residual values. This helped identify specific instances where inconsistent observations occurred. CONCLUSIONS: MFRM is a relatively low-cost, efficient way to test the quality of the scores that are used to make a rank list and to investigate noise that represents outlier scores. When these outlier scores are due to biased factors such as particularly stringent or lenient interviewers, they may be unfairly influencing the rank list, and program directors may choose to adjust for them.

Recruitment and retention of under-represented groups with health disparities into clinical trials: a formative approach.

We evaluated the perceived success of recruitment and retention protocols for Native Hawaiian/Pacific Islander/Filipino populations. These three groups were found to have a significantly higher incidence of health disparities than the general population. Training applications of selected vignettes were also generated. Focus groups and questionnaires were used to achieve the objective: identification of themes related to facilitators and deterrents to participation in clinical trials in these populations. This mixed methods approach evaluated promotional materials preferred. Responses to animated videos and vignettes with actors regarding clinical research participation were analyzed. Participants included adults of Hawaiian/Pacific Islander or Filipino ethnicity. Analysis included grounded theory methods, such as constant comparative techniques. The results revealed that attention to the following categories is essential: culturally sensitive knowledge, attitudes, and beliefs related to individuals, families and communities. These themes are recommended as the structure for future interventions to improve participation and retention within these groups.

Altered membrane structure and surface potential in homozygous hemoglobin C erythrocytes.

BACKGROUND: Hemoglobin C differs from normal hemoglobin A by a glutamate-to-lysine substitution at position 6 of beta globin and is oxidatively unstable. Compared to homozygous AA erythrocytes, homozygous CC erythrocytes contain higher levels of membrane-associated hemichromes and more extensively clustered band 3 proteins. These findings suggest that CC erythrocytes have a different membrane matrix than AA erythrocytes. METHODOLOGY AND FINDINGS: We found that AA and CC erythrocytes differ in their membrane lipid composition, and that a subset of CC erythrocytes expresses increased levels of externalized phosphatidylserine. Detergent membrane analyses for raft marker proteins indicated that CC erythrocyte membranes are more resistant to detergent solubilization. These data suggest that membrane raft organization is modified in CC erythrocytes. In addition, the average zeta potential (a measure of surface electrochemical potential) of CC erythrocytes was approximately 2 mV lower than that of AA erythrocytes, indicating that substantial rearrangements occur in the membrane matrix of CC erythrocytes. We were able to recapitulate this low zeta potential phenotype in AA erythrocytes by treating them with NaNO(2) to oxidize hemoglobin A molecules and increase levels of membrane-associated hemichromes. CONCLUSION: Our data support the possibility that increased hemichrome deposition and altered lipid composition induce molecular rearrangements in CC erythrocyte membranes, resulting in a unique membrane structure.