Validity of the UCEEM in use: How Does it Triangulate with Qualitative Data in Measuring the Effect of an Educational Intervention?

Objectives: Improving medical student placements relies on being able to reliably evaluate how students experience clinical learning environments. The Undergraduate Clinical Education Environment Measure (UCEEM) is an increasingly used validated tool designed to allow such evaluations. This study aims to further characterize how the UCEEM relates to qualitative evaluation. methods: Students on placement at one hospital were invited to complete the UCEEM before and after the implementation of an innovative new placement structure. Additionally, focus groups were employed to collect qualitative data on their experiences. a novel protocol to triangulate the output of the UCEEM with the qualitative data was developed. Results: The UCEEM showed good internal consistency (Cronbach's Alpha 0.79-0.91) and internal correlation. Implementation of the intervention created significant improvements in the overall UCEEM scores (P = .008) and in the "Learning in and through work and quality of supervision" (P = .048), "Preparedness for student entry" (P = .033) and "Workplace interaction patterns and student inclusion" (P = .039) domains. The triangulation of qualitative data with UCEEM output showed that the UCEEM allowed evaluation of some perceptions not reached through open questioning. However, mixed interpretations of UCEEM items by students led to the conflation of themes and challenges in deriving the meaning behind the score. This appeared to be the case for 14 of the 24 UCEEM items. Conclusion: This investigation adds to the literature supporting the UCEEM as a validated tool. It also elucidates the limitations and relationships to qualitative data that investigators need to be aware of in its use.

Nephrotic syndrome with minimal change disease after the Pfizer-BioNTech COVID-19 vaccine: two cases.

We present two cases of nephrotic syndrome with minimal change disease after the Pfizer-BioNTech COVID-19 vaccine. We discuss the initial presentation, investigation and management of these patients along with a discussion around the current evidence base for vaccine-induced nephrotic syndrome.

Expanding our concept of simulation in radiology: a "Radiology Requesting" session for undergraduate medical students.

Objectives: Whilst radiology is central to the modern practice of medicine, graduating doctors often feel unprepared for radiology in practice. Traditional radiological education focuses on image interpretation. Key areas which are undertaught include communication skills relating to the radiology department. We sought to design teaching to fill this important gap. Methods: We developed a small group session using in situ simulation to enable final and penultimate year medical students to develop radiology-related communication and reasoning skills. Students were given realistic cases, and then challenged to gather further information and decide on appropriate radiology before having the opportunity to call a consultant radiologist on a hospital phone and simulate requesting the appropriate imaging with high fidelity. We evaluated the impact of the teaching through before-and-after Likert scales asking students about their confidence with various aspects of requesting imaging, and qualitatively through open-ended short answer questionnaires. Results: The session was delivered to 99 students over 24 sessions. Self-reported confidence in discussing imaging increased from an average of 1.7/5 to 3.4/5 as a result of the teaching (p < 0.001) and students perceived that they had developed key skills in identifying and communicating relevant information. Conclusions: The success of this innovative session suggests that it could form a key part of future undergraduate radiology education, and that the method could be applied in other areas to broaden the application of simulation. Advances in knowledge: This study highlights a gap in undergraduate medical education. It describes and demonstrates the effectiveness of an intervention to fill this gap.

Towards validation of combined-accelerated stress testing through failure analysis of polyamide-based photovoltaic backsheets.

Novel methods for advancing reliability testing of photovoltaic (PV) modules and materials have recently been developed. Combined-accelerated stress testing (C-AST) is one such method which has demonstrated reliable reproduction of some field-failures which were not reproducible by standard certification tests. To increase confidence and assist in the development of C-AST, and other new testing protocols, it is important to validate that the failure modes observed and mechanisms induced are representative of those observed in the field, and not the product of unrealistic stress conditions. Here we outline a method using appropriate materials characterization and modelling to validate the failure mechanisms induced in C-AST such that we can increase confidence in the test protocol. The method is demonstrated by applying it to a known cracking failure of a specific polyamide (PA)-based backsheet material. We found that the failure of the PA-based backsheet was a result of a combination of stress factors. Photo-oxidation from ultra-violet (UV) radiation exposure caused a reduction in fracture toughness, which ultimately lead to the cracking failure. We show that the chemical and structural changes observed in the backsheet following C-AST aging were also observed in field-aged samples. These results increase confidence that the conditions applied in C-AST are representative of the field and demonstrates our approach to validating the failure mechanisms induced.

The Frequency of Ras Mutations in Cancer.

Ras is frequently mutated in cancer, however, there is a lack of consensus in the literature regarding the cancer mutation frequency of Ras, with quoted values varying from 10%-30%. This variability is at least in part due to the selective aggregation of data from different databases and the dominant influence of particular cancer types and particular Ras isoforms within these datasets. To provide a more definitive figure for Ras mutation frequency in cancer, we cross-referenced the data in all major publicly accessible cancer mutation databases to determine reliable mutation frequency values for each Ras isoform in all major cancer types. These percentages were then applied to current U.S. cancer incidence statistics to estimate the number of new patients each year that have Ras-mutant cancers. We find that approximately 19% of patients with cancer harbor Ras mutations, equivalent to approximately 3.4 million new cases per year worldwide. We discuss the Ras isoform and mutation-specific trends evident within the datasets that are relevant to current Ras-targeted therapies.

High-output cardiac failure secondary to high-output arteriovenous fistula: investigations, management and definitive treatment.

A 32 year-old woman was admitted to our institution with progressive dyspnoea. Her medical history was notable for end-stage renal failure secondary to chronic pyelonephritis, and she had undergone a cadaveric renal transplant in 2010. This had been preceded by haemodialysis treatment via a radiocephalic arteriovenous fistula. Her diagnostic evaluation was remarkable for pulmonary hypertension. A subsequent doppler ultrasound of her arteriovenous fistula revealed a blood flow of 3 L/min. This is consistent with a high output fistula. Echocardiography demonstrated an improvement in pulmonary artery pressure with occlusion of the fistula. After multidisciplinary discussion, a decision was made to surgically tie off her fistula. The patient experienced immediate improvement in her shortness of breath along with resolution of pulmonary hypertension on echocardiography. This case highlights the rare complication of high output cardiac failure from a dialysis fistula and its successful surgical management.

Endoscopic measurement of gastric pH associates with persistent acid reflux in patients treated with proton-pump inhibitors for gastroesophageal reflux disease.

Background: Proton-pump inhibitors (PPIs) are the mainstay of gastroesophageal reflux disease (GERD) treatment, however, up to 30% of patients have a poor symptomatic response. PH-impedance is the gold standard to assess whether this is due to persistent acid reflux. We aimed to characterize clinical predictors of persistent esophageal acid reflux on PPIs including gastric pH measured during endoscopy. Methods: We prospectively recruited patients with GERD and/or Barrett's esophagus (BE) on PPIs. All patients completed a symptom questionnaire (RDQ) and underwent gastroscopy with gastric pH analysis, immediately followed by ambulatory 24-hour pH-impedance. We used a modified cut-off of 1.3% for pathological esophageal acid exposure time (AET). Multiple linear regression model was used to analyze the correlation between AET and predictive variables. Results: We recruited 122 patients, of which 92 (75.4%) were included in the final analysis [44 male (47.8%), median age 53 years (IQR: 43-66)]. Forty-four patients (47.8%) had persistent acid reflux with a median total AET of 2.2 (IQR1.2-5.0), as compared to 0.1 (IQR 0.0-0.2) in patients without persistent reflux (n=48; P<.001). There was no difference in age, gender, BMI, PPI-regimen, diagnosis of hiatus hernia or BE, and severity of symptoms between patients with normal and abnormal AET. Median gastric pH was significantly lower in patients with abnormal AET (5.8 vs 6.6, P=0.032) and it correlated with the total AET (P=.045; R2=12.0%). With a pH cut-off of 5.05, single point endoscopic gastric pH analysis had an area under the ROC curve (AUC) of 63.0% (95%CI 51.3-74.7) for prediction of pathological esophageal AET. Conclusions: Symptoms and clinical characteristics are not useful to predict persistent acid reflux in patients on PPIs. One-point gastric pH correlates with 24-hour esophageal AET and could guide clinicians to assess response to PPIs, however, its utility needs validation in larger studies.

The burden of infant group B streptococcal infections in Ontario: Analysis of administrative data to estimate the potential benefits of new vaccines.

Group B streptococcus (GBS) is a leading bacterial cause of neonatal sepsis and meningitis in many countries as well as an important cause of disease in pregnant women. Currently, serotype-specific conjugate vaccines are being developed. We conducted an epidemiological analysis of health administrative data to estimate the burden of infant GBS disease in Ontario, Canada and combined these estimates with literature on serotype distribution to estimate the burden of disease likely to be vaccine-preventable. Between 1st January 2005 and 31st December 2015, 907 of 64320 health care encounters in Ontario in patients under 1 year old had codes specifically identifying GBS as the cause of the disease, of which 717 were under one month of age. In addition, application of epidemiological data to the remaining patients allowed us to estimate a further 2322 cases and among them 1822 were under one month of age. In the same period, 579 confirmed neonatal invasive GBS cases in patients up to one month of age were reported to public health. Depending on serotype distribution, vaccination coverage and early versus late onset disease (0-6 days and 7-90 days of age respectively), the preventable fraction ranged widely. With a vaccine that is 90% effective and 60% immunization coverage, up to 52% of early and late onset disease could be prevented by forthcoming vaccines. GBS is under-reported in Ontario. Uncertainty about the potential impact of vaccine indicates that further analysis and research may be needed to prepare for policy-decision making, including clinical validation studies and an economic evaluation of GBS vaccination in Ontario.

Evaluation of the selectivity and sensitivity of isoform- and mutation-specific RAS antibodies.

There is intense interest in developing therapeutic strategies for RAS proteins, the most frequently mutated oncoprotein family in cancer. Development of effective anti-RAS therapies will be aided by the greater appreciation of RAS isoform-specific differences in signaling events that support neoplastic cell growth. However, critical issues that require resolution to facilitate the success of these efforts remain. In particular, the use of well-validated anti-RAS antibodies is essential for accurate interpretation of experimental data. We evaluated 22 commercially available anti-RAS antibodies with a set of distinct reagents and cell lines for their specificity and selectivity in recognizing the intended RAS isoforms and mutants. Reliability varied substantially. For example, we found that some pan- or isoform-selective anti-RAS antibodies did not adequately recognize their intended target or showed greater selectivity for another; some were valid for detecting G12D and G12V mutant RAS proteins in Western blotting, but none were valid for immunofluorescence or immunohistochemical analyses; and some antibodies recognized nonspecific bands in lysates from "Rasless" cells expressing the oncoprotein BRAFV600E Using our validated antibodies, we identified RAS isoform-specific siRNAs and shRNAs. Our results may help to ensure the accurate interpretation of future RAS studies.

Single Synonymous Mutations in KRAS Cause Transformed Phenotypes in NIH3T3 Cells.

Synonymous mutations in the KRAS gene are clustered at G12, G13, and G60 in human cancers. We constructed 9 stable NIH3T3 cell lines expressing KRAS, each with one of these synonymous mutations. Compared to the negative control cell line expressing the wild type human KRAS gene, all the synonymous mutant lines expressed more KRAS protein, grew more rapidly and to higher densities, and were more invasive in multiple assays. Three of the cell lines showed dramatic loss of contact inhibition, were more refractile under phase contrast, and their refractility was greatly reduced by treatment with trametinib. Codon usage at these glycines is highly conserved in KRAS compared to HRAS, indicating selective pressure. These transformed phenotypes suggest that synonymous mutations found in driver genes such as KRAS may play a role in human cancers.

Recurrent life-threatening haemoptysis from a bleeding vertebral artery pseudoaneurysm: A diagnostic dilemma.

A bleeding vertebral artery pseudoaneurysm is a rare cause of haemoptysis. Pseudoaneurysm can arise due to radionecrosis from previous radiotherapy in the base of skull and neck region and may present with haemoptysis many years later. It is important to be aware of this entity in the work-up of haemoptysis, particularly in patients with previous base of skull and neck radiotherapy. Our patient was successfully treated with endovascular occlusion.

Classic articles in Psychology in the Science Citation Index Expanded: A bibliometric analysis.

Who today are the most highly cited psychologists listed in the Web of Science? This paper reports answers to this question by using the Science Citation Index Expanded to find out. This index covers over 280,350 documents in the Psychology category of the Web of Science from 1900 to 2013 and lists the most highly cited papers published between 1927 and 2012. For example, in 2013, an article published by Jacob Cohen in 1992 obtained (1) the highest ranking with 1,068 citations, (2) the highest for total citations per year, and (3) was ranked 3rd for the total number of citations since publication by 2013. New technology thus provides a seismic shift in the ways that we can obtain and analyse data like these. Indeed, the results for the top 10 articles indicate that practical and methodological papers now receive more citations than the more theoretical papers usually found in earlier surveys.

The role of shed placental DNA in the systemic inflammatory syndrome of preeclampsia.

Preeclampsia is a syndrome occurring only in pregnancy characterized by systemic maternal inflammation and associated with the presence of the placenta. How these 2 aspects of the disease are linked has been the subject of numerous theories and ideas. Recently, there has been increasing interest in DNA shed from the placenta into the maternal circulation as a potential agent initiating the inflammatory response. This review will discuss the current evidence and future directions for placental DNA as the linking factor in preeclampsia in the context of other hypotheses.

Las autocitas deberían considerarse relevantes / Self-citations should be counted

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