Twelve tips for designing and implementing peer-led assessment writing schemes in health professions education.

Peer-led assessment (PLA) has gained increasing prominence within health professions education as an effective means of engaging learners in the process of assessment writing and practice. Involving students in various stages of the assessment lifecycle, including item writing, quality assurance, and feedback, not only facilitates the creation of high-quality item banks with minimal faculty input but also promotes the development of students' assessment literacy and fosters their growth as teachers. The advantages of involving students in the generation of assessments are evident from a pedagogical standpoint, benefiting both students and faculty. However, faculty members may face uncertainty when it comes to implementing such approaches effectively. To address this concern, this paper presents twelve tips that offer guidance on important considerations for the successful implementation of peer-led assessment schemes in the context of health professions education.

Cytokine changes in cerebrospinal fluid following vascular surgery on the thoracic aorta.

There is growing evidence that surgery can drive an inflammatory response in the brain. However, the mechanisms behind this response are incompletely understood. Here, we investigate the hypotheses that 1. Cerebrospinal fluid (CSF) cytokines increase after vascular surgery and 2. That these changes in CSF cytokines are interrelated. Patients undergoing either open or endovascular elective surgery of the thoracic aorta were invited to participate in this study. Cerebrospinal fluid samples were taken before surgery and on the first post-operative day. These were analysed for the presence of ten cytokines by immunoassay to examine for post-operative changes in cytokine levels. After surgery, there were significant increases in six out of the ten measured CSF cytokines (IL-1ß, 2, 6, 8, 10 and 13). This included changes in both putative pro-inflammatory (IL-1ß, 6 and 8) and putative anti-inflammatory (IL-2, 10 and 13) cytokines. The greatest increases occurred in IL-6 and IL-8, which showed a 63-fold and a 31-fold increase respectively. There was strong intercorrelation between CSF cytokines after the operation. Following surgery on the thoracic aorta, there was a marked increase in CSF cytokines, consistent with a potential role in neuroinflammation. The ten measured cytokines showed intercorrelation after the operation, indicating that a balance between multiple pro- and anti-inflammatory cytokines may be present.

Putative Involvement of Cytokine Modulation in the Development of Perioperative Neurocognitive Disorders.

Following surgery, local cytokine-driven inflammation occurs, as part of the normal healing process. Cytokines in the central nervous system such as IL-6 and IL-8 may also be elevated. These cytokine changes likely contribute to neuroinflammation, but the complex mechanisms through which this occurs are incompletely understood. It may be that perioperative changes in pro- and anti-inflammatory cytokines have a role in the development of perioperative neurocognitive disorders (PND), such as post-operative delirium (POD). This review considers the current evidence regarding perioperative cytokine changes in the blood and cerebrospinal fluid (CSF), as well as considering the potential for cytokine-altering therapies to prevent and treat PND.

Cytokine changes in cerebrospinal fluid and plasma after emergency orthopaedic surgery.

Neuroinflammation after surgery and its contribution to peri-operative neurocognitive disorders (PND) is not well understood. Studying the association between central and peripheral cytokines and neuroinflammation is a prelude to the development of treatments for PND. Here, we investigate the hypotheses that there is a greater cytokine response in cerebrospinal fluid (CSF) than plasma after orthopaedic surgery, and that plasma cytokine levels are directly related to CSF cytokine levels, indicating that plasma cytokine levels may have potential as biomarkers of neuroinflammation. Patients admitted with a fractured neck of femur were invited to participate in this study. Participants had a spinal catheter inserted just prior to induction of anaesthesia. Samples of blood and CSF were taken before, immediately after, and on the first day following emergency surgery. The catheter was then removed. Samples were analysed for the presence of ten cytokines by immunoassay. A spinal catheter was successfully inserted in 11 participants during the 18-month study period. Five plasma cytokines (IL-4, IL-6, IL-10, IL-12p70 and IL-13) rose significantly following surgery, whereas all ten CSF cytokines rose significantly (IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IFN-γ and TNF-α) (adjusted-p < 0.05). Central (CSF) cytokine levels were consistently higher than their peripheral (plasma) counterparts after surgery, with some patients having a particularly marked neuroinflammatory response. The greatest increases occurred in IL-8 in CSF and IL-6 in plasma. There were significant, strong positive correlations between several of the measured cytokines in the CSF after surgery, but far fewer in plasma. There was no significant correlation between cytokine levels in the plasma and CSF at each of the three time points. To our knowledge, this is the first study to analyse paired samples of plasma and CSF for cytokine levels before and after emergency orthopaedic surgery. This study demonstrates that following surgery for a fractured neck of femur, there is a far greater rise in cytokines in the CSF compared to plasma. The lack of correlation between peripheral and central cytokines suggests measurement of peripheral cytokines are not necessarily related to which patients may have a large neuroinflammatory response.

The Association Between Antibody Response to Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Post-COVID-19 Syndrome in Healthcare Workers.

It is currently unknown how post-COVID-19 syndrome (PCS) may affect those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This longitudinal study includes healthcare staff who tested positive for SARS-CoV-2 between March and April 2020, with follow-up of their antibody titers and symptoms. More than half (21 of 38) had PCS after 7-8 months. There was no statistically significant difference between initial reverse-transcription polymerase chain reaction titers or serial antibody levels between those who did and those who did not develop PCS. This study highlights the relative commonality of PCS in healthcare workers and this should be considered in vaccination scheduling and workforce planning to allow adequate frontline staffing numbers.

Emerging contaminants removal from effluents with complex matrices by electrooxidation.

The electrooxidation of methiocarb and bisphenol A was studied in complex matrices, namely, simulated and real sanitary landfill leachate samples, using a boron-doped diamond anode. With simulated sanitary landfill leachate samples, the influence of the type and ratio of carbon source (glucose/humic acid) and electrolyte (NaCl or Na2SO4) on the emerging contaminants removal was assessed. Using real sanitary landfill leachate, the influence of current density was evaluated. The experimental results showed that electrooxidation, using a boron-doped diamond anode, can be successfully utilized to degrade methiocarb and bisphenol A when present in complex matrices, such as sanitary landfill leachate, and that methiocarb is more easily oxidized than bisphenol A. Furthermore, it was found that the presence of chloride and high humic acid content increases emerging contaminants removal rate, showing that electrooxidation at boron-doped diamond is particularly adequate to solve the problems raised by sanitary landfill leachate, even when contaminated with emerging contaminants.

The effects of acute arm crank ergometry and cycle ergometry on postural sway and attentional demands during quiet bipedal standing.

Current evidence suggests that acute bouts of lower limb exercise elicits a number of adverse effects on both sensory and motor components of postural control. The effects of acute exercise on quiet standing balance while concurrently performing an attentional task remains equivocal. This study aimed to compare the alterations in postural control and attentional demands elicited by upper and lower limb exercise. Twelve healthy young males (mean ± SD age, 22.2 ± 3.2 years) were examined on six separate occasions. The first two visits determined maximal aerobic fitness on an arm crank ergometer (ACE) and cycle ergometer (CYC). Subsequently, participant's postural sway was assessed during single- (ST) and dual-task (DT) conditions before and immediately after moderate- and high-intensity exercise engaging the upper or lower body musculature. The order of the four exercise tests was counterbalanced. The centre of pressure displacement in the anteroposterior (COPAP) and mediolateral (COPML) directions and the COP path length (COPL) were computed using a force platform. A time × mode interaction was observed for COPAP (ST; p = 0.011, DT; p = 0.018) and COPML (ST; p = 0.001). CYC elicited large (ES; 1.6-2.0) increases in COPAP and COPML, but there were no differences between aerobic and anaerobic tests (p > 0.05). The effect of cognitive load appeared to increase sway in the frontal plane following anaerobic CYC (p = 0.001) but not ACE (p < 0.05). Exercise has different effects on frontal and sagittal plane sway following different cognitive loads. In particular, COPML was increased at the cost of maintaining attentional performance following exercise.