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.

Evaluation of the Coulter three-part differential screen.

An evaluation of the Coulter Electronics, Inc. (Hialeah, FL) three-part differential screen (3PD) was undertaken to determine the performance characteristics of this system. The 3PD measures white blood cell (WBC) volumes and, by automatic analysis of the resultant WBC histogram, produces a determination of the number and percent of lymphocytes, mononuclear cells, and granulocytes. A group of 984 random patient blood samples was tested. The overall review rate (samples requiring some further analysis or review) was 42%. The main source of false negatives on the 3PD was eosinophilia: 5 out of 22 instances of eosinophilia greater than 750/microL were not flagged. The precision of the three parameters, measured as percent coefficient of variation, was 3.3% for lymphocytes, 14.2% for mononuclear cells, 3.1% for granulocytes, and 2.4% for the total WBC. The stability of blood samples was acceptable for up to eight hours at room temperature (less at 4 degrees C).

Spinous injury caused by a sea urchin.

A bather on holiday in Kenya injured a finger on a spiny marine creature living on the sea bed. A skin biopsy specimen from the injured finger contained several black spines about 0.5 mm in diameter and up to 1.5 cm in length. Spines removed from the specimen were embedded in plastic resin to facilitate transverse sectioning. Light microscopical examination using crossed polarisers showed an ornate symmetrical structure brightly illuminated against a dark background. These features are characteristic of sea urchin (Echinoderm) spines which are composed of ornately formed calcite crystals covered by an epithelium. The spines of sea mice, on the other hand, are chitinous in nature; they are also much finer and lack the ornate symmetry of sea urchin spines.

Severe granulomatous arthritis due to spinous injury by a "sea mouse" annelid worm.

A case of destructive arthritis and soft tissue granulomatous inflammation occurred in a 25 year old man who had injured his right index finger while snorkelling in the Mediterranean. It was initially thought that he had fallen on a sea-urchin. He removed some spines at the time of injury but the finger became stiff, swollen, and painful, and after eight months with no symptomatic improvement amputation through the proximal phalanx was performed. Examination showed an exuberant granulomatous and foreign body type inflammation in the dermis and subcutaneous tissues and affecting the bone, with erosion of the cartilaginous surfaces of the proximal interphalangeal joint. Spines present in soft tissue sections contained no calcium but did contain chitin as shown by a von Wisseling reaction for chitosan. It is concluded that the chitinous spines almost certainly came from a sea-mouse (Phylum Annelida, family Aphroditidae). Sea mice are inconspicuous creatures which live on the sea floor and which may cause some injuries thought to be attributable to sea-urchins.

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.

Influence of eye movements on Rett stereotypies: evidence suggesting a stage-specific regression.

The influence of eye movements on hand use and pervasive stereotypies in Rett syndrome was studied, to better understand the developmental abnormality in this disorder. Nine patients in the post-regression phase were offered objects. As expected, the girls looked at the objects but usually did not reach for them. Nor were their characteristic hand stereotypies altered by such looking. But the occurrence of stereotypies was promoted by overall shifts in gaze, ie, eye movements in any direction. This finding may be relevant to the late-infancy loss of voluntary hand use in Rett syndrome associated with onset of pervasive stereotypies. It suggests a stage-specific regression to a level characteristic of normal 3-month-old infants who do not reach and grasp, but whose hand clasping and mouthing may be triggered by the perceptual consequences of exploratory eye movements and shifts in gaze.

Outcome after flap cover for exposed total knee arthroplasties. A report of 25 cases.

The long-term functional result of exposed total knee arthroplasty, treated by flap cover, is presented and the results compared with those of a randomly selected control group. The wound was successfully covered and the prosthesis was preserved in 76% of cases, but the final functional score was not as good as in those with primary wound healing.

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.

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.

Malnutrition and group brain- and body-weight variability: data in search of a hypothesis.

Chronic malnutrition, which may be induced by a number of different experimental manipulations, appears, from a survey of the literature, to lead to greater relative whole-brain-weight variability in affected groups compared with controls; there is a tendency for the same pattern to emerge in the case of body-weight variability. A hypothesis which might throw some light on this general trend is proposed.

Experimental microvascular anastomoses in radiated vessels: a study of the patency rate and the histopathology of healing.

A study of microvascular surgery in radiated tissue is presented. The radiation damage to the vessels and its consequence on the histopathology of blood vessel healing is discussed. The main difficulty encountered was the radiation-induced fibrosis in the perivascular tissues. The patency rate in ther arterial anastomoses was unaltered by prior radiation, but the patency rate in the venous anastomoses fell to 54 percent after high doses of prior radiation.

The free latissimus dorsi myocutaneous flap.

The general anatomy and the detailed vascular anatomy of the latissimus dorsi myocutaneous flap is described, and its use as a free flap is illustrated. The speed and ease with which it can be raised, its long vascular pedicle, the large diameter of the donor vessels, and the potentially large size of the flap are emphasized.

Migration of silicone rods.

Two cases of migration of silastic rods into the forearm after the first stage of flexor tendon grafting are reported. A CT scan shows the rods well if they are not visible on a plain X-ray. Possible factors involved in distal detachment of the rods are the composition of the tendon spacer, method of distal fixation, method of proximal fixation and the time between the stages of reconstruction.

Primary flexible implant arthroplasty of the metacarpophalangeal joints during digital replantation.

Primary silicone rubber arthroplasty in a total of four metacarpophalangeal joints during digital replantation or revascularisation in two patients is reported. The results appear preferable to present alternatives and allow good function without prejudicing further management.

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.

Twenty four thumb replantations.

Of 40 patients with amputated thumbs referred for replantation to the Manchester Microsurgical Unit over five and a half years, 10 (25%) were not considered to be feasible replants, 6(15%) were abandoned at the primary operation, and 24 were replanted. Mode of selection of patients for replantation and operative methods are considered. The 14 thumb replants that survived were studied in detail and functional results are presented. Only one patient had a result that prevented normal activities, the remainder having returned to former occupations.

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.

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.

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%).