Implementation of a Peer Learning Program Replacing Score-Based Peer Review in a Multispecialty Integrated Practice.

OBJECTIVE: The aim of this study was to compare the efficacy of a peer learning program to score-based peer review in a radiology department. MATERIALS AND METHODS: Our score-based peer review program was transitioned to an open, inclusive, education- and improvement-oriented peer learning program. Program performance was evaluated by learning opportunity submissions, program participation, number of learning opportunity distributions to radiologists, number of practice improvement projects resulting from program, and radiologist survey results before and after interventions. RESULTS: Outcomes for the score-based peer review program compared with those of the peer learning program were as follows. The mean number of radiologists participating monthly increased from 5.0 to 35.2 (p < 0.01); submissions increased from 3.0 discrepancies per month to 36.0 learning opportunities per month (p < 0.01); the mean monthly learning opportunity distributions to radiologists increased from 18 to 352 (p < 0.01); improvement projects performed during the study periods increased from 5 to 61 (p < 0.01); and mean monthly continuing medical education credits earned by radiologists increased from 7.7 to 50.6 (p < 0.01). Radiologists felt peer learning accomplished goals better than did score-based peer review. CONCLUSION: In transitioning our score-based peer review program to a peer learning program, our radiologists identified, discussed, and converted more learning opportunities into practice improvement and perceived peer learning to be of higher value than score-based peer review.

Automated analysis of food-borne pathogens using a novel microbial cell culture, sensing and classification system.

We hereby report the design and implementation of an Autonomous Microbial Cell Culture and Classification (AMC(3)) system for rapid detection of food pathogens. Traditional food testing methods require multistep procedures and long incubation period, and are thus prone to human error. AMC(3) introduces a "one click approach" to the detection and classification of pathogenic bacteria. Once the cultured materials are prepared, all operations are automatic. AMC(3) is an integrated sensor array platform in a microbial fuel cell system composed of a multi-potentiostat, an automated data collection system (Python program, Yocto Maxi-coupler electromechanical relay module) and a powerful classification program. The classification scheme consists of Probabilistic Neural Network (PNN), Support Vector Machines (SVM) and General Regression Neural Network (GRNN) oracle-based system. Differential Pulse Voltammetry (DPV) is performed on standard samples or unknown samples. Then, using preset feature extractions and quality control, accepted data are analyzed by the intelligent classification system. In a typical use, thirty-two extracted features were analyzed to correctly classify the following pathogens: Escherichia coli ATCC#25922, Escherichia coli ATCC#11775, and Staphylococcus epidermidis ATCC#12228. 85.4% accuracy range was recorded for unknown samples, and within a shorter time period than the industry standard of 24 hours.

Determinants of the pathways of litter chemical decomposition in a tropical region.

Litter decomposition is a key ecosystem process, yet our understanding of the drivers in chemical changes in leaves during decay is limited. Our aim was to determine the comparative differences (chemical divergence or convergence) between sites and the drivers of decay pathways. We used the litterbag method ('in situ' litterfall and standardized 'control' leaves) in Australian tropical rainforests and near-infrared spectrometry to show the chemical pathways during decomposition (c. 360 d; 12 control sites; 17 in situ sites). Chemical convergence/divergence was determined from spectral dissimilarity and quantile regression along a mass loss moving average. The influence of environment (climate and soil) and litter quality on decay pathways was determined between sites using correlation analysis. Throughout the region, litter composition in both treatments converged chemically during decay. However, divergent chemical pathways were shown for some samples/sites (especially with high initial lignin, phenolics and carbon (C), poor soil phosphorus (P), sodium (Na) and more seasonal moisture), and the diversity of decay residues increased with mass loss despite overall chemical convergence. Our study suggests that there is general chemical convergence of leaf litter during early decay, but also that divergent chemical pathways occur in locations that experience more intense seasonal drying, and contain species or conditions that promote poor-quality litter.

Early detection of Candida albicans biofilms at porous electrodes.

We describe the development of an electrochemical sensor for early detection of biofilm using Candida albicans. The electrochemical sensor used the ability of biofilms to accept electrons from redox mediators relative to the number of metabolically active cells present. Cyclic voltammetry and differential pulse voltammetry techniques were used to monitor the redox reaction of K(3)Fe(CN)(6) at porous reticulated vitreous carbon (RVC) (238.7 cm(2)) working electrodes versus Ag/AgCl reference. A shift in the peak potential occurred after 12 h of film growth, which is attributed to the presence of C. albicans. Moreover, the intensity of the ferricyanide reduction peak first increased as C. albicans deposited onto the porous electrodes at various growth times. The peak current subsequently decreased at extended periods of growth of 48 h. The reduction in peak current was attributed to the biofilm reaching its maximum growth thickness, which correlated with the maximum number of metabolically active cells. The observed diffusion coefficients for the bare RVC and biofilm-coated electrodes were 2.2 × 10(-3) and 7.0 × 10(-6) cm(2)/s, respectively. The increase in diffusivity from the bare electrode to the biofilm-coated electrode indicated some enhancement of electron transfer mediated by the biofilm to the porous electrode. Verification of the growth of biofilm was achieved using scanning electron microcopy and laser scanning confocal imaging microscopy. Validation with conventional plating techniques confirmed that the correlation (R(2) = 0.9392) could be achieved between the electrochemical sensors data and colony-forming units.

Delayed presentation of splenic rupture following colonoscopy: clinical and CT findings.

The purpose of this study is to investigate the clinical and CT findings in patients with symptomatic colonoscopy-induced splenic rupture, and to assess for common features among this cohort. Multi-center search yielded 11 adults with symptomatic splenic injury related to colonoscopy. Workup included abdominal CT in 10 (91%) cases and abdominal radiography in two patients (one patient had both). Colonoscopy findings, post-procedural course, and CT findings were systematically reviewed. Mean patient age was 62.2 years (range, 51-84 years); 8 (73%) of 11 were female. The majority (64%) of colonoscopies were for screening. No immediate complications were reported at optical colonoscopy; tortuosity/redundancy was noted in five cases. Except for a small (8 mm) polyp in one case and a large (10 mm) polyp in another, the remaining nine patients had either diminutive or no polyps. Only one patient presented with hemodynamic instability during post-colonoscopy recovery; the other ten had a delayed presentation ranging from 8 h to 8 days (mean, 2.1 days). All 11 patients presented with abdominal pain. CT was diagnostic for splenic injury with subcaspular and/or perisplenic hematoma in all ten CT cases. Hemoperitoneum was present in eight, visible splenic laceration in three cases, and splenic artery pseudoaneurysm in one case. Five patients underwent splenectomy (four emergent) and six patients were treated conservatively. Average hospital stay was 5.5 days (range, 3-10 days). Colonoscopy-induced splenic rupture characteristically presents as a delayed and often serious complication. In cases of apparent non-traumatic splenic hematoma or rupture at CT, eliciting a history of recent colonoscopy may identify the etiology.