A Comparison of Resident-Completed and Preceptor-Completed Formative Workplace-Based Assessments in a Competency-Based Medical Education Program.

BACKGROUND AND OBJECTIVES: In competency-based medical education (CBME), should resident self-assessments be included in the array of evidence upon which summative progress decisions are made? We examined the congruence between self-assessments and preceptor assessments of residents using assessment data collected in a 2-year Canadian family medicine residency program that uses programmatic assessment as part of their approach to CBME. METHODS: This was a retrospective observational cohort study using a learning analytics approach. The data source was archived formative workplace-based assessment forms (fieldnotes) stored in an online portfolio by family medicine residents and preceptors. Data came from three academic teaching sites over 3 academic years (2015-2016, 2016-2017, 2017-2018), and were analyzed in aggregate using nonparametric tests to evaluate differences in progress levels selected both within and between groups. RESULTS: In aggregate, first-year residents' self-reported progress was consistent with that indicated by preceptors. Progress level rating on fieldnotes improved over training in both groups. Second-year residents tended to assign themselves higher ratings on self-entered assessments compared with those assigned by preceptors; however, the effect sizes associated with these findings were small. CONCLUSIONS: Although we found differences in the progress level selected between preceptor-entered and resident-entered fieldnotes, small effect sizes suggest these differences may have little practical significance. Reasonable consistency between resident self-assessments and preceptor assessments suggests that benefits of guided self-assessment (eg, support of self-regulated learning, program efficacy monitoring) remain appealing despite potential risks.

Diet-related selectivity of macroplastic ingestion in green turtles (Chelonia mydas) in the eastern Mediterranean.

Understanding the drivers of key interactions between marine vertebrates and plastic pollution is now considered a research priority. Sea turtles are primarily visual predators, with the ability to discriminate according to colour and shape; therefore these factors play a role in feeding choices. Classification methodologies of ingested plastic currently do not record these variables, however here, refined protocols allow us to test the hypothesis that plastic is selectively ingested when it resembles the food items of green turtles (Chelonia mydas). Turtles in the eastern Mediterranean displayed strong diet-related selectivity towards certain types (sheet and threadlike), colours (black, clear and green) and shapes (linear items strongly preferred) of plastic when compared to the environmental baseline of plastic beach debris. There was a significant negative relationship between size of turtle (curved carapace length) and number/mass of plastic pieces ingested, which may be explained through naivety and/or ontogenetic shifts in diet. Further investigation in other species and sites are needed to more fully ascertain the role of selectivity in plastic ingestion in this marine vertebrate group.

The true depth of the Mediterranean plastic problem: Extreme microplastic pollution on marine turtle nesting beaches in Cyprus.

We sampled 17 nesting sites for loggerhead (Caretta caretta) and green turtles (Chelonia mydas) in Cyprus. Microplastics (<5 mm) were found at all locations and depths, with particularly high abundance in superficial sand. The top 2 cm of sand presented grand mean ±â€¯SD particle counts of 45,497 ±â€¯11,456 particles m-3 (range 637-131,939 particles m-3). The most polluted beaches were among the worst thus far recorded, presenting levels approaching those previously recorded in Guangdong, South China. Microplastics decreased with increasing sand depth but were present down to turtle nest depths of 60 cm (mean 5,325 ±â€¯3,663 particles m-3. Composition varied among beaches but hard fragments (46.5 ±â€¯3.5%) and pre-production nurdles (47.8 ±â€¯4.5%) comprised most categorised pieces. Particle drifter analysis hindcast for 365 days indicated that most plastic likely originated from the eastern Mediterranean basin. Worsening microplastic abundance could result in anthropogenically altered life history parameters such as hatching success and sex ratios in marine turtles.

Diminishing glutathione availability and age-associated decline in neuronal excitability.

Oxidative stress is frequently implicated in diminished electrical excitability of aging neurons yet the foundations of this phenomenon are poorly understood. This study explored links between alterations in cellular thiol-redox state and age-associated decline in electrical excitability in identified neurons (right pedal dorsal 1 [RPeD1]) of the gastropod Lymnaea stagnalis. Intracellular thiol redox state was modulated with either dithiothreitol or membrane permeable ethyl ester of the antioxidant glutathione (et-GSH). Neuronal antioxidant demand was manipulated through induction of lipid peroxidation with 2,2'-azobis-2-methyl-propanimidamide-dihydrochloride (AAPH). Glutathione synthesis was manipulated with buthionine sulfoximine (BSO). We show that; glutathione content of snail brains declines with age, whereas pyroglutamate content increases; treatment with AAPH and BSO alone aggravated the natural low excitability state of old RPeD1, but only the combination of AAPH + BSO affected electrical excitability of young RPeD1; et-GSH reversed this effect in young RPeD1; et-GSH and dithiothreitol treatment reversed age-associated low excitability of old RPeD1. Together, these data argue for a tight association between glutathione availability and the regulation of neuronal electrical excitability and indicate perturbation of cellular thiol-redox metabolism as a key factor in neuronal functional decline in this gastropod model of biological aging.

Assessment of the addition of prehospital continuous positive airway pressure (CPAP) to an urban emergency medical services (EMS) system in persons with severe respiratory distress.

BACKGROUND: The use of continuous positive airway pressure (CPAP) assisted ventilation in the emergency department(ED) has been well described. OBJECTIVES: The purpose of this study was to measure the efficacy of adding pre-hospital CPAP to an urban emergency medical service (EMS) respiratory distress protocol on persons with respiratory distress. METHODS: A historical cohort analysis of consecutive patients between 2005 and 2010. Groups were matched for severity of respiratory distress. Physiologic variables were the primary outcome obtained from first responders and upon triage in the ED. Additional outcomes included endotracheal intubation rate, hospital mortality, overall hospital length of stay(LOS), intensive care unit (ICU) admission, and ICU length of stay (ICU LOS). RESULTS: There were 410 consecutive patients with predetermined criteria for severe respiratory distress, 235 historical controls matched with 175 post-implementation patients. Average age was 67 years, 54% being male. There were significant median differences in heart and respiratory rates favoring the historical cohort (p < 0.05). There were no significant differences in intubation rate, overall hospital LOS, ICU admission rate, ICU LOS, and hospital mortality (p > 0.05).Patients that were continued on noninvasive ventilatory assistance had a significantly improved rate of intubation and ICU LOS (p < 0.05). CONCLUSIONS: The addition of CPAP to our pre-hospital respiratory distress protocol did not improve physiologic variables.There were no differences in overall and ICU LOS between groups. Persons with apparent continued ventilatory assistance appeared to have improved rates of intubation and ICU LOS [corrected].

Magnetic resonance characteristics of medial plica of the knee: correlation with arthroscopic resection.

OBJECTIVE: The purpose of this study was to determine if there are magnetic resonance (MR) characteristics of the medial plica that correlate with the likelihood of plica resection. METHODS: Sixty-six knee MR examinations from patients who underwent subsequent knee arthroscopy were evaluated retrospectively for the presence of a medial plica. The plicae were then characterized by relative width, thickness, relation to the trochlear cartilage, associated cartilage changes, and effusion. The arthroscopy reports from each knee were reviewed for the presence, description, and resection of medial plicae. RESULTS: A medial plica was demonstrated by MR in 46 of 66 (69.7%) cases. A medial plica was mentioned in 16 of 66 (24.2%) arthroscopic reports. No MR characteristics were significantly predictive of resection. Location of a plica adjacent to cartilage had a P value of 0.0786, plica width had a P value of 0.0858, and plica thickness had a P value of 0.1685. CONCLUSION: No MR characteristics of medial plicae were found to be predictive of subsequent resection at arthroscopy.

MR patterns of involvement of humeral head osteonecrosis.

PURPOSE: To characterize osteonecrosis of the humeral head on coronal and axial MR images. METHODS: We retrospectively reviewed MR examinations in patients with humeral head osteonecrosis. The angle of the entire affected articular surface at three levels was measured and an angle subtended by the margins of osteonecrosis was also measured. RESULTS: The appearance of osteonecrosis is identical to that in the femoral head with signal abnormality (13/13), double-line sign (7/13), and subchondral fractures (3/13). The superior aspect of the humeral head was the most common location of osteonecrosis. The MR staging resulted as follows: stage II (6/13), stage IIIA (1/13), stage IIIB (1/13), and stage IV (5/13). The maximum percentage of involvement of the articular surface demonstrated the following distribution: 0% to 25%, 0/11; 25% to 50%, 1/13; 50% to 75%, 5/13; and 75% to 100%, 7/13. CONCLUSIONS: Quantitative analysis of the percentage of involvement of the humeral head was performed and indicates that in most cases, 75% to 100% of the articular surface at the levels measured was involved.