A study on evaluator factors affecting physician-patient interaction scores in clinical performance examinations: a single medical school experience.

BACKGRUOUND: This study is an analysis of evaluator factors affecting physician-patient interaction (PPI) scores in clinical performance examination (CPX). The purpose of this study was to investigate possible ways to increase the reliability of the CPX evaluation. METHODS: The six-item Yeungnam University Scale (YUS), four-item analytic global rating scale (AGRS), and one-item holistic rating scale (HRS) were used to evaluate student performance in PPI. A total of 72 fourth-year students from Yeungnam University College of Medicine in Korea participated in the evaluation with 32 faculty and 16 standardized patient (SP) raters. The study then examined the differences in scores between types of scale, raters (SP vs. faculty), faculty specialty, evaluation experience, and level of fatigue as time passes. RESULTS: There were significant differences between faculty and SP scores in all three scales and a significant correlation among raters' scores. Scores given by raters on items related to their specialty were lower than those given by raters on items out of their specialty. On the YUS and AGRS, there were significant differences based on the faculty's evaluation experience; scores by raters who had three to ten previous evaluation experiences were lower than others' scores. There were also significant differences among SP raters on all scales. The correlation between the YUS and AGRS/HRS declined significantly according to the length of evaluation time. CONCLUSION: In CPX, PPI score reliability was found to be significantly affected by the evaluator factors as well as the type of scale.

Changes in inner retinal layer thickness in patients with exudative age-related macular degeneration during treatment with anti-vascular endothelial growth factor.

The aim of this study was to identify any changes that occur in the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) in patients with exudative age-related macular degeneration (AMD) during treatment with anti-vascular endothelial growth factor (VEGF) injections.Patients were enrolled in this retrospective study if they had exudative AMD, had received at least 3 injections of ranibizumab or aflibercept, and had a minimum of 12 months of follow-up. We analyzed the changes in the RNFL and GC-IPL using spectral-domain optical coherence tomography in rescan mode.Fifty-two eyes of 52 patients who had been treated with repeated anti-VEGF injections for exudative AMD were included. At the final visit, there was no significant between-group difference in best-corrected visual acuity or intraocular pressure. There was a significant decrease in central macular thickness in all groups (P < .05). There was a decrease in RNFL thickness that was only statistically significant in the ranibizumab group and when the ranibizumab or aflibercept groups were combined (P = .036 and .044, respectively). The thickness of the GC-IPL layer was significantly decreased in the aflibercept and total group (P = .035 and P = .048, respectively).The thicknesses of the RNFL and GC-IPL decreased in patients with exudative AMD who underwent repeated anti-VEGF injections.

Independent Risk Factors for the Shivering Occurrence During Induction Period in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management.

The occurrence of shivering during the induction period of targeted temperature management (TTM) remains a therapeutic obstacle, which delays the achievement of target temperature. The aim of this study was to identify risk factors leading to shivering during the induction period. We analyzed a prospective cohort of adult out-of-hospital cardiac arrest (OHCA) survivors treated with TTM from January 2015 to June 2017. Patients who developed shivering during the induction period were compared to those who did not. Multivariable analysis was performed to determine risk factors of shivering. Among 80 patients treated with TTM, shivering occurred in 22 patients (27.5%). In the shivering group, the time to achieve target temperature was significantly delayed (245 minutes vs. 151 minutes, p = 0.005). Multivariable analysis showed that being underweight (OR, 18.40; 95% CI, 1.89-179.19) or overweight (OR, 8.65; 95% CI, 1.60-46.80), age <65 years (OR, 5.54; 95% CI, 1.25-16.12), and duration of cardiac arrest <20 minutes (OR, 4.50; 95% CI, 1.25-16.12) were predictors for the occurrence of shivering. OHCA patients with abnormal body weight, age <65 years, and duration of cardiac arrest <20 minutes should be monitored thoroughly for early recognition of shivering.

[Academic burnout and selection-optimization-compensation strategy in medical students].

PURPOSE: This study was conducted to examine the relationship between academic demand, academic burnout, and the selection-optimization-compensation (SOC) strategy in medical students. METHODS: A total of 317 students at Yeungnam University, comprising 90 premedical course students, 114 medical course students, and 113 graduate course students, completed a survey that addressed the factors of academic burnout and the selection-optimization-compensation strategy. We analyzed variances of burnout and SOC strategy use by group, and stepwise multiple regression analysis was conducted. RESULTS: There were significant differences in emotional exhaustion and cynicism between groups and year in school. In the SOC strategy, there were no significant differences between groups except for elective selection. The second-year medical and graduate students experienced significantly greater exhaustion (p<0.001), and first-year premedical students experienced significantly higher cynicism (p<0.001). By multiple regression analysis, subfactors of academic burnout and emotional exhaustion were significantly affected by academic demand (p<0.001), and 46% of the variance was explained. Cynicism was significantly affected by elective selection (p<0.05), and inefficacy was significantly influenced by optimization (p<0.001). CONCLUSION: To improve adaptation, prescriptive strategies and preventive support should be implemented with regard to academic burnout in medical school. Longitudinal and qualitative studies on burnout must be conducted.

Optical switching of near infrared light transmission in metamaterial-liquid crystal cell structure.

A metamaterial-liquid crystal cell structure is fabricated with the metamaterial as one of the liquid crystal alignment layers. Nano-sized double-split ring resonator in the metamaterial accommodates two distinct resonances in the near infrared regime. By adopting an azo-nematic liquid crystal in a twisted nematic liquid crystal cell structure, a photo-isomerization process is utilized to achieve an optical switching of light transmissions between two resonances. A single device of the metamaterial-liquid crystal cell structure has a potential application in the photonic switching in optical fiber telecommunications.

Molecular cloning and characterization of WD40-repeat protein from Clonorchis sinensis.

WD40-repeat proteins have four to eight repeating units flanked by Gly-His (GH) and Trp-Asp (WD) at both termini and folds into a beta-propeller. A polypeptide deduced from a Clonorchis sinensis cDNA clone analyzed to have seven WD40-repeats and predicted to form a beta-propeller (CsWD1). The CsWD1 protein was expressed stage-specifically in the metacercariae and localized in the tegumental syncytium. The CsWD1 protein is suggested to serve as a platform for interacting partner proteins in the tegumental syncytium of C. sinensis metacercariae.

Sorting of the human folate receptor in MDCK cells.

The human folate receptor (hFR) is a glycosylphosphatidy-linositol (GPI) linked plasma membrane protein that mediates delivery of folates into cells. We studied the sorting of the hFR using transfection of the hFR cDNA into MDCK cells. MDCK cells are polarized epithelial cells that preferentially sort GPI-linked proteins to their apical membrane. Unlike other GPI-tailed proteins, we found that in MDCK cells, hFR is functional on both the apical and basolateral surfaces. We verified that the same hFR cDNA that transfected into CHO cells produces the hFR protein that is GPI-linked. We also measured the hFR expression on the plasma membrane of type III paroxysmal nocturnal hemoglobinuria (PNH) human erythrocytes. PNH is a disease that is characterized by the inability of cells to express membrane proteins requiring a GPI anchor. Despite this defect, and different from other GPI-tailed proteins, we found similar levels of hFR in normal and type III PNH human erythrocytes. The results suggest the hypothesis that there may be multiple mechanisms for targeting hFR to the plasma membrane.

Sorting and function of the human folate receptor is independent of the caveolin expression in Fisher rat thyroid epithelial cells.

Caveolae are small, flask-shaped, non-clathrin coated invaginations of the plasma membrane of many mammalian cells. Caveolae have a coat that includes caveolin. They have been implicated in numerous cellular processes, including potocytosis. Since the human folate receptor (hFR) and other glycosyl-phosphatidylinositol GPI)-tailed proteins have been co-localized to caveolae, we studied the caveolin role in the hFR function by transfecting hFR and/or caveolin cDNA into Fisher rat thyroid epithelial (FRT) cells that normally do not express detectable levels of either protein. We isolated and characterized stable clones as follows: they express (1) high levels of caveolin alone, (2) hFR and caveolin, or (3) hFR alone. We discovered that hFR is correctly processed, sorted, and anchored by a GPI tail to the plasma membrane in FRT cells. No difference in the total folic acid binding or cell surface folic acid binding activity were found between the FRT cells that were transfected with hFR, or cells that were transfected with hFR and caveolin. The hFR that was expressed on the cell surface of clones that were transfected with hFR was also sensitive to phosphatidylinositol-specific phospholipase C (PI-PLC) release, and incorporated radiolabeled ethanolamine that supports the attachment of a GPI-tail on hFR. We conclude that the processing, sorting, and function of hFR is independent on the caveolin expression in FRT cells.