Bi-cultural bi-national benchmarking and assessment of clinical reasoning in Obstetrics and Gynaecology

Published: 23/06/2016Background: The Script Concordance Test (SCT) is being increasingly used in professional development in clinical reasoning (CR) in postgraduate medicine. On-line delivery favours multi-institutional collaboration. Objectives: To establish if: 1) SCT questions developed in the French-speaking University of Montreal were readily adaptable for use in the English-speaking University of Adelaide 2) expert reference panels (ERP) from both institutions could be used interchangeably 3) student cohorts would perform similarly in the same test. Study Design: 82 SCT questions based on 27 clinical cases in Obstetrics and Gynaecology were developed in Montreal and run in a volunteer cohort of year 3 and year 4 medical students (n=154). Local faculty translated all questions, selecting 31 based on 17 clinical cases for use in summative examinations a year 5 student cohort in Adelaide (n=123). Results: Mean (SD) percentage scores using each ERP key were: 74.2 (6.4) versus 73.3 (6.9), p<0.001 for Adelaide students and 72.5 (7.8) versus 70.6 (8.8), p<0.001 for Montreal students. The correlation coefficients were ≥ 0.928 (p<0.001). Conclusions: Student cohorts performed similarly regardless of which ERP key was used. With appropriate editorial control, SCT’s can be effectively shared between French and English-speaking institutions located in different hemispheres. Potential advantages include the creation of an international database of assessment items, benchmarking and cost sharing.Paul Duggan, Patricia Monnier, Alphonse Roex, Marie-Josée Bédard, Bernard Charli

Bi-cultural, bi-national benchmarking and assessment of clinical reasoning in Obstetrics and Gynaecology

Abstract Background: The Script Concordance Test (SCT) is being increasingly used in professional development in clinical reasoning (CR) in postgraduate medicine. On-line delivery favours multi-institutional collaboration

A flexible MHC class I multimer loading system for large-scale detection of antigen-specific T cells

Tumorimmunolog

Kimberlites reveal 2.5-billion-year evolution of a deep, isolated mantle reservoir

The widely accepted paradigm of Earth's geochemical evolution states that the successive extraction of melts from the mantle over the past 4.5 billion years formed the continental crust, and produced at least one complementary melt-depleted reservoir that is now recognized as the upper-mantle source of mid-ocean-ridge basalts1. However, geochemical modelling and the occurrence of high 3He/4He (that is, primordial) signatures in some volcanic rocks suggest that volumes of relatively undifferentiated mantle may reside in deeper, isolated regions2. Some basalts from large igneous provinces may provide temporally restricted glimpses of the most primitive parts of the mantle3,4, but key questions regarding the longevity of such sources on planetary timescales—and whether any survive today—remain unresolved. Kimberlites, small-volume volcanic rocks that are the source of most diamonds, offer rare insights into aspects of the composition of the Earth’s deep mantle. The radiogenic isotope ratios of kimberlites of different ages enable us to map the evolution of this domain through time. Here we show that globally distributed kimberlites originate from a single homogeneous reservoir with an isotopic composition that is indicative of a uniform and pristine mantle source, which evolved in isolation over at least 2.5 billion years of Earth history—to our knowledge, the only such reservoir that has been identified to date. Around 200 million years ago, extensive volumes of the same source were perturbed, probably as a result of contamination by exogenic material. The distribution of affected kimberlites suggests that this event may be related to subduction along the margin of the Pangaea supercontinent. These results reveal a long-lived and globally extensive mantle reservoir that underwent subsequent disruption, possibly heralding a marked change to large-scale mantle-mixing regimes. These processes may explain why uncontaminated primordial mantle is so difficult to identify in recent mantle-derived melts

Persistent Oxytetracycline Exposure Induces an Inflammatory Process That Improves Regenerative Capacity in Zebrafish Larvae

BACKGROUND: The excessive use of antibiotics in aquaculture can adversely affect not only the environment, but also fish themselves. In this regard, there is evidence that some antibiotics can activate the immune system and reduce their effectiveness. None of those studies consider in detail the adverse inflammatory effect that the antibiotic remaining in the water may cause to the fish. In this work, we use the zebrafish to analyze quantitatively the effects of persistent exposure to oxytetracycline, the most common antibiotic used in fish farming. METHODOLOGY: We developed a quantitative assay in which we exposed zebrafish larvae to oxytetracycline for a period of 24 to 96 hrs. In order to determinate if the exposure causes any inflammation reaction, we evaluated neutrophils infiltration and quantified their total number analyzing the Tg(mpx:GFP)(i114) transgenic line by fluorescence stereoscope, microscope and flow cytometry respectively. On the other hand, we characterized the process at a molecular level by analyzing several immune markers (il-1β, il-10, lysC, mpx, cyp1a) at different time points by qPCR. Finally, we evaluated the influence of the inflammation triggered by oxytetracycline on the regeneration capacity in the lateral line. CONCLUSIONS: Our results suggest that after 48 hours of exposure, the oxytetracycline triggered a widespread inflammation process that persisted until 96 hours of exposure. Interestingly, larvae that developed an inflammation process showed an improved regeneration capacity in the mechanosensory system lateral line

Effects of an anionic surfactant (FFD-6) on the energy and information flow between a primary producer (Scenedesmus obliquus) and a consumer (Daphnia magna)

The effects of a commercially available anionic surfactant solution (FFD-6) on growth and morphology of a common green alga (Scenedesmus obliquus) and on survival and clearance rates of the water flea Daphnia magna were studied. The surfactant-solution elicited a morphological response (formation of colonies) in Scenedesmus at concentrations of 10–100 μl l−1 that were far below the No Observed Effect Concentration (NOEC) value of 1,000 μl l−1 for growth inhibition. The NOEC-value of FFD-6 for colony-induction was 3 μl l−1. Daphnia survival was strongly affected by FFD-6, yielding LC50–24h and LC50–48h of 148 and 26 μl l−1, respectively. In addition, clearance rates of Daphnia feeding on unicellular Scenedesmus were inhibited by FFD-6, yielding a 50% inhibition (EC50–1.5h) at 5.2 μl l−1 with a NOEC of 0.5 μl l−1. When Daphnia were offered FFD-6-induced food in which eight-celled colonies (43 × 29 μm) were most abundant, clearance rates (~0.14 ml ind.−1 h−1) were only 25% the rates of animals that were offered non-induced unicellular (15 × 5 μm) Scenedesmus (~0.56 ml ind.−1 h−1). As FFD-6 concentrations in the treated food used in the experiments were far below the NOEC for clearance rate inhibition, it is concluded that the feeding rate depression was caused by the altered morphology of the Scenedesmus moving them out of the feeding window of the daphnids. The surfactant evoked a response in Scenedesmus that is similar to the natural chemically induced defensive reaction against grazers and could disrupt the natural information conveyance between these plankton organisms

Knowledge translation on dementia: a cluster randomized trial to compare a blended learning approach with a "classical" advanced training in GP quality circles

<p>Abstract</p> <p>Background</p> <p>Thus far important findings regarding the dementia syndrome have been implemented into patients' medical care only inadequately. A professional training accounting for both, general practitioners' (GP) needs and learning preferences as well as care-relevant aspects could be a major step towards improving medical care. In the WIDA-study, entitled "Knowledge translation on dementia in general practice" two different training concepts are developed, implemented and evaluated. Both concepts are building on an evidence-based, GP-related dementia guideline and communicate the guideline's essential insights.</p> <p>Methods/Design</p> <p>Both development and implementation emphasize a procedure that is well-accepted in practice and, thus, can achieve a high degree of external validity. This is particularly guaranteed through the preparation of training material and the fact that general practitioners' quality circles (QC) are addressed. The evaluation of the two training concepts is carried out by comparing two groups of GPs to which several quality circles have been randomly assigned. The primary outcome is the GPs' knowledge gain. Secondary outcomes are designed to indicate the training's potential effects on the GPs' practical actions. In the first training concept (study arm A) GPs participate in a structured case discussion prepared for by internet-based learning material ("blended-learning" approach). The second training concept (study arm B) relies on frontal medical training in the form of a slide presentation and follow-up discussion ("classical" approach).</p> <p>Discussion</p> <p>This paper presents the outline of a cluster-randomized trial which has been peer reviewed and support by a national funding organization – Federal Ministry of Education and Research (BMBF) – and is approved by an ethics commission. The data collection has started in August 2006 and the results will be published independently of the study's outcome.</p> <p>Trial Registration</p> <p>Current Controlled Trials [ISRCTN36550981]</p

Plutonic foundation of a slow-spreading ridge segment : oceanic core complex at Kane Megamullion, 23°30′N, 45°20′W

Author Posting. © American Geophysical Union, 2008. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geochemistry Geophysics Geosystems 9 (2008): Q05014, doi:10.1029/2007GC001645.We mapped the Kane megamullion, an oceanic core complex on the west flank of the Mid-Atlantic Ridge exposing the plutonic foundation of a ∼50 km long, second-order ridge segment. The complex was exhumed by long-lived slip on a normal-sense detachment fault at the base of the rift valley wall from ∼3.3 to 2.1 Ma (Williams, 2007). Mantle peridotites, gabbros, and diabase dikes are exposed in the detachment footwall and in outward facing high-angle normal fault scarps and slide-scar headwalls that cut through the detachment. These rocks directly constrain crustal architecture and the pattern of melt flow from the mantle to and within the lower crust. In addition, the volcanic carapace that originally overlay the complex is preserved intact on the conjugate African plate, so the complete internal and external architecture of the paleoridge segment can be studied. Seafloor spreading during formation of the core complex was highly asymmetric, and crustal accretion occurred largely in the footwall of the detachment fault exposing the core complex. Because additions to the footwall, both magmatic and amagmatic, are nonconservative, oceanic detachment faults are plutonic growth faults. A local volcano and fissure eruptions partially cover the northwestern quarter of the complex. This volcanism is associated with outward facing normal faults and possible, intersecting transform-parallel faults that formed during exhumation of the megamullion, suggesting the volcanics erupted off-axis. We find a zone of late-stage vertical melt transport through the mantle to the crust in the southern part of the segment marked by a ∼10 km wide zone of dunites that likely fed a large gabbro and troctolite intrusion intercalated with dikes. This zone correlates with the midpoint of a lineated axial volcanic high of the same age on the conjugate African plate. In the central region of the segment, however, primitive gabbro is rare, massive depleted peridotite tectonites abundant, and dunites nearly absent, which indicate that little melt crossed the crust-mantle boundary there. Greenschist facies diabase and pillow basalt hanging wall debris are scattered over the detachment surface. The diabase indicates lateral melt transport in dikes that fed the volcanic carapace away from the magmatic centers. At the northern edge of the complex (southern wall of the Kane transform) is a second magmatic center marked by olivine gabbro and minor troctolite intruded into mantle peridotite tectonite. This center varied substantially in size with time, consistent with waxing and waning volcanism near the transform as is also inferred from volcanic abyssal-hill relief on the conjugate African plate. Our results indicate that melt flow from the mantle focuses to local magmatic centers and creates plutonic complexes within the ridge segment whose position varies in space and time rather than fixed at a single central point. Distal to and between these complexes there may not be continuous gabbroic crust, but only a thin carapace of pillow lavas overlying dike complexes laterally fed from the magmatic centers. This is consistent with plate-driven flow that engenders local, stochastically distributed transient instabilities at depth in the partially molten mantle that fed the magmatic centers. Fixed boundaries, such as large-offset fracture zones, or relatively short segment lengths, however, may help to focus episodes of repeated melt extraction in the same location. While no previous model for ocean crust is like that inferred here, our observations do not invalidate them but rather extend the known diversity of ridge architecture.NSF Grants OCE-0118445, OCE-0624408 and OCE-0621660 supported this research. B. Tucholke was also supported by the Henry Bryant Bigelow Chair in Oceanography at Woods Hole Oceanographic Institution

Psychosynthesis: A Foundational Bridge Between Psychology and Spirituality

Pastoral psychologists have long tried to establish a working model that encompasses the seemingly conflicting disciplines of science and religion. Psychosynthesis, a transpersonal psychology and therapeutic approach, offers such a model of the human personality, in which the psychological and spiritual perspectives can converge. This article explores psychosynthesis psychology and therapy as a theoretical framework for pastoral psychology. Although psychosynthesis psychotherapy relies on an array of techniques, it fundamentally works with the clients’ will while emphasizing, exploring, and cultivating their relationships on all levels—intrapersonal, interpersonal, and with the Higher Self. In addition to the subconscious, psychosynthesis includes a higher psychological plane, called the superconscious, from which our higher ethical, aesthetic, scientific, and spiritual values are derived. This article begins by introducing psychosynthesis concepts and techniques. It then provides qualitative findings showing that psychosynthesis counseling helped to awaken spirituality in three out of eleven clients who had formerly identified themselves as atheists. In addition, testimonies are included that show that psychosynthesis counseling also helped all eleven clients to attain personal growth. Finally, the counselor describes her experience of psychosynthesis as a Christian in the therapeutic setting. The framework of psychosynthesis psychology and its techniques are viable methodologies for anyone searching to incorporate spiritual growth into a psychological working mode