Can standardized patients replace physicians as OSCE examiners?

BACKGROUND: To reduce inter-rater variability in evaluations and the demand on physician time, standardized patients (SP) are being used as examiners in OSCEs. There is concern that SP have insufficient training to provide valid evaluation of student competence and/or provide feedback on clinical skills. It is also unknown if SP ratings predict student competence in other areas. The objectives of this study were: to examine student attitudes towards SP examiners; to compare SP and physician evaluations of competence; and to compare predictive validity of these scores, using performance on the multiple choice questions examination (MCQE) as the outcome variable. METHODS: This was a cross-sectional study of third-year medical students undergoing an OSCE during the Internal Medicine clerkship rotation. Fifty-two students rotated through 8 stations (6 physician, 2 SP examiners). Statistical tests used were Pearson's correlation coefficient, two-sample t-test, effect size calculation, and multiple linear regression. RESULTS: Most students reported that SP stations were less stressful, that SP were as good as physicians in giving feedback, and that SP were sufficiently trained to judge clinical skills. SP scored students higher than physicians (mean 90.4% +/- 8.9 vs. 82.2% +/- 3.7, d = 1.5, p < 0.001) and there was a weak correlation between the SP and physician scores (coefficient 0.4, p = 0.003). Physician scores were predictive of summative MCQE scores (regression coefficient = 0.88 [0.15, 1.61], P = 0.019) but there was no relationship between SP scores and summative MCQE scores (regression coefficient = -0.23, P = 0.133). CONCLUSION: These results suggest that SP examiners are acceptable to medical students, SP rate students higher than physicians and, unlike physician scores, SP scores are not related to other measures of competence

Nitric Oxide impacts human gut microbiota diversity and functionalities

International audienc

Proper name anomia in poststroke aphasics: evidence from a multiple-case study

<div><p>We aimed to characterize difficulties in famous face naming in three poststroke aphasic patients with a lesion limited to the left mid-posterior temporal language regions, sparing the anterior temporal lobe. The patients did not present semantic deficits specific to known people. Nonetheless, they showed difficulties naming famous buildings in addition to famous faces, but they were comparable to healthy controls in generating proper names. Our results support the critical role of the mid-posterior temporal language regions in the lexical retrieval of proper names, namely from pictorial stimuli, in absence of semantic impairments.</p></div

Nitric Oxide Impacts Human Gut Microbiota Diversity and Functionalities

International audienceThe disruption of gut microbiota homeostasis has been associated with numerous diseases and with a disproportionate inflammatory response, including overproduction of nitric oxide (NO) in the intestinal lumen. However, the influence of NO on the human gut microbiota has not been well characterized yet. We used in vitro fermentation systems inoculated with human fecal samples to monitor the effect of repetitive NO pulses on the gut microbiota. NO exposure increased the redox potential and modified the fermentation profile and gas production. The overall metabolome was modified, reflecting less strict anaerobic conditions and shifts in amino acid and nitrogen metabolism. NO exposure led to a microbial shift in diversity with a decrease in Clostridium leptum group and Faecalibacterium prausnitzii biomass and an increased abundance of the Dialister genus. Escherichia coli, Enterococcus faecalis, and Proteus mirabilis operational taxonomic unit abundance increased, and strains from those species isolated after NO stress showed resistance to high NO concentrations. As a whole, NO quickly changed microbial fermentations, functions, and composition in a pulse-and dose-dependent manner. NO could shift, over time, the trophic chain to conditions that are unfavorable for strict anaerobic microbial processes, implying that a prolonged or uncontrolled inflammation has detrimental and irreversible consequences on the human microbiome.IMPORTANCE Gut microbiota dysbiosis has been associated with inflammatory diseases. The human inflammatory response leads to an overproduction of nitric oxide (NO) in the gut. However, so far, the influence of NO on the human gut microbiota has not been characterized. In this study, we used in vitro fermentation systems with human fecal samples to understand the effect of NO on the microbiota: NO modified the microbial composition and its functionality. High NO concentration depleted the microbiota of beneficial butyrate-producing species and favored potentially deleterious species (E. coli, E. faecalis, and P. mirabilis), which we showed can sustain high NO concentrations. Our work shows that NO may participate in the vicious circle of inflammation, leading to detrimental and irreversible consequences on human health

The IVS data input to ITRF2014

2015ivs..data....1N - GFZ Data Services, Helmoltz Centre, Potsdam, GermanyVery Long Baseline Interferometry (VLBI) is a primary space-geodetic technique for determining precise coordinates on the Earth, for monitoring the variable Earth rotation and orientation with highest precision, and for deriving many other parameters of the Earth system. The International VLBI Service for Geodesy and Astrometry (IVS, http://ivscc.gsfc.nasa.gov/) is a service of the International Association of Geodesy (IAG) and the International Astronomical Union (IAU). The datasets published here are the results of individual Very Long Baseline Interferometry (VLBI) sessions in the form of normal equations in SINEX 2.0 format (http://www.iers.org/IERS/EN/Organization/AnalysisCoordinator/SinexFormat/sinex.html, the SINEX 2.0 description is attached as pdf) provided by IVS as the input for the next release of the International Terrestrial Reference System (ITRF): ITRF2014. This is a new version of the ITRF2008 release (Bockmann et al., 2009). For each session/ file, the normal equation systems contain elements for the coordinate components of all stations having participated in the respective session as well as for the Earth orientation parameters (x-pole, y-pole, UT1 and its time derivatives plus offset to the IAU2006 precession-nutation components dX, dY (https://www.iau.org/static/resolutions/IAU2006_Resol1.pdf). The terrestrial part is free of datum. The data sets are the result of a weighted combination of the input of several IVS Analysis Centers. The IVS contribution for ITRF2014 is described in Bachmann et al (2015), Schuh and Behrend (2012) provide a general overview on the VLBI method, details on the internal data handling can be found at Behrend (2013)