Impact of an entrustable professional activities-based assessment system

Background: Beginning in 2014, all Accreditation Counsel of Graduate Medical Education (ACGME) accredited residency programs were required to move to a Milestones-based system for biannual resident assessment. The resident assessment system for the Virginia Tech-Carilion Obstetrics and Gynecology (OB/GYN) residency program was re-designed to meet this requirement in July, 2014. The ACGME Milestones based assessment tool was identified on multiple faculty surveys as an area for improvement. To address this issue, an entrustable professional activities (EPA) based assessment system was designed and implemented for assessment of all OB/GYN rotations. Objective: To evaluate the impact of an EPA based resident assessment system on faculty member’s evaluation of resident assessment tools. Methods: In this prospective quality improvement study, a survey was sent to all faculty members prior to the implementation of the EPA-based assessment system. The same survey was performed three months after the implementation of the new system. To facilitate analysis, each level of agreement was assigned a numerical value (1-5). The results were aggregated, and were analyzed using t-tests, assuming unequal variances. Results: Sixty-eight percent of the faculty responded to the first survey, and 67% responded to the follow up survey. Statistically significant (p<.05) improvements were noted in most measures of the EPA based assessment tool including “ease of use” (2.2 vs 4.4, p< 0.001) and “accurate representation of resident performance” (2.5 vs 3.9, p <0.001). Conclusion: An EPA based resident evaluation system significantly improved teaching faculty’s impression of most domains of our OB/GYN resident assessment tools

The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders

Objective: To determine the relationship of motor skills and the core behaviors of young children with autism, social affective skills and repetitive behaviors, as indicated through the calibrated autism severity scores. Design: The univariate GLM tested the relationship of gross and fine motor skills measured by the gross motor scale and the fine motor scale of the MSEL with autism symptomology as measured by calibrated autism severity scores. Setting: Majority of the data collected took place in an autism clinic. Participants: A cohort of 159 young children with ASD (n=110), PDD-NOS (n=26) and non-ASD (developmental delay, n=23) between the ages of 12- 33 months were recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of scores indicted through calibrated autism severity. Interventions: Not applicable. Main Outcome Measures: The primary outcome measures in this study were calibrated autism severity scores. Results: Fine motor skills and gross motor skills significantly predicted calibrated autism severity (p < 0.01). Children with weaker motor skills displayed higher levels of calibrated autism severity. Conclusions: The fine and gross motor skills are significantly related to autism symptomology. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.Keywords: Motor skills, Young children, Autism, Calibrated severit

Expenditure and resource utilisation for cervical screening in Australia

BACKGROUND The National Cervical Screening Program in Australia currently recommends that women aged 18-69 years are screened with conventional cytology every 2 years. Publicly funded HPV vaccination was introduced in 2007, and partly as a consequence, a renewal of the screening program that includes a review of screening recommendations has recently been announced. This study aimed to provide a baseline for such a review by quantifying screening program resource utilisation and costs in 2010. METHODS A detailed model of current cervical screening practice in Australia was constructed and we used data from the Victorian Cervical Cytology Registry to model age-specific compliance with screening and follow-up. We applied model-derived rate estimates to the 2010 Australian female population to calculate costs and numbers of colposcopies, biopsies, treatments for precancer and cervical cancers in that year, assuming that the numbers of these procedures were not yet substantially impacted by vaccination. RESULTS The total cost of the screening program in 2010 (excluding administrative program overheads) was estimated to be A$194.8M. We estimated that a total of 1.7 million primary screening smears costing$96.7M were conducted, a further 188,900 smears costing $10.9M were conducted to follow-up low grade abnormalities, 70,900 colposcopy and 34,100 histological evaluations together costing$21.2M were conducted, and about 18,900 treatments for precancerous lesions were performed (including retreatments), associated with a cost of $45.5M for treatment and post-treatment follow-up. We also estimated that$20.5M was spent on work-up and treatment for approximately 761 women diagnosed with invasive cervical cancer. Overall, an estimated $23 was spent in 2010 for each adult woman in Australia on cervical screening program-related activities. CONCLUSIONS Approximately half of the total cost of the screening program is spent on delivery of primary screening tests; but the introduction of HPV vaccination, new technologies, increasing the interval and changing the age range of screening is expected to have a substantial impact on this expenditure, as well as having some impact on follow-up and management costs. These estimates provide a benchmark for future assessment of the impact of changes to screening program recommendations to the costs of cervical screening in Australia

Pre-Linguistic Autism Diagnostic Observation Schedule Adapted for Older Individuals with Severe to Profound Mental Retardation: A Pilot Study

The Autism Diagnostic Observational Schedule (ADOS) is a semi-structured observational scale developed to assess social interaction, communication and play in individuals who are suspected to have autism. Since the ADOS is not suitable to be used with severely or profoundly mentally retarded adolescents and adults with very limited language skills, materials and some of the tasks of the PL-ADOS and the original ADOS (the former versions of the current ADOS) were adapted. Results indicated that almost all of the overall ratings showed good reliability and discriminative diagnostic validity. Furthermore, the combination of codings into an overall algorithm score on social/communicative behavior resulted in a sensitivity of .82 and a specificity of .85 when using a cut-off score of 15.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44627/1/10803_2005_Article_27.pd

Stratus Ocean Reference Station (20˚S, 85˚W) mooring recovery and deployment cruise STRATUS 8 R/V Ronald H. Brown cruise 07-09 October 9, 2007–November 6, 2007

The Ocean Reference Station at 20°S, 85°W under the stratus clouds west of northern Chile is being maintained to provide ongoing climate-quality records of surface meteorology (air-sea fluxes of heat, freshwater, and momentum), and of upper ocean temperature, salinity, and velocity variability. The Stratus Ocean Reference Station (ORS Stratus) is supported by the National Oceanic and Atmospheric Administration’s (NOAA) Climate Observation Program. It is recovered and redeployed annually, with cruises between October and December. During the October 2007 cruise on the NOAA ship Ronald H. Brown to the ORS Stratus site, the primary activities were recovery of the Stratus 7 WHOI surface mooring that had been deployed in October 2006, deployment of a new (Stratus 8) WHOI surface mooring at that site; in-situ calibration of the buoy meteorological sensors by comparison with instrumentation put on board the ship by staff of the NOAA Earth System Research Laboratory (ESRL); and observations of the stratus clouds and lower atmosphere by NOAA ESRL. Meteorological sensors on a buoy for the Pacific tsunami warning system were also serviced, in collaboration with the Hydrographic and Oceanographic Service of the Chilean Navy (SHOA). The DART (Deep-Ocean Assessment and Reporting of Tsunami) carries IMET sensors and subsurface oceanographic instruments. A new DART II buoy was deployed north of the STRATUS buoy, by personnel from the National Data Buoy Center (NDBC) Argo floats and drifters were launched, and CTD casts carried out during the cruise. The ORS Stratus buoys are equipped with two Improved Meteorological (IMET) systems, which provide surface wind speed and direction, air temperature, relative humidity, barometric pressure, incoming shortwave radiation, incoming longwave radiation, precipitation rate, and sea surface temperature. Additionally, the Stratus 8 buoy received a partial pressure of CO2 detector from the Pacific Marine Environmental Laboratory (PMEL). IMET data are made available in near real time using satellite telemetry. The mooring line carries instruments to measure ocean salinity, temperature, and currents. The ESRL instrumentation used during the 2007 cruise included cloud radar, radiosonde balloons, and sensors for mean and turbulent surface meteorology. Finally, the cruise hosted a teacher participating in NOAA’s Teacher at Sea Program.Funding was provided by the National Oceanic and Atmospheric Administration under Grant No. NA17RJ1223 for the Cooperative Institute for Climate and Ocean Research (CICOR)

Tatton-Brown-Rahman syndrome : cognitive and behavioural phenotypes

The aim of this case series was to assess and characterise cognitive abilities, autistic traits and adaptive behaviour in Tatton-Brown-Rahman syndrome. The sample included 18 individuals with a clinical and genetic diagnosis of TBRS (11 males, seven females; mean age 17y 7mo, SD 9y 5mo, range 7y 2mo–33y 10mo). The British Ability Scales, Third Edition and the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) were administered to all participants. The Social Responsiveness Scale, Second Edition and the Vineland Adaptive Behaviour Scales, Third Edition were completed by a parent/caregiver. The majority of participants (n=15) had intellectual disability and General Conceptual Ability scores ranged from 39 - 76 (mean 53.17, SD 12.13). Participants displayed a profile of better verbal ability compared with non-verbal reasoning ability and spatial ability. Autistic traits were prevalent and eight participants scored above the cut-off on the ADOS-2, though symptoms were less pronounced in older individuals. Adaptive functioning was impaired but commensurate with intellectual ability. Overall, TBRS is associated with an uneven cognitive profile and a high prevalence of autistic traits. This has implications for identifying appropriate services and support which may be beneficial for individuals with TBRS

The influence of habitual endurance exercise on carotid artery strain and strain-rate in young and middle-aged men

Central arterial stiffness is an independent predictor of cardiovascular risk that can be modified by exercise training. However, conventional local measures of carotid artery stiffness display conflicting responses to habitual endurance exercise in young and older adults. 2D-Strain imaging of the common carotid artery (CCA) quantifies circumferential deformation (strain) of the arterial wall across the cardiac cycle, which is more sensitive at detecting age-related alterations in CCA stiffness than conventional methods. Therefore, the study was designed to examine the relationship between habitual endurance exercise (running) and CCA 2D-Strain parameters in young and middle-aged men. Short-axis ultrasound images of the CCA were obtained from 13 young nonrunners (23 years [95% CI: 21-26]), 19 young runners (24 [22-26]), 13 middle-aged nonrunners (54 [52-56]) and 19 middle-aged runners (56 [54-58]). Images were analysed for peak circumferential strain (PCS; magnitude of deformation) as well as systolic and diastolic strain-rate (S-SR and D-SR; deformation velocity) and group differences were examined via two-way ANOVA. PCS, S-SR and D-SR were attenuated in middle-aged males when compared to young men (all P ≤ 0.001). PCS and S-SR were elevated in young and middle-aged runners when compared to nonrunners (P = 0.002 and P =0.009 respectively), but no age*training status interaction was observed. In contrast, there was no influence of habitual running on D-SR. Habitual exercise is associated with comparable improvements in CCA 2D-Strain parameters in young and middle-aged men, but the age-related decline in PCS and S-SR may be more amenable to habitual endurance exercise than D-SR