Intérêt d’un score de la qualité de l'évaluation pour l'apprentissage pour évaluer la rétroaction écrite dans la formation postdoctorale en anesthésiologie : étude de généralisabilité et de décision

Background: Competency based residency programs depend on high quality feedback from the assessment of entrustable professional activities (EPA). The Quality of Assessment for Learning (QuAL) score is a tool developed to rate the quality of narrative comments in workplace-based assessments; it has validity evidence for scoring the quality of narrative feedback provided to emergency medicine residents, but it is unknown whether the QuAL score is reliable in the assessment of narrative feedback in other postgraduate programs. Methods: Fifty sets of EPA narratives from a single academic year at our competency based medical education post-graduate anesthesia program were selected by stratified sampling within defined parameters [e.g. resident gender and stage of training, assessor gender, Competency By Design training level, and word count (≥17 or <17 words)]. Two competency committee members and two medical students rated the quality of narrative feedback using a utility score and QuAL score. We used Kendall’s tau-b co-efficient to compare the perceived utility of the written feedback to the quality assessed with the QuAL score. The authors used generalizability and decision studies to estimate the reliability and generalizability coefficients. Results: Both the faculty’s utility scores and QuAL scores (r = 0.646, p < 0.001) and the trainees’ utility scores and QuAL scores (r = 0.667, p < 0.001) were moderately correlated. Results from the generalizability studies showed that utility scores were reliable with two raters for both faculty (Epsilon=0.87, Phi=0.86) and trainees (Epsilon=0.88, Phi=0.88). Conclusions: The QuAL score is correlated with faculty- and trainee-rated utility of anesthesia EPA feedback. Both faculty and trainees can reliability apply the QuAL score to anesthesia EPA narrative feedback. This tool has the potential to be used for faculty development and program evaluation in Competency Based Medical Education. Other programs could consider replicating our study in their specialty.Contexte : La qualité de la rétroaction à la suite de l’évaluation d’activités professionnelles confiables (APC) est d’une importance capitale dans les programmes de résidence fondés sur les compétences. Le score QuAL (Quality of Assessment for Learning) est un outil développé pour évaluer la qualité de la rétroaction narrative dans les évaluations en milieu de travail. Sa validité a été démontrée dans le cas des commentaires narratifs fournis aux résidents en médecine d'urgence, mais sa fiabilité n’a pas été évaluée dans d'autres programmes de formation postdoctorale. Méthodes : Cinquante ensembles de commentaires portant sur des APC d'une seule année universitaire dans notre programme postdoctoral en anesthésiologie – un programme fondé sur les compétences – ont été sélectionnés par échantillonnage stratifié selon des paramètres préétablis [par exemple, le sexe du résident et son niveau de formation, le sexe de l'évaluateur, le niveau de formation en Compétence par conception, et le nombre de mots (≥17 ou <17 mots)]. Deux membres du comité de compétence et deux étudiants en médecine ont évalué la qualité de la rétroaction narrative à l'aide d'un score d'utilité et d'un score QuAL. Nous avons utilisé le coefficient tau-b de Kendall pour comparer l'utilité perçue de la rétroaction écrite et sa qualité évaluée à l’aide du score QuAL. Les auteurs ont utilisé des études de généralisabilité et de décision pour estimer les coefficients de fiabilité et de généralisabilité. Résultats : Les scores d'utilité et les scores QuAL des enseignants (r = 0,646, p < 0,001) et ceux des étudiants (r = 0,667, p < 0,001) étaient modérément corrélés. Les résultats des études de généralisabilité ont montré qu’avec deux évaluateurs les scores d'utilité étaient fiables tant pour les enseignants (Epsilon=0,87, Phi=0,86) que pour les étudiants (Epsilon=0,88, Phi=0,88). Conclusions : Le score QuAL est en corrélation avec l'utilité de la rétroaction sur les APC en anesthésiologie évaluée par les enseignants et les étudiants. Les uns et les autres peuvent appliquer de manière fiable le score QuAL aux commentaires narratifs sur les APC en anesthésiologie. Cet outil pourrait être utilisé pour le perfectionnement professoral et l'évaluation des programmes dans le cadre d’une formation médicale fondée sur les compétences. D'autres programmes pourraient envisager de reproduire notre étude dans leur spécialité

Biases in Long-term NO2 Averages Inferred from Satellite Observations Due to Cloud Selection Criteria

Retrievals of atmospheric trace gas column densities from space are compromised by the presence of clouds, requiring most studies to exclude observations with significant cloud fractions in the instrument's field of view. Using NO2 observations at three ground stations representing urban, suburban, and rural environments, and tropospheric vertical column densities measured by the Ozone Monitoring Instrument (OMI) over each site, we show that the observations from space represent monthly averaged ground-level pollutant conditions well (R=0.86) under relatively cloud-free conditions. However, by analyzing the ground-level data and applying the OMI cloud fraction as a filter, we show there is a significant bias in long-term averaged NO2 as a result of removing the data during cloudy conditions. For the ground-based sites considered in this study, excluding observations on days when OMI-derived cloud fractions were greater than 0.2 causes 12:00-14:00 mean summer mixing ratios to be underestimated by 12%+/-6%, 20%+/-7%, and 40%+/-10% on average (+/-1 standard deviation) at the urban, suburban, and rural sites respectively. This bias was investigated in particular at the rural site, a region where pollutant transport is the main source of NO2, and where longterm observations of NOy were also available. Evidence of changing photochemical conditions and a correlation between clear skies and the transport of cleaner air masses play key roles in explaining the bias. The magnitude of a bias is expected to vary from site to site depending on meteorology and proximity to NOx sources, and decreases when longer averaging times of ground station data (e.g. 24-h) are used for the comparison

Évaluation d’un programme de recherche canadien pour les résidents en anesthésiologie par rapport aux normes nationales à l’aide d’un modèle logique : une étude d’amélioration de la qualité

Background: Canadian specialty training programs are expected to deliver curriculum content and assess competencies related to the CanMEDS Scholar role. We evaluated our residency research program and benchmarked it against national norms for quality improvement purposes. Methods: In 2021, we reviewed departmental curriculum documents and surveyed current and recently graduated residents.  We applied a logic model framework to assess if our program’s inputs, activities, and outputs addressed the relevant CanMeds Scholar competencies.  We then descriptively benchmarked our results against a 2021 environmental scan of Canadian anesthesiology resident research programs. Results: Local program content was successfully mapped to competencies.  The local survey response rate was 40/55 (73%).  In benchmarking, our program excelled in providing milestone-related assessments, research funding, administrative, supervisory, and methodologic support, and requiring a literature review, proposal presentation, and local abstract submission as output.  Acceptable activities to meet research requirements vary greatly among programs.  Balancing competing clinical and research responsibilities was a frequently reported challenge.   Conclusions: The logic model framework was easily applied and demonstrated our program benchmarked well against national norms.  National level dialogue is needed to develop specific, consistent scholar role activities and competency assessments to bridge the gap between expected outcome standards and education practice.Contexte : Les programmes de spécialité canadiens doivent proposer un contenu de formation en lien avec le rôle CanMEDS d’érudit et évaluer les compétences qui s’y attachent. Nous avons évalué notre programme de résidence en recherche par rapport aux normes nationales en la matière à des fins d’amélioration de la qualité. Méthodes : En 2021, nous avons examiné les documents du programme d’études du département et interrogé des résidents et des médecins récemment diplômés. Nous avons utilisé un modèle logique pour déterminer si les intrants, les activités et les extrants de notre programme couvraient adéquatement les compétences pertinentes liées au rôle CanMeds d’érudit. Nous avons ensuite comparé de façon descriptive nos résultats à une analyse du milieu des programmes de résidence canadiens en recherche en anesthésiologie effectuée la même année. Résultats : Nous avons établi une correspondance entre le contenu du programme local et les compétences. Le taux de réponse à l’enquête était de 40/55 (73 %). D’après l’analyse comparative, notre programme se démarque par l’offre d’évaluations d’étape, de fonds de recherche, de soutien administratif, de supervision, d’orientation méthodologique, et, en ce qui concerne les extrants, par l’exigence d’une analyse documentaire, de la présentation d’une proposition et de la soumission d’un résumé à l’université. Les activités admissibles pour répondre aux exigences de la recherche varient considérablement d’un programme à l’autre. De nombreux répondants ont signalé la difficulté de concilier les responsabilités cliniques et de recherche. Conclusions : L’application du modèle logique a été aisée et elle a permis de montrer que notre programme respecte les normes nationales. Un dialogue au niveau national est nécessaire pour définir de manière précise et cohérente les activités et les évaluations des compétences en lien avec le rôle d’érudit afin de combler le fossé entre les normes quant aux résultats attendus et les pratiques des programmes

Construction of a highly enriched marsupial Y chromosome-specific BAC sub-library using isolated Y chromosomes

The Y chromosome is perhaps the most interesting element of the mammalian genome but comparative analysis of the Y chromosome has been impeded by the difficulty of assembling a shotgun sequence of the Y. B AC-based sequencing has been successful for the human and chimpanzee Y but is difficult to do efficiently for an atypical mammalian model species (Skaletsky et al. 2003, Kuroki et al. 2006). We show how Y-specific sub-libraries can be efficiently constructed using DNA amplified from microdissected or flow-sorted Y chromosomes. A Bacterial Artificial Chromosome (BAC) library was constructed from the model marsupial, the tammar wallaby (Macropus eugenii). We screened this library for Y chromosome-derived BAC clones using DNA from both a microdissected Y chromosome and a flow-sorted Y chromosome in order to create a Y chromosome-specific sub-library. We expected that the tammar wallaby Y chromosome should detect ∼100 clones from the 2.2 times redundant library. The microdissected Y DNA detected 85 clones, 82% of which mapped to the Y chromosome and the flow-sorted Y DNA detected 71 clones, 48% of which mapped to the Y chromosome. Overall, this represented a ∼330-fold enrichment for Y chromosome clones. This presents an ideal method for the creation of highly enriched chromosome-specific sub-libraries suitable for BAC-based sequencing of the Y chromosome of any mammalian species

Campus & alumni news

Boston University Medicine was published by the Boston University Medical Campus, and presented stories on events and topics of interest to members of the BU Medical Campus community. It followed the discontinued publication Centerscope as Boston University Medicine from 1991-2005, and was continued as Campus & Alumni News from 2006-2013 before returning to the title Boston University Medicine from 2014-present

COI metabarcoding of zooplankton species diversity for time-series monitoring of the NW Atlantic continental shelf

© The Author(s), 2022. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Bucklin, A., Batta-Lona, P., Questel, J., Wiebe, P., Richardson, D., Copley, N., & O’Brien, T. COI metabarcoding of zooplankton species diversity for time-series monitoring of the NW Atlantic continental shelf. Frontiers in Marine Science, 9, (2022): 867893, https://doi.org/10.3389/fmars.2022.867893.Marine zooplankton are rapid-responders and useful indicators of environmental variability and climate change impacts on pelagic ecosystems on time scales ranging from seasons to years to decades. The systematic complexity and taxonomic diversity of the zooplankton assemblage has presented significant challenges for routine morphological (microscopic) identification of species in samples collected during ecosystem monitoring and fisheries management surveys. Metabarcoding using the mitochondrial Cytochrome Oxidase I (COI) gene region has shown promise for detecting and identifying species of some – but not all – taxonomic groups in samples of marine zooplankton. This study examined species diversity of zooplankton on the Northwest Atlantic Continental Shelf using 27 samples collected in 2002-2012 from the Gulf of Maine, Georges Bank, and Mid-Atlantic Bight during Ecosystem Monitoring (EcoMon) Surveys by the NOAA NMFS Northeast Fisheries Science Center. COI metabarcodes were identified using the MetaZooGene Barcode Atlas and Database (https://metazoogene.org/MZGdb) specific to the North Atlantic Ocean. A total of 181 species across 23 taxonomic groups were detected, including a number of sibling and cryptic species that were not discriminated by morphological taxonomic analysis of EcoMon samples. In all, 67 species of 15 taxonomic groups had ≥ 50 COI sequences; 23 species had >1,000 COI sequences. Comparative analysis of molecular and morphological data showed significant correlations between COI sequence numbers and microscopic counts for 5 of 6 taxonomic groups and for 5 of 7 species with >1,000 COI sequences for which both types of data were available. Multivariate statistical analysis showed clustering of samples within each region based on both COI sequence numbers and EcoMon counts, although differences among the three regions were not statistically significant. The results demonstrate the power and potential of COI metabarcoding for identification of species of metazoan zooplankton in the context of ecosystem monitoring.This publication resulted in part from support provided by the Scientific Committee on Oceanic Research (SCOR). Funds were also contributed by the U.S. National Science Foundation (Grant OCE-1840868) and by national SCOR committees

Fluoroquinolone Efficacy against Tuberculosis Is Driven by Penetration into Lesions and Activity against Resident Bacterial Populations.

Fluoroquinolones represent the pillar of multidrug-resistant tuberculosis (MDR-TB) treatment, with moxifloxacin, levofloxacin, or gatifloxacin being prescribed to MDR-TB patients. Recently, several clinical trials of "universal" drug regimens, aiming to treat drug-susceptible and drug-resistant TB, have included a fluoroquinolone. In the absence of clinical data comparing their side-by-side efficacies in controlled MDR-TB trials, a pharmacological rationale is needed to guide the selection of the most efficacious fluoroquinolone. The present studies were designed to test the hypothesis that fluoroquinolone concentrations (pharmacokinetics) and activity (pharmacodynamics) at the site of infection are better predictors of efficacy than the plasma concentrations and potency measured in standard growth inhibition assays and are better suited to determinations of whether one of the fluoroquinolones outperforms the others in rabbits with active TB. We first measured the penetration of these fluoroquinolones in lung lesion compartments, and their potency against bacterial populations that reside in each compartment, to compute lesion-centric pharmacokinetic-pharmacodynamic (PK/PD) parameters. PK modeling methods were used to quantify drug penetration from plasma to tissues at human-equivalent doses. On the basis of these metrics, moxifloxacin emerged with a clear advantage, whereas plasma-based PK/PD favored levofloxacin (the ranges of the plasma AUC/MIC ratio [i.e., the area under the concentration-time curve over 24 h in the steady state divided by the MIC] are 46 to 86 for moxifloxacin and 74 to 258 for levofloxacin). A comparative efficacy trial in the rabbit model of active TB demonstrated the superiority of moxifloxacin in reducing bacterial burden at the lesion level and in sterilizing cellular and necrotic lesions. Collectively, these results show that PK/PD data obtained at the site of infection represent an adequate predictor of drug efficacy against TB and constitute the baseline required to explore synergies, antagonism, and drug-drug interactions in fluoroquinolone-containing regimens

The Lotic Intersite Nitrogen Experiments: an example of successful ecological research collaboration

Collaboration is an essential skill for modern ecologists because it brings together diverse expertise, viewpoints, and study systems. The Lotic Intersite Nitrogen eXperiments (LINX I and II), a 17-y research endeavor involving scores of early- to late-career stream ecologists, is an example of the benefits, challenges, and approaches of successful collaborative research in ecology. The scientific success of LINX reflected tangible attributes including clear scientific goals (hypothesis-driven research), coordinated research methods, a team of cooperative scientists, excellent leadership, extensive communication, and a philosophy of respect for input from all collaborators. Intangible aspects of the collaboration included camaraderie and strong team chemistry. LINX further benefited from being part of a discipline in which collaboration is a tradition, clear data-sharing and authorship guidelines, an approach that melded field experiments and modeling, and a shared collaborative goal in the form of a universal commitment to see the project and resulting data products through to completion

Modest serum creatinine elevation affects adverse outcome after general surgery

Modest serum creatinine elevation affects adverse outcome after general surgery.BackgroundModest preoperative serum creatinine elevation (1.5 to 3.0 mg/dL) has been recently shown to be independently associated with morbidity and mortality after cardiac surgery. It is important to know if this association can be applied more broadly to general surgery cases.MethodsMultivariable logistic regression analyses of 46 risk variables in 49,081 cases from the Veterans Affairs National Surgical Quality Improvement Program, undergoing major general surgery from 10/1/96 through 9/30/98.ResultsThirty day mortality and several cardiac, respiratory, infectious and hemorrhagic morbidities were significantly (P < 0.001) higher in patients with a serum creatinine>1.5 mg/dL. With multivariable analysis, the adjusted odds ratio for mortality for patients with a serum creatinine of 1.5 to 3.0 mg/dL was 1.44 [95% confidence interval (95% CI) 1.22 to 1.71] and for creatinine>3.0 mg/dL was 1.93 (95% CI 1.51 to 2.46). The adjusted odds ratio for morbidity (one or more postoperative complications) for patients with a serum creatinine of 1.5 to 3.0 mg/dL was 1.18 (95% CI 1.06 to 1.32) and for creatinine>3.0 mg/dL was 1.19 (95% CI 0.99 to 1.43). Further stratification and recursive partitioning of creatinine levels revealed that a serum creatinine level>1.5 mg/dL was the approximate threshold for both increased morbidity and mortality.ConclusionsModest preoperative serum creatinine elevation (>1.5 mg/dL) is a significant predictor of risk-adjusted morbidity and mortality after general surgery. A preoperative serum creatinine of 1.5 mg/dL or higher is a readily available marker for potential adverse outcomes after general surgery