Experiential Learning in Patient Safety: A Multi-Center Study Examining Emergency Medicine Residents\u27 Situational Awareness of Hazards via Simulation

Introduction The 2016 Clinical Learning Environment Review established that experiential patient safety curricula for residents are uncommon. Moreover, these curricula do not incorporate non-technical skills linked to safety, such as situational awareness (SA). We developed an in-situ patient safety simulation exercise incorporating core SA concepts and subsequently assessed exercise feasibility and acceptability, and measured residents\u27 safety SA. Methods A simulation scenario and mock chart were designed, incorporating 16 patient safety hazards. Residents at two institutions reviewed the chart and had 10 minutes in an emergency department room with the simulated scenario to document identified hazards, followed by a facilitated debriefing. Pre- and post-exercise surveys were completed. We used regression analyses to compare exercise performance and survey responses by training year, and measures of proportional difference and association for survey responses. Results This study included 76 of 104 eligible residents (73.1%). Around 56.5% initially reported being comfortable identifying hazards. During the exercise, hazards requiring higher SA were identified less frequently. Senior residents identified more hazards (OR 2.26; 95%CI 1.56-3.28) (mean 8.28, SD1.45); 93.4% expressed satisfaction with the session, and residents reporting comfort increased significantly (89.5%,

Characterising the KMP-11 and HSP-70 recombinant antigens' humoral immune response profile in chagasic patients

11 pages, 6 figures.-- The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2334/9/186/pre pubBackground: Antigen specificity and IgG subclass could be significant in the natural history of Chagas' disease. The relationship between the different stages of human Chagas' disease and the profiles of total IgG and its subclasses were thus analysed here; they were directed against a crude T. cruzi extract and three recombinant antigens: the T. cruzi kinetoplastid membrane protein-11 (rKMP-11), an internal fragment of the T. cruzi HSP-70 protein192-433, and the entire Trypanosoma rangeli HSP-70 protein. Methods: Seventeen Brazilian acute chagasic patients, 50 Colombian chronic chagasic patients (21 indeterminate and 29 cardiopathic patients) and 30 healthy individuals were included. Total IgG and its subtypes directed against the above-mentioned recombinant antigens were determined by ELISA tests. Results: The T. cruzi KMP-11 and T. rangeli HSP-70 recombinant proteins were able to distinguish both acute from chronic chagasic patients and infected people from healthy individuals. Specific antibodies to T. cruzi crude antigen in acute patients came from IgG3 and IgG4 subclasses whereas IgG1 and IgG3 were the prevalent isotypes in indeterminate and chronic chagasic patients. By contrast, the specific prominent antibodies in all disease stages against T. cruzi KMP-11 and T. rangeli HSP-70 recombinant antigens were the IgG1 subclass.This work was supported by Colciencias Research project No. 1203-333- 18692. IDF was supported by Colciencias and the Universidad Javeriana's Young Researcher 2008 Programme (Bogotá, Colombia). MCT and MCL were supported by P06-CTS-02242 Grant from PAI (Junta de Andalucia) and RICET-RD06/0021-0014, Spain. MS received financial support from the Brazilian agency - CNPq.Peer reviewe

Pattern of Relapse and Treatment Response in WNT- Activated Medulloblastoma

Over the past decade, wingless-activated (WNT) medulloblastoma has been identified as a candidate for therapy de-escalation based on excellent survival; however, a paucity of relapses has precluded additional analyses of markers of relapse. To address this gap in knowledge, an international cohort of 93 molecularly confirmed WNT MB was assembled, where 5-year progression-free survival is 0.84 (95%, 0.763-0.925) with 15 relapsed individuals identified. Maintenance chemotherapy is identified as a strong predictor of relapse, with individuals receiving high doses of cyclophosphamide or ifosphamide having only one very late molecularly confirmed relapse (p = 0.032). The anatomical location of recurrence is metastatic in 12 of 15 relapses, with 8 of 12 metastatic relapses in the lateral ventricles. Maintenance chemotherapy, specifically cumulative cyclophosphamide doses, is a significant predictor of relapse across WNT MB. Future efforts to de-escalate therapy need to carefully consider not only the radiation dose but also the chemotherapy regimen and the propensity for metastatic relapses

ENIGMA CHEK2gether Project: A Comprehensive Study Identifies Functionally Impaired CHEK2 Germline Missense Variants Associated with Increased Breast Cancer Risk

PURPOSE: Germline pathogenic variants in CHEK2 confer moderately elevated breast cancer risk (odds ratio, OR ∼ 2.5), qualifying carriers for enhanced breast cancer screening. Besides pathogenic variants, dozens of missense CHEK2 variants of uncertain significance (VUS) have been identified, hampering the clinical utility of germline genetic testing (GGT). EXPERIMENTAL DESIGN: We collected 460 CHEK2 missense VUS identified by the ENIGMA consortium in 15 countries. Their functional characterization was performed using CHEK2-complementation assays quantifying KAP1 phosphorylation and CHK2 autophosphorylation in human RPE1-CHEK2-knockout cells. Concordant results in both functional assays were used to categorize CHEK2 VUS from 12 ENIGMA case-control datasets, including 73,048 female patients with breast cancer and 88,658 ethnicity-matched controls. RESULTS: A total of 430/460 VUS were successfully analyzed, of which 340 (79.1%) were concordant in both functional assays and categorized as functionally impaired (N = 102), functionally intermediate (N = 12), or functionally wild-type (WT)-like (N = 226). We then examined their association with breast cancer risk in the case-control analysis. The OR and 95% CI (confidence intervals) for carriers of functionally impaired, intermediate, and WT-like variants were 2.83 (95% CI, 2.35-3.41), 1.57 (95% CI, 1.41-1.75), and 1.19 (95% CI, 1.08-1.31), respectively. The meta-analysis of population-specific datasets showed similar results. CONCLUSIONS: We determined the functional consequences for the majority of CHEK2 missense VUS found in patients with breast cancer (3,660/4,436; 82.5%). Carriers of functionally impaired missense variants accounted for 0.5% of patients with breast cancer and were associated with a moderate risk similar to that of truncating CHEK2 variants. In contrast, 2.2% of all patients with breast cancer carried functionally wild-type/intermediate missense variants with no clinically relevant breast cancer risk in heterozygous carriers

A produção escrita de alunos com e sem síndrome de Down: uma análise da coerência textual

Neste trabalho, analisa-se a coerência textual a partir da reescrita do conto de Rapunzel. Baseia-se em uma abordagem psicogenética da língua escrita. Participaram desse estudo nove alunos, sendo seis com síndrome de Down (Grupo I) e os outros três sem deficiência (Grupo II). Eles cursavam entre o 2º e 8º anos do Ensino Fundamental em escolas regulares. O procedimento de produção textual consistiu em um encontro individual, cuja solicitação de produção escrita era precedida pela leitura do conto pela pesquisadora. Os dados indicaram a presença da coerência textual nos dois grupos, embora mais frequente nas produções do grupo II, que demonstrava maior competência com os elementos de coerência textual. O grupo II apresentou estratégias poderosas para mobilizar os recursos cognitivos que permitiram articular conhecimentos anteriores e focalizá-los na produção e articulação de suas ideias no texto. O grupo I, na sua maioria, experimentava dificuldades em elaborar um desfecho em estreita relação com as partes que compunham o texto. Não apresentaram, porém, dificuldades em definir e manter a personagem principal ao longo de toda a história escrita, mesmo quando a história era incoerente se considerarmos outros indicadores. Qualitativamente, os textos dos alunos com síndrome de Down se diferenciaram daqueles produzidos pelo grupo II. Não identificamos, porém, características que podem representar especificidades na produção escrita dos alunos com essa síndrome, visto que alguns alunos com síndrome de Down produziram textos apresentando coerência

Laboratorio de experiencias : una estrategia para la cultura informacional en la Biblioteca-CRAI Universidad de Antioquia

RESUMEN: El laboratorio de experiencias es una estrategia para generar un espacio de participación, aprendizaje y decisión conjunta en el que los involucrados acuerdan trabajar y aprender juntos para identificar de manera conjunta un horizonte formativo en perspectiva de una cultura informacional. Esto significa la consolidación de un marco teórico que ilumine el sendero de la práctica educativa y un modelo pedagógico que orienten sus acciones. En ese sentido, el laboratorio de experiencias se define como un espacio de trabajo colaborativo que busca apropiar conocimientos en el campo de la pedagogía y la didáctica que permitan la comprensión del proceso de formación desde los contenidos educativos, los métodos de enseñanza y las estrategias de evaluación, en la dimensión de una cultura informacional. Igualmente, se tiene en cuenta a otros actores que han aportado conceptualmente, desde las teorías de la formación y las tradiciones pedagógicas que soportan los pilares de la práctica educativa que se desarrolla en el Sistema de Bibliotecas de la Universidad de Antioquia

Where Should Governments Invest? The Impact of Economic, Political, Social and Technological Factors on the Formation of New Firms

The purpose of this paper is to identify the factors that affect the creation of new firms. We take into consideration economic, political, social and technological factors which should also help governments realize the areas that we found to have the greatest impact. The study relies on data from international organizations from which we construct an ordered probit statistical analysis. The results indicate that investments in both ICT and education enhance the probability of generating new business