Preuve de la validité du score de la qualité de l’évaluation pour l’apprentissage : une mesure de qualité pour les commentaires des superviseurs dans la formation médicale fondée sur les compétences

Background: Competency based medical education (CBME) relies on supervisor narrative comments contained within entrustable professional activities (EPA) for programmatic assessment, but the quality of these supervisor comments is unassessed. There is validity evidence supporting the QuAL (Quality of Assessment for Learning) score for rating the usefulness of short narrative comments in direct observation. Objective: We sought to establish validity evidence for the QuAL score to rate the quality of supervisor narrative comments contained within an EPA by surveying the key end-users of EPA narrative comments: residents, academic advisors, and competence committee members. Methods: In 2020, the authors randomly selected 52 de-identified narrative comments from two emergency medicine EPA databases using purposeful sampling. Six collaborators (two residents, two academic advisors, and two competence committee members) were recruited from each of four EM Residency Programs (Saskatchewan, McMaster, Ottawa, and Calgary) to rate these comments with a utility score and the QuAL score.  Correlation between utility and QuAL score were calculated using Pearson’s correlation coefficient. Sources of variance and reliability were calculated using a generalizability study. Results: All collaborators (n = 24) completed the full study.  The QuAL score had a high positive correlation with the utility score amongst the residents (r = 0.80) and academic advisors (r = 0.75) and a moderately high correlation amongst competence committee members (r = 0.68).  The generalizability study found that the major source of variance was the comment indicating the tool performs well across raters. Conclusion: The QuAL score may serve as an outcome measure for program evaluation of supervisors, and as a resource for faculty development.Contexte : Dans la formation médicale fondée sur les compétences (FMFC), l’évaluation programmatique s’appuie sur les commentaires narratifs des superviseurs en lien avec les activités professionnelles confiables (EPA). En revanche, la qualité de ces commentaires n’est pas évaluée. Il existe des preuves de la validité du score QuAL (qualité de l’évaluation pour l’apprentissage, Quality of Assessment for Learning en anglais) pour l’évaluation de l’utilité des commentaires de rétroaction courts lors de la supervision par observation directe. Objectif : Nous avons tenté de démontrer la validité du score QuAL aux fins de l’évaluation de la qualité des commentaires narratifs des superviseurs pour une APC en interrogeant les principaux utilisateurs finaux des rétroactions : les résidents, les conseillers pédagogiques et les membres du comité de compétence. Méthodes : En 2020, les auteurs ont sélectionné au hasard 52 commentaires narratifs anonymisés dans deux bases de données d’APC en médecine d’urgence au moyen d’un échantillonnage intentionnel. Six collaborateurs (deux résidents, deux conseillers pédagogiques et deux membres de comités de compétence) ont été recrutés dans chacun des quatre programmes de résidence en médecine d’urgence (Saskatchewan, McMaster, Ottawa et Calgary) pour évaluer ces commentaires à l’aide d’un score d’utilité et du score QuAL.  La corrélation entre l’utilité et le score QuAL a été calculée à l’aide du coefficient de corrélation de Pearson. Les sources de variance et la fiabilité ont été calculées à l’aide d’une étude de généralisabilité. Résultats : Tous les collaborateurs (n=24) ont réalisé l’étude complète.  Le score QuAL présentait une corrélation positive élevée avec le score d’utilité parmi les résidents (r=0,80) et les conseillers pédagogiques (r=0,75) et une corrélation modérément élevée parmi les membres du comité de compétence (r=0,68).  L’étude de généralisation a révélé que la principale source de variance était le commentaire, ce qui indique que l’outil a fonctionné avec une efficacité égale pour tous les évaluateurs. Conclusion : Le score QuAL peut servir de mesure des résultats pour l’évaluation des superviseurs par les programmes, et de ressource pour le perfectionnement du corps professoral

Genetic diversity of Mycobacterium tuberculosis complex strains isolated from livestock workers and cattle in Nigeria

CITATION: Adesokan, H. K. et al. 2019. Genetic diversity of Mycobacterium tuberculosis complex strains isolated from livestock workers and cattle in Nigeria. PLoS ONE, 14(2):e0211637, doi:10.1371/journal.pone.0211637.The original publication is available at https://journals.plos.org/plosoneENGLISH ABSTRACT: Molecular typing techniques are useful in understanding tuberculosis epidemiology; yet, they have been under-utilised at the human-animal interface in Nigeria. Sixty-four Mycobacterium tuberculosis complex (MTBC) isolates including 42 M. tuberculosis, 13 M. bovis and nine M. africanum obtained from livestock workers (LW, n = 47) and their cattle (n = 17) in three geographical zones of Nigeria were genotyped to identify and evaluate the genetic diversity of the circulating MTBC using spoligotyping. Distribution into clades of M. tuberculosis revealed; 45.3% Uganda I- [SIT46- cattle: 1; LW: 28], 14.1% Latin American Mediterranean- [SIT61, cattle: 1; LW: 8], and 1.6% T- [SIT53—LW: 1]. The M. bovis strains were 6.3% SB0944 [cattle: 4] and 1.6% each of SB0300, SB1026, SB1027 and SB1439 [cattle: 4]. Seventeen MTBC isolates [cattle: 7; LW: 10] yielded 14 new spoligotype patterns including three M. tuberculosis strains (three isolates), five M. bovis strains (five isolates) and six M. africanum strains (nine isolates), two of which belonged to MAF1. Only few families namely, the not previously described Uganda I-, LAM and SB0944 are predominant among the LW and cattle, with other types in lower prevalences. The strain population structure indicates an intriguing diversity and possible zoonotic linkage with consequences for TB control in the country. The need to employ newer molecular techniques such as Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeats and whole genome sequence to decipher circulating MTBC strains in Nigeria is advocated.Tertiary Education Trust Fund (TETFund, 2015) under the Staff Training and Development (ST&D) Scheme of the University of Ibadan, Nigeria.Publisher's versio

Genetic profile of Mycobacterium tuberculosis and treatment outcomes in human pulmonary tuberculosis in Tanzania

Information on the different spoligotype families of Mycobacterium tuberculosis in Tanzania is limited, and where available is restricted to small geographical areas.  This article describes the genetic profile of M. tuberculosis across Tanzania and suggests how spoligotype families might affect drug resistance and treatment outcomes for smear positive pulmonary tuberculosis patients in Tanzania. In this study conducted from 2006 to 2008, the M. tuberculosis isolates were obtained from samples collected under the routine drug resistance surveillance system. The isolates were from specimens collected from 2001 to 2007, and stored at the Central and Reference Tuberculosis Laboratory in Dar es Salaam. A total of 487 isolates from 23 regions in Tanzania were spoligotyped. However, clinical information for 446 isolates was available. Out of the 487 isolates spoligotyped, 195 (40.0%) belonged to the Central Asian (CAS) family, 84 (17.5%) to the Latin American Mediterranean (LAM) family, 49 (10.1%) to the East-African Indian (EAI) family, and 33 (6.8%) to the Beijing family. Other isolates included 1 (0.2%) for H37Rv, 10 (2.1%) for Haarlem, 4 (0.8%) for S family, 58 (11.9%) for T family and 52 (10.7%) for unclassified.  No spoligotype patterns were consistent with M. bovis. As regards to treatment outcomes, the cure rate was 80% with no significant variation between the spoligotype families.  The overall level of MDR-TB was 2.5% (3/121), with no significant difference between the spoligotype families. All Beijing strains (11.8%, 30/254) originated from the Eastern and Southern zones of the country, of which 80% were from Dar es Salaam.  Isolates from the CAS and T families were reported disproportionately from the Eastern-Southern zone, and EAI and LAM families from the Northern-Lake zones but the difference was not statistically significant. Five isolates were identified as Non-tuberculous Mycobacteria. In conclusion, M. tuberculosis isolates from pulmonary tuberculosis cases in Tanzania were classified mostly within the CAS, LAM, and EAI and T families.  Consistently good treatment outcomes were recorded across the spoligotype families.  The proportion of drug resistance strains was low. The findings also suggest variation of spoligotype families with varying geographical localities within the country. 

Visualization of Coronary Wall Atherosclerosis in Asymptomatic Subjects and Patients with Coronary Artery Disease Using Magnetic Resonance Imaging

Background: Magnetic resonance imaging (MRI) is sensitive to early atherosclerotic changes such as positive remodeling in patients with coronary artery disease (CAD). We assessed prevalence, quality, and extent of coronary atherosclerosis in a group of healthy subjects compared to patients with confirmed CAD. Methodology: Twenty-two patients with confirmed CAD (15M, 7F, mean age 60.4±10.4 years) and 26 healthy subjects without history of CAD (11M, 15F, mean age 56.1±4.4 years) underwent MRI of the right coronary artery (RCA) and vessel wall (MR-CVW) on a clinical 1.5T MR-scanner. Wall thickness measurements of both groups were compared. Principal Findings: Stenoses of the RCA (both < and ≥50% on CAG) were present in all patients. In 21/22 patients, stenoses detected at MRI corresponded to stenoses detected with conventional angiography. In 19/26 asymptomatic subjects, there was visible luminal narrowing in the MR luminography images. Fourteen of these subjects demonstrated corresponding increase in vessel wall thickness. In 4/26 asymptomatic subjects, vessel wall thickening without luminal narrowing was present. Maximum and mean wall thicknesses in patients were significantly higher (2.16 vs 1.92 mm, and 1.38 vs 1.22 mm, both p<0.05). Conclusions: In this cohort of middle-aged individuals, both patients with stable angina and angiographically proven coronary artery disease, as well as age-matched asymptomatic subjects. exhibited coronary vessel wall thickening detectable with MR coronary vessel wall imaging. Maximum and mean wall thicknesses were significantly higher in patients. The vast majority of asymptomatic subjects had either positive remodeling without luminal narrowing, or non-significant stenosis. Trial registration ClinicalTrials.gov NCT00456950

Polarization aberrations in next-generation giant segmented mirror telescopes (GSMTs) I. Effect on the coronagraphic performance

Next-generation large segmented mirror telescopes are expected to perform direct imaging and characterization of Earth-like rocky planets, which requires contrast limits of $10^{-7}$ to $10^{-8}$ at wavelengths from I to J band. One critical aspect affecting the raw on-sky contrast are polarization aberrations arising from the reflection from the telescope's mirror surfaces and instrument optics. We simulate the polarization aberrations and estimate their effect on the achievable contrast for three next-generation ground-based large segmented mirror telescopes. We performed ray-tracing in Zemax and computed the polarization aberrations and Jones pupil maps using the polarization ray-tracing algorithm. The impact of these aberrations on the contrast is estimated by propagating the Jones pupil maps through a set of idealized coronagraphs using hcipy, a physical optics-based simulation framework. The optical modeling of the giant segmented mirror telescopes (GSMTs) shows that polarization aberrations create significant leakage through a coronagraphic system. The dominant aberration is retardance defocus, which originates from the steep angles on the primary and secondary mirrors. The retardance defocus limits the contrast to $10^{-5}$ to $10^{-4}$ at 1 $\lambda/D$ at visible wavelengths, and $10^{-5}$ to $10^{-6}$ at infrared wavelengths. The simulations also show that the coating plays a major role in determining the strength of the aberrations. Polarization aberrations will need to be considered during the design of high-contrast imaging instruments for the next generation of extremely large telescopes. This can be achieved either through compensation optics, robust coronagraphs, specialized coatings, calibration, and data analysis approaches or by incorporating polarimetry with high-contrast imaging to measure these effects.Comment: 18 pages, 12 figures, Accepted in Astronomy & Astrophysics manuscript no. aa45651-2

Decision making in interhospital transport of critically ill patients: national questionnaire survey among critical care physicians

Objective: This study assessed the relative importance of clinical and transport-related factors in physicians' decision-making regarding the interhospital transport of critically ill patients. Methods: The medical heads of all 95 ICUs in The Netherlands were surveyed with a questionnaire using 16 case vignettes to evaluate preferences for transportability; 78 physicians (82%) participated. The vignettes varied in eight factors with regard to severity of illness and transport conditions. Their relative weights were calculated for each level of the factors by conjoint analysis and expressed in beta. The reference value (beta = 0) was defined as the optimal conditions for critical care transport; a negative beta indicated preference against transportability. Results: The type of escorting personnel (paramedic only: beta = 3.1) and transport facilities (standard ambulance beta = 1.21) had the greatest negative effect on preference for transportability. Determinants reflecting severity of illness were of relative minor importance (dose of noradrenaline beta = 0.6, arterial oxygenation beta = 0.8, level of peep beta = 0.6). Age, cardiac arrhythmia, and the indication for transport had no significant effect. Conclusions: Escorting personnel and transport facilities in interhospital transport were considered as most important by intensive care physicians in determining transportability. When these factors are optimal, even severely critically ill patients are considered able to undergo transport. Further clinical research should tailor transport conditions to optimize the use of expensive resources in those inevitable road trip

The 20S Proteasome Splicing Activity Discovered by SpliceMet

The identification of proteasome-generated spliced peptides (PSP) revealed a new unpredicted activity of the major cellular protease. However, so far characterization of PSP was entirely dependent on the availability of patient-derived cytotoxic CD8+ T lymphocytes (CTL) thus preventing a systematic investigation of proteasome-catalyzed peptide splicing (PCPS). For an unrestricted PSP identification we here developed SpliceMet, combining the computer-based algorithm ProteaJ with in vitro proteasomal degradation assays and mass spectrometry. By applying SpliceMet for the analysis of proteasomal processing products of four different substrate polypeptides, derived from human tumor as well as viral antigens, we identified fifteen new spliced peptides generated by PCPS either by cis or from two separate substrate molecules, i.e., by trans splicing. Our data suggest that 20S proteasomes represent a molecular machine that, due to its catalytic and structural properties, facilitates the generation of spliced peptides, thereby providing a pool of qualitatively new peptides from which functionally relevant products may be selected

Guidance for studies evaluating the accuracy of rapid tuberculosis drug-susceptibility tests

The development and implementation of rapid molecular diagnostics for tuberculosis (TB) drug-susceptibility testing is critical to inform treatment of patients and to prevent the emergence and spread of resistance. Optimal trial planning for existing tests and those in development will be critical to rapidly gather the evidence necessary to inform World Health Organization review and to support potential policy recommendations. The evidence necessary includes an assessment of the performance for TB and resistance detection as well as an assessment of the operational characteristics of these platforms. The performance assessment should include analytical studies to confirm the limit of detection and assay ability to detect mutations conferring resistance across globally representative strains. The analytical evaluation is typically followed by multisite clinical evaluation studies to confirm diagnostic performance in sites and populations of intended use. This paper summarizes the considerations for the design of these analytical and clinical studies.FIND (Foundation for Innovative New Diagnostics)https://academic.oup.com/jid2020-10-08am2019Medical Microbiolog