3,425 research outputs found
Ăvaluation des compĂ©tences en laparoscopie : comparaison de la fiabilitĂ© des outils dâĂ©valuation globale et des outils dâĂ©valuation de la confiance
Background: Competence by design (CBD) residency programs increasingly depend on tools that provide reliable assessments, require minimal rater training, and measure progression through the CBD milestones. To assess intraoperative skills, global rating scales and entrustability ratings are commonly used but may require extensive training. The Competency Continuum (CC) is a CBD framework that may be used as an assessment tool to assess laparoscopic skills. The study aimed to compare the CC to two other assessment tools: the Global Operative Assessment of Laparoscopic Skills (GOALS) and the Zwisch scale.
Methods: Four expert surgeons rated thirty laparoscopic cholecystectomy videos. Two raters used the GOALS scale while the remaining two raters used both the Zwisch scale and CC. Each rater received scale-specific training. Descriptive statistics, inter-rater reliabilities (IRR), and Pearsonâs correlations were calculated for each scale.
Results: Significant positive correlations between GOALS and Zwisch (r = 0.75, p < 0.001), CC and GOALS (r = 0.79, p < 0.001), and CC and Zwisch (r = 0.90, p < 0.001) were found. The CC had an inter-rater reliability of 0.74 whereas the GOALS and Zwisch scales had inter-rater reliabilities of 0.44 and 0.43, respectively. Compared to GOALS and Zwisch scales, the CC had the highest inter-rater reliability and required minimal rater training to achieve reliable scores.
Conclusion: The CC may be a reliable tool to assess intraoperative laparoscopic skills and provide trainees with formative feedback relevant to the CBD milestones. Further research should collect further validity evidence for the use of the CC as an independent assessment tool.Contexte : Les programmes de rĂ©sidence structurĂ©s autour de la compĂ©tence par conception (CPC) dĂ©pendent de plus en plus dâoutils qui fournissent des Ă©valuations fiables, nĂ©cessitent une formation minimale des Ă©valuateurs et mesurent la progression dans les Ă©tapes de la CPC. Pour Ă©valuer les compĂ©tences peropĂ©ratoires, les Ă©chelles dâĂ©valuation globale et de confiance sont couramment utilisĂ©es mais peuvent nĂ©cessiter une formation approfondie. Le Continuum des compĂ©tences (CC) est un cadre de la CPC qui peut ĂȘtre utilisĂ© comme outil dâĂ©valuation des compĂ©tences laparoscopiques. LâĂ©tude visait Ă comparer le CC Ă deux autres outils dâĂ©valuation : lâĂ©valuation globale opĂ©ratoire des compĂ©tences laparoscopiques (GOALS) et lâĂ©chelle de Zwisch.
MĂ©thodes : Quatre chirurgiens experts ont Ă©valuĂ© trente vidĂ©os de cholĂ©cystectomie laparoscopique. Deux Ă©valuateurs ont utilisĂ© lâĂ©chelle GOALS tandis que les deux autres ont utilisĂ© lâĂ©chelle Zwisch et le CC. Chacun dâeux avait reçu une formation spĂ©cifique Ă lâĂ©chelle utilisĂ©e. Des statistiques descriptives, la fiabilitĂ© inter-Ă©valuateurs (FIĂ) et des corrĂ©lations de Pearson ont Ă©tĂ© calculĂ©es pour chaque Ă©chelle.
RĂ©sultats : Des corrĂ©lations positives significatives ont Ă©tĂ© trouvĂ©es entre les Ă©chelles GOALS et Zwisch (r=0.75, p<0.001), CC et GOALS (r=0.79, p<0.001), et CC et Zwisch (r=0.90, p<0.001). Le CC avait une fiabilitĂ© inter-Ă©valuateurs de 0,74 tandis que les Ă©chelles GOALS et Zwisch avaient des fiabilitĂ©s inter-Ă©valuateurs de 0,44 et 0,43, respectivement. Par rapport aux Ă©chelles GOALS et Zwisch, le CC avait la fiabilitĂ© inter-Ă©valuateurs la plus Ă©levĂ©e et ne nĂ©cessitait quâune formation minimale des Ă©valuateurs pour obtenir des scores fiables.
Conclusion : Le CC constituerait un outil fiable pour Ă©valuer les compĂ©tences laparoscopiques peropĂ©ratoires et pour fournir aux stagiaires une rĂ©troaction formatrice pertinente pour les Ă©tapes de la CPC. Des recherches supplĂ©mentaires devraient ĂȘtre entreprises pour recueillir plus de preuves de validitĂ© pour lâutilisation du CC comme outil dâĂ©valuation indĂ©pendant
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Hydrogeology and Hydrochemistry of the Falls City Uranium Mine Tailings Remedial Action Project, Karnes County, Texas
Oxidized uranium ore deposits were discovered in the Deweesville sandstone (also referred to as the Stones Switch; Bunker and MacKallor [1973]) in the Falls City region in the 1950s. Uranium was mined and milled in the small community of Deweesville by Susquehanna-Western, Inc. (SWI) from April 1961 to August 1973. Tailings composed of sediment residue from the sulfuric acid milling process and residual sulfuric acid solutions were disposed of in six ponds on the outcrop of the Deweesville, within the mined-out uranium pits in the Deweesville, and on the outcrop of the Conquista, creating a set of large tailings impoundments (figs. 1.1 and 1.2). From 1978 to 1982 Solution Engineering, Inc. (SEI) conducted a secondary recovery of the remaining uranium in the tailings piles by in situ leaching. In 1984, the ponds on top of two of the tailings piles were spray evaporated and a clay cap was placed over the piles to prevent additional percolation of water through the piles and into the underlying aquifers. Acidic tailings solutions have been recharging the underlying aquifers since initial tailings disposal and may still be leaking into these aquifers.
Several hydrogeologic investigations have been conducted to assess whether there has been groundwater contamination from the tailings. Early studies were conducted by Turk, Kehle and Associates (1976), and Ford, Bacon & Davis Utah (1978, 1981). Each of these studies included only minor investigations of the hydrogeology and hydrochemistry of the site and, in general, underestimated the extent of contamination from the site. Investigations conducted by the U.S. Department of Energy (DOE) from 1985 to 1991 have since revealed the true extent of contamination (U.S. Department of Energy, 1991).Bureau of Economic Geolog
ASPIRE-2-PREVENT: a survey of lifestyle, risk factor management and cardioprotective medication in patients with coronary heart disease and people at high risk of developing cardiovascular disease in the UK.
OBJECTIVE: To determine in patients with coronary heart disease (CHD) and people at high risk of developing cardiovascular disease (CVD) whether the Joint British Societies' guidelines on CVD prevention (JBS2) are followed in everyday clinical practice. DESIGN: A cross-sectional survey was undertaken of medical records and patient interviews and examinations at least 6 months after the recruiting event or diagnosis using standardised instruments and a central laboratory for measurement of lipids and glucose. SETTINGS: The ASPIRE-2-PREVENT survey was undertaken in 19 randomly selected hospitals and 19 randomly selected general practices in 12 geographical regions in England, Northern Ireland, Wales and Scotland. PATIENTS: In hospitals, 1474 consecutive patients with CHD were identified and 676 (25.6% women) were interviewed. In general practice, 943 people at high CVD risk were identified and 446 (46.5% women) were interviewed. RESULTS: The prevalence of risk factors in patients with CHD and high-risk individuals was, respectively: smoking 14.1%, 13.3%; obesity 38%, 50.2%; not reaching physical activity target 83.3%, 85.4%; blood pressure â„130/80 mm Hg (patients with CHD and self-reported diabetes) or â„140/85 mm Hg (high-risk individuals) 46.9%, 51.3%; total cholesterol â„4 mmol/l 52.6%, 78.7%; and diabetes 17.8%, 43.8%. CONCLUSIONS: The potential among patients with CHD and individuals at high risk of developing CVD in the UK to achieve the JBS2 lifestyle and risk factor targets is considerable. CVD prevention needs a comprehensive multidisciplinary approach, addressing all aspects of lifestyle and risk factor management. The challenge is to engage and motivate cardiologists, physicians and other health professionals to routinely practice high quality preventive cardiology in a healthcare system which must invest in prevention
Vais-je publier ce résumé? Déterminer les caractéristiques de résumés de présentations orales associés au potentiel de publication
Background: Prior studies have shown that most conference submissions fail to be published. Understanding factors that facilitate publication may be of benefit to authors. Using data from the Canadian Conference on Medical Education (CCME), our goal was to identify characteristics of conference submissions that predict the likelihood of publication with a specific focus on the utility of peer-review ratings.
Methods: Study characteristics (scholarship type, methodology, population, sites, institutions) from all oral abstracts from 2011-2015 and peer-review ratings for 2014-2015 were extracted by two raters. Publication data was obtained using online database searches. The impact of variables on publication success was analyzed using logistic regressions.
Results: Of 531 abstracts with peer-review ratings, 162 (31%) were published. Of the 9 analyzed variables, those associated with a greater odds of publication were: multiple vs. single institutions (odds ratio (OR) = 1.72), post-graduate research vs. others (OR=1.81) and peer-review ratings (OR=1.60). Factors with decreased odds of publication were curriculum development (OR=0.17) and innovation vs. others (OR=0.22).
Conclusion: Similar to other studies, the publication rate of CCME presentations is low. However, peer ratings were predictive of publication success suggesting that ratings could be a useful form of feedback to authors. Contexte : Des Ă©tudes ont montrĂ© que la plupart des rĂ©sumĂ©s soumis pour prĂ©sentations orales ne sont pas ultĂ©rieurement publiĂ©s. Il pourrait ĂȘtre utile aux auteurs de comprendre les facteurs qui favorisent la publication. Ă lâaide de donnĂ©es provenant de la ConfĂ©rence canadienne sur lâĂ©ducation mĂ©dicale (CCĂM), notre objectif Ă©tait dâidentifier les caractĂ©ristiques des rĂ©sumĂ©s permettant de prĂ©dire les chances de publication et en particulier lâutilitĂ© des cotes attribuĂ©es par les rĂ©viseurs.
MĂ©thodologie : Les caractĂ©ristiques des Ă©tudes (type de projet dâĂ©rudition, mĂ©thodologie, population, Ă©tablissements, institutions) de tous les rĂ©sumĂ©s de prĂ©sentation orale soumis pour les confĂ©rences de 2011 Ă 2015 et les cotes attribuĂ©es par les rĂ©viseurs entre 2014 et 2015 ont Ă©tĂ© extraites par deux Ă©valuateurs. On a obtenu des donnĂ©es de publication en faisant des recherches dans des bases de donnĂ©es en ligne. Lâeffet des variables sur le potentiel de publication a Ă©tĂ© examinĂ© Ă lâaide de rĂ©gressions logistiques.
RĂ©sultats : Au total, 953 rĂ©sumĂ©s ont Ă©tĂ© rĂ©visĂ© des annĂ©es 2011 Ă 2015. Le taux de publication Ă©tait de 30.5% (291/953) en somme. Des 531 rĂ©sumĂ©s ayant Ă©tĂ© Ă©valuĂ©s des pairs, entre 2014 et 2015, 162 (31 %) ont Ă©tĂ© publiĂ©s. Parmi les neuf variables analysĂ©es, celles qui ont Ă©tĂ© associĂ©es Ă un nombre Ă©levĂ© de chances de publication Ă©taient les suivantes : projet multi-institutionnel par rapport Ă institution unique (risque relatif (RR) = 1,72), travaux de recherche post-graduĂ©e par rapport Ă dâautres types (RR = 1,81) et prĂ©sence de cotes attribuĂ©es par les rĂ©viseurs (RR = 1,6). Les facteurs associĂ©s Ă des moindres chances de publication Ă©taient les suivants : articles portant sur le dĂ©veloppement de cursus (RR = 0,17) et les innovations, par rapport Ă dâautres (RR = 0,22).
Conclusion : Comme ce fut le cas pour dâautres Ă©tudes, le taux de publication Ă la suite dâune prĂ©sentation au CCME est faible. Cependant, les cotes attribuĂ©es par les rĂ©viseurs permettaient de prĂ©dire les chances de publication ce qui semble indiquer que les cotes pourraient constituer une forme de rĂ©troaction utile aux auteurs
Multiscale analyses of solarâinduced florescence and gross primary production
Solarâinduced fluorescence (SIF) has shown great promise for probing spatiotemporal variations in terrestrial gross primary production (GPP), the largest component flux of the global carbon cycle. However, scale mismatches between SIF and groundâbased GPP have posed challenges toward fully exploiting these data. We used SIF obtained at high spatial sampling rates and resolution by NASAâs Orbiting Carbon Observatoryâ2 satellite to elucidate GPPâSIF relationships across space and time in the U.S. Corn Belt. Strong linear scaling functions (R2ââ„â0.79) that were consistent across instantaneous to monthly time scales were obtained for corn ecosystems and for a heterogeneous landscape based on tall tower observations. Although the slope of the corn function was ~56% higher than for the landscape, SIF was similar for corn (C4) and soybean (C3). Taken together, there is strong observational evidence showing robust linear GPPâSIF scaling that is sensitive to plant physiology but insensitive to the spatial or temporal scale.Key PointsGPP scales linearly with SIF from instantaneous to monthly time scalesAggregating ecosystem GPPâSIF functions yield a representative landscape relation that matched one obtained directly using tall tower GPPGPPâSIF relations showed sensitivity to plant physiology but not spatiotemporal scalePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135999/1/grl55274_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135999/2/grl55274.pd
Comparing crop growth and carbon budgets simulated across AmeriFlux agricultural sites using the Community Land Model (CLM)
Improvement of process-based crop models is needed to achieve high fidelity forecasts of regional energy, water, and carbon exchanges. However, most state-of-the-art Land Surface Models (LSMs) assessed in the fifth phase of the Coupled Model Inter-comparison project (CMIP5) simulated crops as unmanaged C3 or C4 grasses. This study evaluated the crop-enabled version of one of the most widely used LSMs, the Community Land Model (CLM4- Crop), for simulating corn and soybean agro-ecosystems at relatively long-time scales (up to 11 years) using 54 site-years of data. We found that CLM4-Crop had a biased phenology during the early growing season and that carbon emissions from corn and soybean were underestimated. The model adopts universal physiological parameters for all crop types neglecting the fact that different crops have different specific leaf area, leaf nitrogen content and vcmax25, etc. As a result, model performance varied considerably according to crop type. Overall, the energy and carbon exchange of corn systems were better simulated than soybean systems. Long-term simulations at multiple sites showed that gross primary production (GPP) was consistently over-estimated at soybean sites leading to very large short and long-term biases. A modified model, CLM4-CropMâ, with optimized phenology and calibrated crop physiological parameters yielded significantly better simulations of gross primary production (GPP), ecosystem respiration (ER) and leaf area index (LAI) at both short (hourly) and long-term (annual to decadal) timescales for both soybean and corn
Resolution of Clinical and Laboratory Abnormalities after Diagnosis of Ventilator-Associated Pneumonia in Trauma Patients
Background: Guidelines advise that patients with ventilator-associated pneumonia (VAP) should respond clinically by Day 3 of antibiotics. White blood cell (WBC) count, maximum temperature (Tmax), and PaO2:FIO2 ratio are all said to respond significantly by Day 6. Resolution of abnormalities has not been evaluated in trauma patients.
Methods: Retrospective review of trauma patients with VAP. The WBC count, Tmax, and PaO2:FIO2 were evaluated for 16 days after diagnosis. Patients were grouped into uncomplicated VAP, complicated VAP (those with inadequate empirical therapy [IEAT], VAP relapse/superinfection, or acute respiratory distress syndrome), and concurrent infection +VAP (those also infected at another site).
Results: There were 126 patients (uncomplicated VAP= 29, complicated VAP = 69, and concurrent infection + VAP = 28). The mean Tmax in patients with uncomplicated VAP decreased significantly from diagnosis to Day 4 (Day 1: 39 â 0.5°C vs. Day 4: 38.6 â 0.7°C; p = 0.028) but never normalized. Their WBC counts and PaO2:FIO2 did not change significantly over the 16-day follow-up and never normalized.When comparing the three groups, the probability of resolving all three abnormalities was not different (p = 0.5).
Conclusions: Clinical and laboratory abnormalities in critically injured patients with VAP do not resolve as quickly as suggested in the guidelines. Future studies should evaluate new methods to determine the response to antibiotic therapy in critically injured patients with VAP
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