Developing and evaluating expertise in colonoscopy

The quality and safety of colonoscopy have become of paramount importance with the worldwide expansion in the utilisation of this procedure, especially with the introduction of colorectal cancer screening in many countries. It is well known that colonoscopic performance varies significantly between practitioners. This thesis explores the effects of assessment in colonoscopy and polypectomy on performance and practice as well as trying to define the factors which differentiate the very best practitioners from the clinically competent. Until 2011, there was no formalised way of certifying polypectomy competence. We looked at the effects of the introduction of mandatory polypectomy assessment on trainee endoscopists applying for certification of competency in the United Kingdom. This work showed that documentation of polypectomy competence significantly improved after these changes were introduced. A global survey of polypectomy practice was undertaken to evaluate international guidance on polypectomy skills training and how trainers deliver teaching on polypectomy around the world, as well as trainees’ experience of gaining polypectomy skills. Significant variability in endoscopists’ experience of polypectomy training was found with few formal national guidelines published. This led to an evaluation of expert endoscopists who underwent an accreditation process with some similarities before commencing Bowel Cancer Screening (BCS). We examined whether it was possible to predict future performance from a single assessment and found that criteria used to assess whether candidates were competent could not predict the best performers from those who passed. Several hundred expert BCS colonoscopists were then monitored over a three year period to determine changes in performance over time and whether long-term performance could be predicted. The best predictors of performance over time for all metrics were initial performance. In order to identify key features of expertise in endoscopy, experienced colonoscopists were interviewed to distinguish characteristics of true endoscopic experts. These interviews revealed the importance of both technical and non-technical skills in defining expertise.Open Acces

A Rare View Of Coding Mutations And Plasma Lipid Levels

A RARE VIEW OF CODING MUTATIONS AND PLASMA LIPID LEVELS. Aniruddh P. Patel, Sekar Kathiresan. Center for Human Genetics Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA and Program in Medical and Population Genetics, the Broad Institute of Harvard and MIT, Cambridge, MA (Sponsored by Richard P. Lifton, Department of Genetics, Yale University School of Medicine, New Haven, CT). Plasma low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) are quantitative, heritable risk factors for coronary heart disease. Genome-wide association screens (GWAS) of common DNA sequence variants have identified many loci associated with plasma lipid levels. Targeted re-sequencing of exons has been proposed as a strategy to pinpoint causal variants and genes based in GWAS loci. Additionally, genotyping of rare and low frequency variants in large cohorts using an exome array has been proposed as a method to assess the contribution of rare variation to plasma lipid levels at the population level. We tested the hypothesis that each genomic region identified with a significant HDL-C level association by GWA studies contains at least one gene causal for HDL-C metabolism. We performed solution-based hybrid selection of 4,118 exons at 407 genes within 47 loci associated with HDL-C and subsequently sequenced individuals drawn from the extremes of the HDL-C distribution (high HDL-C, n=385, mean=102 mg/dl or low HDL-C, n=334, mean=32 mg/dl) using next-generation sequencing technology. We tested whether rare coding sequence variants, individually or aggregated within a gene, were associated with HDL-C. To replicate findings, we performed follow-up genotyping using the Exome Array (Illumina HumanExome BeadChip) in independent participants with extremely high HDL-C (n=514, mean=98 mg/dl) or low HDL-C (n=580, mean=32 mg/dl). Through sequencing, we identified 8,138 rare (minor allele frequency \u3c 5%) missense, nonsense, or splice site variants. Across discovery sequencing and replication genotyping, we found 3 variants to be significantly associated with HDL-C. Of these, none were novel. In gene-level association analyses where rare variants within each gene are collapsed, only the CETP gene was associated with plasma HDL-C (P=2.0 x 10-6). After sequencing genes from GWAS loci in participants with extremely high or low HDL-C, we did not identify any new rare coding sequence variants with a strong effect on HDL-C. These results provide insight regarding the design of similar sequencing studies for cardiovascular traits with respect to sample size, follow-up, and analysis methodology. We then tested the hypothesis that rare coding and splice-site mutations contribute to inter-individual variability in plasma lipid concentrations in the population. We contributed to the design of a new, rare-variant genotyping array based on the sequences of the protein-coding regions of ~18,500 genes ( the exome ) in \u3e12,000 individuals. This genotyping array ( the Exome Chip ) includes approximately 250,000 non-synonymous and splice-site mutations and is estimated to capture nearly all such variation with a \u3e1:1000 allele frequency in the European population. We obtained Exome Chip genotype data in \u3e130,000 individuals from 58 studies. Within each study, we tested the association of plasma lipids with individual rare variants. To combine statistical evidence across studies, we performed meta-analysis. Top results for each trait replicated established associations in the genes APOE, CETP, and APOA5 for LDL-C, HDL-C, and TG, respectively. We identified 11 new genes associated with plasma lipid levels: ABCA6 with LDL-C (C1359R, frequency = 1:100, effect=+8.2 mg/dl, P=9.7 x 10-32, SERPINA with LDL-C (E366K, frequency = 2:100, effect = +3.1 mg/dl, P=2.3 x 10-7), REST with LDL-C (R645W, frequency = 6:10000, effect = +13.7 mg/dl, P=5.0 x 10-7), FBLN1 with LDL-C (H695R, frequency = 2:100, effect = -2.7 mg/dl, P=5.3 x 10-7), CCDC117 with LDL-C (T232I, frequency = 9:1000, effect = -4.3 mg/dl, P=7.3 x 10-7), TMED6 with HDL-C (F6L, frequency = 4:100, effect = -0.8 mg/dl, P=4.4 x 10-9), CDC25A with HDL-C (Q24H, frequency = 3:100, effect = -1.0 mg/dl, P=8.4 x 10-8), MAP1A (P2349L, frequency = 3:100) with HDL-C (effect= -1.4mg/dl, P=3.9 x 10-14) and TG (effect=+8.4mg/dl, P=3.2 x 10-26), PRRC2A with TG (S1219Y, frequency = 2:100, effect = +6.6 mg/dl, P=4.6 x 10-17), COL18A1 with TG (V125I, frequency = 1:1000, effect = +18.0 mg/dl, P=1.3 x 10-7), and EDEM3 with TG (P746S, frequency = 1:100, effect = -5.4 mg/dl, P=2.4 x 10-7). In addition, at some genes previously known to affect lipids, we identified new associations for variants: APOC3 (R19Stop, frequency = 3:10,000) with HDL (effect=+11mg/dl, P=9.9 x 10-12) and with TG (effect=-65.9mg/dl, P=5.8 x 10-23); (splicesite IVS2+1 G\u3eA, frequency = 2:1000) with HDL (effect=+10.6mg/dl, P=3.5 x 10-42) and with TG (effect=-65.2mg/dl, P=2.0 x 10-81). Using the Exome Chip rare variant genotyping array, we have discovered several new genes and variants associated with plasma lipids

Growth and impact of scholarly contributions for SP University: A Bibliometric Analysis

Qualitative analysis of bibliographic datasets becomes advantageous to individuals and institutions since the high weightage of ‘research’ enunciated in assessment ranking or gradation framework. Out of the various existing methods ‘bibliometric methods’ applied in the current study for quantitative examination of research output to measure productivity and performance. A total of 1690 Bibliographic records consulted of Sardar Patel University (SPU) published during the year 2009-2018 retrieved from the Scopus indexing database. To validate the objectives i.e. to determine chronological growth, authorship pattern, core sources for research communication, and influence of productivity by citations received, various indicators, and indices and bibliometric laws i.e. RGR, Dt, CAI, DC, Bradford’s Law of distributions, and more have been applied appropriately. Furthermore, software of ‘MS-Excel’ and ‘bibliometrix’ & ‘biblioshiny’ of R-Package software applied for detailed and accurate analysis. Evaluated data figured out Average yearly contribution 169 research however accounted Mean RGR (P) ‘0.25’; Mean Dt (P) ’3.52 reveals inconsistent growth of research output. Rate of DC ‘0.98’ and the highest ‘51.30%’ productivity for ‘multi authorship’ indicates a higher rate of collaborative research work. Total ‘36 core sources’ identified which are highly relevant to ‘applied / pure science’ discipline. A total of 15153 citations were received for research occurrence in the span with an average of 8.97 ACPP where mean RGR (C) ‘0.19’ and Mean Dt (C) ‘7.06’ of citations should be the matter of anxiety for SPU and individual scholars. SPU has to make more effort to promote research and create quality culture, attention of developing better policies to enhance and enrich the research performance of individuals

Investigating strategies to boost cutaneous varicella zoster virus-specific immune responses in ageing humans

The age-related decline in the immune system, known as immunosenescence, predisposes old individuals to increased mortality and morbidity from infectious diseases (such as shingles, caused by reactivation of varicella zoster virus, VZV) and is associated with impaired vaccine responses. While multiple age-related changes have been identified in circulating memory T cells, little is known about the effects of ageing on memory T cells within peripheral tissues. T cells within human skin were characterised, and surprisingly neither their numbers, differentiation markers or effector functions were altered during ageing. VZV-specific CD4+ T cells were more frequent in the skin than in the blood, and their frequency in the skin did not decline with age. Increased PD-1 expression on T cells and an increased frequency of regulatory T cells in ageing skin consolidated evidence that old skin represents an inhibitory microenvironment. Vaccination of old individuals with the shingles vaccine Zostavax® did not alter the total number of T cells, or frequency of VZV-specific T cells, in the skin but did boost the frequency of circulating VZV-specific T cells. This was associated with a heightened delayed type hypersensitivity (DTH) response to VZV antigen, and with an upregulation of genes involved in T cell migration and activation. It is proposed here that Zostavax® prevents shingles by enhancing the recruitment of circulating VZV-specific memory T cells to sensory nerves during episodes of silent VZV reactivation. Increased early expression of p38 MAPK-associated pro-inflammatory genes has been observed in VZV- or saline-challenged old skin and was associated with poor DTH responses to VZV antigen. In an experimental medicine study, pre-treatment of ageing individuals with the p38 MAPK inhibitor losmapimod effectively restored robust VZV-specific DTH responses. Ageing of the population necessitates improved vaccination strategies, and p38 MAPK inhibition prior to vaccine administration presents a potential therapeutic opportunity to achieve this

Multiplex sorting of foodborne pathogens by on-chip free-flow magnetophoresis

This study reports multiplex sorting of Salmonella typhimurium and Escherichia coli 0157, from broth cultures and from pathogen-spiked skinned chicken breast enrichment broths by employing microfluidic free-flow magnetophoresis. Magnetic beads of different sizes and magnetite content, namely Dynabeads anti-salmonella and Hyglos-Streptavidin beads together with the corresponding pathogen-specific biotinylated recombinant phages, were utilised as affinity solid phases for the capture and concentration of viable S. typhimurium and E. coli 0157. Following optimisation, the protocol was used to demonstrate continuous magnetophoretic sorting of the two pathogen-bound magnetic bead populations from mixed cultures and from pathogen-spiked chicken pre-enrichment broths under the influence of a Halbach magnet array. For example, in the la tter case, a pure population of S. typhimurium-bound Dynabeads (72% recovery) was sorted from a 100 μL mixture containing E. coli 0157-bound Hyglos beads (67% recovery) within 1.2 min in the presence of 0.1% Tween 20. This proof-of-principle study demonstrates how more than one pathogen type can be simultaneously isolated/enriched from a single food pre-enrichment broth (e.g. Universal food enrichment broth)

Occupational stressors and their influence on social, physical and psychological parameters among the LIS professionals in university libraries of Gujarat: A study

The pressure experienced by any working professional in their working surroundings called occupation stress is the reaction when characteristics and working conditions do not match with capacity, resources, environment, and needs of the professionals. LIS field is basically a core service sector and LIS professionals are also suffering with certain stressors. physical or psychological suffering caused by stress reduces the man-hours, indirectly reflects in productivity. library professionals experience constant changes in technology, fraction in the budgetary allotment, extensive workload, public dealing all above can make side effect of internal stress. The current study attempted to identify certain stressors and their influence on social, physical and psychological parameters among the LIS. The study finds that there are several factors affecting the performance of professional and gap between the acceptation and performance cause the stress. i.e. job profiles, job satisfaction, job security, lack of reward & promotion policy, information resources, latest technologies and equipment, patrons need and behavior, colleague’s relationship, administrative support, cast bias, gender inequality, and many more experienced by professionals. These stressors cause the side effects, designated as the impact of stress on professionals i.e. physical, psychological, behavioral, resistors in work efficiency or personal and social life. occupational Stressors equally affect male and female professionals; however, on certain point the ratios of stress between both vary. males facing more psychological challenges compare to female professionals. The individuals, and organizational motivational and supportive attempts towards the encouraging & balanced working environment development to overcome the issue of stress

Synthesis and anti-tubercular activity of novel pyrazol-5(H)-one derivatives

In the present investigation, a series of 1-isonicotinoyl-3-methyl-4-(2-(substituted-phenyl)hydrazono)-1H-pyrazol-5(H)-ones were synthesized by the reaction between isonicotinohydrazide with substituted ethylacetoacetate derivatives using acetic acid as solvent which yielded substituted pyrazol-5(H)-one derivatives. Newly synthesized compounds were tested for their in vitro anti-tubercular activity against Mycobacterium tuberculosis H37Rv using the BACTEC 460 radiometric system. Among the synthesized compounds, 4-(2-(2,6-dichlorophenyl)hydrazono)-1-isonicotinoyl-3-methyl-1H-pyrazol-5(4H)-one and 4-(2-(1-isonicotinoyl-3-methyl-5-oxo-1H-pyrazol-4(5H)-ylidene)hydrazinyl) benzene-sulfonamide were found to be more active agent against M. tuberculosis H37Rv with minimum inhibitory concentration of 0.0034, 0.0032 µM at actual MIC 1.66 and 1.64 µg/mL, respectively

Psychiatric morbidity in older people with moderate and severe learning disability (mental retardation). Part I: development and reliability of the patient interview (the PAS-ADD)

This paper describes the development of the PAS-ADD, a semistructured clinical interview for use specifically with patients with learning disabilities, based on items drawn from the PSE. The PAS-ADD includes a number of novel features including: parallel interviewing of patient and informant; a three-tier structure to provide a flexible interview appropriate to the patient's intellectual level; use of a memorable 'anchor event' in the patient's life to improve time focus; and simplified wording, improved organisation and lay out. Inter-rater reliability was investigated using an experimental design in which two raters viewed and re-rated videotaped PAS-ADD interviews which had been conducted by an experienced clinician. Reliability results compared favourably with those obtained in a major study of PSE reliability with a sample drawn from non-learning disabled individuals. Mean kappa for all items was 0.72. Other indexes of reliability were also good. In the current phase of development, the PAS-ADD is to be expanded to include further diagnostic categories, including schizophrenia and autism. The new version will be updated for use with ICD-10 criteria

Assessing Medical Students’, Residents’, and the Public's Perceptions of the Uses of Personal Digital Assistants

Although medical schools are encouraging the use of personal digital assistants (PDAs), there have been few investigations of attitudes toward their use by students or residents and only one investigation of the public's attitude toward their use by physicians. In 2006, the University of Louisville School of Medicine surveyed 121 third- and fourth-year medical students, 53 residents, and 51 members of the non-medical public about their attitudes toward PDAs. Students were using either the Palm i705 or the Dell Axim X50v; residents were using devices they selected themselves (referred to in the study generically as PDAs). Three survey instruments were designed to investigate attitudes of (a) third- and fourth-year medical students on clinical rotations, (b) Internal Medicine and Pediatrics residents, and (c) volunteer members of the public found in the waiting rooms of three university practice clinics. Both residents and medical students found their devices useful, with more residents (46.8%) than students (16.2%) (p < 0.001) rating PDAs “very useful.” While students and residents generally agreed that PDAs improved the quality of their learning, residents’ responses were significantly higher (p < 0.05) than students’. Residents also responded more positively than students that PDAs made them more effective as clinicians. Although members of the public were generally supportive of PDA use, they appeared to have some misconceptions about how and why physicians were using them. The next phase of research will be to refine the research questions and survey instruments in collaboration with another medical school

Relativistic Solution for a Class of Static Compact Charged Star in Pseudo Spheroidal Space-Time

Considering Vaidya-Tikekar metric, we obtain a class of solutions of the Einstein-Maxwell equations for a charged static fluid sphere. The physical 3-space (t=constant) here is described by pseudo-spheroidal geometry. The relativistic solution for the theory is used to obtain models for charged compact objects, thereafter a qualitative analysis of the physical aspects of compact objects are studied. The dependence of some of the properties of a superdense star on the parameters of the three geometry is explored. We note that the spheroidicity parameter $a$, plays an important role for determining the properties of a compact object. A non-linear equation of state is required to describe a charged compact object with pseudo-spheroidal geometry which we have shown for known masses of compact objects. We also note that the size of a static compact charged star is more than that of a static compact star without charge.Comment: 24 pages, 18 figures, 8 table