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Introduction: Competency-based medical education (CBME) relies on pragmatic assessment to inform trainee progression decisions. It is unclear whether face-to-face workplace-based assessment (WBA) scoring by faculty reflects their true perception of trainee competence, as many factors influence individual assessments. To better defend competence committee decisions, it is critical to understand how accurately WBAs reflect the faculty's honest perception of resident competence and entrustment. Methods: To best capture faculty perception of trainee competence, we created a periodic performance assessment (PPA) tool for anonymous faculty assessment of residents after repeated clinical interactions. PPA surveys were distributed to full-time EM faculty at a single Canadian FRCPC-EM training site. Faculty were asked to score residents on entrustable professional activities (EPAs) based on encounters over the previous 6-months, and were advised that all data would be anonymized. All WBA scores for FRCPC-EM residents (N = 21) were collected from the 6-months preceding PPA completion. Analysis compared paired WBA and PPA entrustment scores for an individual resident, faculty, and EPA using Wilcoxon Signed Ranks tests and Spearman correlations. Data were analyzed across faculty, EPAs, and both faculty and EPA. Results: About half (17/33) of all invited full-time EM faculty participated. Overall, anonymous PPAs had a significantly lower mean score compared to face-to-face WBAs (3.61-3.69 vs. 3.92-4.06, p < 0.001 for all) across all groupings. Individual WBAs had a low-moderate correlation with individual PPAs (rho = 0.44). When scores were averaged across 1) faculty or 2) EPA, there was an increase in correlation, but it remained moderate (rho = 0.53 and 0.54, respectively). When scores were averaged for an individual resident across 3) faculty and EPA, there was a strong correlation between WBA and PPA (rho = 0.86). Conclusion: There is only moderate correlation between an individual faculty's WBAs and their anonymous longitudinal entrustment for a given resident on a specific EPA. These results may signal caution when interpreting WBA scores in the context of high stakes decisions. Aggregated scores from multiple faculty and/or multiple EPAs substantially increased the correlation between WBA and PPA. These findings highlight the importance of using aggregated WBA scores across multiple assessors and EPA for high-stakes resident progression decisions, to minimize the noise and bias in individual assessment.
OBJECTIVES/SPECIFIC AIMS: By combining clinical knowledge of hoarding disorder (HD) with qualitative methods from cultural anthropology, we hope to build a patient-centered approach that will allow us to better understand the clinician perspectives on patient motivations and explanatory models of individuals with HD, and improve treatment outcomes. We describe the ways that these methodologies are productively merged in this project as a result of TL1 collaboration, and present a preliminary picture of methodological and theoretical issues uncovered as part of this processes. We further describe the analytical methods used for this project, and explore issues raised through the combination of psychological and anthropological data and insights. METHODS/STUDY POPULATION: This study represents an attempt to combine the qualitative methodologies of cultural anthropology with the clinical knowledge of psychology and psychiatry in order to better understand gaps between provider and patient beliefs and knowledge about hoarding disorder. This study will present preliminary methodological issues arising from interviews with hoarding experts. RESULTS/ANTICIPATED RESULTS: This study will discuss preliminary issues including shared language, strengths and limitations of both disciplines, and factors for consideration when combining these disparate methodologies. It will close with recommendations for consideration when moving forward with similar collaborations. DISCUSSION/SIGNIFICANCE OF IMPACT: This project seeks to unite psychological and social factors that may contribute to the lived experience of individuals with HD in order to better understand the way that HD is manifested. It also unites disparate methodologies to provide us with a more holistic and complete picture of the experience of HD. While HD has been studied within psychiatry, it has never been assessed using the qualitative methods of anthropology. These methods provide the possibility of expanding knowledge about the ways that this disorder is experienced by individuals and their families, and potentially impacted by shared beliefs and cultures. Furthermore, qualitative data of this nature provides a patient perspective on the experience of HD as a psychiatric illness. This patient perspective can be used to better inform treatment, improve patient outcomes, and to allow providers and researchers to gain a fuller understanding of this complex population.
Volatile organic compounds (VOCs) released by plants are generally involved in host recognition and host selection for many phytophagous insects. However, for leafhoppers and planthoppers, host recognition is mainly thought to involve a phototactic response, but it is not clear if a host plant could be selected based on the volatile cues it emits. In this study we evaluated olfactory responses in dual choice tests of two Hemiptera species, Dalbulus maidis (De Long) (Cicadellidae) and Peregrinus maidis (Ashmead) (Delphacidae), vectors of maize-stunting diseases, to three maize (Zea mays L.) germplasms, a temperate and a tropical hybrid and a landrace. VOCs emitted by the germplasms were collected and identified using gas chromatography-mass spectrometry. The temperate hybrid released significantly more VOCs than the tropical hybrid and the landrace, and its volatile profile was dominated by (±)-linalool. D. maidis preferred odours emitted from the temperate hybrid, whereas P. maidis preferred odours from the tropical hybrid and the landrace over the temperate one. In order to test if linalool plays a role in the behavioural responses, we assayed this compound in combination with the tropical hybrid, to provide other contextual olfactory cues. D. maidis was attracted to the tropical hybrid plus a 0.0001% linalool solution, indicating that this compound could be part of a blend of attractants. Whereas addition of linalool resulted in a slight, though not significant, reduction in host VOC attractiveness for P. maidis. Both hopper species responded to olfactory cues in the absence of supplementary visual cues.
The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with response to antidepressant drugs in depressed patients and with metabolic side effects after antipsychotic treatment. This study aims to assess the association between this polymorphism and insulin resistance after antidepressant treatment in depressed patients.
One hundred forty-eight Caucasian patients with a current unipolar major depressive episode (DSM IV-TR) were genotyped for the BDNF Val66Met polymorphism and assessed at baseline and after 3 and 6 months of antidepressant treatment for the ‘Homoeostasis model assessment of insulin resistance’ (HOMA-IR) index, a valid measure of insulin resistance based on fasting plasma insulinaemia and glycaemia. Because validity assumptions were fulfilled, data were analysed using analysis of variance for repeated measures.
The 52 (35%) Met carriers and 96 (65%) Val/Val patients were not different at baseline for clinical characteristics and HOMA-IR. A significant Val66Met × time interaction (p = 0.02), a significant time effect (p = 0.03) and a significant Val66Met effect (p = 0.0497) were shown for HOMA-IR. A significant Val66Met × time interaction (p = 0.01) and a significant time effect (p = 0.003) were shown for fasting glycaemia. HOMA-IR and fasting glycaemia changes after antidepressant treatment were significantly higher in Met carrier than in Val/Val patients (HOMA-IR changes: Met: 0.71 ± 3.29 v. Val/Val: −0.16 ± 1.34, t = 2.3, df = 146, p = 0.02, glycaemia changes: Met: 0.09 ± 0.30 v. Val/Val: 0.02 ± 0.16, t = −2.0, df = 146, p = 0.045).
The Met allele of the Val66Met BDNF polymorphism confers to depressed patients a higher risk of insulin-resistance after antidepressant treatment. These patients could benefit from specific monitoring of metabolism and preventive measures.
Currently, mark-making practices as a form of identification and proof of life are an unrealized resource. Over a three-year period, systematic walkover surveys were conducted on and within fortifications and other structures on the island of Alderney to locate historic and modern marks. The investigations presented in this article demonstrate the importance of non-invasive recording and examination of marks to identify evidence connected to forced and slave labourers, and soldiers present on the island of Alderney during the German occupation in World War II. Names, hand and footwear impressions, slogans, artworks, dates, and counting mechanisms were recorded electronically and investigated by using international databases, archives, and translation services. We discuss the value and challenges of interpreting traces of human life in the contexts of conflict archaeology and missing person investigations and underline the need for greater recognition of marks as evidence of past lives.
Shortly after the implementation of comprehensive chromosome screening (CCS) techniques for preimplantation genetic testing for aneuploidies (PGT-A), the discussion about the transition from day 3 to blastocyst stage biopsy was initiated. Trophectoderm biopsy with CCS is meant to overcome the limitations of cleavage-stage biopsy and single-cell analysis. The aim of this study was to assess the results obtained in our PGT-A programme after the implementation of this new strategy. Comparisons between the results obtained in 179 PGT-A cycles with day 3 biopsy (D+3) and fresh embryo transfer, and 204 cycles with trophectoderm biopsy and deferred (frozen–thawed) embryo transfer were established. Fewer embryos were biopsied and a higher euploidy rate was observed in the trophectoderm biopsy group. No differences in implantation (50.3% vs. 61.4%) and clinical pregnancy rate per transfer (56.1% vs. 65.3%) were found. Although the mean number of euploid embryos per cycle did not differ between groups (1.5 ± 1.7 vs. 1.7 ± 1.8), the final number of euploid blastocysts available for transfer per cycle was significantly higher in the trophectoderm biopsy group (1.1 ± 1.3 vs. 1.7 ± 1.8). This factor led to an increased cumulative live birth rate in this last group (34.1% vs. 44.6%). Although both strategies can offer good results, trophectoderm biopsy offers a more robust diagnosis and the intervention is less harmful for the embryos so more euploid blastocysts are finally available for transfer and/or vitrification.
It is known that tungsten oxide may be reacted with selenium sources to form WSe2 but literature reports include processing steps that involve high temperatures, reducing atmospheres, and/or oxidative pre-treatments of tungsten oxide. In this work, we report a non-vacuum process for the fabrication of compositionally high quality WSe2 thin films via the selenization of tungsten oxide under milder conditions. Tungsten source materials were various hydrated WO3 and WO2.9 compounds that were prepared using chemical solution techniques. Resulting films were selenized using a two-stage heating profile (250 °C for 15 minutes and 550 °C for 30 minutes) under a static argon atmosphere. Effects of the starting tungsten oxide phase on WSe2 formation after single and double selenization cycles were investigated using Raman spectroscopy and X-ray diffraction (XRD). After two selenization cycles, hydrated WO3 was converted to (002)-oriented WSe2 that exhibits well-resolved peaks for E12g and A1g phonon modes. Only a single selenization cycle was required to convert amorphous WO2.9 to WSe2. All selenizations in this work were achieved in non-reducing atmospheres and at lower temperatures and shorter times than any non-laser-assisted processes reported for WO3-to-WSe2 conversions.
This Article explores Ernst-Wolfgang Böckenförde's views about constitutional judging in a democracy. It offers three ideal types of constitutional judging, each drawn from the extra-judicial writings of prominent constitutional judges who represent it. The three types are: (1) the prophet, who views the constitution as visionary and value-laden, and who entertains an expansive view of the judge's role in giving voice and validity to that vision and those values; (2) the essayist, who shares the prophet's sense of the vast scope and myriad resources of constitutional judging, but who, lacking the prophet's confidence in getting such bewilderingly difficult questions right, approaches constitutional judging cautiously, skeptically, and deferentially; and (3) the executor, who views constitutional judging as the effort to discern the constitution's concrete, limited content, and to enforce that content unflinchingly. Böckenförde, the Article argues, was an executor—one who shared many interpretive commitments with the two most prominent executors in the American constitutional tradition: Hugo Black and, especially, the late Antonin Scalia.
Current understanding of climate change impacts, adaptation and vulnerability among Inuit in the Arctic is relatively static, rooted in the community and time that case studies were conducted. This paper captures the dynamism of Inuit–climate relationships by applying a longitudinal approach to assessing vulnerability to climate change among Inuit in Ulukhaktok, Northwest Territories, Canada. Data were collected in 2005 and 2016 following a consistent methodology and analytical framework. Findings from the studies are analysed comparatively together with longitudinal datasets. The data reveal that many of the climatic changes recorded in 2005 that adversely affected hunting activities have been observed to be persisting or progressing, such as decreasing sea ice thickness and extent, and stronger and more consistent summer winds. Inuit are responding by altering travel routes and equipment, taking greater pre-trip precautions, and concentrating their efforts on more efficient and accessible hunts. Increasing living and subsistence costs and time-constraints, changes in the generation and transmission of environmental knowledge and land skills, and the concentration of country food sharing networks were identified as key constraints to adaptation. The findings indicate that the connections between subsistence activities and the wage economy are central to understanding how Inuit experience and respond to climate change.
As of 1997, the United States faces an unprecedented degree of security, stability, and economic prosperity in its relations with Latin America. Never before have US strategic interests in Latin America been as well-protected or have its prospects seemed, at least on the surface, so promising. Yet while the US strategic interests are in better shape — militarily, politically, and economically — this decade than at any time since the end of the Second World War, some problems remain. Over the long run, there is also the risk that old problems, which today seem to have ebbed away, will return. Thus, the positive tone of any contemporary assessment must be tempered with an awareness of remaining areas of concern as well as of possible future crises.
Bòbila Madurell-Can Gambús is the most emblematic Neolithic cemetery in the northeastern Iberian peninsula, with a total of 179 documented pit burials. Artifacts made of exogenous raw materials, such as honey flint (southeastern France), jadeite, amphibolite, eclogite and nephrite (Alps and the Pyrenees), variscite (coast of northeastern Iberia), and even obsidian (Sardinia), have been found in the burials. The presence of these raw materials is not exclusive to this necropolis, but they have also been documented in many of the graves of this region during this period. The literature has singled out this funerary practice as the Pit Burials cultural horizon. However, until now the chronology of this funerary practice has not been fully defined, so it was difficult to explain the development of the chronology and the networks through which the materials reached northeast Iberia. New, unpublished radiocarbon (14C) dates of Bòbila Madurell-Can Gambús are presented, as well as the results of different statistical analyses and Bayesian modeling that specify its chronology. Through the contribution of new data on the chronology of Bòbila Madurell-Can Gambús new clues regarding the temporal dynamics of pit burials and the raw materials exchange networks associated with them are presented.
Youth who immigrate to the US navigate unique and increasingly complex challenges. These challenges include stressful or unsafe sociopolitical pre-migration contexts, protracted or unpredictable migration processes, and post-migration stressors while adapting to a new culture. In this chapter, we examine such effects of immigration and acculturation on children in different historical periods. The example of migration from Mexico to the US is used to illustrate how our historical perspectives change and shape developmental possibilities and experiences for children. Our recent historical perspective embraced the goal of assimilating children and families into the US host culture, with little adherence to the values and traditions of the culture of origin. Over time this perspective has shifted to the current view that the goal of acculturation should be a bicultural one. Implications of various migratory paths for children’s adjustment are discussed, as are the developmental implications of current policies related to migration.
This study was aimed to investigate associations between birth weight and multiple adiposity indicators in youth, and to examine potential mediating effects by biological maturation. This was a school-based study involving 981 Brazilian adolescents aged between 10 and 17 years. Birth weight was reported retrospectively by mothers. Maturation was estimated by age of peak height velocity. Adiposity indicators included body mass index (BMI), waist circumference and percent body fat estimated from triceps and subscapular skinfolds. Multilevel mediation analyses were performed using the Sobel test, adjusted for chronological age, gestational age, cardiorespiratory fitness and socio-economic status. Except for body fat in girls, biological maturation partly or fully mediated (P<0.05) positive relationships between birth weight with all other obesity indicators in both sexes with their respective values of indirect effects with 95% confidence intervals: BMI [boys: 0.44 (0.06–0.82); girls: 0.38 (0.13–0.64)], waist circumference [boys: 1.14 (0.22–2.05); girls: 0.87 (0.26–1.48)] and body fat [boys: 0.60 (0.13–1.07)]. To conclude, birth weight is associated with elevated obesity risk in adolescence and biological maturation seems to at least partly mediate this relationship.