bluuebunny/crossref_metadata_2025_split huggingface dataset:
56. Proficiency at the end of practice predicts retention of a technical clinical skills
Authors: Carnahan H. , Hagemann E. , Dubrowski A. 
Published: May 2017

A debate is emerging regarding the efficacy of proficiency based versus duration based training of technical skills. It is not clear whether the performance level attained at the end of practice (i.e., proficiency criteria), or the overall amount of practice performed during learning will best predict the retention of a technical clinical skill.
The skill learned was the single-handed double square-knot. Forty two trainees learned the skill through video-based instruction and were divided into three groups (14 participants per group) each with a specific criterion time to tie the knot (10, 15, and 20 seconds). Practice continued until participants completed the knot within their criterion time. The total number of trials, and the overall practice time required to obtain each respective criterion were recorded during practice. Participants returned one-week later for a timed retention test consisting of one trial of the knot tying skill with no video instruction.
A multiple regression analysis tested whether the amount of practice, the total practice time, or the criterion reached at the end of practice was the best predictor of the time taken to perform the skill during retention. This analysis showed that the number of practice trials was highly correlated with total practice time (r = .82, p = .01), therefore total practice time was withdrawn as a predictor variable from the subsequent analysis. The regression showed that the only significant predictor of retention performance was the criterion reached at the end of practice (p = .03). The number of practice trials was not found to significantly predict the retention performance (p = .87).
The results support the notion that proficiency based training results in better retention of a technical clinical skill in comparison to duration based approaches. This provides evidence for the introduction of proficiency based educational approaches in technical skills curricula.
Jowett N, LeBlanc V, Xeroulis G, MacRae H, Dubrowski A. Surgical skill acquisition with self-directed practice using computer-based video training. Am J Surg. 2007; 193(2):237-42.
Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, Smith CD, Satava RM. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg. 2005; 241(2):364-72.
Van Sickle KR, Ritter EM, McClusky DA, Lederman A, Baghai M, Gallagher AG, Smith CD. Attempted establishment of proficiency levels for laparoscopic performance on a national scale using simulation: the results from the 2004 SAGES Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) learning center study. Surg Endosc. 2007; 21(1):5-10.
57. The power of power: Comparative evaluations of medical residency training across teaching sites and programs at the University of Torontos
Authors: Abrahams C. , Verma S. , Muharuma L. , Imrie K. , Vestemean R. , Poldre P. , McIlroy J. , Woods N. 
Published: May 2017

To meet accountability and accreditation requirements, teaching partners and the faculty postgraduate office required more robust and integrated feedback on teaching and assessment. The web-based evaluation system known as POstgraduate Web Evaluation and Registration (POWER) was implemented in 2004/05 by most residency training programs, using their existing forms and scoring scales. At start up, over 250 different evaluation forms and 85 varying scoring scales were in operation across programs for the In-Training Evaluation Reports (ITERs) and resident-completed evaluations for Rotation Evaluation Scores (RES) and Teaching Effectiveness Scores (TES).
The POWER Evaluation Working Group was formed to develop a methodology to gather and consolidate evaluations to report on medical residents, their teachers, and rotations in a clear, consistent user-friendly format, map general questions against CanMEDS roles and Family Medicine principles, and convert all scoring scales to a consistent 5 point Likert scale. A standardized naming protocol was developed to map rotation services to individual teaching sites.
The 2004/05 analysis of these evaluations (2004/05 Annual POWER Report: Lessons Learned) provide baseline data to begin monitoring trends in resident and faculty performance, assess the quality of programs and identify areas for improvement by CanMEDS standards and CFPC principles. Mean scores, standard deviations and number of evaluations were presented by teaching site and program.
Consolidation of evaluations by program and teaching site provides valuable feedback to hospitals and programs wishing to standardize and improve their assessment systems, and to postgraduate medical offices who must maintain evaluation standards and illustrate trends for accreditation purposes. Future activities include: standardizing evaluation forms starting July 2007, improving scoring consistency and accuracy, improve participation rates and timeliness of responses, develop a procedure/case log tracking system, and trend analysis.
Afrin LB, Arana GW, Medio FJ, Ybarra AF, Clarke HS Jr. Improving oversight of the graduate medical education enterprise: one institution’s strategies and tools. Academic Medicine 2006 (May); 81(5):419-25.
Benjamin S, Robbins LI, Kung S. Online Sources for assessment and evaluation. Academic Psychiatry 2006 (Nov-Dec); 30(6):498-504.
Rosenberg ME, Watson K, Paul J Miller W, Harris I, Valdivia TD. Development and Implementation of a web-based evaluation system for an internal medicine residency program. Academic Medicine 2001 (Jan); 76(1):92-5.
62. Does an expert presentation raise awareness of CanMEDs Roles among residents?s
Authors: Jenkins S. , Crocker K. , Jeon P. , Borgaonkar M. , Pace D. , Verma S. 
Published: May 2017

We set out to determine whether an expert presentation on CanMEDS would raise awareness of CanMEDS roles among residents. We addressed this question with paired surveys distributed before and after the expert presentation.
Each survey outlined seven different clinical scenarios each of which required one of the seven core CanMEDS competencies. Paired surveys were distributed prior to the presentation to the audience that was composed of a selection of residents from various disciplines. One survey was filled out prior to and the second survey completed following the expert presentation.
Data were analysed using nonparamentric statistical methods. There was in general, a low pre-presentation background knowledge of CanMEDS roles, with wide variability between specialties. Our hypothesis that disciplines with less patient contact would have less understanding of CanMEDS roles was not fully supported. All specialties demonstrated improvement in their understanding of CanMEDS roles in the post-presentation survey.
While there is a low background level of knowledge about CanMEDS roles, we determined that following an expert presentation (in this case by Dr. Serita Verma) the residents were significantly more able to correctly apply the core competencies of the CanMEDS model to the given clinical scenarios. We propose that an expert presentation could be applied as an innovative educational tool advancing CanMEDS education among residents.
64. International child health (ICH) education in Canadian paediatric residency programss
Authors: Audcent T. , MacDonnell H. , Brenner J. , Samson L. 
Published: May 2017

A national survey was conducted of current ICH exposure and curriculum in pediatric residency programs. Our objectives were to quantify ICH teaching presently occurring, to identify how programs support trainees in undertaking ICH electives during their training, to determine attitudes towards ICH amongst paediatric program directors and chief residents across the country, and to identify barriers to ICH curriculum expansion within the post-graduate programs.
A population census of all 44 chief residents and program directors from the 16 Canadian pediatric programs was undertaken. A self-administered survey was developed de novo for this study. Twenty-two qualitative and quantitative questions were developed under the following domains: demographics, program content, electives, attitudes and perceptions, barriers and future directions. Surveys were completed electronically. Descriptive statistics were used, and common themes were extracted from qualitative responses.
The response rate was 65% (29 surveys), with 81% of the training programs represented. Seventy-three percent of the program directors, and 44% of the chief residents from across the country responded. Eighty-nine percent reported that their program did not have a formal curriculum in ICH. All respondents reported some ICH related educational sessions, however certain areas felt to be key were lacking. 80% agreed that electives should be encouraged as part of residency training, but 72% indicated lack of adequate funding for these electives. Overall, 86% agreed that ICH issues are important for paediatric trainees and 84% indicated that more emphasis should be placed on ICH in the paediatric resident curriculum. Eighty-six percent of respondents agreed that their program would be interested in new initiatives regarding ICH.
The results of this survey demonstrate that although there are opportunities for ICH exposure in most paediatric training programs, formalized curriculum is lacking. The majority of programs indicated a willingness to support the integration of an ICH curriculum into their core educational components.
The Association of Faculties of Medicine of Canada (AFMC). Towards a Medical Education Relevant to All : The Case for Global Health in Medical Education. A Report of the Global Health Resource Group. April 2006.
Bateman C, et al. Bringing global issues to medical teaching. Lancet, 2001; 358:1539-42.
Edwards R, et al. Understanding global health issues: are international health electives the answer? Medical Education, 2004; 38:688-690.
74. Remediation plans: Effectively matching trainee needs to remediation planss
Authors: Takahashi S. Glover , Martin D. , Verma S. , Edwards S. 
Published: May 2017

This paper is a retrospective study reporting on the development of remediation plans for residents who are having difficulty meeting the established program goals and objectives. Additionally, the paper describes the implementation of a consistent, competency focused approach to remediation using a standardized needs assessment and intervention planning tool has functioned to better manage difficulty. First, the paper provides a profile of the educational needs of 20 recent cases describing their specialty programs, training levels and the competency areas of difficulty. Next the paper outlines an educational inquiry tool used by residency program directors to develop, implement and evaluate the trainee’s remediation programs. The tool includes inquiry questions which the faculty answer in the development of a customized remedial educational plan in the such areas as: trainee background, trainee information, overall rationale for remediation plan, training profile, purpose of remediation, details of remediation plan, anticipated outcome of remediation plan, other factors impacting trainee success. The tool is designed to be reviewed with trainee input to ensure the desired outcomes and process for the remediation plan are transparent for both the trainee and program director. Finally three case studies are described in detail including of the types of problems that lead to remediation, examples of the remediation plans developed and the range of approaches employed to support the success of residents. The paper then summarizes the identified key issues and options in optimizing success for residents in difficulty.
Christopher I, Doty CI, Lucchesi M. The Value of a Web-based Testing System to Identify Residents Who Need Early Remediation: What Were We Waiting For? Acad Emerg Med 11(3):324.
Beeson MS, Jwayyed S. Development of a Specialty-wide Web-based Medical Knowledge Assessment Tool for Resident Education. Acad. Emerg. Med 2004 (Mar); 11(3):324.
Boiselle PM. Remedy for Resident Evaluation and Remediation, Academic Radiology 2005(July); 12(7):894-900.
Profiling YB-1 responsive genes in basal-like breast cancer cells by ChIP-on-chip reveals direct binding to PIK3CAs
Authors: Astanehe A , Finkbeiner M 
Published: May 2017

Purpose: Basal-like breast cancers (BLBC) are typically very aggressive and they are also prone to a high rate of recurrence. We recently identified the transcription factor Y-box binding protein-1 (YB-1) as an important component of BLBC by screening breast tumour tissue microarrays. YB-1 is well known for its ability to confer chemotherapy resistance and to promote the growth of a wide range of cancer cell types. The breast cancer cell line SUM149 was characterized by us as having all the hallmarks of BLBC including a lack of the estrogen, progesterone, and Her-2 receptors. We also find that they express high levels of the epidermal growth factor receptor, a YB-1 responsive gene.
We performed a genome-wide promoter screen of the possible YB-1 responsive genes using the NimbleGen ChIP-on-chip (COC) platform to begin to understand how this oncogene regulates the growth of basal-like breast cancer cells. YB-1 was found to bind to ~6,700 human promoters. Several members of the phosphatidylinositol-3-kinase (PI3K) pathway were identified (p110a, p85, Akt-2, ILK). Of particular interest was the identification of PIK3CA, the gene that codes for the p110a catalytic subunit of PI3K. PI3K, a lipid kinase with important roles in neoplasia, phosphorylates membrane inositol lipids resulting in activation of downstream effectors that are involved in cellular responses such as cell proliferation, survival, metabolism, and cytoskeletal reorganization. Many studies have suggested importance of the role of PI3K signaling in various types of cancer. Approximately 20% of breast cancers harbour somatic activating mutations in PIK3CA, and about 8% have amplification of PIK3CA. The remainder of the cancers have elevated levels of PI3K via other mechanisms including increased transcription.
Methods & Results: Here we propose that YB-1 overexpression in cancer leads to increased PIK3CA transcription via direct binding to the promoter. To extend our COC findings, we knocked down YB-1 with siRNA and observed a concomitant loss in p110a by immunoblotting. We have recently identified two alternate PIK3CA transcriptional start sites (exon 1a and 1b) and two alternate PIK3CA promoters (promoter 1a and 1b). We mapped potential YB-1 binding sites on PIK3CA promoters 1a and 1b, and identified five putative YB-1 binding sites within promoter 1a and one putative binding site within promoter 1b. We further performed traditional ChIP and EMSA to confirm the interaction of YB-1 with the putative binding sites on PIK3CA promoter, and determined that YB-1 binds to promoter 1a, but not to promoter 1b.
Conclusion:The demonstration that YB-1 binds directly to the PIK3CA promoter and induces its activity identifies a novel mechanism whereby activation of YB-1 and subsequent up-regulation of PIK3CA may contribute to the pathophysiology, outcomes and therapeutic responsiveness of breast cancer.
Molecular characterization of the development of the K65R and M184V drug resistance mutations in Subtype C HIV-1s
Authors: Coutsinos Dimitrios , Invernizzi Cédric F. , Moisi Daniela , Oliveira Maureen , Brenner Bluma G. , Wainberg Mark A. 
Published: May 2017

Background: We have shown that the K65R mutation is selected more rapidly in subtype C than in subtype B HIV-1 isolates in both cell culture and clinical studies. Biochemical comparisons between subtype B and C-derived reverse transcriptase (RT) enzymes revealed similar molecular characteristics that do not explain the more rapid selection of K65R with subtype C viruses. This study attempts to establish the mechanistic basis for the difference.
Methods: Recombinant subtype C and B HIV-1 RT enzymes were expressed and purified in E. coli. Gel-based nucleotide extension assays were used to study DNA synthesis from various natural and synthetic DNA and RNA templates that spanned regions of the pol gene responsible for the K65R and M184V mutations. Cell based experiments were performed using MT2 cells infected with mutated subtype B HIV-1 pNL4-3 viruses.
Results: The propensity for the more rapid selection of K65R with subtype C enzymes is due to the mechanism of DNA synthesis from a subtype C template. The use of templates containing the 64, 65 and 66 codons of the pol gene led to different patterns of DNA synthesis. When subtype C RT was employed to synthesize DNA from subtype C templates, preferential pausing was seen at the nucleotide position responsible for the AAG to AGG mutation on codon 65 which gives rise to K65R. In contrast, the use of subtype B RT together with a subtype B template reveals a different pattern of DNA synthesis. When subtype B RT was employed with a subtype C template, DNA synthesis stopped at the exact nucleotide position responsible for K65R. This phenomenon was not observed when subtype C RT was used with a subtype B template. A similar method was employed to investigate if differences exist in the appearance of M184V between subtypes. The results suggest that M184V is not favoured due to its coding sequence and that the propensity for the development of M184V remains the same in subtype B and C HIV. In cell culture, K65R was detected faster in subtype B that has been mutated to include the 64/65 codons of subtype C, when compared to wild-type subtype B HIV.
Conclusions: The more rapid emergence of K65R but not M184V in subtype C RT appears to be based on the pol gene coding sequence. These results urge for the analysis of resistance mechanisms to be studied in all HIV subtypes separately and have clinical relevance in regard to the management of subtype C infections.
Elucidating the role of P63 during development of the mammalian nervous systems
Authors: Dugani Sagar , Paquin Annie , Kaplan David R. , Miller Freda D. 
Published: May 2017

Background: The protein p63, a recently discovered member of the p53 family of proteins, is implicated in the maintenance and differentiation of stem cells in the epidermis and is involved in the regulation of naturally-occurring cell death in sympathetic neurons of the peripheral nervous system. Since initial data from our laboratory indicated that p63 is also widely expressed in stem cells and neurons within the developing brain, we assessed its involvement in regulating the genesis and survival of developing cortical neurons. As neurogenesis is initiated at embryonic day 12 (E12), we isolated cortical precursors from p63-/- embryos at E14 and cultured them for 2 days in vitro (DIV).
Methods: Based on immunocytochemistry to known markers of apoptosis and neurons, we assessed the level of cell death and neurogenesis.
Results: Compared to p63+/+ cortical precursors, p63-/- precursors from littermates showed a 50 % reduction in neuronal death, as assessed by the apoptosis marker, cleaved caspase 3. Interestingly, the proportion of neurons and astrocyte precursors, the latter identified by S100b was also reduced in p63-/- embryos, as compared to p63+/+ littermates.
Conclusions: These results suggest that p63 may be involved in the regulation of cell survival and in the differentiation of precursors into neurons and astrocytes. To assess the former, we overexpressed TAp63a, a full-length isoform of p63, in E12/13 cortical precursors and assessed the level of cell death after 2 DIV. Compared to control cells, cells transfected with TAp63a demonstrated a 2-fold increase in cell death. Ongoing work will characterize p63 involvement in differentiation of precursor cells into neurons and astrocytes. To assess if these findings are relevant in vivo, we will use p63flox,flox X Nextin-Cre mice, which have p63 specifically ablated in neural precursors. We will analyze the survival, proliferation, and fate of these p63-/- cells. Together, these studies will help to determine a role for p63 in neural proliferation and apoptosis, processes central to development and response to injury.
An analysis of the adaptive immune response towards an embryonic stem cell grafts
Authors: Wu Douglas , Wood Kathryn 
Published: May 2017

Background: Although clinical transplantation has had enormous impact on the treatment of premature organ failure, shortage of donor organs continues to be a crucial limiting factor. Embryonic stem cells represent an attractive potential source of replacement tissue because of their inherent pluripotentiality and ability to self-renew. However, before any ES cell-based cellular replacement strategies can be considered, many issues must be addressed. Among these is an evaluation of the potential immune response elicited by any ES cell graft. Because ES cells express very low levels of MHC class I and no MHC class II, their immunogenicity has been questioned. Here we utilize a BM3 TCR transgenic model to analyze the adaptive immune response against an ES cell graft in vivo.
Methods: BM3 CD8 TCR-tg T cells (H2K background) specific for the MHC class I molecule H2Kb were labelled with CFSE and adoptively transferred into CBA rag recipients. The following day, ES cells derived from a CBA, B6, or CBK background were implanted beneath the kidney capsule of adoptively transferred mice. Response of the CD8 T cells was measured via CSFE division profiling and graft infiltration.
Results: CFSE division profile of naïve BM3 CD8 T cells was unaltered by the presence of either a syngeneic or an allogeneic ES cell graft. These naïve cells were also unable to recognize and infiltrate either a syngeneic or allogeneic ES cell graft on days 5 and 10 post-implantation, despite strong expression of the MHC class I molecule H2Kb by engrafted allogeneic ES cells. On the other hand, H2Kb+ islets begun to be infiltrated by day 5, and were obliterated by a vigorous allogeneic response by day 10. When H2Kb+ islets were implanted into the same kidney as allogeneic ES cells (opposite poles), islet grafts were rapidly infiltrated by CD4 and CD8 T cells and destroyed, but ES cell grafts exhibited markedly reduced cellular infiltrate. In contrast to naïve BM3 CD8 T cells, however, activated cells recognized and mounted an aggressive cytotoxic response against an allogeneic ES cell graft which could be detected by day 6 and resulted in complete graft destruction by day 10.
Conclusions: Under certain circumstances, an ES cell graft may have reduced immunogenicity as compared with other conventional tissue or solid organ allografts. This may be due to their lack of passenger APC, which may in turn cripple their ability to elicit a robust allogeneic response via the direct pathway of allorecognition. However, because of their strong upregulation of allogeneic MHC class I molecules after transplantation, they are still likely to elicit a significant rejection response when transplanted into recipients replete with both CD4 and CD8 T cells.