PURPOSE: Prior descriptions of the psychometric properties of validated knowledge assessment tools designed to determine Emergency medicine (EM) residents understanding of physiologic and clinical concepts related to mechanical ventilation are lacking. In this setting, we have performed this study to describe the psychometric and performance properties of a novel knowledge assessment tool that measures EM residents' knowledge of topics in mechanical ventilation. METHODS: Results from a multicenter, prospective, survey study involving 219 EM residents from 8 academic hospitals in northeastern United States were analyzed to quantify reliability, item difficulty, and item discrimination of each of the 9 questions included in the knowledge assessment tool for 3 weeks, beginning in January 2013. RESULTS: The response rate for residents completing the knowledge assessment tool was 68.6% (214 out of 312 EM residents). Reliability was assessed by both Cronbach's alpha coefficient (0.6293) and the Spearman-Brown coefficient (0.6437). Item difficulty ranged from 0.39 to 0.96, with a mean item difficulty of 0.75 for all 9 questions. Uncorrected item discrimination values ranged from 0.111 to 0.556. Corrected item-total correlations were determined by removing the question being assessed from analysis, resulting in a range of item discrimination from 0.139 to 0.498. CONCLUSION: Reliability, item difficulty and item discrimination were within satisfactory ranges in this study, demonstrating acceptable psychometric properties of this knowledge assessment tool. This assessment indicates that this knowledge assessment tool is sufficiently rigorous for use in future research studies or for assessment of EM residents for evaluative purposes.
Discrimination (Psychology) ; Emergencies* ; Emergency Medicine* ; New England* ; Prospective Studies ; Psychometrics* ; Reproducibility of Results ; Respiration, Artificial* ; United States

The quality of reporting of cohort studies published in the most prestigious scientific medical journals was investigated to indicate to what extent the items in the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist are addressed. Six top scientific medical journals with high impact factor were selected including New England Journal of Medicine, Journal of the American Medical Association, Lancet, British Medical Journal, Archive of Internal Medicine, and Canadian Medical Association Journal. Ten cohort studies published in 2010 were selected randomly from each journal. The percentage of items in the STROBE checklist that were addressed in each study was investigated. The total percentage of items addressed by these studies was 69.3 (95% confidence interval: 59.6 to 79.0). We concluded that reporting of cohort studies published in the most prestigious scientific medical journals is not clear enough yet. The reporting of other types of observational studies such as case-control and cross-sectional studies particularly those being published in less prestigious journals expected to be much more imprecise.
American Medical Association ; Archives ; Case-Control Studies ; Checklist ; Cohort Studies ; Internal Medicine ; New England

As the government has a plan to terminate medical internships and to start the New Resident program, postgraduate medical students should encounter the new residency training program without the internship from 2015. To keep pace with this significant change, the Korean Neuropsychiatry association launched the task force team to manage this problem. The task force team has examined the psychiatry residency training programs from major countries, including England, Japan, Germany, Australia, New Zealand, and the Unites States. In addition, we conducted a survey for teaching psychiatrists and psychiatry residents who just finished the Psychiatry Board Examination in 2013 using a premade questionnaire on the expected problems that might occur if the internship program were abolished, and some significant issues regarding resident rotation schedule to other departments. In this paper, we summarized the results of our examination and survey. Establishment of a new residency training program based on these surveys would be desirable.
Advisory Committees ; Appointments and Schedules ; Australia ; England ; Germany ; Humans ; Internship and Residency ; Japan ; Korea ; Neuropsychiatry ; New Zealand ; Psychiatry ; Surveys and Questionnaires ; Students, Medical

New England School of Acupuncture is the first Chinese Medicine School in the United States. From the aspects of school history, status of students and situation of teachers, curriculum design, clinical practice and scientific research, this present article makes a simple introduction for this school, and briefly compares the Chinese Medicine education between China and west. Different from China, the American education is more lively and vivid, open and flexible, but lacks enough attention on the study of classic and clinical practice. In a word, China and the West could learn from each other and make the best of the both worlds.
Acupuncture ; education ; history ; manpower ; organization & administration ; Acupuncture Therapy ; history ; Faculty ; History, 20th Century ; History, 21st Century ; Humans ; Learning ; Medicine, African Traditional ; history ; New England ; Students

Autosomal dominant polycystic kidney disease (ADPKD) is the most common life-threatening hereditary disease in the USA resulting in chronic kidney disease and the need for dialysis and transplantation. Approximately 85% of cases of ADPKD are caused by a mutation in the Pkd1 gene that encodes polycystin-1, a large membrane receptor. The Pkd1 gene mutation results in abnormal proliferation in tubular epithelial cells, which plays a crucial role in cyst development and/or growth in PKD. Activation of the proliferative mammalian target of rapamycin (mTOR) signaling pathway has been demonstrated in polycystic kidneys from rodents and humans. mTOR inhibition with sirolimus or everolimus decreases cysts in most animal models of PKD including Pkd1 and Pkd2 gene deficient orthologous models of human disease. On the basis of animal studies, human studies were undertaken. Two large randomized clinical trials published in the New England Journal of Medicine of everolimus or sirolimus in ADPKD patients were very unimpressive and associated with a high side-effect profile. Possible reasons for the unimpressive nature of the human studies include their short duration, the high drop-out rate, suboptimal dosing, lack of randomization of "fast" and "slow progressors" and the lack of correlation between kidney size and kidney function in ADPKD. The future of mTOR inhibition in ADPKD is discussed.
Animals ; Dialysis ; Epithelial Cells ; Everolimus ; Genetic Diseases, Inborn ; Humans ; Kidney ; Membranes ; Models, Animal ; New England ; Polycystic Kidney Diseases ; Polycystic Kidney, Autosomal Dominant ; Random Allocation ; Renal Insufficiency, Chronic ; Rodentia ; Sirolimus ; Transplants

BACKGROUND: The objective of this study was to report on the prevalence of musculoskeletal pain in lobstermen in the northeast USA. METHODS: Crews were randomly selected from those licensed to fish in Maine and Massachusetts and followed prospectively. The survey used a Nordic Musculoskeletal Questionnaire format to characterize musculoskeletal disorders. RESULTS: A total of 395 individuals participated. One half of the respondents reported low back pain. Back pain was attributed to or exacerbated by lobstering. Low back pain was prevalent among both captains and sternmen, while sternmen reported more hand/wrist pain than captains. Multiple locations for pain were common in individual participants. CONCLUSION: Equipment or technology to assist material handling should be a priority, as the body segments with high prevalence of pain (back, hand/wrists, shoulders, knees) are all affected by the repetitive and forceful handling of the lobster traps.
Back Pain ; Low Back Pain ; Maine ; Massachusetts ; Musculoskeletal Pain ; Prevalence ; Prospective Studies ; Shoulder ; Surveys and Questionnaires

PURPOSE: Preamplifier and amplifier are very important parts for developing a portable counting or imaging gamma probe. They can be used for analyzing pulses containing energy and position information for the emitted radiations. The commercial Nuclear Instrument Modules (NIMs) can be used for processing these pulses. However, it may be improper to use NIMs in developing a portable gamma probe, because of its size and high price. The purpose of this study was to develop both preamplifier and amplifier and measure their performance characteristics. MATERIALS and Methodes: The preamplifier and amplifier were designed as a charge sensitive device and a capacitor resistor-rsistor capacitor (CR-RC) electronic circuit, respectively, and they were mounted on a print circuit board (PCB). We acquired and analyzed energy spectra for Tc-99m and Cs-137 using both PCB and NIMs. Multichannel analyzer (Accuspec/A, Caberra Industries Inc., Meriden Connecticut, U.S.A) and scintillation detectors (EP-047 (Bicron Saint-Gobain/Norton Industrial EP-047 (Ceramics Co., Ohio, U.S.A) with 2"x2" NaI (T1) crystal and R1535 (Hamamatsu Photonics K.K., Electron Tube Center, Shizuoka-ken, Japan) with 1"x1"NaI (T1) crystal) were used for acquiring the energy spectra. RESULTS: Using PCB, energy resolutions or EP-047 detectors for Tc-99m and Cs-137 were 12.92% and 5.01%, respectively, whereas R1535 showed 13.75% and 5.19% of energy resolution. Using the NIM devices, energy resolutions of EP-047 detector for Tc-99m and Cs-137 were measured as 14.6% and 7.58%, respectively. However, reliable energy spectrum of R1535 detector could not be acquired, since its photomultiplier tube (PMT) requires a specific type of preamplifier. CONCLUSION: We developed a special preamplifier and amplifier suitable for a small sized gamma probe that showed good energy resolutions independent of PMT types. The RESULTS indicate that the PCB can be used in developing both counting and imaging gamma probe.
Connecticut ; Ohio ; Optics and Photonics

OBJECTIVE: Although unilateral transforaminal lumbar interbody fusion (TLIF) is widely used because of its benefits, it does have some technical limitations. Removal of disk material and endplate cartilage is difficult, but essential, for proper fusion in unilateral surgery, leading to debate regarding the surgery's limitations in removing the disk material on the contralateral side. Therefore, authors have conducted a randomized, comparative cadaver study in order to evaluate the efficiency of the surgery when using conventional instruments in the preparation of the disk space and when using the recently developed high-pressure water jet system, SpineJet(TM) XL. METHODS: Two spine surgeons performed diskectomies and disk preparations for TLIF in 20 lumbar disks. All cadaver/surgeon/level allocations for preparation using the SpineJet(TM) XL (HydroCision Inc., Boston, MA, USA) or conventional tools were randomized. All assessments were performed by an independent spine surgeon who was unaware of the randomizations. The authors measured the areas (cm2) and calculated the proportion (%) of the disk surfaces. The duration of the disk preparation and number of instrument insertions and withdrawals required to complete the disk preparation were recorded for all procedures. RESULTS: The proportion of the area of removed disk tissue versus that of potentially removable disk tissue, the proportion of the area of removed endplate cartilage, and the area of removed disk tissue in the contralateral posterior portion showed 74.5 +/- 17.2%, 18.5 +/- 12.03%, and 67.55 +/- 16.10%, respectively, when the SpineJet(TM) XL was used, and 52.6 +/- 16.9%, 22.8 +/- 17.84%, and 51.64 +/- 19.63%, respectively, when conventional instrumentations were used. The results also showed that when the SpineJet(TM) XL was used, the proportion of the area of removed disk tissue versus that of potentially removable disk tissue and the area of removed disk tissue in the contralateral posterior portion were statistically significantly high (p < 0.001, p < 0.05, respectively). Also, compared to conventional instrumentations, the duration required to complete disk space preparation was shorter, and the frequency of instrument use and the numbers of insertions/withdrawals were lower when the SpineJet(TM) XL was used. CONCLUSION: The present study demonstrates that hydrosurgery using the SpineJet(TM) XL unit allows for the preparation of a greater portion of disk space and that it is less traumatic and allows for more precise endplate preparation without damage to the bony endplate. Furthermore, the SpineJet(TM) XL appears to provide tangible benefits in terms of disk space preparation for graft placement, particularly when using the unilateral TLIF approach.
Boston ; Cadaver ; Cartilage ; Diskectomy ; Spine ; Transplants ; Water

BACKGROUND: To elucidate the earliest changes of language function in patients with dementia of Alzheimer's type (DAT), performance on the various semantic language tasks were compared between patients with amnestic mild cognitive impairment (aMCI) (n=20), mild DAT (n=20) and normal cognition elderly individuals (NC, n=20). METHODS: Language tasks included levels of word, sentence and discourse. In the word level, confrontation naming test (Korean version-Boston Naming Test, K-BNT) and the verbal fluency (semantic and phonemic fluency) tasks were used. In the sentence level, the verbal definition tasks including 24 nouns four categories were used. In the discourse level, the Boston Cookie-Theft picture description task was used. The picture description task was analyzed for both productive aspect (total number of sentences, total number of phrases and phrases per sentence) and semantic aspect (ratio of CIU: Correct Information Unit). RESULTS: The results from this study are as follow: 1) In the confrontation naming test, mild DAT group showing worse performances than the NC and aMCI group. However, no differences were observed between the NC and aMCI group. 2) The performances of verbal fluency task showed significantly differences between the all groups. 3) In the verbal definition task, performances of NC group showing better performances than aMCI and mild DAT group. However, no differences were observed between the aMCI and mild DAT group. 4) In the picture description task, performances of the aMCI and mild DAT group were non-informative and inefficient in semantic aspect compared to the NC group. However, no differences were observed between the three groups on productive aspect. CONCLUSIONS: These results demonstrated that the deficit of semantic language is readily identified in the aMCI stage, and it can be revealed by tasks of sentence and discourse level.
Aged ; Boston ; Cognition ; Dementia ; Humans ; Mild Cognitive Impairment ; Semantics

BACKGROUND: Local steroid injection is used to treat carpal tunnel syndrome (CTS). The aim of this study was to evaluate the clinical and electrophysiological effects of local steroid injection in patients with CTS over a 3-months period. METHODS: Twenty-one patients (35 hands) with clinical and electrophysiological evidence of CTS were treated by injection of triamcinolone 40 mg to the carpal tunnel. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), rates of paresthesia, night awakening, and electrophysiological studies were used as outcomes. Clinical and electrophysiological assessments were performed before, 1 and 3 months after treatment. RESULTS: Prior to treatment, 86% of patients complained of night awakening. At 1 and 3 months after injection, only 17% and 29% of the patients, respectively, had night awakening (p<0.001). All patients complained of paresthesia before the treatment. This symptom disappeared in 60% and 31% of the patients after 1 and 3 months, respectively (p<0.001). Compared to baseline, both BCTQ and VAS show significant improvement during the 3 months of the study (p<0.005). Although significant improvements in clinical parameters were shown, electrophysiological parameters were not significantly improved at 1 and 3 months. CONCLUSIONS: Local corticosteroid injection for the treatment of CTS provides significant improvement in symptoms for 3 months. On the other hand, no significant improvement was observed in electrophysiological parameters.
Boston ; Carpal Tunnel Syndrome ; Electrophysiology ; Hand ; Humans ; Paresthesia ; Triamcinolone