Publications by authors named "Ryan Palmer"

31 Publications

Development of continuous flow systems to access secondary amines through previously incompatible biocatalytic cascades.

Angew Chem Int Ed Engl 2021 Apr 15. Epub 2021 Apr 15.

The University of Manchester, chemistry, UNITED KINGDOM.

A key aim of biocatalysis is to mimic the ability of eukaryotic cells to carry out multistep cascades in a controlled and selective way. As biocatalytic cascades get more complex, reactions become unattainable under typical batch conditions. Here a number of continuous flow systems were used to overcome batch incompatibility, thus allowing for successful biocatalytic cascades. As proof-of-principle, reactive carbonyl intermediates were generated in situ using alcohol oxidases, then passed directly to a series of packed-bed modules containing different aminating biocatalysts which accordingly produced a range of structurally distinct amines. The method was expanded to employ a batch incompatible sequential amination cascade via an oxidase/transaminase/imine reductase sequence, introducing different amine reagents at each step without cross reactivity. The combined approaches allowed for the biocatalytic synthesis of the natural product 4O-methylnorbelladine. The flow biocatalysis platform shown here significantly increases the scope of novel biocatalytic cascades, removing previous limitations due to reaction and reagent batch incompatibility.
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http://dx.doi.org/10.1002/anie.202103805DOI Listing
April 2021

Screening and characterization of a diverse panel of metagenomic imine reductases for biocatalytic reductive amination.

Nat Chem 2021 02 30;13(2):140-148. Epub 2020 Dec 30.

Department of Chemistry, University of Manchester, Manchester Institute of Biotechnology, Manchester, UK.

Finding faster and simpler ways to screen protein sequence space to enable the identification of new biocatalysts for asymmetric synthesis remains both a challenge and a rate-limiting step in enzyme discovery. Biocatalytic strategies for the synthesis of chiral amines are increasingly attractive and include enzymatic asymmetric reductive amination, which offers an efficient route to many of these high-value compounds. Here we report the discovery of over 300 new imine reductases and the production of a large (384 enzymes) and sequence-diverse panel of imine reductases available for screening. We also report the development of a facile high-throughput screen to interrogate their activity. Through this approach we identified imine reductase biocatalysts capable of accepting structurally demanding ketones and amines, which include the preparative synthesis of N-substituted β-amino ester derivatives via a dynamic kinetic resolution process, with excellent yields and stereochemical purities.
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http://dx.doi.org/10.1038/s41557-020-00606-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7116802PMC
February 2021

Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions 2020 think tank.

Catheter Cardiovasc Interv 2020 11 25;96(6):1258-1265. Epub 2020 Aug 25.

University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.

The society for cardiovascular angiography and interventions (SCAI) think tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community for high-level field-wide discussions. The 2020 think tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease (CHD). Each session was moderated by a senior content expert and co-moderated by a member of SCAI's emerging leader mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialogue from a broader base, and thereby aid SCAI and the industry community in developing specific action items to move these areas forward.
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http://dx.doi.org/10.1002/ccd.29197DOI Listing
November 2020

More behavioral recommendations produce more change: A meta-analysis of efficacy of multibehavior recommendations to reduce nonmedical substance use.

Psychol Addict Behav 2020 Nov 20;34(7):709-725. Epub 2020 Apr 20.

Department of Psychology.

Death and morbidity associated with substance use have risen continuously over the last few decades, increasing the need for rigorous examination of promising programs. Interventions attempting to change multiple behaviors have been designed to address interconnected problems such as use of both alcohol and drugs. This meta-analysis aimed to examine the efficacy of multibehavior interventions to curb nonmedical substance use in relation to the theoretical relation among different substance use behaviors. Specifically, our synthesis aimed to estimate the optimal number of recommendations for intervention efficacy and evaluate the impact of different combinations of recommendations on intervention efficacy. A synthesis of multibehavior interventions addressing nonmedical substance use was conducted to measure behavioral changes between the pretest and the follow-up. These changes were then compared across different numbers of recommendations. Sixty-nine reports and 233 effect sizes (k of conditions = 155, n = 28,295) were included. A positive linear relation was found between the number of targeted behaviors and intervention efficacy, which was stronger for drug use than alcohol use. Furthermore, recommendations on drug use worked better when paired with recommendations targeting other behaviors, whereas recommendations on alcohol use worked more independently. Lastly, multibehavior interventions were especially efficacious when delivered by experts. Overall, our synthesis indicated that targeting multiple substances is beneficial for changing drug use outcomes, but less so for alcohol use outcomes. Therefore, in the current substance use epidemic, innovative multibehavior programs appear to hold promise, especially to combat nonmedical drug use. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/adb0000586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572872PMC
November 2020

Insomnia Telemedicine OSCE (TeleOSCE): A Simulated Standardized Patient Video-Visit Case for Clerkship Students.

MedEdPORTAL 2019 12 27;15:10867. Epub 2019 Dec 27.

Professor, Department of Family Medicine, Oregon Health & Science University.

Introduction: Telemedicine is a growing practice with minimal training in US medical schools. Telemedicine OSCE (TeleOSCE) simulations allow students to practice this type of patient interaction in a standardized way.

Methods: The Insomnia-Rural TeleOSCE was implemented as part of a required clinical clerkship for students in their second, third, or fourth year of medical school. This case addressed a patient with depression in a medically underserved area. Students performed it as a formative experience and received immediate feedback. They then completed a survey to evaluate the experience.

Results: Students ( = 287) rated the quality of the experience 7.59 out of 10. Comments showed that 61 learners thought the TeleOSCE was a positive experience, 35 wanted more teaching about telemedicine, 28 improved their understanding of barriers to care, 25 expressed concern over minimal other training, 23 found the TeleOSCE important and challenging, 16 appreciated the differences between in-person and remote visits, and 15 wanted fewer distractions. Eight students worried about how they would be judged, five learned from the technical limitations, five requested more time, five were skeptical of the utility, and five saw telemedicine as triage.

Discussion: The TeleOSCE allows learners to gain exposure to telemedicine in a safe simulated teaching environment and assesses learner competencies. The TeleOSCE also improves students' understanding of barriers to care and the utility of telemedicine. It logistically allows faculty to directly assess distance students on their clinical reasoning and patient communication skills.
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http://dx.doi.org/10.15766/mep_2374-8265.10867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012306PMC
December 2019

An Interscholastic Network To Generate LexA Enhancer Trap Lines in Drosophila.

G3 (Bethesda) 2019 Jul;9(7):2097-2106

Phillips Exeter Academy, Exeter, NH 03833.

Binary expression systems like the LexA-LexAop system provide a powerful experimental tool kit to study gene and tissue function in developmental biology, neurobiology, and physiology. However, the number of well-defined LexA enhancer trap insertions remains limited. In this study, we present the molecular characterization and initial tissue expression analysis of nearly 100 novel StanEx LexA enhancer traps, derived from the StanEx1 index line. This includes 76 insertions into novel, distinct gene loci not previously associated with enhancer traps or targeted LexA constructs. Additionally, our studies revealed evidence for selective transposase-dependent replacement of a previously-undetected KP element on chromosome III within the StanEx1 genetic background during hybrid dysgenesis, suggesting a molecular basis for the over-representation of LexA insertions at the NK7.1 locus in our screen. Production and characterization of novel fly lines were performed by students and teachers in experiment-based genetics classes within a geographically diverse network of public and independent high schools. Thus, unique partnerships between secondary schools and university-based programs have produced and characterized novel genetic and molecular resources in Drosophila for open-source distribution, and provide paradigms for development of science education through experience-based pedagogy.
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http://dx.doi.org/10.1534/g3.119.400105DOI Listing
July 2019

An Interscholastic Network To Generate LexA Enhancer Trap Lines in .

G3 (Bethesda) 2019 07 9;9(7):2097-2106. Epub 2019 Jul 9.

Phillips Exeter Academy, Exeter, NH 03833.

Binary expression systems like the LexA-LexAop system provide a powerful experimental tool kit to study gene and tissue function in developmental biology, neurobiology, and physiology. However, the number of well-defined LexA enhancer trap insertions remains limited. In this study, we present the molecular characterization and initial tissue expression analysis of nearly 100 novel StanEx LexA enhancer traps, derived from the index line. This includes 76 insertions into novel, distinct gene loci not previously associated with enhancer traps or targeted LexA constructs. Additionally, our studies revealed evidence for selective transposase-dependent replacement of a previously-undetected element on chromosome III within the StanEx genetic background during hybrid dysgenesis, suggesting a molecular basis for the over-representation of LexA insertions at the locus in our screen. Production and characterization of novel fly lines were performed by students and teachers in experiment-based genetics classes within a geographically diverse network of public and independent high schools. Thus, unique partnerships between secondary schools and university-based programs have produced and characterized novel genetic and molecular resources in for open-source distribution, and provide paradigms for development of science education through experience-based pedagogy.
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http://dx.doi.org/10.1534/g3.119.400105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6643891PMC
July 2019

Using visualisation methods to analyse referral networks within community health care among patients aged 65 years and over.

Health Informatics J 2020 03 8;26(1):354-375. Epub 2019 Feb 8.

North East London NHS Foundation Trust, UK.

Community health care services are considered integral to overcoming future problems in health care. However, this sector faces its own challenges, such as how to organise services to provide coordinated care given: their physical distribution, patients using multiple services, increased patient use and differing patient needs. The aim of this work was to explore, analyse and understand patterns in community referrals for patients aged 65 years and over, and their use of multiple services through data visualisation. Working with a large community provider, these methods helped researchers and service managers to investigate questions that were otherwise difficult to answer from raw data. Each map focuses on a different characteristic of community referrals: patients reusing services, concurrent uses of different services and patterns of subsequent referrals. We apply these methods to routine patient data and discuss their implications in designing of a single point of access - a service for streamlining referrals.
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http://dx.doi.org/10.1177/1460458218824717DOI Listing
March 2020

Design and Implementation of a Competency-Based Family Medicine Clerkship Curriculum.

Fam Med 2019 03 24;51(3):234-240. Epub 2019 Jan 24.

Department of Family Medicine, Oregon Health & Science University, Portland, OR.

Background And Objectives: Competency-based medical education (CBME) has been incorporated into graduate medical education accreditation and is being introduced in undergraduate medical education. Family medicine (FM) faculty at one institution developed a CBME FM clerkship to intentionally maintain the integrity of FM specialty-specific teaching during their institutional CBME curricular revision.

Methods: From the five FM domains (Access to Care, Continuity of Care, Comprehensive Care, Coordination of Care, and Contextual Care), 10 competencies and 23 FM educational activities (EAs) were defined. The set of EAs encompasses the wide scope of care available to FM clerkship students. Students complete four required EAs (preventive care, care transitions, chronic disease management, and acute care) and select four additional EAs matching their interests. EA selection frequency and course evaluations were assessed for the first cohort of learners (N=156; February 2016-July 2017).

Results: The most frequently selected EAs were: information coordination, procedures, and care of the family. The least selected were: patient e-communication, end-of-life care, and shared medical decision making. Student perceptions of the experience were strong prior to and after implementation.

Conclusions: Having both required and selective EAs ensures a robust FM experience tailored to students' interests. The FM CBME curriculum allowed comparable clinical experiences despite variations in clinical sites and preceptor scope. Because of its breadth, FM is uniquely suited to address multiple competencies; this demonstrates the educational value of required FM clerkships to institutional leaders interested in implementing CBME curriculum. The CBME framework can provide a structure for more intentional student-clinic assignments based on EAs available at specific sites.
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http://dx.doi.org/10.22454/FamMed.2019.539833DOI Listing
March 2019

Validation and Comparison of a Brief Instrument vs a Single-Item Screen to Predict Entry to Family Medicine at Matriculation to Medical School.

Fam Med 2018 10;50(9):672-678

American University of the Caribbean.

Background And Objectives: A strong US primary care workforce is necessary to meet health care needs, yet fewer than 9% of allopathic medical students choose family medicine each year. No validated instrument exists to identify students likely to enter family medicine upon medical school matriculation.

Methods: A subset of a larger survey at the University of Washington School of Medicine (UWSOM) was used to create the Family Medicine Interest Survey (FMIS), a 15-item instrument to predict eventual practice in family medicine for a 2003-2007 matriculating cohort. A single-item screen asking about top specialty choice was administered at UWSOM for the same cohort and for a 2006-2012 matriculating cohort of students at Oregon Health & Science University (OHSU). Test performance measures including D (discrimination) and Cronbach α were calculated. Logistic regression determined whether FMIS score or reporting family medicine as the top specialty choice predicted family medicine practice for 601 UWSOM graduates or family medicine residency match for 744 OHSU graduates.

Results: The FMIS is reliable (Cronbach α=0.76). Both tests significantly predicted the probability of entering family medicine. Listing family medicine as the preferred specialty choice yielded a 47% predicted probability for UWSOM graduates entering family medicine. OHSU graduates listing family medicine first had an eightfold odds of matching to family medicine residencies. Combining the two instruments for UWSOM graduates showed a dose-response curve for predicted probability of entering family medicine with increasing levels of interest.

Conclusion: Each screening tool can predict students more likely to enter family medicine upon matriculation.
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http://dx.doi.org/10.22454/FamMed.2018.258795DOI Listing
October 2018

Effect of Blocking Screws on Union of Infraisthmal Femur Fractures Stabilized With a Retrograde Intramedullary Nail.

J Orthop Trauma 2018 05;32(5):251-255

Ohio Health, Department of Orthopedic Surgery, Columbus, OH.

Objective: To investigate the effect of blocking screws (BS) on the union rate and stability of infraisthmal femur fractures treated with retrograde intramedullary nail (RIMN) insertion.

Design: Retrospective cohort study.

Setting: A single level 1 trauma center.

Patients/participants: All patients with an infraisthmal femur fracture treated with a RIMN from 2005 to 2012 were included.

Intervention: All fractures were treated with a RIMN. BS were used at the discretion of the treating surgeon.

Main Outcome Measurements: (1) Radiographic time to union, (2) initial postoperative sagittal and coronal angulation, and (3) final sagittal and coronal angulation.

Results: Neither the average time to union (BS 21.1 weeks vs. 21.8 weeks), nor union rates (BS 61% vs. 77%) were statistically different between BS and non-BS constructs. No significant alignment differences existed whether BS were used or not.

Conclusions: In this study, we were not able to verify our hypothesis. In fact, we did not find any significant advantages when BS were added to a RIMN construct for distal femur fractures with respect to union time, union rate, or improvements in alignment. Additional studies are needed to determine the actual benefit of BS in the treatment of infraisthmal femoral shaft fractures treated with retrograde intramedullary nailing.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000001119DOI Listing
May 2018

A systematic literature review of operational research methods for modelling patient flow and outcomes within community healthcare and other settings.

Health Syst (Basingstoke) 2018 18;7(1):29-50. Epub 2018 Jan 18.

Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK.

An ambition of healthcare policy has been to move more acute services into community settings. This systematic literature review presents analysis of published operational research methods for modelling patient flow within community healthcare, and for modelling the combination of patient flow and outcomes in all settings. Assessed for inclusion at three levels - with the references from included papers also assessed - 25 "Patient flow within community care", 23 "Patient flow and outcomes" papers and 5 papers within the intersection are included for review. Comparisons are made between each paper's setting, definition of states, factors considered to influence flow, output measures and implementation of results. Common complexities and characteristics of community service models are discussed with directions for future work suggested. We found that in developing patient flow models for community services that use outcomes, transplant waiting list may have transferable benefits.
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http://dx.doi.org/10.1057/s41306-017-0024-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452842PMC
January 2018

Learning by doing: the MD-PA Interprofessional Education Rural Rotation.

Rural Remote Health 2017 Jan-Mar;17(1):4167. Epub 2017 Mar 22.

3181 SW Sam Jackson Park Road, Portland, Oregon, 97239.

While much investment has gone into developing interprofessional education (IPE) curriculum for healthcare professional students, many of these efforts have focused on classroom rather than clinical environments. Implementing robust IPE experiences into clinical training is often complicated by obstacles such as differing rotating schedules and differing curricular requirements. The Combined Medical-Physician Assistant Student Rural Rotation (Med-PARR) at the Oregon Health and Science University takes a practical approach to these challenges. Med-PARR students participate in focused IPE activities that overlay, or 'float', on top of each trainee's profession-specific curricular requirements. Through critical reflection, goal setting, and a community-based project, students get the opportunity to critically reflect on their interprofessional roles while participating in their rural clinical settings. The practical approach of the Med-PARR can serve as a model for other institutions seeking to solve similar logistical issues in their own rural and community clinical IPE implementation efforts.
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http://dx.doi.org/10.22605/rrh4167DOI Listing
December 2017

Implementation of interprofessional education (IPE) in 16 U.S. medical schools: Common practices, barriers and facilitators.

J Interprof Educ Pract 2016 Sep 19;4:41-49. Epub 2016 Jul 19.

Oregon Health & Science University, Portland, OR, USA.

Background: Enhanced patient outcomes and accreditation criteria have led schools to integrate interprofessional education (IPE). While several studies describe IPE curricula at individual institutions, few examine practices across multiple institutions.

Purpose: To examine the IPE integration at different institutions and determine gaps where there is potential for improvement.

Method: In this mixed methods study, we obtained survey results from 16 U.S. medical schools, 14 of which reported IPE activities.

Results: The most common collaboration was between medical and nursing schools (93%). The prevalent format was shared curriculum, often including integrated modules (57%). Small group activities represented the majority (64%) of event settings, and simulation-based learning, games and role-play (71%) were the most utilized learning methods. Thirteen schools (81.3%) reported teaching IPE competencies, but significant variation existed. Gaps and barriers in the study include limitations of using a convenience sample, limited qualitative analysis, and survey by self-report.

Conclusions: Most IPE activities focused on the physician role. Implementation challenges included scheduling, logistics and financial support. A need for effective faculty development as well as measures to examine the link between IPE learning outcomes and patient outcomes were identified.
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http://dx.doi.org/10.1016/j.xjep.2016.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295473PMC
September 2016

Applying the institutional review board data repository approach to manage ethical considerations in evaluating and studying medical education.

Med Educ Online 2016 20;21:32021. Epub 2016 Jul 20.

Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.

Issue: Medical educators and educational researchers continue to improve their processes for managing medical student and program evaluation data using sound ethical principles. This is becoming even more important as curricular innovations are occurring across undergraduate and graduate medical education. Dissemination of findings from this work is critical, and peer-reviewed journals often require an institutional review board (IRB) determination.

Approach: IRB data repositories, originally designed for the longitudinal study of biological specimens, can be applied to medical education research. The benefits of such an approach include obtaining expedited review for multiple related studies within a single IRB application and allowing for more flexibility when conducting complex longitudinal studies involving large datasets from multiple data sources and/or institutions. In this paper, we inform educators and educational researchers on our analysis of the use of the IRB data repository approach to manage ethical considerations as part of best practices for amassing, pooling, and sharing data for educational research, evaluation, and improvement purposes.

Implications: Fostering multi-institutional studies while following sound ethical principles in the study of medical education is needed, and the IRB data repository approach has many benefits, especially for longitudinal assessment of complex multi-site data.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956727PMC
http://dx.doi.org/10.3402/meo.v21.32021DOI Listing
July 2017

The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record.

Acad Med 2017 01;92(1):87-91

F.E. Biagioli is professor of family medicine, Oregon Health & Science University, Portland, Oregon. D.L. Elliot is professor, Division of Health Promotion & Sports Medicine, Oregon Health & Science University, Portland, Oregon. R.T. Palmer is assistant professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon. C.C. Graichen is a 2016 graduate, Oregon Health & Science University, Portland, Oregon. R.E. Rdesinski is research associate, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon. K.A. Kumar is distinguished teaching professor and vice chair of medical student education, Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas. A.B. Galper is research assistant, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon. J.W. Tysinger is distinguished teaching professor and vice chair of professional development, Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.

Problem: Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety.

Approach: Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills.

Outcomes: The authors collected performance data for students (n = 71) at the first institution during academic years 2011-2013 and for students (n = 211) at the second institution during academic year 2013-2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students' EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals.

Next Steps: Cross-institutional data comparisons will help determine whether differences in curricula affect students' EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice.
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http://dx.doi.org/10.1097/ACM.0000000000001276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5177541PMC
January 2017

Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review.

Acad Med 2016 05;91(5):730-42

P.A. Carney is professor of family medicine and of public health and preventive medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. R.T. Palmer is assistant professor of family medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. M.F. Miller is senior research assistant, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. E.K. Thayer is research assistant, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. S.E. Estroff is professor, Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. D.K. Litzelman is D. Craig Brater Professor of Medicine and senior director for research in health professions education and practice, Indiana University School of Medicine, Indianapolis, Indiana. F.E. Biagioli is professor of family medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. C.R. Teal is assistant professor, Department of Medicine, and director, Educational Evaluation and Research, Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, Texas. A. Lambros is active emeritus associate professor, Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina. W.J. Hatt is programmer analyst, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. J.M. Satterfield is professor of clinical medicine, University of California, San Francisco, School of Medicine, San Francisco, California.

Purpose: Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies.

Method: The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality.

Results: Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills.

Conclusions: These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development.
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http://dx.doi.org/10.1097/ACM.0000000000001090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846480PMC
May 2016

The feasibility and acceptability of administering a telemedicine objective structured clinical exam as a solution for providing equivalent education to remote and rural learners.

Rural Remote Health 2015 Oct-Dec;15(4):3399. Epub 2015 Dec 3.

Oregon Health and Science University, Portland, Oregon, USA.

Introduction: Although many medical schools incorporate distance learning into their curricula, assessing students at a distance can be challenging. While some assessments are relatively simple to administer to remote students, other assessments, such as objective structured clinical exams (OSCEs) are not. This article describes a means to more effectively and efficiently assess distance learners and evaluate the feasibility and acceptability of the assessment.

Methods: We developed a teleOSCE, administered online in real time, to two cohorts of students on a rural clerkship rotation and assessed the feasibility and acceptability of using such an approach to assess medical students' clinical skills at rural locations. Project feasibility was defined as having development and implementation costs of less than $5000. Project acceptability was determined by analyzing student interview transcripts. A qualitative case study design framework was chosen due to the novel nature of the activity.

Results: The implementation cost of the teleOSCE was approximately US$1577.20, making it a feasible educational endeavor. Interview data indicated the teleOSCE was also acceptable to students.

Conclusions: The teleOSCE format may be useful to other institutions as a method to centrally administer clinical skills exams for assessment of distance medical students.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763875PMC
July 2016

Development and use of an instrument adapted to assess the clinical skills learning environment in the pre-clinical years.

Med Sci Educ 2015 Sep 27;25(3):285-291. Epub 2015 May 27.

Professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.

Background: The Communication, Curriculum, and Culture (C3) instrument is a well-established survey for measuring the professional learning climate or hidden curriculum in the clinical years of medical school. However, few instruments exist for assessing professionalism in the pre-clinical years. We adapted the C3 instrument and assessed its utility during the pre-clinical years at two U.S. medical schools.

Methods: The ten-item Pre-Clinical C3 survey was adapted from the C3 instrument. Surveys were administered at the conclusion of the first and second years of medical school using a repeated cross-sectional design. Factor analysis was performed and Cronbach's alphas were calculated for emerging dimensions.

Results: The authors collected 458 and 564 surveys at two medical schools during AY06-07 and AY07-09 years, respectively. Factor analysis of the survey data revealed nine items in three dimensions: "Patients as Objects", "Talking Respectfully of Colleagues", and "Patient-Centered Behaviors". Reliability measures (Cronbach's alpha) for the Pre-Clinical C3 survey data were similar to those of the C3 survey for comparable dimensions for each school. Gender analysis revealed significant differences in all three dimensions.

Conclusions: The Pre-Clinical C3 instrument's performance was similar to the C3 instrument in measuring dimensions of professionalism. As medical education moves toward earlier and more frequent clinical and inter-professional educational experiences, the Pre-Clinical C3 instrument may be especially useful in evaluating the impact of curricular revisions.
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http://dx.doi.org/10.1007/s40670-015-0141-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617779PMC
September 2015

Robotic guidance does not improve component position or short-term outcome in medial unicompartmental knee arthroplasty.

J Arthroplasty 2014 Sep 18;29(9):1784-9. Epub 2014 Apr 18.

Department of Orthopedic Surgery, Grant Medical Center, Columbus, Ohio.

We performed a retrospective review in a matched group of patients on the use of robotic-assisted UKA implantation versus UKA performed using standard operative techniques to assess differences between procedures. While both techniques resulted in reproducible and excellent outcomes with low complication rates, the results demonstrate little to no clinical or radiographic difference in outcomes between cohorts. Average operative time differed significantly with, and average of 20 minutes greater in, the robotic-assisted UKA group (P=0.010). Our minimal clinical and radiographic differences lend to the argument that it is difficult to justify the routine use of expensive robotic techniques for standard medial UKA surgery, especially in a well-trained, high-volume surgeon. Further surgical, clinical and economical study of this technology is necessary.
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http://dx.doi.org/10.1016/j.arth.2014.04.012DOI Listing
September 2014

Ligand redox non-innocence in the stoichiometric oxidation of Mn2(2,5-dioxidoterephthalate) (Mn-MOF-74).

J Am Chem Soc 2014 Mar 21;136(9):3334-7. Epub 2014 Feb 21.

Department of Chemistry, Massachusetts Institute of Technology , 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States.

Unsaturated metal sites within the nodes of metal-organic frameworks (MOFs) can be interrogated by redox reagents common to small molecule chemistry. We show, for the first time, that an analogue of the iconic M2(2,5-dioxidoterephthalate) (M2DOBDC, MOF-74) class of materials can be stoichiometrically oxidized by one electron per metal center. The reaction of Mn2DOBDC with C6H5ICl2 produces the oxidized material Cl2Mn2DOBDC, which retains crystallinity and porosity. Surprisingly, magnetic measurements, X-ray absorption, and infrared spectroscopic data indicate that the Mn ions maintain a formal oxidation state of +2, suggesting instead the oxidation of the DOBDC(4-) ligand to the quinone DOBDC(2-). These results describe the first example of ligand redox non-innocence in a MOF and a rare instance of stoichiometric electron transfer involving the metal nodes. The methods described herein offer a synthetic toolkit that will be of general use for further explorations of the redox reactivity of MOF nodes.
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http://dx.doi.org/10.1021/ja411808rDOI Listing
March 2014

Homogeneous water oxidation catalysts containing a single metal site.

Chem Commun (Camb) 2013 Jan 7;49(3):218-27. Epub 2012 Nov 7.

Department of Chemistry and Centre for Advanced Solar Materials, University of Calgary, 2500 University Drive N.W., Calgary, Canada T2N 1N4.

The recent recognition that a single metal site is capable of mediating the multiple electron and proton transfer events associated with water oxidation represents a pivotal discovery for the field. This finding has led to a remarkable expansion of known synthetic water oxidation catalysts, and has provided the means to gain unprecedented insight into the reaction steps involved with O-O bond formation. This perspective reflects on the key studies that have advanced our understanding of water oxidation catalysis while summarizing molecular features that are integral to negotiating this complicated reaction pathway with the goal of helping identify new frontiers of discovery for the field.
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http://dx.doi.org/10.1039/c2cc35632eDOI Listing
January 2013

Intraoperative intradermal skin testing.

Laryngoscope 2012 Oct 6;122(10):2158-9. Epub 2012 Jun 6.

Department of Otolaryngology, Millcreek Community Hospital, Erie, Pennsylvania, USA.

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http://dx.doi.org/10.1002/lary.23447DOI Listing
October 2012

Interrogation of electrocatalytic water oxidation mediated by a cobalt complex.

Chem Commun (Camb) 2012 Feb 13;48(15):2107-9. Epub 2012 Jan 13.

Department of Chemistry, University of Calgary and the Institute for Sustainable Energy, Environment & Economy, University of Calgary, 2500 University Drive N.W., Calgary, CanadaT2N-1N4.

Examination of the aqueous electrochemistry of a Co(II) complex bearing a pentadentate ligand suggests that the catalytic current corresponding to water oxidation is molecular in origin, and does not emanate exclusively from Co-oxide phases formed in situ.
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http://dx.doi.org/10.1039/c2cc16674gDOI Listing
February 2012

Pediatric cough: what the otolaryngologist needs to know.

Curr Opin Otolaryngol Head Neck Surg 2011 Jun;19(3):204-9

Millcreek Community Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 16508, USA.

Purpose Of Review: Pediatric cough is a common complaint in 35% of preschool children and 9% of 7-11-year-olds. The cause of the cough is often elusive. This review article presents a framework from which to approach the pediatric patient with chronic cough.

Recent Findings: The cause of cough in the pediatric patient is often allergy, postnasal drip, asthma, or infection. The existence of cough-variant asthma has been brought into question and evidence is detailed in this article.

Summary: The treatment of chronic cough in a pediatric population should be approached from a multidisciplinary team consisting of pulmonologists, gastroenterologists, allergists, immunologists and otolaryngologists. Once a specific diagnosis is determined, treatment should be specific to that diagnosis.
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http://dx.doi.org/10.1097/MOO.0b013e328345aa7cDOI Listing
June 2011

Meniscal pathology associated with acute anterior cruciate ligament tears in patients with open physes.

J Pediatr Orthop 2011 Apr-May;31(3):272-6

Department of Orthopaedics, Nationwide Children's Hospital, Columbus, OH 43205-2696, USA.

Background: The purpose of this study is to characterize meniscal pathology associated with anterior cruciate ligament (ACL) rupture in skeletally immature patients. We also evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting ACL and meniscus pathology.

Methods: A retrospective chart review was performed on 124 skeletally immature patients who underwent arthroscopically assisted ACL reconstruction within 3 months of injury. Operative reports and arthroscopic images were reviewed to determine patterns of meniscal injury. The accuracy of preoperative MRI in predicting ACL rupture and meniscus pathology was also compared.

Results: One hundred twenty-four patients, including 80 males with an average age of 14.3 years, and 44 females with an average age of 14.1 years were included. The lateral meniscus was torn in 51 patients, the medial meniscus in 17 patients, and both menisci in 19. The prevalence of meniscus tear was 69.3%. Location of the tear occurred in the posterior horn in 69 tears (65.0%), the middle and posterior horn in 31 tears (29.2%), the middle horn in 4 tears (3.7%), and the anterior horn and posterior horn in 2 tears (1.8%). MRI showed 95.6% sensitivity in detecting complete ACL rupture. Further, MRI had a sensitivity of 58.6% and a specificity of 91.3% in characterizing meniscus tears.

Conclusions: There are many studies that evaluate ACL rupture in the skeletally immature population, but few studies focus on the meniscus pathology that is associated with these injuries. We reinforce the fact that meniscal injury is commonly associated with ACL rupture in patients with open physes (prevalence of 69.3%). We were able to conclude that lateral meniscus tears are more common than medial meniscus tears, which were equally as common as combined tears in our patient population. The posterior horn is injured in most of patients, and is usually in a repairable configuration and vascular zone. These findings will help to guide surgeons in their clinical evaluation and treatment of skeletally immature patients with ACL rupture.

Level Of Evidence: Level IV, retrospective case series.
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http://dx.doi.org/10.1097/BPO.0b013e31820fc6b8DOI Listing
July 2011

Eosinophilic gastroenteritis of the pancreas: an unusual cause of obstructive jaundice.

J Clin Gastroenterol 2006 Aug;40(7):623-5

Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA.

Eosinophilic gastroenteritis (EG) is a rare gastrointestinal disorder of undetermined etiology and is manifest by eosinophilic infiltration of any area of gastrointestinal tract, most frequently stomach and small intestine. Peripheral eosinophilia is present in about 80% of patients. Definitive diagnosis requires histologic evidence of eosinophilic infiltration; which is usually patchy in distribution. Steroids are the mainstay of treatment. We present a case of 47-year-old man with abdominal pain, jaundice, and marked eosinophilia. Endoscopic retrograde cholangio-pancreatogram revealed a dilated common bile duct. There was biopsy proven eosinophilic infiltration in stomach, duodenum, gall bladder, and pancreas. Obstructive jaundice is an extremely rare manifestation of EG. This unusual case illustrates the wide variety of gastrointestinal manifestations caused by EG and emphasizes the importance of clinical suspicion and endoscopic mucosal biopsies in diagnosis of EG. This entity should be considered in the patients with chronic and relapsing gastrointestinal symptoms.
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http://dx.doi.org/10.1097/00004836-200608000-00012DOI Listing
August 2006

Fluorogold labeling of descending brain neurons in larval lamprey does not cause cell death.

Neurosci Lett 2006 Jun 31;401(1-2):119-24. Epub 2006 Mar 31.

Division of Biological Sciences and Interdisciplinary Neuroscience Program, 114 Lefevre Hall, University of Missouri, Columbia, MO 65211-6190, USA.

In our previous double-labeling studies, the fluorescent anatomical tracers Fluorogold (FG) and Texas red dextran amine (TRDA) were used to demonstrate that descending brain neurons, approximately 80% of which are reticulospinal (RS) neurons, in spinal cord-transected larval lamprey regenerate their axons. However, the numbers of FG-labeled descending brain neurons decreased significantly with increasing recovery times, from 2 to 16 weeks. For some FG-labeled mammalian neurons, FG appears to degrade and/or be lost over time, while in other neurons this tracer can kill neurons. In the present study, these possibilities were examined in larval lamprey for FG-labeled descending brain neurons. As in our previous studies, FG was applied to the spinal cord at 40% body length (BL, relative distance from the head) to retrogradely labeled descending brain neurons, and after recovery times of 2, 8, or 16 weeks, HRP, a non-toxic retrograde tracer, was applied to the spinal cord at 20% BL to determine if the numbers of HRP-labeled neurons were reduced. At these three recovery times, the numbers of HRP-labeled descending brain neurons were not significantly different than the numbers of HRP-labeled neurons in control animals that were not labeled with FG. Furthermore, the size and morphology of cell bodies and dendritic trees were not noticeably different in descending brain neurons with and without FG. Thus, in larval lamprey, FG does not appear to kill these neurons, but some FG probably is degraded and/or lost from neurons with increasing recovery times.
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http://dx.doi.org/10.1016/j.neulet.2006.02.078DOI Listing
June 2006

Conditioning lesions enhance axonal regeneration of descending brain neurons in spinal-cord-transected larval lamprey.

J Comp Neurol 2004 Oct;478(4):395-404

Division of Biological Sciences and Interdisciplinary Neuroscience Program, University of Missouri, Columbia, Missouri 65211-6190, USA.

In larval lamprey, with increasing recovery times after a transection of the rostral spinal cord, there is a gradual recovery of locomotor behavior, and descending brain neurons regenerate their axons for progressively greater distances below the transection site. In the present study, spinal cord "conditioning lesions" (i.e., transections) were performed in the spinal cord at 30% body length (BL; normalized distance from the head) or 50% BL. After various "lesion delay times" (D), a more proximal spinal cord "test lesion" (i.e., transection) was performed at 10% BL, and then, after various recovery times (R), horseradish peroxidase was applied to the spinal cord at 20% BL to determine the extent of axonal regeneration of descending brain neurons. Conditioning lesions at 30% BL, lesion delay times of 2 weeks, and recovery times of 4 weeks (D-R = 2-4 group) resulted in a significant enhancement of axonal regeneration for the total numbers of descending brain neurons as well as neurons in certain brain cell groups compared to control animals without conditioning lesions. Experiments with hemiconditioning lesions, which reduce interanimal variability, confirmed that conditioning lesions do significantly enhance axonal regeneration and indicate that axotomy rather than diffusible factors released at the injury site is primarily involved in this enhancement. Results from the present study suggest that conditioning lesions "prime" descending brain neurons via cell body responses and enhance subsequent axonal regeneration, probably by reducing the initial delay and/or increasing the initial rate of axonal outgrowth.
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http://dx.doi.org/10.1002/cne.20297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915934PMC
October 2004

Incidence of outpatient physician claims for upper gastrointestinal symptoms among new users of celecoxib, ibuprofen, and naproxen in an insured population in the United States.

Am J Gastroenterol 2003 Dec;98(12):2627-34

Department of Medicine, Section of Digestive Diseases and Nutrition, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.

Objective: The aim of this study was to compare the risk of outpatient medical claims for UGI symptoms among new users of celecoxib versus ibuprofen, and naproxen.

Methods: The study was conducted using LifeLink, an insurance claims database of approximately 1.8 million employees, dependents, and retirees in the United States. Patients newly treated with a prescription of celecoxib, ibuprofen, or naproxen between June 1, 1999, and June 30, 2001, were included. A patient with an upper GI (UGI) symptom was any individual with an outpatient physician claim for dyspepsia (ICD-9 = 536.8), abdominal pain (789.0), or nausea/vomiting (787.0). Incidence was determined using person-time analysis. Multivariate analyses were conducted using Poisson and Cox regression models.

Results: The cohort consisted of patients prescribed celecoxib (n = 68,939), ibuprofen (n = 71,456), or naproxen (n = 50,014). At baseline, celecoxib users were older and more likely to have a history of UGI or cardiovascular conditions. The incidence rate of any UGI symptom was 0.46 per 1,000 patient-days for celecoxib, 0.70 for ibuprofen, and 0.62 for naproxen. After adjusting for confounding factors using Poisson regression, the ibuprofen rate was 48% higher than the celecoxib rate (incidence rate ratio (IRR) = 1.48; 95% CI = 1.39-1.58; p < 0.001), whereas the naproxen rate was 40% higher (IRR = 1.40; 95% CI = 1.31-1.49; p < 0.001). The association between drug use and UGI symptoms was confirmed by Cox regression analysis; the hazard ratios were 1.21 (95% CI = 1.13-1.29; p < 0.001) for ibuprofen and 1.15 (95% CI = 1.07-1.23; p < 0.001) for naproxen relative to celecoxib. Younger age, female sex, medical history of UGI, cardiovascular and renal conditions, and higher baseline average healthcare expenditures for the 12-month period preceding the index prescription were also significantly associated with an increased incidence of UGI symptoms.

Conclusions: Celecoxib use is associated with a significantly decreased risk of outpatient physician claims for UGI symptoms compared with commonly used prescription nonspecific nonsteroidal anti-inflammatory drugs.
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http://dx.doi.org/10.1111/j.1572-0241.2003.08722.xDOI Listing
December 2003