Inter-Rater Reliability of the PIPES Tool: Validation of a Surgical Capacity Index for Use in Resource-Limited Settings

Introduction

In response to the need for simple, rapid means of quantifying surgical capacity in low resource settings, Surgeons OverSeas (SOS) developed the personnel, infrastructure, procedures, equipment and supplies (PIPES) tool. The present investigation assessed the inter-rater reliability of the PIPES tool.

Methods

As part of a government assessment of surgical services in Santa Cruz, Bolivia, the PIPES tool was translated into Spanish and applied in interviews with physicians at 31 public hospitals. An additional interview was conducted with nurses at a convenience sample of 25 of these hospitals. Physician and nurse responses were then compared to generate an estimate of reliability. For dichotomous survey items, inter-rater reliability between physicians and nurses was assessed using the Cohen’s kappa statistic and percent agreement. The Pearson correlation coefficient was used to assess agreement for continuous items.

Results

Cohen’s kappa was 0.46 for infrastructure, 0.43 for procedures, 0.26 for equipment, and 0 for supplies sections. The median correlation coefficient was 0.91 for continuous items. Correlation was 0.79 for the PIPES index, and ranged from 0.32 to 0.98 for continuous response items.

Conclusions

Reliability of the PIPES tool was moderate for the infrastructure and procedures sections, fair for the equipment section, and poor for supplies section when comparing surgeons’ responses to nurses’ responses—an extremely rigorous test of reliability. These results indicate that the PIPES tool is an effective measure of surgical capacity but that the equipment and supplies sections may need to be revised.     

Specific MUC1 Splice Variants Are Correlated With Tumor Progression in Esophageal Cancer

Background

Mucin 1 (MUC1) is a complex glycoprotein expressed on the apical surface of normal glandular epithelial cells. It plays a role in a number of biologic processes, and its overexpression is associated with various malignancies. A growing body of literature suggests that MUC1 is a potential diagnostic and therapeutic marker. Increasing numbers of variants are being identified for the MUC1 gene, but their role in carcinogenesis is unclear. Alternative splicing and a specific region on a variable number of tandem repeats are characteristic features of MUC1. However, the underlying mechanisms, overall prevalence, and the function of various MUC1 isoforms are not well characterized.

Methods

In the present study, mRNA expression of nine variants of the MUC1 gene (A–D, X–Z, REP, SEC) was evaluated in normal and tumor tissues obtained from 50 patients with esophageal squamous cell carcinoma (ESCC). Associations between expression of various isoforms of MUC1 and important clinicopathologic factors were studied.

Results

Specific MUC1 splice variants (i.e., MUC1/C, D, and Z) are correlated with tumor progression in ESCC, whereas MUC1/B—previously suggested as a “normal” variant in some other cancers—has protective effects and is associated with more favorable tumor behavior and better prognosis.

Conclusions

Specific isoforms of ESCC are associated with prognosis. Further characterization of different isoforms of MUC1 and their biologic effects is needed to explore their diagnostic and prognostic potential in clinical practice.     

Effects of alpha lipoic acid supplementation on serum levels of IL-8 and TNF-α in patient with ESRD undergoing hemodialysis

Background

Chronic renal failure is a progressive and irreversible loss of kidney function, and the hemodialysis (HD) is one of the most common modalities in this regard. Oxidative stresses [like interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-α)] and inflammation are the main risk factors associated with cardiovascular diseases and other complications in many organs in hemodialysis patients; meanwhile, antioxidants like alpha lipoic acid (ALA) may reduce the oxidative stress markers and the levels of inflammatory cytokines, so can improve of the patient’s quality of life.

Methods

In this randomized clinical trial study, 60 HD patients were randomly categorized in two case and control groups. Case group received a daily capsule of 600 mg of ALA supplementation for 8 weeks, and the control group received placebo capsules daily. The serum level of IL-8 and TNF-α was measured in both groups before and after the intervention.

Results

There were no significant differences in age, gender, duration of dialysis, and causative factor for dialysis between both groups (P > 0.05). The mean of IL-8 and TNF-α after the intervention in case group was 26.20 ± 15.34 and 21.25 ± 9.61, respectively; the difference between both groups was not statistically significant (P > 0.05).

Conclusion

Based on the better feeling and other beneficial effects of ALA were found in our study; we can conclude that it is a beneficial and recommended supplement, especially, for diabetic and dialysis patients.     

Introgression of a synthetic sex ratio distortion transgene into different genetic backgrounds of Anopheles coluzzii

The development of genetically modified mosquitoes (GMM) and their subsequent field release offers innovative approaches for vector control of malaria. A non-gene drive self-limiting male-bias Ag(PMB)1 strain has been developed in a 47-year-old laboratory G3 strain of Anopheles gambiae s.l. When Ag(PMB)1 males are crossed to wild-type females, expression of the endonuclease I-PpoI during spermatogenesis causes the meiotic cleavage of the X chromosome in sperm cells, leading to fertile offspring with a 95% male bias. However, World Health Organization states that the functionality of the transgene could differ when inserted in different genetic backgrounds of Anopheles coluzzii which is currently a predominant species in several West-African countries and thus a likely recipient for a potential release of self-limiting GMMs. In this study, we introgressed the transgene from the donor Ag(PMB)1 by six serial backcrosses into two recipient colonies of An. coluzzii that had been isolated in Mali and Burkina Faso. Scans of informative Single Nucleotide Polymorphism (SNP) markers and whole-genome sequencing analysis revealed a nearly complete introgression of chromosomes 3 and X, but a remarkable genomic divergence in a large region of chromosome 2 between the later backcrossed (BC6) transgenic offspring and the recipient paternal strains. These findings suggested to extend the backcrossing breeding strategy beyond BC6 generation and increasing the introgression efficiency of critical regions that have ecological and epidemiological implications through the targeted selection of specific markers. Disregarding differential introgression efficiency, we concluded that the phenotype of the sex ratio distorter is stable in the BC6 introgressed An. coluzzii strains.     

Effect of Short Fiber Reinforcements on Fracture Performance of Cement-Based Materials: A Systematic Review Approach

Fracture characteristics were used to effectively evaluate the performance of fiber-reinforced cementitious composites. The fracture parameters provided the basis for crack stability analysis, service performance, safety evaluation, and protection. Much research has been carried out in the proposed study field over the previous two decades. Therefore, it was required to analyze the research trend from the available bibliometric data. In this study, the scientometric analysis and science mapping techniques were performed along with a comprehensive discussion to identify the relevant publication field, highly used keywords, most active authors, most cited articles, and regions with largest impact on the field of fracture properties of cement-based materials (CBMs). Furthermore, the characteristic of various fibers such as steel, polymeric, inorganic, and carbon fibers are discussed, and the factors affecting the fracture properties of fiber-reinforced CBMs (FRCBMs) are reviewed. In addition, future gaps are identified. The graphical representation based on the scientometric review could be helpful for research scholars from different countries in developing research cooperation, creating joint ventures, and exchanging innovative technologies and ideas.     

Standardization of Prothrombin Time/International Normalized Ratio (PT/INR)

The prothrombin time (PT) represents the most commonly used coagulation test in clinical laboratories. The PT is mathematically converted to the international normalized ratio (INR) for use in monitoring anticoagulant therapy with vitamin K antagonists such as warfarin in order to provide test results that are adjusted for thromboplastin and instrument used. The INR is created using two major PT ‘correction factors’, namely the mean normal PT (MNPT) and the international sensitivity index (ISI). Manufacturers of reagents and coagulometers have made some efforts to harmonizing INRs, for example, by tailoring reagents to specific coagulometers and provide associated ISI values. Thus, two types of ISIs may be generated, with one being a ‘general’ or ‘generic’ ISI and others being reagent/coagulometer-specific ISI values. Although these play a crucial role in improving INR results between laboratories, these laboratories reported INR values are known to still differ, even when laboratories use the same thromboplastin reagent and coagulometer. Moreover, ISI values for a specific thromboplastin can vary among different models of coagulometers from a manufacturer using the same method for clot identification. All these factors can be sources of error for INR reporting, which in turn can significantly affect patient management. In this narrative review, we provide some guidance to appropriate ISI verification/validation, which may help decrease the variability in cross laboratory reporting of INRs.