Background: HPLC is currently the preferred method for accurate measurement of mycophenolic acid (MPA). This study was designed to validate the Emit compared with HPLC in relation to clinical outcome measurements. Methods: Pediatric renal-transplant recipients (n = 50) on an immunosuppressive triple regimen consisting of cyclosporin A, prednisone, and mycophenolate mofetil (600 mg/m2 twice per day) were investigated in an open-label prospective study. Pharmacokinetic profiles over 12 h were obtained at 1 week, 3 weeks, 3 months, and 6 months posttransplant. Plasma MPA was measured by both reversed-phase HPLC and the Emit immunoassay. Results: There was an association between the risk of acute rejection episodes and low area under the curve values from t0 to t12h (AUC0–12) for MPA (MPA-AUC0–12) or predose concentrations of MPA derived from both HPLC and Emit measurements. According to ROC analysis, an AUC value of 33.8 mg · h/L for MPA from t0 to t12h (MPA-AUC0–12) determined by HPLC had a diagnostic sensitivity of 80% and a diagnostic specificity of 57%. The corresponding value of the Emit was 36.1 mg · h/L. For the predose concentration (MPA-c12), a concentration of 1.2 mg/L determined by HPLC and 1.4 mg/L determined by Emit gave a sensitivity of 80% and a specificity of 60%, respectively. There was no association of any pharmacokinetic variables derived from total MPA measurements with an increased risk of side effects related to mycophenolate mofetil. Conclusions: The Emit assay appears to have a comparable diagnostic efficacy to HPLC for assessing the risk of acute rejection in pediatric renal-transplant recipients. However, because of the cross-reactivity of the antibody used in the Emit assay with the active MPA acyl glucuronide metabolite, the decision thresholds for the Emit were higher than those calculated from HPLC measurements.

Neural correlates of mind wanderingThe ability to detect mind wandering as it occurs is an important step towards improving our understanding of this phenomenon and studying its effects on learning and performance. Current detection methods typically rely on observable behaviour in laboratory settings, which do not capture the underlying neural processes and may not translate well into real-world settings. We address both of these issues by recording electroencephalography (EEG) simultaneously from 15 participants during live lectures on research in orthopedic surgery. We performed traditional group-level analysis and found neural correlates of mind wandering during live lectures that are similar to those found in some laboratory studies, including a decrease in occipitoparietal alpha power and frontal, temporal, and occipital beta power. However, individual-level analysis of these same data revealed that patterns of brain activity associated with mind wandering were more broadly distributed and highly individualized than revealed in the group-level analysis.Mind wandering detectionTo apply these findings to mind wandering detection, we used a data-driven method known as common spatial patterns to discover scalp topologies for each individual that reflects their differences in brain activity when mind wandering versus attending to lectures. This approach avoids reliance on known neural correlates primarily established through group-level statistics. Using this method for individual-level machine learning of mind wandering from EEG, we were able to achieve an average detection accuracy of 80–83%.ConclusionsModelling mind wandering at the individual level may reveal important details about its neural correlates that are not reflected when using traditional observational and statistical methods. Using machine learning techniques for this purpose can provide new insight into the varieties of neural activity involved in mind wandering, while also enabling real-time detection of mind wandering in naturalistic settings.

This scoping review suggests that task-specific checklists, entrustment scales, evaluation portfolios from multiple assessments and faculty training sessions are key aspects to incorporate as OTL-HNS training programmes shift towards a CBME curriculum.

Objectives: Point-of-care ultrasound (POCUS) has become an integral diagnostic and interventional tool.Barriers to POCUS training persist, and it continues to remain heterogeneous across training programs. Structured POCUS assessment tools exist, but remain limited in their feasibility, acceptability, reliability, and validity; none of these tools are entrustment-based. The objective of this study was to derive a simple, entrustment-based POCUS competency assessment tool and pilot it in an assessment setting.Methods: This study was composed of two phases. First, a three-step modified Delphi design surveyed 60 members of the Canadian Association of Emergency Physicians Emergency Ultrasound Committee (EUC) to derive the anchors for the tool. Subsequently, the derived ultrasound competency assessment tool (UCAT) was used to assess trainee (N = 37) performance on a simulated FAST examination. The intraclass correlation (ICC) for inter-rater reliability and Cronbach's alpha for internal consistency were calculated. A statistical analysis was performed to compare the UCAT to other competency surrogates. Results:The three-round Delphi had 22, 26, and 26 responses from the EUC members. Consensus was reached, and anchors for the domains of preparation, image acquisition, image optimization, and clinical integration achieved approval rates between 92 and 96%. The UCAT pilot revealed excellent inter-rater reliability (with ICC values of 0.69-0.89; p < 0.01) and high internal consistency (α = 0.91). While UCAT scores were not impacted by level of training, they were significantly impacted by the number of previous POCUS studies completed. Conclusions:We developed and successfully piloted the UCAT, an entrustment-based bedside POCUS competency assessment tool suitable for rapid deployment. The findings from this study indicate early validity evidence for the use of the UCAT as an assessment of trainee POCUS competence on FAST. The UCAT should be trialed in different populations performing several POCUS study types.