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BackgroundHealthcare professionals require many personal attributes in addition to cognitive abilities and psychomotor skills for competent practice. Multiple Mini- Interviews are being employed globally to assess personality attributes of candidates for selection in health professions education at all level of entry; these attributes are namely, communication skills, critical thinking, honesty, responsibility, health advocacy, empathy and sanctity of life. Considering the high stakes involved for students, faculty, institutions and the society, rigorous quality assurance mechanisms similar to those used for student assessment must be employed for student selection, throughout the continuum of medical education. It is a difficult undertaking as these psychological constructs are difficult to define and measure. Though considered to yield reliable and valid scores, studies providing multiple evidences of internal structure especially dimensionality of Multiple Mini-Interviews are sparse giving rise to questions if they are measuring a single or multiple constructs and even if they are measuring what they are purported to be measuring.ObjectiveThe main objective is to provide statistical support of the multi-dimensional nature of our Multiple Mini Interviews, hypothesized a-priori, through CFA. Another objective is to provide multiple evidences for the internal structure. Our study highlights the link between content and internal structure evidences of the constructs, thus establishing that our Multiple Mini Interviews measure what they were intended to measure.MethodAfter securing permission from the Institutional review board, an a-priori seven factor-model was hypothesized based on the attributes considered most essential for the graduating student of the institution. After operationally defining the attributes through extensive literature search, scenarios were constructed to assess them. A 5-point rating scale was used to rate each item on the station. A total 259 students participated in the multiple mini interviews over a period of three days. A training workshop had been arranged for the participating faculty.ResultsThe reliability coefficient using Cronbach's alpha were calculated (range from 0.73 to 0.94), Standard Error of Measurement (ranged from 0.80 to1.64), and item to station-total correlation ranged from 0.43-0.50 to 0.75-0.83. Inter-station correlation was also determined. Confirmatory factor analysis endorsed the results of Exploratory factor analysis in the study revealing a seven model fit with multiple indices of Goodness-of-fit statistics such as Root mean square error of approximation (RMSEA) value 0.05, Standardized root mean square residual (SRMR) value with less than 0.08. All these indices showed that model fit is good. The Confirmatory factor analysis confirmed the multi-dimensional nature of our MMIs and also confirmed that our stations measured the attributes that they were supposed to measure.ConclusionThis study adds to the validity evidence of Multiple Mini-Interviews, in selection of candidates, with required personality traits for healthcare profession. It provides the evidence for the multi-dimensional structure of Multiple Mini interviews administered with multiple evidences for its internal structure and demonstrates the independence of different constructs being measured.

Aims: The goal of this study was to analyze the bacterial microleakage following two methods (heat vs. rotary) of postspace preparation after two-time intervals (immediate vs. 1 week later). Setting and Design: In vitro-comparative study. Materials and Methods: Eighty-two single-rooted teeth were decoronated at the cementoenamel junction. Root canals were prepared using rotary files. After root canal obturation, specimens were randomly allocated to 4 experimental groups based on the method of postspace preparation (heat or peeso reamer) and time interval (immediate or 1 week later) (n = 18). Group 1: Peeso reamer-immediate, Group 2: Heat-immediate, Group 3: Peeso reamer-1 week later, Group 4: Heat-1 week later. 10 specimens were considered as positive and negative controls (n = 5 each). Custom-made dual-chamber devices were used to appraise the bacterial microleakage for 60 days. Statistical Analysis Used: Data were analyzed with Chi-Square and Log-Rank tests and Cox regression. Results: All through the experimental period, there was no significant difference (P = 0.41) between the studied groups. Groups 2 and 4 had the highest microleakage and the lowest survival rate (55.56% ± 11.71%). Group 1 showed the lowest microleakage and the highest survival rate (77.8% ± 9.80%). Conclusions: The applied techniques for postspace preparation and the time intervals (neither independently nor simultaneously) showed no significant difference in the field of bacterial leakage.

Objectives. The present study aimed to assess the effect of ferrule location on fracture resistance of maxillary premolars. Materials and Methods. A total of 72 extracted human maxillary premolars were selected and randomly assigned to six groups (n = 12 in each) considering ferrule location: circumferential ferrule (CF), without ferrule (WF), buccal ferrule (BF), lingual ferrule (LF), mesial ferrule (MF), and buccal–lingual ferrule (BLF). Cast posts were cemented into the prepared post spaces. Following conventional impression, Ni–Cr crowns were cemented to the specimens. After thermocycling (5,000 cycles, 5–55°C), the specimens were loaded at 45° in a universal testing machine until fracture. Data were analyzed with one-way ANOVA, Kolmogorov–Smirnov, and Tamhane tests. Results. The maximum and minimum mean fracture resistance were related to the CF (1,143.84 N) and WF (514.89 N) groups, respectively, (P=0.039). Fracture resistance in the BF (933.67 N) and BLF (874.01 N) groups was significantly higher than in the MF group (617.54 N) (P=0.001). There was no significant difference between the MF, LF (722.89 N), and WF groups in terms of fracture resistance (P>0.05). Conclusion. Teeth with CF showed maximum fracture resistance. The location of the ferrule effects on the fracture resistance of maxillary premolars and also the mode of failure.

Summary: Background: Donor-characteristics and donor characteristics-based decision algorithms are being progressively used in the decision process whether or not to accept an available donor kidney graft for transplantation. While this may improve outcomes, the performance characteristics of the algorithms remains moderate. To estimate the impact of donor factors of grafts accepted for transplantation on transplant outcomes, and to test whether implementation of donor-characteristics-based algorithms in clinical decision-making is justified, we applied an instrumental variable analysis to outcomes for kidney donor pairs transplanted in different individuals. Methods: This analysis used (dis)congruent outcomes of kidney donor pairs as an instrument and was based on national transplantation registry data for all donor kidney pairs transplanted in separate individuals in the Netherlands (1990-2018, 2,845 donor pairs), and the United Kingdom (UK, 2000-2018, 11,450 pairs). Incident early graft loss (EGL) was used as the primary discriminatory factor. It was reasoned that a scenario with a dominant impact of donor variables on transplantation outcomes would result in high concordance of EGL in both recipients, whilst dominance of asymmetrical outcomes could indicate a more complex scenario, involving an interaction of donor, procedural and recipient factors. Findings: Incidences of congruent EGL (Netherlands: 1·2%, UK: 0·7%) were slightly lower than the arithmetical (stochastic) incidences, suggesting that once a graft has been accepted for transplantation, donor factors minimally contribute to incident EGL. A long-term impact of donor factors was explored by comparing outcomes for functional grafts from donor pairs with asymmetrical vs. symmetrical outcomes. Recipient survival was similar for both groups, but a slightly compromised graft survival was observed for grafts with asymmetrical outcomes in the UK cohort: (10-years Hazard Ratio for graft loss: 1·18 [1·03-1·35] p

Hassan Tariq, 1, 2 Harish Patel, 1, 2 Muhammad Umar Kamal, 1 Naeem Abbas, 1, 2 Muhammad Ameen, 1 Sara Azam, 1 Kishore Kumar, 1, 2 Madhavi Ravi, 1, 2 Vamshidhar Vootla, 1, 2 Danial Shaikh, 1, 2 Vamsi Amanchi, 1 Ali N Hussain, 3 Jasbir Makker 1, 2 1Department of Medicine, BronxCare Health System, Bronx, NY 10457, USA; 2Division of Gastroenterology, BronxCare Health System, Bronx, NY 10457, USA; 3Baruch College, City University of New York (CUNY), New York, NY 10010, USACorrespondence: Muhammad Umar KamalBronxCare Health System, 1650 Selwyn Ave, Suite #10C, Bronx, NY 10457, USATel +1 718-960-1234Fax +1 718-960-2055Email muhammadumarkamal@gmail.comBackground: Helicobacter pylori is a common cause of gastritis, peptic ulcer disease, and non-ulcer dyspepsia, and is also associated with gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. Despite being known about for more than 30 years, finding an effective therapeutic strategy against it remains a challenge.Aim: There are no US studies evaluating the efficacy of a Levofloxacin based therapy for H. pylori infection. We here intend to study the efficacy of Levofloxacin based triple antibiotic regimen as compared to Clarithromycin based triple therapy and Bismuth based quadruple therapy in our patient population.Methods: This is a retrospective single center observational study. Patients with Helicobacter pylori infection who underwent treatment for H. pylori with one of the three therapies, i.e. Clarithromycin triple, Bismuth Quadruple or Levofloxacin triple, were included in the study and the eradication rates were compared. The confirmation of the H. pylori was done 4 weeks after the completion of anti-microbial therapy.Results: A total of 177 individuals underwent the H. pylori treatment in our retrospective review. Of these, 54% (n=97) of patients were treated with Clarithromycin based triple therapy (Group 1), 35% (n=63) were treated with Levofloxacin based regimen (Group 2), and the remaining 11% (n=17) were treated with Bismuth based quadruple therapy (Group 3). The eradication rates were significantly higher in patients treated with Clarithromycin based triple therapy as compared to Levofloxacin based triple therapy and Bismuth quadruple therapy (78.3% vs 49.2% vs 41.1% P=0.001).Conclusion: In conclusion, our study shows significantly lower eradication rates with Levofloxacin triple therapy among a selected US population. Thus, it may not be a good first-line therapy among this US population and the Clarithromycin based regimen may still be used successfully.Keywords: Helicobacter pylori, clarithromycin, levofloxacin, quadruple therapy, peptic ulcer

Richard D Bartlett,1,* Sheikh MB Momin,1,* Saima Azam,1 Oloruntobi Rotimi,1 Tom J Quick1,21UCL Medical School, University College London, London WC1E 6BT, UK; 2Peripheral Nerve Injury Unit, Royal National Orthopedic Hospital NHS Trust, Stanmore, HA7 4LP, UK*These authors contributed equally to this workPurpose: To establish a sustainable model for a “Surgical Shadowing Scheme” (SSS) and assess how this affects undergraduate attitudes to surgical careers.Patients and methods: Surgeons at university teaching hospitals associated with UCL Medical School and UCL Partners, United Kingdom, were approached for their willingness to participate in the scheme. Medical students were then invited to apply for the scheme, where students were individually matched to operating theater sessions with surgeons in their specialty of choice. Feedback was subsequently obtained, evaluating experiences of the placement and the effect this had on future career aspirations.Results: After running for four consecutive years, approximately 220 students have participated in the scheme across a range of surgical units and specialties. A total of 91.5% of the students were pre-clinical (years 1–3), whilst the remainder were clinical (years 4–6). Fifty-four percent were female and 46% male. Eighty-three percent of the students did not have any previous experience of the specialty that they shadowed, and 67% agreed that participating in the scheme had either “increased” or “strongly increased” their desire to pursue a surgical career. Ninety-four percent said they would “recommend” or “strongly recommend” the SSS to a peer. Over a third of students reported scrubbing-up during their placements and 35% of these directly assisted the lead surgeon. Traditionally male-dominated surgical sub-specialties recruited a high proportion of female students.Conclusion: This is the first published example of an established “Surgical Shadowing Scheme” for medical undergraduates. Our SSS has been highly valued by students and indicates that even a single high-quality surgical exposure is sufficient to increase the desire of undergraduates to pursue a surgical career. We hope that this SSS will act as a blueprint for other centers to develop their own shadowing schemes, in turn helping to ensure that surgery continues to inspire and attract the very best candidates for the future.Keywords: Surgical Shadowing Scheme, surgical education, medical education, medical student, surgical careers, women in surgery

Objectives. Despite the widespread use of resin cements in cementing dental restorations, their bond strength to CAD/CAM base metal alloys is not widely studied. This study aimed to evaluate the microshear bond strength (μSBS) between cobalt-chrome (Co-Cr) alloys fabricated using casting or CAD/CAM methods with three types of resin cements. Materials and Methods. Fifty Co-Cr blocks were prepared with CAD/CAM or casting technique. Specimens were divided using primer or not and bonded to three types of resin cements: Panavia F2, RelyX Unicem, and Duo-Link. The differences between the mean μSBS values were analyzed using the two-way ANOVA test and Tukey analysis (α = 0.05). The mode of failure was evaluated using a stereomicroscope. In addition, the specimens were examined by scanning electron microscopy (SEM) based on two received signals: backscattered electrons (SEB) and secondary electrons (SEs). One intact alloy specimen in each group was analyzed by energy-dispersive X-ray spectroscopy (EDX). Results. Most of the specimens in the no-primer group were prematurely debonded. Statistical analyses showed that the interaction between the alloy substrate and cement type was significant (p=0.001). The bond strength of Panavia F2 was significantly higher than Duo-Link in the CAD/CAM group (p=0.001). SEM evaluation confirmed the difference in grain structures, while EDX showed no remarkable difference in the chemical composition of the alloy substrates. Conclusion. Alloy fabrication technique may influence the bond strength of resin cements. In the CAD/CAM group, cement containing MDP molecules exhibited higher strength than the etch-and-rinse one.

The use of kidneys donated after circulatory death (DCD) remains controversial due to concerns with regard to high incidences of early graft loss, delayed graft function (DGF), and impaired graft survival. As these concerns are mainly based on data from historical cohorts, they are prone to time-related effects and may therefore not apply to the current timeframe. To assess the impact of time on outcomes, we performed a time-dependent comparative analysis of outcomes of DCD and donation after brain death (DBD) kidney transplantations. Data of all 11,415 deceased-donor kidney transplantations performed in The Netherlands between 1990-2018 were collected. Based on the incidences of early graft loss, two eras were defined (1998-2008 [n = 3,499] and 2008-2018 [n = 3,781]), and potential time-related effects on outcomes evaluated. Multivariate analyses were applied to examine associations between donor type and outcomes. Interaction tests were used to explore presence of effect modification. Results show clear time-related effects on posttransplant outcomes. The 1998-2008 interval showed compromised outcomes for DCD procedures (higher incidences of DGF and early graft loss, impaired 1-year renal function, and inferior graft survival), whereas DBD and DCD outcome equivalence was observed for the 2008-2018 interval. This occurred despite persistently high incidences of DGF in DCD grafts, and more adverse recipient and donor risk profiles (recipients were 6 years older and the KDRI increased from 1.23 to 1.39 and from 1.35 to 1.49 for DBD and DCD donors). In contrast, the median cold ischaemic period decreased from 20 to 15 hours. This national study shows major improvements in outcomes of transplanted DCD kidneys over time. The time-dependent shift underpins that kidney transplantation has come of age and DCD results are nowadays comparable to DBD transplants. It also calls for careful interpretation of conclusions based on historical cohorts, and emphasises that retrospective studies should correct for time-related effects.

Background: Despite growing waiting lists for renal transplants, hesitations persist with regard to the use of deceased after cardiac death (DCD) renal grafts. We evaluated the outcomes of DCD donations in The Netherlands, the country with the highest proportion of DCD procedures (42.9%) to test whether these hesitations are justified. Methods: This study included all procedures with grafts donated after brain death (DBD) (n = 3611) and cardiac death (n = 2711) performed between 2000 and 2017. Transplant outcomes were compared by Kaplan Meier and Cox regression analysis, and factors associated with short (within 90 days of transplantation) and long-term graft loss evaluated in multi-variable analyses. Findings: Despite higher incidences of early graft loss (+50%) and delayed graft function (+250%) in DCD grafts, 10-year graft and recipient survival were similar for the two graft types (Combined 10-year graft survival: 73.9% (95% CI: 72.5–75.2), combined recipient survival: 64.5% (95 CI: 63.0–66.0%)). Long-term outcome equivalence was explained by a reduced impact of delayed graft function on DCD graft survival (RR: 0.69 (95% CI: 0.55–0.87), p

Background: Accurate impression making is an essential prerequisite for achieving a passive fit between the implant and the superstructure. The aim of this in vitro study was to compare the three-dimensional accuracy of open-tray and three closed-tray impression techniques. Materials and Methods: Three acrylic resin mandibular master models with four parallel implants were used: Biohorizons (BIO), Straumann tissue-level (STL), and Straumann bone-level (SBL). Forty-two putty/wash polyvinyl siloxane impressions of the models were made using open-tray and closed-tray techniques. Closed-tray impressions were made using snap-on (STL model), transfer coping (TC) (BIO model) and TC plus plastic cap (TC-Cap) (SBL model). The impressions were poured with type IV stone, and the positional accuracy of the implant analog heads in each dimension (x, y and z axes), and the linear displacement (ΔR) were evaluated using a coordinate measuring machine. Data were analyzed using ANOVA and post-hoc Tukey tests (α = 0.05). Results: The ΔR values of the snap-on technique were significantly lower than those of TC and TC-Cap techniques (P < 0.001). No significant differences were found between closed and open impression techniques for STL in Δx, Δy, Δz and ΔR values (P = 0.444, P = 0.181, P = 0.835 and P = 0.911, respectively). Conclusion: Considering the limitations of this study, the snap-on implant-level impression technique resulted in more three-dimensional accuracy than TC and TC-Cap, but it was similar to the open-tray technique.

School culture is considered to be a system of meanings that influence every aspect of the school including school effectiveness. The aim of this study is to examine the impact of school culture on school effectiveness in government schools in Maldives. A quantitative approach using a survey design was adopted for the study. In order to achieve the research objective, a sample of 359 teachers was selected from government schools in the capital city, Malé through stratified random sampling. In the study, data were collected with scales related to two different variables, school culture and school effectiveness. Descriptive and inferential statistics were used to analyse the data using SPSS-25 and AMOS-25. The study revealed that the level of school culture and school effectiveness were high in Maldivian schools. According to the results, school culture had a significant influence on school effectiveness. The findings suggest that a positive and collaborative school culture enhances school effectiveness. In addition, it reflects the importance of creating a positive and collaborative school culture that empowers all school members to work towards common goals, which improves the effectiveness of the school. The findings confirm the current proposition that a positive school culture is instrumental in achieving school effectiveness, adding clarity to the understanding of school culture as a critical component of an effective school.

Higher educational institutions are exposed to various types of risks what other entities face naming strategic, operational, financial, compliance, technological and reputational risk owing to terrifying competition, rapid technological advancements and unpredictable environmental tremors. Implementation of enterprise risk management is the best strategic tool to identify, assess and mitigate the overall risks faced by entities. The implementation of enterprise risk management is however hindered by the high cost for ERM systems implementation and the inability of justification of increasing performances. Many research studies conducted by academicians and practitioners to ascertain the significant positive relationship of Enterprise Risk Management implementation and firm performance concluded with contradictory deductions. This study is an investigation of the reliability of the indicators measuring the impact of ERM implementation on the performance of non-state higher education institutions in Sri Lanka. The sample of hundred and seventy senior professionals was selected from the study population of seven hundred and seven senior persons attached to non-state institutions in Sri Lanka using stratified random sampling technique. This paper presents the outcomes of the quantitative investigation conducted to test the reliability of the indicators that were used to measure the latent variables in the survey instrument. As the Cronbach's alpha value of each latent variable was well above the threshold of 0.70, the items used in each variable were fitting to the construct and therefore accepted as reliable indicators to measure the constructs.

The quality of education is a major concern in the Maldivian education system. Previous literature posits that effective leadership is critical for the realization of school goals. As such, instructional leadership is claimed to contribute to the teaching and learning process of the school. The purpose of this research is to determine the impact of deputy principal's instructional leadership on school effectiveness in public schools in Malé, the capital city of Maldives. It also aims to analyze the interaction effect of school level on the relationship between instructional leadership and school effectiveness. A quantitative research approach is selected for this study. The data was collected using a survey questionnaire. The sample consisted of 359 teachers working in the public schools of the capital city, Malé, who were selected through stratified random sampling. Structural equation modeling (SEM) was used to analyze the conceptual relationships. The findings revealed that deputy principal's instructional leadership has a direct and positive relationship with school effectiveness. The moderation test indicated that school level moderates the relationship between deputy principal's instructional leadership and school effectiveness, where the interaction effect is higher at secondary level compared to primary level. The results present many implications towards theory and practice of instructional leadership and school effectiveness.

In recent years, there has been a growing interest among researchers on students' epistemological beliefs and learning approaches which are considered as important predictors of academic achievement. The aim of present study was to ascertain the relationship between Sri lankan senior secondary students' scientific epistemological beliefs and approaches to learning science. The sample included 415 students from western province of Sri Lanka. The partial least square-structural equation modelling (PLS-SEM) was employed to ascertain the relationships. The results revealed that sophisticated scientific epistemological beliefs of senior secondary students predict their deep learning approaches while less sophisticated scientific epistemological beliefs predict the surface approaches. The findings provide important implications for science learning -- teaching process and curriculum reforms.

Purpose: This study aims to assess the adequacy of unified theory of acceptance and use of technology-3 (UTAUT-3) model in understanding academician's adoption to e-Learning, with intent of getting more academicians to accept e-Learning in the Sri Lankan higher education context. Limited validity of the model in an educational context led to this study. The emergence of internet-based technology has changed the way people live, work and study. Technological platforms such as e-Learning have advanced educational systems by enhancing learner experience while benefiting teachers and educators in many ways. Design/methodology/approach: The study used a deductive approach and quantitative methodology, in which a theoretical model was tested using hypotheses to assess causality between study variables. The simple random sampling was used to collect data using a self-administered questionnaire that was sent via Google Forms to targeted respondents. The final sample consisted of 441 academicians who responded to factors of e-Learning adoption on a seven-point Likert scale. Structured equation modelling was used for data analysis. Findings: It was revealed that performance expectancy, effort expectancy, facilitating conditions, habit and hedonic motivation were significant influences of academician's adoption to e-Learning. However, social influence and personal innovativeness in IT were not significant predictors of e-Learning. Research limitations/implications: Due to the scope of the study, the factors that determine e-Learning adoption were limited to UTAUT-3 variables. Additionally, the concept was tested from only an academician's perspective using quantitative methodology. Practical implications: The findings are useful to higher education institute (HEI) administration, instructors and teaching assistants, policymakers to design and implement their online strategy as well as to make appropriate decisions in getting e-Learning accepted among a higher number of local HEI academicians. It is recommended for the decision-makers in the HEIs to consider the effect of the above findings in setting plans for higher e-Learning adoption. For instance, staff training catering to specific departmental needs, continuous awareness building, periodic reviewal of e-Learning system, e-Learning champions, introduction of policies and guidelines to encourage trial usage would be useful in this aspect. Social implications: Successful use of e-Learning would help HEIs to overcome certain issues that exist in a traditional classroom. e-Learning facilitates education delivery beyond time and space while supporting enhanced performance monitoring and skill development which ultimately improve quality of output and institutional performance. Originality/value: The study examined the adequacy of UTAUT-3 in understanding the adoptability to e-Learning. Second, it recognised a set of factors that affect the academic staff acceptance of e-Learning in higher education environments. A useful framework is provided to the HEI's administration to successfully implement e-Learning systems. This study contributes to the growing body of information system literature by examining the validity of UTAUT-3 framework in the use and acceptance of educational technology in a developing country.