Tweetorials: Digital scholarship deserving of inclusion in promotion portfolios.

Since their first appearance in 2018, tweetorials have emerged as a popular tool for medical education. Despite some calls for their inclusion in educational and promotion portfolios, questions have been raised about the appropriateness of these forms of digital scholarship. Also unclear is how a promotion committee might identify educational tweetorials most deserving of inclusion. We argue that educational tweetorials do warrant consideration as digital scholarship and offer a means of evaluation that promotion committees might use when assessing an individual tweetorial.

[Root anatomy and root canal morphology of mandibular canines in Israeli population].

INTRODUCTION: Furcated root and root canal separation are anatomic variations of mandibular canines. Other studies found that up to 20% of mandibular canines have root canal separation and up to 6.8% are bifurcated teeth. The purpose of this study was to investigate the prevalence of two-rooted mandibular canines and the root canal morphology of mandibular canines. METHODS: A total of 1,020 Israeli patients' cone-beam computed tomography (CBCT) scans were screened and evaluated. A total of 1,981 mandibular canines were examined and the prevalence of furcated mandibular canines and root canal separation was recorded and analyzed. RESULTS: The overall prevalence of furcated mandibular canines and root canal separation in mandibular canines were 1.9% and 10.3% respectively. The bilateral prevalence of furcated mandibular canines was 22.5%. Statistically significant difference was detected by the side of occurrence (left vs right side, p < 0.05) and by gender in right mandibular canine (p < 0.05). CONCLUSION: the prevalence of furcated roots and root canal separation in mandibular canines was not frequent. Clinicians should be aware of the special characteristic of those anatomic variations.

Eye on the Prize: Patient Outcomes Research in Medical Education.

The overarching goal of medical education is to train clinicians who achieve and maintain competence in patient care. Although the field of medical education research has acknowledged the importance of education on clinical practices and outcomes, most research endeavors continue to focus on learner-centered outcomes, such as knowledge and attitudes. The absence of clinical and patient-centered outcomes in pulmonary and critical care medicine medical education research has been attributed to barriers at multiple levels, including financial, methodological, and practical considerations. This Perspective explores clinical outcomes relevant to pulmonary and critical care medicine educational research and offers strategies and solutions that educators can use to accomplish what many consider the "prize" of medical education research: an understanding of how our educational initiatives impact the health of patients.

A Way Forward in the COVID-19 Pandemic: Making the Case for Narrative Competence in Pulmonary and Critical Care Medicine.

Each surge of the coronavirus disease (COVID-19) pandemic presented new challenges to pulmonary and critical care practitioners. Although some of the initial challenges were somewhat less acute, clinicians now are left to face the physical, emotional, and mental toll of the past 2 years. The pandemic revealed a need for a more varied skillset, including space for reflection, tolerance of uncertainty, and humanism. These skills can assist clinicians who are left to heal from the difficulty of caring for patients in the absence of families who were excluded from the intensive care unit, public distrust of vaccines, and morgues overtaken by our patients. As pulmonary and critical care medicine practitioners and educators, we believe that cultivating practices, pedagogies, and institutional structures that foster narrative competence, "the ability to acknowledge, absorb, interpret, and act on the stories and plights of others," in our ourselves, our trainees, and our colleagues, may provide a productive way forward. In addition to fostering needed skills, this practice can promote necessary healing as well. This perspective introduces the practice of narrative competence, provides evidence of support for its implementation, and suggests opportunities for curricular integration.

Incorporating Retrieval Practice Into Intensive Care Unit Teaching Rounds: A Feasibility Study.

BACKGROUND: Teaching rounds are an important component of the learning environment for residents in the intensive care unit (ICU). Retrieval practice is a cognitive learning tool that helps learners consolidate information and might improve the quality and culture of teaching rounds. OBJECTIVE: We performed a feasibility study from October 2018 to June 2019 to investigate the incorporation of retrieval practice into ICU rounds. METHODS: Participants included internal medicine and family medicine residents and pulmonary and critical care medicine fellows and faculty on medical ICU (MICU) teams at a tertiary care academic medical center. For 1-week periods, residents were asked to use retrieval practice after rounds, sharing one learning point. Participants were anonymously surveyed about the feasibility and acceptability of this strategy and perceptions of the educational value of ICU rounds before and after incorporating retrieval practice. RESULTS: We enrolled 9 MICU teams, including 31 residents, 8 fellows, and 8 attendings. Pre- and postsurvey response rates were 89% and 91% (42 and 43 of 47, respectively). Sixty-nine percent of respondents (30 of 43) reported sharing learning points on at least 3 days of the intervention week. Eighty-six percent of respondents (37 of 43) said retrieval practice did not adversely affect the workflow at the end of rounds. The perception that teaching on rounds was a priority increased after the intervention (3.93 versus 4.28 on 1-5 Likert scale, P = .047). CONCLUSIONS: Using retrieval practice on MICU rounds was feasible and acceptable and was associated with an increase in the perceived priority given to teaching on rounds.

Continental accretion: from oceanic plateaus to allochthonous terranes.

Some of the regions of the anomalously high sea-floor topography in today's oceans may be modern allochthonous terranes moving with their oceanic plates. Fated to collide with and be accreted to adjacent continents, they may create complex volcanism, cut off and trap oceanic crust, and cause orogenic deformaton. The accretion of plateaus during subduction of oceanic plates may be responsible for mountain building comparable to that produced by the collision of continents.

Continental breakup by a leaky transform: the gulf of elat (aqaba).

The floor of the Gulf of Elat consists of five distinct deeps. Its structure is controlled by faulting which has produced rhomb-shaped grabens. The gulf is a newly formed plate boundary between Arabia and Sinai.

Passive smoking, NAT2 polymorphism, and breast cancer risk in Israeli Arab women: a case-control study.

BACKGROUND: The effect of passive smoking (PS) on breast cancer (BC) is controversial, and may be modified by polymorphism of the N-Acetyl-transferase (NAT) 2 enzyme which is involved in tobacco carcinogen metabolism. We aimed to evaluate the relationship between PS and BC by NAT2 variants in Arab-Israeli women, a unique population with low active smoking rates, and high exposure to PS. METHODS: A population-based case-control study was carried out on non-smoking 137 prevalent breast cancer patients and 274 population-based controls, aged 30-70 years. Data on past and current PS, sociodemographic, and other characteristics were retrieved through interviews, and buccal smears were provided for NAT2 analyses. Logistic regression models adjusting for potential confounders assessed the odds ratios (ORs) and 95% confidence intervals (95% CI) of the association between PS and BC. RESULTS: Ever PS was associated with increased BC risk: OR = 2.22, 95% CI 1.28-3.87. Higher lifetime PS exposure was associated with higher BC risk: Compared to never exposed women, women exposed to PS most of their lives had a threefold higher BC risk (OR = 3.16, 95% CI 1.70-5.87, P trend < 0.001). NAT2 polymorphism did not modify these associations. CONCLUSIONS: PS exposure in non-smoking Israeli Arab women is significantly associated with increased risk for BC, potentially allowing for specific intervention; NAT2 polymorphism does not modify this association.

Educational Handoffs from Medical School to Residency: an Emerging Opportunity.

This article was migrated. The article was marked as recommended. In this Personal View article we discuss the limitations of the summative medical student data currently received by residencies pre-match (such as transcripts, the Dean's Letter and letters of recommendation) to adequately communicate a student's strengths, weaknesses, and learning needs as they begin internship. We briefly summarize the evolution of medical student and resident performance evaluation, and discuss the role that educational handoffs may play in the future as students transition to internship. We then consider emerging questions about the feasibility and mechanics of educational handoffs and discuss possible steps forward.

Management of Atrial Fibrillation with Rapid Ventricular Response in the Intensive Care Unit: A Secondary Analysis of Electronic Health Record Data.

PURPOSE: Atrial fibrillation with rapid ventricular response (RVR) is common during critical illness. In this study, we explore the comparative effectiveness of three commonly used drugs (metoprolol, diltiazem, and amiodarone) in the management of atrial fibrillation with RVR in the intensive care unit (ICU). METHODS: Data pertaining to the first ICU admission were extracted from the Medical Information Mart for Intensive Care III database. Patients who received one of the above pharmacologic agents while their heart rate was > 110 bpm and had atrial fibrillation documented in the clinical chart were included. Propensity score weighting using a generalized boosted model was used to compare medication failure rates (second agent prior to termination of RVR). Secondary outcomes included time to control, control within 4 h, and mortality. RESULTS: One thousand six hundred forty-six patients were included: 736 received metoprolol, 292 received diltiazem, and 618 received amiodarone. Compared with those who received metoprolol, failure rates were higher amongst those who received amiodarone (OR 1.39, 95% CI 1.03-1.87, P = 0.03) and there was a trend towards increased failure rates in patients who received diltiazem (OR 1.35, CI 0.89-2.07, P = 0.16). Amongst patients who received a single agent, patients who received diltiazem were less likely to be controlled at 4-h than those who received metoprolol (OR 0.64, CI 0.43-097, P = 0.03). Initial agent was not associated with in-hospital mortality. CONCLUSIONS: In this study, metoprolol was the most commonly used agent for atrial fibrillation with RVR. Metoprolol had a lower failure rate than amiodarone and was superior to diltiazem in achieving rate control at 4 h.