Extractive FTIR spectroscopy with cryogen-free low-temperature inert preconcentration for autonomous measurements of atmospheric organics: 1: Instrument development and preliminary performance.

In collaboration with the Jefferson County Department of Health and the Environmental Protection Agency (EPA), the University of Alabama in Huntsville developed a novel sensor for detecting very low levels of volatile organic compounds (VOCs). This sensor uses a commercial Fourier-transform infrared (FTIR) spectrometer, a commercial long-path IR gas cell, a commercial acoustic Stirling cyrocooler, and a custom cryogen-free cryotrap to improve sensitivity in an autonomous system with on-board quality control and quality assurance. Laboratory and initial field results show this methodology is sensitive to and well-suited for a wide variety of VOC atmospheric research and monitoring applications, including EPA National Air Toxics Trends Stations and the National Core monitoring network.

The Military Medicine Leadership Life Cycle: A Model for Longitudinal Leadership Development for Staff Physicians.

Leadership development is a challenge for all health care systems. Military Medicine has unique challenges with increased frequency of physician turnover and more junior leaders taking on positions of leadership earlier in their careers. Military medical corps officers are also challenged with leading in clinical, academic, and operational settings. Effective leadership within the Military Healthcare System requires an intentional and ongoing leadership development process across the careers of military medical corps officers. This article describes the leadership lifecycle of military medical corps officers, highlighting existing leadership development opportunities and providing an example of a leadership lifecycle from junior staff to senior executive for other organizations. The article concludes with specific recommendations that will allow military medicine to continue to strengthen the leadership skills of its officers to meet ever growing challenges.

A Common Trajectory Toward a Professional Identity as a Faculty Developer.

BACKGROUND AND OBJECTIVES: Professional identity formation is a complex construct that continually evolves in relation to an individual's experiences. The literature on educators identifying as faculty developers is limited and incompletely addresses how that identify affects other identities, careers, and influences on teaching. Twenty-six health professionals were trained to serve as faculty developers within our educational system. We sought to examine the factors that influence the professional identity of these faculty developers and to determine whether a common trajectory existed. METHODS: We employed a constructivist thematic analysis methodology using an inductive approach to understand the experiences of faculty developers. We conducted semistructured recorded interviews. Coding and thematic analysis were completed iteratively. RESULTS: We identified eight primary themes: (1) initial invitation, (2) discovery of faculty development as a professional activity, (3) discovery of educational theory, skills, and need for more education, (4) process of time and experience, (5) fostering relationships and community, (6) transfer of skills to professional and personal roles, (7) experiences that lead to credibility, and (8) sense of greater impact. CONCLUSIONS: An individual's journey to a faculty developer identity is variable, with several shared pivotal experiences that help foster the emergence of this identity. Consideration of specific programmatic elements to support the themes identified might allow for a strategic approach to faculty development efforts in health professions education.

A Critical Review of Professional Identity Formation Interventions in Medical Education.

PURPOSE: Professional identity formation (PIF) can be defined as the integration of the knowledge, skills, values, and behaviors of a profession with one's preexisting identity and values. Several different, and sometimes conflicting, conceptualizations and theories about PIF populate the literature; applying these different theories in PIF curricula and pedagogic strategies can profoundly impact the PIF of future physicians. The authors conducted a critical review of the recent literature on PIF interventions in medical education to explore the conceptualizations of and theoretical approaches to PIF that underlie them. METHOD: The authors searched articles on PIF educational interventions published in 5 major medical education journals between 2010 and March 2021. The articles' context and findings were extracted, analyzed, and summarized to identify conceptualizations and theoretical approaches to PIF. RESULTS: The authors identified 43 studies examining medical education interventions aimed at influencing PIF. The majority of the studies (n = 31) focused on undergraduate medical education. Reflective writing and the use of narrative reflections were the dominant modes of student activity in PIF interventions, supporting the dominant individualist approach to PIF. Less commonly PIF was understood as a socialization process or as an active process with both individually and socially focused influences. CONCLUSIONS: Relying on reflective writing as the intervention of choice to impact PIF feeds the dominant individualist perspective on PIF. An unintended consequence of this individualist orientation is that cultural problems embedded in the profession can become burdens for individual physicians to personally bear. Future education and research into PIF should account for theoretical preferences and the impact of these preferences.

Analysis of low-concentration gas samples with continuous-flow isotope ratio mass spectrometry: eliminating sources of contamination to achieve high precision.

Developments in continuous-flow isotope ratio mass spectrometry have made possible the rapid analysis of delta13C in CO2 of small-volume gas samples with precisions of < or = 0.1 per thousand. Prior research has validated the integrity of septum-capped vials for collection and short-term storage of gas samples. However, there has been little investigation into the sources of contamination during the preparation and analysis of low-concentration gas samples. In this study we determined (1) sources of contamination on a Gasbench II, (2) developed an analytical procedure to reduce contamination, and (3) identified an efficient, precise method for introducing sample gas into vials. We investigated three vial-filling procedures: (1) automated flush-fill (AFF), (2) vacuum back-fill (VBF), and (3) hand-fill (HF). Treatments were evaluated based on the time required for preparation, observed contamination, and multi-vial precision. The worst-case observed contamination was 4.5% of sample volume. Our empirical estimate showed that this level of contamination results in an error of 1.7 per thousand for samples with near-ambient CO2 concentrations and isotopic values that followed a high-concentration carbonate reference with an isotope ratio of -47 per thousand (IAEA-CO-9). This carry-over contamination on the Gasbench can be reduced by placing a helium-filled vial between the standard and the succeeding sample or by ignoring the first two of five sample peaks generated by each analysis. High-precision (SD < or = 0.1 per thousand) results with no detectable room-air contamination were observed for AFF and VBF treatments. In contrast, the precision of HF treatments was lower (SD > or = 0.2 per thousand). VBF was optimal for the preparation of gas samples, as it yielded faster throughput at similar precision to AFF.

Antiphospholipid syndrome in a 21-year-old with Klinefelter syndrome.

We describe a patient with Klinefelter syndrome presenting with recurrent arterial thromboses secondary to the antiphospholipid syndrome. Previous case reports noted association of Klinefelter syndrome with systemic lupus erythematosus including some cases with antiphospholipid syndrome. Clinicians should consider autoimmune processes, including the antiphospholipid syndrome, when patients with Klinefelter syndrome present with recurrent thrombosis or additional features of a systemic autoimmune disorder.

Mesenteric Panniculitis Presenting as Fever of Unknown Etiology in a Patient with History of Abdominal Surgery.

Mesenteric panniculitis is characterized by nonspecific fibrous inflammation of the small bowel mesentery, appendix, and mesoappendix. Clinical course is usually benign and outcome is favorable. We report a case of mesenteric panniculitis presenting as fever of unknown etiology in a patient with history of abdominal surgery.

Review for Disease of the Year: Epidemiology of HLA-B27 Associated Ocular Disorders.

Acute anterior uveitis is generally recognized as the most common form of uveitis. An association with HLA-B27 is seen in approximately half of cases of acute anterior uveitis. The prevalence of HLA-B27 varies widely between ethnic populations, with an approximate 8-10% prevalence in non-Hispanic whites and lower prevalence in Mexican- (4%) and African- (2-4%) Americans. A group of systemic inflammatory diseases, the spondyloarthropathies, similarly demonstrates a strong association with HLA-B27. The strength of association varies, depending on the specific spondyloarthropathy, with the strongest association found in patients with ankylosing spondylitis. The majority of patients with HLA-B27 associated uveitis will have an underlying spondyloarthropathy. Suspicion for HLA-B27 associated uveitis should prompt a careful clinical history to assess for features of a spondyloarthropathy as the characteristics of any associated uveitis may vary.

New Perspectives in Rheumatology: Avoiding Antimalarial Toxicity.

This report inaugurates New Perspectives in Rheumatology, a series of authoritative articles that focus on recent scientific and clinical developments and their potential to reshape rheumatology practice. Anticipated topics include the implementation of new guidelines and emerging information from clinical and translational research. Richard J. Bucala, MD, PhDEditor-in-ChiefRobert Terkeltaub, MDCo-Editor and Review Article Editor.

Acute cardiac tamponade in light-chain amyloidosis.

A 71-year-old woman, with a history of light-chain amyloidosis, presented with a sudden onset dyspnoea. Echocardiography showed a large pericardial effusion with compression of the right atrium and the right ventricle. Right heart catheterisation demonstrated equalisation of her diastolic pressures consistent with cardiac tamponade. Pericardiocentesis revealed a haemmorrhagic exudative effusion with no evidence of malignancy. Bone marrow biopsy and other investigations showed no evidence of multiple myeloma. Her effusion recurred 2 weeks later and repeat pericardiocentesis demonstrated similar findings. She was started on chemotherapy with no further recurrence of pericardial effusion. The patient was unable to tolerate chemotherapy and died 1 year after initial presentation. This case represents a rare manifestation of cardiac amyloidosis and explores the reported aetiologies for cardiac tamponade in the setting of light-chain amyloidosis. Acute and definitive treatments are also discussed.

An End-of-Year Oral Examination for Internal Medicine Residents: An Assessment Tool for the Clinical Competency Committee.

BACKGROUND: Comprehensive evaluations of clinical competency consume a large amount of time and resources. An oral examination is a unique evaluation tool that can augment a global performance assessment by the Clinical Competency Committee (CCC). OBJECTIVE: We developed an oral examination to aid our CCC in evaluating resident performance. METHODS: We reviewed tools used in our internal medicine residency program and other training programs in our institution. A literature search failed to identify reports of a similar evaluation tool used in internal medicine programs. We developed and administered an internal medicine oral examination (IMOE) to our postgraduate year-1 and postgraduate year-2 internal medicine residents annually over a 3-year period. The results were used to enhance our CCC's discussion of overall resident performance. We estimated the costs in terms of faculty time away from patient care activities. RESULTS: Of the 54 residents, 46 (86%) passed the IMOE on their first attempt. Of the 8 (14%) residents who failed, all but 1 successfully passed after a mentored study period and retest. Less than 0.1 annual full-time equivalent per faculty member was committed by most faculty involved, and the time spent on the IMOE replaced regular resident daily conference activities. CONCLUSIONS: The results of the IMOE were added to other assessment tools and used by the CCC for a global assessment of resident performance. An oral examination is feasible in terms of cost and can be easily modified to fit the needs of various competency committees.

Critical ostial left main and right coronary artery stenosis secondary to takayasu arteritis in a young female simulating pulmonary embolism at presentation.

A 28-year-old Caucasian female presented to the Emergency Department (ED) with sudden-onset chest pain. Thirty-six hours earlier, she was diagnosed with a pulmonary embolism, for which anticoagulation was started. Evaluation was significant for atrial fibrillation, elevated cardiac biomarkers, and echocardiography demonstrating a new wall motion abnormality. Symptoms resolved with spontaneous conversion to normal sinus rhythm and the patient was initiated on intravenous heparin and eptifibatide, followed by admission. Shortly after admission, the patient experienced recurrent chest pain with dynamic electrocardiographic (ECG) changes that prompted emergent cardiac catheterization. Prior to angiography, the patient developed pulseless cardiac arrest for which advanced cardiac lifesaving (ACLS) techniques were initiated. Coronary angiography showed critical ostial stenosis of the left main coronary artery. Despite transient periods of hemodynamic stability after successful stenting, the patient decompensated and was pronounced dead. Postmortem findings were consistent with Takayasu arteritis (TA). TA involving the coronary arteries is rare, presenting in fewer than 5% of cases. Diagnosis relies heavily on clinical suspicion. For our patient, dynamic ECG changes with wall motion abnormalities visible on echocardiography prompted diagnostic/therapeutic cardiac catheterization and stenting. Management involves high-dose systemic steroid therapy. However, due to recurrence of disease and adverse effects of prolonged steroid use, additional disease-modifying agents such as methotrexate, azathioprine, or cyclophosphamide may be used. With appropriate therapy, short-term prognosis is favorable. This case underlines the importance of having a high clinical suspicion for TA in the young female population with ischemic symptoms in order to allow early diagnosis in hopes of preventing further complications.

Ground-based zenith sky abundances and in situ gas cross sections for ozone and nitrogen dioxide with the Earth Observing System Aura Ozone Monitoring Instrument.

High-accuracy spectral-slit-function calibration measurements, in situ ambient absorption gas cell measurements for ozone and nitrogen dioxide, and ground-based zenith sky measurements with the Earth Observing System Aura Ozone Monitoring Instrument (OMI) flight instrument are reported and the results discussed. For use of high-spectral-resolution gas absorption cross sections from the literature in trace gas retrieval algorithms, accurate determination of the instrument's spectral slit function is essential. Ground-based measurements of the zenith sky provide a geophysical determination of atmospheric trace gas abundances. When compared with other measurements, they can be used to verify the performance of the OMI flight instrument. We show that the approach of using published high-resolution absolute absorption cross sections convolved with accurately calibrated spectral slit functions for OMI compares well with in situ gas absorption cell measurements made with the flight instrument and that use of these convolved cross sections works well for reduction of zenith sky data taken with the OMI flight instrument for ozone and nitrogen dioxide that are retrieved from measured spectra of the zenith sky with the differential optical absorption spectroscopy technique, the same method to be used for the generation of in-flight data products. Finally, it is demonstrated that the spectral stability and signal-to-noise ratio performance of the OMI flight instrument, as determined from preflight component and full instrument tests, are sufficient to meet OMI mission objectives.

Modification of the pyridine moiety of non-peptidyl indole GnRH receptor antagonists.

The synthesis of a number of indole GnRH antagonists is described. Oxidation of the pyridine ring nitrogen, combined with alkylation at the two position, led to a compound with an excellent in vitro activity profile as well as oral bioavailability in both rats and dogs.

2-Arylindoles as gonadotropin releasing hormone (GnRH) antagonists: optimization of the tryptamine side chain.

A series of 2-arylindoles containing novel heteroaromatic substituents on the tryptamine tether, based on compound 1, was prepared and evaluated for their ability to act as gonadotropin releasing hormone (GnRH) antagonists. Successful modifications of 1 included chain length variation (reduction) and replacement of the pyridine with heteroaromatic groups. These alterations culminated in the discovery of compound 27kk which had excellent in vitro potency and oral efficacy in rodents.