Effect of Spatial and Spectral Scaling on Joint Characterization of the Spectral Mixture Residual: Comparative Analysis of AVIRIS and WorldView-3 SWIR for Geologic Mapping in Anza-Borrego Desert State Park.

A geologic map is both a visual depiction of the lithologies and structures occurring at the Earth's surface and a representation of a conceptual model for the geologic history in a region. The work needed to capture such multifaced information in an accurate geologic map is time consuming. Remote sensing can complement traditional primary field observations, geochemistry, chronometry, and subsurface geophysical data in providing useful information to assist with the geologic mapping process. Two novel sources of remote sensing data are particularly relevant for geologic mapping applications: decameter-resolution imaging spectroscopy (spectroscopic imaging) and meter-resolution multispectral shortwave infrared (SWIR) imaging. Decameter spectroscopic imagery can capture important mineral absorptions but is frequently unable to spatially resolve important geologic features. Meter-resolution multispectral SWIR images are better able to resolve fine spatial features but offer reduced spectral information. Such disparate but complementary datasets can be challenging to integrate into the geologic mapping process. Here, we conduct a comparative analysis of spatial and spectral scaling for two such datasets: one Airborne Visible/Infrared Imaging Spectrometer-Classic (AVIRIS-classic) flightline, and one WorldView-3 (WV3) scene, for a geologically complex landscape in Anza-Borrego Desert State Park, California. To do so, we use a two-stage framework that synthesizes recent advances in the spectral mixture residual and joint characterization. The mixture residual uses the wavelength-explicit misfit of a linear spectral mixture model to capture low variance spectral signals. Joint characterization utilizes nonlinear dimensionality reduction (manifold learning) to visualize spectral feature space topology and identify clusters of statistically similar spectra. For this study area, the spectral mixture residual clearly reveals greater spectral dimensionality in AVIRIS than WorldView (99% of variance in 39 versus 5 residual dimensions). Additionally, joint characterization shows more complex spectral feature space topology for AVIRIS than WorldView, revealing information useful to the geologic mapping process in the form of mineralogical variability both within and among mapped geologic units. These results illustrate the potential of recent and planned imaging spectroscopy missions to complement high-resolution multispectral imagery-along with field and lab observations-in planning, collecting, and interpreting the results from geologic field work.

Do Admissions Multiple Mini-Interview and Traditional Interview Scores Predict Subsequent Academic Performance? A Study of Five California Medical Schools.

PURPOSE: To compare the predictive validities of medical school admissions multiple mini-interviews (MMIs) and traditional interviews (TIs). METHOD: This longitudinal observational study of 2011-2013 matriculants to five California public medical schools examined the associations of MMI scores (two schools) and TI scores (three schools) with subsequent academic performance. Regression models adjusted for sociodemographics and undergraduate academic metrics examined associations of standardized mean MMI and TI scores with United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge (CK) scores and, for required clerkships, with mean National Board of Medical Examiners Clinical Science subject (shelf) exam score and number of honors grades. RESULTS: Of the 1,460 medical students, 746 (51.1%) interviewed at more than one study school; 579 (39.7%) completed at least one MMI and at least one TI. Neither interview type was associated with Step 1 scores. Higher MMI scores were associated with more clerkship honors grades (adjusted incidence rate ratio [AIRR] 1.28 more [95% CI 1.18, 1.39; P < .01] per SD increase) and higher shelf exam and Step 2 CK scores (adjusted mean 0.73 points higher [95% CI 0.28, 1.18; P < .01] and 1.25 points higher [95% CI 0.09, 2.41; P = .035], respectively, per SD increase). Higher TI scores were associated only with more honors grades (AIRR 1.11 more [95% CI 1.01, 1.20; P = .03] per SD increase). CONCLUSIONS: MMI scores were more strongly associated with subsequent academic performance measures than were TI scores.

Medical School Performance of Socioeconomically Disadvantaged and Underrepresented Minority Students Matriculating after a Multiple Mini-Interview.

Multiple Mini-Interviews (MMIs) are increasingly used in medical school admissions. We previously reported that while under-represented minority (URM) status was not associated with MMI scores, self-designated disadvantaged applicants had lower MMI scores, possibly affecting their matriculation prospects. No studies have examined how URM status or socioeconomic disadvantage (SED) are associated with academic performance following admission through an MMI. We examined the adjusted associations of MMI scores, SED, and URM status with U.S. Medical Licensing Examination Steps 1 and 2 performance and third-year clerkship Honors, measures affecting residency matching. While URM status was not associated with the measures, students with greater SED had lower Step 1 scores and fewer Honors. Students with higher MMI scores had more Step 1 failures, but more Honors. The findings identify areas to address in medical school admissions, student support, and evaluation processes, which is important given the need for a more representative physician workforce.

Medical School Applicant Characteristics Associated With Performance in Multiple Mini-Interviews Versus Traditional Interviews: A Multi-Institutional Study.

PURPOSE: To examine applicant characteristics associated with multiple mini-interview (MMI) or traditional interview (TI) performance at five California medical schools. METHOD: Of the five California Longitudinal Evaluation of Admission Practices consortium schools, three used TIs and two used MMIs. Schools provided retrospective data on 2011-2013 admissions cycle interviewees: age, gender, race/ethnicity (underrepresented in medicine [UIM] or not), disadvantaged (DA) status, undergraduate GPA, Medical College Admission Test (MCAT) score, and interview score (standardized as z score; mean = 0; SD = 1). Adjusted linear regression analyses, stratified by interview type, examined associations with interview performance. RESULTS: The 4,993 applicants who completed 7,516 interviews included 931 (18.6%) UIM and 962 (19.3%) DA individuals; 3,226 (64.6%) had only 1 interview. Mean age was 24.4 (SD = 2.7); mean GPA and MCAT score were 3.72 (SD = 0.22) and 33.6 (SD = 3.7), respectively. Older age, female gender, and number of prior interviews were associated with better performance on both MMIs and TIs. Higher GPA was associated with lower MMI scores (z score, per unit GPA = -0.26; 95% CI = -0.45, -0.06) but unrelated to TI scores. DA applicants had higher TI scores (z score = 0.17; 95% CI = 0.07, 0.28) but lower MMI scores (z score = -0.18; 95% CI = -0.28, -0.08) than non-DA applicants. Neither UIM status nor MCAT score was associated with interview performance. CONCLUSIONS: These findings have potentially important workforce implications, particularly regarding MMI performance of DA applicants, and illustrate the need for other multi-institutional studies.

Improvement on the Neo-umbilicoplasty Technique and Review of the Literature.

INTRODUCTION: The umbilicus is an important component of body esthetics, and its absence or dysmorphia may give rise to psychological discomfort, making it a common concern in surgical planning. Many techniques of umbilicus reconstruction have been proposed, each with its own limitations in terms of esthetics, risk of stenosis or final positioning. Reconstruction techniques may involve skin grafting, cartilage, purse-string suture and flaps. One of the most promising approaches is scarless neo-umbilicoplasty. OBJECTIVE: To improve the technique of neo-umbilicoplasty, creating a deeper and more natural-looking umbilicus, and propose a reoperation technique for shallow umbilici. PATIENTS AND METHODS: The sample consisted of 108 patients aged 25-67 years submitted to abdominoplasty and scarless neo-umbilicoplasty under epidural anesthesia performed by the same surgeon and at the same hospital between July 2013 and October 2015. RESULTS: Follow-up lasted from 6 to 24 months. The new umbilici were scarless. DISCUSSION: Many different techniques may be used to reconstruct the umbilicus. The main purpose is to create an adequately localized structure with a natural, youthful appearance and minimal scarring. To do so, we used ten (rather than six) attachment stitches and mobilized the adipose tissue toward the center of the new umbilicus to achieve greater depth, even in lean patients. Techniques which involve suturing the umbilical stalk onto the incised skin of the abdominal flap tend to produce unesthetic results, such as visible scars and umbilical skin islands of varying size. Scarless neo-umbilicoplasty does not require suture removal and poses no risk of dehiscence, secretion or umbilical stenosis, as observed with other techniques. CONCLUSION: The localization of the new umbilicus in the space between the rectus abdominis muscles, the use of ten rather than six stitches and the mobilization of the adipose tissue toward the periumbilical area constitute an improvement on the neo-umbilicoplasty technique. The resulting umbilici were scarless and very natural-looking. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reducing Medical School Admissions Disparities in an Era of Legal Restrictions: Adjusting for Applicant Socioeconomic Disadvantage.

A diverse physician workforce is needed to increase access to care for underserved populations, particularly as the Affordable Care Act expands insurance coverage. Yet legal restrictions constrain the extent to which medical schools may use race/ethnicity in admissions decisions. We conducted simulations using academic metrics and socioeconomic data from applicants to a California public medical school from 2011 to 2013. The simulations systematically adjusted medical school applicants' academic metrics for socioeconomic disadvantage. We found that socioeconomic and under-represented minority disparities in admissions could be eliminated while maintaining academic readiness. Adjusting applicant academic metrics using socioeconomic information on medical school applications may be a race-neutral means of increasing the socioeconomic and racial/ethnic diversity of the physician workforce.

Surgical treatment of hidradenitis suppurativa with anterior and posterior lateral thoracic fasciocutaneous flaps / Tratamento cirúrgico de hidradenite supurativa com retalho fasciocutâneo torácico lateral anterior e posterior

Introduction: Hidradenitis suppurativa (HS) is a chronic, multifactorial, and often recurrent bacterial infection, affecting the skin and subcutaneous tissues. However, complete HS resolution can be achieved through surgical treatment. A series of patients with HS complications is described herein, along with their evolution and complications after complete axillary surgical resection and lateral thoracic fasciocutaneous flap rotation. The evaluation of associated affected areas is also reported. Methods: Between 2009 and 2014, 6 patients with an average age of 25.5 years (range: 15 to 35 years) underwent surgery for the treatment of HS. All patients had long-standing, chronic axillary lesions that were refractory to non-surgical treatment. Results: Six patients with HS (2 males and 4 females) underwent surgery. The average follow-up period was 16 months (range: 4 months to 5 years). Complete resolution was achieved and no HS recurrence was observed. Bilateral resection was performed in 4 cases, and unilateral resection in 2. Five patients also had inguinal involvement, and 3 had surgery concurrent with the axilla. Five patients had partial dehiscence and serosanguinous discharge, followed by complete scar formation by second intention healing. Conclusion: Surgery is often the most appropriate and definitive treatment for HS. The lateral thoracic fasciocutaneous flap technique is associated with high success rates in this patient population.

Introdução: A hidradenite supurativa (HS) é uma infecção bacteriana crônica, multifatorial e frequentemente recorrente na pele e nos tecidos subcutâneos. No entanto, a resolução completa pode ser conseguida por meio de cirurgia. É descrita uma série de pacientes com complicações de HS, sua evolução, as complicações após a ressecção cirúrgica completa axilar e a rotação de retalho fasciocutâneo torácico lateral, além da análise das áreas acometidas associadas. Métodos: Entre 2009 e 2014, seis pacientes com idade entre 25,5 anos em média (intervalo: 15-35) foram submetidos à cirurgia para HS. Todos os pacientes apresentaram lesões de longa data axilares crônicas refratárias ao tratamento clínico. Resultados: Seis pacientes com HS (dois homens e quatro mulheres) foram submetidos à cirurgia. O período de acompanhamento foi de 16 meses, em média (intervalo: 4 meses - 5 anos). A resolução completa foi alcançada e nenhuma recorrência foi observada. A ressecção foi bilateral em quatro casos e unilateral em dois. Cinco pacientes apresentaram lesão inguinal, das quais três foram operadas no mesmo tempo cirúrgico. Cinco pacientes apresentaram deiscência parcial e descarga serossanguinolenta, seguida de cura completa após cicatrização por segunda intenção. Conclusão: A cirurgia é frequentemente o tratamento definitivo mais adequado para a HS. A técnica de retalho fasciocutâneo torácico lateral está associada a altas taxas de sucesso nesta população de doentes.

How Medical School Applicant Race, Ethnicity, and Socioeconomic Status Relate to Multiple Mini-Interview-Based Admissions Outcomes: Findings From One Medical School.

PURPOSE: To examine associations of medical school applicant underrepresented minority (URM) status and socioeconomic status (SES) with Multiple Mini-Interview (MMI) invitation and performance and acceptance recommendation. METHOD: The authors conducted a correlational study of applicants submitting secondary applications to the University of California, Davis, School of Medicine, 2011-2013. URM applicants were black, Southeast Asian, Native American, Pacific Islander, and/or Hispanic. SES from eight application variables was modeled (0-1 score, higher score = lower SES). Regression analyses examined associations of URM status and SES with MMI invitation (yes/no), MMI score (mean of 10 station ratings, range 0-3), and admission committee recommendation (accept versus not), adjusting for age, sex, and academic performance. RESULTS: Of 7,964 secondary-application applicants, 19.7% were URM and 15.1% self-designated disadvantaged; 1,420 (17.8%) participated in the MMI and were evaluated for acceptance. URM status was not associated with MMI invitation (OR 1.14; 95% CI 0.98 to 1.33), MMI score (0.00-point difference, CI -0.08 to 0.08), or acceptance recommendation (OR 1.08; CI 0.69 to 1.68). Lower SES applicants were more likely to be invited to an MMI (OR 5.95; CI 4.76 to 7.44) and recommended for acceptance (OR 3.28; CI 1.79 to 6.00), but had lower MMI scores (-0.12 points, CI -0.23 to -0.01). CONCLUSIONS: MMI-based admissions did not disfavor URM applicants. Lower SES applicants had lower MMI scores but were more likely to be invited to an MMI and recommended for acceptance. Multischool collaborations should examine how MMI-based admissions affect URM and lower SES applicants.

Does applicant personality influence multiple mini-interview performance and medical school acceptance offers?

PURPOSE: To examine relationships among applicant personality, Multiple Mini-Interview (MMI) performance, and medical school acceptance offers. METHOD: The authors conducted an observational study of applicants who participated in the MMI at the University of California, Davis, School of Medicine during the 2010-2011 admissions cycle and responded to the Big Five Inventory measuring their personality factors (agreeableness, conscientiousness, extraversion, neuroticism, openness). Individuals' MMI performance at 10 stations was summarized as a total score. Regression analyses examined associations of personality factors with MMI score, and associations of personality factors and MMI score with acceptance offers. Covariates included sociodemographic and academic performance measures. RESULTS: Among the 444 respondents, those with extraversion scores in the top (versus bottom) quartile had significantly higher MMI scores (adjusted parameter estimate = 5.93 higher, 95% CI: 4.27-7.59; P < .01). In a model excluding MMI score, top (versus bottom) quartile agreeableness (AOR = 3.22; 95% CI 1.57-6.58; P < .01) and extraversion (AOR = 3.61; 95% CI 1.91-6.82; P < .01) were associated with acceptance offers. After adding MMI score to the model, high agreeableness (AOR = 4.77; 95% CI 1.95-11.65; P < .01) and MMI score (AOR 1.33; 95% CI 1.26-1.42; P < .01) were associated with acceptance offers. CONCLUSIONS: Extraversion was associated with MMI performance, whereas both extraversion and agreeableness were associated with acceptance offers. Adoption of the MMI may affect diversity in medical student personalities, with potential implications for students' professional growth, specialty distribution, and patient care.