Contextual Factors Influencing the Adoption of Physical Activity Direct Education and Policy, Systems, and Environmental Change Initiatives by Virginia EFNEP and SNAP-Ed Staff.

OBJECTIVE: To explore factors influencing the adoption of direct education programs and policy, systems, and environmental (PSE) change initiatives focused on physical activity for Supplemental Nutrition Assistance Program-eligible audiences by Virginia Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education (SNAP-Ed) staff. METHODS: Online survey with Expanded Food and Nutrition Education Program and SNAP-Ed peer (paraprofessional) educators (n = 28) and SNAP-Ed agents (master of science level) (n = 9) in Virginia. Descriptive statistics were computed for sociodemographic characteristics and responses to questions on the basis of Likert-type scales. Exploratory factor analyses were run to identify the underlying structures of the different variables. RESULTS: The main factors for peer educators were related to substituting nutrition programs or content for physical activity programs. Other factors included staff qualifications and expectations about leading vs teaching physical activities. For PSEs, the top factors were the capacity to reach many community members, attract new partners and stakeholders, and personal interest in the PSE. CONCLUSIONS AND IMPLICATIONS: The results provide insight into potential barriers and motivators for adopting physical activity education and PSEs within community-based initiatives and can be used to inform program planning and staff training. Additional research is warranted to examine other factors influencing the adoption and implementation of physical activity programs and PSEs.

Sex differences in type 2 diabetes: an opportunity for personalized medicine.

Over the past several decades, substantial ground has been gained in understanding the biology of sex differences. With new mandates to include sex as a biological variable in NIH-funded research, greater knowledge is forthcoming on how sex chromosomes, sex hormones, and social and societal differences between sexes can affect the pathophysiology of health and disease. A detailed picture of how biological sex impacts disease pathophysiology will directly inform clinicians in their treatment approaches and challenge canonical therapeutic strategies. Thus, a profound opportunity to explore sex as a variable in personalized medicine now presents itself. While many sex differences are apparent in humans and have been described at length, we are only beginning to see how such differences impact disease progression, treatment efficacy, and outcomes in obesity, type 2 diabetes, and cardiovascular disease. Here, we briefly present the most salient and convincing evidence of sex differences in type 2 diabetes detection, diagnostics, disease course, and therapeutics. We then offer commentary on how this evidence can inform clinicians on how to approach the clinical workup and management of different patients with diabetes. Finally, we discuss some gaps that remain in the literature and propose several research questions to guide basic and translational researchers as they continue in this growing area of scientific exploration.

For decades, most research in the laboratory and clinical settings focused primarily on males. However, more recently, grant-funding agencies, including the National Institutes of Health, have prioritized research that studies both males and females. This has dramatically improved our understanding of how biological sex impacts whether a person is at higher risk for developing a particular disease and what treatment options may be best to achieve the healthiest outcomes. This article offers the perspectives of practicing physicians and scientists on how our knowledge about biological sex may impact disease incidence, progression, treatment options, and outcomes in obesity, diabetes, and heart disease. The piece will offer a broad overview of the current science and personalized medicine approaches in these areas. It then discusses gaps in our knowledge and proposes several questions to guide future research.

Robotization of Industrial Processes: Motivational Differences between Companies with and without Existing Robotic Processes.

OCCUPATIONAL APPLICATIONSOur survey of 100 manufacturing facilities revealed statistically significant differences among company types in their perceptions of cost savings, productivity gains, and safety improvements as benefits of robotic implementation. Regardless of company type or size, indications of presence of cumulative, incidental, and static postural hazards were identified as primary perceived factors for injury potential. More than half of the surveyed companies reported being unaware of general safety standards utilized within their facilities, and most (70%) robotic companies were unaware of any robotic-specific standards utilized at their company. Our results indicate the importance of accounting for varying perspectives between company types regarding motivation for and safety impacts of robotics. With the advancement of technology and robotization of the manufacturing industry, there are also pressing needs for advancing robotic safety standards, implementing training programs, and continuous promotion of the general safety awareness.

Background: Introducing robotics to industrial processes is generally thought to lead to increased productivity, decreased costs, and improved occupational health and safety. These expected benefits are assumed to drive the motivation of companies to robotize their manufacturing processes.Purpose: Robotics presumably pose different hazards than manual labor, illustrating their potential to positively alter company safety outcomes. However, our literature review identified minimal research showcasing driving factors for why companies choose to utilize industrial robotics. Moreover, the question of how motivational factors differ between companies based on their type or size, has not been fully explored.Methods: We investigated the differentiation in motivation for robotization with an emphasis on safety related issues for companies that already have robotic processes (robotic companies) and companies without current robotic installations (non-robotic). For the latter, a finer distinction was made between those planning on obtaining robots in the future and those not planning to do so. A custom designed and validated survey was distributed, and data were collected from 100 companies in the general manufacturing sector (52 of which currently utilize robotics).Results: We found statistically significant differences in motivational factors among robotic companies, companies planning to obtain robotics, and companies not planning on obtaining robotics. Economic aspects were the biggest justification factor for all company types. Perceived safety hazards and differences in injury types between robotic and non-robotic companies were identified. Robotics showcase the potential to reduce certain hazard types, but also to pose harm to employees if not properly implemented.Conclusions: Regardless of their size or geographic location, companies with and without existing robotic processes differ in their perspectives on motivation and safety impacts of robotization of industrial processes.

Understanding the Geographic Distribution of Diverticulitis Hospitalizations in Washington State.

BACKGROUND: The incidence of diverticulitis in the United States is increasing, and hospitalization remains a surrogate for disease severity. State-level characterization of diverticulitis hospitalization is necessary to better understand the distribution of disease burden and target interventions. METHODS: A retrospective cohort of diverticulitis hospitalizations from 2008 through 2019 was created using Washington State's Comprehensive Hospital Abstract Reporting System. Hospitalizations were stratified by acuity, presence of complicated diverticulitis, and surgical intervention using ICD diagnosis and procedure codes. Patterns of regionalization were characterized by hospital case burden and distance travelled by patients. RESULTS: During the study period, 56,508 diverticulitis hospitalizations occurred across 100 hospitals. Most hospitalizations were emergent (77.2%). Of these, 17.5% were for complicated diverticulitis, and 6.6% required surgery. No single hospital received more than 5% (n = 235) of average annual hospitalizations. Surgeons operated in 26.5% of total hospitalizations (13.9% of emergent hospitalizations, and 69.2% of elective hospitalizations). Operations for complicated disease made up 40% of emergent surgery and 28.7% of elective surgery. Most patients traveled fewer than 20 miles for hospitalization, regardless of acuity (84% for emergent hospitalization and 77.5% for elective hospitalization). DISCUSSION: Hospitalizations for diverticulitis are primarily emergent, nonoperative, and broadly distributed across Washington State. Hospitalization and surgery occur close to patients' homes, regardless of acuity. This decentralization needs to be considered if improvement initiatives and research in diverticulitis are to have meaningful, population-level impact.

Human exposures to Phytolacca americana in Kentucky.

Phytolacca americana, known more commonly as "pokeweed", is a large perennial plant found ubiquitously throughout the United States. Despite known toxicities, characterization of pokeweed exposure demographics, symptoms, treatments, and outcomes is currently limited. The objective of this study is to describe human pokeweed exposures, treatments, and outcomes, in the state of Kentucky, between 2000 and 2019. The National Poison Database System was queried for all Phytolacca americana exposures in the state of Kentucky between 2000 and 2019. After the removal of non-human cases, investigators independently reviewed data to ensure all coding was appropriate per the standards set forth by NPDS. The primary objective of this study was to describe pokeweed exposure demographics within the state of Kentucky during the previously established timeframe. Secondary objectives included characterizing pokeweed treatment trends and evaluating their affiliated medical outcomes. 1669 cases of human pokeweed exposure were reported. Patients were predominantly young in age, with a median age of 3 years reported. The majority of patients were male (54.9%), with unintentional exposures representing most exposure reasons (97.2%). Oral ingestion of plant material represented the bulk of the exposure route (98.3%), with pokeberries most often implicated in these cases (93.9%). Exposures were generally well tolerated. 239 total adverse events were noted during the timeframe. Abdominal pain, nausea, vomiting, and diarrhea were most common. Dermal exposures resulted in cutaneous edema, pain, and swelling. Treatments were mainly supportive, with no deaths reported during the study timeframe. In conclusion, Phytolacca americana is commonly encountered in the United States. In this observational study, patients most heavily implicated in pokeweed exposures are young males. Oral ingestion was most commonly reported, with berries most often implicated. Exposures are generally well tolerated, with gastrointestinal symptoms most frequently reported. Cutaneous exposures represent an underappreciated exposure route. Treatments are largely supportive in nature.

A desert bee thermoregulates with an abdominal convector during flight.

Flying endothermic insects thermoregulate, likely to improve flight performance. Males of the Sonoran Desert bee, Centris caesalpiniae, seek females at aggregations beginning at sunrise and cease flight near midday when the air temperature peaks. To identify the thermoregulatory mechanisms for C. caesalpiniae males, we measured tagma temperature, wingbeat frequency, water loss rate, metabolic rate and tagma mass of flying bees across shaded air temperatures of 19-38°C. Surface area, wet mass and dry mass declined with air temperature, suggesting that individual bees do not persist for the entire morning. The largest bees may be associated with cool, early mornings because they are best able to warm themselves and/or because they run the risk of overheating in the hot afternoons. Thorax temperature was high (38-45°C) and moderately well regulated, while head and abdomen temperatures were cooler and less controlled. The abdominal temperature excess ratio increased as air temperature rose, indicating active heat transfer from the pubescent thorax to the relatively bare abdomen with warming. Mass-specific metabolic rate increased with time, and air and thorax temperatures, but wingbeat frequency did not vary. Mass-specific water loss rate increased with air temperature, but this was a minor mechanism of thermoregulation. Using a heat budget model, we showed that whole-body convective conductance more than doubled through the morning, providing strong evidence that the primary mechanism of regulating thorax temperature during flight for these bees is increased use of the abdomen as a convector at higher air temperatures.

A Multicenter Analysis of the Early Impact of COVID-19 on Junior Resident Operative Case Volume.

INTRODUCTION: Institutions have reported decreases in operative volume due to COVID-19. Junior residents have fewer opportunities for operative experience and COVID-19 further jeopardizes their operative exposure. This study quantifies the impact of the COVID-19 pandemic on resident operative exposure using resident case logs focusing on junior residents and categorizes the response of surgical residency programs to the COVID-19 pandemic. MATERIALS AND METHODS: A retrospective multicenter cohort study was conducted; 276,481 case logs were collected from 407 general surgery residents of 18 participating institutions, spanning 2016-2020. Characteristics of each institution and program changes in response to COVID-19 were collected via surveys. RESULTS: Senior residents performed 117 more cases than junior residents each year (P < 0.001). Prior to the pandemic, senior resident case volume increased each year (38 per year, 95% confidence interval 2.9-74.9) while junior resident case volume remained stagnant (95% confidence interval 13.7-22.0). Early in the COVID-19 pandemic, junior residents reported on average 11% fewer cases when compared to the three prior academic years (P = 0.001). The largest decreases in cases were those with higher resident autonomy (Surgeon Jr, P = 0.03). The greatest impact of COVID-19 on junior resident case volume was in community-based medical centers (246 prepandemic versus 216 during pandemic, P = 0.009) and institutions which reached Stage 3 Program Pandemic Status (P = 0.01). CONCLUSIONS: Residents reported a significant decrease in operative volume during the 2019 academic year, disproportionately impacting junior residents. The long-term consequences of COVID-19 on junior surgical trainee competence and ability to reach cases requirements are yet unknown but are unlikely to be negligible.

Evidence-Based Criteria Supporting Early Discharge for Pediatric Patients With Osteosarcoma Receiving High-Dose Methotrexate: A Retrospective Chart Review.

Purpose: The purpose of this study is to describe the outcomes following the implementation of an early discharge protocol for pediatric patients with osteosarcoma receiving high-dose methotrexate (MTX) to determine if the protocol safely decreased length of stay without increased toxicity. Methods: This was a retrospective descriptive cohort design. Participants included children, 5 to 25 years of age, diagnosed with osteosarcoma, who received methotrexate between December 2017 and July 2019. A total of 141 doses across fifteen individual patients were included in the cohort. Data were abstracted from the electronic health record and analyzed using descriptive statistics. Results: The majority of administrations (n = 94, 67%) met early discharge criteria without an increase in toxicity or hospital readmission. Conclusion: Pediatric patients receiving high-dose MTX for osteosarcoma can be safely discharged from the hospital when serum MTX level < 0.4 µmol/L with the implementation of education, hydration goals, frequent lab monitoring, and close follow-up. More than half of patients on this study were able to be discharged from the hospital sooner than prior protocol. More importantly, this retrospective chart review highlighted the ability to maintain safe administration without increasing toxicity.

A Preliminary Evaluation of Virginia Fresh Match: Impacts and Demographic Considerations for Future Fruit and Vegetable Incentive Programs.

The purpose of this communication is to describe the preliminary evaluation of the Virginia Fresh Match (VFM) financial incentive program for fresh fruits and vegetables for Virginia Supplemental Nutrition Assistance Program shoppers and to determine if there were differences in incentive outcomes by race. In this cross-sectional study, a questionnaire was administered to shoppers using Virginia Fresh Match incentives at participating farmers markets and community-based food retail outlets. Repeated measures ANOVAs were used to detect differences in fruit and vegetable consumption between demographic groups over time. Chi-square tests were used to determine if there were associations between race and perceived impact of VFM incentives on making food last and the attribution of VFM incentives to changes in fruit and vegetable consumption frequency. Frequency of fruit and vegetable intake was significantly higher during VFM incentive use, with a difference of 1.17 ± 0.07 and 1.07 ± 0.07 on a Likert scale measure, respectively (p ≤ 0.001). There were racial differences in assertions that VFM incentives helped food to last. VFM incentives were effective at increasing fruit and vegetable consumption, but racial differences should be considered in the administration of VFM to avoid reinforcing systems or approaches that may contribute to disparities in food access and food security.

A Review of Selumetinib in the Treatment of Neurofibromatosis Type 1-Related Plexiform Neurofibromas.

OBJECTIVE: To evaluate the safety and efficacy of selumetinib, a novel MEK inhibitor, for the treatment of plexiform neurofibromas (PN) in patients with neurofibromatosis type 1 (NF1). DATA SOURCES: An English-based literature search of PubMed, EMBASE, and ClinicalTrials.gov was conducted using the terms selumetinib AND neurofibromatosis from inception to August 1, 2021. STUDY SELECTION AND DATA EXTRACTION: Relevant prescribing information, abstracts, and articles identified through the search were considered for inclusion in this review. DATA SYNTHESIS: The open-label, multicenter, single-arm, phase II SPRINT trial demonstrated clinically significant improvements in PN-related complications. Of 50 symptomatic patients, 68% experienced a partial response, with a median change in tumor volume of -27.9% from baseline. Estimated progression-free survival at 3 years was 84%. Additionally, clinically meaningful improvements were seen on patient- and parent-reported assessments evaluating pain, range of motion, disfigurement, and quality of life. Overall, the adverse effect profile for selumetinib appears mild and manageable. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Selumetinib is the first FDA-approved treatment for inoperable PN in patients with NF1, demonstrating that MEK inhibition is a promising therapeutic strategy. Studies are ongoing to assess the effect of selumetinib on other NF1-associated tumor types and to determine the optimal dosing schedule and treatment duration. Cost and treatment burden must be considered when selecting selumetinib therapy. CONCLUSION: Selumetinib exhibits impressive antitumor activity and sustained clinical benefit in patients lacking other viable treatment options. Further studies are warranted to determine the optimal age of initiation, treatment duration, and overall cost-effectiveness of selumetinib.

Colony field test reveals dramatically higher toxicity of a widely-used mito-toxic fungicide on honey bees (Apis mellifera).

Honey bees (Apis mellifera) and other pollinator populations are declining worldwide, and the reasons remain controversial. Based on laboratory testing, fungicides have traditionally been considered bee-safe. However, there have been no experimental tests of the effects of fungicides on colony health under field conditions, and limited correlational data suggests there may be negative impacts on bees at levels experienced in the field. We tested the effects of one of the most commonly used fungicides on colony health by feeding honey bee colonies pollen containing Pristine® (active ingredients: 25.2% boscalid, 12.8% pyraclostrobin) at four levels that bracketed concentrations we measured for pollen collected by bees in almond orchards. We also developed a method for calculating per-bee and per-larva dose. Pristine® consumption significantly and dose-dependently reduced worker lifespan and colony population size, with negative health effects observed even at the lowest doses. The lowest concentration we tested caused a 15% reduction in the worker population at an estimated dosage that was three orders of magnitude below the estimated LD15 values for previous acute laboratory studies. The enhanced toxicity under field conditions is at least partially due to activation of colonial nutritional responses missed by lab tests. Pristine® causes colonies to respond to perceived protein malnutrition by increasing colony pollen collection. Additionally, Pristine induces much earlier transitioning to foraging in individual workers, which could be the cause of shortened lifespans. These findings demonstrate that Pristine® can negatively impact honey bee individual and colony health at concentrations relevant to what they experience from pollination behavior under current agricultural conditions.

Reducing Prescribing Errors in Hospitalized Children on the Ketogenic Diet.

BACKGROUND: Children on the ketogenic diet must limit carbohydrate intake to maintain ketosis and reduce seizure burden. Patients on ketogenic diet are vulnerable to harm in the hospital setting where carbohydrate-containing medications are commonly prescribed. We developed clinical decision support to reduce inappropriate prescription of carbohydrate-containing medications in hospitalized children on ketogenic diet. METHODS: A clinical decision support alert was developed through formative and summative usability testing. The alert warned prescribers when they entered an order for a carbohydrate-containing medication in patients on ketogenic diet. The alert was implemented using a quasi-experimental design with sequential crossover from control to intervention at two tertiary care pediatric hospitals within a single health system. The primary outcome was carbohydrate-containing medication orders per patient-day. RESULTS: During the study period, there were 280 ketogenic diet patient admissions totaling 1219 patient-days. The carbohydrate-containing medication order rate declined from 0.69 to 0.35 orders per patient-day (absolute rate reduction 0.34, 95% confidence interval 0.25-0.43), corresponding to 256 inappropriate orders prevented. The alert fired 398 times and was accepted (i.e., the order was removed) 227 times for an overall acceptance rate of 57%. CONCLUSIONS: Implementation of a clinical decision support alert at order-entry resulted in a sustained reduction in carbohydrate-containing medication orders for hospitalized patients on ketogenic diet without an increase in alert burden. Clinical decision support developed with user-centered design principles can improve patient safety for children on ketogenic diet by influencing prescriber behavior.

Where did the patients go? Changes in acute appendicitis presentation and severity of illness during the coronavirus disease 2019 pandemic: A retrospective cohort study.

BACKGROUND: The coronavirus disease 2019 pandemic restricted movement of individuals and altered provision of health care, abruptly transforming health care-use behaviors. It serves as a natural experiment to explore changes in presentations for surgical diseases including acute appendicitis. The objective was to determine if the pandemic was associated with changes in incidence of acute appendicitis compared to a historical control and to determine if there were associated changes in disease severity. METHODS: The study is a retrospective, multicenter cohort study of adults (N = 956) presenting with appendicitis in nonpandemic versus pandemic time periods (December 1, 2019-March 10, 2020 versus March 11, 2020-May 16, 2020). Corresponding time periods in 2018 and 2019 composed the historical control. Primary outcome was mean biweekly counts of all appendicitis presentations, then stratified by complicated (n = 209) and uncomplicated (n = 747) disease. Trends in presentations were compared using difference-in-differences methodology. Changes in odds of presenting with complicated disease were assessed via clustered multivariable logistic regression. RESULTS: There was a 29% decrease in mean biweekly appendicitis presentations from 5.4 to 3.8 (rate ratio = 0.71 [0.51, 0.98]) after the pandemic declaration, with a significant difference in differences compared with historical control (P = .003). Stratified by severity, the decrease was significant for uncomplicated appendicitis (rate ratio = 0.65 [95% confidence interval 0.47-0.91]) when compared with historical control (P = .03) but not for complicated appendicitis (rate ratio = 0.89 [95% confidence interval 0.52-1.52]); (P = .49). The odds of presenting with complicated disease did not change (adjusted odds ratio 1.36 [95% confidence interval 0.83-2.25]). CONCLUSION: The pandemic was associated with decreased incidence of uncomplicated appendicitis without an accompanying increase in complicated disease. Changes in individual health care-use behaviors may underlie these differences, suggesting that some cases of uncomplicated appendicitis may resolve without progression to complicated disease.

Studying the Effects of Collagenase (Type 1) on the Collagen in Woody Breast Meat.

Abnormal collagen infiltration in the Pectoralis major, breast muscle, of fast-growing big broilers has led to woody breast (WB) myopathy resulting in meat quality issues. Mechanisms to degrade the collagen were investigated to potentially improve WB texture. Freshly deboned WB fillets (n = 5 per trial; 3 trials) were ground and divided in to 25 g portions. Aqueous collagenase Type I solution (1 mL) from concentrations of 2.5, 5, and 10 mg/mL were incorporated in ground WB samples (n = 3 samples/treatment × 3 trials). Ground WB with 1 mL water acted as a control. All the samples were placed at 4 °C for 24 h and frozen at -80 °C. Control samples without any treatment or water addition (n = 3/trial) were frozen immediately upon grinding. Data collected on total (TC), soluble (SC), and insoluble collagen (IC) content was analyzed using one-way ANOVA with Tukey's honestly significant difference (HSD) (p ≤ 0.05). Fresh WB fillets had TC, SC, and IC content of 19.5, 4.9, and 14.6 mg/g, respectively. The addition of collagenase decreased (p ≤ 0.05) the IC to 5.8 mg/g in the 10 mg/mL treatment after 24 h. Converting IC to SC using collagenase can potentially help the poultry industry to reduce WB toughness.

MRI-guided core needle biopsy of the breast: Radiology-pathology correlation and impact on clinical management.

OBJECTIVE: Breast MRI is used to screen high-risk patients and determine extent of disease in breast cancer (BC) patients. The goal of this study was to determine the pathologic correlates of breast MRI abnormalities biopsied under MRI guidance. METHODS: We retrospectively identified 101 MRI-guided core needle biopsies (CNB) of the breast from 79 women over a 4-year period. MRI-detected lesions biopsied with ultrasound or stereotactic guidance were excluded. MRI studies and pathology were reviewed by breast radiologists and pathologists. RESULTS: Of the 79 patients, 72 (91%) had a history of prior (n = 13) or concurrent (n = 59) BC. There were 101 MRI abnormalities: 60 (59%) with non-mass enhancement (NME) and 41 (41%) with mass enhancement. Pathology was benign in 83/101 (82%), including in the majority of NME lesions (43/60, 72%). The most common benign findings were: fibrocystic changes (FCC) (49%), sclerosing lesions (13%), and fibroadenoma (FA) (9%). There were 18 (18%) malignant diagnoses: 8 (44%) invasive lobular carcinoma (ILC), 7 (39%) ductal carcinoma in situ (DCIS), and 3 (17%) invasive ductal carcinoma (IDC). Of the 18 malignant diagnoses, 16 (89%) occurred in 14 unique patients with concurrent BC. Based on the malignant MRI-guided CNB, 6 (46%) of these patients had additional (sentinel lymph node biopsy or contralateral breast surgery) or more extensive (wider lumpectomy) surgery. CONCLUSION: In this series, most MRI-guided CNB of the breast were benign. The vast majority of malignant diagnoses occurred in patients with concurrent BC and frequently resulted in changes in clinical management.

Understanding the Radiologist's Role in Evaluating Multiple Sclerosis: A Review of the Tip of the Iceberg.

Radiologists add value in the setting of clinically suspected multiple sclerosis (MS) predominantly through knowledge of typical and atypical imaging findings, thus aiding the neurologist in differentiating multiple disease processes with similar clinical presentations which may mimic MS. This paper is meant as a guide to deepen understanding for the radiologist, enabling them to be a helpful member of the care team for MS patients.

Rules of Engagement: Implementing Student-Centered Learning in Breast Imaging.

In response to changing learner needs, our institution launched a new translational curriculum wherein basic sciences and clinical skills were integrated, longitudinal patient care experiences provided, and earlier opportunities in specialty fields introduced to better inform residency program decisions. Medical students taking the breast imaging elective were enrolled in a breast imaging immersive experience designed to meet the School of Medicine's core competencies. In focusing the elective on a narrow range of specialized topics and skills, we labeled this experience the Breast Imaging Boot Camp. Outcome data from March 6, 2017, to April 26, 2019, have been analyzed for this report. The modifications made to the elective include: e-mailing a detailed orientation document to students prior to the start of the rotation; assigning students to diagnostic, procedural, and screening roles; the attendance of students at introductory radiology symposia; students' weekly attendance at institutional multidisciplinary and divisional breast radiologic-pathologic correlation conferences; student self-study assignments using faculty-vetted resources; student participation in breast biopsy simulation and small parts ultrasound laboratories; the development of a student-centric radiology educational website; and student-directed publishing of digital case files. Medical student feedback and course analytics indicated superior course evaluation scores reinforced by narrative feedback. In website domain utilization data, the breast file domain is the most viewed subspecialty domain. The Breast Imaging Boot Camp is a successful curriculum. Its novelty lies in both its integrated approach to medical student core competencies and its clinician educators' use of today's student-favored teaching tools.

Essential multimeric enzymes in kinetoplastid parasites: A host of potentially druggable protein-protein interactions.

Parasitic diseases caused by kinetoplastid parasites of the genera Trypanosoma and Leishmania are an urgent public health crisis in the developing world. These closely related species possess a number of multimeric enzymes in highly conserved pathways involved in vital functions, such as redox homeostasis and nucleotide synthesis. Computational alanine scanning of these protein-protein interfaces has revealed a host of potentially ligandable sites on several established and emerging anti-parasitic drug targets. Analysis of interfaces with multiple clustered hotspots has suggested several potentially inhibitable protein-protein interactions that may have been overlooked by previous large-scale analyses focusing solely on secondary structure. These protein-protein interactions provide a promising lead for the development of new peptide and macrocycle inhibitors of these enzymes.

Fabricating biomedical origami: a state-of-the-art review.

PURPOSE: Origami-based biomedical device design is an emerging technology due to its ability to be deployed from a minimal foldable pattern to a larger volume. This paper aims to review state-of-the-art origami structures applied in the medical device field. METHODS: Publications and reports of origami structure related to medical device design from the past 10 years are reviewed and categorized according to engineering specifications, including the application field, fabrication material, size/volume, deployment method, manufacturability, and advantages. RESULTS: This paper presents an overview of the biomedical applications of devices based on origami structures, including disposable sterilization covers, cardiac catheterization, stent grafts, encapsulation and microsurgery, gastrointestinal microsurgery, laparoscopic surgical grippers, microgrippers, microfluidic devices, and drug delivery. Challenges in terms of materials and fabrication, assembly, modeling and computation design, and clinical adoptability are discussed at the end of this paper to provide guidance for future origami-based design in the medical device field. CONCLUSION: Concepts from origami can be used to design and develop novel medical devices. Origami-based medical device design is currently progressing, with researchers improving design methods, materials, fabrication techniques, and folding efficiency.

Pseudotumor cerebri: What We Have Learned from the Idiopathic Intracranial Hypertension Treatment Trial.

Idiopathic intracranial hypertension, also known as pseudotumor cerebri, is an unexplained increase in intracranial pressure associated with permanent severe visual loss in 25% of cases and debilitating headaches. The condition is often associated with obesity. The Idiopathic Intracranial Hypertension Treatment Trial, a large, randomized, collaborative clinical trial, evaluated the efficacy of acetazolamide with weight loss versus placebo with weight loss in participants. Herein, we describe the major components of the clinical trial and discuss its shortcomings. [Full article available at http://rimed.org/rimedicaljournal-2016-05.asp, free with no login].