Some Perceptions Differ, Match Outcomes Do Not: A Multisite Retrospective Cross-Sectional Comparison of Virtual vs. In-Person Recruitment.

BACKGROUND: Virtual interviewing for residency provides considerable savings. Its impact on match outcomes remains unclear. OBJECTIVE: Evaluate the impact of virtual residency recruitment on program and applicant assessment and match outcomes. DESIGN: Cross-sectional survey, September 2020-July 2021 PARTICIPANTS: Faculty interviewers and 2019 and 2020 PGY-1 classes at three academic internal medicine residencies. MAIN MEASURES: Survey items rating effectiveness of interview format, preference for future interview format, and perceived impact on diversity. KEY RESULTS: A total of 247/436 faculty (57%) interviewers responded. Faculty perceived that in-person interviews enhanced applicant assessment (3.23 ± 0.38, p < 0.01) and recruitment of the most qualified applicants (p < 0.01) but did not impact recruitment of a racially or gender diverse class (3.03 ± 0.99, p = 0.95 and 3.09 ± 0.76, p = 0.14 respectively). They also did not demonstrate a preference for future interview formats. A total of 259/364 matched applicants responded, corresponding to a 76% response rate in the in-person cohort and a 66% response rate for virtual. Trainees were equally likely to match at their top choice when interviewing virtually vs. in-person (p = 0.56), and racial/ethnic and gender composition of the incoming class also did not differ (p = 0.81 and p = 0.19 respectively). Trainees perceived many aspects of the institution were better assessed in-person, though the impact varied according to assessment domain. Trainees who interviewed in-person preferred in-person formats. Of those who interviewed virtually, 47% preferred virtual and 54% preferred in-person. There were no predictors of virtual preference for future interview formats. CONCLUSIONS: Faculty and applicants who experienced virtual recruitment had no preference for future recruitment format. Virtual recruitment had no impact on the racial/gender diversity of matched classes or on applicants matching at their top-ranked institution. Institutions should consider the potential non-inferiority of virtual interviews with financial and other benefits when making decisions about future interview formats.

Internal Medicine Residents' Perceptions of Virtual Morning Report: a Multicenter Survey.

IMPORTANCE: The COVID-19 pandemic disrupted graduate medical education, compelling training programs to abruptly transition to virtual educational formats despite minimal experience or proficiency. We surveyed residents from a national sample of internal medicine (IM) residency programs to describe their experiences with the transition to virtual morning report (MR), a highly valued core educational conference. OBJECTIVE: Assess resident views about virtual MR content and teaching strategies during the COVID-19 pandemic. DESIGN: Anonymous, web-based survey. PARTICIPANTS: Residents from 14 academically affiliated IM residency programs. MAIN MEASURES: The 25-item survey on virtual MR included questions on demographics; frequency and reason for attending; opinions on who should attend and teach; how the virtual format affects the learning environment; how virtual MR compares to in-person MR with regard to participation, engagement, and overall education; and whether virtual MR should continue after in-person conferences can safely resume. The survey included a combination of Likert-style, multiple option, and open-ended questions. RESULTS: Six hundred fifteen residents (35%) completed the survey, with a balanced sample of interns (39%), second-year (31%), and third-year (30%) residents. When comparing their overall assessment of in-person and virtual MR formats, 42% of residents preferred in-person, 18% preferred virtual, and 40% felt they were equivalent. Most respondents endorsed better peer-engagement, camaraderie, and group participation with in-person MR. Chat boxes, video participation, audience response systems, and smart boards/tablets enhanced respondents' educational experience during virtual MR. Most respondents (72%) felt that the option of virtual MR should continue when it is safe to resume in-person conferences. CONCLUSIONS: Virtual MR was a valued alternative to traditional in-person MR during the COVID-19 pandemic. Residents feel that the virtual platform offers unique educational benefits independent of and in conjunction with in-person conferences. Residents support the integration of a virtual platform into the delivery of MR in the future.

Internal Medicine Residents' Perceptions of Morning Report: a Multicenter Survey.

BACKGROUND: Residents rate morning report (MR) as an essential educational activity. Little contemporary evidence exists to guide medical educators on the optimal content or most effective delivery strategies, particularly in the era of resident duty-hour limitations and shifts towards learner-centric pedagogy in graduate medical education. OBJECTIVE: Assess resident views about MR content and teaching strategies. DESIGN: Anonymous, online survey. PARTICIPANTS: Internal medicine residents from 10 VA-affiliated residency programs. MAIN MEASURES: The 20-item survey included questions on demographics; frequency and reason for attending; opinions on who should attend, who should teach, and how to prioritize the teaching; and respondents' comfort level with participating in MR. The survey included a combination of Likert-style and multiple-choice questions with the option for multiple responses. KEY RESULTS: A total of 497 residents (46%) completed the survey, with a balanced sample of R1s (33%), R2s (35%), and R3s (31%). Self-reported MR attendance was high (31% always attend; 39% attend > 50% of the time), with clinical duties being the primary barrier to attendance (85%). Most respondents felt that medical students (89%), R1 (96%), and R2/R3s (96%) should attend MR; there was less consensus regarding including attendings (61%) or fellows (34%). Top-rated educational topics included demonstration of clinical reasoning (82%), evidence-based medicine (77%), and disease pathophysiology (53%). Respondents valued time spent on diagnostic work-up (94%), management (93%), and differential building (90%). Overall, 82% endorsed feeling comfortable speaking; fewer R1s reported comfort (76%) compared with R2s (87%) or R3s (83%, p = 0.018). Most (81%) endorsed that MR was an inclusive learning environment (81%), with no differences by level of training. CONCLUSIONS: MR remains a highly regarded, well-attended educational conference. Residents value high-quality cases that emphasize clinical reasoning, diagnosis, and management. A supportive, engaging learning environment with expert input and concise, evidence-based teaching is desired.

Executive functions as a mediator of childhood maltreatment on adult psychopathology: A longitudinal mediation analysis comparing maltreatment factor models.

BACKGROUND: Childhood maltreatment (CM), executive functions (EFs), and psychiatric disorders all correlate highly. Changes in EFs during adolescence related to CM present a possible mediating mechanism for the development of psychiatric disorders, yet no study has analyzed this longitudinally while comparing predictive capacity of different CM factor structures. We hypothesized that changes in EFs from adolescence to adulthood would mediate, in part, associations between CM, internalizing disorders (INT), and anti-social personality disorder (ASPD) while different subtypes of CM would differentially predict INT and ASPD. OBJECTIVE: This study longitudinally examined the mediating effects of EFs on associations between CM, INT, and ASPD while comparing prediction of two CM factor structures. PARTICIPANTS: High-risk subjects selected for drug use in adolescence (N = 658) from mean ages 16 to 23. METHODS: A Bayesian structural equation model was deployed to analyze change in EFs as a mediator of the relationship between CM and adult INT and ASPD. CM was measured using two factor structures: a single overall factor and four correlated factors representing CM subtypes. RESULTS: CM significantly predicted INT and ASPD but there was no evidence that the relationship was substantially mediated through EFs. High correlations among subtypes of CM limited the unique predictions of each subtype on INT and ASPD. CONCLUSION: In this high-risk sample, the collinearity of CM subtypes obscured their predictions of outcome measures supporting the use of one CM factor. EFs did not significantly mediate associations between CM and psychiatric disorders, but further research on these relationships is warranted.

Apoptotic effects of dietary and synthetic sphingolipids in androgen-independent (PC-3) prostate cancer cells.

Stress-induced activation and metabolism of plasma membrane sphingolipids results in intracellular ceramide accumulation and has been shown to induce apoptosis in human prostate cancer cells. This effect has been observed using synthetic ceramide analogs, such as C6-ceramide; however, the effects of naturally-occurring sphingolipids, such as C18-ceramide and sphingomyelin (CerPCho), on apoptosis and prostate cancer cell proliferation have not been examined. The results of the present study demonstrate that natural (CerPCho, C18-ceramide) and synthetic (C6-ceramide) sphingolipids reduced PC-3 cell proliferation by 15 +/- 1.8, 17 +/- 2.5, and 46 +/- 2.1%, respectively (P < 0.05). These reductions in proliferation were due, in part, to increased cellular apoptosis. Treatment of PC-3 cells with CerPCho and C18-ceramide significantly increased apoptosis by 3.0 +/- 0.8 and 3.6 +/- 0.6%, respectively, compared to the untreated control, while the synthetic C6-ceramide significantly increased apoptosis by 55.7 +/- 0.4%. C6-ceramide-induced apoptosis was associated with cell cycle arrest in the G(2)/M phase, decreased extracellular signal-regulated kinase (ERK1/2) signaling and activation of the cell cycle regulatory protein, retinoblastoma (pRb). Treatment of PC-3 cells with C18-ceramide and CerPCho did not alter cell cycle distribution, pRb or ERK1/2 activation. Taken together, these results suggest that natural and synthetic sphingolipids induce apoptosis in PC-3 cells via distinct signaling mechanisms and potencies.

Assessment of Discharge Readiness and Readmission Risk in Patients With Acute Decompensated Heart Failure.

Failure to achieve euvolemia before discharge in patients admitted with acute heart failure (HF) syndromes has gained attention as a marker for increased readmission risk. This study assessed whether variations in discharge documentation practices reflected the readmission risk of patients admitted for decompensated HF. This was a retrospective cohort study of 100 adult patients discharged from an admission for an acute HF syndrome from May 2014 to June 2015. Characteristics at discharge were retrieved from the discharge summaries (DS). Coprimary outcomes were 30-day and 6-month composites of all-cause readmissions or emergency department visits. Mean age was 62.1 years (SD 15.3), and 56% were men. Traditional cardiovascular risk factors were common. All-cause 30-day readmission occurred in 18%, and HF-related 30-day readmission occurred in 12% of the population. A DS physical exam in support of decongestion occurred more often in those not readmitted, for example, a normal jugular venous pulse (53.2 vs 12.5%, p = 0.03). Discussion of jugular venous pulse improvement occurred more frequently in those not readmitted (8.5 vs 0%, p = 0.03). No other markers of volume status reached statistical significance. A clear statement in the DS supporting euvolemia was uncommon, but tended to occur more commonly in those not readmitted (20.7 vs 5.6%, p = 0.13). In conclusion, documenting markers of euvolemia and incorporating these markers into the DS volume status assessment was associated with a reduced rate of 30-day readmission.

Community visual field screening: prevalence of follow-up and factors associated with follow-up of participants with abnormal frequency doubling perimetry technology results.

PURPOSE: To determine if a community screening with Frequency Doubling Technology perimetry (FDT) results in a high proportion of follow-up with an eye care provider and the factors associated with follow-up. DESIGN: Cross-sectional study. SETTING: Telephone survey METHODS: We conducted a telephone survey of participants with abnormal results 3-6 months after the community screening. RESULTS: We were able to interview 121 participants (57% of 212 eligible subjects). Sixty-nine percent (83 of 121) of participants visited an eye care provider after the screening. Patients were more likely to attain an eye exam if they were female, older, or had an educational level of high school or more (p<0.05). Of those participants who did not visit an eye care provider, 41% (18/38) did not believe the results of the test, 21% (8/38) reported not having insurance or an eye care provider, 11% (4/38) did not have time for an eye exam, and 11% (4/38) reported not knowing they needed to see an eye care provider. CONCLUSION: A community screening program with FDT encouraged more than two thirds of participants with abnormal results to seek an eye exam. The most common reason not to attain an eye exam was failing to recognize the importance of an abnormal test result.

Resveratrol reduces oxidation and proliferation of human retinal pigment epithelial cells via extracellular signal-regulated kinase inhibition.

Epidemiological evidence suggests that moderate wine consumption and antioxidant-rich diets may protect against age-related macular degeneration (AMD), the leading cause of vision loss among the elderly. Development of AMD and other retinal diseases, such as proliferative vitreoretinopathy (PVR), is associated with oxidative stress in the retinal pigment epithelium (RPE), a cell layer responsible for maintaining the health of the retina by providing structural and nutritional support. We hypothesize that resveratrol, a red wine polyphenol, may be responsible, in part, for the health benefits of moderate red wine consumption on retinal disease. To test this hypothesis, the antioxidant and antiproliferative effects of resveratrol were examined in a human RPE cell line (designated ARPE-19). Cell proliferation was determined using the bromodeoxyuridine (BrdU) assay, intracellular oxidation was assessed by dichlorofluorescein fluorescence, and activation of the mitogen-activated protein kinase (MAPK) cascade was measured by immunoblotting. Treatment with 50 and 100 micromol/L resveratrol significantly reduced proliferation of RPE cells by 10% and 25%, respectively (P<0.05). This reduction in proliferation was not associated with resveratrol-induced cytotoxicity. Resveratrol (100 micromol/L) inhibited basal and H2O2-induced intracellular oxidation and protected RPE cells from H2O2-induced cell death. The observed reduction in cell proliferation was associated with inhibition of mitogen activated protein kinase/ERK (MEK) and extracellular signal-regulated kinase (ERK 1/2) activities at concentrations of resveratrol as low as 5 micromol/L. These results suggest that resveratrol can reduce oxidative stress and hyperproliferation of the RPE.

Bovine pituitary extract provides remarkable protection against oxidative stress in human prostate epithelial cells.

Bovine pituitary extract (BPE) is routinely used as a mitogenic supplement in serum-free growth medium. In addition to its mitogenic activity, BPE contains a variety of growth factors and hormones with reported antioxidant activity. This study examines the antioxidant potential of BPE in nontumorigenic human prostate epithelial cells (RWPE-1). Treatment of RWPE-1 cells with BPE (50 microg/ml) provided significant protection against H(2)O(2)-induced cell death, deoxyribonucleic acid fragmentation, protein oxidation, and membrane damage. Treatment with heat (71 degrees C, 10 min) and proteolytic enzymes reduced the antioxidant activity of BPE, suggesting that proteins present in BPE may be responsible for the antioxidant activity. Residual catalase activity present in BPE was responsible for a portion (30%) of the antioxidant activity. Interestingly, RWPE-1 cells treated with BPE and H(2)O(2) rapidly accumulated intracellular reactive oxygen species (ROS) to a greater extent than cells receiving only H(2)O(2). Pretreatment of RWPE-1 cells with tyrosine kinase inhibitors (genistein, tyrphostin 47, and AG-1296) before the addition of H(2)O(2) diminished BPE protection against H(2)O(2)-induced cell death, whereas treatment with purified mitogens commonly found in BPE, growth hormone and basic fibroblast growth factor, did not protect against oxidative damage. Taken together, these data suggest that BPE contains proteins or protein complexes with remarkable antioxidant activity. These yet unidentified compounds appear to confer protection against H(2)O(2)-induced cell death by tyrosine kinase-dependent pathways that increase intracellular ROS generation. The antioxidant activity of BPE may represent a confounding variable when studying oxidative stress in cells maintained in BPE-supplemented serum-free medium.

Transitioning Toward Competency: A Resident-Faculty Collaborative Approach to Developing a Transitions of Care EPA in an Internal Medicine Residency Program.

BACKGROUND: Residency training and evaluation are moving toward competency-based models. Managing transitions of care is 1 of 16 entrustable professional activities (EPAs) that signal readiness for independent internal medicine practice. Methods for developing EPAs are evolving within the medical education community. OBJECTIVE: We describe a process for developing a transitions-of-care EPA for internal medicine inpatient and ambulatory settings using an iterative, consensus-building, resident-faculty collaborative approach. METHODS: We used an independent rank-ordering process and successive consensus group meetings to cull an initial list of 142 developmental Milestones to the 15 most relevant to transitions of care for internal medicine patients in an academic medical center and affiliated Veterans Administration hospital. Four senior internal medicine residents and 4 internal medicine faculty members representing inpatient and ambulatory practice settings identified examples of specific tasks and evaluative techniques for each Milestone. RESULTS: We demonstrate a feasible resident-faculty collaboration to develop transitions of care as an EPA for an internal medicine training program. Inclusion of residents along with faculty provided broader insights as well as an important learning opportunity for trainees. CONCLUSIONS: Our process demonstrated the feasibility of designing an EPA, but questions remain about how entrustment-based evaluation can be implemented in clinical settings. Our framework may serve as a foundation for EPA development in other areas of clinical practice.

Discrimination of Swiss cheese from 5 different factories by high impact volatile organic compound profiles determined by odor activity value using selected ion flow tube mass spectrometry and odor threshold.

Swiss cheese contains more than 200 volatile organic compounds (VOCs). Gas chromatography-mass spectrometry has been utilized for the analysis of volatile compounds in food products; however, it is not sensitive enough to measure VOCs directly in the headspace of a food at low concentrations. Selected ion flow tube mass spectrometry (SIFT-MS) provides a basis for determining the concentrations of VOCs in the head space of the sample in real time at low concentration levels of parts per billion/trillion by volume. Of the Swiss cheese VOCs, relatively few have a major impact on flavor quality. VOCs with odor activity values (OAVs) (concentration/odor threshold) greater than one are considered high-impact flavor compounds. The objective of this study was to utilize SIFT-MS concentrations in conjunction with odor threshold values to determine OAVs thereby identifying high-impact VOCs to use for differentiating Swiss cheese from five factories and identify the factory variability. Seventeen high-impact VOCs were identified for Swiss cheese based on an OAV greater than one in at least 1 of the 5 Swiss cheese factories. Of these, 2,3-butanedione was the only compound with significantly different OAVs in all factories; however, cheese from any pair of factories had multiple statistically different compounds based on OAV. Principal component analysis using soft independent modeling of class analogy statistical differentiation plots, with all of the OAVs, showed differentiation between the 5 factories. Overall, Swiss cheese from different factories was determined to have different OAV profiles utilizing SIFT-MS to determine OAVs of high impact compounds.

Perceived spatial frequency of sinusoidal gratings.

PURPOSE: The "frequency-doubling" effect or illusion, in which the apparent spatial frequency of a grating appears to be doubled, is produced when a low spatial frequency sinusoidal grating is counterphase flickered at a high temporal frequency. This study examines changes in apparent spatial frequency of sinusoids of various spatiotemporal content after equating them for detectability. METHODS: Detection contrast thresholds were determined for various spatiotemporal gratings. The perceived spatial frequency was then evaluated using stimuli that were four and six times detection threshold. Match ratios were determined for each spatiotemporal combination, whereby the periodicity of a stationary sinusoid was matched with that of a counterphase flickered grating. The same matching task was repeated under different matching task instructions for five randomly chosen spatiotemporal combinations. RESULTS: Match ratios were fractional for many spatiotemporal combinations. Apparent spatial frequency ranged from less than veridical to greater than double depending on observer and spatiotemporal stimulus content. The effect of task instruction on match ratios was very small, yet significant. CONCLUSIONS: The appearance of fractional spatial frequency percepts draws into question the notion that frequency-doubling is solely generated by spatially non-linear Y-type magnocellular ganglion cells.

Characterization of limonin glucoside metabolites from human prostate cell culture medium using high-performance liquid chromatography/electrospray ionization mass spectrometry and tandem mass spectrometry.

The metabolism of limonin 17-beta-D-glucopyranoside (LG) by non-cancerous (RWPE-1) and cancerous (PC-3) human prostate epithelial cells was investigated using high-performance liquid chromatography/electrospray ionization mass spectrometry (LC/ESI-MS) with in-source fragmentation and tandem mass spectrometry (MS/MS). During positive ion LC/ESI-MS, LG formed an abundant sodiated species ([M+Na]+) while the protonated molecule was barely observable. [M+Na]+ further fragmented into the less abundant [LARL+H]+ and a predominantly protonated aglycone molecule (limonin) due to in-source fragmentation. The major metabolite, limonin A-ring lactone (LARL), formed an abundant protonated molecule that was fragmented into a protonated molecule of limonin by loss of one molecule of water. In MS/MS by collisionally activated dissociation (CAD), LG produced the sodiated aglycone, [aglycone+Na]+, while LARL fragmented into [M+H]+ of limonin and fragment ions resulted by further loss of water, carbon monoxide and carbon dioxide, indicating the presence of oxygenated-ring structures. The limits of detection of LG were 0.4 and 20 fmol in selected-ion monitoring (SIM) and selected-reaction monitoring (SRM) detection, respectively.