Medical Resident Resource Use Trends: Looking at the Past to Inform Future Decisions

Objective: Since 2006, the University of Tennessee’s Preston Medical Library (PML) has collected survey feedback from exiting residents. One question asks residents which types of articles or sources they use to find information. In this study, we examine responses to this question, assessing the change in resident utilization of resources to better inform future library decisions on instruction and marketing. Methods: Surveys were distributed to exiting residents through targeted emails or at the required exit process in the library. The question asked them to select which types of articles or sources they used to find information from among the 16 options currently listed, including an “other” box with free text functionality. The resident can select any number of options. Some options have changed over time as resources have ceased to exist, merged, or been cancelled. Survey results were examined from each year, noting how many times each resource had been selected and the total number of residents taking the survey. Results were compiled by resource usage per year and particular resource usage over the study’s timespan. Results: Results indicated changing resident use of PML’s resources. Of note, we found UpToDate usage to be remarkably consistent, with 80% of residents, on average, selecting it every year. Usage of reviews, RCTs, case reports, and practice guidelines generally increased over the survey period while use of Google, colleagues, and librarians modestly decreased. Conclusions: Resident resource usage varied over time, demonstrating an encouraging increase in attention to other evidence-based tools. UpToDate’s consistent popularity shows the durability of the product. The increase in resource type (reviews, RCTs, case reports, practice guidelines) selection reflects greater employment of more in-depth resources than merely expert opinion. Survey results will inform future outreach focus

Design Simulation and Testing of a Custom CoProcessor for Cubesatellites in LEO

An arms race in the last decade between computing performance and power-reduction has led to accelerated progress in both hardware and software, provisioning fast, efficient algorithms and small, capable, low-power hardware devices. Meanwhile, small satellites have become increasingly important in defense and commercial missions, due to their low resource consumption in terms of power, space, and cost. Improvements in computer vision algorithms and commercial off-the-shelf (COTS) edge computing introduce a means of addressing challenges posed for spacecraft in the realm of autonomy and perception. The University of Georgia’s Small Satellite Research Laboratory has been working to address these obstacles in developing an interface to merge Graphics Processing Unit (GPU) computations into the standard PC104+ satellite stack. This paper presents the Core GPU Interface (CORGI), a hardware solution which integrates the NVIDIA Jetson TX2/TX2i module into the cube satellite stack. The CORGI can be used as a standalone flight computer or as a co-processor with a designated onboard computer (OBC). This board will fly on the Multi-view Onboard Computational Imager (MOCI), a 6U satellite scheduled for launch into low earth orbit (LEO) in 2022, and will serve NASA and the Air Force Research Laboratories’ (AFRL) efforts to demonstrate autonomy and high-performance computing on small satellites. The CORGI provides input/output capability for command and telemetry and development interfaces for increased usability, specifically DisplayPort and two USB 3.0 type-A interfaces. Additionally, a UART umbilical provides an interface between an off-PCB computer through the PC104+ stack, enabling the TX2i to be externally triggered for science data handoff by a radiation-tolerant onboard computer. The CORGI is designed as a payload processor, and thus utilizes the TX2i module’s USB 3.0 hub to connect one or more satellite imagers over USB. The CORGI provides other standard development access points, including general-purpose input-output (GPIOs), from both the designated onboard computer and TX2i module. Standard headers also provide a means of testing the TX2i line voltages for discharge monitoring and power status. An SD card provides flash memory for logging science data and telemetry. This paper presents 1) PCB design and manufacturing specifications to assist teams in designing hardware for space applications. 2) Spice simulations to validate power management circuit design and evaluation for relevant cases. 3) Electrical test results demonstrate the nominal operation of both power management and regulation circuitry and the validation of correct discharge behavior during a power outage. 4) We present tests that demonstrate CORGI’s operation and performance characteristics under load

Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer.

BackgroundIn 2007, we reported a summary of data comparing diabetic foot complications to cancer. The purpose of this brief report was to refresh this with the best available data as they currently exist. Since that time, more reports have emerged both on cancer mortality and mortality associated with diabetic foot ulcer (DFU), Charcot arthropathy, and diabetes-associated lower extremity amputation.MethodsWe collected data reporting 5-year mortality from studies published following 2007 and calculated a pooled mean. We evaluated data from DFU, Charcot arthropathy and lower extremity amputation. We dichotomized high and low amputation as proximal and distal to the ankle, respectively. This was compared with cancer mortality as reported by the American Cancer Society and the National Cancer Institute.ResultsFive year mortality for Charcot, DFU, minor and major amputations were 29.0, 30.5, 46.2 and 56.6%, respectively. This is compared to 9.0% for breast cancer and 80.0% for lung cancer. 5 year pooled mortality for all reported cancer was 31.0%. Direct costs of care for diabetes in general was $237 billion in 2017. This is compared to$80 billion for cancer in 2015. As up to one-third of the direct costs of care for diabetes may be attributed to the lower extremity, these are also readily comparable.ConclusionDiabetic lower extremity complications remain enormously burdensome. Most notably, DFU and LEA appear to be more than just a marker of poor health. They are independent risk factors associated with premature death. While advances continue to improve outcomes of care for people with DFU and amputation, efforts should be directed at primary prevention as well as those for patients in diabetic foot ulcer remission to maximize ulcer-free, hospital-free and activity-rich days

Arabidopsis thaliana computationally-generated next-state gene interaction models

The construction of gene interaction models must be a fully collaborative and intentional effort. All aspects of the research, such as growing the plants, extracting the measurements, refining the measured data, developing the statistical framework, and forming and applying the algorithmic techniques, must lend themselves to repeatable and sound practices. This paper holistically focuses on the process of producing gene interaction models based on transcript abundance data from Arabidopsis thaliana after stimulation by a plant hormone

Metagenomic discovery and directed evolution of genes that defend against chemotherapeutics

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Mutant huntingtin enhances activation of dendritic Kv4 K+ channels in striatal spiny projection neurons

Huntington\u27s disease (HD) is initially characterized by an inability to suppress unwanted movements, a deficit attributable to impaired synaptic activation of striatal indirect pathway spiny projection neurons (iSPNs). To better understand the mechanisms underlying this deficit, striatal neurons in ex vivo brain slices from mouse genetic models of HD were studied using electrophysiological, optical and biochemical approaches. Distal dendrites of iSPNs from symptomatic HD mice were hypoexcitable, a change that was attributable to increased association of dendritic Kv4 potassium channels with auxiliary KChIP subunits. This association was negatively modulated by TrkB receptor signaling. Dendritic excitability of HD iSPNs was rescued by knocking-down expression of Kv4 channels, by disrupting KChIP binding, by restoring TrkB receptor signaling or by lowering mutant-Htt (mHtt) levels with a zinc finger protein. Collectively, these studies demonstrate that mHtt induces reversible alterations in the dendritic excitability of iSPNs that could contribute to the motor symptoms of HD

Thromboembolism After Intramedullary Nailing for Metastatic Bone Lesions.

BACKGROUND: The risk of venous thromboembolism (VTE) in patients undergoing intramedullary nailing for skeletal metastatic disease is currently undefined. The purpose of our study was to determine the risk of thromboembolic events, to define the risk factors for VTE, and to define the rate of wound complications in this population. METHODS: A retrospective review of surgical databases at three National Cancer Institute (NCI)-designated cancer centers identified 287 patients with a total of 336 impending or pathologic long-bone fractures that were stabilized with intramedullary nailing between February 2001 and April 2013. Statistical analysis was performed utilizing multivariable logistic regression and Fisher exact tests. RESULTS: The overall rate of VTE was twenty-four (7.1%) of the 336; thirteen (3.9%) were pulmonary embolism (PE), and eleven (3.3%), deep venous thrombosis (DVT). In two patients, adequate anticoagulation data were not available. We found no significant relationship between the type of anticoagulant used and VTE. There was a significant positive correlation found between lung-cancer histology and the development of VTE (p \u3c 0.001) or PE (p \u3c 0.001). The absence of radiation therapy approached significance (p = 0.06) with respect to decreased overall VTE risk. Wound complications were documented for 11 (3.3%) of the operations. CONCLUSIONS: There is a high rate of VTE among those with skeletal metastatic disease who undergo intramedullary nailing, even while receiving postoperative thromboembolic prophylaxis. Current anticoagulation protocols may be inadequate. Wound-complication risk with anticoagulant use in this population is low and should not be a deterrent to adequate anticoagulant use for this population

Watershed-scale changes in terrestrial nitrogen cycling during a period of decreased atmospheric nitrate and sulfur deposition

AbstractRecent reports suggest that decreases in atmospheric nitrogen (N) deposition throughout Europe and North America may have resulted in declining nitrate export in surface waters in recent decades, yet it is unknown if and how terrestrial N cycling was affected. During a period of decreased atmospheric N deposition, we assessed changes in forest N cycling by evaluating trends in tree-ring δ15N values (between 1980 and 2010; n = 20 trees per watershed), stream nitrate yields (between 2000 and 2011), and retention of atmospherically-deposited N (between 2000 and 2011) in the North and South Tributaries (North and South, respectively) of Buck Creek in the Adirondack Mountains, USA. We hypothesized that tree-ring δ15N values would decline following decreases in atmospheric N deposition (after approximately 1995), and that trends in stream nitrate export and retention of atmospherically deposited N would mirror changes in tree-ring δ15N values. Three of the six sampled tree species and the majority of individual trees showed declining linear trends in δ15N for the period 1980–2010; only two individual trees showed increasing trends in δ15N values. From 1980 to 2010, trees in the watersheds of both tributaries displayed long-term declines in tree-ring δ15N values at the watershed scale (R = −0.35 and p = 0.001 in the North and R = −0.37 and p <0.001 in the South). The decreasing δ15N trend in the North was associated with declining stream nitrate concentrations (−0.009 mg N L−1 yr−1, p = 0.02), but no change in the retention of atmospherically deposited N was observed. In contrast, nitrate yields in the South did not exhibit a trend, and the watershed became less retentive of atmospherically deposited N (−7.3% yr−1, p < 0.001). Our δ15N results indicate a change in terrestrial N availability in both watersheds prior to decreases in atmospheric N deposition, suggesting that decreased atmospheric N deposition was not the sole driver of tree-ring δ15N values at these sites. Other factors, such as decreased sulfur deposition, disturbance, long-term successional trends, and/or increasing atmospheric CO2 concentrations, may also influence trends in tree-ring δ15N values. Furthermore, declines in terrestrial N availability inferred from tree-ring δ15N values do not always correspond with decreased stream nitrate export or increased retention of atmospherically deposited N