Medical Student POCUS Peer-to-Peer Teaching: Ready for Mainstream

Background: Point of care ultrasound (POCUS) is changing the face of clinical practice and medical education. Worldwide consensus based on expert opinion has advocated for POCUS teaching in undergraduate medical school curricula. Significant barriers, including lack of available instructors and limited resources, prevents medical learners from acquiring core competencies at most institutions. Here, we describe a peer-to-peer learning POCUS workshop and advocate for the use of this type of training to meet the demands of POCUS learning. Methods: A two-day POCUS workshop was held in Toronto, Ontario with twenty-six medical student participants. The workshop was structured according to a graduated model of POCUS skill development, beginning with didactic teaching, then progressing to hands-on peer-to-peer teaching, and finishing with competency evaluation by POCUS experts. Participants completed pre-and post-workshop surveys regarding prior POCUS teaching and exposure, self-reported skill development, and feedback on the workshop itself. Results: Of the 20 respondents to the questionnaire, 70% had prior POCUS exposure, with 85% of these individuals having less than 5 hours of prior POCUS education. Eighty-five percent of students reported that the organization of the course allowed them to participate fully, and 95% of participants indicated that peer-to-peer learning was effective. Conclusion: These findings suggest that peer-to-peer POCUS teaching is an effective learning method to acquire and consolidate well-established POCUS competencies. This initiative is scalable and could be applied to all learners in various disciplines. As such, we recommend medical schools consider integration of peer-to-peer POCUS teaching into longitudinal clerkship training programs, and transition-to-residency courses

Augment on Manifold: Mixup Regularization with UMAP

Data augmentation techniques play an important role in enhancing the performance of deep learning models. Despite their proven benefits in computer vision tasks, their application in the other domains remains limited. This paper proposes a Mixup regularization scheme, referred to as UMAP Mixup, designed for ``on-manifold" automated data augmentation for deep learning predictive models. The proposed approach ensures that the Mixup operations result in synthesized samples that lie on the data manifold of the features and labels by utilizing a dimensionality reduction technique known as uniform manifold approximation and projection. Evaluations across diverse regression tasks show that UMAP Mixup is competitive with or outperforms other Mixup variants, show promise for its potential as an effective tool for enhancing the generalization performance of deep learning models.Comment: accepted paper to be published in the proceedings of ICASSP 202

Rapid holographic phase transition with brane-localized curvature

We study the finite-temperature properties of the Randall-Sundrum model in the presence of brane-localized curvature. At high temperature, as dictated by AdS/CFT, the theory is in a confined phase dual to the planar AdS black hole. When the radion is stabilized, à la Goldberger-Wise, a holographic first-order phase transition proceeds. The brane-localized curvature contributes to the radion kinetic energy, substantially decreasing the critical bubble energy. Contrary to previous results, the phase transition completes at much larger values of N , the number of degrees of freedom in the CFT. Moreover, the field value of the bulk scalar on the TeV-brane is allowed to become large, while remaining consistent with back-reaction constraints. Assisted by this fact, we find that for a wide region in the parameter space tunneling happens rather quickly, i.e. the nucleation temperature becomes of the order of the critical temperature. At zero temperature, the most important signature of brane-localized curvature is the reduction of spin-2 Kaluza-Klein graviton masses and a heavier radion

The TLR2-MyD88-NOD2-RIPK2 signalling axis regulates a balanced pro-inflammatory and IL-10-mediated anti-inflammatory cytokine response to Gram-positive cell walls

Systemic infection with Streptococcus pneumoniae is associated with a vigorous pro-inflammatory response to structurally complex cell wall fragments (PnCW) that are shed during cell growth and antibiotic-induced autolysis. Consistent with previous studies, inflammatory cytokine production induced by PnCW was dependent on TLR2 but independent of NOD2, a cytoplasmic NLR protein. However, in parallel with the pro-inflammatory response, we found that PnCW also induced prodigious secretion of anti-inflammatory IL-10 from macrophages. This response was dependent on TLR2, but also involved NOD2 as absence of NOD2-reduced IL-10 secretion in response to cell wall and translated into diminished downstream effects on IL-10-regulated target gene expression. PnCW-mediated production of IL-10 via TLR2 required RIPK2 a kinase required for NOD2 function, and MyD88 but differed from that known for zymosan in that ERK pathway activation was not detected. As mutations in NOD2 are linked to aberrant immune responses, the temporal and quantitative effects of activation of the TLR2-NOD2-RIPK2 pathway on IL-10 secretion may affect the balance between pro- and anti-inflammatory responses to Gram-positive bacteria.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74582/1/j.1462-5822.2008.01189.x.pd

Local host-dependent persistence of the entomopathogenic nematode Steinernema carpocapsae used to control the large pine weevil Hylobius abietis

Entomopathogenic nematodes (EPN) applied inundatively to suppress insect pests are more likely to persist and establish in stable agroecosystems than in annual crops. We investigated a system of intermediate stability: three stumps harbouring the large pine weevil (Hylobius abietis L.; Coleoptera: Curculionidae), a major European forestry pest. We tested whether persistence of EPN Steinernema carpocapsae Weiser (Rhabditida: Steinernematidae) applied around stumps is maintained by recycling of EPN through pine weevils developing within stumps. Steinernema carpocapsae was detected in soil around and under the bark of treated tree stumps up to two years, but not 4–5 years after application. Differences in nematode presence between sites were better explained by tree species (pine or spruce) than soil type (mineral or peat). Presence of S. carpocapsae in soil was positively correlated with the number of H. abietis emerging from untreated stumps the previous year, which was greater for pine stumps than spruce stumps

Field efficacy of Imidacloprid and Steinernema carpocapsae in a chitosan formulation against the Red Palm Weevil Rhynchophorus ferrugineus (Coleoptera: Curculionidae) in Phoenix canariensis

BACKGROUND: The invasive red palm weevil, Rhynchophorus ferrugineus (Olivier), has become the major pest of palms in the Mediterranean Basin. Chemical control against this species is difficult because of its cryptic habits and is mainly based on the repeated application of large quantities of synthetic insecticides. The aim of this work has been to evaluate in the field the efficacy of imidacloprid (Confidor 240 OD) and Steinernema carpocapsae Weiser with chitosan (Biorend R Palmeras) as soil and stipe treatments respectively, alone or in combination, against this pest. RESULTS: All treatments significantly reduced the mean number of immature stages of R. ferrugineus per palm. However, there were no significant differences among the different treatments considered. Efficacies ranged from 83.8 to 99.7% for the mean number of immature stages found in the palms and resulted in a significant increase in palm survival compared with the untreated control (75.0–90.0% versus 16.5% respectively). CONCLUSION: Both imidacloprid and S. carpocapsae in a chitosan formulation proved highly effective against R. ferrugineus in the field, and their efficacies did not significantly change when used in combinatio

A record-linkage study of the development of hepatocellular carcinoma in persons with hepatitis C infection in Scotland

We investigated trends in first time hospital admissions and deaths attributable to hepatocellular carcinoma (HCC) in a large population based cohort of 22 073 individuals diagnosed with hepatitis C viral (HCV) infection through laboratory testing in Scotland in 1991 2006. We identified new cases of HCC through record linkage to the national inpatient hospital discharge database and deaths registry. A total of 172 persons diagnosed with HCV were admitted to hospital or died with first time mention of HCC. Hepatocellular carcinoma incidence increased between 1996 and 2006 (average annual change of 6.1, 95% confidence interval (CI):0.9 11.6%, P¼0.021). The adjusted relative risk of HCC was greater for males (hazard ratio¼2.7, 95% CI: 1.7 4.2), for those aged 60 years or older (hazard ratio ¼2.7, 95% CI: 1.9 4.1) compared with 50 59 years, and for those with a previous alcohol related hospital admission (hazard ratio¼2.5, 95% CI: 1.7 3.7). The risk of individuals diagnosed with HCV developing HCC was greatlyincreased compared with the general Scottish population (standardised incidence ratio¼127, 95% CI: 102 156). Owing to the advancing age of the Scottish HCV diagnosed population, the annual number of HCC cases is projected to increase, with a consequent increasing burden on the public healthcare system

The Micro-Elimination Approach to Eliminating Hepatitis C:Strategic and Operational Considerations

The introduction of efficacious new hepatitis C virus (HCV) treatments galvanized the World Health Organization to define ambitious targets for eliminating HCV as a public health threat by 2030. Formidable obstacles to reaching this goal can best be overcome through a micro-elimination approach, which entails pursuing elimination goals in discrete populations through multi-stakeholder initiatives that tailor interventions to the needs of these populations. Micro-elimination is less daunting, less complex, and less costly than full-scale, country-level initiatives to eliminate HCV, and it can build momentum by producing small victories that inspire more ambitious efforts. The micro-elimination approach encourages stakeholders who are most knowledgeable about specific populations to engage with each other and also promotes the uptake of new models of care. Examples of micro-elimination target populations include medical patients, people who inject drugs, migrants, and prisoners, although candidate populations can be expected to vary greatly in different countries and subnational areas

Periplasmic phosphorylation of lipid A is linked to the synthesis of undecaprenyl phosphate

One-third of the lipid A found in the Escherichia coli outer membrane contains an unsubstituted diphosphate unit at position 1 (lipid A 1-diphosphate). We now report an inner membrane enzyme, LpxT (YeiU), which specifically transfers a phosphate group to lipid A, forming the 1-diphosphate species. 32P-labelled lipid A obtained from lpxT mutants do not produce lipid A 1-diphosphate. In vitro assays with Kdo2-[4′-32P]lipid A as the acceptor shows that LpxT uses undecaprenyl pyrophosphate as the substrate donor. Inhibition of lipid A 1-diphosphate formation in wild-type bacteria was demonstrated by sequestering undecaprenyl pyrophosphate with the cyclic polypeptide antibiotic bacitracin, providing evidence that undecaprenyl pyrophosphate serves as the donor substrate within whole bacteria. LpxT-catalysed phosphorylation is dependent upon transport of lipid A across the inner membrane by MsbA, a lipid A flippase, indicating a periplasmic active site. In conclusion, we demonstrate a novel pathway in the periplasmic modification of lipid A that is directly linked to the synthesis of undecaprenyl phosphate, an essential carrier lipid required for the synthesis of various bacterial polymers, such as peptidoglycan