Curricular factors associated with medical students\u27 practice of the skin cancer examination: an educational enhancement initiative by the integrated skin exam consortium

IMPORTANCE: As medical school curricula become progressively integrated, a need exists to optimize education related to the skin cancer examination (SCE) for melanoma, a relevant competency gap that influences secondary prevention efforts. OBJECTIVES: To identify curricular factors associated with medical students\u27 confidence, intent, and performance regarding the SCE. DESIGN, SETTING, AND PARTICIPANTS: Survey-based cross-sectional study from the Integrated Skin Exam Consortium at accredited US medical schools among a volunteer sample of second-year students representing 8 geographically varied public and private institutions. Students were administered a questionnaire to assess characteristics, curricular exposures, and educational and practical experiences related to skin cancer, as well as knowledge of melanoma risk and a detection method. MAIN OUTCOMES AND MEASURES: Primary outcomes were confidence in performing the SCE, intent to perform an integrated skin examination, and actual performance of the SCE. RESULTS: Physical diagnosis session and clinical encounter were most predictive of confidence in performance of the SCE (odds ratios [ORs], 15.35 and 11.48, respectively). Other curricular factors associated with confidence included instruction time of at least 60 minutes on skin cancer (OR, 6.35), lecture on the SCE (OR, 7.54), knowledge of melanoma risk (OR, 3.71), and at least 1 opportunity to observe the SCE (OR, 2.70). Physical diagnosis session and at least 4 opportunities to observe the SCE were most predictive of intent to perform an integrated skin examination (ORs, 4.84 and 4.72, respectively). Other curricular factors associated with intent included knowledge of melanoma risk (OR, 1.83), clinical encounter (OR, 2.39), and at least 1 opportunity to observe the SCE (OR, 1.95). Clinical encounter, physical diagnosis session, and at least 1 opportunity to observe the SCE were most predictive of performance of the SCE (ORs, 21.67, 15.48, and 9.92, respectively). Other curricular factors associated with performance included instruction time of at least 60 minutes on skin cancer (OR, 2.42) and lecture on the SCE (OR, 5.04). CONCLUSIONS AND RELEVANCE: To augment the practice of the SCE among medical students, course directors may design an integrated curriculum that includes at least 60 minutes of instruction related to melanoma and the SCE, a description of the integrated skin examination as part of the physical diagnosis course, and education on high-risk demographic groups and anatomic sites specific to men and women and on the ABCDEs of melanoma, and at least 1 opportunity to observe the SCE

The Utility of Complete Skin Examinations

Background: Complete skin examinations (CSE’s), also known as full body skin examinations (FBSE’s), are routinely performed on new patients presenting to dermatology clinics with the goal of detecting pre-malignant and malignant cutaneous lesions, resulting in decreased morbidity and mortality. Current literature is limited, focusing solely on neoplasm detection. One recent retrospective study demonstrated the utility of FBSE’s in the early detection of melanoma in a private practice setting.(1) Data combining the discovery of incidental cutaneous neoplasms and premalignancies on CSE by a dermatologist is not readily available. Currently, groups such as the United States Preventive Forces Task Force do not make recommendations for CSE’s. The prognosis of cutaneous neoplasms is based on the depth of penetration, which can be curtailed if lesions are discovered early. Melanomas are most worrisome and the 5-year survival rate for those diagnosed with melanoma at a thickness of \u3c 0.76 mm is 98%. (2) Other malignancies include basal cell (BCC) and squamous cell carcinomas (SCC). Pre-malignancies include actinic keratoses (AK) and dysplastic nevi (DN). Although most dermatologists perform CSE’s on all new patients, many primary care physicians (PCP’s) do not regularly do so. Dermatologists are both more likely to perform CSE’s on patients perceived to be at high risk for cutaneous malignancy (3) and more likely than PCP’s to identify lesions. (4) Careful CSE’s result in cost and morbidity reduction. (4) Barriers to performing CSE’s include time limits and lack of emphasis on CSE’s during training. (3) While it seems appropriate for dermatologists and PCP’s to perform CSE’s in daily practice, PCP’s have a vital role in recognizing, diagnosing, and appropriately referring patients with concerning lesions. Objectives: Our pilot-study sought to provide data demonstrating the benefits of CSE’s for detecting both pre-malignant and malignant cutaneous lesions. By performing CSE’s on all new patients, we hoped to demonstrate that lesions that would otherwise go undiagnosed, are discovered earlier, decreasing morbidity. We hypothesized new patients presenting to the dermatology clinic for one skin lesion would actually have others discovered incidentally. Methods: Study subjects were identified as new patients presenting to the dermatology clinic at the University of Massachusetts Medical Center from September 2009 through March 2010, of varying ages, ethnicities, and sex. Each patient was asked to indicate “birthmarks, moles, or spots” they wanted examined; these lesions were considered the primary reason for the CSE. A CSE was performed on each subject with the patient’s complaints in mind. These were noted, and depending on the clinical diagnosis, the patient was biopsied, reassured, scheduled for follow-up, or treated. Other lesions detected by a dermatologist were noted, clinically diagnosed, and appropriately biopsied or treated, if necessary. Data analysis was done utilizing Microsoft excel. Data included the percentage of patients with physician-detected lesions and breakdown according to malignant potential and lack of it. Relationships between gender and incidental discovery of lesions were examined. Results: A total of 53 patients were recruited, 50 adults (94.3%) and 3 children (5.7%) from October 2009 through March 2010. There were 35 females (66.0%) and 18 males (34.0%). Of the 53 patients, a total of 10 (18.9%) had dermatologist-detected lesions and 5 (9.4%) had consequential (premalignant or malignant) lesions. There were not any lesions detected in children. A total of 14 lesions were detected and 8 (57.1%) of these lesions were considered consequential. Six (42.9%) of the 14 lesions were premalignant and 2 (14.3%) were malignant. Both malignancies were BCC’s and did not include more malignant neoplasms. Fifty percent of the premalignancies were diagnosed pathologically via a shave biopsy and 50 % were diagnosed clinically. All of the malignant lesions were diagnosed pathologically. Of the 35 females, 5 (14.3%) had lesions detected by a dermatologist. Of the 18 males, 5 (27.8%) had lesions detected similarly. There were no statistically significant differences in the patients having lesions discovered on exam with respect to gender (Fisher exact test p = 0.279); test of proportions revealed statistically insignificant results (p = 0.117, z score -1.188). An equal amount (50%) of premalignant lesions was discovered in both genders. Six (42.9%) of the 14 lesions were benign, including a blue nevus, nevus sebaceus, acne, dermatofibroma, and perioral dermatitis. Discussion: To our knowledge, our pilot-study is the first attempting to determine the utility of CSE’s in detecting lesions other than just cutaneous neoplasms. We also focused on premalignancies such as AK’s and DN. Because of our study, one female patient was worked up for neurofibromatosis type 1 (NF1) because she had multiple café-au-lait macules and inguinal freckling, suspicious for NF1. Our study’s limitations included the small patient population surveyed. The surveys were also not consistently used in all clinics. Although unintentional, this may have led to selection bias by not including new patients at all clinics attended by the dermatologists involved in the study. Our study also included twice as many females as males. Women may be more likely to seek dermatologic evaluation. Although no statistical significance was found with dermatologist detection of lesions comparing patient gender, this may have resulted from the small number of study subjects. Therefore, gender differences should be examined with a larger population. Racial and ethnic differences, as well as the cost-benefit ratio of discovering consequential lesions early on, should also be studied in the future. Conclusion: According to our pilot-study, we were able to demonstrate that a CSE does detect consequential lesions in 9.4% of patients. Although this is clinically significant, there does not appear to be any statistical significance since our population size was small. This pilot-study has been used as a basis for a larger scale study in the future with a larger patient population including children and adults of all ethnicities. Although further data collection is needed, this study demonstrates that lesions may be detected by a dermatologist even though a patient may not recognize them, helping decrease morbidity. References: 1. Kantor J, Kantor DE. Routine dermatologist-performed full-body skin examination and early melanoma detection. Arch Dermatol 2009;145(8):873-876. 2. Aitken, Joanne F, Youl, Philippa H, Janda, Monika, Lowe, John B, Ring, Ian T, Elwood, Mark. Increase in skin cancer screening during a community-based randomized intervention trial. Int J Cancer 2006;118:1010-1016. 3. Federman, Daniel G, Kravetz, Jeffrey D, Kirsner, Robert S. Skin cancer screening by dermatologists: prevalence and barriers. J Am Acad Dermatol 2002;46:710-4. 4. Hubert, Jason N, Callen, Jeffrey P, Kasteler, Scott J. Prevalence of Cutaneous Findings in Hospitalized Pediatric Patients. Pediatr Dermatol 1997;14(6):426-429. Presented as part of the Senior Scholars Program at the University of Massachusetts Medical School, May 3, 2010

Conteúdo Calórico de Músculos de Prochilodus Lineatus (Characiformes, Prochilodontidae) no Reservatório de Manso, Brasil

Com o objetivo de conhecer as variações intraespecíficas no conteúdo calórico, presentes em músculos de Prochilodus lineatus, foram analisados 118 espécimes durante o período de outubro 2002 a setembro 2003 no reservatório de Manso, Mato Grosso, Brasil. De cada exemplar foram obtidas as medidas morfométricas, identificando o sexo e estádio de maturação gonadal e extraindo amostras da musculatura da base da nadadeira dorsal. Cinco amostras de diferentes regiões da musculatura foram amostradas de 18 fêmeas em repouso para se verificar a existência de diferenças calóricas num mesmo indivíduo, associadas à região muscular. Todas as amostras foram secas em estufa a 60ºC até alcançar peso constante, maceradas, homogeneizadas e submetidas à queima em bomba calorimétrica (PARR). Não foram identificadas variações significativas entre diferentes regiões da musculatura, bem como entre sexos. Entre os estádios reprodutivos, apenas para fêmeas verificaram-se diferenças significativas, sendo o estádio repouso significativamente diferente dos demais. Para machos, durante o estádio de maturação, as amostras musculares apresentaram maior concentração calórica que nos demais estádios. A análise de correlação entre o comprimento padrão e o conteúdo calórico dos músculos das fêmeas demonstrou que para indivíduos no estádio de repouso existe correlação. Entre os machos, a correlação embora baixa, foi significativa para indivíduos imaturos, em repouso e em maturação. O presente estudo confirma a importância de se considerar as variações calóricas por classe de comprimento e ressalta a importância de se compreender as alterações energéticas decorrentes da maturação gonadal.Fil: Espínola, Luis Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto Nacional de Limnología. Universidad Nacional del Litoral. Instituto Nacional de Limnología; ArgentinaFil: Pinheiro dos Santos, Erik Allan. Universidade Federeral de Sergipe; BrasilFil: Marques Domingues, Wladimir. Universidade Estadual de Maringá; BrasilFil: Benedito, Evanilde. Universidade Estadual de Maringá; Brasi

The reversal of the multi-decadal trends of the equatorial Pacific easterly winds, and the Indonesian Throughflow and Leeuwin Current transports

Multi-decadal weakening trend of the equatorial Pacific easterly winds since 1960 has reversed after 1993. The trend reversal has induced cooling (shallow thermocline) trend in the equatorial western Pacific before 1993, followed by a warming (deep thermocline) trend from 1993 to the present. All available atmospheric reanalysis products corroborate the trend reversal during the two multi-decadal periods. The magnitudes of the multi-decadal trends of the easterly winds, however, differ among the reanalysis products. The trend reversals of regional ocean circulations are assessed using linear regressions between wind and transport anomalies in an eddy-permitting numerical model, suggesting that since 1993 the Indonesian Throughflow and the Leeuwin Current transports have also reversed their multi-decadal weakening trends. Key Points: - There have been reversals of the multi-decadal weakening trends of trade winds - Different reanalysis products capture different trends in trade wind

Cellular Prion Protein Mediates α‐Synuclein Uptake, Localization, and Toxicity In Vitro and In Vivo

Background: The cellular prion protein (PrPC ) is a membrane-bound, multifunctional protein mainly expressed in neuronal tissues. Recent studies indicate that the native trafficking of PrPC can be misused to internalize misfolded amyloid beta and α-synuclein (aSyn) oligomers. Objectives: We define PrPC 's role in internalizing misfolded aSyn in α-synucleinopathies and identify further involved proteins. Methods: We performed comprehensive behavioral studies on four transgenic mouse models (ThySyn and ThySynPrP00, TgM83 and TgMPrP00) at different ages. We developed PrPC -(over)-expressing cell models (cell line and primary cortical neurons), used confocal laser microscopy to perform colocalization studies, applied mass spectrometry to identify interactomes, and determined disassociation constants using surface plasmon resonance (SPR) spectroscopy. Results: Behavioral deficits (memory, anxiety, locomotion, etc.), reduced lifespans, and higher oligomeric aSyn levels were observed in PrPC -expressing mice (ThySyn and TgM83), but not in homologous Prnp ablated mice (ThySynPrP00 and TgMPrP00). PrPC colocalized with and facilitated aSyn (oligomeric and monomeric) internalization in our cell-based models. Glimepiride treatment of PrPC -overexpressing cells reduced aSyn internalization in a dose-dependent manner. SPR analysis showed that the binding affinity of PrPC to monomeric aSyn was lower than to oligomeric aSyn. Mass spectrometry-based proteomic studies identified clathrin in the immunoprecipitates of PrPC and aSyn. SPR was used to show that clathrin binds to recombinant PrP, but not aSyn. Experimental disruption of clathrin-coated vesicles significantly decreased aSyn internalization. Conclusion: PrPC 's native trafficking can be misused to internalize misfolded aSyn through a clathrin-based mechanism, which may facilitate the spreading of pathological aSyn. Disruption of aSyn-PrPC binding is, therefore, an appealing therapeutic target in α-synucleinopathies. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Global variability in leaf respiration in relation to climate, plant functional types and leaf traits

• Leaf dark respiration (Rdark) is an important yet poorly quantified component of the global carbon cycle. Given this, we analyzed a new global database of Rdark and associated leaf traits. • Data for 899 species were compiled from 100 sites (from the Arctic to the tropics). Several woody and nonwoody plant functional types (PFTs) were represented. Mixed-effects models were used to disentangle sources of variation in Rdark. • Area-based Rdark at the prevailing average daily growth temperature (T) of each site increased only twofold from the Arctic to the tropics, despite a 20°C increase in growing T (8–28°C). By contrast, Rdark at a standard T (25°C, Rdark25) was threefold higher in the Arctic than in the tropics, and twofold higher at arid than at mesic sites. Species and PFTs at cold sites exhibited higher Rdark25 at a given photosynthetic capacity (Vcmax25) or leaf nitrogen concentration ([N]) than species at warmer sites. Rdark25 values at any given Vcmax25 or [N] were higher in herbs than in woody plants. • The results highlight variation in Rdark among species and across global gradients in T and aridity. In addition to their ecological significance, the results provide a framework for improving representation of Rdark in terrestrial biosphere models (TBMs) and associated land-surface components of Earth system models (ESMs)