Hot topics, urgent priorities, and ensuring success for racial/ethnic minority young investigators in academic pediatrics.

BackgroundThe number of racial/ethnic minority children will exceed the number of white children in the USA by 2018. Although 38% of Americans are minorities, only 12% of pediatricians, 5% of medical-school faculty, and 3% of medical-school professors are minorities. Furthermore, only 5% of all R01 applications for National Institutes of Health grants are from African-American, Latino, and American Indian investigators. Prompted by the persistent lack of diversity in the pediatric and biomedical research workforces, the Academic Pediatric Association Research in Academic Pediatrics Initiative on Diversity (RAPID) was initiated in 2012. RAPID targets applicants who are members of an underrepresented minority group (URM), disabled, or from a socially, culturally, economically, or educationally disadvantaged background. The program, which consists of both a research project and career and leadership development activities, includes an annual career-development and leadership conference which is open to any resident, fellow, or junior faculty member from an URM, disabled, or disadvantaged background who is interested in a career in academic general pediatrics.MethodsAs part of the annual RAPID conference, a Hot Topic Session is held in which the young investigators spend several hours developing a list of hot topics on the most useful faculty and career-development issues. These hot topics are then posed in the form of six "burning questions" to the RAPID National Advisory Committee (comprised of accomplished, nationally recognized senior investigators who are seasoned mentors), the RAPID Director and Co-Director, and the keynote speaker.Results/conclusionsThe six compelling questions posed by the 10 young investigators-along with the responses of the senior conference leadership-provide a unique resource and "survival guide" for ensuring the academic success and optimal career development of young investigators in academic pediatrics from diverse backgrounds. A rich conversation ensued on the topics addressed, consisting of negotiating for protected research time, career trajectories as academic institutions move away from an emphasis on tenure-track positions, how "non-academic" products fit into career development, racism and discrimination in academic medicine and how to address them, coping with isolation as a minority faculty member, and how best to mentor the next generation of academic physicians

The evaluation of vesicoureteral reflux among children using contrast-enhanced ultrasound : a literature review

Q2Artículo de revisión1Introduction Voiding cystourethrogram (VCUG) with fluoroscopy remains the gold standard for detection and evaluation of vesicoureteral reflux (VUR) among children. However, the ionizing radiation exposure remains a concern for this diagnostic modality. Recent studies have proposed using contrast-enhanced ultrasound as an alternative option for VUR screening and follow-up in children. The aim of the study was to review the literature of comparative studies that assessed the diagnostic accuracy of contrast-enhanced ultrasound compared with VCUG. Methodology A systematic literature search was performed on electronic medical literature databases in July 2017. Literature identification, screening, and assessment of eligibility were performed by five reviewers with a pediatric radiologist. Literature was summarized for the study population, contrast used, and ultrasound mode as well as the timing of comparative reference study being performed. The studies were clustered according to the kind of contrast used. Reported diagnostic accuracy was extracted from individual studies and summarized across the included studies using descriptive statistics of median and interquartile range (IQR). Result A total of 45 comparative studies were identified as eligible for the summary of the literature. Two generations of ultrasound contrast were identified in the available studies (first generation, Levovist and second generation, SonoVue). For the ultrasound studies using the first-generation contrast, the median sensitivity, regardless of the ultrasound mode, was 90.25 (IQR 83.25–97), and the median specificity was 93 (IQR 91.3–95.25). Among studies using the second-generation contrast, the median sensitivity was 86.26 (IQR 81.13–97), and the median specificity was 90.99 (IQR 84–98). No serious adverse events were reported in any of the studies. Conclusion Overall, this review highlights the application of contrast-enhanced ultrasound for its advantage of no exposure to ionizing radiation and diagnostic accuracy relatively comparable to VCUG in the evaluation of VUR. In addition to the functional evaluation of the VUR, it also provides an anatomic evaluation of the kidneys and bladder with ultrasound imaging. However, one should also note that this alternate procedure is highly operator dependent where diagnostic accuracy is excellent when the expertise is available.Revista Internacional - Indexad

Global and regional IUCN red list assessments: 4

In this contribution, the conservation status assessments of three vascular plants are presented following to IUCN categories and criteria. It includes the assessment at global level of Saxifraga caprariae Mannocci, Ferretti, Mazzoncini & Viciani and S. montis-christi Mannocci, Ferretti, Mazzoncini & Viciani and the regional assessment of Halocnemum cruciatum (Forssk.) Tod. (Spain)

Visibility Assessment of New Photovoltaic Power Plants in Areas with Special Landscape Value

Power plants based on renewable sources offer environmental, technical and economic advantages. Of particular importance is the reduction in greenhouse gas emissions compared to conventional power plants. Despite the advantages, people are often opposed to the construction of these facilities due to their high visual impact, particularly if they are close to places with a great cultural and/or landscape value. This paper proposes a new methodology for identifying the most suitable geographical areas for the construction of new photovoltaic (PV) power plants in zones of special scenic or cultural interest, helping to keep the environment free from the visual intrusions caused by these facilities. From several repeated analyses, the degree of visibility of the new PV plant, the potential observation time of passing visitors, considering the route they follow and their speed, and the increase in visibility of the plants when seen totally or partially with the sky as background, are determined. The result obtained is a map showing the ranking of the geographical areas based on a variable calculated in such analyses: the Global Accumulated Perception Time (GAPT). The application of this methodology can help the different agents involved in the decision-making process for the installation of new PV plant by providing them with an objective visibility criterion

The evolution of ultraviolet emission lines from the circumstellar material surrounding SN 1987A

The presence of narrow high-temperature emission lines from nitrogen-rich gas close to SN 1987A has been the principal observational constraint on the evolu- tionary status of the supernova's progenitor. A new analysis of the complete five-year set of low and high resolution IUE ultraviolet spectra of SN 1987A (1987.2--1992.3) provide fluxes for the N V 1240, N IV] 1486, He II 1640, OIII] 1665, NIII] 1751, and CIII] 1908 lines with significantly reduced random and systematic errors and reveals significant short-term fluctuations in the light curves. The N V, N IV] and N III] lines turn on sequentially over 15 to 20 days and show a progression from high to low ionization potential, implying an ioni- zation gradient in the emitting region. The line emission turns on suddenly at 83+/-4 days after the explosion, as defined by N IV]. The N III] line reaches peak luminosity at 399+/-15 days. A ring radius of (6.24+/-0.20)E{17} cm and inclination of 41.0+/-3.9 is derived from these times, assuming a circular ring. The probable role of resonant scattering in the N V light curve introduces systematic errors that leads us to exclude this line from the timing analysis. A new nebular analysis yields improved CNO abundance ratios N/C=6.1+/-1.1 and N/O=1.7+/-0.5, confirming the nitrogen enrichment found in our previous paper. From the late-time behavior of the light curves we find that the emission origi- nates from progressively lower density gas. We estimate the emitting mass near maximum (roughly 400 days) to be roughly 4.7E{-2} solar masses, assuming a filling factor of unity and an electron density of 2.6E4 cm^{-3}. These results are discussed in the context of current models for the emission and hydrodynamics of the ring.Comment: 38 pages, AASTeX v.4.0, 13 Postscript figures; ApJ, in pres

Building Babies - Chapter 16

In contrast to birds, male mammals rarely help to raise the offspring. Of all mammals, only among rodents, carnivores, and primates, males are sometimes intensively engaged in providing infant care (Kleiman and Malcolm 1981). Male caretaking of infants has long been recognized in nonhuman primates (Itani 1959). Given that infant care behavior can have a positive effect on the infant’s development, growth, well-being, or survival, why are male mammals not more frequently involved in “building babies”? We begin the chapter defining a few relevant terms and introducing the theory and hypotheses that have historically addressed the evolution of paternal care. We then review empirical findings on male care among primate taxa, before focusing, in the final section, on our own work on paternal care in South American owl monkeys (Aotus spp.). We conclude the chapter with some suggestions for future studies.Deutsche Forschungsgemeinschaft (HU 1746/2-1) Wenner-Gren Foundation, the L.S.B. Leakey Foundation, the National Geographic Society, the National Science Foundation (BCS-0621020), the University of Pennsylvania Research Foundation, the Zoological Society of San Dieg

Trimethylamine-N-Oxide (TMAO) Predicts Cardiovascular Mortality in Peripheral Artery Disease

Peripheral artery disease (PAD) is a major cause of acute and chronic illness, with extremely poor prognosis that remains underdiagnosed and undertreated. Trimethylamine-N-Oxide (TMAO), a gut derived metabolite, has been associated with atherosclerotic burden. We determined plasma levels of TMAO by mass spectrometry and evaluated their association with PAD severity and prognosis. 262 symptomatic PAD patients (mean age 70 years, 87% men) categorized in intermittent claudication (IC, n = 147) and critical limb ischemia (CLI, n = 115) were followed-up for a mean average of 4 years (min 1-max 102 months). TMAO levels were increased in CLI compared to IC (P 2.26 µmol/L exhibited higher risk of cardiovascular death (sub-hazard ratios ≥2, P < 0.05) that remained significant after adjustment for confounding factors. TMAO levels were associated to disease severity and CV-mortality in our cohort, suggesting an improvement of PAD prognosis with the measurement of TMAO. Overall, our results indicate that the intestinal bacterial function, together with the activity of key hepatic enzymes for TMA oxidation (FMO3) and renal function, should be considered when designing therapeutic strategies to control gut-derived metabolites in vascular patients

Shape-sensing robotic-assisted bronchoscopy for pulmonary nodules: initial multicenter experience using the Ion™ Endoluminal System

BACKGROUND: Traditional bronchoscopy provides limited approach to peripheral nodules. Shape-sensing robotic-assisted bronchoscopy (SSRAB, Ion™ Endoluminal System) is a new tool for minimally invasive peripheral nodule biopsy. We sought to answer the research question: Does SSRAB facilitate sampling of pulmonary nodules during bronchoscopists\u27 initial experience? METHODS: The lead-in stage of a multicenter, single-arm, prospective evaluation of the Ion Endoluminal System (PRECIsE) is described. Enrolled subjects ≥ 18 years old had recent computed tomography evidence of one or more solid or semi-solid pulmonary nodules ≥ 1.0 to ≤ 3.5 cm in greatest dimension and in any part of the lung. Subjects were followed at 10- and 30-days post-procedure. This stage provided investigators and staff their first human experience with the SSRAB system; safety and procedure outcomes were analyzed descriptively. Neither diagnostic yield nor sensitivity for malignancy were assessed in this stage. Categorical variables are summarized by percentage; continuous variables are summarized by median/interquartile range (IQR). RESULTS: Sixty subjects were enrolled across 6 hospitals; 67 nodules were targeted for biopsy. Median axial, coronal and sagittal diameters were \u3c 18 mm with a largest cardinal diameter of 20.0 mm. Most nodules were extraluminal and distance from the outer edge of the nodule to the pleura or nearest fissure was 4.0 mm (IQR: 0.0, 15.0). Median bronchial generation count to the target location was 7.0 (IQR: 6.0, 8.0). Procedure duration (catheter-in to catheter-out) was 66.5 min (IQR: 50.0, 85.5). Distance from the catheter tip to the closest edge of the virtual nodule was 7.0 mm (IQR: 2.0, 12.0). Biopsy completion was 97.0%. No pneumothorax or airway bleeding of any grade was reported. CONCLUSIONS: Bronchoscopists leveraged the Ion SSRAB\u27s functionality to drive the catheter safely in close proximity of the virtual target and to obtain biopsies. This initial, multicenter experience is encouraging, suggesting that SSRAB may play a role in the management of pulmonary nodules. Clinical Trial Registration identifier and date NCT03893539; 28/03/2019