Survey of Osteopathic Medical Students Regarding Physician Shadowing Experiences Before and During Medical School Training.

Introduction: Shadowing a physician is an observational experience which includes a student observing a licensed healthcare provider caring for patients. Shadowing is commonly done by students before and during medical school, but little is known about the nature or extent of these extra-curricular observational experiences. Objective: We hypothesized that shadowing experiences were common yet variable. We investigated the prevalence, nature, and perceived value of medical student experiences with shadowing physicians (both before and during medical school). Methods: This survey-based study was non-experimental with a cross-sectional convenience sample of osteopathic medical students about their shadowing experiences before and during medical school. The survey was sent to all matriculated osteopathic medical students (OMS1-4) for the 2017 to 2018 academic year from two medical schools: Philadelphia College of Osteopathic Medicine (PCOM) (1084 total students) and PCOM-Georgia (554 total students). The final survey instrument included three sections: demographics (6 questions), pre-medical shadowing experiences (21 questions), and medical student shadowing experiences (24 questions). Results: Respondents (357) identified themselves as OMS1 (96), OMS2 (89), OMS3 (73), OMS4 (95) and other (2, OMS5) with enrollment at PCOM-Philadelphia (242) and PCOM-Georgia (115). Among survey respondents, 339 (95.5%) reported shadowing a physician as a pre-medical student, and 110 (30.8%) reported shadowing (outside of their required clinical rotations) a physician during medical school. Requirements to participate were inconsistent; fewer than 50% of shadowing experiences required Health Insurance Portability and Accountability Act of 1996 (HIPAA) training, proof of vaccination, or purified protein derivative (PPD) documentation. In addition to observation, pre-medical and medical students, respectively, participated in history taking (44 [13%], 47 [42.7%]), physical examinations (45 [13.3%], 44 [40%]) and procedures (13, [3.8%], 20 [18.2%]) during their shadowing experiences. Motivations to participate in shadowing varied between pre-medical and medical student experiences, but both groups mentioned their desire to learn more about a particular discipline, obtain letters of recommendation, and gain patient care experience. Students recommended both pre-medical (273 [80.5%]) and medical school (93 [84.5%]) shadowing to future students. Conclusion: Shadowing remains a common and important tool for students to learn about patient care, medicine and careers. The nature of each shadowing experience and participation requirements are quite variable. Measures to ensure patient safety, confidentiality, liability and supervision are inconsistently applied. Promoting guidelines, as well as codes of conduct, for shadowing could serve as a helpful resource for students, academic advisors and supervising clinicians

Good practices for 68Ga radiopharmaceutical production

Background: The radiometal gallium-68 (Ga-68) is increasingly used in diagnostic positron emission tomography (PET), with Ga-68-labeled radiopharmaceuticals developed as potential higher-resolution imaging alternatives to traditional Tc-99m agents. In precision medicine, PET applications of Ga-68 are widespread, with Ga-68 radiolabeled to a variety of radiotracers that evaluate perfusion and organ function, and target specific biomarkers found on tumor lesions such as prostate-specific membrane antigen, somatostatin, fibroblast activation protein, bombesin, and melanocortin. Main body: These Ga-68 radiopharmaceuticals include agents such as [Ga-68]Ga-macroaggregated albumin for myocardial perfusion evaluation, [Ga-68]Ga-PLED for assessing renal function, [Ga-68]Ga-t-butyl-HBED for assessing liver function, and [Ga-68]Ga-PSMA for tumor imaging. The short half-life, favourable nuclear decay properties, ease of radiolabeling, and convenient availability through germanium-68 (Ge-68) generators and cyclotron production routes strongly positions Ga-68 for continued growth in clinical deployment. This progress motivates the development of a set of common guidelines and standards for the Ga-68 radiopharmaceutical community, and recommendations for centers interested in establishing Ga-68 radiopharmaceutical production. Conclusion: This review outlines important aspects of Ga-68 radiopharmacy, including Ga-68 production routes using a Ge-68/Ga-68 generator or medical cyclotron, standardized Ga-68 radiolabeling methods, quality control procedures for clinical Ga-68 radiopharmaceuticals, and suggested best practices for centers with established or upcoming Ga-68 radiopharmaceutical production. Finally, an outlook on Ga-68 radiopharmaceuticals is presented to highlight potential challenges and opportunities facing the community

Corona, Jet, and Relativistic Line Models for Suzaku/RXTE/Chandra-HETG Observations of the Cygnus X-1 Hard State

Using Suzaku and the Rossi X-ray Timing Explorer, we have conducted a series of four simultaneous observations of the galactic black hole candidate Cyg X-1 in what were historically faint and spectrally hard low states. Additionally, all of these observations occurred near superior conjunction with our line of sight to the X-ray source passing through the dense phases of the focused wind from the mass donating secondary. One of our observations was also simultaneous with observations by the Chandra-High Energy Transmission Grating. These latter spectra are crucial for revealing the ionized absorption due to the secondary's focused wind. Such absorption is present and must be accounted for in all four spectra. These simultaneous data give an unprecedented view of the 0.8-300 keV spectrum of Cyg X-1, and hence bear upon both corona and X-ray emitting jet models of black hole hard states. Three models fit the spectra well: coronae with thermal or mixed thermal/non-thermal electron populations, and jets. All three models require a soft component that we fit with a low temperature disk spectrum with an inner radius of only a few tens of GM/c^2. All three models also agree that the known spectral break at 10\,keV is not solely due to the presence of reflection, but each gives a different underlying explanation for the augmentation of this break. Thus whereas all three models require that there is a relativistically broadened Fe line, the strength and inner radius of such a line is dependent upon the specific model, {thus making premature line-based estimates of the black hole spin in the Cyg X-1 system. We look at the relativistic line in detail, accounting for the narrow Fe emission and ionized absorption detected by HETG. Although the specific relativistic parameters of the line are continuum-dependent, none of the broad line fits allow for an inner disk radius that is >40 GM/c^2.Comment: 22 pages, 16 figures. Uses emulateapj style. Final three tables inserted as a figure to avoid issues with astro-ph's version of latex mangling the use of lscape. To be published in the Astrophysical Journal, January, 201

Solution structure of a bacterial microcompartment targeting peptide and its application in the construction of an ethanol bioreactor

Targeting of proteins to bacterial microcompartments (BMCs) is mediated by an 18-amino-acid peptide sequence. Herein, we report the solution structure of the N-terminal targeting peptide (P18) of PduP, the aldehyde dehydrogenase associated with the 1,2-propanediol utilization metabolosome from Citrobacter freundii. The solution structure reveals the peptide to have a well-defined helical conformation along its whole length. Saturation transfer difference and transferred NOE NMR has highlighted the observed interaction surface on the peptide with its main interacting shell protein, PduK. By tagging both a pyruvate decarboxylase and an alcohol dehydrogenase with targeting peptides, it has been possible to direct these enzymes to empty BMCs in vivo and to generate an ethanol bioreactor. Not only are the purified, redesigned BMCs able to transform pyruvate into ethanol efficiently, but the strains containing the modified BMCs produce elevated levels of alcohol

Inhibition of release of inflammatory mediators in primary and cultured cells by a Chinese herbal medicine formula for allergic rhinitis

BACKGROUND: We demonstrated that a Chinese herbal formula, which we refer to as RCM-101, developed from a traditional Chinese medicine formula, reduced nasal and non-nasal symptoms of seasonal allergic rhinitis (SAR). The present study in primary and cultured cells was undertaken to investigate the effects of RCM-101 on the production/release of inflammatory mediators known to be involved in SAR. METHODS: Compound 48/80-induced histamine release was studied in rat peritoneal mast cells. Production of leukotriene B(4 )induced by the calcium ionophore A23187 was studied in porcine neutrophils using an HPLC assay and lipopolysaccharide-stimulated prostaglandin E(2 )production was studied in murine macrophage (Raw 264.7) cells by immune-enzyme assay. Expression of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) was determined in Raw 264.7 cells, using western blotting techniques. RESULTS: RCM-101 (1–100 μg/mL) produced concentration-dependent inhibition of compound 48/80-induced histamine release from rat peritoneal mast cells and of lipopolysaccharide-stimulated prostaglandin E(2 )release from Raw 264.7 cells. Over the range 1 – 10 μg/mL, it inhibited A23187-induced leukotriene B(4 )production in porcine neutrophils. In addition, RCM-101 (100 μg/mL) inhibited the expression of COX-2 protein but did not affect that of COX-1. CONCLUSION: The findings indicate that RCM-101 inhibits the release and/or synthesis of histamine, leukotriene B(4 )and prostaglandin E(2 )in cultured cells. These interactions of RCM-101 with multiple inflammatory mediators are likely to be related to its ability to reduce symptoms of allergic rhinitis

Association Between Fish Consumption, Long Chain Omega 3 Fatty Acids, and Risk of Cerebrovascular Disease: Systematic Review and Meta-Analysis

Objective: To clarify associations of fish consumption and long chain omega 3 fatty acids with risk of cerebrovascular disease for primary and secondary prevention. Design Systematic review and meta-analysis. Data sources Studies published before September 2012 identified through electronic searches using Medline, Embase, BIOSIS, and Science Citation Index databases. Eligibility criteria Prospective cohort studies and randomised controlled trials reporting on associations of fish consumption and long chain omega 3 fatty acids (based on dietary self report), omega 3 fatty acids biomarkers, or supplementations with cerebrovascular disease (defined as any fatal or non-fatal ischaemic stroke, haemorrhagic stroke, cerebrovascular accident, or transient ischaemic attack). Both primary and secondary prevention studies (comprising participants with or without cardiovascular disease at baseline) were eligible. Results: 26 prospective cohort studies and 12 randomised controlled trials with aggregate data on 794 000 non-overlapping people and 34 817 cerebrovascular outcomes were included. In cohort studies comparing categories of fish intake the pooled relative risk for cerebrovascular disease for 2-4 servings a week versus ≤1 servings a week was 0.94 (95% confidence intervals 0.90 to 0.98) and for ≥5 servings a week versus 1 serving a week was 0.88 (0.81 to 0.96). The relative risk for cerebrovascular disease comparing the top thirds of baseline long chain omega 3 fatty acids with the bottom thirds for circulating biomarkers was 1.04 (0.90 to 1.20) and for dietary exposures was 0.90 (0.80 to 1.01). In the randomised controlled trials the relative risk for cerebrovascular disease in the long chain omega 3 supplement compared with the control group in primary prevention trials was 0.98 (0.89 to 1.08) and in secondary prevention trials was 1.17 (0.99 to 1.38). For fish or omega 3 fatty acids the estimates for ischaemic and haemorrhagic cerebrovascular events were broadly similar. Evidence was lacking of heterogeneity and publication bias across studies or within subgroups. Conclusions: Available observational data indicate moderate, inverse associations of fish consumption and long chain omega 3 fatty acids with cerebrovascular risk. Long chain omega 3 fatty acids measured as circulating biomarkers in observational studies or supplements in primary and secondary prevention trials were not associated with cerebrovascular disease. The beneficial effect of fish intake on cerebrovascular risk is likely to be mediated through the interplay of a wide range of nutrients abundant in fish

Unknowable bodies, unthinkable sexualities: lesbian and transgender legal invisibility in the Toronto women's bathhouse raid

Although litigation involving sexual orientation and gender identity discrimination claims has generated considerable public attention in recent years, lesbian and transgender bodies and sexualities still remain largely invisible in Anglo-American courts. While such invisibility is generally attributed to social norms that fail to recognize lesbian and transgender experiences, the capacity to 'not see' or 'not know' queer bodies and sexualities also involves wilful acts of ignorance. Drawing from R. v Hornick (2002) a Canadian case involving the police raid of a women's bathhouse, this article explores how lesbian and transgender bodies and sexualities are actively rendered invisible via legal knowledge practices, norms and rationalities. It argues that limited knowledge and limited thinking not only regulate the borders of visibility and belonging, but play an active part in shaping identities, governing conduct and producing subjectivity

Biosynthesis of Modular Ascarosides in C. elegans

The nematode Caenorhabditis elegans uses simple building blocks from primary metabolism and a strategy of modular assembly to build a great diversity of signaling molecules, the ascarosides, which function as a chemical language in this model organism. In the ascarosides, the dideoxysugar ascarylose serves as a scaffold to which diverse moieties from lipid, amino acid, neurotransmitter, and nucleoside metabolism are attached. However, the mechanisms that underlie the highly specific assembly of ascarosides are not understood. We show that the acyl-CoA synthetase ACS-7, which localizes to lysosome-related organelles, is specifically required for the attachment of different building blocks to the 4′-position of ascr#9. We further show that mutants lacking lysosome-related organelles are defective in the production of all 4′-modified ascarosides, thus identifying the waste disposal system of the cell as a hotspot for ascaroside biosynthesis

Aspiration Before Tissue Filler—An Exercise in Futility and Unsafe Practice

Background: Aesthetic physicians rely on certain anecdotal beliefs regarding the safe practice of filler injections. These include a presumed safety advantage of bolus injection after a negative aspiration. Objectives: The authors sought to review and summarize the published literature on inadvertent intravascular injection of hyaluronic acid and to investigate whether the technique of aspiration confers any safety to the practitioner and the patient. Methods: Pertinent literature was analyzed and the current understanding of the safety of negative and positive aspiration outlined. Results: The available studies demonstrate that aspiration cannot be relied on and should not be employed as a safety measure. It is safer to adopt injection techniques that avoid injecting an intravascular volume with embolic potential than utilize an unreliable test to permit a risky injection. Conclusions: To prevent intravascular injection, understanding "injection anatomy"and injection plane and techniques such as slow, low-pressure injection are important safety measures. Assurance of safety when delivering a bolus after negative aspiration does not appear to be borne out by the available literature. If there is any doubt about the sensitivity or reliability of a negative aspiration, there is no role for its utilization. Achieving a positive aspiration would just defer the risk to the next injection location where a negative aspiration would then be relied on