Too Big Too Fast? Potential Implications of the Rapid Increase in Emergency Medicine Residency Positions

Emergency medicine (EM) has expanded rapidly since its inception in 1979. Workforce projections from current data demonstrate a rapid rise in the number of accredited EM residency programs and trainee positions. Based on these trends, the specialty may soon reach a point of saturation, particularly in urban areas. This could negatively impact future trainees entering the job market as well as the career plans of medical students. More time and resources should be devoted to obtaining accurate projections, assessing the distribution of emergency physicians in rural versus urban settings, and implementing central workforce planning to protect the future of graduating trainees.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154425/1/aet210400.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154425/2/aet210400_am.pd

Unwinding of a cholesteric liquid crystal and bidirectional surface anchoring

We examine the influence of bidirectional anchoring on the unwinding of a planar cholesteric liquid crystal induced by the application of a magnetic field. We consider a liquid crystal layer confined between two plates with the helical axis perpendicular to the substrates. We fixed the director twist on one boundary and allow for bidirectional anchoring on the other by introducing a high-order surface potential. By minimizing the total free energy for the system, we investigate the untwisting of the cholesteric helix as the liquid crystal attempts to align with the magnetic field. The transitions between metastable states occur as a series of pitchjumps as the helix expels quarter or half-turn twists, depending on the relative sizes of the strength of the surface potential and the bidirectional anchoring. We show that secondary easy axis directions can play a significant role in the unwinding of the cholesteric in its transition towards a nematic, especially when the surface anchoring strength is large

Circle talks as situated experiential learning: Context, identity, and knowledgeability in \u27learning from reflection\u27

This article presents research that used ethnographic and sociolinguistic methods to study ways participants learn through reflection when carried out as a “circle talk.” The data indicate that participants in the event (a) invoked different contextual frames that (b) implicated them in various identity positions, which (c) affected how they could express their knowledge. These features worked together to generate socially shared meanings that enabled participants to jointly achieve conceptualization—the ideational role “reflection” is presumed to play in the experiential learning process. The analysis supports the claim that participants generate new knowledge in reflection, but challenges individualistic and cognitive assumptions regarding how this occurs. The article builds on situated views of experiential learning by showing how knowledge can be understood as socially shared and how learning and identity formation are mutually entailing processes

Multi-patch methods in general relativistic astrophysics - I. Hydrodynamical flows on fixed backgrounds

Many systems of interest in general relativistic astrophysics, including neutron stars, accreting compact objects in X-ray binaries and active galactic nuclei, core collapse, and collapsars, are assumed to be approximately spherically symmetric or axisymmetric. In Newtonian or fixed-background relativistic approximations it is common practice to use spherical polar coordinates for computational grids; however, these coordinates have singularities and are difficult to use in fully relativistic models. We present, in this series of papers, a numerical technique which is able to use effectively spherical grids by employing multiple patches. We provide detailed instructions on how to implement such a scheme, and present a number of code tests for the fixed background case, including an accretion torus around a black hole.Comment: 26 pages, 20 figures. A high-resolution version is available at http://www.cct.lsu.edu/~bzink/papers/multipatch_1.pd

Comprehensive genotype-phenotype analysis in 230 patients with tetralogy of Fallot

Tetralogy of Fallot (TOF), the most frequent cyanotic congenital heart disease, is associated with a wide range of intra- and extracardiac phenotypes. We investigated genotype-phenotype correlation in a large cohort of 230 unselected patients with TOF, in whom we performed karyotyping, comprehensive 22q11.2 deletion testing and sequencing of TBX1, NKX2.5 and JAG1, as well as molecular karyotyping in patients with TOF and otherwise unexplained mental retardation. We found pathogenic genetic aberrations in 42 patients (18%), with 22q11.2 deletion as the most common diagnosis (7.4%), followed by trisomy 21 (5.2%) and other chromosomal aberrations or submicroscopic copy number changes (3%). Mutations in JAG1 were detected in three patients with Alagille syndrome (1.3%), while NKX2.5 mutations were seen in two patients with non-syndromic TOF (0.9%). One patient showed a polyalanine stretch elongation within TBX1 which was previously reported as variant of unknown significance in a patient with isolated interruption of the aortic arch. We show that this represents a true mutation resulting in loss of transcriptional activity due to cytoplasmatic protein aggregation, for the first time linking the latter to congenital heart defects. The cardiac anomalies of this patient fit into the spectrum of 22q11.2 deletion, and were distinct for obstruction of the proximal pulmonary artery, hypoplastic central pulmonary arteries and subclavian artery anomalies. Atrioventricular septal defect associated with TOF was very suggestive of trisomy 21 and was absent in 22q11.2 deletion

Enzyme-Responsive Snap-Top Covered Silica Nanocontainers

Mesoporous silica nanoparticles, capable of storing a payload of small molecules and releasing it following specific catalytic activation by an esterase, have been designed and fabricated. The storage and release of the payload is controlled by the presence of [2]rotaxanes, which consist of tri(ethylene glycol) chains threaded by α-cyclodextrin tori, located on the surfaces of the nanoparticles and terminated by a large stoppering group. These modified silica nanoparticles are capable of encapsulating guest molecules when the [2]rotaxanes are present. The bulky stoppers, which serve to hold the tori in place, are stable under physiological conditions but are cleaved by the catalytic action of an enzyme, causing dethreading of the tori and release of the guest molecules from the pores of the nanoparticles. These snap-top covered silica nanocontainers (SCSNs) are prepared by a modular synthetic method, in which the stoppering unit, incorporated in the final step of the synthesis, may be changed at will to target the response of the system to any of a number of hydrolytic enzymes. Here, the design, synthesis, and operation of model SCSNs that open in the presence of porcine liver esterase (PLE) are reported. The empty pores of the silica nanoparticles were loaded with luminescent dye molecules (rhodamine B), and stoppering units that incorporate adamantyl ester moieties were then attached in the presence of α-cyclodextrin using the copper-catalyzed azide−alkyne cycloaddition (CuAAC), closing the SCSNs. The release of rhodamine-B from the pores of the SCSN, following PLE-mediated hydrolysis of the stoppers, was monitored using fluorescence spectroscopy

Electrochemical investigation of the kinetics of chloride substitution upon reduction of [Ru(porphyrin)(NO)Cl] complexes in THF.

The electrochemistry of several ruthenium porphyrin nitrosyl chloride complexes [Ru(por)(NO)Cl] have been examined in tetrahydrofuran. The complexes undergo 1-electron irreversible reductions which result in the diffusion-limited substitutions of the chloride ligands for THF. This chloride metathesis is reversible in the presence of added NBu4Cl, and equilibrium constants and rate constants for chloride loss have been estimated. These parameters correlate with the NO stretching frequencies of the parent complexes, with more electron-donating porphyrin ligands favouring chloride loss from the reduced complexes. The [Ru(por)(NO)(THF)] products of the reductions can be detected by IR, EPR and visible spectroscopies. These species undergo three further reductions, with good reversibility at scan rates \u3e0.40 V s-1. The [Ru(por)(NO)(THF)]+/0 couples have also been determined, and the rate constants and equilibrium constants for recombination with chloride have been estimated. One-electron reductions of the [Ru(por)(NO)Cl] complexes result in ~1018 enhancement of the rates of chloride loss