Developmental Neurotoxicity Study of Dietary Bisphenol A in Sprague-Dawley Rats

This study was conducted to determine the potential of bisphenol A (BPA) to induce functional and/or morphological effects to the nervous system of F1 offspring from dietary exposure during gestation and lactation according to the Organization for Economic Cooperation and Development and U.S. Environmental Protection Agency guidelines for the study of developmental neurotoxicity. BPA was offered to female Sprague-Dawley Crl:CD (SD) rats (24 per dose group) and their litters at dietary concentrations of 0 (control), 0.15, 1.5, 75, 750, and 2250 ppm daily from gestation day 0 through lactation day 21. F1 offspring were evaluated using the following tests: detailed clinical observations (postnatal days [PNDs] 4, 11, 21, 35, 45, and 60), auditory startle (PNDs 20 and 60), motor activity (PNDs 13, 17, 21, and 61), learning and memory using the Biel water maze (PNDs 22 and 62), and brain and nervous system neuropathology and brain morphometry (PNDs 21 and 72). For F1 offspring, there were no treatment-related neurobehavioral effects, nor was there evidence of neuropathology or effects on brain morphometry. Based on maternal and offspring body weight reductions, the no-observed-adverse-effect level (NOAEL) for systemic toxicity was 75 ppm (5.85 and 13.1 mg/kg/day during gestation and lactation, respectively), with no treatment-related effects at lower doses or nonmonotonic dose responses observed for any parameter. There was no evidence that BPA is a developmental neurotoxicant in rats, and the NOAEL for developmental neurotoxicity was 2250 ppm, the highest dose tested (164 and 410 mg/kg/day during gestation and lactation, respectively)

Motor Preparation Rather Than Decision-Making Differentiates Parkinson’s Disease Patients With And Without Freezing of Gait

Objective: Freezing of gait (FOG) is a brief, episodic phenomenon affecting over half of people with Parkinson’s disease (PD) and leads to significant morbidity. The pathophysiology of FOG remains poorly understood but is associated with deficits in cognitive function and motor preparation. Method: We studied 20 people with PD (10 with FOG, 10 without FOG) and performed a timed response target detection task while electroencephalographic data were acquired. We analysed the data to detect and examine cortical markers of cognitive decision making (P3b or centroparietal positivity, CPP) and motor readiness potential. We analysed current source density (CSD) to increase spatial resolution and allow identification of distinct signals. Results: There was no difference in the P3b/CPP response between people with PD with and without FOG, suggesting equivalent cognitive processing with respect to decision-making. However, the FOG group had significant difference with an earlier onset and larger amplitude of the lateralized readiness potential. Furthermore, the amplitude of the lateralised readiness potential correlated strongly with total Frontal Assessment Battery score. Conclusions: The difference in lateralized readiness potentials may reflect excessive recruitment of lateral premotor areas to compensate for dysfunction of the supplementary motor area and resultant loss of automatic motor control. This early, excessive recruitment of frontal networks occurs in spite of equivalent motor scores and reaction times between groups. Significance: The saturation of frontal processing mechanisms could help explain deficits in attentional set-shifting, dual-tasking and response inhibition which are frequently reported in FOG

Relationship between admissions committee review and student performance in medical school and internship

Purpose: To investigate the association between tertiary reviewer (admissions committee member) comments and medical students\u27 performance during medical school and into internship. Methods: We collected data from seven year-groups (1993-1999) and coded tertiary reviewer comments into 14 themes. We then conducted an exploratory factor analysis to reduce the dimensions of the themes (excluding the Overall impression theme). Subsequently, we performed Pearson correlation analyses and multiple linear regression analysis to examine the relationship between the factors and seven outcome measures: medical school preclinical grade point average (GPA), medical school clinical GPA, cumulative medical school GPA, U.S. Medical Licensing Examination Step 1 and 2 scores, and scores on a program director\u27s evaluation measuring intern professionalism and expertise. Results: We extracted seven factors from the 13 themes and found small-to-moderate, significant correlations between the factors, the Overall impression theme, and the outcome measures. In particular, positive comments on Test and Maturity were associated with higher U.S. Medical Licensing Examination Step 1 and 2 scores. Negative comments on Interview and Recommendations were associated with lower ratings of professionalism during internship. Comments on Overall impression were significantly associated with all the outcome measures. Conclusions: Tertiary reviewer comments were weakly associated with performance in medical school and internship. Compared with positive comments, negative comments had stronger associations with medical school and internship performance measures. © Association of Military Surgeons of the U.S. All rights reserved

Where are they now? USU School of Medicine graduates after their military obligation is complete

The Uniformed Services University\u27s (USU) F. Edward Hébert School of Medicine was chartered in 1972, with the goal of providing high-quality physicians for the Uniformed Services. In exchange for their education, USU graduates incur an active duty service obligation, after which they may choose to stay on active duty or transition to civilian practice. The purpose of this study is to describe the practice characteristics of USU graduates after this obligation has been completed in order to determine the societal benefits during this phase of their careers. To accomplish this purpose, we performed a retrospective cohort study of the first 20 years of USU graduates (1980-1999). We used the American Medical Association Physician Masterfile to determine the graduates\u27 current practice location and characteristics, as well as their board certification status. Of these 2,760 graduates, nearly all (91%) were involved in active clinical practice in over 100 self-declared specialties, the vast majority (89%) practiced in locations other than the immediate vicinity of the medical school (i.e., Maryland and the District of Columbia), and most still worked for the federal government (71%). Finally, USU graduates in full-time clinical practice had a board certification rate of 93%, which was better than the average of all other graduates of U.S. Medical Schools (88%) in the same time period. Thus, it seems USU is attaining its goal of producing high-quality physicians who continue to benefit the nation after their service obligation has been completed, with many still in federal service. © Association of Military Surgeons of the U.S. All rights reserved

Identifying themes within a medical school admission committee\u27s reviews of applicants

Background: Admissions committees attempt to select the most qualified applicants based on many cognitive and noncognitive factors. Purpose: Identify common themes cited in the admissions committee member summaries of medical school matriculants and determine the relative frequency and importance of these themes. Methods: After reviewing a convenience sample of 150 reviewer comments, 14 qualitative themes were identified. Utterances (thematic word strings) from each of the three reviewer comments for each matriculant for 7 academic years (1989-1996) were then categorized and coded as being positive, negative, or neutral. Intra-rater and inter-rater reliabilities were calculated. Results: Utterances (n = 9299) about 981 matriculants were categorized by theme and sorted as being positive, neutral, or negative. Intra-rater reliabilities were excellent (mean K = 0.98, range 0.90-1.00). Similarly, inter-rater reliabilities were also excellent (mean K = 0.94, range 0.55-1.00 and mean K = 0.90, range 0.08-1.00). Four themes (overall summarizing comments, academic, test scores, and motivation) accounted for more than half (56%) of the utterances. Conclusions: We were able to qualitatively identify themes and provide information about how one committee weighs both cognitive and noncognitive factors. Admission committees should consider reexamining their process and potentially expanding, eliminating, or modifying application components. © Association of Military Surgeons of the U.S. All rights reserved

40 years of military medical education: An overview of the Long-Term Career Outcome Study (LTCOS)

In 2005, the Long-Term Career Outcome Study (LTCOS) was established by the Dean, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU). The original charge to the LTCOS team was to establish an electronic database of current and past students at USU. Since its inception, however, the LTCOS team has broadened its mission and started collecting and analyzing data on a continuous basis for the purposes of program evaluation and, in some cases, research. The purpose of this commentary is to review the history of the LTCOS, including details about USU, a brief review of prior LTCOS work, and progress made since our last essay on LTCOS efforts. This commentary also provides an introduction to the special issue, which is arranged as a series of articles that span the medical education continuum (i.e., before, during, and after medical school). The relative balance of articles in each phase of training represents the LTCOS team\u27s efforts to address the entire continuum of medical education

The Long-Term Career Outcome Study (LTCOS): What have we learned from 40 years of military medical education and where should we go?

The work of the Long-Term Career Outcome Study (LTCOS), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU) has been a multidisciplinary effort spanning more than 5 years. Borrowing from the established program evaluation and quality assurance literature, the LTCOS team has organized its evaluation and research efforts into three phases: before medical school, during medical school, and after medical school. The purpose of this commentary is to summarize the research articles presented in this special issue and to answer two fundamental questions: (1) what has been learned from LTCOS research conducted to date, and (2) where should the LTCOS team take its evaluation and research efforts in the future? Answers to these questions are relevant to USU, and they also can inform other medical education institutions and policy makers. What is more, answers to these questions will help to ensure USU meets its societal obligation to provide the highest quality health care to military members, their families, and society at large. © Association of Military Surgeons of the U.S. All rights reserved

Leadership success and the Uniformed Services University: Perspectives of flag officer alumni

The Uniformed Services University of the Health Sciences (USU) houses the nation\u27s only federal medical school, the F. Edward Hébert School of Medicine. A key aspect of the curriculum at USU is leadership education as graduates go on to serve the Department of Defense through a variety of senior positions in the military. We surveyed a specific group of USU graduates who have achieved the rank of General or Admiral ( flag officers ) to enhance our understanding of successful leadership for military physicians and to gain an understanding of how USU might shape its curriculum in the future. Methods: We sent an Internet-based survey to 13 flag officer graduates. The first section of the survey contained items from the multifactor leadership questionnaire-6S, a questionnaire with evidence of reliability and validity for evaluating leadership styles. The second section of the survey contained openended questions addressing key characteristics of an effective leader in the Military Health System, experiences that prepared them for leadership, USU\u27s role in leadership positions, and advice for USU for better educating future leaders. The second section of the survey was coded using the constant comparative method. Results: Eight flag officers (63%) responded to the survey. They all scored highly on transformational leadership style. Qualitative themes reached saturation for each open-ended question. The flag officers identified characteristics consistent with published literature from other fields regarding effective leadership. They endorsed USU\u27s role in achieving their leadership positions and suggested areas for improvement. Conclusions: Characteristics of effective leadership (transformational leadership style) identified by the flag officers surveyed in this study are consistent with the literature from other fields. These finding have important implications for leadership education at USU and potentially other institutions. The results also provide additional data to support the notion that USU is meeting its societal obligation to educate future leaders in military medicine. © Association of Military Surgeons of the U.S. All rights reserved