Interactive teaching and repeat exposure maximize medical student satisfaction but do not promote long-term retention of dermatologic knowledge

Background: Instructional methods for teaching medical students to recognize common skin lesions vary widely. There is little published data comparing various teaching methods and their impact on medical student retention of dermatologic knowledge. Methods: Our prospective cohort study analyzed how teaching methods (interactive teaching versus. traditional didactic teaching versus. self-guided review alone) impacted second year medical students' ability to recognize common skin lesions one year after initial exposure to the material. Our study also looked at student satisfaction with different teaching methods. Results: There was no significant difference in long-term retention of knowledge between different teaching methods. However, students preferred the interactive format over the traditional didactic format. Spaced review is important for long-term retention, but an in-class review session two months after content was initially taught provided no added benefit over spaced self-review alone. Conclusions: Medical students are able to maintain long-term retention of dermatologic knowledge irrespective of in-class teaching method. Repeat exposure to material is important but self-review of dermatology alone is sufficient for long-term retention. Dermatology course directors should incorporate interactive teaching into medical school curricula to increase learner satisfaction

Id1 Promotes Tumor Cell Migration in Nonsmall Cell Lung Cancers

Id1, which belongs to the Id family of helix-loop-helix transcription factors has been most associated with tumor progression and metastatsis; however, its significance in lung cancers has not been extensively explored. Here we seek to evaluate the expression of Id1 in a pilot study of nonsmall-cell lung cancers (NSCLCs) and determine its diagnostic and functional significance in these tumors. Paired normal and malignant lung tissues as well as a panel of NSCLC primary tumors and cell lines were evaluated for Id1 expression using Western blotting and quantitative RT-PCR. Functional assays were performed to evaluate the role of Id1 in tumor cell growth, migration and progression. We find Id1 expression is upregulated in squamous cell carcinoma when compared to adenocarcinoma of the lung and that expression of Id1 versus the normal control is variable in NSCLCs. We also note that Id1 expression in NSCLC cells is largely growth factor dependant and constitutive expression of Id1 in NSCLC cells significantly increases tumor cell migration without affecting cell proliferation. We conclude that Id1, as a mediator of tumor cell migration, may be an indicator of aggressive potential in nonsmall-cell lung cancers

Systematic Multi-Domain Alzheimer's Risk Reduction Trial (SMARRT): Study Protocol.

This article describes the protocol for the Systematic Multi-domain Alzheimer's Risk Reduction Trial (SMARRT), a single-blind randomized pilot trial to test a personalized, pragmatic, multi-domain Alzheimer's disease (AD) risk reduction intervention in a US integrated healthcare delivery system. Study participants will be 200 higher-risk older adults (age 70-89 years with subjective cognitive complaints, low normal performance on cognitive screen, and ≥ two modifiable risk factors targeted by our intervention) who will be recruited from selected primary care clinics of Kaiser Permanente Washington, oversampling people with non-white race or Hispanic ethnicity. Study participants will be randomly assigned to a two-year Alzheimer's risk reduction intervention (SMARRT) or a Health Education (HE) control. Randomization will be stratified by clinic, race/ethnicity (non-Hispanic white versus non-white or Hispanic), and age (70-79, 80-89). Participants randomized to the SMARRT group will work with a behavioral coach and nurse to develop a personalized plan related to their risk factors (poorly controlled hypertension, diabetes with evidence of hyper or hypoglycemia, depressive symptoms, poor sleep quality, contraindicated medications, physical inactivity, low cognitive stimulation, social isolation, poor diet, smoking). Participants in the HE control group will be mailed general health education information about these risk factors for AD. The primary outcome is two-year cognitive change on a cognitive test composite score. Secondary outcomes include: 1) improvement in targeted risk factors, 2) individual cognitive domain composite scores, 3) physical performance, 4) functional ability, 5) quality of life, and 6) incidence of mild cognitive impairment, AD, and dementia. Primary and secondary outcomes will be assessed in both groups at baseline and 6, 12, 18, and 24 months

Dual-Chamber Pacing for Hypertrophic Cardiomyopathy: A Randomized, Double-Blind, Crossover Trial

AbstractObjectives. In a double-blind, randomized, crossover trial we sought to evaluate the effect of dual-chamber pacing in patients with severe symptoms of hypertrophic obstructive cardiomyopathy.Background. Recently, several cohort trials showed that implantation of a dual-chamber pacemaker in patients with severely symptomatic hypertrophic obstructive cardiomyopathy can relieve symptoms and decrease the severity of the left ventricular outflow tract gradient. However, the outcome of dual-chamber pacing has not been compared with that of standard therapy in a randomized, double-blind trial.Methods. Twenty-one patients with severely symptomatic hypertrophic obstructive cardiomyopathy were entered into this trial after baseline studies consisting of Minnesota quality-of-life assessment, two-dimensional and Doppler echocardiography and cardiopulmonary exercise tests. Nineteen patients completed the protocol and underwent double-blind randomization to either DDD pacing for 3 months followed by backup AAI pacing for 3 months, or the same study arms in reverse order.Results. Left ventricular outflow tract gradient decreased significantly to 55 ± 38 mm Hg after DDD pacing compared with the baseline gradient of 76 ± 61 mm Hg (p < 0.05) and the gradient of 83 ± 59 mm Hg after AAI pacing (p < 0.05). Quality-of-life score and exercise duration were significantly improved from the baseline state after the DDD arm but were not significantly different between the DDD arm and the backup AAI arm. Peak oxygen consumption did not significantly differ among the three periods. Overall, 63% of patients had symptomatic improvement during the DDD arm, but 42% also had symptomatic improvement during the AAI backup arm. In addition, 31% had no change and 5% had deterioration of symptoms during the DDD pacing arm.Conclusions. Dual-chamber pacing may relieve symptoms and decrease gradient in patients with hypertrophic obstructive cardiomyopathy. In some patients, however, symptoms do not change or even become worse with dual-chamber pacing. Subjective symptomatic improvement can also occur from implantation of the pacemaker without its hemodynamic benefit, suggesting the role of a placebo effect. Long-term follow-up of a large number of patients in randomized trials is necessary before dual-chamber pacing can be recommended for all patients with severely symptomatic hypertrophic obstructive cardiomyopathy.(J Am Coll Cardiol 1997;29:435–41

Loss of 5-hydroxymethylcytosine correlates with increasing morphologic dysplasia in melanocytic tumors

DNA methylation is the most well studied epigenetic modification in cancer biology. 5-hydroxymethylcytosine is an epigenetic mark that can be converted from 5-methylcytosine by the ten-eleven translocation gene family. We recently reported the loss of 5-hydroxymethylcytosine in melanoma compared to benign nevi and suggested that loss of this epigenetic marker is correlated with tumor virulence based on its association with a worse prognosis. In this study we further characterize the immunoreactivity patterns of 5-hydroxymethylcytosine in the full spectrum of melanocytic lesions to further validate the potential practical application of this epigenetic marker. 175 cases were evaluated: 18 benign nevi, 20 dysplastic nevi (10 low-grade and 10 high-grade lesions), 10 atypical Spitz nevi, 20 borderline tumors, 5 melanomas arising within nevi, and 102 primary melanomas. Progressive loss of 5-hydroxymethylcytosine from benign dermal nevi to high-grade dysplastic nevi to borderline melanocytic neoplasms to melanoma was observed. In addition, an analysis of the relationship of nuclear diameter to 5-hydroxymethylcytosine staining intensity within lesional cells revealed a significant correlation between larger nuclear diameter and decreased levels of 5-hydroxymethylcytosine. Furthermore, borderline lesions uniquely exhibited a diverse spectrum of staining of each individual case. This study further substantiates the association of 5-hydroxymethylcytosine loss with dysplastic cytomorphologic features and tumor progression and supports the classification of borderline lesions as a biologically distinct category of melanocytic lesions

On the evolution of a star cluster and its multiple stellar systems following gas dispersal

We investigate the evolution, following gas dispersal, of a star cluster produced from a hydrodynamical calculation. We find that when the gas, initially comprising 60% of the mass, is removed, the system settles into a bound cluster containing 30-40% of the stellar mass surrounding by an expanding halo of ejected stars. The bound cluster expands from an initial radius of <0.05 pc to 1-2 pc over 4-10 Myr, depending on how quickly the gas is removed, implying that stellar clusters may begin with far higher stellar densities than usually assumed. With rapid gas dispersal the most massive stars are found to be mass segregated for the first ~1 Myr of evolution, but classical mass segregation only develops for cases with long gas removal timescales. Eventually, many of the most massive stars are expelled from the bound cluster. Despite the high initial stellar density and the extensive dynamical evolution of the system, we find that the stellar multiplicity is almost constant during the 10 Myr of evolution. This is because the primordial multiple systems are formed in a clustered environment and, thus, by their nature are already resistant to further evolution. The majority of multiple system evolution is confined to the decay of high-order systems and the formation of a significant population of very wide (10^4-10^5 AU) multiple systems in the expanding halo. This formation mechanism for wide binaries potentially solves the problem of how most stars apparently form in clusters and yet a substantial population of wide binaries exist in the field. Many of these wide binaries and the binaries produced by the decay of high-order multiple systems have unequal mass components, potentially solving the problem that hydrodynamical simulations of star formation are found to under-produce unequal-mass solar-type binaries.Comment: Accepted by MNRAS, 18 pages, 13 figure

Infant mortality in the hierarchical merging scenario: dependence on gas expulsion time-scales

We examine the effects of gas expulsion on initially substructured and out-of-equilibrium star clusters. We perform N-body simulations of the evolution of star clusters in a static background potential before adjusting that potential to model gas expulsion. We investigate the impact of varying the rate at which the gas is removed, and the instant at which gas removal begins. Reducing the rate at which the gas is expelled results in an increase in cluster survival. Quantitatively, this dependence is approximately in agreement with previous studies, despite their use of smooth and virialized initial stellar distributions. However, the instant at which gas expulsion occurs is found to have a strong effect on cluster response to gas removal. We find if gas expulsion occurs prior to one crossing time, cluster response is poorly described by any global parameters. Furthermore, in real clusters the instant of gas expulsion is poorly constrained. Therefore, our results emphasize the highly stochastic and variable response of star clusters to gas expulsion

Dynamical evolution of star-forming regions

We model the dynamical evolution of star-forming regions with a wide range of initial properties. We follow the evolution of the regions’ substructure using the Q-parameter, we search for dynamical mass segregation using the !MSR technique, and we also quantify the evolution of local density around stars as a function of mass using the "LDR method. The amount of dynamical mass segregation measured by !MSR is generally only significant for subvirial and virialized, substructured regions – which usually evolve to form bound clusters. The "LDR method shows that massive stars attain higher local densities than the median value in all regions, even those that are supervirial and evolve to form (unbound) associations. We also introduce the Q − "LDR plot, which describes the evolution of spatial structure as a function of mass-weighted local density in a star-forming region. Initially dense (>1000 stars pc−2), bound regions always have Q > 1, "LDR > 2 after 5 Myr, whereas dense unbound regions always have Q 2 after 5 Myr. Less dense regions (<100 stars pc−2) do not usually exhibit "LDR > 2 values, and if relatively high local density around massive stars arises purely from dynamics, then the Q − "LDR plot can be used to estimate the initial density of a star-forming region

Sleep Duration and Risk of Ischemic Stroke in Postmenopausal Women * Supplemental Appendix

Many studies have shown a U-shape association between sleep duration and mortality, but epidemiological evidence linking cardiovascular diseases (CVD) with habitual sleep patterns is limited and mixed