“They don’t have the history and the stature:” examining perceptions of Caribbean offshore medical schools held by Canadian medical education stakeholders

Background: Caribbean offshore medical schools are for-profit, private institutions that provide undergraduate medical education to primarily international students, including from the United States or Canada. Despite the growing role that offshore medical schools play in training Canadian physicians, little is known about how these institutions are perceived by those in professional and decision-making positions where graduates intend to practice.Methods: The authors interviewed 13 Canadian medical education stakeholders whose professional positions entail addressing the medical education system or physician workforce. Participants were employed in academic, governmental, and non-governmental organizations in leadership roles.Results: Thematic analysis revealed three cross-cutting perceptions of offshore medical schools: (a) they are at the bottom of an international hierarchy of medical schools; (b) they are heterogeneous in quality of education and student body; and (c) they have a unique business model, characterized by profit-generating and serving international students.Conclusion: Consistent growth of the offshore medical school industry in the Caribbean may result in adverse reputational harms for well-established offshore or regional medical schools. Both comparative (e.g., USMLE pass rate) and intuitive factors (e.g., professional familiarity) informed participants’ perceptions. Participants believed that core principles of social accountability in medical education are incompatible with the offshore medical school model

Drivers of diatom production and the legacy of eutrophication in two river plume regions of the northern Gulf of Mexico

In the northern Gulf of Mexico (nGoM), the Louisiana Shelf (LS) and Mississippi Bight (MB) subregions are influenced by eutrophication to varying degrees. Despite recognition that dissolved silicon may regulate diatom productivity in the nGoM, there is only one published data set reporting biogenic silica (bSiO2) production rates for each subregion. We report that bSiO2 production rates on the LS and MB are high and appear to be controlled by different nutrients among seasons. Despite exceptional upper trophic level biomass regionally, which suggests significant primary production by diatoms (as in other systems), gross euphotic-zone integrated bSiO2 production rates are lower than major bSiO2 producing regions (e.g. upwelling systems). However, when normalizing to the depth of the euphotic zone, the bSiO2 production rates on the LS are like normalized rates in upwelling systems. We suggest local river-plume influenced hydrography concentrates diatom productivity within shallow euphotic zones, making production more accessible to higher trophic organisms. Comparison of rates between the LS and MB suggest that the fluvial nitrate within the LS stimulates bSiO2 production above that in the MB, which has a smaller watershed and is less eutrophic (relatively). Beyond understanding the factors controlling regional bSiO2 production, these data offer the most comprehensive Si-cycle baseline to date as the LS and MB will likely exchange freely in the mid to late century due to land subsidence of the Mississippi River delta and/or sea-level rise

Elliptic general analytic solutions

In order to find analytically the travelling waves of partially integrable autonomous nonlinear partial differential equations, many methods have been proposed over the ages: "projective Riccati method", "tanh-method", "exponential method", "Jacobi expansion method", "new ...", etc. The common default to all these "truncation methods" is to only provide some solutions, not all of them. By implementing three classical results of Briot, Bouquet and Poincare', we present an algorithm able to provide in closed form \textit{all} those travellingz waves which are elliptic or degenerate elliptic, i.e. rational in one exponential or rational. Our examples here include the Kuramoto-Sivashinsky equation and the cubic and quintic complex Ginzburg-Landau equations.Comment: 17 pages, to appear, Studies in Applied Mathematic

Tenecteplase for ST-elevation myocardial infarction in a patient treated with drotrecogin alfa (activated) for severe sepsis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Drotrecogin alfa (activated) (DrotAA), an activated protein C, promotes fibrinolysis in patients with severe sepsis. There are no reported cases or studies that address the diagnosis and treatment of myocardial infarction in septic patients treated with DrotAA.</p> <p>Case presentation</p> <p>A 59-year-old Caucasian man with septic shock secondary to community-acquired pneumonia treated with DrotAA, subsequently developed an ST-elevation myocardial infarction 12 hours after starting DrotAA. DrotAA was stopped and the patient was given tenecteplase thrombolysis resulting in complete resolution of ST-elevation and no adverse bleeding events. DrotAA was restarted to complete the 96-hour course. The sepsis resolved and the patient was discharged from hospital.</p> <p>Conclusion</p> <p>In patients with severe sepsis or septic shock complicated by myocardial infarction, it is difficult to determine if the myocardial infarction is an isolated event or caused by the sepsis process. The efficacy and safety of tenecteplase thrombolysis in septic patients treated with DrotAA need further study.</p

Distinct pattern of TP53 mutations in human immunodeficiency virusâ related head and neck squamous cell carcinoma

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142251/1/cncr31063.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142251/2/cncr31063_am.pd