Regional Medical Campuses: A New Classification System

There is burgeoning belief that regional medical campuses (RMCs) are a significant part of the narrative about medical education and the health care workforce in the United States and Canada. Although RMCs are not new, in the recent years of medical education enrollment expansion, they have seen their numbers increase. Class expansion explains the rapid growth of RMCs in the past 10 years, but it does not adequately describe their function. Often, RMCs have missions that differ from their main campus, especially in the areas of rural and community medicine. The absence of an easy-to-use classification system has led to a lack of current research about RMCs as evidenced by the small number of articles in the current literature. The authors describe the process of the Group on Regional Medical Campuses used to develop attributes of a campus separate from the main campus that constitute a “classification” of a campus as an RMC. The system is broken into four models—basic science, clinical, longitudinal, and combined—and is linked to Liaison Committee on Medical Education standards. It is applicable to all schools and can be applied by any medical school dean or medical education researcher. The classification system paves the way for stakeholders to agree on a denominator of RMCs and conduct future research about their impact on medical education

Ideal magnetohydrodynamic simulations of unmagnetized dense plasma jet injection into a hot strongly magnetized plasma

We present results from three-dimensional ideal magnetohydrodynamic simulations of unmagnetized dense plasma jet injection into a uniform hot strongly magnetized plasma, with the aim of providing insight into core fueling of a tokamak with parameters relevant for ITER and NSTX (National Spherical Torus Experiment). Unmagnetized dense plasma jet injection is similar to compact toroid injection but with much higher plasma density and total mass, and consequently lower required injection velocity. Mass deposition of the jet into the background appears to be facilitated via magnetic reconnection along the jet's trailing edge. The penetration depth of the plasma jet into the background plasma is mostly dependent on the jet's initial kinetic energy, and a key requirement for spatially localized mass deposition is for the jet's slowing-down time to be less than the time for the perturbed background magnetic flux to relax due to magnetic reconnection. This work suggests that more accurate treatment of reconnection is needed to fully model this problem. Parameters for unmagnetized dense plasma jet injection are identified for localized core deposition as well as edge localized mode (ELM) pacing applications in ITER and NSTX-relevant regimes.Comment: 16 pages, 8 figures and 2 tables; accepted by Nuclear Fusion (May 11, 2011

Biological activity differences between TGF-β1 and TGF-β3 correlate with differences in the rigidity and arrangement of their component monomers

[Image: see text] TGF-β1, -β2, and -β3 are small, secreted signaling proteins. They share 71–80% sequence identity and signal through the same receptors, yet the isoform-specific null mice have distinctive phenotypes and are inviable. The replacement of the coding sequence of TGF-β1 with TGF-β3 and TGF-β3 with TGF-β1 led to only partial rescue of the mutant phenotypes, suggesting that intrinsic differences between them contribute to the requirement of each in vivo. Here, we investigated whether the previously reported differences in the flexibility of the interfacial helix and arrangement of monomers was responsible for the differences in activity by generating two chimeric proteins in which residues 54–75 in the homodimer interface were swapped. Structural analysis of these using NMR and functional analysis using a dermal fibroblast migration assay showed that swapping the interfacial region swapped both the conformational preferences and activity. Conformational and activity differences were also observed between TGF-β3 and a variant with four helix-stabilizing residues from TGF-β1, suggesting that the observed changes were due to increased helical stability and the altered conformation, as proposed. Surface plasmon resonance analysis showed that TGF-β1, TGF-β3, and variants bound the type II signaling receptor, TβRII, nearly identically, but had small differences in the dissociation rate constant for recruitment of the type I signaling receptor, TβRI. However, the latter did not correlate with conformational preference or activity. Hence, the difference in activity arises from differences in their conformations, not their manner of receptor binding, suggesting that a matrix protein that differentially binds them might determine their distinct activities

Actin cytoskeleton assembly regulates collagen production via TGF‐β type II receptor in human skin fibroblasts

The dermal compartment of skin is primarily composed of collagen‐rich extracellular matrix (ECM), which is produced by dermal fibroblasts. In Young skin, fibroblasts attach to the ECM through integrins. During ageing, fragmentation of the dermal ECM limits fibroblast attachment. This reduced attachment is associated with decreased collagen production, a major cause of skin thinning and fragility, in the elderly. Fibroblast attachment promotes assembly of the cellular actin cytoskeleton, which generates mechanical forces needed for structural support. The mechanism(s) linking reduced assembly of the actin cytoskeleton to decreased collagen production remains unclear. Here, we report that disassembly of the actin cytoskeleton results in impairment of TGF‐β pathway, which controls collagen production, in dermal fibroblasts. Cytoskeleton disassembly rapidly down‐regulates TGF‐β type II receptor (TβRII) levels. This down‐regulation leads to reduced activation of downstream effectors Smad2/Smad3 and CCN2, resulting in decreased collagen production. These responses are fully reversible; restoration of actin cytoskeleton assembly up‐regulates TβRII, Smad2/Smad3, CCN2 and collagen expression. Finally, actin cytoskeleton‐dependent reduction of TβRII is mediated by induction of microRNA 21, a potent inhibitor of TβRII protein expression. Our findings reveal a novel mechanism that links actin cytoskeleton assembly and collagen expression in dermal fibroblasts. This mechanism likely contributes to loss of TβRII and collagen production, which are observed in aged human skin.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145494/1/jcmm13685_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145494/2/jcmm13685-sup-0001-FigS1-S2.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145494/3/jcmm13685.pd

Training Students on the Effective Use of Translator Services: How Can You Treat Someone You Don’t Understand?

In 2005, the Virginia Commonwealth University School of Medicine partnered with the Inova Health System to create the first regional branch medical campus in Northern Virginia. As a part of this partnership, the VCU School of Medicine Inova Campus accepts a minimum of twenty-four medical students from the third and fourth year classes annually. In an effort to better prepare the incoming students for their clinical years and an extremely diverse patient population, a video was created to demonstrate effective use of translator services

The Medical Futures Program: How One Regional Medical Campus Educates Its Community

Poster created for the 2012 GRMC Session of the AAMC Annual Meeting. The Virginia Commonwealth University School of Medicine Inova Campus has extensive ties to the northern Virginia community. The Medical Futures Program was created to provide valuable information regarding medical school admissions and current physician workforce issues to high school and university students, their parents, and guests

Faecal Matrix Metalloprotease-9 Is a More Sensitive Marker For Diagnosing Pouchitis Than Faecal Calprotectin – Results From a Pilot Study

Background. Potential non-invasive markers of pouchitis would have a great deal of significance within clinical practice. This study is aimed at assessing the diagnostic accuracy of faecal calprotectin and matrix metalloprotease-9 as potential markers in patients both with and without pouchitis. Patients and methods. Stool and blood samples were collected from 33 ileal pouch-anal anastomosis patients before a follow-up pouchoscopy. Biopsy samples were taken for histological purposes. The presence of cuffitis and stenosis was evaluated with an endoscopy. Calprotectin and matrix metalloprotease-9 were quantified with an enzyme-linked immunosorbent assay. Results. Pouchitis was detected in 30.3% of the patients. The levels of faecal calprotectin and matrix metalloprotease-9 increased significantly in patients with pouchitis. The sensitivity and specificity of matrix metalloprotease-9 was higher than that of faecal calprotectin. Only matrix metalloprotease-9 correlated significantly with the severity of pouchitis. Conclusions. Faecal matrix metalloprotease-9 has a high specificity in the diagnosis of pouchitis

M3 SOAP Note Training: Don’t Take the Basics for Granted

The Virginia Commonwealth University School of Medicine (VCU SOM) is a premier academic medical center in the United States that is focused on medical education innovation. The main campus is located in Richmond, Virginia. In 2005, the VCU SOM partnered with Inova Health Systems to create a regional medical campus in Northern Virginia, the VCU SOM Inova Campus. In August 2009, two fourth-year medical students created and presented on “SOAP Notes: A M3 Primer” to third year students at the Clinical Skills Day, as part of M3 orientation. This project was completed in collaboration with Inova Research in Medical Education Center

A Frameshift in CSF2RB Predominant Among Ashkenazi Jews Increases Risk for Crohn's Disease and Reduces Monocyte Signaling via GMCSF

BACKGROUND & AIMS: Crohn's disease (CD) has the highest prevalence in Ashkenazi Jewish populations. We sought to identify rare, CD-associated frameshift variants of high functional and statistical effects. METHODS: We performed exome-sequencing and array-based genotype analyses of 1477 Ashkenazi Jewish individuals with CD and 2614 Ashkenazi Jewish individuals without CD (controls). To validate our findings, we performed genotype analyses of an additional 1515 CD cases and 7052 controls for frameshift mutations in the colony stimulating factor 2 receptor beta common subunit gene (CSF2RB). Intestinal tissues and blood samples were collected from patients with CD; lamina propria leukocytes were isolated and expression of CSF2RB and GMCSF-responsive cells were defined by mass cytometry (CyTOF analysis). Variants of CSF2RB were transfected into HEK293 cells and expression and functions of gene products were compared. RESULTS: In the discovery cohort, we associated CD with a frameshift mutation in CSF2RB (P=8.52x10-4); the finding was validated in the replication cohort (combined P=3.42x10-6). Incubation of intestinal lamina propria leukocytes with GMCSF resulted in high levels of phosphorylation of STAT5 and lesser increases in phosphorylation of ERK and AKT. Cells co-transfected with full-length and mutant forms of CSF2RB had reduced pSTAT5 following stimulation with GMCSF, compared to cells transfected with control CSF2RB, indicating a dominant negative effect of the mutant gene. Monocytes from patients with CD who were heterozygous for the frameshift mutation (6% of CD cases analyzed) had reduced responses to GMCSF and markedly decreased activity of aldehyde dehydrogenase; activity of this enzyme has been associated with immune tolerance. CONCLUSIONS: In a genetic analysis of Ashkenazi Jewish individuals, we associated CD with a frameshift mutation in CSF2RB. Intestinal monocytes from carriers of this mutation had reduced responses to GMCSF, providing an additional mechanism for alterations to the innate immune response in individuals with CD

Regional Medical Campus Match Data 2007-2009 Comparisons, Analysis, and Trends

Poster created for the 2010 AAMC Workforce Conference, present analysis of match data from all regional medical campuses for 2007-2009