Reimagining the Path of an Unmatched Orthopaedic Residency Application: A Survey of Program Directors

BACKGROUND: Few evidence-based suggestions are available to help applicants and mentors improve reapplication outcomes. We sought to provide program directors\u27 (PDs) perspectives on actionable steps to improve reapplicants\u27 chances for a match. METHODS: The PDs were asked to rank positions unmatched applicants can pursue, steps these applicants can take for the next application cycle, and reasons why reapplicants do not match. RESULTS: Responses from 66 of 123 PDs were received (53.6% response rate). Obtaining new recommendation letters and rotating with orthopaedics were the highest 20 ranked steps unmatched applicants can take. No curriculum vitae (CV) improvement, poor interview, and poor letters of recommendation were the most important reasons hindering applicants from matching when reapplying. CONCLUSIONS: Steps reapplicants could prioritize include obtaining new recommendation letters, rotating in orthopaedics, and producing new research items. CV strengthening and improving interview skills address the 2 main reasons why unmatched applicants failed in subsequent attempts. LEVEL OF EVIDENCE: Level IV

Induction Heating Model of Cermet Fuel Element Environmental Test (CFEET)

Deep space missions with large payloads require high specific impulse and relatively high thrust to achieve mission goals in reasonable time frames. Nuclear Thermal Rockets (NTR) are capable of producing a high specific impulse by employing heat produced by a fission reactor to heat and therefore accelerate hydrogen through a rocket nozzle providing thrust. Fuel element temperatures are very high (up to 3000 K) and hydrogen is highly reactive with most materials at high temperatures. Data covering the effects of hightemperature hydrogen exposure on fuel elements are limited. The primary concern is the mechanical failure of fuel elements due to large thermal gradients; therefore, highmeltingpoint ceramicsmetallic matrix composites (cermets) are one of the fuels under consideration as part of the Nuclear Cryogenic Propulsion Stage (NCPS) Advance Exploration System (AES) technology project at the Marshall Space Flight Center. The purpose of testing and analytical modeling is to determine their ability to survive and maintain thermal performance in a prototypical NTR reactor environment of exposure to hydrogen at very high temperatures and obtain data to assess the properties of the nonnuclear support materials. The fission process and the resulting heating performance are well known and do not require that active fissile material to be integrated in this testing. A smallscale test bed; Compact Fuel Element Environmental Tester (CFEET), designed to heat fuel element samples via induction heating and expose samples to hydrogen is being developed at MSFC to assist in optimal material and manufacturing process selection without utilizing fissile material. This paper details the analytical approach to help design and optimize the test bed using COMSOL Multiphysics for predicting thermal gradients induced by electromagnetic heating (Induction heating) and Thermal Desktop for radiation calculations

Human fecal contamination of water, soil, and surfaces in households sharing poor-quality sanitation facilities in Maputo, Mozambique

Identifying the origin of fecal contamination can support more effective interventions to interrupt enteric pathogen transmission. Microbial source tracking (MST) assays may help to identify environmental routes of pathogen transmission although these assays have performed poorly in highly contaminated domestic settings, highlighting the importance of both diagnostic validation and understanding the context-specific ecological, physical, and sociodemographic factors driving the spread of fecal contamination. We assessed fecal contamination of compounds (clusters of 2-10 households that share sanitation facilities) in low-income neighborhoods of urban Maputo, Mozambique, using a set of MST assays that were validated with animal stool and latrine sludge from study compounds. We sampled five environmental compartments involved in fecal microbe transmission and exposure: compound water source, household stored water and food preparation surfaces, and soil from the entrance to the compound latrine and the entrances to each household. Each sample was analyzed by culture for the general fecal indicator Escherichia coli (cEC) and by real-time PCR for the E. coli molecular marker EC23S857, human-associated markers HF183/BacR287 and Mnif, and GFD, an avian-associated marker. We collected 366 samples from 94 households in 58 compounds. At least one microbial target (indicator organism or marker gene) was detected in 96% of samples (353/366), with both E. coli targets present in the majority of samples (78%). Human targets were frequently detected in soils (59%) and occasionally in stored water (17%) but seldom in source water or on food surfaces. The avian target GFD was rarely detected in any sample type but was most common in soils (4%). To identify risk factors of fecal contamination, we estimated associations with sociodemographic, meteorological, and physical sample characteristics for each microbial target and sample type combination using Bayesian censored regression for target concentration responses and Bayesian logistic regression for target detection status. Associations with risk factors were generally weak and often differed in direction between different targets and sample types, though relationships were somewhat more consistent for physical sample characteristics. Wet soils were associated with elevated concentrations of cEC and EC23S857 and odds of detecting HF183. Water storage container characteristics that expose the contents to potential contact with hands and other objects were weakly associated with human target detection. Our results describe a setting impacted by pervasive domestic fecal contamination, including from human sources, that was largely disconnected from the observed variation in socioeconomic and sanitary conditions. This pattern suggests that in such highly contaminated settings, transformational changes to the community environment may be required before meaningful impacts on fecal contamination can be realized

Dietary Supplements and Sports Performance: Minerals

Minerals are essential for a wide variety of metabolic and physiologic processes in the human body. Some of the physiologic roles of minerals important to athletes are their involvement in: muscle contraction, normal hearth rhythm, nerve impulse conduction, oxygen transport, oxidative phosphorylation, enzyme activation, immune functions, antioxidant activity, bone health, and acid-base balance of the blood. The two major classes of minerals are the macrominerals and the trace elements. The scope of this article will focus on the ergogenic theory and the efficacy of such mineral supplementation

Swarming populations of Salmonella represent a unique physiological state coupled to multiple mechanisms of antibiotic resistance

Salmonella enterica serovar Typhimurium is capable of swarming over semi-solid surfaces. Although its swarming behavior shares many readily observable similarities with other swarming bacteria, the phenomenon remains somewhat of an enigma in this bacterium since some attributes skew away from the better characterized systems. Swarming is quite distinct from the classic swimming motility, as there is a prerequisite for cells to first undergo a morphological transformation into swarmer cells. In some organisms, swarming is controlled by quorum sensing, and in others, swarming has been shown to be coupled to increased expression of important virulence factors. Swarming in serovar Typhimurium is coupled to elevated resistance to a wide variety of structurally and functionally distinct classes of antimicrobial compounds. As serovar Typhimurium differentiates into swarm cells, the pmrHFIJKLM operon is up-regulated, resulting in a more positively charged LPS core. Furthermore, as swarm cells begin to de-differentiate, the pmr operon expression is down-regulated, rapidly reaching the levels observed in swim cells. This is one potential mechanism which confers swarm cells increased resistance to antibiotics such as the cationic antimicrobial peptides. However, additional mechanisms are likely associated with the cells in the swarm state that confer elevated resistance to such a broad spectrum of antimicrobial agents

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations

Impacts of an urban sanitation intervention on fecal indicators and the prevalence of human fecal contamination in Mozambique

Fecal source tracking (FST) may be useful to assess pathways of fecal contamination in domestic environments and to estimate the impacts of water, sanitation, and hygiene (WASH) interventions in low-income settings. We measured two non-specific and two human-associated fecal indicators in water, soil, and surfaces before and after a shared latrine intervention from low-income households in Maputo, Mozambique participating in the Maputo Sanitation (MapSan) trial. Up to a quarter of households were impacted by human fecal contamination, but trends were unaffected by improvements to shared sanitation facilities. The intervention reduced E. coli gene concentrations in soil but did not impact culturable E. coli or the prevalence of human FST markers in a difference-in-differences analysis. Using a novel Bayesian hierarchical modeling approach to account for human marker diagnostic sensitivity and specificity, we revealed a high amount of uncertainty associated with human FST measurements and intervention effect estimates. The field of microbial source tracking would benefit from adding measures of diagnostic accuracy to better interpret findings, particularly when FST analyses convey insufficient information for robust inference. With improved measures, FST could help identify dominant pathways of human and animal fecal contamination in communities and guide implementation of effective interventions to safeguard health

An assessment of the dilution required to mitigate Hanford tank 241-SY-101

A group of experts from PNL and WHC convened November 2 and 3, 1994, to screen the current state of knowledge about dilution and reach a consensus on the minimum dilution ratio that will achieve passive mitigation of Tank 241-SY-101 wastes and the dilution ratio that would satisfy the given cross-site transfer criteria with reasonable assurance. The panel evaluated the effects of dilution on the parameters important in gas generation, retention, and release and reached the following conclusions, which are deduced from the existing body of data, experience, and analyses: (1) Dissolution of solids is the single most important aspect of mitigation by dilution. We are confident that diluting until nitrates, nitrites, and aluminum salts are dissolved will mitigate Hanford flammable gas tanks; (2) Sufficient solids dissolution can be achieved in Tank 241-SY-101 at a dilution ratio of 1:1, which will result in a average specific gravity of approximately 1.35. It is likely that a 0.5:1 dilution will also mitigate 241-SY-101, but the current uncertainty is too high to recommend this dilution ratio; (3) The recommended dilution requires a diluent with at least 2 molar free hydroxide, because aluminum probably precipitates at lower hydroxide concentrations. The transfer criteria for Tank 241-SY-101 waste were also evaluated. These criteria have been specified as solids content {<=}30% (volume), viscosity {<=}30% cP and density <1.5 g/mL. (1) Solids content is the limiting criterion if it is defined as volume fraction of settled solids. A 1:1 dilution will satisfy this criterion at nominal premixing conditions in Tank 241-SY-101; however, analysis of Window E core samples suggests that up to 1.5:1 might be required. If the solids content is interpreted simply as solids volume fraction no further dilution is necessary, because Tank 241-SY-101 waste (excluding the crust) is already below 30%; (2) Bulk density is the next limiting criterion and is met at 0.4:1 dilution