Development and Validation of a Model to Predict Milestone Levels Based on Entrustable Professional Activity Entrustment-Supervision Levels.

Purpose: Residency programs are increasingly interested in or required to assess residents using Accreditation Council for Graduate Medical Education (ACGME) milestones and specialty-defined entrustable professional activities (EPAs). The authors aimed to develop a model to predict individual residents' milestone levels based on their assigned EPA entrustment-supervision levels.

Method: During 3 academic years from 2021 to 2024, the authors conducted a multisite prospective cohort study at 48 U.

Seizures exacerbate excitatory: inhibitory imbalance in Alzheimer's disease and 5XFAD mice.

Approximately 22% of Alzheimer's disease (AD) patients suffer from seizures, and the co-occurrence of seizures and epileptiform activity exacerbates AD pathology and related cognitive deficits, suggesting that seizures may be a targetable component of AD progression. Given that alterations in neuronal excitatory:inhibitory (E:I) balance occur in epilepsy, we hypothesized that decreased markers of inhibition relative to those of excitation would be present in AD patients. We similarly hypothesized that in 5XFAD mice, the E:I imbalance would progress from an early stage (prodromal) to later symptomatic stages and be further exacerbated by pentylenetetrazol (PTZ) kindling.

Weekend Admissions for Somatic Symptom and Related Disorders and Length of Stay.

Objectives: To evaluate whether admission on weekends affects the length of stay (LOS) for patients hospitalized with somatic symptom and related disorders (SSRDs).

Methods: Data from 2012-2018 was obtained for all patients aged 4 to 21 years (N = 5459) with a primary discharge diagnosis of SSRDs from 52 tertiary care pediatric hospitals in the United States. We obtained patient demographics, admission date and/or time, LOS, procedure count, and comorbid conditions.

The role of mTORC1 activation in seizure-induced exacerbation of Alzheimer's disease.

The risk of seizures is 10-fold higher in patients with Alzheimer's disease than the general population, yet the mechanisms underlying this susceptibility and the effects of these seizures are poorly understood. To elucidate the proposed bidirectional relationship between Alzheimer's disease and seizures, we studied human brain samples (n = 34) from patients with Alzheimer's disease and found that those with a history of seizures (n = 14) had increased amyloid-β and tau pathology, with upregulation of the mechanistic target of rapamycin (mTOR) pathway, compared with patients without a known history of seizures (n = 20). To establish whether seizures accelerate the progression of Alzheimer's disease, we induced chronic hyperexcitability in the five times familial Alzheimer's disease mouse model by kindling with the chemoconvulsant pentylenetetrazol and observed that the mouse model exhibited more severe seizures than the wild-type.

The Medial Metaphyseal Periosteal Artery (MMPA): An Alternate Pedicle for the Medial Femoral Trochlea Flap.

We report a case of medial femoral trochlea flap used for scaphoid proximal pole reconstruction, in which the transverse branch of the descending genicular artery was vestigial. The medial metaphyseal periosteal artery was clearly the dominant pedicle supplying the trochlear region. The flap was safely raised on the medial metaphyseal periosteal artery pedicle.

Implementing Resident Team Assistant Programs at Academic Medical Centers: Lessons Learned.

Background: Excessive inpatient administrative tasks can lead to adverse consequences for residents and their patients. Furthermore, this burden has been linked to depersonalization, a major component of physician burnout.

Objective: To describe the development, implementation, feasibility, acceptability, and early outcomes of Resident Team Assistant (RTA) programs.

Bio-Efficacy of Diatomaceous Earth, Household Soaps, and Neem Oil against (Lepidoptera: Noctuidae) Larvae in Benin.

was first reported in Africa in 2016 and has since become a serious threat to maize/cereal production on the continent. Current control of the pest relies on synthetic chemical insecticides, which can negatively impact the environment and promote the development of resistance when used indiscriminately. Therefore, great attention is being paid to the development of safer alternatives.

Vertebral osteomyelitis due to Poona in a healthy adolescent female.

We present a case of vertebral osteomyelitis in a previously healthy, adolescent Caucasian female athlete. After months of lower back pain, spinal imaging demonstrated phlegmon and suspected osteomyelitis of the L4 vertebral body. A bone biopsy was obtained, and microbiologic cultures yielded pure growth of subsp.

New Mosquitocide Derived From Volcanic Rock.

Malaria, dengue, yellow fever, and the Zika and West Nile Viruses are major vector-borne diseases of humans transmitted by mosquitoes. According to the World Health Organization, over 80% of the world's population is at risk of contacting these diseases. Insecticides are critical for mosquito control and disease prevention, and insect insecticide resistance is on the increase; new alternatives with potentially different modes of action from current chemistry are needed.

ImergardWP: A Non-Chemical Alternative for an Indoor Residual Spray, Effective against Pyrethroid-Resistant (s.l.) in Africa.

Malaria is the deadliest mosquito-borne disease and kills predominantly people in sub-Saharan Africa (SSA). The now widespread mosquito resistance to pyrethroids, with rapidly growing resistance to other insecticide classes recommended by the World Health Organization (WHO), may overturn the successes gained in mosquito control in recent years. It is of utmost importance to search for new, inexpensive, and safe alternatives, with new modes of action, that might improve the efficacy of current insecticides.

Iatrogenic Femur Fracture Following Medial Femoral Condyle Flap Harvest.

A case of iatrogenic femoral fracture after harvest of a medial femoral condyle flap is presented. The procedure was performed for a recalcitrant nonunion of the clavicle that required a flap of 6 × 1 × 1 cm. The patient suffered a supracondylar fracture at the proximal extent of the flap harvest site 3 weeks after surgery, requiring surgical fixation of the femur.

Surgical Treatment and Outcomes of Syndactyly: A Systematic Review.

Different techniques are used to release simple and complex congenital syndactyly in order to create an adequate web space, and to separate the fingers to allow independent function. This article is a systematic review of the literature, aiming to evaluate the evidence for the different techniques and outcome measures utilised. The studies consisted mainly of retrospective, non-controlled descriptive series and a few retrospective cohort studies.

Effects of Non-Invasive Brain Stimulation on Clinical Pain Intensity and Experimental Pain Sensitivity Among Individuals with Central Post-Stroke Pain: A Systematic Review.

Purpose: Central post-stroke pain (CPSP) is a neuropathic disorder resulting in pain and disability. An emerging treatment for CPSP is non-invasive brain stimulation including direct current stimulation [tDCS] and repetitive transcranial magnetic stimulation [rTMS]. This systematic review analyzes the efficacy and quality of non-invasive brain stimulation intervention studies for CPSP.

Cadaveric Dissection of the Axillary Nerve: An Investigation of Extra-Muscular and Intra-Muscular Branching Patterns.

Background: Variations in the axillary nerve branching patterns have been reported. The aim of the study is to investigate the extra- and intra-muscular course of the axillary nerve and quantify the regional innervation of the deltoid.

Methods: In fresh frozen specimens, the origin of the axillary nerve from the posterior cord of the brachial plexus and its extra- and intra-muscular course were identified.

Cost Comparison of Collagenase Clostridium Histolyticum and Fasciectomy for Treatment of Dupuytren's Contracture in the Australian Health System.

Background: Dupuytren's disease results in contracted cords in the hand that lead to deformity and disability. Current treatment options include fasciectomy and an injectable, collagenase clostridium histolyticum. No cost comparison studies have been published within the Australian health care environment.

Neutrophilic Dermatosis of the Hands: A Review of 17 Cases.

Purpose: Neutrophilic dermatosis of the hands is an inflammatory skin condition related to Sweet syndrome that responds to corticosteroids. It commonly affects the dorsum of the hand and often mimics infection, with violaceous inflammatory papules and plaques that may ulcerate. The aim of this study was to review the clinical presentation of neutrophilic dermatosis of the hands.

Pigmented lesions of the nail bed - Clinical assessment and biopsy.

Background: Subungual melanoma is an uncommon type of melanoma that can be difficult to diagnose. Patients often present with advanced primary lesions and have an associated increased risk of nodal disease. Delays in diagnosis are believed to contribute to poor patient outcomes.

House Staff Participation in Patient Safety Reporting: Identification of Predominant Barriers and Implementation of a Pilot Program.

Objectives: Patient safety event (PSE) reporting is a critical element for healthcare organizations that are striving for continuous quality improvement. Although resident physicians routinely provide the majority of direct patient care, the level of their participation in PSE reporting historically has been low. In addition, as part of the Accreditation Council for Graduate Medical Education's Next Accreditation System, the Clinical Learning Environment Review site visit assesses residents' engagement in PSE reporting at each accredited academic institution.

Improving Interdisciplinary Provider Communication Through a Unified Paging System.

Objectives: Interdisciplinary communication at a Veterans Affairs (VA) academic teaching hospital is largely dependent on alphanumeric paging, which has limitations as a result of one-way communication and lack of reliable physician identification. Adverse patient outcomes related to difficulty contacting the correct consulting provider in a timely manner have been reported.

Methods: House officers were surveyed on the level of satisfaction with the current VA communication system and the rate of perceived adverse patient outcomes caused by potential delays within this system.

Application of lower extremity injury severity scores in children.

Purpose: Severe lower extremity trauma presents challenges in decision-making in terms of reconstruction or amputation. While injury severity scores have been developed to aid decision-making in adults, evaluation of their use in children is limited.

Methods: Children presenting with severe lower limb trauma from 2000 to 2010 in a major trauma centre were identified from a trauma registry.

Bilateral scaphotrapezium-trapezoid coalition with bipartite scaphoid: case report.

We report on a 15-year-old girl with bilateral scaphotrapezium-trapezoid coalitions and bipartite scaphoids. There was no history of trauma or any other associated pathology. Wrist pain was alleviated by arthrodesis of the pseudarthrosis of the scaphoid component of the coalitions.