To assess the impact of applicant and residency program characteristics on preference signaling outcomes in the Match during the first 2 years of implementation across 6 specialties.
Data were ...obtained from the Texas Seeking Transparency in Application to Residency survey for applicants applying into otolaryngology during the 2020-2021 and 2021-2022 application cycles and into dermatology, internal medicine (categorical and preliminary year), general surgery, and urology during the 2021-2022 application cycle. The primary outcome was signal yield, defined as the number of interviews at signaled programs divided by the total number of signals sent. Associations with applicant-reported characteristics and geographic connections to residency programs were assessed using Wilcoxon rank sum testing, Spearman's rank correlation testing, and ordinary least squares regression.
1,749 applicants with preference signaling data were included from internal medicine (n = 884), general surgery (n = 291), otolaryngology (n = 217), dermatology (n = 147), urology (n = 124), and internal medicine preliminary year (n = 86). On average 60.9% (standard deviation 32.3%) of signals resulted in an interview (signal yield). There was a stepwise increase in signal yield with the percentage of signals sent to programs with a geographic connection (57.3% for no signals vs. 68.9% for 5 signals, P < .01). Signal yield was positively associated with applicant characteristics, such as United States Medical Licensing Exam Step 1 and 2 scores, honors society membership, and number of publications ( P < .01). Applicants reporting a lower class rank quartile were significantly more likely to have a higher percentage of their interviews come from signaled programs ( P < .01).
Signal yield is significantly associated with geographic connections to residency programs and applicant competitiveness based on traditional metrics. These findings can inform applicants, programs, and specialties as preference signaling grows.
Most cases of pediatric epistaxis are spontaneous and self-resolve. However, a subset of children may experience significant bleeding and require procedural or medical intervention.
We aim to ...identify risk factors associated with moderate and severe epistaxis in the emergency department (ED) and explore management outcomes.
We retrospectively reviewed all patients under 22 years old with epistaxis who presented to our ED between 2013 and 2022. Epistaxis severity was defined as mild (required nasal compression or intranasal medications), moderate (required cautery or packing), or severe (required factor replacement, transfusion, hospital admission, or surgery). We performed univariable and multinomial regression analyses, with risk factors and outcomes analyzed according to severity.
Of 858 visits, 41 (5%) patients had moderate and 67 (8%) had severe epistaxis. Patients with moderate epistaxis were older than those with mild and severe epistaxis (median 15.6 vs. 8.3 vs. 10.7 years, p < 0.001). In regression analysis, moderate epistaxis was associated with older age, prior ED visit within 72 h, and antiplatelet medication use (p < 0.01). Severe epistaxis was associated with bleeding disorders, nasal procedures within 30 days, and anticoagulation medication use (p ≤ 0.001). Bleeding over 30 min prior to arrival was associated with both moderate and severe epistaxis (p < 0.05). Of the 67 patients with severe epistaxis, 10 (15%) required factor replacement, 28 (42%) required transfusion, 52 (77%) required hospital admission, and 5 (7%) underwent surgery.
Epistaxis severity is associated with certain risk factors. However, most cases of pediatric epistaxis are mild and do not require intervention or ED evaluation.
Somatic mutations in DNA‐binding sites for CCCTC‐binding factor (CTCF) are significantly elevated in many cancers. Prior analysis has suggested that elevated mutation rates at CTCF‐binding sites in ...skin cancers are a consequence of the CTCF‐cohesin complex inhibiting repair of UV damage. Here, we show that CTCF binding modulates the formation of UV damage to induce mutation hot spots. Analysis of genome‐wide CPD‐seq data in UV‐irradiated human cells indicates that formation of UV‐induced cyclobutane pyrimidine dimers (CPDs) is primarily suppressed by CTCF binding but elevated at specific locations within the CTCF motif. Locations of CPD hot spots in the CTCF‐binding motif coincide with mutation hot spots in melanoma. A similar pattern of damage formation is observed at CTCF‐binding sites in vitro, indicating that UV damage modulation is a direct consequence of CTCF binding. We show that CTCF interacts with binding sites containing UV damage and inhibits repair by a model repair enzyme in vitro. Structural analysis and molecular dynamic simulations reveal the molecular mechanism for how CTCF binding modulates CPD formation.
Synopsis
In skin cancers, somatic mutations are elevated at a specific hotspot within DNA binding sites of the CTCF insulator protein. Here, genome‐wide analyses and biochemical studies reveal the mechanisms driving UV mutagenesis at CTCF binding sites.
UV‐induced CPD lesions are induced by CTCF binding at the mutation hotspot.
CTCF binding causes a similar pattern of UV damage formation in vitro.
Molecular dynamics simulations reveal the mechanism of UV damage modulation.
CTCF binding inhibits repair of UV damage in cells and in vitro
Genome‐wide CPD‐seq analyses and biochemical studies with a model repair enzyme reveal the mechanisms driving UV mutagenesis at CTCF‐insulator binding sites.
We use the very deep and homogeneous I-band selected dataset of the FORS Deep Field (FDF) to trace the evolution of the luminosity function over the redshift range 0.5 < z < 5.0. We show that the FDF ...I-band selection down to I sub(AB) = 26.8 misses of the order of 10% of the galaxies that would be detected in a K-band selected survey with magnitude limit K sub(AB) = 26.3 (like FIRES). Photometric redshifts for 5558 galaxies are estimated based on the photometry in 9 filters (U, B, Gunn g, R, I, SDSS z, J, K and a special filter centered at 834 nm). A comparison with 362 spectroscopic redshifts shows that the achieved accuracy of the photometric redshifts is Delta z/(z sub(spec) + 1) less than or equal to 0.03 with only similar to 1% outliers. This allows us to derive luminosity functions with a reliability similar to spectroscopic surveys. In addition, the luminosity functions can be traced to objects of lower luminosity which generally are not accessible to spectroscopy. We investigate the evolution of the luminosity functions evaluated in the restframe UV (1500 AA and 2800 AA), u', B, and g' bands. Comparison with results from the literature shows the reliability of the derived luminosity functions. Out to redshifts of z similar to 2.5 the data are consistent with a slope of the luminosity function approximately constant with redshift, at a value of -1.07 plus or minus 0.04 in the UV (1500 AA, 2800 AA) as well as u', and -1.25 plus or minus 0.03 in the blue (g', B). We do not see evidence for a very steep slope ( alpha less than or equal to -1.6) in the UV at < z > similar to 3.0 and < z > similar to 4.0 favoured by other authors. There may be a tendency for the faint-end slope to become shallower with increasing redshift but the effect is marginal. We find a brightening of M* and a decrease of phi * with redshift for all analyzed wavelengths. The effect is systematic and much stronger than what can be expected to be caused by cosmic variance seen in the FDF. The evolution of M* and phi * from z = 0 to z = 5 is well described by the simple approximations M*(z) = M* sub(0) + a ln (1 + z) and phi *(z) = phi * sub(0)(1 + z) super(b) for M* and phi *. The evolution is very pronounced at shorter wavelengths (a = -2.19, and b = -1.76 for 1500 AA rest wavelength) and decreases systematically with increasing wavelength, but is also clearly visible at the longest wavelength investigated here (a = -1.08, and b = -1.29 for g'). Finally we show a comparison with semi-analytical galaxy formation models.
Using the Very Large Telescope in Multi Object Spectroscopy mode, we have observed a sample of 113 field spiral galaxies in the FORS Deep Field (FDF) with redshifts in the range $0.1<z<1.0$. The ...galaxies were selected based on apparent brightness ($R<23^{\rm m}$) and encompass all late spectrophotometric types from Sa to Sdm/Im. Spatially resolved rotation curves have been extracted for 77 galaxies and fitted with synthetic velocity fields taking into account all observational effects from inclination and slit misalignment to seeing and slit width. We also compared different shapes for the intrinsic rotation curve. To obtain robust values of Vmax, our analysis is focused on galaxies with rotation curves that extend well into the region of constant rotation velocity at large radii. If the slope of the local Tully-Fisher relation (TFR) is held fixed, we find evidence for a mass-dependent luminosity evolution which is as large as up to $\Delta M_B \approx -2^{\rm m}$ for the lowest-mass galaxies, but is small or even negligible for the highest-mass systems in our sample. In effect, the TFR slope is shallower at $z \approx 0.5$ in comparison to the local sample. We argue for a mass-dependent evolution of the mass-to-light ratio. An additional population of blue, low-mass spirals does not seem a very appealing explanation. The flatter tilt we find for the distant TFR is in contradiction to the predictions of recent semi-analytic simulations.
Changes in neural activity caused by exposure to drugs may trigger homeostatic mechanisms that attempt to restore normal neural excitability. In Drosophila, a single sedation with the anesthetic ...benzyl alcohol changes the expression of the slo K+ channel gene and induces rapid drug tolerance. We demonstrate linkage between these two phenomena by using a mutation and a transgene. A mutation that eliminates slo expression prevents tolerance, whereas expression from an inducible slo transgene mimics tolerance in naive animals. The behavioral response to benzyl alcohol can be separated into an initial phase of hyperkinesis and a subsequent phase of sedation. The hyperkinetic phase causes a drop in slo gene expression and makes animals more sensitive to benzyl alcohol. It is the sedative phase that stimulates slo gene expression and induces tolerance. We demonstrate that the expression level of slo is a predictor of drug sensitivity.
This article reviews the presentation of children with craniofacial anomalies by the most common sites of airway obstruction. Major craniofacial anomalies may be categorized into those with midface ...hypoplasia, mandible hypoplasia, combined midface and mandible hypoplasia, and midline deformities. Algorithms of airway interventions are provided to guide the initial management of these complex patients.
Optimal Timing of Entry-Level Otolaryngology Simulation Kovatch, Kevin J.; Wertz, Aileen P.; Carle, Taylor R. ...
OTO open : the official open access journal of the American Academy of Otolaryngology--Head and Neck Surgery Foundation,
April‐June 2019, Letnik:
3, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Objective
Appropriate timing of subspecialty simulation is critical to maximize learner benefit and guide resource utilization. We aimed to determine optimal timing of a simulation-based curriculum ...designed to teach entry-level procedural skills for otolaryngology residency.
Study Design
Simulation curriculum intervention tested among 3 comparison groups of varying clinical levels.
Setting
Academic otolaryngology training program and medical school.
Subjects and Methods
We developed a simulation-based technical skills curriculum incorporating the following task trainers: flexible laryngoscopy, peritonsillar abscess drainage, and myringotomy and tube insertion. Preclinical medical students (n = 40), subintern rotators (n = 35), and midyear interns (n = 8) completed the simulation-based curriculum. Pre- and postintervention knowledge/confidence and “level appropriateness” were rated on a 5-point Likert scale, and effect size was calculated.
Results
Overall self-reported knowledge/confidence levels improved in all 3 groups preintervention (1.05, 2.15, 3.17) to postintervention (2.79, 3.45, 4.38, respectively; all P < .01). Preclinical medical students uniformly reported very little to no familiarity with the procedures prior to the curriculum, while interns approached independence following the intervention. Large effect sizes were seen in all tasks for preclinical students (d = 3.13), subinterns (d = 1.46), and interns (d = 2.14). Five-point Likert scale measures of level appropriateness (1 = too challenging, 5 = too easy) for preclinical students, subinterns, and interns were 2.70 (95% CI, 2.56-2.84), 3.11 (95% CI, 2.97-3.25), and 3.75 (95% CI, 3.35-4.15), respectively.
Conclusion
Subinternship may represent the optimal timing for entry-level skills simulation training. The proposed curriculum shows utility for clinical levels ranging from medical students to postgraduate year 1 resident levels, with large effect sizes for all tested groups.
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