Recent publications
The lack of training in generative AI (GenAI) among most medical educators poses an important challenge. Recognizing this need, an introductory session was created. A pre- and post-survey was distributed to gain insights on the impact of the module and identify concerns about GenAI in medical education. Scores for each statement were higher upon completion of the module session. Feedback showed that the module was well-received and reflected an openness to discuss the benefits and challenges of GenAI. We need to help educators and learners how to use GenAI tools judiciously and understand their benefits and limitations.
The occurrence of white sharks, Carcharodon carcharias, in Ecuadorian waters has been based on informal reports and questionable circumstantial evidence. We reviewed unique video evidence from a commercial tuna purse seiner and confirmed the first record for this apex predator within Ecuadorian waters and one of the few available for the Tropical Eastern Pacific. It is hypothesized that the oceanography resulting from the 2021 La Niña ENSO event may be related to this unusual sighting. We propose a vagrant status for the Galapagos Islands until further evidence can confirm residency.
Background
The secondary NRAS mutation can occur as soon as six months of treatment with BRAF inhibitors such as vemurafenib making this disease extremely challenging to treat. We previously reported novel melanoma leads, 2155-14 and 2155-18 that act via downregulation of spliceosomal heterogenous nuclear ribonuclear proteins H1 and H2 (hnRNPH1/H2) were efficacious in an in vivo model of A375 BRAF mutation. This study aimed to evaluate novel anti-melanoma leads for in vivo efficacy and mechanism of action against different melanoma sub-types.
Methods
To determine these compounds’ broad-spectrum therapeutic potential, we tested them in A375 BRAF/NRAS cell-line derived xenograft in nude mice (n=11). Additionally, we used the B16F10 C57BL/6J syngeneic mouse model to determine in vivo immune response (n=5). Finally, we used BRAF, NRAS, and triple-wild type melanoma cells to assess the mechanism of cell immune response to spliceosomal modulation (n=6). All in vivo data were analyzed using one-way ANOVA to compare means, and significant differences were further analyzed by Sidak’s multiple comparisons. Statistical significance was set at p < 0.05. For NanoString experiments 1.5-fold difference and p-value 0.05 (n=3) were set as cutoffs.
Results
Both 2155-14 and 2155-18 significantly decreased the growth of A375 BRAF/NRAS tumors which was comparable to vemurafenib/cobimetinib. Specifically, tumor weights were vehicle = 0.588±0.25g, vemurafenib/cobimetinib = 0.119±0.104 (p-value <0.0001), 2155-14 = 0.08±0.06 (p-value <0.0001), 2155-18 = 0.08±0.08 (p-value <0.0001). These results were further confirmed by measuring tumor volumes, histopathological assessment of tumor tissues, and immunochemistry. In vitro experiments with BRAF, NRAS, and triple-wild type melanoma cells demonstrated that spliceosomal modulation by 2155-14 and 2155-18 leads to an increase of double-stranded RNA, a known stimulator of interferon signaling. NanoString analysis of gene expression confirmed upregulation of interferon signaling and cellular immune response which is known to upregulate cellular immunogenicity. Finally, treatment of B16F10 syngeneic melanoma mouse model with 2155-14 and 2155-18 resulted in increased tumor infiltration of macrophages (p-value <0.01), dendritic cells (p-value <0.05), B cells (p-value <0.05), and CD4+ T cells (p-value <0.05) as determined by flow cytometry analysis.
Conclusions
In summary, these results suggest a therapeutic potential of targeting spliceosomal proteins hnRNPH1 and H2 and support the potential of 2155-14 and 2155-18 as drug candidates for the treatment of melanoma. Additionally, it demonstrates the potential of spliceosomal inhibition to stimulate immune system response, suggesting the possibility of using such therapies in combination with FDA-approved immunotherapies.
Background
Empathy stands as a cornerstone of humanistic qualities and is essential in healthcare for understanding and alleviating emotional suffering. Despite its necessity, formal empathy training remains elusive in postgraduate medical education across the globe, contributing to decline of humanistic practice among trainees. This study aims to assess and establish the need for empathy training by evaluating the perspectives of postgraduate trainees and faculty.
Materials and Methods
The study was conducted in a medical college of western India in 2023. Three online validated questionnaires were used to assess empathy-related perceptions among faculty and postgraduate trainees across various specialties. The questionnaires focused on demographic data, importance of empathy in patient care, empathy training, perceived levels of empathy, reasons for shortfalls in empathetic behavior and recommendations for nurturing empathy. Data were analyzed quantitatively and thematically.
Results
A total of 150 and 127 responses were gathered and analyzed from faculty and trainees, respectively. Excessive workload, lack of formal training, and technology-dependent fast paced lifestyle were attributed for lack of empathy in clinical care. All the faculty agreed that empathy training is essential and majority (67%) believed that lack of empathetic behavior led to dissatisfaction among patients and caregivers.
Conclusion
Empathetic communication and behaviors are fundamental competencies for health-care professionals. There is need for a structured training for empathy in postgraduate medical curriculum.
Fishes inhabiting the mesopelagic zone of the world's oceans are estimated to account for the majority of the world's fish biomass. They have recently attracted new attention because they are part of the biological carbon pump and have been reconsidered as a contribution to food security. Hence, there is an urgent need to understand how environmental conditions and species interactions shape their assemblages, and how they contribute to the functioning of marine ecosystems. Trait‐based approaches are valuable for addressing these types of questions. However, the biology and ecology of mesopelagic fishes are understudied compared to fishes in shallow and epipelagic waters. Here, we synthesise existing knowledge of traits of mesopelagic fishes and relate them to their role in survival, feeding and growth and reproduction, the key functions that contribute to fitness. Vertical migrations, specialised vision and the use of bioluminescence are among the most striking adaptations to the conditions in the mesopelagic realm. Many traits are interrelated as a result of trade‐offs, which may help to understand selection pressures. While morphological traits are straightforward to observe, major knowledge gaps exist for traits that require frequent sampling, assessment under experimental conditions or age determination. The unique adaptations of mesopelagic fishes need to be included in management strategies as well as fundamental research of the habitat.
Stony coral tissue loss disease (SCTLD) has swept through Florida reefs and caused mass mortality of numerous coral species. In the wake of these losses, efforts are underway to propagate coral species impacted by SCTLD and promote population recovery. However, numerous knowledge gaps must be addressed to effectively grow, outplant, and restore populations of the slower growing, massive species that were lost. Here, we used sexual recruits of Diploria labyrinthiformis spawned in captivity to understand how conditioning, coral size, and nutritional status at outplanting affect coral survivorship, growth, and susceptibility to predation. We found that ex situ conditioning with supplemental feeding increased coral growth rates, resulting in larger sized corals at the time of outplanting. In turn, these corals had higher growth rates in the field and a lower probability of being removed by predators than outplants that were conditioned in in situ nurseries. Additionally, we found that coral size was an important predictor of survivorship, suggesting that hastening the speed at which young corals grow and outplanting larger juveniles can improve restoration outcomes. Taken together, our results suggest that providing supplemental food to corals at ex situ facilities confers benefits that could help restore populations of massive coral species impacted by SCTLD.
Dermatology remains highly competitive, with strong USMLE Step 1 scores traditionally crucial for securing residency positions. The 2023–2024 cycle introduced significant changes, including pass/fail USMLE Step 1 score reports and an expanded program signaling system. This study explores dermatology residency applicant profiles within this new context. A survey of 2023–2024 dermatology applicants was conducted via social media to gather demographic and application data. A total of 63 survey responses were collected: 74.6% matched and 25.4% unmatched. The racial distribution was 54% White/Caucasian, 25.4% Asian/Pacific Islander, 9.5% Black/African American, 4.8% Hispanic/Latino, and 6.3% other. The median USMLE Step 2 score was 257 (215–277). Racial differences in USMLE Step 2 scores were significant (P = 0.031), but did not affect match rates (P = 0.116). Letters of recommendation from dermatology program directors were linked to lower match rates (P = 0.036). A positive correlation was found between the number of audition rotations completed and matching at such programs (r²=0.817). Of all matched respondents, 46.8% matched to a program they did not signal; of these, 50.0% matched to a program at which they completed an audition rotation and 40.9% to their home dermatology program affiliation. The mean number of interviews was 8.02, with matched applicants receiving more invitations than unmatched applicants (9.02 vs. 5.06, P = 0.002). The shift to pass/fail USMLE Step 1 scores and expanded program signaling did not notably affect the median USMLE Step 2 score from prior years or match rates among underrepresented minorities. Success in matching continues to depend on a holistic evaluation.
Social media use (SMU) among millennials (i.e., persons born between 1981 and 1996) is considered a hallmark behavior, with nearly 79% of individuals in this age bracket reportedly using social media multiple times a day. Despite the potential benefits of social media access, this communication method impedes forming deep connections, posing detrimental consequences to enduring romantic relationships among millennials. In recent years, SMU among millennials has skyrocketed, potentially contributing to the increased relational ruptures during this time, such as increased conflict and infidelity rates. With social media providing an outlet for individuals to text, share thoughts, photos, and intimate messages—all with the possibility of evading being caught, the millennial culture is shifting the dynamics of romantic relationships. As a result, therapists are seeing an increased number of couples from the millennial culture with heightened relational dysfunction due to social media and the digital world. Now more than ever, clinicians must be equipped with the necessary skills and competencies to assist millennial romantic relationships impacted by SMU. An in-depth literature review will provide a landscape to examine the role of social media, online dating, partner selection, and issues surrounding infidelity over the last decade. This article will conclude with a case study and recommendations for best practices to help facilitate healing among millennial relationships affected by negative SMU.
The phenomenon of massive coral bleaching around the world is a black storm in coastal ecosystems this century. The annual increase in sea temperature by more than 1⁰C is a terrible fact that occurs due to global warming. There are many concerns raised especially on the cumulative impact of stress that corals experience when sea water temperature rise occurs. For this reason, this article is an intervention to reveal the high- level threat caused by global warming and the connection to coral bleaching events that disrupt coastal ecosystems. The literature study method in this article is useful to review and critically evaluate a number of articles that are closely related to support the fact of the urgency of coral bleaching in various countries. The great biological concern of coral bleaching that damages coastal ecosystems requires immediate mitigation and conservation, if it continues to degrade the number of coral populations significantly affects the decline in fish populations and biodiversity which affects the catch of fishermen and communities that have a major impact on coastal ecosystems. A good conservation strategy is expected to minimize the risk of damage so that it does not backfire on the chaos of coastal ecosystems in the future.
Introduction
The potential capabilities of generative artificial intelligence (AI) tools have been relatively unexplored, particularly in the realm of creating personalized statements for medical students applying to residencies. This study aimed to investigate the ability of generative AI, specifically ChatGPT and Google BARD, to generate personal statements and assess whether faculty on residency selection committees could (1) evaluate differences between real and AI statements and (2) determine differences based on 13 defined and specific metrics of a personal statement.
Methods
Fifteen real personal statements were used to generate 15 unique and distinct personal statements from ChatGPT and BARD each, resulting in a total of 45 statements. Statements were then randomized, blinded, and presented to a group of faculty reviewers on residency selection committees. Reviewers assessed the statements by 14 metrics including if the personal statement was AI-generated or real. Comparison of all metrics was performed.
Results
Faculty correctly identified 88% (79/90) real statements, 90% (81/90) BARD, and 44% (40/90) ChatGPT statements. Accuracy of identifying real and BARD statements was 89%, but this dropped to 74% when including ChatGPT. In addition, the accuracy did not increase as faculty members reviewed more personal statements (area under the curve [AUC] 0.498, p = 0.966). BARD performed poorer than both real and ChatGPT across all metrics (p < 0.001). Comparing real with ChatGPT, there was no difference in most metrics, except for Personal Interests, Reasons for Choosing Residency, Career Goals, Compelling Nature and Originality, and all favoring the real personal statements (p = 0.001, p = 0.002, p < 0.001, p < 0.001, and p < 0.001, respectively).
Conclusion
Faculty members accurately identified real and BARD statements, but ChatGPT deceived them 56% of the time. Although AI can craft convincing statements that are sometimes indistinguishable from real ones, replicating the humanistic experience, personal nuances, and individualistic elements found in real personal statements is difficult. Residency selection committees might want to prioritize these particular metrics while assessing personal statements, given the growing capabilities of AI in this arena.
Clinical Relevance
Residency selection committees may want to prioritize certain metrics unique to the human element such as personal interests, reasons for choosing residency, career goals, compelling nature, and originality when evaluating personal statements.
Context
There is an increasing number of medical school graduates opting for surgical specialties, and the osteopathic applicant match rate for urology is lower than that of allopathic applicants. Factors influencing this may include a lack of interest, perceived challenges in matching into urology, insufficient urology mentorship, limited research opportunities, and inadequate osteopathic representation in urology.
Objectives
The objective of this survey is to assess osteopathic medical students’ perspectives on pursuing urology and enhancing preclinical exposure to and knowledge of urology.
Methods
A 20-question survey addressing experiences and the factors influencing osteopathic medical students’ specialty selection and their interest in and perception of urology was designed by the investigators on Research Electronic Data Capture (REDCap) software. This survey was distributed via email listserv to all current osteopathic medical students attending Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine over 2 months. Responses were collected and analyzed utilizing Fisher’s exact test.
Results
Among 150 respondents, 91 % found mentors crucial in selecting a medical specialty, 95 % emphasized the importance of early exposure, and 68 % lacked familiarity with urology, with more M1 students unfamiliar with urology compared to M2 (70.4 % vs. 59 %). A larger proportion of combined M1 and M2 (preclinical) students are considering urology as a specialty compared to M3 and M4 (clinical) students who are actively on rotations (56.5 % vs. 28.6 %; p=0.0064). Also, a greater percentage of males are considering urology compared to females (64.2 % vs. 42.7 %; p=0.0164). Among those considering urology (n=75), 57.3 % lack awareness of urology’s scope, and 84 % report no preclinical discussions with urologists. Those students who report that they are considering urology value early exposure significantly more than others (98.7 % vs. 78.7 %; p=0.0001). They also express greater interest in having a core urology course (73.3 % vs. 38.7 %; p<0.0001). More urology-considering students are interested in extracurricular urology-related workshops, seminars, or conferences (61.3 % vs. 17.3 %; p<0.0001). Students who are considering urology as a specialty show greater interest in having a mentorship program (85.3 % vs. 28 %; p<0.0001).
Conclusions
Results suggested that increased urology exposure during the preclinical years is important. Urology elective offerings and urology mentorship are of high interest among those considering urology. However, additional investigation is needed to determine the impact of preclinical urology curricula implementation on urology match outcomes.
Purpose
To examine quality of life (QoL) and mental health among Asian Indians in Southwest and Central-west Florida by COVID-related lifestyle changes, and demographic characteristics.
Methods
QoL was assessed using SF-12 questionnaire while mental health/healthcare was assessed using the household pulse survey. Face-to-face interviews and self-administered online surveys were conducted among 151 participants in 2021–22. F and Chi-square statistics were used to examine the differences in QoL scores and mental health/mental healthcare by sociodemographic factors and COVID-related lifestyle changes.
Results
Mental Component Summary (MCS) scores were lower for those who experienced changes in work expectations (p 0.041), sleep (p 0.002), exercise (p < 0.001), meditation (p.004) and connecting with family (p 0.007) and among those with family testing COVID positive (p.012). Mean Physical Component Summary (PCS) scores were lower for caregivers (p .008). PCS scores were lower for certain income groups (p 0.006), retired (p 0.004), older age groups (p 0.002). Lower MCS scores with college education (p .005), those who were students (p <0 .001), younger age groups (p < 0.001). Those who helped with homeschooling felt anxious (p 0.049), couldn’t stop worrying (p 0.046) and took medications (p < 0.001). Participants’ families who tested COVID positive were anxious (p = 0.019) and worried (p = 0.015). Those with greater work expectations sought counseling (p = 0.009) and those who connected more with their family were anxious (p = 0.008).
Conclusion
The pandemic affected QoL, especially the mental component and increased anxiety and worrying. Mental health services for younger individuals, those with caregiving responsibilities and facing increased job demands must be prioritized.
The inoculum effect has been observed for nearly all antibiotics and bacterial species. However, explanations accounting for its occurrence and strength are lacking. Previous work found that the relationship between [ATP] and growth rate can account for the strength and occurrence of the inoculum effect for bactericidal antibiotics. However, the molecular pathway(s) underlying this relationship, and therefore determining the inoculum effect, remain undiscovered. Using a combination of flux balance analysis and experimentation, we show that nucleotide synthesis can determine the relationship between [ATP] and growth and thus the strength of inoculum effect in an antibiotic class-dependent manner. If the [ATP]/growth rate is sufficiently high as determined by exogenously supplied nitrogenous bases, the inoculum effect does not occur. This is consistent for both Escherichia coli and Pseudomonas aeruginosa . Interestingly, and separate from activity through the tricarboxylic acid cycle, we find that transcriptional activity of genes involved in purine and pyrimidine synthesis can predict the strength of the inoculum effect for β-lactam and aminoglycosides antibiotics, respectively. Our work highlights the antibiotic class-specific effect of purine and pyrimidine synthesis on the severity of the inoculum effect, which may pave the way for intervention strategies to reduce the inoculum effect in the clinic.
IMPORTANCE
If a bacterial population can grow and reach a sufficiently high density, routine doses of antibiotics can be ineffective. This phenomenon, called the inoculum effect, has been observed for nearly all antibiotics and bacterial species. It has also been reported to result in antibiotic failure in the clinic. Understanding how to reduce the inoculum effect can make high-density infections easier to treat. Here, we show that purine and pyrimidine synthesis affect the strength of the inoculum effect; as the transcriptional activity of pyrimidine synthesis increases, the strength of the inoculum effect for aminoglycosides decreases. Conversely, as the transcriptional activity of purine synthesis increases, the strength of the inoculum effect for β-lactam antibiotics decreases. Our work highlights the importance of nucleotide synthesis in determining the strength of the inoculum effect, which may lead to the identification of new ways to treat high-density infections in the clinic.
In the absence of demographic data, readily measurable life history traits, like egg size, can be used to predict how vital rates vary across species, facilitating modeling and analysis of high-diversity assemblages. We assessed the larval survival and competency dynamics of four previously unstudied coral species at current and warmed temperatures, and combined it with data for three other species to assess how well egg size predicts the sensitivity to warming of mortality and the minimum time to competency, both determinants of larval dispersal. Minimum time to competency increased with egg size; moreover, warming-induced reductions in time to competency were greater for species with larger eggs. In contrast, mortality rate and its response to warming were both independent of egg size. These findings show how assemblage-level responses to environmental change can be inferred for diverse communities and indicate how warming-induced changes in larval biology may reshape reef coral metacommunities.
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