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In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course. [ABSTRACT FROM AUTHOR]

Severe sepsis, a lethal syndrome after infection or injury, is the third leading cause of mortality in the United States. The pathogenesis of severe sepsis is characterized by organ damage and accumulation of apoptotic lymphocytes in the spleen, thymus, and other organs. To examine the potential causal relationships of apoptosis to organ damage, we administered Z-VAD-FMK, a broad-spectrum caspase inhibitor, to mice with sepsis. We found that Z-VAD-FMK-treated septic mice had decreased levels of high mobility group box 1 (HMGB1), a critical cytokine mediator of organ damage in severe sepsis, and suppressed apoptosis in the spleen and thymus. In vitro, apoptotic cells activate macrophages to release HMGB1. Monoclonal antibodies against HMGB1 conferred protection against organ damage but did not prevent the accumulation of apoptotic cells in the spleen. Thus, our data indicate that HMGB1 production is downstream of apoptosis on the final common pathway to organ damage in severe sepsis. [ABSTRACT FROM AUTHOR]

Letters of recommendation (LORs) play an important role in applicant selection for graduate medical education programs. LORs may be of increasing importance in the evaluation of applicants given the recent change of the USMLE Step 1 to pass/fail scoring and the relative lack of other objective measures by which to differentiate and stratify applicants. Narrative letters of recommendation (NLORs), although widely used, have certain limitations, namely variability in interpretation, introduction of gender/race bias, and performance inflation. Standardized letters of recommendation (SLOR) have been proposed as a potential corrective to these limitations. We conducted a series of semi-structured interviews and focus groups to gather perspectives from letter writers and readers to inform methods for improving information elicited by SLORs from which we collected and analyzed data using the constant comparative method and a process of iterative coding. We applied our findings to the development of a novel SLOR for use in surgical residency program applications and were subsequently invited to help revise existing SLORs for a surgical post-graduate training program., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) has mandated that surgical residencies incorporate formal curricula in each of the 6 competencies, including professionalism. A questionnaire study was developed by the authors that aimed (1) to measure the ability of surgical residents to define components of professionalism, (2) to evaluate the efficacy of the American College of Surgeons (ACS) case-based scenarios in teaching concepts of professionalism, and (3) to determine whether postgraduate level correlates with the ability to articulate the meaning of professionalism., Methods: Surgical residents (n = 47) were matched for PG level and were administered a questionnaire that assessed their ability to articulate concepts of professionalism after either (1) watching the ACS case-based DVD, (2) reading the ACS "Code of Professional Conduct," or (3) neither. Blinded faculty rated responses according to a scoring scale. Data were analyzed statistically to assess differences., Results: Residents who watched the ACS DVD scored higher than those who did not (p = 0.096). Junior and senior residents (PG 2-5) who watched the DVD were more likely to score above the mean than interns (p = 0.095). In contrast to interns, where no differences were observed, among junior and senior residents, the proportion of participants who scored above the mean was higher in the ACS DVD group (p = 0.009)., Conclusions: Surgical residents at all levels were successful in defining components of professionalism. With increased postgraduate level, they matured in their ability to extract concepts of professionalism from the multimedia case-based educational tool. The ACS DVD enhanced the comfort of residents in recognizing challenges to professionalism.