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1) Help novice students scaffold problem-solving, engage safely in the deliberate practice of diagnostic reasoning and medical decision-making in real-time; 2) Assess how accurately students gather and apply data in medical reasoning and treatment during High Fidelity Patient Simulations (HFPS); 3) Identify students scientific misconceptions related to the case; 4) Promote student metacognitive processing, self-assessment and self-efficacy; 5) Facilitate the explicit calibration of student confidence in deliberate reasoning with patient outcomes.Mixed method; metacognitive calibration self-assessing (MCC) survey tool applied to HFPS; N=80, 20 teams of 6 medical students; Semi-structured interviews with faculty N=5.When scored by faculty using a rubric, the mean student accuracy ranged from 23-74%, whereas their self-assessment of confidence ranged from 71-86%. This result revealed overconfidence bias in novice students regarding the correctness of their wrong responses. The most common misconception identified was inverting cause and effect: metabolic acidosis was pointed to as the cause of the patient's problems, rather than a consequence of untreated diabetes mellitus. The most common treatment error was overtreatment, with unnecessary added medication. Interviews with faculty suggested the MCC tool improved the team process by slowing students down, requiring them to think through their answers, and that overall, the tool improved their critical thinking.This study demonstrated the feasibility of using a metacognitive confidence calibration tool to assist students in learning to make deliberate diagnostic reasoning and on patient care in real-time during simulations while observing objectively their levels of psychological confidence against patient outcomes.

Pentraxin-related protein 3 (PTX3), commonly produced by myeloid and endothelial cells, is a humoral pattern recognition protein of the innate immune system. Because PTX3 plasma levels of patients with chronic lymphocytic leukemia (CLL) are high and most circulating cells in patients with CLL are CLL cells, we reasoned that CLL cells produce PTX3. Western immunoblotting revealed that low-density cells from seven of seven patients with CLL produce high levels of PTX3, flow cytometry analysis revealed that the PTX3-producing cells are B lymphocytes coexpressing CD19 and CD5, and confocal microscopy showed that PTX3 is present in the cytoplasm of CLL cells. Because STAT3 is constitutively activated in CLL cells, and because we identified putative STAT3 binding sites within the PTX3 gene promoter, we postulated that phosphorylated STAT3 triggers transcriptional activation of PTX3. Immunoprecipitation analysis of CLL cells’ chromatin fragments showed that STAT3 Abs precipitated PTX3 DNA. STAT3 knockdown induced a marked reduction in PTX3 expression, indicating a STAT3-induced transcriptional activation of the PTX3 gene in CLL cells. Using an EMSA, we established and used a dual-reporter luciferase assay to confirm that STAT3 binds the PTX3 gene promoter. Downregulation of PTX3 enhanced apoptosis of CLL cells, suggesting that inhibition of PTX3 might benefit patients with CLL.

Whole-cell spectra of human pathogens are examined to identify species-specific wavelengths of maximum light absorption. It is presented how these data relate to clinical efficacy for antimicrobial phototherapies. Twelve species of microorganisms were cultured to exponential growth then processed and suspended in a scattering solution. Diffuse reflectance from the sample was delivered to two spectrometers that covered a spectral range of 370nm to 1200nm. Reflectance spectra were converted to relative absorbance. Absorbance spectra from multiple trials were averaged to produce a representative spectrum for each species. All pathogens studied demonstrated an absorbance spectrum with a primary component in the range 405-426 nm and 1-4 secondary components in the range 445-636 nm. Antibiotic-resistant and antibiotic-sensitive strains of Pseudomonas aeruginosa (Pa) had identical absorbance spectra. Whole-cell spectra support the hypothesis that a pathogen’s absorbance is directly related to efficacy of photoinactivation. The spectral signatures in all pigmented bacteria tested appear to be that of various combinations of in situ porphyrins. The knowledge of the absorption spectrum of a given pathogen provides a logical start for selecting the appropriate light source for a clinical trial.

Supplemental Table 1. Patient Characteristics

Patient and disease characteristics

There is uncertainty about the choice of anticoagulation therapy in patients with malignancy and venous thromboembolism (VTE). While low-molecular weight heparin (LMWH) remains the current standard, direct oral anticoagulants (DOACs) have emerged as an appealing alternative option. The primary objective of this analysis was to compare the efficacy and safety of DOACs versus LMWH in patients with malignancy and VTE. The secondary objective was to compare the safety and efficacy of the different DOACs. An online search of PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov from inception until April 2020 was conducted. Four RCTs encompassing 2,907 patients, (50.5% men and mean age of 65.7 ± 10.5) were selected. At a mean follow up of 12 months, moderate certainty evidence showed no differences between DOAC and LMWH in VTE recurrence (HR, 0.54 [CI 0.23 to 1.28], I2 = 56%, p=0.23), in major bleeding (HR, 1.38 [CI 0.45 to 4.22], I2 = 33%, p=0.21) or clinically relevant non-major bleeding (CRNMB) (HR, 1.77 [CI 0.49 to 6.40], I2 = 73.9%, p=0.087). There was no difference between the DOACs when compared to each other. In conclusion, DOACs are an acceptable alternative to LMWHs for the treatment of VTE in patients with malignancy.

It is well known that undergraduate medical education demands learners to master large amounts of material. To help cope with learning, medical students have resorted to e-learning resources that include video lectures, visual mnemonics, and flashcard systems. The purpose of the current study was to determine the usage of Anki (Damien Elmes, https://apps.ankiweb.net/) among first-year medical students in an integrated first-year module consisting of anatomy and physiology. Additionally, this study aimed to elucidate how students used Anki in conjunction with their lectures. Sixty first-year medical students were recruited in a twelve-week longitudinal study consisting of three surveys (Weeks 1, 7, and 13) about usage of Anki and their perceptions of how to use it with formal lecture. About 70% of participants utilized Anki in the course and the usage increased significantly from Week 1 to Weeks 7 and 13. There was variation to how many days a week students used Anki. Survey data shows that students value formal lectures and prefer to supplement their studies with Anki. A large proportion of first-year medical students use Anki to supplement their studies. Faculty should consider ways to incorporate Anki into their teaching to facilitate student learning through active recall and spaced repetition.

The purpose of this innovation was to utilize high-fidelity patient simulation (HFPS) activities for students to self-reflect on their study strategies and performance to provide metacognitive awareness. Students wrote self-reflections after HFPS activities comparing their individual responses to faculty answers focusing on study approach and future planning.

Commercial-off-the-shelf learning platforms developed for medical education (herein referred to as MedED-COTS) have emerged as a resource used by a majority of medical students to prepare for licensing examinations. As MedED-COTS proliferate and include more functions and features, there is a need for an up-to-date review to inform medical educators on (a) students’ use of MedED-COTS outside the formal medical school curriculum, (b) the integration of MedED-COTS into the formal curriculum, and (c) the potential effects of MedED-COTS usage on students’ national licensing exam scores in the USA. Due to the limited number of studies published on either the use or integration of MedED-COTS, a focused review of literature was conducted to guide future research and practice. Data extraction and quality appraisal were conducted independently by three reviewers; with disagreements resolved by a fourth reviewer. A narrative synthesis was completed to answer research questions, contextualize results, and identify trends and issues in the findings reported by the studies included in the review. Results revealed consistent positive correlations between students’ use of question banks and their licensing exam performance. The limited number of integration studies, combined with a number of methodological issues, makes it impossible to isolate specific effects or associations of integrated commercial resources on standardized test or course outcomes. However, consistent positive correlations, along with students’ pervasive use and strong theoretical foundations explaining the results, provide evidence for integrating MedED-COTS into medical school curricula and highlight the need for further research. Based on findings, we conclude that students use exam preparation materials broadly and they have a positive impact on exam results; the literature on integration of MedED-COTS into formal curriculum and the use by students of resources outside of exam preparation is scant.

Low voltage activated (ICa-LVA) calcium currents including Cav1.3 and T-type calcium current (ICa-T) have not been reported in adult human left ventricular myocytes (HLVMs). We tried to examine the...

Illness scripts describe the mental model used by experienced clinicians to store and recall condition-specific knowledge when making clinical decisions. Studies demonstrate that novice clinicians struggle to develop and apply strong illness scripts. We developed the Integrated Illness Script and Mechanism of Disease (IIS-MOD) map framework to address this challenge.

Recommendations have been made for improving medical education based on the available evidence regarding learning. Traditional learning methods in medical education (e.g. reading from textbooks) do not ensure long-term retention. However, expanded-retrieval studying methods have been shown to improve studying efficiency. Using evidence-based practices to optimize an expanded-retrieval platform has the potential to greatly benefit knowledge acquisition and retention for medical students. This literature review was conducted to identify the best practices of expanded-retrieval platforms. Themes within learning that promote knowledge gain and retention include presentation of related categorical information, schema formation, dual-coding, concrete examples, elaboration, changes in text appearance, and interleaving. Presentation of related categorical material together may mitigate retrieval-induced forgetting (RIF). Spaced retrieval helps to reinforce schema formation by solidifying the framework the individual students form when learning the material. Dual-coding improves learning by creating more neural pathways. Multiple concrete examples can be compared by students to see their respective differences, highlighting the true underlying principle. Variation in text appearance is most useful during the initial, short-term inter-study intervals. Interleaving is a theme where different topics are combined in the same study session and is unpopular with students but shown to be successful. Students' subjective competency ratings of new material are largely inaccurate. More in-depth processing and learning methods that give off a sense of lower competency are actually associated with improved long-term retention. Expanded-retrieval platforms should utilize these evidence-based components of learning to increase knowledge gain and retention within all fields of medical education.

Low voltage activated (ICa-LVA) calcium currents including Cav1.3 and T-type calcium current (ICa-T) have not been reported in adult human left ventricular myocytes (HLVMs). We tried to examine their existence and possible correlation with etiology and patient characteristics in a big number of human LVMs isolated from explanted terminally failing (F) hearts, failing hearts with left ventricular assist device (F-LVAD) and nonfailing (NF) human hearts. LVA (ICa-LVA) was determined by subtracting L-type Ca2+ current (ICa-L) recorded with the holding potential of −50 mV from total Ca2+ current recorded with the holding potential of −90 mV or −70 mV. ICa- LVA was further tested with its sensitivity to 100 µM CdCl2 and tetrodotoxin. Three HLVMs (3 of 137 FHLVMs) from 2 (N = 30 hearts) failing human hearts, of which one was idiopathic and the other was due to primary pulmonary hypertension, were found with ICa-LVA. ICa-LVA in one FHLVM was not sensitive to 100 µM CdCl2 while ICa-LVA in another two FHLVMs was not sensitive to tetrodotoxin. It peaked at the voltage of −40~-20 mV and had a time-dependent decay faster than ICa-L but slower than sodium current (INa). ICa-LVA was not found in any HLVMs from NF (75 HLVMs from 17 hearts) or F-LVAD hearts (82 HLVMs from 18 hearts) but a statistically significant correlation could not be established. In conclusion, ICa-LVA was detected in some HLVMs of a small portion of human hearts that happened to be nonischemic failing hearts.

The intent of this study was to provide a retrospective analysis of the clinical outcomes of 222 consecutive patients with 437 implants diagnosed with peri-implantitis and treated with the LAPIP protocol. All patients treated with LAPIP therapy at this practice were included. The primary outcome variable studied was probing depth (PD), and secondary variables were erythema, bleeding on probing, and suppuration. The significance of reductions in PD and clinical signs was assessed using repeated-measures analysis of variance. Complete data for both baseline and follow-up visits were available for 116 patients with a total of 224 treated implants. The rate of successful treatments-defined as follow-up PD ≤ 4.0 mm and elimination of clinical signs-was 90%. The reduction in PD from 5.4 mm at baseline to 3.4 mm at a median of 7.6 months was statistically significant (P ≤ 0.001). The reduction in the frequency of clinical signs was also statistically significant (P ≤ 0.001). Among 138 patients who had follow-up visits but not necessarily complete PD data, 15 implants were recorded as failed and 249 were recorded as intact at the median longest follow-up time of 13.1 months, resulting in a survival rate of 94%. In this single clinical practice, use of the minimally invasive LAPIP protocol for the treatment of peri-implantitis provided effective and predictable clinical outcomes. Future randomized controlled trials are indicated.

teaching healthcare providers, such as physicians, nurses, medical assistants, psychologists, and physical therapists, about the physiology of nutrition, sleep, and exercise (lifestyle medicine) is essential for their professional education ([8][1]); however, such instruction has proven to be

Patients expect physicians to be lifelong learners who are able to interpret and evaluate diagnostic tests, and most medical schools list the development of lifelong learning in their program objectives. However, lecture is the most often utilized form of teaching in the first two years and is considered passive learning. The current generation of medical students has many characteristics that should support active learning pedagogies. The purpose of this study was to analyze student and faculty perceptions of active learning in an integrated medical curriculum at the second-year mark, where students have been exposed to multiple educational pedagogies. The first hypothesis of the study was that faculty would favor active learning methods. The second hypothesis was that Millennial medical students would favor active learning due to their characteristics. Primary faculty for years 1 and 2 and second-year medical students were recruited for an e-mail survey consisting of 12 questions about active learning and lecture. Students perceived that lecture and passive pedagogies were more effective for learning, whereas faculty felt active and collaborative learning was more effective. Students believed that more content should be covered by lecture than faculty. There were also significant differences in perceptions of what makes a good teacher. Students and faculty both felt that lack of time in the curriculum and preparation time were barriers for faculty. The data suggest that students are not familiar with the process of learning and that more time may be needed to help students develop lifelong learning skills.

Multiple-choice questions are a gold-standard tool in medical school for assessment of knowledge and are the mainstay of licensing examinations. However, multiple-choice questions items can be criticized for lacking the ability to test higher-order learning or integrative thinking across multiple disciplines. Our objective was to develop a novel assessment that would address understanding of pathophysiology and pharmacology, evaluate learning at the levels of application, evaluation and synthesis, and allow students to demonstrate clinical reasoning. The rubric assesses student writeups of clinical case problems. The method is based on the physician's traditional postencounter Subjective, Objective, Assessment and Plan note. Students were required to correctly identify subjective and objective findings in authentic clinical case problems, to ascribe pathophysiological as well as pharmacological mechanisms to these findings, and to justify a list of differential diagnoses. A utility analysis was undertaken to evaluate the new assessment tool by appraising its reliability, validity, feasibility, cost effectiveness, acceptability, and educational impact using a mixed-method approach. The Subjective, Objective, Assessment and Plan assessment tool scored highly in terms of validity and educational impact and had acceptable levels of statistical reliability but was limited in terms of acceptance, feasibility, and cost effectiveness due to high time demands on expert graders and workload concerns from students. We conclude by making suggestions for improving the tool and recommend deployment of the instrument for low-stakes summative assessment or formative assessment.

Background and objective It is commonly believed that pigmented pathogens are selectively targeted by dental lasers. To test this notion optical diffuse reflection spectroscopy (DRS) was used to obtain absorption spectra for the periodontal pathogens, Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi). Materials and methods Spectra from 400 to 1,100 nm wavelengths of Pg colonies cultured with different concentrations of hemin were obtained to test the hypothesis that "visual pigmentation" predicts absorption of near-infrared (IR) dental laser energy. Ablation threshold at 1,064 nm [1] was measured for the pathogenic fungus, Candida albicans (Ca). Results The hypothesis was demonstrated to be true at 810 nm, it was false at 1,064 nm. Diode laser (810 nm) efficacy and "depth of kill" is dependent on hemin availability from 400 to about 900 nm. Pg and Pi absorption at 1,064 nm (µa = 7.7 ± 2.6 cm(-1) ) is independent of hemin availability but is determined by another unknown chromophore. Ca is non-pigmented but very sensitive to 1,064 nm irradiation. Conclusions The amount of visual pigmentation does not necessarily predict sensitivity to dental laser irradiation. Spectra in visible and near-IR wavelengths demonstrate a large difference in absorption between soft tissue and Pg or Pi. This difference represents a host/pathogen differential sensitivity to laser irradiation, the basis for selective photoantisepsis. Lasers Surg. Med. 48:706-714, 2016. © 2016 Wiley Periodicals, Inc.

High-fidelity patient simulation (HFPS) is expensive in money and faculty resources. There has been a recent push to increase the use of HFPS for undergraduates to teach basic science. However, it is still unclear if HFPS is superior to other cost-effective modalities for learning, and there have been limited studies comparing HFPS directly with other methods. The purpose of this study was to compare learning between three groups: 1) students who participated in a HFPS after reading material (RS); 2) students who reread material (RR) individually; and 3) students who had no intervention or reading (CON). Quizzes (10 true/false questions) were given presimulation, immediately after the simulation (post-sim 1), and 1 wk later to all groups (post-sim 2). Ninety-seven undergraduate students consented to include their data in the study. All groups scored the same on the presimulation quiz (median of 6). The RR and RS scored significantly higher than the CON group on post-sim 1 (medians 8 vs. 6). All groups performed similarly on post-sim 2. A questionnaire also showed that students had increased perceived confidence about pathophysiology. These data suggest that a single-time use of HFPS for knowledge learning for undergraduate students is not more effective than other methods. Future studies need to determine whether increasing the number of HFPS and developing social learning networks could make HFPS more effective for undergraduates. Additionally, future studies should focus on soft skill development, such as confidence, critical thinking, and teamwork/communication skills, as opposed to knowledge acquisition.