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Andrew J Foy,1,2,* Kent E Vrana,3 Paul Haidet,1,2 Bernice L Hausman,2,4 Nancy E Adams,5 Ira Ropson,6 Daniel R Wolpaw,1 David Rabago,2,7 Richard B Mailman,3,8 Xuemei Huang3,8– 10,* 1Penn State Department of Medicine, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 2Penn State Department of Public Health Science, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 3Penn State Department of Pharmacology, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 4Penn State Department of Humanities, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 5Harrel Library Foundational Sciences, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 6Penn State Department of Biochemistry and Molecular Biology, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 7Penn State Department of Family and Community Medicine, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 8Penn State Department of Neurosurgery, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 9Penn State Department of Neurology, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA; 10Penn State Department of Kinesiology, Penn State Milton S Hershey Medical Center and College of Medicine, Hershey, PA, USA*These authors contributed equally to this workCorrespondence: Andrew J Foy, Penn State Milton S Hershey Medical Center and College of Medicine, Penn State Heart and Vascular Institute, Division of Cardiology, Hershey, PA, USA, Email afoy@pennstatehealth.psu.eduPurpose: Critical thinking and the ability to engage with others of differing views in a civil manner is essential to the practice of medicine. A new format for medical student education (“Argue-to-Learn”) that uses staged debates followed by small group discussions was introduced into the curriculum of first year medical school at the Penn State College of Medicine. The goal was to create a structured environment for spirited, civil discourse, and to encourage students to think critically about clinically controversial topics. This manuscript describes the development of the program, and presents comparative data on student perceptions of the first two mandatory sessions that focused on the treatment of post-menopausal osteoporosis and on COVID-19 vaccine mandates.Methods: Quantitative results were gathered from standardized post-block student surveys for each session and compared to cumulative results of all other courses included in the learning block. Post-block surveys of students include four session-evaluation questions scored on a 5 point Likert scale. Scores were compared using Student’s t-test. Thematic analysis of qualitative data was performed on a single open-ended response from the same survey.Results: Compared to all other courses in the learning block, scores on each of the four questions were either the same or numerically higher for the Argue-to-Learn sessions, but none reached statistical significance. Two important qualitative themes were identified. First, students enjoyed the format, found it interesting and engaging and want more similar sessions. Second, students appreciated hearing opposing viewpoints and presenting their own viewpoints in a safe and supportive environment.Conclusion: These findings support evidence from educational scholarship outside of medicine showing argumentation as a learning tool is well received by students. Further work is needed to determine whether it improves critical thinking skills and enhances learning in medical education.Keywords: argumentation, critical discourse, collaborative learning

Introduction Northern Nigeria is part of the meningitis belt, an area that in large part consists of the Sahel (Fig. 1). In 1996 northern Nigeria was struck once again by [...], From November 1995 to May 1996, a meningitis epidemic occurred in northern Nigeria. More than 75 000 cases and 8440 deaths (case fatality rate (CFR), 11%) were recorded. Medecins sans Frontieres, in cooperation with the Nigerian government, carried out an assistance programme (support to case management, surveillance and mass vaccination) in three states (Bauchi, Kano, Katsina) where 75% of cases occurred. Cost analysis of this assistance in Katsina State reveals that case management and mass vaccination were efficient: US$ 35 per case treated and US$ 0.64 per vaccination. There was, however, a remarkable difference in cost-effectiveness between the two strategies. The cost per death averted by improved case treatment was estimated to be US$ 396, while the cost per death averted by vaccination was estimated to be US$ 6000. In large part this difference is attributed to the late start of vaccination: more than 6 weeks after the epidemic threshold had been passed. During meningitis epidemics in countries where surveillance systems are inadequate, such as in most of sub-Saharan Africa, curative programmes should have priority.

The article provides information about acute myocardial infarction to the target reader group of educational diagnosticians. Topics include preliminary diagnosis of heart attacks, risks to educational diagnosticians and lifestyle changes to mitigate the risks. Lifestyle changes include exercising, a healthy diet regimen and relaxation techniques.

Abstract This short essay examines infant formula marketing and information sources for their representation of "choice" in the infant feeding context, and finds that while providing information about breast and bottle feeding, infant formula manufacturers focus on mothers' feelings and intuition rather than knowledge in making decisions. In addition, the essay considers how "choice" operates in the history of reproductive rights, shifting the discourse from a rights-based set of arguments to one based on a consumerist mentality. Utilizing the work of historian Rickie Solinger and a 2007 paper for the National Bureau of Labor Statistics, I argue that the structure of market work, and not abstract maternal decision making, determine mothers' choices and practices concerning infant feeding. For true freedoms for mothers to be achieved, freedoms that would include greater social provisions for mothers, our culture will have to confront how structural constraints make breastfeeding difficult, as well as how the concept of choice divides mothers into those who make good choices and those who do not.

The article discusses the possible challenges confronting educational diagnosticians in the field. It notes that field-based diagnosticians may face difficulty when they become first responders for school-based children with physical anomalies. It suggests that educational diagnostic personnel should have adequate knowledge and skills to identify the signs and symptoms of amino acid disorders.

Chronic ischemic wounds affect millions of people causing significant pain and disability. They can be considered to be stalled in the inflammatory stage and cannot heal without additional measures. A valid animal model is necessary to evaluate the efficacy of topical wound healing therapies and wearable technologies. A porcine model, although higher in cost, maintenance, and space requirements, is superior to the commonly used rodent or rabbit model for wound healing. Previous studies have shown that pig wounds have greater similarity to human wounds in responses to a variety of treatments, including wound dressings and antibiotics. The current study created a porcine model of large chronic wounds to assess a wearable electroceutical technology, with monitoring of healing variables and infection. Electroceutical therapy is the only adjunctive treatment recommended for chronic wound therapy. A porcine model of large chronic wounds of clinically realistic size was created and utilized to evaluate a wearable electroceutical biotechnology. Multivariate non-invasive assessment was used to monitor wound progression over multiple timepoints. Outcomes suggest that a wearable electrostimulation bandage, has the potential to offer therapeutic benefit in human wounds. The tested wearable device provides the same proven effectiveness of traditional electroceutical therapy while mitigating commonly cited barriers, including substantial time requirements, and availability and complexity of currently available equipment, preventing its implementation in routine wound care. The model is also appropriate for evaluation of other wearables or topical therapeutics., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Published by Elsevier Ltd.)

Implant infection impairs osseointegration of orthopaedic implants by inducing inflammation. Acinetobacter spp. are increasingly prevalent multi-drug resistant bacteria that can cause osteomyelitis. Acinetobacter spp. can also cause inflammation and thereby inhibit osseointegration in mice. The purpose of the present study was to investigate the role of quorum sensing in this context. Therefore, wild-type bacteria were compared with an isogenic abaI mutant defective in quorum sensing in a murine osseointegration model. The abaI quorum- sensing mutant affected significantly less osseointegration and interleukin (IL) 1β levels, without detectably altering other pro-inflammatory cytokines. Wild-type bacteria had fewer effects on IL1 receptor (IL1R)-/- mice. These results indicated that quorum sensing in Acinetobacter spp. contributed to IL1β induction and the resultant inhibition of osseointegration in mice. Moreover, targeting the Gram-negative acyl-homoserine lactone quorum sensing may be particularly effective for patients with Acinetobacter spp. infections.

Purpose: The classic fracture model, described by Bonnarens and Einhorn in 1984, enlists a blunt guillotine to generate a closed fracture in a pre-stabilized rodent femur. However, in less experienced hands, this technique yields considerable variability in fracture pattern and requires highly-specialized equipment. This study describes a reproducible and low-cost model of mouse fracture healing using an open femoral osteotomy., Methods: Femur fractures were produced in skeletally mature male and female mice using an open femoral osteotomy after intramedullary stabilization. Mice were recovered for up to 28 days prior to analysis with microradiographs, histomorphometry, a novel μCT methodology, and biomechanical torsion testing at weekly intervals., Results: Eight mice were excluded due to complications (8/193, 4.1%), including unacceptable fracture pattern (2/193, 1.0%). Microradiographs showed progression of the fracture site to mineralized callus by 14 days and remodelling 28 days after surgery. Histomorphometry from 14 to 28 days revealed decreased cartilage area and maintained bone area. μCT analysis demonstrated a reduction in mineral surface from 14 to 28 days, stable mineral volume, decreased strut number, and increased strut thickness. Torsion testing at 21 days showed that fractured femurs had 61% of the ultimate torque, 63% of the stiffness, and similar twist to failure when compared to unfractured contralateral femurs., Conclusions: The fracture model described herein, an open femoral osteotomy, demonstrated healing comparable to that reported using closed techniques. This simple model could be used in future research with improved reliability and reduced costs compared to the current options., (© 2020 The Authors.)

At the beginning of the 21st century, malaria remains one of the most important public health problems in the world. An important control strategy to address this burden is adequate case management of malaria patients. The success of this strategy, however, does not solely depend on diagnosis and treatment, but also on a sequence of steps that patients have to take when they are ill. Only when patients go through all these steps successfully will they be cured. In this paper, a model is presented in which these steps are described. The model provides a framework for analysing this type of malaria control strategy and for identifying the most critical challenges faced. Furthermore, the model is used to analyse recent literature on case management as part of malaria control programmes in order to highlight current knowledge, core issues and constraints, and to make recommendations for programme development and research.

We report the identification of rfbF and rfbC located adjacent to the previously identified rfbG (Gavini et. al. Biochem. Biophys. Res. Commun. 1997, 240, 153-161) from the non-symbiotic, non-pathogenic soil bacterium Azotobacter vinelandii. The rfbF open reading frame encodes a putative polypeptide of 256 amino acids. This polypeptide shares a homology of 74% with the RfbF of Synechocystis sp. and a 70% homology with the AscA of Yersinia pseudotuberculosis which function as alpha-D-glucose-1-phosphate cytidylyltransferases in the biosynthesis of the O-antigen. The rfbC encodes a putative polypeptide of 186 amino acids. It shows strongest homology to the RfbC of Synechocystis sp. (64%) and Salmonella typhimurium (40%). RfbC functions as a dTDP-4-Dehydrorhamnose 3,5-Epimerase. The genes identified here have a low G + C content (approximately 56%) as compared to the A. vinelandii chromosome (approximately 63%) which is characteristic of the rfb clusters identified in other bacteria and may be indicative of the acquisition of the rfb genes by interspecific gene transfer. Despite the high level of sequence conservation, the organization of the rfb genes in A. vinelandii deviates from the arrangement of the most thoroughly studied rfb gene clusters of Enterobacteriaceae.

We have identified the rfbG from a non-symbiotic and non-pathogenic soil bacterium, Azotobacter vinelandii. The nucleotide sequence analysis of the rfbG revealed an open reading frame that encodes a peptide of 360 amino acids. This deduced peptide shares 57% homology with the RfbG of Synechocystis and 47% homology with the RfbG of Yersinia pseudotuberculosis. The previously identified short-chain dehydrogenases/reductases family signature sequence is conserved in the sequence of the RfbG of A. vinelandii. Southern blotting analysis of A. vinelandii chromosome by probed with 1.1 kb PstI DNA fragment corresponding to rfbG revealed that it is present as single copy on A. vinelandii chromosome. Disrupting the rfbG present on the chromosome of A. vinelandii, by insertion of kanamycin resistance marker via homologous recombination, resulted in drastic changes in the growth characteristics. The rfbG-negative A. vinelandii grown in liquid medium exhibited agglutination that is characteristic of rfb- mutants of other bacteria, suggesting that we have cloned the functional copy of the rfbG of A. vinelandii.

The same factors that impede a mother's ability to maintain a stable residence are likely to impair her capacity to nurture children. This double crisis of homelessness and child rearing confronts caregivers with a special set of ethical and practical dilemmas. Psychosocial characteristics of homeless mothers and children are reviewed, and the need to support these mothers is underscored.