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Brent Bauman,1 Peter Kernahan,1,2 Anthony Weinhaus,2 Michael J Walker,2 Eric Irwin,1 Andrew Sundin,1 Derek Yerxa,3 Victor Vakayil,1 James V Harmon1,2 1Department of Surgery, University of Minnesota, Minneapolis, MN, USA; 2Program in Human Anatomy, University of Minnesota, Minneapolis, MN, USA; 3College of Biological Sciences, University of Minnesota, Minneapolis, MN, USACorrespondence: James V Harmon 420 Delaware St SE, MMC 195, Minneapolis, MN 55455, USATel +1 612-625-7911Email harm0031@umn.eduPurpose: Senior medical students are variably prepared to begin surgical training; and a national curriculum was established through the American College of Surgeons to better prepare senior medical students for surgical training. The purpose of our course is to prepare senior medical students to more effectively enter surgical training programs. We recently enhanced our independently developed surgical training preparation course by increasing exposure to surgical anatomy, medical physiology, surgical skills, and point-of-care ultrasound. We evaluated the impact of our interprofessional training course to increase confidence and readiness among senior medical students entering surgical training.Methods: The course focused on pre- and post-operative patient care, surgical anatomy, human physiology, and bedside ultrasound. Didactic lectures in anatomy, human physiology, and bedside ultrasound were provided prior to all hands-on simulated patient care sessions and mock surgical procedures. To evaluate our interprofessional curriculum, we administered pre- and post-course surveys, pre- and post-course knowledge tests, and a final surgical anatomy laboratory practical examination to 22 senior medical students who were enrolled in the course. All students created a final surgical anatomy presentation.Results: The students demonstrated a 100% pass rate in surgical anatomy. The knowledge test, which included assessment of knowledge on perioperative surgical decision making, human physiology, and bedside ultrasound, demonstrated an average improvement of 10%. Statistically significant improvements in median confidence values were identified in 10 of 32 surveyed categories, including surgical skills (p < 0.05); 84% of student goals for the course were achieved. The medical students’ surveys confirmed increased confidence related to the use of point-of-care ultrasound, teamwork experience, and basic surgical skills through small group interactive seminars and surgical simulation exercises.Conclusion: Our preparation for surgical training course resulted in high student satisfaction and demonstrated an increased sense of confidence to begin surgical training. The 10% improvement in medical student knowledge, as evaluated by a written examination, and the significant improvement in confidence level self-assessment scores confirms this surgery preparation course for senior medical students successfully achieved the desired goals of the course.Keywords: surgical trainee, simulation-based training, clinical anatomy, medical student education

Abstract: Background: This study assessed the factor structure and psychometric properties of the Swedish version of the Empathic Experience Scale (EES), a recently developed scale for empathic traits (Innamorati et al., 2019). According to previous research, EES has two dimensions: Vicarious Experience and Intuitive Understanding. Methods: We used a split-sample method with a combination of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for an adult population (N = 805) from both Sweden and Finland. Results: Our findings support previous research, favoring a two-factor model over a unidimensional model. The final model provided support for measurement invariance across different grouping variables. Consistent with previous research on empathic traits, women obtained higher scores on both dimensions of the scale compared to men. Furthermore, the EES showed high internal consistency, good discriminant, and convergent validity.

This article critically engages with the concept of screen time. We explore the screen time recommendations from the World Health Organization (WHO) and their application in the Swedish context. We also investigate the experiences and opinions on the recommendations and advice on screen time and screen media use in early childhood among parents of young children (0–3 yrs.) in Sweden. The study draws from qualitative semi-structured interviews during multiple home visits from a diverse sample of 16 families. Findings are discussed through the prism of the ‘moral economy’ of the household and the ‘social imaginaries’ underpinning this. We have identified two types of approaches to guidelines on screen time among parents, and based on our findings we recommend organizations in Sweden and beyond, to rethink and revise the current guidelines, including the WHO recommendations.

We review comprehensive observations of electromagnetic ion cyclotron (EMIC) wave-driven energetic electron precipitation using data collected by the energetic electron detector on the Electron Losses and Fields InvestigatioN (ELFIN) mission, two polar-orbiting low-altitude spinning CubeSats, measuring 50-5000 keV electrons with good pitch-angle and energy resolution. EMIC wave-driven precipitation exhibits a distinct signature in energy-spectrograms of the precipitating-to-trapped flux ratio: peaks at >0.5 MeV which are abrupt (bursty) (lasting ∼17 s, or ΔL∼0.56) with significant substructure (occasionally down to sub-second timescale). We attribute the bursty nature of the precipitation to the spatial extent and structuredness of the wave field at the equator. Multiple ELFIN passes over the same MLT sector allow us to study the spatial and temporal evolution of the EMIC wave - electron interaction region. Case studies employing conjugate ground-based or equatorial observations of the EMIC waves reveal that the energy of moderate and strong precipitation at ELFIN approximately agrees with theoretical expectations for cyclotron resonant interactions in a cold plasma. Using multiple years of ELFIN data uniformly distributed in local time, we assemble a statistical database of ∼50 events of strong EMIC wave-driven precipitation. Most reside at L∼5-7 at dusk, while a smaller subset exists at L∼8-12 at post-midnight. The energies of the peak-precipitation ratio and of the half-peak precipitation ratio (our proxy for the minimum resonance energy) exhibit an L-shell dependence in good agreement with theoretical estimates based on prior statistical observations of EMIC wave power spectra. The precipitation ratio's spectral shape for the most intense events has an exponential falloff away from the peak (i.e., on either side of ∼1.45 MeV). It too agrees well with quasi-linear diffusion theory based on prior statistics of wave spectra. It should be noted though that this diffusive treatment likely includes effects from nonlinear resonant interactions (especially at high energies) and nonresonant effects from sharp wave packet edges (at low energies). Sub-MeV electron precipitation observed concurrently with strong EMIC wave-driven >1 MeV precipitation has a spectral shape that is consistent with efficient pitch-angle scattering down to ∼ 200-300 keV by much less intense higher frequency EMIC waves at dusk (where such waves are most frequent). At ∼100 keV, whistler-mode chorus may be implicated in concurrent precipitation. These results confirm the critical role of EMIC waves in driving relativistic electron losses. Nonlinear effects may abound and require further investigation.

Background: Metastatic neuroendocrine carcinoma (NEC) is associated with short survival. Other than platinum-based chemotherapy, there is no clear standard regimen. Current guidelines suggest that combination treatment with BRAF-inhibitors should be considered for patients with BRAF V600E-mutated NEC. However, since only eight such patients have been reported in the literature, our object was to confirm the validity of this recommendation. Methods: This was a single-center retrospective cohort study conducted at Uppsala University Hospital. The included patients 1) had a histopathologically confirmed diagnosis of NEC, 2) were diagnosed between January 1st, 2018 and December 31st, 2023, 3) had tumor tissue genetically screened by a broad next-generation sequencing (NGS) panel, and 4) showed a tumor mutation for which there is a currently available targeted therapy. Results: We screened 48 patients diagnosed with NEC between January 1st, 2018 and December 31st, 2023. Twelve had been analyzed with a broad NGS-panel, and two had a targetable mutation. Both these patients harbored a BRAF V600E-mutated colon-NEC and were treated with BRAF- and MEK-inhibitors dabrafenib and trametinib in second-line. At first radiological evaluation (RECIST 1.1), both patients had a reduction of tumor size, which decreased by 31 and 40%. Both had short response periods, and their overall survival was 12 and 9 months. Conclusions: BRAF-mutated NEC is sensitive to treatment with BRAF- and MEK-inhibitor combination. These results further support that DNA sequencing should be considered as standard of care in NECs to screen for potential treatment targets.

Professional development aims to facilitate the maintenance, improvement and broadening of knowledge and skills, and has become a standard or even compulsory component of professional practice for many occupational groups. This paper traces the uptake of professional development amongst certified translators and interpreters in Australia, where in 2014 it was introduced as a requirement for newly-certified practitioners only, and in 2019 for all holders of translation or interpreting certification from the national certifying authority. Based on responses gained from a sample of 3,268 practitioners, we report high uptake overall with little variation according to level of qualifications. Slightly lower uptake rates are recorded only amongst ‘newcomers’ with less experience while for all others, it is consistently high. Lower uptake rates are recorded amongst those who work 1-10 hours per week and those earning up to A$10,000 per year compared to others working more hours and those earning more. A desire for more work does not co-occur with elevated levels of PD uptake. The data presented reflects the reported experiences of those who had already been required to engage with PD, those for whom this requirement was new with a three-year time window to undertake PD, as well as those for whom it still remains optional. These findings contribute to our understanding of PD uptake amongst a professional group whose engagement with post-certification training has been under-studied. Findings may inform relevant stakeholders in other countries considering measures to arrest atrophy and extend the skill sets of practising translators and interpreters.

BackgroundHuman papillomavirus (HPV) vaccines can significantly reduce the burden of HPV-associated cancers, but remain underutilized. We evaluated a multi-component, system-level intervention to improve HPV vaccination in a large Federally Qualified Health Center (FQHC) that serves a primarily low income Latino population.MethodsFrom January 2015 through March 2017, we evaluated the effectiveness of a multi-component, system-level intervention to improve HPV vaccination rates in eight clinics randomly assigned to study condition (four intervention, four usual care). The intervention included parent reminders for HPV vaccine series completion, provider training, clinic-level audit and feedback, and workflow modifications to reduce missed opportunities for vaccination. Using a difference-in-differences approach, we compared HPV vaccination rates among patients, ages 11 to 17 during a 12-month preintervention period and a 15-month intervention period. Linear mixed models were used to estimate intervention effects on vaccine initiation and completion.ResultsThe sample included approximately 15,000 adolescents each quarter (range 14,773-15,571; mean age 14 years; 51% female, 88% Latino). A significantly greater quarterly increase in HPV vaccine initiation was observed for intervention compared with usual care clinics (0.75 percentage point greater increase, P < 0.001), corresponding to 114 additional adolescents vaccinated per quarter. The intervention led to a greater increase in HPV vaccine completion rates among boys (0.65 percentage point greater increase, P < 0.001), but not girls.ConclusionsOur system-level intervention was associated with modest improvements in HPV vaccine initiation overall and completion among boys.ImpactStudy findings have implications for reducing HPV-related cancers in safety net populations.

Introduction Severe osteogenesis imperfecta (OI) is a debilitating disease with no cure or sufficiently effective treatment. Mesenchymal stem cells (MSCs) have good safety profile, show promising effects and can form bone. The Boost Brittle Bones Before Birth (BOOSTB4) trial evaluates administration of allogeneic expanded human first trimester fetal liver MSCs (BOOST cells) for OI type 3 or severe type 4.Methods and analysis BOOSTB4 is an exploratory, open-label, multiple dose, phase I/II clinical trial evaluating safety and efficacy of postnatal (n=15) or prenatal and postnatal (n=3, originally n=15) administration of BOOST cells for the treatment of severe OI compared with a combination of historical (1–5/subject) and untreated prospective controls (≤30). Infants