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Objective: Up to 40% of pediatric surgery procedures occur at adult hospitals. We aim to evaluate how competent graduating general surgery residents are to perform common pediatric surgery procedures., Design: Pediatric and adult inguinal (IH) and umbilical (UH) hernia operative evaluations were collected. Ratings were analyzed using Bayesian generalized linear mixed models. The primary outcome was graduating residents' estimated probability of being competent to perform an IH or UH repair., Setting: This study was conducted using operative assessment data from general surgery programs in the Society for Improving Medical and Professional Learning (SIMPL) collaborative., Participants: 113,621 evaluations (2,924 UH, 5,555 IH) from 7,032 categorical general surgery residents were analyzed from 2015-2023., Results: Graduating residents had an adjusted probability of being competent to perform an adult IH of 94.3% (Interquartile Range [IQR] 83.4%-98.3%). In contrast, competence probabilities were 79.5% (IQR 52.7%-93.3%) for a <6 month old, 89.6% (IQR 72.1%-96.9%) for a 6 month to 5 year old, and 89.9% (IQR 71.9%-96.9%) for a >5 year old. For UH repairs, competence probabilities were similar for adult (97.6%, IQR 92.4%-99.3%) and pediatric procedures (97.3% for <5 years old [IQR 91.4%-99.2%]; 97.6% for >5 years old [IQR 92.3%-99.3%])., Conclusions: Nearly all graduating general surgery residents are competent to perform pediatric UH repairs. However, there is variability in competence of general surgery residents performing pediatric IH repairs, especially in children <6 months old., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Preliminary surgery positions are associated with a negative stigma, and this stigma may persist for those residents who later go on to obtain a categorical position. However, it is currently unknown if general surgery residents who complete a preliminary year perform differently than their categorical peers throughout training. To examine these potential differences, we compared operative performance and autonomy across all 5 years of training for those who completed a nondesignated preliminary training year with those who did not., Design: Faculty ratings of categorical general surgery residents were collected from the Society for Improving Medical and Professional Learning (SIMPL) application. Residents were categorized based on the completion of a nondesignated preliminary year ("Previous Prelim" [PP]) or not ("Traditional Categorical" [TC]). Operative performance and autonomy ratings were tracked over 5 training years and analyzed using generalized mixed effects models. Performance and autonomy outcomes were dichotomized: "not competent" or "competent" and "no meaningful autonomy" or "meaningful autonomy", respectively. Fixed effects included cohort group, academic month, case complexity, resident level (junior [PGYs 1 and 2] vs senior [PGYs 3, 4, and 5] residents), and an interaction term between cohort group and resident level, while random effects included resident, faculty, program, and procedure., Setting: Operative performance and autonomy ratings were collected from the SIMPL application between 2015 and 2023., Participants: A total of 89 general surgery residency programs, which encompassed 1,108 categorical general surgery residents., Results: A total of 42,416 evaluations were analyzed. Of these, 809 evaluations were from PP residents. Faculty ratings of PP vs TC residents revealed no significant differences in adjusted probabilities of achieving a "competent" rating as a junior (5.6%, 95% Confidence Interval [CI] 2.7%-11.1% vs 3.0%, 95% CI 2.4%-3.7%, p = 0.28) or senior (23.7%, 95% CI 12.2%-41% vs 34.1%, 95% CI 29.1%-39.5%, p = 0.59) resident. Similarly, no significant differences were identified in adjusted probabilities of achieving a "meaningful autonomy" rating between PP and TC junior (9.0%, 95% CI 5.4%-14.6% vs 8.1%, 95% CI 6.9%-9.5%, p = 0.97) or senior (42.3%, 95% CI 28.7%-57.1% vs 49.6%, 95% CI 44.9%-54.2%, p = 0.76) residents., Conclusions: PP and TC residents may have similar operative performance and autonomy ratings throughout their residency training. Although further study of more senior residents is warranted, these initial findings could help combat the negative stigma associated with a preliminary year of training., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study is to explore the patient characteristics and practice patterns of non-certified surgeons who treat Medicare patients in the United States., Background: Although most surgeons in the United States are board-certified, non-certified surgeons are permitted to practice in many locations. At the same time, surgical workforce shortages threaten access to surgical care for many patients. It is possible that noncertified surgeons may be able to help fill these access gaps. However, little is known about the practice patterns of non-certified surgeons., Methods: A 100% sample of Medicare claims data from 2014 to 2019 was used to identify practicing general surgeons. Surgeons were categorized as certified or non-certified in general surgery​​ based on data from the American Board of Surgery. Surgeon practice patterns and patient characteristics were analyzed., Results: A total of 2,097,206 patient cases were included in the study. These patients were treated by 16,076 surgeons, of which 6% were identified as non-certified surgeons. Compared with certified surgeons, non-certified surgeons were less frequently fellowship-trained (20.5% vs 24.2%, P =0.008) and more likely to be foreign medical graduates (14.5% vs 9.2%, P <0.001). Non-certified surgeons were more frequently practicing in for-profit hospitals (21.2% vs 14.2%, P <0.001) and critical access hospitals (2.2% vs 1.3%, P <0.001) and were less likely to practice in a teaching hospital (63.2% vs 72.4%, P <0.001). Compared with certified surgeons, non-certified surgeons treated more non-White patients (19.6% vs 14%, P <0.001) as well as a higher percentage of patients in the 2 lowest SES quintiles (36.2% vs 29.2%, P <0.001). Operations related to emergency admissions were more common amongst non-certified surgeons (68.8% vs 55.7%, P <0.001). There were no differences in sex or age of the patients treated by certified and non-certified surgeons., Conclusions: For Medicare patients, non-certified surgeons treated more patients who are non-White, of lower socioeconomic status, and in more rural, critical-access hospitals., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Surgery residents who complete a nondesignated preliminary year have an additional year of training compared to those who begin as categorical residents. While this additional year is sometimes perceived negatively, these more experienced residents may outperform traditional categorical (TC) residents in their first year of training., Methods: Operative assessment ratings were recorded for first year categorical general surgery residents in the United States between 2015 and 2023 using the Society for Improving Medical and Professional Learning assessment platform. Residents were categorized based on the completion of a nondesignated preliminary year ("Previous Prelim" [PP]) or not ("Traditional Categorical"). Ratings were analyzed using generalized mixed effects models. Performance and autonomy outcomes were dichotomized: "less experience" or "more experience" and "no autonomy" or "some autonomy", respectively. Fixed effects included academic month and case complexity, while random effects included resident, faculty, program, and procedure., Results: A total of 34,353 evaluations from 86 general surgery programs were collected. Of these, 829 were evaluations from PP residents. Faculty ratings of PP versus TC revealed no differences in adjusted probabilities of achieving a "more experience" rating (82% versus 76%, P = 0.26) but a higher adjusted probability of achieving a "some autonomy" rating (88% versus 80%, P = 0.04) for PP compared to TC. Analysis of resident self-reported ratings revealed higher adjusted probabilities of a "more experience" rating (77% versus 50%, P = 0.01) and "some autonomy" rating (87% versus 73%; P = 0.02) for PP compared to TC., Conclusions: First year general surgery residents who previously completed a preliminary year have similar operative performance faculty ratings when compared to their peers., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To evaluate severe complications and mortality over years of independent practice among general surgeons., Background: Despite concerns that newly graduated general surgeons may be unprepared for independent practice, it is unclear whether patient outcomes differ between early and later career surgeons., Methods: We used Medicare claims for patients discharged between July 1, 2007 and December 31, 2019 to evaluate 30-day severe complications and mortality for 26 operations defined as core procedures by the American Board of Surgery. Generalized additive mixed models were used to assess the association between surgeon years in practice and 30-day outcomes while adjusting for differences in patient, hospital, and surgeon characteristics., Results: The cohort included 1,329,358 operations performed by 14,399 surgeons. In generalized mixed models, the relative risk (RR) of mortality was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [5.5% (95% CI: 4.1%-7.3%) vs 4.7% (95% CI: 3.5%-6.3%), RR: 1.17 (95% CI: 1.11-1.22)]. Similarly, the RR of severe complications was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [7.5% (95% CI: 6.6%-8.5%) versus 6.9% (95% CI: 6.1%-7.9%), RR: 1.08 (95% CI: 1.03-1.14)]. When stratified by individual operation, 21 operations had a significantly higher RR of mortality and all 26 operations had a significantly higher RR of severe complications in the first compared with the 15th year of practice., Conclusions: Among general surgeons performing common operations, rates of mortality and severe complications were higher among newly graduated surgeons compared with later career surgeons., Competing Interests: R.A.H. receives unrelated funding from the Blue Cross Blue Shield of Michigan Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK108740-05). A.E.T. receives unrelated funding from the Ruth L Kirschstein Institutional National Service Award administered by the National Institutes of Health. C.S.B. receives unrelated funding from the Ruth L. Kirschstein Postdoctoral Research Fellowship Award administered by the National Institute on Drug Abuse (F32-DA050416). A.M.R. receives unrelated funding from the NIH and AHRQ. B.M. receives funding from the NIH. J.B.D. receives grant funding from the NIH, AHRQ, Blue Cross Blue Shield of Michigan Foundation, and is a cofounder of ArborMetrix, Inc. B.C.G received funding for this work from the Agency for Healthcare Research and Quality (AHRQ; 5K08HS027653-02) and receives unrelated funding from the National Board of Medical Examiners (NBME) Edward J. Stemmler M.D. Medical Education Research Fund, the American Board of Medical Specialties, the American Board of Family Medicine, and the Accreditation Council for Graduate Medical Education (ACGME). The remaining authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: As medical education systems increasingly move toward competency-based training, it is important to understand the tools available to assess competency and how these tools are utilized. The Society for Improving Medical Professional Learning (SIMPL) offers a smart phone-based assessment system that supports workplace-based assessment of residents' and fellows' operative autonomy, performance, and case complexity. The purpose of this study was to characterize implementation of the SIMPL app within vascular surgery integrated residency (0+5) and fellowship (5+2) training programs., Methods: SIMPL operative ratings recorded between 2018 and 2022 were collected from all participating vascular surgery training institutions (n = 9 institutions with 5+2 and 0+5 programs; n = 4 institutions with 5+2 program only). The characteristics of programs, trainees, faculty, and SIMPL operative assessments were evaluated using descriptive statistics., Results: Operative assessments were completed for 2457 cases by 85 attendings and 86 trainees, totaling 4615 unique operative assessment ratings. Attendings included dictated feedback in 52% of assessments. Senior-level residents received more assessments than junior-level residents (postgraduate year [PGY]1-3, n = 439; PGY4-5, n = 551). Performance ratings demonstrated increases from junior to senior trainees for both resident and fellow cohorts with "performance-ready" or "exceptional performance" ratings increasing by nearly two-fold for PGY1 to PGY5 residents (28.1% vs 40.6%), and from first- to second-year fellows (PGY6, 46.7%; PGY7, 60.3%). Similar gains in autonomy were demonstrated as trainees progressed through training. Senior residents were more frequently granted autonomy with "supervision only" than junior residents (PGY1, 8.7%; PGY5, 21.6%). "Supervision only" autonomy ratings were granted to 21.8% of graduating fellows. Assessment data included a greater proportion of complex cases for senior compared with junior fellows (PGY6, 20.9% vs PGY7, 26.5%). Program Directors felt that faculty and trainee buy-in were the main barriers to implementation of the SIMPL assessment app., Conclusions: This is the first description of the SIMPL app as an operative assessment tool within vascular surgery that has been successfully implemented in both residency and fellowship programs. The assessment data demonstrates expected progressive gains in trainees' autonomy and performance, as well as increasing case complexity, across PGY years. Given the selection of SIMPL as the assessment platform for required American Board of Surgery and Vascular Surgery Board Entrustable Professional Activities assessments, understanding facilitators and barriers to implementation of workplace-based assessments using this app is imperative, particularly as we move toward competency-based medical education., (Copyright © 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

A branched [8]catenane from an efficient one-pot synthesis (72 % HPLC yield, 59 % isolated yield) featuring the simultaneous use of three kinds of templates and cucurbit[6]uril-mediated azide-alkyne cycloaddition (CBAAC) for ring-closing is reported. Design and assembly of the [8]catenane precursors are unexpectedly complex that can involve cooperating, competing and non-influencing interactions. Due to the branched structure, dynamics of the [8]catenane can be modulated in different extent by rigidifying/loosening the mechanical bonds at different regions by using solvent polarity, acid-base and metal ions as the stimuli. This work not only highlights the importance of understanding the delicate interplay of the weak and non-obvious supramolecular interactions in the synthesis of high-order [n]catenane, but also demonstrates a complex control of dynamics and flexibility for exploiting [n]catenanes applications., (© 2021 Wiley-VCH GmbH.)

Stroke is the second leading cause of death and a major cause of disability worldwide. Both modifiable and non-modifiable risk factors can affect the occurrence of ischemic stroke at varying degrees. Among them, atherosclerosis has been well-recognized as one of the main culprits for the rising incidence of stroke-related mortality. Hence, the current review aimed to summarize the prominent role of lipid metabolism genes such as PCSK9, ApoB, ApoA5, ApoC3, ApoE, and ABCA1 in mediating ischemic stroke occurrence., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

A pair of radial [5]catenanes, with either an isomeric cyclic -AABB- or -ABAB- type sequence of the interlocked β-cyclodextrin (β-CD) and cucurbit[6]uril (CB[6]) units, has been efficiently synthesized. Because of a marked difference in the binding strength and interlocking sequence of the peripheral macrocycles, interesting sequence-dependent properties, characteristic of mechanically bonded macrocycles, were realized. Variable-temperature 1 H NMR studies showed that the -ABAB- isomer has a more independent β-CD dynamic, whereas the β-CD motions in the -AABB- isomer are coupled. Dynamics of the pH-insensitive β-CD can also be further modulated upon base-triggered mobilization of the CB[6]. These unique properties of the mechanical bond expressed in a sequence-specific fashion and the transmission of the control on the macrocycle dynamics from one interlocked component to another, highlight the potential of similar complex hetero[n]catenanes in the design of advanced, multicomponent molecular machines., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Introduction: This study aimed to develop and validate a Chinese version of the See, Think, Act Scale (C-STA). The relational security of the Department of Forensic Psychiatry of Castle Peak Hospital, which provides territory-wide forensic psychiatric services in Hong Kong, was measured., Methods: The See, Think, Act Scale was first translated into Chinese, then back-translated into English for comparison, and finally, subject to modification until alignment was achieved. Its content validity and face validity were explored through expert panel evaluation and focus group discussion, respectively. Eighty-nine Chinese mental health professionals were recruited from six service units to measure the relational security of the Department of Forensic Psychiatry using the C-STA., Results: The Cronbach's alpha coefficient for internal consistency was high, with all components exceeding 0.90. The intraclass correlation coefficients for the test-retest reliability of all components ranged from 0.50 to 0.72. Participants had the lowest score on the "patient focus" component (M = 2.56, standard deviation [SD] = 0.32). A significant sex difference in total relational security scores was found (P < 0.001)., Discussion: The C-STA is a valid and reliable instrument to measure the relational security of forensic psychiatric services. "Patient focus" might be the target component of relational security for which the Department of Forensic Psychiatry needs to have interventions. The significant sex difference in total relational security scores needs further exploration., (© 2018 John Wiley & Sons Australia, Ltd.)

We report here that the product topology in a copper-templated catenane synthesis can be controlled by favouring a particular macrocyclisation pathway, offering an additional strategy for improving the efficiency of catenane formation. A linear [4]catenane was obtained by non-covalently modifying a flexible building block that favours the intra-ligand cyclisation.

We report here the efficient synthesis of a series of [3]catenanes featuring the use of cucurbit[6]uril to simultaneously mediate the mechanical and covalent bond formations. By coupling the mechanical interlocking with covalent macrocyclization, formation of topological isomers is eliminated and the [3]catenanes are formed exclusively in good yields. The efficient access to these [3]catenanes and the presence of other recognition units render them promising building blocks for the construction of other high-order interlocked structures.

As a major class of mechanically interlocked molecules, not only are catenanes topologically intriguing targets that challenge the chemical synthesis to the efficient formation of mechanical bonds, but also the mechanical properties arising from the topology offer unique and attractive features for the development of novel functional molecular materials. Despite advancements in templated methods for different types of interlocked architectures, [ n]catenane possessing multiple numbers of interlocked macrocycles still remains a difficult synthetic target with very few reported examples. If the unique mechanical properties of catenanes are to be fully exploited, reliable, controllable, and efficient strategies for accessing [ n]catenanes will be necessary. In this Viewpoint, challenges, considerations, and strategies to [ n]catenanes are discussed.

Objective: Despite the significant size of the Asian American population, few studies have been conducted to improve cancer survivorship in this underserved group. Research has demonstrated that expressive writing interventions confer physical and psychological benefits for a variety of populations, including Non-Hispanic White cancer survivors. The study aims to evaluate the health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors in the U.S. It was hypothesized that expressive writing would increase health-related quality of life (HRQOL)., Method: Ninety-six Chinese breast cancer survivors were randomly assigned to 1 of 3 writing conditions: a self-regulation group, an emotional disclosure group, or a cancer-fact group. The self-regulation group wrote about one's deepest feelings and coping efforts in addition to finding benefits from their cancer experience. The emotional disclosure group wrote about one's deepest thoughts and feelings. The cancer-fact group wrote about facts relevant to their cancer experience. HRQOL was assessed by FACT-B at baseline, 1, 3, and 6-month follow-ups. Effect sizes and residual zed change models were used to compare group differences in HRQOL., Results: Contrary to expectations, the cancer-fact group reported the highest level of overall quality of life at the 6-month follow-up. The self-regulation group had higher emotional well-being compared to the emotional disclosure group., Conclusions: The study challenges the implicit assumption that psychosocial interventions validated among Non-Hispanic Whites could be directly generalized to other populations. It suggests that Asians may benefit from writing instructions facilitating more cognitive than emotional processes. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

A water soluble [6]catenane consisting of two interlocking [3]catenanes was synthesised in 91% yield using readily accessible precursors. The new strategy features the simultaneous use of orthogonal Cu + -phenanthroline and CB[6]-ammonium interactions for preorganising the precursors and the efficient CB[6]-catalysed azide-alkyne cycloaddition as bond forming reactions for ring closing, resulting in high structural complexity and fidelity of the products without compromising interlocking efficiency. A related [4]catenane with three different types of macrocycles was also obtained in good yield.

Objectives: To study the association between cerebral white matter disease and burden of behavioral and psychological symptoms (BPSD) among patients with moderate to severe AD., Methods: Patients with moderate to severe AD having undergone MRI brain, cognitive and behavioral evaluations were studied. BPSD was diagnosed based on established clinical guidelines. White matter hyperintensity (WMH) and medial temporal lobe atrophy (MTA) were quantified by a blinded rater., Results: 122 AD patients were studied. Age [76.84 vs. 72.70, p = 0.014] and MMSE [11.69 vs. 15.16, p < 0.001] was significantly higher in patients with BPSD. BPSD patients demonstrated higher periventricular [5.44 vs. 4.21, p < 0.001], deep subcortical [5.07 vs. 3.43, p < 0.001], and total WMH [10.51 vs. 7.65, p < 0.001] compared to non-BPSD patients. Higher proportion of BPSD patients had WMH in the highest tertile of severity (82.22% vs. 45.45%, p < 0.001). After correcting for age, baseline cognition and degree of MTA, total WMH remained significantly associated with a diagnosis of BPSD [odds ratio: 1.45 (1.14-1.85; p = 0.002)]. With severe WMH, the association is significantly increased [odds ratio: 4.3 (1.3-12.5); p = 0.016]., Conclusion: WMH is independently associated with BPSD in moderate to severe AD. Optimizing vascular risk factors may be a strategy to reduce the severity of BPSD in AD., (Copyright © 2013 Elsevier B.V. All rights reserved.)

To investigate the mechanism of DNA recognition by the homeodomain, truncated proteins containing the entire homeodomain encoded by the Drosophila engrailed gene were expressed in Escherichia coli. Each protein was accumulated to an amount representing more than 40% of the total bacterial protein and recovered in the soluble fraction. Of the three truncated proteins, the shortest one (71 amino acid residues) was further purified by conventional chromatography. The purified engrailed homeodomain (En-HD) protected a DNA sequence, TTAATT, the core element of consensus sequences recognized by many other homeodomain proteins, from DNase I digestion. UV-CD spectra of the En-HD showed that it mainly consisted of alpha-helix. Based on one-dimensional 1H-NMR spectra, the tertiary structure of the En-HD was shown to be stable against temperature up to 50 degrees C and low pH. The low pH resistance of the protein was also demonstrated by UV-CD measurement. Thus, the current over-production system provides an active and stable homeodomain, which is suitable for structure-function analysis.