Regional Medical Campuses: A New Classification System

There is burgeoning belief that regional medical campuses (RMCs) are a significant part of the narrative about medical education and the health care workforce in the United States and Canada. Although RMCs are not new, in the recent years of medical education enrollment expansion, they have seen their numbers increase. Class expansion explains the rapid growth of RMCs in the past 10 years, but it does not adequately describe their function. Often, RMCs have missions that differ from their main campus, especially in the areas of rural and community medicine. The absence of an easy-to-use classification system has led to a lack of current research about RMCs as evidenced by the small number of articles in the current literature. The authors describe the process of the Group on Regional Medical Campuses used to develop attributes of a campus separate from the main campus that constitute a “classification” of a campus as an RMC. The system is broken into four models—basic science, clinical, longitudinal, and combined—and is linked to Liaison Committee on Medical Education standards. It is applicable to all schools and can be applied by any medical school dean or medical education researcher. The classification system paves the way for stakeholders to agree on a denominator of RMCs and conduct future research about their impact on medical education

Ideal magnetohydrodynamic simulations of unmagnetized dense plasma jet injection into a hot strongly magnetized plasma

We present results from three-dimensional ideal magnetohydrodynamic simulations of unmagnetized dense plasma jet injection into a uniform hot strongly magnetized plasma, with the aim of providing insight into core fueling of a tokamak with parameters relevant for ITER and NSTX (National Spherical Torus Experiment). Unmagnetized dense plasma jet injection is similar to compact toroid injection but with much higher plasma density and total mass, and consequently lower required injection velocity. Mass deposition of the jet into the background appears to be facilitated via magnetic reconnection along the jet's trailing edge. The penetration depth of the plasma jet into the background plasma is mostly dependent on the jet's initial kinetic energy, and a key requirement for spatially localized mass deposition is for the jet's slowing-down time to be less than the time for the perturbed background magnetic flux to relax due to magnetic reconnection. This work suggests that more accurate treatment of reconnection is needed to fully model this problem. Parameters for unmagnetized dense plasma jet injection are identified for localized core deposition as well as edge localized mode (ELM) pacing applications in ITER and NSTX-relevant regimes.Comment: 16 pages, 8 figures and 2 tables; accepted by Nuclear Fusion (May 11, 2011

The transcription factor osterix (SP7) regulates BMP6‐induced human osteoblast differentiation

The transcription factor Osterix (Sp7) is essential for osteoblastogenesis and bone formation in mice. Genome wide association studies have demonstrated that Osterix is associated with bone mineral density in humans; however, the molecular significance of Osterix in human osteoblast differentiation is poorly described. In this study we have characterized the role of Osterix in human mesenchymal progenitor cell (hMSC) differentiation. We first analyzed temporal microarray data of primary hMSC treated with bone morphogenetic protein‐6 (BMP6) using clustering to identify genes that are associated with Osterix expression. Osterix clusters with a set of osteoblast‐associated extracellular matrix (ECM) genes, including bone sialoprotein (BSP) and a novel set of proteoglycans, osteomodulin (OMD), osteoglycin, and asporin. Maximum expression of these genes is dependent upon both the concentration and duration of BMP6 exposure. Next we overexpressed and repressed Osterix in primary hMSC using retrovirus. The enforced expression of Osterix had relatively minor effects on osteoblastic gene expression independent of exogenous BMP6. However, in the presence of BMP6, Osterix overexpression enhanced expression of the aforementioned ECM genes. Additionally, Osterix overexpression enhanced BMP6 induced osteoblast mineralization, while inhibiting hMSC proliferation. Conversely, Osterix knockdown maintained hMSC in an immature state by decreasing expression of these ECM genes and decreasing mineralization and hMSC proliferation. Overexpression of the Osterix regulated gene OMD with retrovirus promoted mineralization of hMSC. These results suggest that Osterix is necessary, but not sufficient for hMSC osteoblast differentiation. Osterix regulates the expression of a set of ECM proteins which are involved in terminal osteoblast differentiation. J. Cell. Physiol. 227: 2677–2685, 2012. © 2011 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90208/1/jcp_23010_sm_SupplData.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/90208/2/23010_ftp.pd

CANWELL: USING EXERCISE TO EMPOWER PEOPLE WITH CANCER

Details on the CanWell program can be found at www.canwellprogram.caPeople with cancer face many challenges related to their disease and its associated treatments. This dissertation consists of two studies directly evaluating the effects of exercise on cancer survivors who participated in a community-based exercise program (CanWell program) and a measurement paper that evaluated a measure of symptom burden. The first study outlines the development and effectiveness of the CanWell program as measured by the 6-minute walk test, STEEP treadmill test, Functional Cancer Therapy Assessment – General, and the Edmonton Symptom Assessment System (ESAS). This study found that participants in the CanWell program have significantly improved physical abilities, improved quality-of-life, and lower levels of cancer disease burden. The second study was conducted to evaluate the long-term exercise compliance, facilitators and barriers to continuation of exercise. Outcome measures used were similar to those in the first study with a survey explored facilitators and barriers to exercise. The results of this study found that while CanWell graduates were able to maintain the functional levels (no change in 6-minute walk test), there were significant reductions in exercise aerobic abilities (time on treadmill). The main exercise barriers included fatigue, cost, and return to work. In the last study, the measurement properties of the ESAS were investigated using Rasch analysis leading to a revised scoring algorithm to meet unidimensionality and interval scaling. The ESAS scores from study #1 were re-analyzed using the new interval-level scoring scheme. This Rasch-based scoring resulted in different conclusions than the traditional ordinal scaling.Doctor of Philosophy (PhD

A conservationist, an economist, and a medic walk into a moral dilemma: Environmental decisions and rationalizing behavior

A recent Biological Conservation paper found that while conservationists behave more sustainably than other professionals in some respects (e.g. compost more), they still have much room to improve. Three key domains of behavior the paper tested were meat consumption, daily commuting behavior, and air travel. In this research, we analyzed the voluntary comments people made in response to questions about their behavior in these areas to seek a better understanding of how conservationists explain or rationalize their behavior despite their knowledge of how their behavior impacts the environment. The results revealed that conservationists were more likely to rationalize their meat consumption behavior than economists. Otherwise, there was not a significant difference between the likelihood of conservationists, economists, and medical professionals to rationalize their behavior. The most common types of rationalizations used by respondents to justify their unsustainable behavior were Self-Sanctions and Moral Justification. Interestingly, the rationalizations offered in the comments of the respondents also took the form of Positive Self-Reactions, or self-praise for behaving in a sustainable manner. A future line of study could assess the efficacy of interrupting the ability of people to rationalize their unsustainable behavior as a leverage point to alter behavior

Biological activity differences between TGF-β1 and TGF-β3 correlate with differences in the rigidity and arrangement of their component monomers

[Image: see text] TGF-β1, -β2, and -β3 are small, secreted signaling proteins. They share 71–80% sequence identity and signal through the same receptors, yet the isoform-specific null mice have distinctive phenotypes and are inviable. The replacement of the coding sequence of TGF-β1 with TGF-β3 and TGF-β3 with TGF-β1 led to only partial rescue of the mutant phenotypes, suggesting that intrinsic differences between them contribute to the requirement of each in vivo. Here, we investigated whether the previously reported differences in the flexibility of the interfacial helix and arrangement of monomers was responsible for the differences in activity by generating two chimeric proteins in which residues 54–75 in the homodimer interface were swapped. Structural analysis of these using NMR and functional analysis using a dermal fibroblast migration assay showed that swapping the interfacial region swapped both the conformational preferences and activity. Conformational and activity differences were also observed between TGF-β3 and a variant with four helix-stabilizing residues from TGF-β1, suggesting that the observed changes were due to increased helical stability and the altered conformation, as proposed. Surface plasmon resonance analysis showed that TGF-β1, TGF-β3, and variants bound the type II signaling receptor, TβRII, nearly identically, but had small differences in the dissociation rate constant for recruitment of the type I signaling receptor, TβRI. However, the latter did not correlate with conformational preference or activity. Hence, the difference in activity arises from differences in their conformations, not their manner of receptor binding, suggesting that a matrix protein that differentially binds them might determine their distinct activities

Discovery of Rubidium, Strontium, Molybdenum, and Rhodium Isotopes

Currently, thirty-one rubidium, thirty-five strontium, thirty-five molybdenum and thirty-eight rhodium isotopes have been observed and the discovery of these isotopes is discussed here. For each isotope a brief synopsis of the first refereed publication, including the production and identification method, is presented.Comment: To be published in Atomic Data and Nuclear Data Table

Discovery of Yttrium, Zirconium, Niobium, Technetium, and Ruthenium Isotopes

Currently, thirty-four yttrium, thirty-five zirconium, thirty-four niobium, thirty-five technetium, and thirty-eight ruthenium isotopes have been observed and the discovery of these isotopes is discussed here. For each isotope a brief synopsis of the first refereed publication, including the production and identification method, is presented.Comment: To be published in Atomic Data and Nuclear Data Table

Tailoring Crohn's disease treatment : the impact of small bowel capsule endoscopy

"Article in Press"; "Epub 2014 Mar 14"BACKGROUND AND AIMS: Small bowel capsule endoscopy (SBCE) may detect proximal small bowel lesions that have been previously missed by ileocolonoscopy and small bowel imaging in patients with known ileal and/or colonic Crohn's disease (CD). We aimed to evaluate whether the therapeutic management is influenced by SBCE findings. METHODS: Retrospective single center study. Inclusion of consecutive patients with known non-stricturing and non-penetrating ileal and/or colonic CD, submitted to SBCE to evaluate disease extension and activity, with ≥ 1year follow-up. Lesions were classified with the Lewis score (LS) as non-significant (LS790). Therapeutic changes were assessed three months after SBCE. RESULTS: Fifty consecutive patients (35±13years, 52% females) were included. At ileocolonoscopy, disease location was ileal (L1) in 60%, colonic (L2) in 10% and ileocolonic (L3) in 30% of the patients. In 33 patients (66%) SBCE detected significant proximal lesions previously missed by other modalities. The proportion of patients on thiopurines and/or biologics before SBCE was 2/50 (4%); this was significantly higher three months after SBCE, 15/50 (30%), p=0.023. Treatment with thiopurines and/or biologics was started more often in patients with proximal small bowel lesions [13/33 (39%) vs. 1/17 (6%), p=0.011, relative risk (RR) 6.5], particularly when severe (6%, 36% and 45% of patients with non-significant, mild and moderate-to-severe inflammation, respectively). CONCLUSIONS: SBCE diagnoses previously undetected lesions and it influences therapeutic management of CD, triggering an earlier introduction of immunomodulators and/or biological therapy