Medical fruits of labor

My grandfather's death made a profound impact on my life personally and professionally. Our family was able to share in his last joyous days thanks to a caring physician who first suggested palliative care. During these final days in which friends and family said their goodbyes, I realized as a medical student the immense impact we as healthcare workers truly make in our patients' lives. Reflections on palliative care, faith, medicine, and death following this experience influenced my formation as a Catholic, grandson, and as a physician in training. Lay summary: This article describes the personal experience of a medical student who witnesses the final days of his grandfather's life. Life, death, faith, palliative care, and the impact of physicians on families during these times is the subject of his reflection following his grandfather's death

Epeoloides pilosulus (Cresson) Rediscovered in Michigan, with Notes on the Distribution and Status of its Macropis hosts.

Epeoloides pilosulus (Cresson 1878) is one of the rarest bees in North America with only a handful of records since 1960. The last collection in Michigan was made in 1944. Epeoloides pilosulus is a brood parasite of Macropis bees, which until recently had not been collected in Michigan for several decades. Bee surveys in Midland County, Michigan have led to the rediscovery of E. pilosulus in this state – the first record in 74 years. Michigan becomes the fourth state where E. pilosulus has been rediscovered after Connecticut in 2006, New York in 2014 and Maine in 2016, and the sixth region in North America after Nova Scotia in 2002 and Alberta in 2010. State-wide bee surveys have also shown that the principal host, Macropis nuda (Provancher 1882), remains widespread in Michigan, and that Macropis patellata Patton 1880 is newly recorded for the state

Comparison of Three Dispenser Distribution Patterns for Pheromone Mating Disruption of Paralobesia viteana (Lepidoptera: Tortricidae) in Vineyards

Over two growing seasons, Isomate GBM-Plus tube-type dispensers releasing the major pheromone component of grape berry moth, Paralobesia viteana (Clemens) (Lepidoptera: Tortricidae), were evaluated in vineyards (Vitis spp.) in Michigan, New York, and Pennsylvania. Dispensers were deployed in three different density-arrangement treatments: 124 dispensers per ha, 494 dispensers per ha, and a combined treatment with 124 dispensers per ha in the vineyard interior and 988 dispensers per ha at the vineyard border, equivalent to an overall density of 494 dispensers per ha. Moth captures and cluster infestation levels were compared at the perimeter and interior of vineyards receiving these different pheromone treatments and in vineyards receiving no pheromone. Orientation of male moths to pheromone-baited traps positioned at the perimeter and interior of vineyards was reduced as a result of mating disruption treatments compared with the nontreated control. These findings were consistent over both years of the study. Disruption of male moth captures in traps varied from 93 to 100% in treated vineyards, with the 494 dispensers per ha application rates providing significantly higher level of disruption than the 124 dispensers per ha rate, but only in 2007. Measurements of percentage of cluster infestation indicated much higher infestation at perimeters than in the interior of the vineyards in all three regions, but in both sample positions there was no significant effect of dispenser density on cluster infestation levels in either year. The contrasting results of high disruption of moth orientation to traps in vineyards that also had low levels of crop protection from this pheromone treatment are discussed in the context of strategies to improve mating disruption of this tortricid pes

Rational optimization of tolC as a powerful dual selectable marker for genome engineering

Selection has been invaluable for genetic manipulation, although counter-selection has historically exhibited limited robustness and convenience. TolC, an outer membrane pore involved in transmembrane transport in E. coli, has been implemented as a selectable/counter-selectable marker, but counter-selection escape frequency using colicin E1 precludes using tolC for inefficient genetic manipulations and/or with large libraries. Here, we leveraged unbiased deep sequencing of 96 independent lineages exhibiting counter-selection escape to identify loss-of-function mutations, which offered mechanistic insight and guided strain engineering to reduce counter-selection escape frequency by ∼40-fold. We fundamentally improved the tolC counter-selection by supplementing a second agent, vancomycin, which reduces counter-selection escape by 425-fold, compared colicin E1 alone. Combining these improvements in a mismatch repair proficient strain reduced counter-selection escape frequency by 1.3E6-fold in total, making tolC counter-selection as effective as most selectable markers, and adding a valuable tool to the genome editing toolbox. These improvements permitted us to perform stable and continuous rounds of selection/counter-selection using tolC, enabling replacement of 10 alleles without requiring genotypic screening for the first time. Finally, we combined these advances to create an optimized E. coli strain for genome engineering that is ∼10-fold more efficient at achieving allelic diversity than previous best practices

Epidural Hematoma Following Cervical Spine Surgery.

STUDY DESIGN: A multicentered retrospective case series. OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. CONCLUSION: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements

Epidemiology and Outcomes of Vertebral Artery Injury in 16 582 Cervical Spine Surgery Patients: An AOSpine North America Multicenter Study.

STUDY DESIGN: A multicenter retrospective case series was compiled involving 21 medical institutions. Inclusion criteria included patients who underwent cervical spine surgery between 2005 and 2011 and who sustained a vertebral artery injury (VAI). OBJECTIVE: To report the frequency, risk factors, outcomes, and management goals of VAI in patients who have undergone cervical spine surgery. METHODS: Patients were evaluated on the basis of condition-specific functional status using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score, the Nurick scale, and the 36-Item Short-Form Health Survey (SF-36). RESULTS: VAIs were identified in a total of 14 of 16 582 patients screened (8.4 per 10 000). The mean age of patients with VAI was 59 years (±10) with a female predominance (78.6%). Patient diagnoses included myelopathy, radiculopathy, cervical instability, and metastatic disease. VAI was associated with substantial blood loss (770 mL), although only 3 cases required transfusion. Of the 14 cases, 7 occurred with an anterior-only approach, 3 cases with posterior-only approach, and 4 during circumferential approach. Fifty percent of cases of VAI with available preoperative imaging revealed anomalous vessel anatomy during postoperative review. Average length of hospital stay was 10 days (±8). Notably, 13 of the 14 (92.86%) cases resolved without residual deficits. Compared to preoperative baseline NDI, Nurick, mJOA, and SF-36 scores for these patients, there were no observed changes after surgery (P = .20-.94). CONCLUSIONS: Vertebral artery injuries are potentially catastrophic complications that can be sustained from anterior or posterior cervical spine approaches. The data from this study suggest that with proper steps to ensure hemostasis, patients recover function at a high rate and do not exhibit residual deficits

Small representations of finite classical groups

Finite group theorists have established many formulas that express interesting properties of a finite group in terms of sums of characters of the group. An obstacle to applying these formulas is lack of control over the dimensions of representations of the group. In particular, the representations of small dimensions tend to contribute the largest terms to these sums, so a systematic knowledge of these small representations could lead to proofs of important conjectures which are currently out of reach. Despite the classification by Lusztig of the irreducible representations of finite groups of Lie type, it seems that this aspect remains obscure. In this note we develop a language which seems to be adequate for the description of the "small" representations of finite classical groups and puts in the forefront the notion of rank of a representation. We describe a method, the "eta correspondence", to construct small representations, and we conjecture that our construction is exhaustive. We also give a strong estimate on the dimension of small representations in terms of their rank. For the sake of clarity, in this note we describe in detail only the case of the finite symplectic groups.Comment: 18 pages, 9 figures, accepted for publications in the proceedings of the conference on the occasion of Roger Howe's 70th birthday (1-5 June 2015, Yale University, New Haven, CT