Preparing Residents for Rural Practice and Advocacy: The Experiences of Three Residency Training Programs in the Northeast United States (2009-2023).

Residents that are exposed to rural practice during their training may be more likely to consider working in rural settings after training, whether that be in primary or specialty care. The authors describe 3 programs in northern New England that have had rural rotations and opportunities for residents for decades, and discuss curricular similarities and differences, and workforce outcomes postresidency. In addition, they share a collaborative curriculum and approach to advocacy that brings residents together to share ideas and projects to learn from each other.

Delayed Posterior Fossa Hemorrhage Following a Tangential Gunshot Wound to the Occiput in a Patient With Chronic Liver Disease: A Case Report.

Gunshot wounds (GSWs) to the head and neck are a common etiology of traumatic brain injury. Tangential GSWs (TGSWs) are a subset of GSWs wherein the missile penetrates tissue adjacent to the cranium, causing varying degrees of intracranial injury. Most patients sustaining TGSWs present with relatively benign neurological findings, and while a significant proportion have varying degrees of intracranial hemorrhage (ICH) on computed tomography, these tend to respond well to nonoperative management.

Genomically recoded with optimized functional phenotypes.

Genomically recoded organisms hold promise for many biotechnological applications, but they may exhibit substantial fitness defects relative to their non-recoded counterparts. We used targeted metabolic screens, genetic analysis, and proteomics to identify the origins of fitness impairment in a model recoded organism, C321.∆A.

Assisted Fluid Management and Sublingual Microvascular Flow During High-Risk Abdominal Surgery: A Randomized Controlled Trial.

Background: Implementation of goal-directed fluid therapy (GDFT) protocols remains low. Protocol compliance among anesthesiologists tends to be suboptimal owing to the high workload and the attention required for implementation. The assisted fluid management (AFM) system is a novel decision support tool designed to help clinicians apply GDFT protocols.

Designing Quantum Spaces of Higher Dimensionality from a Tetranuclear Erbium-Based Single-Molecule Magnet.

The spin relaxation of an Er tetranuclear single-molecule magnet, , (hdcCOT = hexahydrodicyclopentacyclooctatetraenide dianion), is modeled as a near-tetrahedral arrangement of Ising-type spins. Combining evidence from single-crystal X-ray diffraction, magnetometry, and computational techniques, the slow spin relaxation is interpreted as a consequence of symmetry restrictions imposed on quantum tunneling within the cluster core. The union of spin and spatial symmetries describe a ground state spin-spin coupled manifold wherein 16 eigenvectors generate the 3D quantum spin-space described by the vertices of a rhombic dodecahedron.

Restrictive versus Decision Support Guided Fluid Therapy during Major Hepatic Resection Surgery: A Randomized Controlled Trial.

Background: Fluid therapy during major hepatic resection aims at minimizing fluids during the dissection phase to reduce central venous pressure, retrograde liver blood flow, and venous bleeding. This strategy, however, may lead to hyperlactatemia. The Acumen assisted fluid management system uses novel decision support software, the algorithm of which helps clinicians optimize fluid therapy.

Simultaneous genetic transformation and genome editing of mixed lines in soybean () and maize ().

Unlabelled: Robust genome editing technologies are becoming part of the crop breeding toolbox. Currently, genome editing is usually conducted either at a single locus, or multiple loci, in a variety at one time. Massively parallel genomics platforms, multifaceted genome editing capabilities, and flexible transformation systems enable targeted variation at nearly any locus, across the spectrum of genotypes within a species.

Effects of age on oxidative stress and locomotion in the pollinator, Megachile rotundata.

Despite numerous aging studies, the relationship between oxidative stress, aging, and decline in functions such as locomotion is still debated. Insects offer a promising model for analyzing the relationship between oxidative stress and aging, because they exhibit vast differences in lifespan that may be affected by the environment, social factors, levels of activity, and aging interventions. In this study, we explore the effects of aging on oxidative stress and locomotion using the pollinator, Megachile rotundata, a species that is very mobile and active in the adult stage.

Telomere length is longer following diapause in two solitary bee species.

The mechanisms that underlie senescence are not well understood in insects. Telomeres are conserved repetitive sequences at chromosome ends that protect DNA during replication. In many vertebrates, telomeres shorten during cell division and in response to stress and are often used as a cellular marker of senescence.

Elastocapillary effects determine early matrix deformation by glioblastoma cell spheroids.

During cancer pathogenesis, cell-generated mechanical stresses lead to dramatic alterations in the mechanical and organizational properties of the extracellular matrix (ECM). To date, contraction of the ECM is largely attributed to local mechanical stresses generated during cell invasion, but the impact of "elastocapillary" effects from surface tension on the tumor periphery has not been examined. Here, we embed glioblastoma cell spheroids within collagen gels, as a model of tumors within the ECM.

Non-covalent planarizing interactions yield highly ordered and thermotropic liquid crystalline conjugated polymers.

Controlling the multi-level assembly and morphological properties of conjugated polymers through structural manipulation has contributed significantly to the advancement of organic electronics. In this work, a redox active conjugated polymer, TPT-TT, composed of alternating 1,4-(2-thienyl)-2,5-dialkoxyphenylene (TPT) and thienothiophene (TT) units is reported with non-covalent intramolecular S⋯O and S⋯H-C interactions that induce controlled main-chain planarity and solid-state order. As confirmed by density functional theory (DFT) calculations, these intramolecular interactions influence the main chain conformation, promoting backbone planarization, while still allowing dihedral rotations at higher kinetic energies (higher temperature), and give rise to temperature-dependent aggregation properties.

Clinical Knowledge and Reasoning Abilities of AI Large Language Models in Anesthesiology: A Comparative Study on the American Board of Anesthesiology Examination.

Background: Over the past decade, artificial intelligence (AI) has expanded significantly with increased adoption across various industries, including medicine. Recently, AI-based large language models such as Generative Pretrained Transformer-3 (GPT-3), Bard, and Generative Pretrained Transformer-3 (GPT-4) have demonstrated remarkable language capabilities. While previous studies have explored their potential in general medical knowledge tasks, here we assess their clinical knowledge and reasoning abilities in a specialized medical context.

Dipolar Coupling as a Mechanism for Fine Control of Magnetic States in ErCOT-Alkyl Molecular Magnets.

The design of molecular magnets has progressed greatly by taking advantage of the ability to impart successive perturbations and control vibronic transitions in 4f systems through the careful manipulation of the crystal field. Herein, we control the orientation and rigidity of two dinuclear ErCOT-based molecular magnets: the inversion-symmetric bridged [ErCOT(μ-Me)(THF)] () and the nearly linear Li[(ErCOT)(μ-Me)] (). The conserved anisotropy of the ErCOT synthetic unit facilitates the direction of the arrangement of its magnetic anisotropy for the purposes of generating controlled internal magnetic fields, improving control of the energetics and transition probabilities of the electronic angular momentum states with exchange biasing via dipolar coupling.

Characterizing Chronic Pain and Adverse Childhood Experiences in the Lesbian, Gay, Bisexual, Transgender, or Queer Community.

Background: Childhood adversity is associated with chronic pain in adulthood. Additionally, individuals identifying as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) report a greater prevalence of chronic pain and increased adverse childhood experiences (ACEs). While the LGTBQ+ community has a disproportionately high chronic disease burden, limited research has been conducted on the associations between chronic pain conditions or intensity and childhood adversity in this population.

Control of mean arterial pressure using a closed-loop system for norepinephrine infusion in severe brain injury patients: the COMAT randomized controlled trial.

Brain injury patients require precise blood pressure (BP) management to maintain cerebral perfusion pressure (CPP) and avoid intracranial hypertension. Nurses have many tasks and norepinephrine titration has been shown to be suboptimal. This can lead to limited BP control in patients that are in critical need of cerebral perfusion optimization.

Metabolic and transcriptomic characterization of summer and winter dormancy in the solitary bee, Osmia lignaria.

The solitary bee Osmia lignaria is a native pollinator in North America with growing economic importance. The life cycle of O. lignaria provides a unique opportunity to compare the physiological and molecular mechanisms underlying two ecologically contrasting dormancies within the same species.

Perioperative Fluid and Vasopressor Therapy in 2050: From Experimental Medicine to Personalization Through Automation.

Intravenous (IV) fluids and vasopressor agents are key components of hemodynamic management. Since their introduction, their use in the perioperative setting has continued to evolve, and we are now on the brink of automated administration. IV fluid therapy was first described in Scotland during the 1832 cholera epidemic, when pioneers in medicine saved critically ill patients dying from hypovolemic shock.

A Delphi Process to Identify Relevant Outcomes That May Be Associated With a Predictive Analytic Tool to Detect Hemodynamic Deterioration in the Intensive Care Unit.

Background The critical care literature has seen an increase in the development and validation of tools using artificial intelligence for early detection of patient events or disease onset in the intensive care unit (ICU). The hemodynamic stability index (HSI) was found to have an AUC of 0.82 in predicting the need for hemodynamic intervention in the ICU.

Closed-loop anesthesia: foundations and applications in contemporary perioperative medicine.

A closed-loop automatically controls a variable using the principle of feedback. Automation within anesthesia typically aims to improve the stability of a controlled variable and reduce workload associated with simple repetitive tasks. This approach attempts to limit errors due to distractions or fatigue while simultaneously increasing compliance to evidence based perioperative protocols.