In situ architecture of a nucleoid-associated biomolecular co-condensate that regulates bacterial cell division.

In most bacteria, cell division depends on the tubulin-homolog FtsZ that polymerizes in a GTP-dependent manner to form the cytokinetic Z-ring at the future division site. Subsequently, the Z-ring recruits, directly or indirectly, all other proteins of the divisome complex that executes cytokinesis. A critical step in this process is the precise positioning of the Z-ring at the future division site.

Variation in Case Exposure During Internal Medicine Residency.

Importance: Variation in residency case exposure affects resident learning and readiness for future practice. Accurate reporting of case exposure for internal medicine (IM) residents is challenging because feasible and reliable methods for linking patient care to residents are lacking.

Objective: To develop an integrated education-clinical database to characterize and measure case exposure variability among IM residents.

Label-free single-cell RNA multiplexing leveraging genetic variability.

Single cell RNA sequencing has provided unprecedented insights into the molecular cues and cellular heterogeneity underlying human disease. However, the high costs and complexity of single cell methods remain a major obstacle for generating large-scale human cohorts. Here, we compare current state-of-the-art single cell multiplexing technologies, and provide a widely applicable demultiplexing method, SoupLadle, that enables simple, yet robust high-throughput multiplexing leveraging genetic variability of patients.

A Rollercoaster of Grades Versus Growth in the Clerkship Year: A Phenomenological Study of Medical Student Experience with Competency Development.

Purpose: As competency-based medical education (CBME) continues to advance in undergraduate medical education, students are expected to simultaneously pursue their competency development while also discriminating themselves for residency selection. During the foundational clerkship year, it is important to understand how these seemingly competing goals are navigated.

Methods: In this phenomenological qualitative study, the authors describe the experience of 15 clerkship students taking part in a pilot pathway seeking to implement CBME principles.

An Untold Story: The Feelings of Pediatric Residents Early in the COVID-19 Pandemic and What They Can Teach Us Today.

Objective: To understand the feelings of pediatrics residents early in the COVID-19 pandemic and to offer insights still relevant today.

Methods: We performed a thematic analysis exploring resident feelings early in the pandemic using free-text responses on a national survey distributed between May and June 2020. We analyzed responses from the following multi-part free text question embedded in the larger survey, "Which of the following feelings have you experienced in your role as a pediatric resident during the COVID-19 pandemic" with response prompts including relief, guilt, pride, sadness, worry, fear, and other.

Public Board Score Reporting Undermines Holistic Review for Residency Selection.

Holistic review has become the gold standard for residency selection. As a result, many programs are de-emphasizing standardized exam scores and other normative metrics. However, if standardized exam scores predict passing of an initial certifying exam, this may lead to an increase in board failure rates within specific residency training programs who do not emphasize test scores on entry.

Legitimation Without Argumentation: An Empirical Discourse Analysis of 'Validity as an Argument' in Assessment.

Introduction: Validity is frequently conceptualized in health professions education (HPE) assessment as an argument that supports the interpretation and uses of data. However, previous work has shown that many validity scholars believe argument and argumentation are relatively lacking in HPE. To better understand HPE's discourse around argument and argumentation with regard to assessment validity, the authors explored the discourses present in published HPE manuscripts.

A retrospective observational study - exploring food pantry referral as a clinical proxy for residents' ability to address unmet health-related social needs.

Background: Assessment of residents' ability to address unmet health-related social needs to promote social accountability remains subjective and difficult. Existing approaches rely on self-assessment surveys of residents' knowledge, skills, and attitudes following social determinants of health training, with few studies explicitly measuring clinical practice. We aimed to characterize social accountability using resident referrals to a food pantry embedded in a pediatric primary care center as an objective measure of resident ability to address unmet health-related social needs in clinical practice.

ADAMTS12 promotes fibrosis by restructuring extracellular matrix to enable activation of injury-responsive fibroblasts.

Fibrosis represents the uncontrolled replacement of parenchymal tissue with extracellular matrix (ECM) produced by myofibroblasts. While genetic fate-tracing and single-cell RNA-Seq technologies have helped elucidate fibroblast heterogeneity and ontogeny beyond fibroblast to myofibroblast differentiation, newly identified fibroblast populations remain ill defined, with respect to both the molecular cues driving their differentiation and their subsequent role in fibrosis. Using an unbiased approach, we identified the metalloprotease ADAMTS12 as a fibroblast-specific gene that is strongly upregulated during active fibrogenesis in humans and mice.

Validity in the Next Era of Assessment: Consequences, Social Impact, and Equity.

Validity has long held a venerated place in education, leading some authors to refer to it as the "sine qua non" or "cardinal virtue" of assessment. And yet, validity has not held a fixed meaning; rather it has shifted in its definition and scope over time. In this Eye Opener, the authors explore if and how current conceptualizations of validity fit a next era of assessment that prioritizes patient care and learner equity.

Breast Cancer Stem Cells Upregulate IRF6 in Stromal Fibroblasts to Induce Stromagenesis.

The microenvironment of a cancer stem cell (CSC) niche is often found in coexistence with cancer-associated fibroblasts (CAFs). Here, we show the first in-depth analysis of the interaction between primary triple-negative breast cancer stem cells (BCSCs) with fibroblasts. Using 2D co-culture models with specific seeding ratios, we identified stromal fibroblast aggregation at the BCSC cluster periphery, and, on closer observation, the aggregated fibroblasts was found to encircle BCSC clusters in nematic organization.

A realist evaluation of prospective entrustment decisions in paediatric residency clinical competency committees.

Purpose: Making entrustment decisions (granting more responsibility, advancement and graduation) are important actions in medical training that pose risks to trainees and patients if not done well. A previous realist synthesis of the existing literature revealed that clinical competency committees (CCCs) do not typically make deliberate entrustment decisions, instead defaulting to the promotion and graduation of trainees in the absence of red flags. This study sought further understanding of these areas through empirical data.

Dryland self-expansion enabled by land-atmosphere feedbacks.

Dryland expansion causes widespread water scarcity and biodiversity loss. Although the drying influence of global warming is well established, the role of existing drylands in their own expansion is relatively unknown. In this work, by tracking the air flowing over drylands, we show that the warming and drying of that air contributes to dryland expansion in the downwind direction.

Competency-based medical education: Connecting training outcomes to patient care.

Competency-based medical education (CBME) is a patient-centered and learner-focused approach to education where curricula are delivered in a manner tailored to the individuals' learning needs, and assessment focuses on ensuring trainees achieve requisite and clearly specified learning outcomes. Despite calls to focus assessment on what matters for patients. In this article, the authors explore one aspect of this next era: the use of electronic health record clinical performance indicators, such as Resident-Sensitive Quality Measures (RSQMs) and TRainee Attributable and Automatable Care Evaluations in Real-time (TRACERs), for learner assessment.

High repetition-rate dual-channel X-ray spectrometer for high-intensity laser-plasma experiments.

We describe the development and demonstration of a high-repetition-rate-capable dual-channel (DC) x-ray spectrometer designed for high-intensity laser-plasma experiments (≥1×1021 W/cm2). The spectrometer, which operates at high repetition rates, is limited only by the refresh rate of targets and the camera's frame rate. It features two channels, each equipped with a flat highly oriented pyrolytic graphite (HOPG) crystal and a unique detector plane, allowing it to resolve two distinct x-ray bands: approximately 7-10 and 10-13 keV.

Reimagining Initial Certification as a Process That Begins During Residency to Support Continuous Development Across Training and Practice.

In the United States, initial board certification remains focused on a high-stakes knowledge examination after completion of training. A more contemporary view supports a program of assessment that includes multiple types and sources of data with an emphasis on direct workplace observation to get the best picture of an individual's performance. In this article, the authors reimagine initial certification as a continuous assessment for learning that begins in residency, focuses on both knowledge acquisition and its application, and interdigitates intentionally with the first cycle of maintenance of certification to advance learning and smooth the transition from training to practice.

Coronary Microvascular Dysfunction in Acute Cholestasis-Induced Liver Injury.

Background: Previous studies have shown cardiac abnormalities in acute liver injury, suggesting a potential role in the associated high mortality.

Methods: We designed an experimental study exploring the short-term effects of acute cholestasis-induced liver injury on cardiac function and structure in a rodent bile duct ligation (BDL) model to elucidate the potential interplay. Thirty-seven male rats were subjected to BDL surgery ( = 28) or served as sham-operated ( = 9) controls.

Program Director Attitudes Toward Acceptance of Pediatric Dentistry Entrustable Professional Activities (EPAs).

To acquire comments on pediatric dentistry entrustable professional activities (EPAs) from pediatric dentistry residency program directors (PDs). An electronic survey invited PDs to evaluate 16 previously developed EPAs on whether they were critical to patient safety, resident education, or both. PDs were asked to evaluate a fully developed EPA to assess structure and clarity and describe barriers to EPA.

Level of Supervision for the Entrustable Professional Activities Common to General Pediatrics and the Subspecialties Decreases from Residency to Fellowship.

Objectives: To compare level of supervision (LOS) ratings of graduating pediatric residents with their assessments as fellows for the five Entrustable Professional Activities (EPAs) common to general pediatrics and the subspecialties and to determine if the difference between ratings from residency to fellowship is less for the QI and Practice Management EPAs, since the skills needed to perform these may be less context-dependent.

Methods: We compared ratings of graduating residents with their assessments as fellows using LOS data from two sequential EPA studies.

Results: There were 65 ratings from 41 residents at the first fellow assessment.