Adapt or Perish: Updating the Predoctoral Training Model.

The fate of biomedical research lies in the hands of future generations of scientists. In recent decades the diversity of scientific career opportunities has exploded multidimensionally. However, the educational system for maintaining a pipeline of talented biomedical trainees remains unidimensional and has become outdated.

Dermatology elective curriculum: Birdwatching list and travel guide.

Primary care physicians often see patients with dermatologic complaints, but do not perform as well as dermatologists in the diagnoses of common dermatologic conditions. This article describes a dermatology curriculum that aims to close the clinical practice gap by providing an efficient and effective way to teach dermatology to medical students and non-dermatology residents in the setting of a busy, outpatient dermatology practice.

Control of a depolarizing GABAergic input in an auditory coincidence detection circuit.

Neurons in the chicken nucleus laminaris (NL), the third-order auditory neurons that detect the interaural time differences that enable animals to localize sounds in the horizontal plane, receive glutamatergic excitation from the cochlear nucleus magnocellularis (NM) and GABAergic inhibition from the ipsilateral superior olivary nucleus. Here, we study metabotropic glutamate receptor (mGluR)- and GABAB receptor (GABABR)-mediated modulation of synaptic transmission in NL neurons. Gramicidin-perforated recordings from acute brain stem slice preparations showed that the reversal potential of the GABAergic responses in NL neurons was more depolarized than the spike threshold.

Temporal features of spectral integration in the inferior colliculus: effects of stimulus duration and rise time.

This report examines temporal features of facilitation and suppression that underlie spectrally integrative responses to complex vocal signals. Auditory responses were recorded from 160 neurons in the inferior colliculus (IC) of awake mustached bats. Sixty-two neurons showed combination-sensitive facilitation: responses to best frequency (BF) signals were facilitated by well-timed signals at least an octave lower in frequency, in the range 16-31 kHz.

The eyelids: some common disorders seen in everyday practice.

The eyelids, essential to protecting and cleansing the eye, are a common site for a range of disorders affecting older adults. Some of these are benign and some serious, with the most clinically important being suspicious lid lesions that may harbor malignancy and neurologic disorders, as well as structural malpositions that cause poor lid function and may lead to globe damage and visual impairment. The ability to recognize eyelid problems is important, as they often present first to the primary care physician.

The science of selecting antimicrobials for community-acquired pneumonia (CAP).

Background: Among infectious diseases, community-acquired pneumonia (CAP) is the leading cause of death in the United States and is associated with a substantial economic burden to the health care system. Initiating appropriate empiric therapy can be challenging given elevated resistance rates among Streptococcus pneumoniae strains.

Objective: To present current recommendations for management of CAP with respect to (a) choosing the appropriate site of care, and (b) antimicrobial selection based on bacterial etiology and the prevalence of resistance.

Mineral deposition in the extracellular matrices of vertebrate tissues: identification of possible apatite nucleation sites on type I collagen.

The possible means by which type I collagen may mediate mineralization in normal vertebrate bone, tendon, dentin and cementum as well as in pathological mineral formation are not fully understood. One consideration in this regard is that the structure of the protein is somehow important in binding calcium and phosphate ions in a stereochemical configuration conducive to nucleation of apatite crystals. In the present study, type I collagen, packed in a quarter-staggered arrangement in two dimensions and a quasi-hexagonal model of microfibrillar assembly in three dimensions, has been examined in terms of several of its charged amino acid residues.

The Six-Item Screener to detect cognitive impairment in older emergency department patients.

Background: Cognitive impairment due to delirium or dementia is common in older emergency department (ED) patients. To prevent errors, emergency physicians (EPs) should use brief, sensitive tests to evaluate older patient's mental status. Prior studies have shown that the Six-Item Screener (SIS) meets these criteria.

Prevalence of health-related behaviors among physicians and medical trainees.

Objective: The authors studied the prevalence of health-promoting and health-risking behaviors among physicians and physicians-in-training. Given the significant potential for negative outcomes to physicians' own health as well as the health and safety of their patients, examination of the natural history of this acculturation process about physician self-care and wellness is critical to the improvement of the western health care delivery system.

Methods: 963 matriculating medical students, residents, or attending physicians completed the Empathy, Spirituality, and Wellness in Medicine (ESWIM) survey between the years 2000 and 2004.

Redox-dependent coronary metabolic dilation.

We have observed that hydrogen peroxide (H2O2), the dismutated product of superoxide, is a coronary metabolic dilator and couples myocardial oxygen consumption to coronary blood flow. Because the chemical activity of H2O2 favors its role as an oxidant, and thiol groups are susceptible to oxidation, we hypothesized that coronary metabolic dilation occurs via a redox mechanism involving thiol oxidation. To test this hypothesis, we studied the mechanisms of dilation of isolated coronary arterioles to metabolites released by metabolically active (paced at 400 min) isolated cardiac myocytes and directly compared these responses with authentic H2O2.

Novel method used to test pullout parameters of different nephrostomy catheters.

Purpose: To present a novel in-vitro pig model for testing the design and function of different internal catheter constructs, along with the resulting exit wound resulting from removal.

Materials And Methods: We compared the pullout parameters of two nephrostomy catheters that differ only in their internal loop design.

Results: Greater force, work, and displacement are necessary to extricate catheters with a double loop without increasing exit-wound size.

Tethered cord syndrome in a 24-year-old woman presenting with urinary retention.

We discuss a case of newly diagnosed tethered cord syndrome (TCS) in a 24-year-old woman who presented with dysuria, hematuria, and urinary retention. Physical exam revealed hyperreflexic lower extremity deep tendon reflexes. MRI showed filum terminale terminating in a lipoma, consistent with TCS.

Insulin regulation of cholesterol 7alpha-hydroxylase expression in human hepatocytes: roles of forkhead box O1 and sterol regulatory element-binding protein 1c.

Bile acid synthesis and pool size increases in diabetes, whereas insulin inhibits bile acid synthesis. The objective of this study is to elucidate the mechanism of insulin regulation of cholesterol 7alpha-hydroxylase gene expression in human hepatocytes. Real-time PCR assays showed that physiological concentrations of insulin rapidly stimulated cholesterol 7alpha-hydroxylase (CYP7A1) mRNA expression in primary human hepatocytes but inhibited CYP7A1 expression after extended treatment.

The medically underserved: who is likely to exercise and why?

Adults who exercise regularly have better health, but only 15% of U.S. adults engage in regular exercise, with some social groups, such as people with lower incomes and women, having even lower rates.

Role of positional instillation of contrast cystography in the algorithm for evaluating children with confirmed pyelonephritis.

Objectives: To assess the utility of positional instillation of contrast (PIC) cystography in detecting vesicoureteral reflux (VUR) in patients with renal scarring from recurrent febrile urinary tract infections that standard voiding cystourethrography and nuclear cystogram imaging failed to reveal.

Methods: Between June 2004 and November 2004, a total of 5 pediatric patients with recurrent febrile urinary tract infections and radiologic evidence of upper tract involvement were examined with PIC cystography. All patients had at least one previous negative standard reflux study (voiding cystourethrography or nuclear cystography).

Purse-string platysmaplasty: the third dimension for neck contouring.

Techniques and concepts for treatment of the aging neck have been evolving since the late 1960s and rely on two-dimensional anterior approximation with lateral imbrication of the platysma with or without submental fat reduction, However, the medial approximation can sometimes give a "boxy" appearance to the anterior neck, especially if anterior shifting of the platysma recurs after platysmaplasty with laxity redeveloping in this midline location. The "purse-string" platysmaplasty (PSP) is a new concept in neck contouring that facilitates an enhanced definition for the cervicomandibular transition to better simulate the well-defined contour of this transition that is present in youth. It aids in the contouring of difficult poorly defined necks and in male patients.

Subperiosteal deep plane rhytidectomy: the composite midface lift.

Techniques for facial rejuvenation have long involved specific remedies for each facial segment affected by the aging process. Traditional facial rejuvenation techniques have addressed the anterior neck and platysma complex as well as the acquired jaw deformity. These techniques often left the nasolabial complex and the "infraorbital hollow" un-addressed.