Digital Resources for Residency Recruitment: A Pilot Study of What Applicants Really Utilize.

Background: The COVID-19 pandemic in 2020 led to multiple changes in graduate medical education programs across the country, including the switch to virtual interviews for all residency applicants instead of on-site visits. The rapid transition to virtual interviews introduced challenges, including limited opportunities to formally and informally interact with residents and faculty, observe the clinical and educational environments, and explore the local culture and community. As a result, programs were advised to heavily invest in and create comprehensive digital resources including but not limited to video tours and multimedia resources describing programmatic details. Methods: In preparation for the virtual interview season of 2020-2021, digital recruitment materials were created for the University of Nebraska Medical Center's Anesthesiology residency applicants to provide the information that they would traditionally receive during an in-person interview experience. The objectives of the study were (1) to assess which digital materials residency applicants accessed most frequently during the interview season, and (2) to determine if the digital materials were helpful for the residency applicant in best determining program fit as part of the interview process. A post-interview survey and user analytics were analyzed. Results: With a survey response rate of 58% (n = 87 of 150) and a Web-based email-open rate of 98% (n =147 of 150), the data revealed that the favored digital materials were the "What Residents Say" video and the Residency Applicant Handbook. These were also the most helpful for the residency applicant in best determining program fit. Conclusion: This study shows that resources that allowed students to better assess their "fit" in the program were highly accessed and valued, as were detailed descriptions of the clinical and educational aspects of the training program found in the resident handbook.

Distinct Synaptic Vesicle Proteomic Signatures Associated with Pre- and Post-Natal Oxycodone-Exposure.

The current opioid crisis, which has ravaged all segments of society, continues to pose a rising public health concern. Importantly, dependency on prescription opioids such as oxycodone (oxy) during and after pregnancy can significantly impact the overall brain development of the exposed offspring, especially at the synapse. A significant knowledge gap that remains is identifying distinct synaptic signatures associated with these exposed offspring. Accordingly, the overall goal of this current study was to identify distinct synaptic vesicle (SV) proteins as signatures for offspring exposed to oxy in utero (IUO) and postnatally (PNO). Using a preclinical animal model that imitates oxycodone exposure in utero (IUO) and postnatally (PNO), we used a quantitative mass spectrometry-based proteomics platform to examine changes in the synaptic vesicle proteome on post-natal day 14 (P14) IUO and PNO offspring. We identified MEGF8, associated with carpenter syndrome, to be downregulated in the IUO offspring while LAMTOR4, associated with the regulator complex involved in lysosomal signaling and trafficking, was found to be upregulated in the PNO groups, respectively. Their respective differential expression was further validated by Western blot. In summary, our current study shows exposure to oxy in utero and postnatally can impact the SV proteome in the exposed offspring and the identification of these distinct SV signatures could further pave the way to further elucidate their downstream mechanisms including developing them as potential therapeutic targets.

Bloodless Repair of Aortic Arch with Dual Aortic Cannulation in a Jehovah's Witness Patient.

Various methods for surgical repair of the aortic arch are described throughout the literature with many focused on cannulation techniques and degree of systemic cooling in an effort to reduce postoperative morbidities. Despite advancements in techniques, this surgery is still often associated with higher levels of blood loss and subsequent allogenic blood transfusions. Although blood products can be safely transfused to the majority of patients undergoing repair of the aortic arch, the complexity and risk is further multiplied when the patient is of Jehovah's Witness faith and refuses blood transfusions. This paper will detail our technique of surgical repair of the aortic arch in a Jehovah's Witness patient with dual aortic cannulation and our multidisciplinary approach to avoiding blood products.

Failed calibration of anesthesia machine due to look-alike oxygen sensors.

Labels and medications with similar appearances have the potential to harm patients and cause delays in hospital services. We report a problem involving the Maxtec MAX-1 and MAX-11 oxygen sensors which are commonly used on anesthesia machines. These oxygen sensors have nearly identical labels which resulted in inadvertent interchanging of the sensors. The incident required the replacement of a MAX-11 sensor with a MAX-1 sensor to ensure proper functioning of the anesthesia machine. Identification of these cases can educate health care professionals of potential sources of labeling errors and safety issues and can also bring about Food and Drug Administration policy changes.

Cardiac baroreflex sensitivity is not correlated to sympathetic baroreflex sensitivity within healthy, young humans.

The purpose of this study was to evaluate the relationship between the cardiac and sympathetic baroreflex sensitivities within healthy, young humans. The sensitivities of the cardiac and sympathetic baroreflexes were compared in 53 normotensive individuals (28 men and 25 women; age: 24.0 ± 0.9 years; body mass index: 24.0 ± 0.3 cm/kg², mean ± SEM). Heart rate, arterial blood pressure, and peroneal muscle sympathetic nerve activity were recorded under resting conditions (heart rate: 58 ± 1 bpm; systolic blood pressure: 126 ± 2 mm Hg; diastolic blood pressure: 72 ± 1 mm Hg; mean arterial blood pressure: 89 ± 1 mm Hg; muscle sympathetic nerve activity: 18 ± 1 bursts per min) and during rapid changes in blood pressure induced by sequential boluses of nitroprusside and phenylephrine. Cardiac and sympathetic baroreflex sensitivities were analyzed using the slopes of the linear portions of the muscle sympathetic nerve activity-diastolic blood pressure and R-R interval-systolic blood pressure relationships, respectively. When individual cardiac baroreflex sensitivity was compared with sympathetic baroreflex sensitivity, no correlation (R-R interval: r = -0.13; heart rate: r = 0.21) was observed when studied as a group. Analysis by sex unveiled a correlation in women between the cardiac and sympathetic baroreflex sensitivities (R-R interval: r = -0.54; P = 0.01; no correlation with hazard ratio: r = 0.29). No relationship was found in men (R-R interval: r = 0.17; heart rate: r = 0.12). These results indicate that, although both cardiac and sympathetic efferents function in baroreflex control of arterial pressure, there is no correlation in their sensitivities within healthy normotensive humans. However, sex-stratified data indicate that sex-based differential correlations might exist.

Anesthetic implications of ornithine transcarbamylase deficiency.

BACKGROUND: Ornithine transcarbamylase deficiency (OTCD) is an X-linked urea cycle disorder associated with potentially fatal episodes of hyperammonemia. Children with OTCD often require anesthesia. There is insufficient information regarding perioperative complications and optimal management of anesthesia in these patients. AIM: To retrospectively review the medical records of children with OTCD to ascertain the nature and frequency of peri-procedural complications. METHODS/MATERIALS: The electronic medical records of Mayo Clinic patients with OTCD who underwent anesthesia between the dates of January 2003 and September 2009 were reviewed. RESULTS: Nine patients with OTCD underwent 25 anesthetics using a variety of anesthetic techniques, including four major surgeries. Eleven procedures were performed prior to OTCD diagnosis and those patients were not receiving therapy for a urea cycle disorder. In the other cases, patients were on a variety of therapies for OTCD. Fourteen patients were outpatient procedures. Clinical signs of postoperative metabolic decompensation did not occur. CONCLUSIONS: In this series, patients with OTCD tolerated anesthesia well. Choice of perioperative management of OTCD and the choice of anesthetic technique should be individualized and based on clinical circumstances, but should have the underlying aim of minimizing protein catabolism. It appears patients with stable OTCD may undergo minor procedures as outpatients safely.

Evaluation of plateau-potential-mediated 'warm up' in human motor units.

Spinal motor neurones can exhibit sustained depolarization in the absence of maintained synaptic or injected current. This phenomenon, referred to as a plateau potential, is due to the activation of monoamine-dependent persistent inward currents. Accordingly, activation of a plateau potential should result in a decrease in the excitatory synaptic drive required to activate a motor unit. This, in turn, has been suggested to cause a progressive decline in the muscle force at which motor units are recruited during repeated voluntary contractions. Such a progressive decrease in threshold force associated with preceding activation of a plateau potential is referred to as 'warm up'. Furthermore, activation of a plateau potential is thought to manifest itself as a decrease in the derecruitment force compared to recruitment force. Multiple muscles, however, can contribute to the detected force and their relative contributions may vary over time, which could confound measures of recruitment and derecruitment force. Therefore, the purpose of this study was to compare the recruitment and derecruitment forces of single motor units in the human extensor digitorum and tibialis anterior during repetitive triangular-force contractions in which the contributions of other muscles had been minimized. In both muscles, we found that the recruitment thresholds of single motor units were unchanged during repeated contractions, and that the derecruitment force was consistently greater than the recruitment force. These results suggest either that plateau potentials were not engaged (or were rapidly extinguished) under these experimental conditions or that changes in recruitment and derecruitment force are not suitable criteria for detecting them.