Metastatic gastric adenocarcinoma to the cutaneous neck and chest wall.

This case describes an atypical cutaneous presentation of metastatic gastric carcinoma in a patient initially presenting with dysphagia and a sclerotic red plaque overlying the anterior neck and chest. Skin biopsy revealed metastatic adenocarcinoma from the upper gastrointestinal tract. Esophagogastroduodenoscopy revealed stage IV metastatic gastric adenocarcinoma. Treatment with chemotherapy was initiated.

The Urgency of Now: Rethinking and Improving Assessment Practices in Medical Education Programs.

Assessment is essential to professional development. Assessment provides the information needed to give feedback, support coaching and the creation of individualized learning plans, inform progress decisions, determine appropriate supervision levels, and, most importantly, help ensure patients and families receive high-quality, safe care in the training environment. While the introduction of competency-based medical education has catalyzed advances in assessment, much work remains to be done. First, becoming a physician (or other health professional) is primarily a developmental process, and assessment programs must be designed using a developmental and growth mindset. Second, medical education programs must have integrated programs of assessment that address the interconnected domains of implicit, explicit and structural bias. Third, improving programs of assessment will require a systems-thinking approach. In this paper, the authors first address these overarching issues as key principles that must be embraced so that training programs may optimize assessment to ensure all learners achieve desired medical education outcomes. The authors then explore specific needs in assessment and provide suggestions to improve assessment practices. This paper is by no means inclusive of all medical education assessment challenges or possible solutions. However, there is a wealth of current assessment research and practice that medical education programs can use to improve educational outcomes and help reduce the harmful effects of bias. The authors' goal is to help improve and guide innovation in assessment by catalyzing further conversations.

Comprehensive analysis of aerobic and anaerobic bacteria found on dental bib clips.

Multiple-use dental bib clips are considered to present relatively low risks for transmitting infections and, thus, are thought to only require disinfection between patient visits. This study was designed to: 1) determine the presence and composition of bacterial contaminants on reusable rubber-faced metal bib clips after dental treatment at the hygiene clinic at Tufts University School of Dental Medicine and 2) evaluate the effectiveness of the disinfection for this clip type. Aerobic and anaerobic bacterial contaminant loads on the surfaces of the clips were investigated immediately after hygiene treatments were rendered and again after clips were disinfected. The species and strains of bacterial isolates were identified using 16S rDNA sequencing and Human Oral Microbe Identification Microarray analyses. The results demonstrated that although the use of disinfection proved to be significantly effective, some clips retained at least one bacterium on their surfaces after disinfection. Although the bacterial species present on disinfected clips were typical skin or environmental isolates, some were oral in origin. In the study's settings, bacterial presence on the clips did not indicate an infectious disease problem. The different bacterial loads on clips suggest that cross-contamination risks may not be the same for all clinics, and that this difference may be related to the type of treatments and services performed.

A predictive distribution map for the giant tropical ant, Paraponera clavata.

Paraponera clavata (Fabricius 1775) (Formicidae: Paraponerinae) is a widely distributed Neotropical ant whose large size has attracted the attention of numerous collectors. Working from museum specimens, a georeferenced database of collection localities was developed. This database then served as the source for computer generated predictive distribution maps. Annual rainfall was the most important variable chosen by the computer model to predict the distribution of P. clavata, both on the scale of the neotropics and at a finer scale at the northern end its distribution in Costa Rica and Nicaragua. When the model was forced to use vegetation as the first predictive variable, the Neotropical model used temperature and rainfall variance as additional variables, while the Mesoamerican model used both climatic and soils variables. Overall, the modeling suggests that P. clavata is more sensitive to abiotic factors (rainfall, temperature, soils) than to biotic factors (vegetation type) in its distribution, although this conclusion comes with the caveat that the vegetation types used in the model are quite generalized. Predictive distribution mapping holds great promise for generating more precise representations of insect distributions, thereby allowing better tests of the extent of distribution overlaps and other community relationships.