Motivating High School Students From Rural Areas to Attend College and Pursue Careers as Osteopathic Physicians.

CONTEXT: One potential way to address critical current and future projected health care workforce shortages is through comprehensive programs that could potentially inspire high school students to pursue osteopathic medical careers in underserved areas. OBJECTIVE: To determine whether a comprehensive, 5-week enrichment program could promote interest among rural high-school students in careers osteopathic medicine. METHODS: In May 2018, 116 high school students with a grade point average of 2.8 or higher from rural areas, including New Mexico and its surrounding rural areas in the US-Mexico border region, enrolled in а 5-week program offering American College Testing (ACT) preparation and biomedical sciences enrichment at Burrell College of Osteopathic Medicine (BCOM). During the program, students were offered more than 150 hours of interactive in-class lectures and hands-on activities with laboratories focusing on college preparedness, health sciences, and motivating students to pursue osteopathic medical career and practice medicine in rural areas. Clinically-oriented sessions covering osteopathic philosophy and osteopathic manipulative medicine were included. After completion, a voluntary and anonymous survey was sent to students who completed the program students through QualtricsXM©. Blinded ACT scores were collected from participants' schools, along with college enrollment status information. RESULTS: Of 116 enrolled students, 106 (91.4%) completed the program successfully. In their postcompletion survey responses, students reported that they had gained a realistic perception of the field of medicine and were motivated to attend college (mean [standard error, SE] score on 5-point Likert scale over 2 questions, 4.8 [0.06]) and osteopathic medical school (mean [SE], 4.7 [0.1]). Participants also felt more informed about physician shortage in rural areas (mean [SE], 4.7 [0.07]) and appeared to be inspired to practice medicine in rural areas (mean [SE], 4.6 [0.09]). Students also reported feeling better prepared to take the ACT after finishing this program (mean [SE], 4.9 [0.04]). Finally, we were able to collect the ACT scores of 51 participants (48.1%) who completed the program; the mean ACT score was 24.3, compared with a reported national mean of 20.7 on a scoring scale of 1-36. We also performed a follow-up inquiry showing that 78 of the 81 participating students (96%) who had graduated from high school were enrolled in college or university and 59 (73%) had elected in science, technology, engineering, mathematics, or health majors. CONCLUSION: Rural high school pipeline programs could be a tool to motivate high school students to attend college and ultimately to develop physicians who are interested to practice in medically underserved areas.

Sexual Differentiation of Circadian Clock Function in the Adrenal Gland.

Sex differences in glucocorticoid production are associated with increased responsiveness of the adrenal gland in females. However, the adrenal-intrinsic mechanisms that establish sexual dimorphic function remain ill defined. Glucocorticoid production is gated at the molecular level by the circadian clock, which may contribute to sexual dimorphic adrenal function. Here we examine sex differences in the adrenal gland using an optical reporter of circadian clock function. Adrenal glands were cultured from male and female Period2::Luciferase (PER2::LUC) mice to assess clock function in vitro in real time. We confirm that there is a pronounced sex difference in the intrinsic capacity to sustain PER2::LUC rhythms in vitro, with higher amplitude rhythms in adrenal glands collected from males than from females. Changes in adrenal PER2::LUC rhythms over the reproductive life span implicate T as an important factor in driving sex differences in adrenal clock function. By directly manipulating hormone levels in adult mice in vivo, we demonstrate that T increases the amplitude of PER2::LUC rhythms in adrenal glands of both male and female mice. In contrast, we find little evidence that ovarian hormones modify adrenal clock function. Lastly, we find that T in vitro can increase the amplitude of PER2::LUC rhythms in male adrenals but not female adrenals, which suggests the existence of sex differences in the mechanisms of T action in vivo. Collectively these results reveal that activational effects of T alter circadian timekeeping in the adrenal gland, which may have implications for sex differences in stress reactivity and stress-related disorders.

Routine diagnostic procedures of myelodysplastic syndromes: value of a structural blood cell parameter (NEUT-X) determined by the Sysmex XE-2100™.

INTRODUCTION: Diagnostic features of myelodysplastic syndromes (MDS) are often polymorphic and nonspecific including anemia in most cases. Standard parameters provided by an automated analyzer seldom bring any argument for this diagnosis. The aim of this study was to investigate whether some structural parameters, not routinely provided by Sysmex™ XE 2100 analyzer, could help diagnose MDS in a simple way, adapted to routine practice. METHODS: Blood samples from 184 MDS fully annotated cases and 3545 normal blood count controls were performed with XE 2100 Sysmex™ analyzer. Quantitative and structural parameters were considered. RESULTS: We found that the structural neutrophil parameter, NEUT-X, converted into a semi-quantitative parameter, the granularity index (GI), could be used as a flag for MDS in front of anemia. Negative GI and anemia were able to make otherwise unrecognized MDS stand out in routine practice, increasing the number of slides addressed to review from 67% to 96%, without leading to a large excess of unfounded slide review among non-MDS. CONCLUSION: Including the GI index in the routine parameters provided by the Sysmex analyzer could be of major help for nonspecialized routine laboratories in detecting MDS.

Occurrence of electromyographic and ventilatory thresholds in professional road cyclists.

The temporal relationship between the electromyographic (EMG) and ventilatory thresholds was investigated during incremental exercise performed by eight professional road cyclists. The exercise, performed on a cycloergometer, started at 100 W with successive increments of 26 Wx min(-1) until exhaustion. Gas exchange and the root mean square value of EMG (RMS) from eight lower limb muscles were examined throughout the exercise period. Professional cyclists achieved a maximal oxygen consumption, i.e. VO(2max), of 5.4 (0.5) l x min(-1) [74.6 (2.5) ml x min(-1) x kg(-1), range: 67.8-82.4 ml x min(-1) x kg(-1)] and a maximum power ( W(max)) of 475 (30) W (range: 438-516 W). Our results showed at least the occurrence of a first EMG threshold (EMG(Th1)) in 50% (gastrocnemius lateralis) of the subjects and a second EMG threshold (EMG(Th2)) in 63% (gastrocnemius medialis). EMG(Th1) occurred significantly before the first ventilatory threshold (VT(1)), i.e. at 52 (2)% and 62 (9)% of W(max), respectively. Inversely, no significant difference was observed between the occurrence of EMG(Th2) and the second ventilatory threshold (VT(2)), i.e. at 86 (1)% and 89 (7)% of W(max), respectively. These results suggest that the use of EMG may be a useful non-invasive method for detecting the second ventilatory threshold in most of the muscles involved in cycling exercise.

Silent myocardial ischemia in patients with diabetes: who to screen.

OBJECTIVE: Silent myocardial ischemia (SMI) is more common in diabetic patients than in the general population. However, the exact prevalence of SMI is not known, and routine screening is costly. The purpose of this 1-year study was to estimate the prevalence of SMI and define a high-risk diabetic population by systematically testing patients with no symptoms of coronary artery disease (CAD). RESEARCH DESIGN AND METHODS: The criteria for inclusion in this study were age (between 25 and 75 years), duration of diabetes (>15 years for type 1 diabetes, 10 years for type 2 diabetes with no cardiovascular risk factors, and 5 years for type 2 diabetes with at least one cardiovascular risk factor), and absence of clinical or electrocardiogram (ECG) symptoms of CAD. For 1 year, 203 patients were screened, including 28 women and 45 men with type 1 diabetes (aged 41.5+/-10.9 years, mean duration of diabetes 20.9+/-7.7 years [mean +/- SD]) and 61 women and 69 men with type 2 diabetes (aged 60.7+/-8.7 years, duration of diabetes 16.5+/-7.1 years). Exercise ECG was the first choice for screening method. If exercise ECG was not possible or inconclusive, thallium myocardial scintigraphy (TMS) with exercise testing and/or dipyridamole injection was performed. If any one of these tests was positive, coronary angiography was carried out and was considered to be positive with a stenosis of > or =50%. RESULTS: Positive screening results were obtained in 32 patients (15.7%). Coronary angiography demonstrated significant lesions in 19 patients (9.3%) and nonsignificant lesions in 7 patients (1 false-positive result for exercise ECG and 6 false-positive results for TMS). Coronary angiography was not performed in six patients. All but 3 of the 19 patients (15 men and 4 women) in whom silent coronary lesions were detected presented with type 2 diabetes. The main differences between the 16 type 2 diabetic patients presenting with coronary lesions and the type 2 diabetic patients without SMI were a higher prevalence of peripheral macroangiopathy (56.2 vs. 15.1%, respectively, P < 0.01) and a higher prevalence of retinopathy (P < 0.05). No correlation was found between SMI and duration of diabetes, HbA1c level, renal status, or cardiovascular risk factors except for family history of CAD. CONCLUSIONS: The results of this study allowed us to determine a high-risk group for SMI in the diabetic population. SMI with significant lesions occurs in 20.9% of type 2 diabetic male patients who are totally asymptomatic for CAD. Based on these findings, we recommend routine screening for male patients in whom the duration of type 2 diabetes is >10 years or even less when more than one cardiovascular risk factor is present.

[Mast cells as a test of body state during electromagnetic exposure of varying intensity]. / Tuchnye kletki kak test sostoianiia organizma pri élektromagnitnykh vozdeistviiakh raznoi intensivnosti.

Effects of single and repeated exposure of mice, rats, and rabbits in magnetic fields at 50 Hz and 2 kA/m, 16 kA/m, and 32 kA/m on the populations of dermal, intestinal, and popliteal lymph node labrocytes were studied immediately and within one month after exposure. Single exposure in the magnetic fields of 2 kA/m and 16 kA/m for 4 hours did not produce any changes in labrocytes of these organs. Repeated exposure to 2 kA/m, 16 kA/m, and 32 kA/m for 4 hours during 5 days modulated the functional activity of labrocytes in all the organs. More extended (1.5-2 months) repeated exposure to the intensive magnetic field (32 kA/m) stimulated adaptation and regain of labrocyte populations in the dermal and popliteal lymph nodes whereas enhanced secretion, i.e. degranulation of labrocytes persisted in the intestine. Following one month after the 1.5-2-month exposure to 32 kA/m, labrocyte populations were recovered with the maximum effect in the lymph nodes. High magnetic sensitivity of labrocytes revealed in this study can be used as a test of body reactivity and adaptation to this physical agent. Differences in the reactivity of labrocytes of individual organs and species must be taken into account.

[Flecainide exercise induced left bundle branch with chest pain]. / Bloc de branche gauche douloureux d'effort induit par flécaïnide.

Ischaemia has been the suggested mechanism of simultaneous left bundle branch block and chest pain on effort with normal coronary angiography. This hypothesis is very controversial and was not the mechanism in the two new cases of this syndrome. The two patients in whom effort pain and left bundle branch block were observed had been treated for paroxysmal supraventricular tachycardia with flecaine. Withdrawal of the anti-arrhtymic resulted in the disappearance of this syndrome. In these cases, the ischaemic mechanism could be excluded without ambiguity. The flecaine was the only cause of rate-related LBBB by slowing conduction in the left bundle branch with no effects on coronary reserve. It would seem that LBBB alone was the cause of chest pain. The absence of coronary artery disease was confirmed in the first patient and the diagnosis was highly improbable in the second.

[Dosimetry in setting practical hygienic standards for radio-wave irradiation]. / Dozimetriia v praktike gigienicheskogo normirovaniia radiovolnovykh obluchenii.

In dosimetric approach to the hygienic norm setting of radio waves adequate metrological basis is required. Joint investigations, carried by physicists and hygienists helped solve the new medical and technical problems, connected with the creation of individual dosimeters and indicators, monitor the hygienic norms of superhigh frequency electromagnetic waves. The devices are small, light, with autonomic power supply and digital indication of current exposure dose. The devices are supposed to give signals (light, sound) if the individual hygienic levels of superhigh frequency electromagnetic waves are surpassed.

[Standardization of electromagnetic fields of 3-30 MHz with reference to the time factor]. / Normierung elektromagnetischer Felder von 3-30 MHz unter Berücksichtigung des Zeitfaktors.

In chronic experiments (4 months) in rabbits, rats, and mice biological effects were investigated from 7 exposure regimen of electromagnetic fields with a frequency of 24 MHz at field strengths of the electric field component of 125, 250, 500, and 1,000 V/m, respectively, and an exposure time of 0.25, 1, and 4 hrs. respectively. The effects on the CNS, the immune and hormone systems, the peripheral blood and on the spermato and embryo genesis were estimated. The results delivered the basis for the introduction of an index. In point of time different limit values are to be determined according to the energetic load. A concrete value for the energetic load 7,200 (V/m)2.h is proposed as maximum allowable field strength of the electric component 300 V/m.

[Spasm, stenosis and thrombosis. Their role in the genesis of myocardial infarction]. / Spasme, sténose et thrombose. Leur rôle dans la genèse d'un infarctus du myocarde.

A 42 year old patient underwent coronary angiography 3 hours after the onset of inferior myocardial infarction with the object of local thrombolysis therapy. Complete proximal obstruction of the right coronary artery was relieved mechanically by the catheter. This was associated with a return of the ST segment to the isoelectric line but Q waves persisted in Lead III and AVF. A second injection showed 70 p. 100 stenosis at the site of the obstruction and the radiolucent appearances of thrombus below it. This was followed by 4 successive periods of ST elevation as the right coronary artery reoccluded. These phenomena were relieved by injection of nitroglycerine suggesting a spastic mechanism. The radiolucent image of thrombus disappeared and was replaced by amputation of a distal branch of the right coronary artery. Further coronary opacification showed good run-off beyond the stenosis and reappearance of the distal branch. This case suggests that three factors played a role in the mechanism of infarction: stenosis accompanied by spasm and thrombosis.

[Serial measurement of serum levels of amikacin. Value in therapy]. / Mesures répétées des taux sériques d'amikacine. Intérèt dans la conduite thérapeutique.

Amikacin serum levels were measured 256 times in 65 patients admitted into the intensive care unit for various reasons over 18 months. These measurements confirmed the dosage of 5 micrograms per kg repeated every 8 hours in patients with normal renal function. Forty eight hours before the first measurement, a control assay is essential to check that there is no residual antibiotic and that the antibacterial activity of the serum is zero. After this a single weekly control is sufficient to check that the residual level is effective and non toxic, i.e. between 2 and 6 micrograms per ml. However, in patients with acute renal insufficiency, there are three dosage schemas which should be used depending on the creatinine level. These three schemas are nevertheless not sufficient to continue effective therapy without a risk of toxic side effects. It is therefore necessary to check both the pack levels and the residual levels regularly from the beginning of treatment. Two to three weekly controls are essential to avoid a risk of toxic side effects.