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After implementation of the Lung Allocation Score in 2005, idiopathic pulmonary fibrosis (IPF) emerged as the most common indication for lung transplantation (LT) in the United States. The age and comorbidity of patients undergoing LT have since increased, and the indications for LT have evolved. However, limited data have been used to analyze more recent outcomes among the IPF population. This study analyzed LTs for the primary indication of IPF by using the United Network for Organ Sharing database. An eras-based analysis was performed, comparing patient characteristics, survival, and related outcomes during 2005 to 2009 (era 1) and 2010 to 2014 (era 2) with χ2, Wilcoxon rank sum, and Kaplan-Meier analyses. The study compared 1-year survival from 2005 to 2020 and survival at milestones ranging from 1 month to 5 years. Two adjusted Cox proportional hazards models were conducted: 5-year survival by era and 1-year survival annually from 2010 to 2020. From era 1 (n = 1818) to era 2 (n = 3227), the median age of LT recipients increased from 61 to 63 years (P <.001). The percentage of patients in the intensive care unit before LT climbed from 7.7% to 12.1% (P <.001), and the percentage of patients with diabetes grew from 17.9% to 19.4% (P =.003). Despite increased severity of illness, 5-year survival increased from 51.9% in era 1 to 55.2% in era 2 (P =.02). Adjusted modeling indicated that LT during era 2 featured a 17% hazard reduction compared with era 1 (hazard ratio, 0.83; 95% CI, 0.76-0.91). Survival is improving for patients undergoing LT for IPF, despite the challenges of transplant recipients with progressively higher risk profiles. [Display omitted] [ABSTRACT FROM AUTHOR]

The selective oxidation of n -butane to maleic anhydride is a strongly exothermic reaction. Resulting local hot-spots and intraparticle temperatures high above the surrounding fluid temperature are challenging for safe and economic operation of reactors. Detailed modelling on all length scales is therefore required for an accurate description of this process. In this contribution, the one dimensional description of the ring-shaped catalyst, commonly used in continuum reactor modelling, is compared to three dimensional computational fluid dynamics simulations for the case of a single catalyst particle at different inclination angles (0 to 90°). Polytropic chemical reaction is considered under typical n -butane oxidation conditions (R e p = 400), representing a catalyst particle close to the inlet, (T = 673 K) and at the hot-spot (T = 730 K) of an industrial reactor. Comparative analysis suggests that the one dimensional simplification is justified when external transport phenomena are not the limiting resistance. Otherwise, neglecting two spatial dimensions leads to erroneous predictions. [Display omitted] • Comparing single particle CFD & continuum model simulations for n -butane oxidation • Continuum model representation can lead to erroneous intraparticle profiles • Description of surface conditions decisive under external transport limitation [ABSTRACT FROM AUTHOR]

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Primary stakeholders in the Accreditation Council for Graduate Medical Education (ACGME) Milestones Project are: ACGME, Residency Programs, Residents, Fellowship Programs, Fellows, and Certification Boards. The intent of the Milestones is to describe the educational and professional developmental trajectory of a trainee from the first stages of their postgraduate education through the completion of their clinical training. The Milestones 2.0 project includes changes made based on experience with Milestones 1.0. The ACGME solicited volunteers to participate in the development of subspecialty Milestones 2.0. The workgroup was charged with reviewing/making any additions to the four "Harmonized Milestones", developing subspecialty specific milestones for the Patient Care and Medical Knowledge competencies, and creating a supplemental guide. The Milestones were finalized following review of input from an open comment period. The Cytopathology Milestones 2.0 will go into effect July 2021. They include additional subcompetencies in the 4 harmonized competency areas and cytopathology-specific edits to the patient care and medical knowledge subcompetencies. Although the number of subcompetencies has increased from 18 to 21, within each subcompetency, the number of milestone trajectories has decreased. Additionally, within each subcompetency, the wording has been streamlined. A supplemental guide was created and Milestones 1.0 were compared to 2.0; however, curriculum mapping has been left to programs to develop. The ultimate goal of the Cytopathology Milestones 2.0 is to provide better real-time documentation of the progress of cytopathology fellows. The expected outcome is to produce highly competent cytopathologists, improving the care they provide, regardless of the program at which they trained. • The ultimate goal of the Cytopathology Milestones 2.0 is to provide better real-time documentation of the progress of cytopathology fellows. • The expected outcome is to produce highly competent cytopathologists, improving the care they provide, regardless of the program at which they trained. [ABSTRACT FROM AUTHOR]

Burn is one of the leading causes of injury and death in children. Currently, the Residency Review Committee does not require general surgery residents to rotate on a burn service. With many trainees no longer receiving burn training during residency, we sought to evaluate the exposure to burn management in pediatric surgery training programs. An electronic survey was sent to program directors at accredited pediatric surgery training programs (56) during the 2020 academic year. Case log reviews were performed for 2005-2019. Descriptive statistical analysis was performed. Thirty-six program directors participated in the survey (64%), and 56% reported having an inpatient and outpatient component for burn management. Nearly 20% of program directors reported having no burn management at their institution. Fifty-four percent of responding programs had fellow participation in burn management. Over a fifteen-year period, case logs identified a median of 0–2 burn cases logged each year for graduating fellows. Logistically, 65% of burn centers relied on general pediatric surgeons for management. Pediatric surgery trainee involvement in burn management varies with many programs offering no designated burn training. Increasing exposure to pediatric burn management during training is needed to provide improved care for this patient population. III, Retrospective Review [ABSTRACT FROM AUTHOR]

To quantify trends in ophthalmology practice consolidation in the United States. A retrospective cross-sectional study. Providers in the Centers for Medicare and Medicaid Services (CMS) National Downloadable File with a primary specialty designation of ophthalmology. We used the CMS database to determine national practice consolidation trends in ophthalmology on individual physician and group practice levels and analyzed by region, sex, and years spent in practice. We used the Cochran-Armitage test to determine the statistical significance of practice size differences between 2015 and 2022. Temporal practice size trends for physicians and practices in ophthalmology and regional, sex-specific, and age-related trends. Between 2015 and 2022, the number of ophthalmologists decreased from 17 656 to 17 615 (–0.2%), whereas the number of practices decreased from 7149 to 5890 (–18%). The percentage of ophthalmologists in practices of 1 to 2 members decreased from 35% to 28%, whereas those in groups of 50 or more increased from 7% to 11%. The percentage of practices with 1 to 2 members decreased from 75% to 71%, and those with 50 or more increased from 0.2% to 0.4%. Consolidation trends were significant on individual ophthalmologist (P < 0.001) and group practice (P < 0.001) levels. All regions, sexes, and subgroups of years spent in practice demonstrated consolidation (P < 0.001). The Northeast showed the greatest increase in groups of 50 or more physicians (+7%) between 2015 and 2022. Proportionally fewer female than male ophthalmologists were associated with practice sizes of 1 to 2 members in 2015 (29% and 36%, respectively) and 2022 (23% and 30%, respectively). Proportionally fewer ophthalmologists with 0 to 10 years of experience in practice were associated with practice sizes of 1 to 2 members than those with more than 30 years in practice in 2015 (18% and 48%, respectively) and 2022 (14% and 40%, respectively). Ophthalmology has undergone practice consolidation from 2015 to 2022. A decrease in the proportion of physicians affiliated with smaller practice sizes seems to have occurred. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

There is strong evidence that mitochondrial DNA mutations and mitochondrial dysfunction play a role in diabetes pathogenesis. The homozygous knock-in mtDNA mutator mouse is a model of premature aging due to the accumulation of mitochondrial DNA mutations. We used this mouse model to investigate the relationship between mitochondrial subunit expression and pancreatic islet cell composition. Quadruple immunofluorescence was used to quantify mitochondrial subunit expression (complex I and IV) and cell composition in pancreatic islets from mitochondrial DNA mutator mice (PolgA mut/mut ) and control C57BL/6 mice at 12 and 44 weeks of age. Mitochondrial complex I subunit expression was decreased in islets from 12 week PolgA mut/mut mice. This complex I deficiency persisted with age and was associated with decreased insulin staining intensity at 44 weeks. Complex I deficiency was greater in α-cells compared with β-cells in islets from 44 week PolgA mut/mut mice. Islet cell composition was normal in 12 week PolgA mut/mut mice, but the β: α cell ratio was decreased in islets from 44 week PolgA mut/mut mice. This was due to an increase in α-cell number linked to an increase in α-cell proliferation. Complex I deficiency promotes α-cell proliferation and alters islet cell composition. • Decreased islet complex I expression was established in PolgA mut/mut mice at 12 weeks. • Decreased islet complex I expression was associated with increased pancreatic α-cell number in PolgA mut/mut mice at 44 weeks. • Increased α-cell proliferation contributes to the increased α-cell number. [ABSTRACT FROM AUTHOR]

The first licensed malaria vaccine, RTS,S/AS01 E , confers moderate protection against symptomatic disease. Because many malaria infections are asymptomatic, we conducted a large-scale longitudinal parasite genotyping study of samples from a clinical trial exploring how vaccine dosing regimen affects vaccine efficacy. Between Sept 28, 2017, and Sept 25, 2018, 1500 children aged 5–17 months were randomly assigned (1:1:1:1:1) to receive four different RTS,S/AS01 E regimens or a rabies control vaccine in a phase 2b open-label clinical trial in Ghana and Kenya. Participants in the four RTS,S groups received two full doses at month 0 and month 1 and either full doses at month 2 and month 20 (group R012-20); full doses at month 2, month 14, month 26, and month 38 (group R012-14); fractional doses at month 2, month 14, month 26, and month 38 (group Fx012-14; early fourth dose); or fractional doses at month 7, month 20, and month 32 (group Fx017-20; delayed third dose). We evaluated the time to the first new genotypically detected infection and the total number of new infections during two follow-up periods (12 months and 20 months) in more than 36 000 dried blood spot specimens from 1500 participants. To study vaccine effects on time to the first new infection, we defined vaccine efficacy as one minus the hazard ratio (HR; RTS,S vs control) of the first new infection. We performed a post-hoc analysis of vaccine efficacy based on malaria infection status at first vaccination and force of infection by month 2. This trial (MAL-095) is registered with ClinicalTrials.gov , NCT03281291. We observed significant and similar vaccine efficacy (25–43%; 95% CI union 9–53) against first new infection for all four RTS,S/AS01 E regimens across both follow-up periods (12 months and 20 months). Each RTS,S/AS01 E regimen significantly reduced the mean number of new infections in the 20-month follow-up period by 1·1–1·6 infections (95% CI union 0·6–2·1). Vaccine efficacy against first new infection was significantly higher in participants who were infected with malaria (68%; 95% CI 50–80) than in those who were uninfected (37%; 23–48) at the first vaccination (p=0·0053). All tested dosing regimens blocked some infections to a similar degree. Improved vaccine efficacy in participants infected during vaccination could suggest new strategies for highly efficacious malaria vaccine development and implementation. GlaxoSmithKline Biologicals SA, PATH, Bill & Melinda Gates Foundation, and the German Federal Ministry of Education and Research. [ABSTRACT FROM AUTHOR]