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Periparturient hypocalcaemia is a widespread metabolic disorder in dairy cows. Clinical and subclinical cases occur primarily in multiparous (Multi) cows, but subclinical cases have also been reported in primiparous (Primi) cows. A preventive strategy was investigated by administering the physiologically active vitamin D3 metabolite, 1,25-dihydroxyvitamin D3 (1,25-dihydroxycholecalciferol, 1,25(OH)2D3) as a rumen bolus. The bolus contained tablets of 1,25(OH)2D3 glycoside extract from Solanum glaucophyllum (SGE), releasing SGE over several days. The aim was to study the effect of a bolus containing 0 (C) or 500 µg (SGE) of 1,25(OH)2D3 on 1,25(OH)2D3 and mineral status in periparturient cows up to three weeks into lactation and on colostrum, milk and calves’ blood mineral contents. The bolus was administered three to four days prior to expected calving to Primi and Multi cows fed a herbage-based diet (dietary cation-anion difference of +522 mEq/kg DM). One C or SGE bolus was applied to 12 Primi and 12 Multi cows. Blood was regularly sampled (and selected a posteriori for antepartum samples) in regard to the actual calving day (d0), immediately prior to bolus application and at day −2, 0.5, 1, 1.5, 2, 4, 8, 11, 15, 18 and 22. Additional samples included urine (at bolus application, d0.5 and d2), colostrum, milk samples (weekly) and calves’ blood (d2). Blood serum 1,25(OH)2D3 increased between d0.5 and d2 in Primi-SGE, but remained unchanged in Primi-C, as did parathyroid hormone (PTH) and Ca in all Primi. Urinary Ca of Primi-SGE was increased on d2, indicating regulation of Ca excess. Three Multi-C cows with confirmed clinical hypocalcaemia needed treatment and thus were excluded from the dataset and replaced. Blood serum 1,25(OH)2D3 and PTH increased while Ca dropped by 40% between d0.5 and d2 in Multi-C, whereas 1,25(OH)2D3, Ca and PTH remained unchanged in Multi-SGE. Blood serum carboxyterminal telopeptide of type I collagen was higher in Primi than in Multi and increased with time, except in Primi-C. Mineral contents in colostrum, milk and blood serum of calves were not influenced to a relevant degree. In conclusion, Primi-C did not, in contrast to Multi-C, develop subclinical hypocalcaemia (

High quality feedback on resident clinical performance is pivotal to growth and development. Therefore, a reliable means of assessing faculty feedback is necessary. A feedback assessment instrument would also allow for appropriate focus of interventions to improve faculty feedback. We piloted an assessment of the interrater reliability of a seven-item feedback rating instrument on faculty educators trained via a three-workshop frame-of-reference training regimen. The rating instrument's items assessed for the presence or absence of six feedback traits: actionable, behavior focused, detailed, negative feedback, professionalism / communication, and specific; as well as for overall utility of feedback with regard to devising a resident performance improvement plan on an ordinal scale from 1 to 5. Participants completed three cycles consisting of one-hour-long workshops where an instructor led a review of the feedback rating instrument on deidentified feedback comments, followed by participants independently rating a set of 20 deidentified feedback comments, and the study team reviewing the interrater reliability for each feedback rating category to guide future workshops. Comments came from four different anesthesia residency programs in the United States; each set of feedback comments was balanced with respect to utility scores to promote participants’ ability to discriminate between high and low utility comments. On the third and final independent rating exercise, participants achieved moderate or greater interrater reliability on all seven rating categories of a feedback rating instrument using Gwet's agreement coefficient 1 for the six feedback traits and using intraclass correlation for utility score. This illustrates that when this instrument is utilized by trained, expert educators, reliable assessments of faculty-provided feedback can be made. This rating instrument, with further validity evidence, has the potential to help programs reliably assess both the quality and utility of their feedback, as well as the impact of any educational interventions designed to improve feedback.

Gallstone ileus is an uncommon cause of mechanical bowel obstruction, often presenting a diagnostic challenge due to its nonspecific symptoms and the variable presence of Rigler's triad (pneumobilia, small bowel obstruction, and ectopic gallstone). We report a case of an 80-year-old female who presented to the emergency department with a two-week history of vague abdominal pain. An initial CT scan revealed mild pneumobilia and a 2 cm calcified mass in the distal small bowel. The diagnosis of gallstone ileus was not initially apparent but was established after reviewing a previous CT scan that showed an identical large mass in the gallbladder. The patient underwent robotic exploration and enterotomy, resulting in the removal of a 4 cm gallstone. This case underscores the importance of reviewing historical imaging in diagnosing gallstone ileus. While Rigler's triad (pneumobilia, small bowel obstruction, and ectopic gallstone) is not always fully present, partial findings should raise suspicion. The unified electronic medical record (EMR) system played a crucial role in expediting the diagnosis by facilitating access to previous imaging studies. This report highlights the value of correlating current and historical imaging findings in diagnosing gallstone ileus, particularly in elderly patients with nonspecific abdominal symptoms. Future educational efforts should focus on increasing awareness of gallstone ileus among emergency physicians and radiologists, emphasizing the importance of correlating current findings with historical imaging data., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alhomaid et al.)

The field of facial plastic and reconstructive surgery (FPRS) is an incredibly diverse, multispecialty field that seeks innovative and novel solutions for the management of physical defects on the head and neck. To aid in the advancement of medical and surgical treatments for these defects, there has been a recent emphasis on the importance of translational research. With recent technological advancements, there are now a myriad of research techniques that are widely accessible for physician and scientist use in translational research. Such techniques include integrated multiomics, advanced cell culture and microfluidic tissue models, established animal models, and emerging computer models generated using bioinformatics. This study discusses these various research techniques and how they have and can be used for research in the context of various important diseases within the field of FPRS., Competing Interests: None declared., (Thieme. All rights reserved.)