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Introduction: Mentorship is essential for professional development and advancement within the military. In civilian medicine, the intersection between gender and mentorship holds important implications for research opportunities, academic success, and career progression. However, the intersection of gender and mentorship has not yet been explored within the field of military medicine. The purpose of this study, therefore, was to investigate the role of gender in mentorship within the field of military medicine., Materials and Methods: We investigated gender and mentorship within military medicine by developing and distributing a 16-item Likert survey to active-duty military physicians. We used the Chi-squared test of independence and the independent samples t-test to examine the role of gender in mentorship among the 16 questions., Results: The male respondents reported more same-gender mentors than females (male [M]: 61.9% vs. female [F]: 33.0%), whereas the female respondents had significantly more mentors of the opposite gender than males (M: 12.4% vs. F: 47.3%). A higher proportion of males indicated no preference compared to females. Conversely, a significant preference for a same-sex mentor was expressed by female respondents compared to male respondents (M: 5.2% vs. F: 30.1%). In contrast, female respondents considered having a mentor more important than their male counterparts (t(206) = -2.26, P = .012, F: 3.86 vs. M: 3.57). Both male and female respondents had significantly more female mentees ($\chi &#95;{\left( 1 \right)}^2$ = 12.92, P < .001, Cramer's V = 0.254)., Conclusions: While the female participants in our study preferred female mentors, the male participants had more same-gender mentors than the female participants. In addition, more females reported that they did not have the time to be mentored. Our results, therefore, suggest that training males to be better mentors to females and providing accessible mentorship training to females may promote equitable career development within military medicine., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Military physicians must be prepared to lead health care teams across complex landscapes of war during future small- and large-scale combat operations. This preparation optimally begins in medical school so that early career physicians are fully ready for their first deployment. Past qualitative research has suggested that military physicians who attended civilian medical school are not as well prepared for the operational environment as physicians who attended the Uniformed Services University (USU), our nation's military medical school. However, there is a lack of larger-scale quantitative research comparing the readiness differences between the two medical school pathways. The purpose of this study, therefore, was to quantify any differences in first deployment preparation between students attending USU and civilian medical schools through the Health Professions Scholarship Program (HPSP)., Materials and Methods: We compared USU and HPSP graduates' first deployment experiences by distributing a 14-item Likert survey to active duty military physicians in the U.S. Army, U.S. Navy, and U.S. Air Force who graduated within the past 10 years from medical school (USU or civilian)., Results: The USU graduates rated themselves significantly higher than the HPSP graduates on their readiness for deployment (3.83 vs. 3.24; P < .001); ability to navigate the operational environment (3.59 vs. 2.99; P < .001); confidence in communicating with their commanding officer (3.59 vs. 2.99; P = .002); navigating the combined role as physician and officer (3.33 vs. 2.84; P = .004); leading a health care team (3.94 vs. 3.43; P = .001); preparation by a medical school (3.78 vs. 2.52; P < .001); and overall readiness compared to peers (4.20 vs. 3.49; P < .001). There was no significant difference between the two pathways regarding their stress level at the beginning of deployment (2.74 vs. 2.68; P = .683); clinical preparation (3.94 vs. 3.76; P = .202); and success of first deployment (3.87 vs. 3.91; P = .792). The largest effect size of the difference between the two pathways was noted on the question "How well did medical school prepare you for your first deployment" (Cohen's d = 1.02)., Conclusions: While both groups believed that they were prepared for their first deployment, USU graduates consistently reported being more prepared by medical school for their first deployment than HPSP graduates. To close this readiness gap, supplemental military unique curricula may help to optimize HPSP students' readiness., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Objectives: This nationwide retrospective cohort study assessed the impact of the explanted valve type on reoperative outcomes in aortic valve surgery within the UK over a 23-year period., Methods: Data were sourced from the National Institute for Cardiovascular Outcomes Research (NICOR) database. All patients undergoing first-time isolated reoperative aortic valve replacement between 1996 and 2019 in the UK were included. Concomitant procedures, homograft implantation or aortic root enlargement were excluded. Propensity score matching was utilized to compare outcomes and risk factors for in-hospital mortality was evaluated through multivariable logistic regression. Final model selection was conducted using Akaike Information Criterion through bootstrapping. The primary end point was in-hospital mortality, and secondary end points included postoperative morbidities., Results: Out of 2371 patients, 24.9% had mechanical and 75% had bioprosthetic valves implanted during the primary procedure. Propensity matched groups of 324 patients each, were compared. In-hospital mortality for mechanical and bioprosthetic valve explants was 7.1% and 5.9%, respectively (P = 0.632). On multivariable logistic regression analysis, valve type was not a risk factor for mortality [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.37-1.05; P = 0.1]. Age (OR 1.03, 95% CI 1.01-1.05; P < 0.05), left ventricular ejection fraction (OR 1.62, 95% CI 1.08-2.42; P < 0.05), creatinine ≥ 200 mg/dl (OR 2.21, 95% CI 1.17-4.04; P < 0.05) and endocarditis (OR 2.66, 95% CI 1.71-4.14; P < 0.05) emerged as risk factors for mortality., Conclusions: The type of valve initially implanted (mechanical or bioprosthetic) did not determine mortality. Instead, age, left ventricular ejection fraction, renal impairment and endocarditis were significant risk factors for in-hospital mortality., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

MYB transcription factors play important roles during abiotic stress responses in plants. However, little is known about the accurate systematic analysis of MYB genes in the four cotton species, Gossypium hirsutum, G. barbadense, G. arboreum and G. raimondii. Herein, we performed phylogenetic analysis and showed that cotton MYBs and Arabidopsis MYBs were clustered in the same subfamilies for each species. The identified cotton MYBs were distributed unevenly on chromosomes in various densities for each species, wherein genome-wide tandem and segment duplications were the main driving force of MYB family expansion. Synteny analysis suggested that the abundant collinearity pairs of MYBs were identified between G. hirsutum and the other three species, and that they might have undergone strong purification selection. Characteristics of conserved motifs, along with their consensus sequence, promoter cis elements and gene structure, revealed that MYB proteins might be highly conserved in the same subgroups for each species. Subsequent analysis of differentially expressed genes and expression patterns indicated that most GhMYBs might be involved in response to drought (especially) and salt stress, which was supported by the expression levels of nine GhMYBs using real-time quantitative PCR. Finally, we performed a workflow that combined virus-induced gene silencing and the heterologous transformation of Arabidopsis, which confirmed the positive roles of GhMYBs under drought conditions, as validated by determining the drought-tolerant phenotypes, damage index and/or water loss rate. Collectively, our findings not only expand our understanding of the relationships between evolution and function of MYB genes, but they also provide candidate genes for cotton breeding., (© The Author(s) 2023. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, with diarrhea predominant IBS (IBS-D) as the most common subtype. Increasing evidence reported that the gut microbiota-mediated serotonin pathway plays a crucial role in the pathogenesis of IBS-D. In this study, potential herbal medicine, plant extracts and its monomers that can be employed as the candidate molecules for IBS-D through gut microbiota-mediated serotonin pathway were reviewed., Key Findings: The bacteria indigenous to gut microbiota regulates serotonin pathway, mainly increasing tryptophan hydroxylase (TPH) and decreasing serotonin reuptake transporter (SERT), by activating cyclooxygenase/prostaglandin E2 (COX/PGE2) signaling. It further accelerated gastrointestinal motility and visceral hyperalgesia. Herbal medicine prescription including Tongxie yaofang and Shugan decoction, as well as some monomers of flavonoid and polyphenol compounds can be regarded as the potential agents for IBS-D. The predominate mechanisms were related to regulating serotonin pathway by driving on the specific bacterial abundance (such as Firmicutes and Bacteroidetes). However, there are few reports on which specific bacteria species play a regulatory role in serotonin pathway, and most of these effective agents were only evidenced by preclinical studies. We hope this review will provide some useful directions for the treatment strategy of IBS-D., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society.)

Objectives: The popularity of off-pump coronary artery bypass grafting (CABG) varies across the world, ranging from 20% in Europe and the USA to 56% in Asia. We present the trend and early clinical outcomes in off pump in the UK., Methods: All patients who underwent elective or urgent isolated CABG from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. The trend in operating surgeons and units volume and training in off pump were analysed. Early clinical outcomes between off- and on-pump CABG were compared using propensity score matching., Results: A total of 351 422 patients were included. The overall off-pump rate during the study period was 15.17%, it peaked in 2008 (19.8%), followed by a steady decreased to 2018 (7.63%). Its adoption varied across centres and surgeons, ranging from <1% to 48.36% and <1% to 85.5%, respectively, of total cases performed. After propensity score matching for the period 1996-2019, off pump, when compared to on pump, was associated with a lower in-hospital/30-day mortality (1.2% vs 1.5%, P < 0.001), return to theatre (3.7% vs 4.5%, P < 0.001), cerebrovascular accident (transient ischaemic attack: 0.3% vs 0.6%, stroke: 0.3% vs 0.6%, P < 0.001) and deep sternal wound infection (0.8% vs 1.2%, P ≤ 0.001). In a sub-analysis from the introduction of EuroScore II (2012-2019), there were no differences in-hospital/30-day mortality (1.0% vs 1.0%, P = 0.71). However, on pump, had a higher return to theatre (4.2% vs 2.7%, P < 0.001), cerebrovascular accident (transient ischaemic attack: 0.4% vs 0.2%, stroke: 0.5% vs 0.3%, P = 0.003) and deep sternal wound infection (1.0% vs 0.6%, P = 0.004)., Conclusions: Our data show a decreasing trend in the use of off pump in the UK since 2008. This is likely to be multifactorial and raises the question of whether it should be a specialized revascularization technique., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objectives: To perform a systematic comparison of in-hospital mortality risk prediction post-cardiac surgery, between the predominant scoring system-European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, logistic regression (LR) retrained on the same variables and alternative machine learning techniques (ML)-random forest (RF), neural networks (NN), XGBoost and weighted support vector machine., Methods: Retrospective analyses of prospectively routinely collected data on adult patients undergoing cardiac surgery in the UK from January 2012 to March 2019. Data were temporally split 70:30 into training and validation subsets. Mortality prediction models were created using the 18 variables of EuroSCORE II. Comparisons of discrimination, calibration and clinical utility were then conducted. Changes in model performance, variable-importance over time and hospital/operation-based model performance were also reviewed., Results: Of the 227 087 adults who underwent cardiac surgery during the study period, there were 6258 deaths (2.76%). In the testing cohort, there was an improvement in discrimination [XGBoost (95% confidence interval (CI) area under the receiver operator curve (AUC), 0.834-0.834, F1 score, 0.276-0.280) and RF (95% CI AUC, 0.833-0.834, F1, 0.277-0.281)] compared with EuroSCORE II (95% CI AUC, 0.817-0.818, F1, 0.243-0.245). There was no significant improvement in calibration with ML and retrained-LR compared to EuroSCORE II. However, EuroSCORE II overestimated risk across all deciles of risk and over time. The calibration drift was lowest in NN, XGBoost and RF compared with EuroSCORE II. Decision curve analysis showed XGBoost and RF to have greater net benefit than EuroSCORE II., Conclusions: ML techniques showed some statistical improvements over retrained-LR and EuroSCORE II. The clinical impact of this improvement is modest at present. However the incorporation of additional risk factors in future studies may improve upon these findings and warrants further study., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Introduction: We compared core pediatric clerkship student assessments across 11 geographically distinct learning environments following a major curriculum change. We sought to determine if intersite consistency existed, which can be used as a marker of program evaluation success., Methods: We evaluated students' overall pediatric clerkship performance along with individual assessments that target our clerkship learning objectives. Using the data of graduating classes from 2015 to 2019 (N = 859), we conducted an analysis of covariance and multivariate logistic regression analysis to investigate whether the performance varied across training sites., Results: Of the students, 833 (97%) were included in the study. The majority of the training sites did not show statistically significant differences from each other. After controlling for the Medical College Admission Test total score and the average pre-clerkship National Board of Medical Examiners final exam score, the clerkship site only explained a 3% additional variance of the clerkship final grade., Conclusions: Over the ensuing 5-year period after a curriculum overhaul to an 18-month, integrated module pre-clerkship curriculum, we found that student pediatric clerkship performance in clinical knowledge and skills did not differ significantly across 11 varied geographic teaching sites when controlling for students' pre-clerkship achievement. Specialty-specific curriculum resources, faculty development tools, and assessment of learning objectives may provide a framework for maintaining intersite consistency when faced with an expanding network of teaching facilities and faculty., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Purpose: To determine whether medical school curricular change impacted the assessment of graduates in their first year of postgraduate training., Methods: The authors examined for differences in the survey of postgraduate year one (PGY-1) program directors for Uniformed Services University (USU) medical school graduates from the Classes of 2011 and 2012 (pre-curriculum reform, pre-CR), Classes of 2015, 2016, and 2017 (curriculum transition), and Classes of 2017, 2018, and 2019 (post-curriculum reform, post-CR). Multivariate analysis of variance was used to explore for differences among the cohorts in the 5 previously identified factors on the PGY-1 survey (Medical Expertise; Professionalism; Military Unique Practice, Deployments and Humanitarian Missions; System-Based Practice and Practiced-Based Learning; Communication and Interpersonal Skills). Nonparametric tests were used when the error variance between cohorts was found to be unequal across samples. Kruskal-Wallis (a rank ordered analysis of variance) and Tamhan's T2 were used to characterize specific differences., Results: There were 801 students included: 245 (pre-CR); 298 (curricular transition); and 212 (post-CR). Multivariate analysis of variance demonstrated significant differences in all survey factors among the comparison groups. From pre-CR to the curricular transition, ratings in all factors declined, but none reached the level of a statistical significance. Ratings of all 5 factors showed significant improvement from the curricular transition to post-CR, and scores from pre-CR to post-CR trended in the positive direction with Practice-Based Learning (effect size 0.77), showing significant gains., Conclusion: Ratings by PGY-1 program directors of USU graduates over time demonstrated a very small decline soon after curriculum reform but later showed a large improvement in domains reflecting areas of emphasis in the curriculum. In the eyes of a key stakeholder, the USU curriculum reform did no harm and led to improved PGY-1 assessments., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Despite increases in the number of female matriculants in medical school, civilian data demonstrate that women still struggle to reach parity in attainment of leadership positions. In military medicine, we have seen a major increase in the number of women graduating from the USU. Yet, we still know little about the representation of female military physicians in leadership positions. The aim of this study is to examine the relationship between gender and academic and military achievement among USU School of Medicine graduates., Methods: Utilizing the USU alumni survey sent to graduates from the classes of 1980 to 2017, items of interest, such as highest military rank, leadership positions held, academic rank, and time in service, were used to evaluate the relationship between gender and academic and military achievement. Contingency table statistical analysis was conducted to compare the gender distribution on the survey items of interest., Results: Pairwise comparison demonstrated significant differences between gender in the O-4 (P = .003) and O-6 (P = .0002) groups, with females having a higher-than-expected number of O-4 officers and males having a higher-than-expected number of O-6 officers. These differences persisted in a subsample analysis that excluded those who separated from active duty prior to 20 years of service. There was a significant association between gender and holding the position of commanding officer (χ2(1) = 6.61, P < .05) with fewer females than expected. In addition, there was a significant association between gender and the highest academic rank achieved (χ2(3) = 9.48, P < 0.05) with lower-than-expected number of females reaching the level of full professor, in contrast to males who exceed the expected number., Conclusions: This study suggests that female graduates of USU School of Medicine have not achieved promotion to the highest levels of rank, military, or academic leadership at the projected rate. Efforts to explore what barriers may impact military medicine's desire to have more equal representation of women in higher ranks and positions should be undertaken with specific attention to what drives retention versus separation of medical officers and if systematic changes are needed to help promote equity for women in military medicine., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Physical and psychological well-being play a critical role in the academic and professional development of medical students and can alter the trajectory of a student's quality of personal and professional life. Military medical students, given their dual role as officer and student, experience unique stressors and issues that may play a role in their future intentions to continue military service, as well as practice medicine. As such, this study explores well-being across the 4 years of medical school at Uniformed Services University (USU) and how well-being relates to a student's likelihood to continue serving in the military and practicing medicine., Methods: In September 2019, 678 USU medical students were invited to complete a survey consisting of three sections-the Medical Student Well-being Index (MSWBI), a single-item burnout measure, and six questions regarding their likelihood of staying in the military and medical practice. Survey responses were analyzed using descriptive statistics, analysis of variance (ANOVA), and contingency table analysis. Additionally, thematic analysis was conducted on open-ended responses included as part of the likelihood questions., Results: Our MSWBI and burnout scores suggest that the overall state of well-being among medical students at USU is comparable to other studies of the medical student population. ANOVA revealed class differences among the four cohorts, highlighted by improved well-being scores as students transitioned from clerkships to their fourth-year curriculum. Fewer clinical students (MS3s and MS4s), compared to pre-clerkship students, indicated a desire to stay in the military. In contrast, a higher percentage of clinical students seemed to "reconsider" their medical career choice compared to their pre-clerkship student counterparts. "Medicine-oriented" likelihood questions were associated with four unique MSWBI items, whereas "military-oriented" likelihood questions were associated with one unique MSWBI item., Conclusion: The present study found that the overall state of well-being in USU medical students is satisfactory, but opportunities for improvement exist. Medical student well-being seemed to have a stronger association with medicine-oriented likelihood items than with military-oriented likelihood items. To obtain and refine best practices for strengthening engagement and commitment, future research should examine if and how military and medical contexts converge and diverge throughout training. This may enhance the medical school and training experience and, ultimately, reinforce, or strengthen, the desire and commitment to practice and serve in military medicine., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: An objective of undergraduate medical education is to teach students how to think like physicians through a process called clinical reasoning. Currently, clerkship directors often feel that students enter their clinical years with a marginal comprehension of clinical reasoning concepts; instruction in this area could be improved. Although there have been previous educational studies assessing curricular interventions to improve the instruction of clinical reasoning, it is not yet known what happens at an individual level between an instructor and a small group of students in the teaching of clinical reasoning. This research will identify how clinical reasoning is being taught in a longitudinal clinical reasoning course., Methods: The Introduction to Clinical Reasoning course is a 15-month-long case-based course held in the preclinical curriculum of the USU. Individual sessions involve small-group learning with approximately seven students per group. Throughout the academic year of 2018-2019, 10 of these sessions were videotaped and transcribed. All participants provided informed consent. A thematic analysis was performed using a constant comparative approach. Transcripts were analyzed until thematic sufficiency was reached., Results: Over 300 pages of text were analyzed; new themes ceased to be identified after the eighth session. Topics included obstetrics, general pediatric issues, jaundice, and chest pain; these sessions were taught either by attendings, fellows, or fourth-year medical students with attending supervision. The thematic analysis revealed themes associated with clinical reasoning processes, themes associated with knowledge organization, and a theme associated with clinical reasoning in the military. The clinical reasoning process themes included problem list construction and refinement, differential diagnosis, naming and defending a leading diagnosis, and clinical reasoning heuristics. The knowledge organization themes included illness script development and refinement and semantic competence. The final theme was military relevant care., Conclusions: In individual teaching sessions, preceptors emphasized problem lists, differential diagnoses, and leading diagnoses in a course designed to strengthen diagnostic reasoning in preclerkship medical students. The use of illness scripts was more often implicitly used rather than explicitly stated, and students used these sessions to use and apply new vocabularies related to a clinical presentation. Instruction in clinical reasoning could be improved by encouraging faculty to provide further context to their thinking, by encouraging the comparing and contrasting of illness scripts, and by using a shared vocabulary for clinical reasoning. Limitations of this study include that it was done in the context of a clinical reasoning course and that it was done at a military medical school, which may limit generalizability. Future studies could determine if faculty development could improve the frequency of references to the clinical reasoning processes that could improve student readiness for clerkship., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: The field of medicine is experiencing a crisis as high levels of physician and trainee burnout threaten the pipeline of future physicians. Grit, or passion and perseverance for long-term goals, has been studied in high-performing and elite military units and found to be predictive of successful completion of training in adverse conditions. The Uniformed Services University of the Health Sciences (USU) graduates military medical leaders who make up a significant portion of the Military Health System physician workforce. Taken together, an improved understanding of the relationships between burnout, well-being, grit, and retention among USU graduates is critical to the success of the Military Health System., Materials and Methods: The current study was approved by the Institutional Review Board at USU and explored these relations among 519 medical students across three graduating classes. These students participated in two surveys approximately one year apart from October 2018 until November 2019. Participants completed measures on grit, burnout, and likelihood of leaving the military. These data were then merged with demographic and academic data (e.g., Medical College Admission Test scores) from the USU Long Term Career Outcome Study. These variables were then analyzed simultaneously using structural equation modeling to examine the relationships among variables in a single model., Results: Results reaffirmed the 2-factor model of grit as both passion and perseverance (or interest consistency). No significant relationships emerged between burnout and other study variables. Sustained and focused interest was predictive of less likelihood of staying in the military., Conclusion: This study offers important insights into the relationship among well-being factors, grit, and long-term career planning in the military. The limitations of using a single-item measure of burnout and measuring behavioral intentions in a short time frame during undergraduate medical education highlight the importance of future longitudinal studies that can examine actual behaviors across a career lifespan. However, this study offers some key insights into potential impacts on the retention of military physicians. The findings suggest that military physicians who are most likely to stay in the military tend to embrace a more fluid and flexible medical specialty path. This is critical in expectation setting for the military to train and retain military physicians across a wide range of critical wartime specialties., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: The current study reports career accomplishments of Uniformed Services University (USU) graduates in four areas: (1) positions held over the course of their entire career, (2) military awards, decorations, and rank, (3) first residency completed, and (4) academic achievements., Method: Utilizing the responses to the alumni survey sent to USU graduates in the Class 1980 to 2017, we extracted relevant data and reported descriptive statistics., Results: 1,848 out of 4,469 responded to the survey (41%). 86% (n = 1,574) of respondents indicated having served as a full-time clinician (seeing patients at least 70% of the time during a typical week), while many of them serve in leadership such as educational, operational, or command leadership roles. 87% (n = 1,579) of respondents are ranked from O-4 to O-6, and 64% (n = 1,169) of the respondents received a military award or medal. Family medicine, internal medicine, and pediatrics were the most chosen medical specialties, which is similar to the national patterns reported by AAMC. 45% (n = 781) held an academic appointment., Conclusion: USU graduates continue to make significant contributions to military medicine. USU graduates' medical specialty preferences are similar to the past, which calls for further investigation to identify driving factors on such preference., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

The Long Term Career Outcome Study is a central program of research in the Center for Health Professions Education at the Uniformed Services University. The overarching goal of Long Term Career Outcome Study is to perform evidence-based evaluations before, during, and after medical school, and as such, it represents a form of educational epidemiology. In this essay, we highlighted the findings of the investigations published in this special issue. These investigations span from "before" medical school matriculation to "during" medical school and "after" learners go on to graduate training and practice. Furthermore, we discuss how this scholarship might shed light on improving the educational practices at the Uniformed Services University and potentially elsewhere. We hope that this work demonstrates how research can enhance medical education processes and connect research, policy, and practice., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Well-being concerns among medical students are more prevalent than their age-matched peers in the United States. It remains unknown, however, if individual differences in well-being exist among U.S. medical students serving in the military. In this study, we sought to identify profiles (i.e., subgroups) of well-being in military medical students and examine the associations between these well-being profiles and burnout, depression, and intended retention in military and medical fields., Methods: Using a cross-sectional research design, we surveyed military medical students and then conducted latent class analysis to explore profiles of well-being, and applied the three-step latent class analysis method to assess predictors and outcomes of well-being profiles., Results: Heterogeneity in well-being was identified among the 336 military medical students surveyed, portraying medical students' falling into three distinct subgroups: High well-being (36%), low well-being (20%), and moderate well-being (44%). Different subgroups were associated with different risks of outcomes. Students in the subgroup of low well-being were at the highest risk of burnout, depression, and leaving medicine. In contrast, students in the moderate well-being group were at the highest risk of leaving military service., Conclusions: These subgroups may be clinically important as burnout, depression, and intention to leave medical field and/or military service occurred with varying likelihoods among medical students across the different well-being subgroups. Military medical institutions may consider improving recruitment tools to identify the best alignment between students' career goals and the military setting. Besides, it is crucial for the institution to address diversity, equity, and inclusion issues that may lead to alienation, anxiety, and a sense of wanting to leave the military community., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: The Uniformed Services University (USU) implemented the Enlisted to Medical Degree Preparatory Program (EMDP2) with the goal of enhancing the diversity of the military physician corps. Programs like EMDP2 can assist students in making the social and intellectual transition from undergraduate studies to medical school and beyond. These types of programs are also opportunities to reduce health disparities and prepare students to work in multicultural settings. The purpose of this study was to evaluate whether there was any significant difference in performance between USU medical students who had attended the EMDP2 and those who had not., Materials and Methods: We compared the results of National Board of Medical Examiners (NBME) Clinical Science Subjects, United States Medical Licensing Examination (USMLE) Step 1, and USMLE Step 2 Clinical Knowledge exams of EMDP2 learners from the School of Medicine classes of 2020 to 2023 to those of four similarly sized cohorts of their peers who varied by age and prior military service., Results: We found that the performance of EMDP2 graduates was comparable to their peers who followed more traditional and other alternative paths to medical school. For example, regression models showed that EMDP2 status was not a statistically significant predictor of average clerkship NBME exam score, nor of USMLE Step 1 failure., Conclusion: EMDP2 graduates performed on a par with their medical school peers, and EMDP2 status does not appear to influence NBME or USMLE performance. EMDP2 provides a focused curriculum and addresses the mandate to make medical education opportunities available to a more diverse population., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: In order to evaluate the outcomes of a USU School of Medicine (SOM) education, a program director (PD) evaluation survey was developed in 2005 and is completed annually by PDs regarding trainees who graduated from USU and are in their first post-graduate training year (PGY-1) and their third post-graduate training year (PGY-3). The survey was last reviewed and revised in 2010 to better align with the competencies established by the Accreditation Council for Graduate Medical Education but has not been further evaluated or revised. The objective of the study was to utilize 12 years of aggregated data to improve the psychometric properties of the survey, with an emphasis on shortening the survey. A secondary objective was to refine the verbiage of the existing questions and add new items to assess health systems science competencies., Methods: The survey was sent out to PDs who supervised USU SOM graduates in the classes of 2008 to 2019 (n = 1,958) with 997 responses for the PGY-1 PD survey and 706 responses to the PGY-3 PD survey. Exploratory factor analysis (EFA) was conducted on 334 complete responses of the PGY-1 survey and 327 responses of the PGY-3 survey. A working group of PDs, USU Deans, and health professions education scholars reviewed the results from the EFA and from a survey of experienced PDs and, in an iterative process, developed a proposed revised survey., Results: The EFA for both the PGY-1 data and the PGY-3 data yielded three factors, and a total of 17 items were identified with cross-loading across the factors in the PGY-1 and/or PGY-3 surveys. Items without clean loadings or that were determined to be unclear, redundant, or difficult to assess by PDs were revised or removed. Items were revised or added to address needs within the SOM curriculum, including the new health systems science competencies. The proposed revised survey had 36 items in place of the original 55 items and contained at least four items for each of the six competency domains (patient care, communication and interpersonal skills, medical knowledge, professionalism, system-based practice and practice-based learning and improvement, and military-unique practice, deployment, and humanitarian missions)., Conclusions: The USU SOM has benefited from over 15 years of results from the PD surveys. We identified those questions that performed well, and these were refined and augmented in order to optimize the performance of the survey and fill gaps in our knowledge of graduates' performance. To determine how well the revised set of questions performs, efforts will be made to increase the response rate and completion of 100% of items on the survey, and the EFA should be repeated after about 2-4 years. Furthermore, the USU graduates should continue to be tracked longitudinally past residency to determine if PGY-1 and PGY-3 survey measures predict long-term performance and patient outcomes., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

The purpose of this short essay is to describe the data management processes utilized in the Long Term Career Outcome Study at the Center for Health Professions Education and the Postgraduate Dental College of the Uniformed Services University. It includes descriptions of our workflow, how we obtain the data, challenges, and recommendations based on our experience for data managers and institutions to follow. This descriptive writing may help guide practice for other institutions looking to streamline their data management plan., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Previous studies have shown that medical students experience a great level of burnout and poor well-being during their clinical training periods. In this study, we sought to understand how military medical students cope with stress to prevent burnout and support their well-being. We also investigated if these coping strategies are associated with military medical students' self-reported well-being, burnout, and depression levels. The findings could help inform programming, resources, and educational strategies to better support students to thrive in their careers long term., Methods: Using a cross-sectional research design, we surveyed military medical students and conducted content analysis on participant responses to the open-ended item by trained coders. Coding was based on the existing coping theory frameworks as well as categories that emerged inductively to represent the data., Results: The primary four strategies military medical students utilized included social connection (59.9%), exercise (58.3%), personal relaxation (36%), and work-life balance (15.7%). The use of work-life balance strategy was significantly associated with more positive well-being and lower depression compared to those who did not use this strategy. Three main coping typologies were further extracted, including personal care, connection, and cognitive strategies. Based on the typologies, 62% of students were recognized as multi-type copers (who combined more than two coping typologies), who reported significantly more positive well-being compared to students who relied on a single typology., Conclusions: The findings demonstrate that certain coping strategies are more positively associated with a good state of well-being and less burnout, and that utilization of multiple types of coping strategies is more supportive. This study amplifies the voice of military medical students concerning the importance of prioritizing self-care and available resources given the unique pressures and demands of their dual military medical curriculum., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Developing physicians as leaders has gained attention across the United States. Undergraduate medical education (UME) and graduate medical education (GME) leader development programs have increased. During postgraduate years (PGY), graduates bring their leadership education to the bedside; however, associations between leader performance in medical school and GME is largely unknown. It is important to find experiences that can assess leader performance that may be useful to predict future performance. The purpose of this study was to determine if (1) there is a correlation between leader performance during the fourth year of medical school versus leader performance in PGY1 and 3, and (2) leader performance during the fourth year of medical school is associated with military leadership performance in PGY1 and 3s while taking previous academic performance markers into account., Methods: This study examined overall leader performance of learners (classes of 2016-2018) during the fourth year of medical school and their graduate leader performance post-medical school. Leader performance was assessed by faculty during a medical field practicum (UME leader performance) and graduate leader performance was assessed by program directors at the end of PGY1 (N = 297; 58.3%) and 3 (N = 142; 28.1%). Pearson correlation analysis examined relationships among UME leader performance and between the PGY leader performance items. In addition, stepwise multiple linear regression analyses were conducted to examine the relationship between leader performance at the end of medical school with military leadership performance in PGY1 and 3, while taking into account the academic performance markers., Results: Pearson correlation analyses revealed that the UME leader performance was correlated with 3 of 10 variables at PGY1, and was correlated at PGY3 with 10 out of 10 variables. Results of the stepwise multiple linear regression analysis indicated that leader performance during the fourth year of medical school explained an additional 3.5% of the variance of PGY1 leader performance after controlling for the previous academic performance markers (MCAT total score, USMLE Step 1 score and Step 2 CK score). In contrast, leader performance during the fourth year of medical school alone accounted for an additional 10.9% of the variance of PGY3 leader performance above and beyond the set of academic performance markers. Overall, UME leader performance has more predictive power in PGY leader performance than the MCAT or USMLE Step exams., Conclusions: The findings of this study indicate that a positive relationship exists between leader performance at the end of medical school and leader performance in PGY1 and 3 years of residency. These correlations were stronger in PGY3 compared to PGY1. During PGY1, learners may be more focused on being a physician and an effective team member compared to PGY3 where they have a deeper understanding of their roles and responsibilities and can take on more leadership roles. Additionally, this study also found that MCAT and USMLE Step exams performance was not predictive of PGY1 or PGY3 leader performance. These findings provide evidence of the power of continued leader development in UME and beyond., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Previously, researchers investigated the career accomplishments of USU medical graduates using the data from a USU alumni survey. To better understand if such accomplishments are related to military retention, the current study investigates the relationship between accomplishments (such as military career milestones and academic achievement) and military retention., Methods: Utilizing the responses to the alumni survey sent to USU graduates in the Classes of 1980 to 2017, the researchers investigated the relationship between a series of survey items (e.g., military rank, medical specialties, and operation experiences) and military retention., Results: Among the respondents who had a deployment history in support of an operational mission, 206 (67.1%) stayed longer than their initial active duty service or planned on staying longer than their current active duty service commitment. Fellowship directors (n = 65, 72.3%) showed a higher retention rate than other positions. The PHS alumni had the highest retention rate (n = 39, 69%) of the military branches, whereas physicians in medical specialties with higher demand (e.g., otolaryngology and psychiatry) showed less promising retention., Conclusions: By conducting future research on underlying reasons as to why full-time clinicians, junior physicians, and physicians in medical specialties with higher demand showed less promising retention, stakeholders will be able to identify what needs to be addressed to retain highly skilled physicians in the military., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: The Medical College Admission Test (MCAT) is designed to inform members of the admissions committee about applicants' academic readiness for medical school. Although previous work has shown that MCAT scores have some predictive validity evidence for a variety of medical student outcomes, there is also a concern that the MCAT is overly emphasized by admissions committees, which may, for example, affect matriculant diversity. The purpose of this study was to understand whether deemphasizing the MCAT by blinding committee members to applicants' specific scores has resulted in matriculants with different pre-clerkship and clerkship performance., Method: The Admissions Committee from the Uniformed Services University of the Health Sciences (USU) created a policy to blind admissions committee members to MCAT scores. The MCAT-blinded policy was implemented for classes of 2022 to 2024. This MCAT-blinded cohort's performance was compared with a previous cohort, classes of 2018 to 2020. Two analyses of covariance were performed to test for differences in the pre-clerkship and clerkship module scores. Undergraduate grade point average (uGPA) and MCAT percentile for matriculants were included as covariates., Results: There were no statistically significant differences in either pre-clerkship or clerkship performance between the MCAT-revealed and MCAT-blinded cohorts., Conclusion: This study found similar medical school performance between the MCAT-blinded and MCAT-revealed cohorts. The research team plans to continuously follow these two cohorts to understand their performance further down their education path, including step 1 and step 2 examinations., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Virtual patient cases (VPCs), a type of simulated, interactive electronic learning, are a potentially important tool for military health care providers in austere or pandemic settings to maintain skills but need more validation. Our military internal medicine clerkship is spread across military treatment facilities around the country and has 15 weekly live student lectures, but students randomly miss the first, second, or third 5 weeks due to their psychiatry clerkship. We hypothesized that VPCs would be an adequate replacement for lost lectures., Materials and Methods: We compared live lectures to a web-based VPC and analyzed the academic outcomes of 734 students from 2015 to 2022., Results: Using our end-of-clerkship Script Concordance Test (SCT) as the primary outcome, there was no significant difference in performance between the 2 learning methods (VPC, 63.9% correct; lectures 63.2%, P = .27). After controlling for gender, baseline knowledge, and the total number of VPCs completed, there was still not a statistically significant difference between teaching methods (F(1,728) = 0.52, P = .47). There was also no significant differences in all other clerkship outcomes including National Board of Medical Examiner and Objective Structured Clinical Examination scores., Conclusion: VPCs appear noninferior at teaching clinical reasoning as measured by SCT. VPCs might be substituted for traditional, live lectures in clerkships when time or other resources are limited, in austere environments such as military deployments, or during conditions limiting interpersonal contact such as pandemics but are not a complete substitution for in-person learning., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Medical school leaders are seeking strategies to increase the diversity of their student populations. Post-baccalaureate premedical (PBPM) programs are one such pipeline that has supported diversity in medicine. The purpose of this study was to evaluate the Uniformed Services University's (USU's) PBPM program (the Enlisted to Medical Degree Preparatory Program, EMDP2) to determine how well it prepares its learners for the School of Medicine (SOM)., Materials and Methods: The National Board of Medical Examiners Clinical Science Subject Examination scores of EMDP2 learners from the SOM classes of 2020-2023 were compared to those of four similarly sized cohorts of their peers that varied by age and prior military service., Results: We found that the performance of program graduates was comparable to their peers who followed more traditional and other alternative preparatory paths., Conclusions: The EMDP2 appears to prepare medical students on a par with their non-EMDP2 peers. The EMDP2 contributes to USU's commitment to train physicians who represent the nation and its citizens by making medical education available to enlisted service members, a population that closely mirrors the diversity of the nation., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Objectives: Benefits of using multiple arterial grafting (MAG), over single arterial grafting in major adverse cardiac event rates and the need for repeat revascularization, have been widely reported. Several guidelines have recommended the use of MAG in selected patients. We report the trend of MAG in patients undergoing isolated coronary artery bypass grafting (CABG) in the UK., Methods: This is a retrospective analysis of a prospectively collected UK national database in patients undergoing non-emergency, isolated CABG from 1996 to 2018. Patients were divided into single arterial grafting and MAG, and trends in perioperative characteristics were analysed., Results: A total of 336 321 patients were included, of whom 284 003 (84.44%) received single arterial grafting and 52 318 (15.56%) received MAG. The use of MAG after an initial increase from 1996 to 2001, steadily decreased thereafter, particularly in the use of radial artery. MAG was likely to be performed in younger patients [66.72 (standard deviation: 9.22) vs 62.30 (standard deviation: 10.06), P < 0.001] and males (85% vs 81%, P < 0.001). After propensity score matching, the single arterial grafting group was more likely to undergo on-pump CABG (90% vs 69%, P < 0.001), experienced a lower in-hospital mortality (1.1% vs 1.3%, P < 0.001) and incidence of return to theatre for bleeding (2.5% vs 3.0%, P < 0.001)., Conclusions: Our data show that the use of MAG in CABG in the UK after an initial increase from 1996 to 2001 steadily decreased thereafter until 2018. This is likely to be multifactorial and a better understanding of the main causes may contribute to establishing the best indication for MAG in everyday clinical practice., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

The capacity of plants to resist abiotic stresses is of great importance to agricultural, ecological and environmental sustainability, but little is known about its genetic underpinnings. Existing genetic tools can identify individual genetic variants mediating biochemical, physiological, and cellular defenses, but fail to chart an overall genetic atlas behind stress resistance. We view stress response as an eco-evo-devo process by which plants adaptively respond to stress through complex interactions of developmental canalization, phenotypic plasticity, and phenotypic integration. As such, we define and quantify stress response as the developmental change of adaptive traits from stress-free to stress-exposed environments. We integrate composite functional mapping and evolutionary game theory to reconstruct omnigenic, information-flow interaction networks for stress response. Using desert-adapted Euphrates poplar as an example, we infer salt resistance-related genome-wide interactome networks and trace the roadmap of how each SNP acts and interacts with any other possible SNPs to mediate salt resistance. We characterize the previously unknown regulatory mechanisms driving trait variation; i.e. the significance of a SNP may be due to the promotion of positive regulators, whereas the insignificance of a SNP may result from the inhibition of negative regulators. The regulator-regulatee interactions detected are not only experimentally validated by two complementary experiments, but also biologically interpreted by their encoded protein-protein interactions. Our eco-evo-devo model of genetic interactome networks provides an approach to interrogate the genetic architecture of stress response and informs precise gene editing for improving plants' capacity to live in stress environments., (© The Author(s) 2022. Published by Oxford University Press on behalf of Nanjing Agricultural University.)

Objectives: Several studies have shown worse outcomes in patients operated on later in the week. We tested this hypothesis in a large UK national audit database in elective patients undergoing adult cardiac surgery., Methods: We used a generalized additive model to evaluate the effect of the day of the week on the following postoperative outcomes: 30-day mortality, stroke, need for dialysis and return to theatre for bleeding. We have adjusted for the relevant European System for Cardiac Operative Risk Evaluation (EuroSCORE) II covariates, plus responsible consultant, hospital and year of operation and performed subgroup analysis for isolated coronary artery bypass grafting (CABG) procedures., Results: Out of 371 500 patients, 60 555 (16.3%) underwent AVR, 36 553 (9.8%) AVR plus CABG, 238 812 (64.3%) isolated CABG, 26 517 (7.1%) isolated mitral valve repair or replacement and 9063 (2.4%) mitral valve plus CABG. A total of 13 997 (3%) had surgery over the weekend. After covariate adjustment, we found no effect of day of surgery on mortality (P = 0.081), stroke (P = 0.137) and need for postop dialysis (P = 0.732). However, across all operations, there was evidence of a lower rate of return to theatre for bleeding/tamponade at the weekend (P = 0.039). In subgroup analysis of isolated CABG, the day of the week did not affect any outcomes., Conclusions: We found no effect of the day of the week on risk-adjusted short-term mortality, stroke, and the requirement for postoperative dialysis after elective cardiac surgery. Overall, the patients operated on during the weekdays were less likely to return to theatre for bleeding. In isolated CABG, the day of the week did not affect any outcomes., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Wound age estimation is a crucial and challenging problem in forensic pathology. Although mRNA is the most commonly used indicator for wound age estimation, screening criteria are lacking. In the present study, the feasibility of screening criteria using mRNA to determine injury time based on the adenylate-uridylate-rich element (ARE) structure and gene ontology (GO) categories were evaluated. A total of 78 Sprague-Dawley male rats were contused and sampled at 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, and 48 h after inflicting injury. The candidate mRNAs were classified based on with or without ARE structure and GO category function. The mRNA expression levels were detected using qRT-PCR. In addition, the standard deviation (STD), mean deviation (MD), relative average deviation (d%), and coefficient of variation (CV) were calculated based on mRNA expression levels. The CV score (CVs) and the CV of CV (CV'CV) were calculated to measure heterogeneity. Finally, based on classic principles, the accuracy of combination of candidate mRNAs was assessed using discriminant analysis to construct a multivariate model for inferring wound age. The results of homogeneity evaluation of each group based on CVs were consistent with the MD, STD, d%, and CV results, indicating the credibility of the evaluation results based on CVs. The candidate mRNAs without ARE structure and classified as cellular component (CC) GO category (ARE-CC) had the highest CVs, showing the mRNAs with these characteristics are the most homogenous mRNAs and best suited for wound age estimation. The highest accuracy was 91.0% when the mRNAs without ARE structure were used to infer the wound age based on the discrimination model. The accuracy of mRNAs classified into CC or multiple function (MF) GO category was higher than mRNAs in the biological process (BP) category. In all subgroups, the accuracy of the composite identification model of mRNA composition without ARE structure and classified as CC was higher than other subgroups. The mRNAs without ARE structure and belonging to the CC GO category were more homogenous, showed higher accuracy for estimating wound age, and were appropriate for rat skeletal muscle wound age estimation. Supplemental data for this article is available online at https://doi.org/10.1080/20961790.2021.1986770 ., Competing Interests: No potential conflict of interest was reported by all authors., (© 2022 The Author(s). Published by Taylor & Francis Group on behalf of the Academy of Forensic Science.)

Objectives: Natural borneol and synthetic borneol were commonly used to treat ischaemic stroke in clinical practice. This study evaluated their different neuroprotective effects on the remodelling and repair of the neurovascular unit (NVU) after cerebral ischaemia., Methods: We evaluated the different effects of borneol through neurological test and staining methods in cerebral ischaemia injury. Western blot, immunohistochemistry and transmission electron microscopy were used to evaluate the reparative effects of borneol on NVU., Key Findings: The prevention and treatment of borneol could prolong recovery time, reduce body temperature and cerebral infarction rate and improve pathological conditions. Further investigations revealed that borneol could inhibit the expression of DII4, Hes1, Hes5 and p65 and increase the Nissl body number and microvessel density. They also inhibited the activation of the microglia. It was also observed through an ultramicroelectron microscope that the structural stability of the NVU has also been repaired. Moreover, natural borneol shows better results in most indicators when compared with synthetic borneol., Conclusions: Natural borneol showed a stronger effectiveness and had better regulation and neuroprotection on the NVU when compared with synthetic borneol, indicating that it may be better to use natural borneol in the prescription of Chinese patent medicine in clinical practice., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The PhageDx™ Listeria Assay is a simple, specific, and sensitive assay based on the infection of Listeria spp. by selected bacteriophages and the resultant expression of a luciferase reporter gene. Results are generated in as little as 24.5 h for stainless steel and ceramic environmental surfaces., Objective: An AOAC Performance Tested MethodsSM (PTM) study was conducted to validate the PhageDx Listeria Assay for the detection of Listeria on stainless steel and ceramic surfaces., Method: The performance of the PhageDx method was compared to that of the U.S. Food and Drug Administration (FDA) Bacterial Analytical Manual (BAM) Ch. 10. Inclusivity/exclusivity, product consistency and stability, and robustness testing also were conducted., Results: Inclusivity testing demonstrated that the reporter bacteriophages were specific for Listeria ssp. and detected 58/61 Listeria strains tested, including all 34 L. monocytogenes strains. The reporter bacteriophage also was shown to not detect 46/47 non-Listeria bacteria in exclusivity testing. Robustness testing showed that the method performed well with specific deviations from the standard protocol. Consistency and stability testing demonstrated that the recombinant phage gave consistent results across three production lots and was stable when stored under appropriate conditions for at least 6 months. Matrix studies on stainless steel and ceramic surfaces showed that there was no significant difference between the PhageDx Listeria Assay and the FDA/BAM Chapter 10 reference method., Conclusions and Highlights: The validation study demonstrates that the PhageDx Listeria Assay is an effective method for the detection of Listeria spp. on stainless steel and ceramic environmental surfaces and meets the qualifications for AOAC PTM status., (© AOAC INTERNATIONAL 2021.)

Mesocotyl elongation of rice is crucial for seedlings pushing out of deep soil. The underlying mechanisms of phospholipid signaling in mesocotyl growth of rice are elusive. Here we report that the rice non-specific phospholipase C6 (OsNPC6) is involved in mesocotyl elongation. Our results indicated that all five OsNPCs (OsNPC1, OsNPC2, OsNPC3, OsNPC4 and OsNPC6) hydrolyzed the substrate phosphatidylcholine to phosphocholine (PCho), and all of them showed plasma membrane localization. Overexpression (OE) of OsNPC6 produced plants with shorter mesocotyls compared to those of Nipponbare and npc6 mutants. Although the mesocotyl growth of npc6 mutants was not much affected without gibberellic acid (GA)3, it was obviously elongated by treatment with GA. Upon GA3 treatment, SLENDER RICE1 (SLR1), the DELLA protein of GA signaling, was drastically increased in OE plants; by contrast, the level of SLR1 was found decreased in npc6 mutants. The GA-enhanced mesocotyl elongation and the GA-impaired SLR1 level in npc6 mutants were attenuated by the supplementation of PCho. Further analysis indicated that the GA-induced expression of phospho-base N-methyltransferase 1 in npc6 mutants was significantly weakened by the addition of PCho. In summary, our results suggest that OsNPC6 is involved in mesocotyl development via modulation of PCho in rice., (© The Author(s) 2021. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: The purpose of this study was to report on the career accomplishments of Public Health Service (PHS) alumni from the Uniformed Services University (USU) School of Medicine (SOM) in several professional areas such as specialty choice, board certification rates, leadership roles, academic achievements, deployments, and length of service., Materials and Methods: This study was conducted using the data obtained from the Long-Term Career Outcomes Study Alumni Survey. The cohort included all alumni who graduated from the SOM classes of 1980-2017. We analyzed the frequency distributions of the survey items of interest of the PHS alumni., Results: Out of the 144 PHS alumni we reached, 39 responded, yielding a 27.1% response rate. 56.0% of PHS alumni entered primary care specialties and 97.0% were board certified in their first residency trained specialty. 30.6% of PHS alumni completed residency training in a military facility. 87.2% of PHS alumni have been in a leadership role since medical school, and 67.6% of PHS alumni currently hold a leadership role. 7.7% of PHS alumni have deployed for ≥30 days to a theater of combat operations. 66.7% and 71.8% of PHS alumni engaged in medical humanitarian and volunteering missions, respectively, and 75% of PHS alumni stayed in active duty longer than their initial commitment. 71.8% of PHS alumni were published in peer-reviewed journals and 17.6% were academically affiliated with USU., Conclusions: Our findings suggest that PHS alumni are likely to enter primary care specialties, engage in medical volunteering and humanitarian missions, frequently remain in uniform longer than their initial active duty commitment, and are affiliated with numerous universities and medical schools throughout their career. PHS alumni appear to be successfully meeting the mission set forth by the U.S. PHS., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: The admission interview is regarded as one of the most significant moments in the process of applying to medical school, but there is limited empirical evidence that supports this claim. Previous analyses have offered what is largely anecdotal evidence of the interview's importance while also suggesting that there is ample opportunity for ethnic and gender bias to impact interview scores. We also asked what medical schools can learn from comparing the attributes of matriculants and those applicants who rejected offers of acceptance., Materials and Methods: This study investigated the association between interview performance and admission committee decisions for applicants applying to the School of Medicine of the USU. The study cohort included all candidates who were invited for an on-site interview at the USU in 2014, 2015, and 2016 (n = 1825)., Results: Seventeen percent of the variance of the outcome variables-admission committee decisions to accept, place on the alternate list, or reject an applicant-can be explained by considering interview scores alone. Applicant age, race, ethnicity, and gender did not significantly impact interview overall ratings. Matriculants to the USU had similar interview ratings and distribution of gender, race, and ethnicity when compared to those applicants who rejected offers of acceptance. Matriculants were more likely to have previous military experience., Conclusion: Our analysis provides some justification for the importance of the interview in the admission process. Applicant demographics (age, race, gender, and ethnicity) were not associated with interview scores. Differences between matriculants to the USU and those who rejected offers of acceptance are small, indicating that the USU continues to build a class body that excels in both cognitive and noncognitive domains., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Health professions educators seek understanding of the process of learner performance and achievement. Grit, defined as passion and perseverance for long-term goals, has been implicated in this process. Research suggests that effort counts twice in achievement: skill times effort equals skill and, subsequently, skill times effort equals achievement. Research also suggests that an individual's interest influences job performance and satisfaction. Grit, composed of Perseverance of Effort and Consistency of Interest, has been shown to positively correlate with performance and achievement in various disciplines. Limited research reveals Grit negatively correlates with resident attrition and physician burnout. This study evaluates relationships between Grit and medical student performance measures. We gather validity evidence for Grit scale use among medical students and, subsequently, use this data to evaluate for differences in Grit score by gender and assess whether there is a relationship between Grit and standardized exam scores. We hypothesize that Grit will not vary with gender and that it will be positively associated with standardized examination scores., Methods: Enrolled students receive the 12-item Grit survey. An exploratory factor analysis evaluates validity evidence of Grit. Descriptive statistical analysis, Pearson correlation, and moderation analysis evaluate if Grit score differs by gender and if there are relationships with standardized exams., Results: The survey response rate is 59% (412/698) and exploratory factor analysis replicates the two-factor structure of Grit found in other fields-Perseverance of Effort and Consistency of Interest. Average Grit scores do not significantly differ by gender. Grit weakly correlates with United States Medical Licensing Exam Step 1 (r = 0.10,  = 0.36) and United States Medical Licensing Exam Step 2 Clinical Knowledge (r = 0.12, P=0.29). Grit weakly and negatively correlates with Medical College Admission Test score (r = - 0.18, P<0.05). Grit is not a significant moderator of the relationship between Medical College Admission score and Step exams scores., Conclusion: Exploratory factor analysis results provide preliminary validity evidence for Grit scale use in medical students. Grit does not significantly moderate the Medical College Admission Test-Step score relationship. Grit correlates negatively with Medical College Admission Test scores. Though the correlations in this study were not significant, the results showed that Grit may tend to positively correlate with Step 1 and Step 2 Clinical Knowledge examinations. Given that these three exams are taken at different levels of training, the stepwise progression towards positive correlation may suggest that the theory "effort counts twice" applies to medical training., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Undergraduate and graduate medical education both have been reported to have high rates of depression, anxiety, and burnout as a result of the rigors of their educational curricula. Wellness, including physical fitness, is important to the profession because it may help mitigate these increased rates of depression and anxiety. While several studies examine physical fitness and academic performance in primary and secondary education, few studies have examined the association between fitness and performance in health professions education. Given the demands of medical school, this investigation aimed to investigate the possibility of an association between physical fitness and body mass index (BMI) with academic performance. Another goal was to examine the change in physical fitness and BMI throughout medical school., Materials and Methods: Standardized measures of physical fitness were examined in 192 Army students from the Uniformed Services University of Health Sciences over 4 years from the classes of 2017-2019. Measurements include (1) body composition (BMI); (2) muscular endurance (timed push-ups); (3) aerobic endurance (timed run), and (4) total fitness defined as total points from sit-ups, run, and push-ups (everything but BMI). Pearson correlation analysis was conducted between physical fitness and academic performance measures such as United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2 Clinical Knowledge (CK), and average core clerkship National Board of Medical Examiners (NBME) exam scores. A repeated measures analysis of variance was conducted to examine the differences of students' fitness total points and BMI over 4 fitness measurements spanning approximately 1.7 years., Results: There were weak positive correlations, 0.20 and 0.22, between USMLE Step 2 CK exam scores and push-up points and total fitness points, respectively. There also were weak positive correlations, 0.21 and 0.24, between core clerkship average NBME exam scores and push-up points and total fitness points, respectively. No statistically significant change of individual students' fitness total point change was observed (F(2.52, 334.93 = 1.37, P = 0.26)). There was also no individual BMI change (F(2.36, 274.21 = 2.78, P = .06)) over the first four assessment measurements (about 1.7 years lapse). However, the class means over the four measurements showed a decrease of fitness total points and an increase of BMI., Conclusions: Our investigation suggests that there may be correlations between physical fitness and clinical exam performance such as USMLE Step 2 CK and average core clerkship NBME exams. Although there is no statistically significant change in individual fitness total points or BMI, the study suggests that physical fitness and BMI may decline during medical school. This may be as a result of increasing academic demands while balancing clinical duties from clerkship rotations., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Holistic review, in which medical schools seek to balance applicant attributes and experiences alongside traditional academic metrics in making admissions decisions, has been in place for over a decade. Medical school applicants and the admissions' community are still trying to understand the impact of holistic review on the composition of those medical schools choose to interview and accept., Materials and Method: The study cohort included all candidates who applied to Uniformed Services University of the Health Sciences (USU) in 2014, 2015, and 2016 (N = 8,920). We conducted logistic regression analysis to examine the associations between the sociodemographic, academic, and military service variables of applicants applying to the School of Medicine and offers for interview., Results: Medical College Admission Test scores and undergraduate grade point averages were important in predicting who would receive an interview. Having military experience, being a woman, and being self-reported African American race also predicted a higher likelihood of receiving an interview invitation. For example, controlling for all other variables in the model, if an applicant had previous military experience, the odds of being invited for interview was about 4 times that of an applicant who had no previous military experience. Leave this for the text and discussion. The resulting pool of interviewed and accepted students more increasingly represented the Military Health Service population served., Conclusions: The use of holistic review generated a class with a composition different from that which would be predicted by Medical College Admission Test and grade point average alone. Further, holistic review produced an interview pool and class more representative of the wider Military Health Service beneficiary population. In the case of USU, holistic review allowed the school to better meet its mission to create a representative class able to "care for those in harm's way.", (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: The Uniformed Services University of the Health Sciences coordinates a 2-week Summer Operational Experience (SOE) during the first year of medical school. The SOE aims to provide students with operational context and enhance familiarity with service-specific operational environments, the services' medical department capabilities, and/or general warfighter skills. One overarching goal of the SOE is to provide an experience that may motivate students to pursue an operational medicine assignment at some point in their military career. However, to date, little evaluation data have been collected regarding the effectiveness of the SOE in encouraging medical students to pursue operational medicine assignments. The purpose of this project was to develop and collect initial validity evidence for a survey instrument designed to assess various aspects of students' attitudes and behavioral intentions to pursue an operational medicine assignment at some point in their military career., Materials and Methods: Using the theory of planned behavior as a framework, we developed a survey that focused on three distinct constructs: attitude, subjective norms, and perceived behavioral control. We followed a systematic, seven-step design process to develop the survey and collect initial validity evidence. Students completed the 20-item survey prior to their operational experience to evaluate their intentions to pursue an operational medicine assignment at some point in their military career. An exploratory factor analysis (EFA) and reliability analysis were performed to examine the internal structure of the instrument. In addition, bivariate correlation and multiple linear regression analyses were used to explore the relationships between the identified factors and students' intentions to pursue operational medicine., Results: Results from the expert reviews and cognitive interviews suggested the instrument was clear and interpretable. We then invited the entire class of 2020 who participated in the SOE (149 students) to take the survey; in total, 122 students (response rate = 82%) completed the entire survey. Findings from the EFA suggested four underlying factors with satisfactory internal consistency reliability, and the regression analysis revealed that three factors statistically significantly predicted students' intentions to pursue operational medicine: Attitude: Personal Growth (b = 0.67, β = 0.42, P < 0.001); Behavioral Control (b = 0.20, β = 0.15, P < 0.05); and Attitude: Career Progression (b = 0.36, β = 0.30, P < 0.001). The factor related to student's perception of the importance that others placed on an operational medicine assignment was not a statistically significant predictor of intention., Conclusions: Findings from this study suggest the developed survey yields scores that can reliably assess students' attitudes, subjective norms, perceived behavioral control, and intentions to pursue operational medicine. Using this survey, course leaders have a tool for evaluating the success of the SOE and identifying potential areas for improvement within the curriculum. More broadly, other educators can use the theoretical framework and instrument design process described here to evaluate students' behavioral intentions in their own contexts., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by US Government employees and is in the public domain in the US.)

Introduction: This article uses alumni survey data from the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine to assess the professional impact of pediatric-trained USU graduates over the course of their careers. We specifically report on the clinical and leadership roles held, career accomplishments, and operational involvement among military pediatricians., Materials and Methods: This study analyzed survey data that were collected from alumni of USU. We used descriptive statistics to report the career achievements and operational experiences among USU graduates who completed training in pediatrics. This study was deemed exempt by the USU Institutional Review Board., Results: The survey response rate was 49.5% among 2,400 eligible respondents. Out of 1,189 alumni respondents, 110 (9.3%) trained in pediatrics. Among the pediatric-trained USU graduates, 98.2% spent some time as a full-time clinician, 73.6% served as chief of a clinical service, 42.7% held the role of department chair/chief or the equivalent, and 26.3% filled leadership positions in deployed settings. Forty percent of USU-trained military pediatricians deployed to combat areas at least once, and 35.5% participated in at least one peacetime humanitarian mission., Conclusions: Our findings contribute to the unique story of military pediatricians who graduated from USU. These uniformed pediatricians participate actively in all realms of military medicine and have demonstrated their versatility through participation in a wide variety of vital functions. Their contributions include the provision of clinical care for both military children and active duty service members, serving in varied leadership positions, engaging in health professions education and other academic pursuits, and participating in operational assignments. Future studies could aim to more fully address the diverse contributions of military pediatricians to the overall mission by including more specific data about career experiences from all uniformed pediatricians., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020.)

Effects of climate warming on tree growth and physiology may be driven by direct thermal effects and/or by changes in soil moisture. Dioecious tree species usually show sexual spatial segregation along abiotic gradients; however, few studies have assessed the sex-specific responses to warming in dioecious trees. We investigated the sex-specific responses in growth, photosynthesis, nonstructural carbohydrate (NSC), water-use efficiency and whole-plant hydraulic conductance (KP) of the dioecious tree species Populus cathayana Rehd. under +4 °C elevated temperature with and without supplemental water. For both sexes, high-temperature treatments significantly decreased growth (height and biomass), photosynthetic rate (A), the ratio of A to dark respiration rate, stomatal conductance (gs), transpiration rate, NSC, leaf water potential and KP, but increased water-use efficiency (estimated from carbon isotope composition). Under warming with supplemental water, most traits of females did not change relative to ambient conditions, but traits of males decreased, resulting in greater sexual differences. Females showed a lower KP, and their gs and A responded more steeply with water-related traits than males. These results show that the effect of summer warming on growth and photosynthesis was driven mainly by soil moisture in female P. cathayana, while male performance was mainly related to temperature. Females may experience less thermal stress than males due to flexible water balance strategy via stomata regulation and water use., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Gender disparity in medicine has drawn increased attention in the form of root cause analysis and programmatic solutions with the goal of equity. Research indicates that mentoring, guidance, and support, which include the provision of social and academic guidance and support from more experienced practitioners, can mitigate challenges associated with gender disparity. The purpose of this study was to explore women medical students' self-reports of mentorship during their time at Uniformed Services University (USU), if women report similar levels of mentorship as compared to men, and if levels of characteristics associated with mentoring (eg, social support, academic guidance) changed over time., Materials and Method: Using data from the American Association of Medical College's Graduate Questionnaire, a survey sent to all medical students prior to graduation, items were coded as related to mentorship, guidance, and support and analyzed to compare responses of female and male students from graduating USU classes of 2010-2017., Results: No significant difference was found between experiences of female and male survey respondents. Equitable experiences were consistent across time for the 8 years of the study., Conclusions: Although mentorship is cited as a key factor in mediating gender disparity in medicine, other STEM fields, and the military, the findings suggest that there is equity at the USU undergraduate medical education level. Further studies are needed to understand if disparities in mentorship experiences occur at other stages of a military physician's career, such as graduate medical education, faculty and academic promotion levels., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

A major unanswered question in the current global coronavirus disease 2019 (COVID-19) outbreak is why severe disease develops in a small minority of infected individuals. In the current article, we report that homozygosity for the C allele of rs12252 in the interferon-induced transmembrane protein 3 (IFITM3) gene is associated with more severe disease in an age-dependent manner. This supports a role for IFITM3 in disease pathogenesis and the opportunity for early targeted intervention in at-risk individuals., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.)

Introduction: Any implicit and explicit biases that exist may alter our interpretation of people and events. Within the context of assessment, it is important to determine if biases exist and to decrease any existing biases, especially when rating student performance to provide meaningful, fair, and useful input. The purpose of this study was to determine if the experience and gender of faculty members contribute to their ratings of students in a military medical field practicum. This information is important for fair ratings of students. Three research questions were addressed: Were there differences between new versus experienced faculty raters? Were there differences in assessments provided by female and male faculty members? Did gender of faculty raters impact ratings of female and male students?., Materials and Methods: This study examined trained faculty evaluators' ratings of three cohorts of medical students during 2015-2017 during a medical field practicum. Female (n = 80) and male (n = 161) faculty and female (n = 158) and male (n = 311) students were included. Within this dataset, there were 469 students and 241 faculty resulting in 5,599 ratings for each of six outcome variables that relate to overall leader performance, leader competence, and leader communication. Descriptive statistics were computed for all variables for the first four observations of each student. Descriptive analyses were performed for evaluator experience status and gender differences by each of the six variables. A multivariate analyses of variance was performed to examine whether there were differences between gender of faculty and gender of students., Results: Descriptive analyses of the experience status of faculty revealed no significant differences between means on any of the rating elements. Descriptive analyses of faculty gender revealed no significant differences between female and male faculty ratings of the students. The overall MANOVA analyses found no statistically significant difference between female and male students on the combined dependent variables of leader performance for any of the four observations., Conclusions: The study revealed that there were no differences in ratings of student leader performance based on faculty experience. In addition, there were no differences in ratings of student leader performance based on faculty gender., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

It is clear that 2-oxoglutarate-dependent dioxygenases have critical functions in salicylic acid (SA) metabolism in plants, yet their role in SA biosynthesis is poorly understood. Here, we report that two dioxygenase-encoding genes, SLENDER AND CRINKLY LEAF1 (SLC1) and SLC2, play essential roles in shoot development and SA production in rice. Overexpression of SLC1 (SLC1-OE) or SLC2 (SLC2-OE) in rice produced infertile plants with slender and crinkly leaves. Disruption of SLC1 or SLC2 led to dwarf plants, while simultaneous down-regulation of SLC1 and SLC2 resulted in a severe defect in early leaf development. Enhanced SA levels in SLC1-OE plants and decreased SA levels in slc1 and slc2 mutants were observed. Accordingly, these lines all showed altered expression of a set of SA-related genes. We demonstrated that SLC1 interacts with homeobox1 (OSH1), and that either the knotted1-like homeobox (KNOX1) or glutamate, leucine, and lysine (ELK) domain of OSH1 is sufficient for accomplishing this interaction. Collectively, our data reveal the importance of SLC1 and SLC2 in rice shoot development., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Experimental Biology.)

Introduction: Many medical schools in the United States are introducing leader and leadership curricula. However, there is a large gap regarding how to assess leader performance during undergraduate medical education. With the guidance of a conceptual framework, leadership assessment measures can be developed, learners can make expected improvements in performance over time, and assessment measures can be used in relevant, applied, medical teaching settings. Uniformed Services University (USU) medical students are educated to become healthcare leaders who can perform effectively in various settings. Medical students are assessed on multiple occasions for elements of leader performance during "Operation Bushmaster" - the capstone military medical field practicum event for fourth year medical students - by experienced faculty. A conceptual framework guides the assessment approach for leader performance during Bushmaster. The USU Leader and Leadership Education and Development program developed an assessment tool to measure student leader performance used in a military medical field practicum. The present paper examines whether: (1) leader performance can be measured at Bushmaster; (2) leader performance changed during Bushmaster; (3) leader performance elements are related to each other; and (4) overall leader performance is related to other medical academic performance., Materials and Methods: Trained faculty assessed students' leader performance. Data from three cohorts of USU medical students (N = 509) were collected. All data were collected, compiled, deidentified, and analyzed with approval from the USU Institutional Review Board (Protocol number: KM83XV). Descriptive statistics, repeated measures t-tests, trend analyses, and correlation analyses were performed., Results: Data were available from 483/509 [95%] students. Results revealed that: (1) average leader performance was satisfactory; (2) overall leader performance and performance on each of the major elements of leader performance significantly improved over the course of Bushmaster; (3) major elements of leader performance were significantly correlated with each other and with overall leader performance; (4) leader performance was not correlated with students' performance on the MCAT total score or USMLE Step exam scores., Conclusion: With the guidance of a conceptual framework, the assessment tool was used to assess leader performance in a relevant, applied, medical teaching setting. The findings of this study indicate that leader performance can be measured. Additionally, leader performance appears to be a separate skillset from medical academic performance and both types of performance can be taught and developed. This was a retrospective correlation study and was conducted during a military medical field practicum at a single institution. Gathering additional validity evidence of the assessment tool is needed. With additional validity evidence, the assessment tool could be applied to other medical exercises in different settings and help with the assessment of leader performance beyond medical school., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Natural killer (NK) cells are an important type of effector cell in the innate immune response, and also have a role in regulation of the adaptive immune response. Several studies have indicated that NK cells may influence CD4+ T cells during HIV infection., Methods: In total, 51 HIV-infected individuals and 15 healthy controls participated in this study. We performed the flow cytometry assays and real-time PCR for the phenotypic analysis and the functional assays of NK cell-mediated deletion of CD4+ T cells, phosphorylation of nuclear factor-κB (NF-κB/p65) and the intervention of metformin., Results: Here we detected high CD54 expression on CD4+ T cells in HIV-infected individuals, and demonstrate that upregulated CD54 is associated with disease progression in individuals infected with HIV. We also show that CD54 expression leads to the deletion of CD4+ T cells by NK cells in vitro, and that this is modulated by NF-κB/p65 signaling. Further, we demonstrate that metformin can suppress CD54 expression on CD4+ T cells by inhibiting NF-κB/p65 phosphorylation., Conclusions: Our data suggest that further studies to evaluate the potential role of metformin as adjunctive therapy to reconstitute immune function in HIV-infected individuals are warranted., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

This study examined the physiological effects of different amounts of nitrogen (N) supplementation (0 to 2.72 kg/year) on the citrus cultivar Huangguogan ( Citrus reticulata × Citrus sinensis ). Root activity, chlorophyll content, and fruit quality were measured, and the activities of the antioxidant enzymes superoxide dismutase (SOD), guaiacol peroxidase (POD), and catalase (CAT), and the contents of malondialdehyde (MDA) and soluble protein in root, leaf, and fruit tissues were examined at different developmental stages. Root activity, chlorophyll content, fruit quality, antioxidant enzyme activity, MDA content, and soluble protein content increased in plants treated with an appropriate amount of N. Both excessive N and N deficiency decreased the content of MDA and the activities of antioxidant enzymes. Application of 1.36-1.81 kg N/year is suggested for citrus fertilization and the lower end of this range is recommended for minimizing environmental impact and production cost.

The APETALA1 (AP1)/FRUITFULL (FUL)-like transcription factor OsMADS18 plays diverse functions in rice development, but the underlying molecular mechanisms are far from fully understood. Here, we report that down-regulation of OsMADS18 expression in RNAi lines caused a delay in seed germination and young seedling growth, whereas the overexpression of OsMADS18 produced plants with fewer tillers. In targeted OsMADS18 genome-edited mutants (osmads18-cas9), an increased number of tillers, altered panicle size, and reduced seed setting were observed. The EYFP-OsMADS18 (full-length) protein was localized to the nucleus and plasma membrane but the EYFP-OsMADS18-N (N-terminus) protein mainly localized to the nucleus. The expression of OsMADS18 could be stimulated by abscisic acid (ABA), and ABA stimulation triggered the cleavage of HA-OsMADS18 and the translocation of OsMADS18 from the plasma membrane to the nucleus. The inhibitory effect of ABA on seedling growth was less effective in the OsMADS18-overexpressing plants. The expression of a set of ABA-responsive genes was significantly reduced in the overexpressing plants. The phenotypes of transgenic plants expressing EYFP-OsMADS18-N resembled those observed in the osmads18-cas9 mutants. Analysis of the interaction of OsMADS18 with OsMADS14, OsMADS15, and OsMADS57 strongly suggests an essential role for OsMADS18 in rice development., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Experimental Biology.)