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The objective of this work was to delineate career progression and research productivity of women practicing cardiothoracic surgery in the academic setting.Cardiothoracic surgeons at the 79 accredited US cardiothoracic surgery training programs in 2020 were included in this cross-sectional analysis. Data regarding subspecialization, training, practice history, and publications were gathered from public sources including department websites, CTSNet, and Scopus.A total of 1065 surgeons (51.3% cardiac, 32.1% thoracic, 16.6% congenital) were identified. Women accounted for 10.6% (113) of the population (7.9% of cardiac, 15.5% of thoracic, 9.6% of congenital surgeons). The median number of cardiothoracic surgeons per institution was 12 (interquartile range [IQR], 10-17), with a median of 1 woman (IQR, 0-2). Fifteen of 79 programs (19%) had no women. Among women faculty 5.3% were clinical instructors, 51.3% were assistant professors, 23.0% were associate professors, 16.8% were full professors, and 3.5% had unspecified titles (vs 2.0%, 32.9%, 23.0%, 37.5%, and 4.6% among men, respectively; P.001). Women and men authored a comparable number of first-author (0.4 [IQR, 0.0-1.3] vs 0.5 [IQR, 0.0-1.1], P = .56) publications per year but fewer last-author (0.1 [IQR, 0.0-0.7] vs 0.4 [IQR, 0.0-1.3], P.0001) and total publications per year (2.7 [IQR, 1.0-6.2] vs 3.7 [IQR, 1.3-7.8], P = .05) than men. The H-index was lower for women than for men overall (8.0 [IQR, 3.0-15.0] vs 15.0 [IQR, 7.0-28.0], P.001) but was similar between men and women who had been practicing for 10 to 20 years.Gender disparities persist in academic cardiothoracic surgery. Efforts should be made to support women in achieving senior roles and academic productivity.

Large-language models have recently demonstrated impressive zero-shot capabilities in a variety of natural language tasks such as summarization, dialogue generation, and question-answering. Despite many promising applications in clinical medicine, adoption of these models in real-world settings has been largely limited by their tendency to generate incorrect and sometimes even toxic statements. In this study, we develop Almanac, a large language model framework augmented with retrieval capabilities for medical guideline and treatment recommendations. Performance on a novel dataset of clinical scenarios (n = 130) evaluated by a panel of 5 board-certified and resident physicians demonstrates significant increases in factuality (mean of 18% at p-value < 0.05) across all specialties, with improvements in completeness and safety. Our results demonstrate the potential for large language models to be effective tools in the clinical decision-making process, while also emphasizing the impor- tance of careful testing and deployment to mitigate their shortcomings.

Background:Coronary artery disease is an incurable, life-threatening disease that was once considered primarily a disorder of lipid deposition. Coronary artery disease is now also characterized by chronic inflammation‚ notable for the buildup of atherosclerotic plaques containing immune cells in various states of activation and differentiation. Understanding how these immune cells contribute to disease progression may lead to the development of novel therapeutic strategies.Methods:We used single-cell technology and in vitro assays to interrogate the immune microenvironment of human coronary atherosclerotic plaque at different stages of maturity.Results:In addition to macrophages, we found a high proportion of αβ T cells in the coronary plaques. Most of these T cells lack high expression ofCCR7andL-selectin, indicating that they are primarily antigen-experienced memory cells. Notably, nearly one-third of these cells express theHLA-DRAsurface marker, signifying activation through their TCRs (T-cell receptors). Consistent with this, TCR repertoire analysis confirmed the presence of activated αβ T cells (CD4HLA-DRA, 2 clusters expressed a proinflammatory and cytolytic signature characteristic of CD8 cells, while the other expressed AREG (amphiregulin), which promotes smooth muscle cell proliferation and fibrosis, and, thus, contributes to plaque progression.Conclusions:Taken together, these findings demonstrate that plaque T cells are clonally expanded potentially by antigen engagement, are potentially reactive to self-epitopes, and may interact with smooth muscle cells and macrophages in the plaque microenvironment.

Background. The revolutions in AI hold tremendous capacity to augment human achievements in surgery, but robust integration of deep learning algorithms with high-fidelity surgical simulation remains a challenge. We present a novel application of reinforcement learning (RL) for automating surgical maneuvers in a graphical simulation. Methods. In the Unity3D game engine, the Machine Learning-Agents package was integrated with the NVIDIA FleX particle simulator for developing autonomously behaving RL-trained scissors. Proximal Policy Optimization (PPO) was used to reward movements and desired behavior such as movement along desired trajectory and optimized cutting maneuvers along the deformable tissue-like object. Constant and proportional reward functions were tested, and TensorFlow analytics was used to informed hyperparameter tuning and evaluate performance. Results. RL-trained scissors reliably manipulated the rendered tissue that was simulated with soft-tissue properties. A desirable trajectory of the autonomously behaving scissors was achieved along 1 axis. Proportional rewards performed better compared to constant rewards. Cumulative reward and PPO metrics did not consistently improve across RL-trained scissors in the setting for movement across 2 axes (horizontal and depth). Conclusion. Game engines hold promising potential for the design and implementation of RL-based solutions to simulated surgical subtasks. Task completion was sufficiently achieved in one-dimensional movement in simulations with and without tissue-rendering. Further work is needed to optimize network architecture and parameter tuning for increasing complexity.

Patients with myocardial bridges (MBs) have a higher prevalence of atherosclerosis. Wall shear stress (WSS) has previously been correlated with plaque in coronary artery disease patients, but such correlations have not been investigated in symptomatic MB patients. The aim of this paper was to use a multi-scale computational fluid dynamics (CFD) framework to simulate hemodynamics in MB patient, and investigate the co-localization of WSS and plaque.We identified N = 10 patients from a previously reported cohort of 50 symptomatic MB patients, all of whom had plaque in the proximal vessel. Dynamic 3D models were reconstructed from coronary computed tomography angiography (CCTA), intravascular ultrasound (IVUS) and catheter angiograms. CFD simulations were performed to compute WSS proximal to, within and distal to the MB. Plaque was quantified from IVUS images in 2 mm segments and registered to CFD model. Plaque area was compared to absolute and patient-normalized WSS.WSS was lower in the proximal segment compared to the bridge segment (6.1 ± 2.9 vs. 16.0 ± 7.1 dynes/cmWSS may be obtained non-invasively in MB patients and provides a surrogate marker of plaque area. Using CFD, it may be possible to non-invasively assess the extent of plaque area, and identify patients who could benefit from frequent monitoring or medical management.

Aim This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. Methods A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure Chest pain is a frequent cause for emergency department visits in the United States. The “2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain” provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.

Introduction: National Institutes of Health (NIH) grants are an essential funding source for cardiothoracic (CT) surgeon-scientists. The association between NIH funding and an article’s research impact, however, has not been explored. We hypothesized that CT surgery research articles supported by NIH funding exhibit enhanced scholarly impact. Methods: Research records and NIH funding history for all CT surgery faculty (n=992) at accredited United States CT surgery training institutions in 2018 were obtained using Scopus and Grantome, respectively. Using the NIH iCite database, all articles published by these surgeons were classified as either basic science research (BSR, iCite animal or molecular/cellular score >0) or clinical research (CR, iCite animal and molecular/cellular score = 0). The relative citation ratio (RCR), an NIH-validated field-normalized metric of scholarly impact, was calculated for each article, where RCR 1.00 indicates equal impact as other NIH-funded articles in the same field, and RCR 2.00 indicates twice the impact. Data are presented as median [interquartile range] and analyzed using the Mann-Whitney test. Results: A total of 37,402 unique articles were identified, including 9,469 supported by NIH funding and 27,933 without NIH funding. CT surgery research articles with NIH funding exhibit a significantly greater median RCR than those without NIH funding (1.08 [0.53-2.19] vs 0.75 [0.28-1.72], p Conclusions: At single-article resolution, CT surgery research publications supported by NIH grant funding exhibit enhanced scholarly impact and compare favorably in median RCR versus other NIH-funded biomedical research.

The Stanford classification of aortic dissection was described in 1970. The classification proposed that type A aortic dissection should be surgically repaired immediately, whereas type B aortic dissection can be treated medically. Since then, diagnostic tools and management of acute type A aortic dissection (ATAAD) have undergone substantial evolution. This paper evaluated historical changes of ATAAD repair at Stanford University since the establishment of the aortic dissection classification 50 years ago. The surgical approaches to the proximal and distal extent of the aorta, cerebral perfusion methods, and cannulation strategies were reviewed. Additional analyses using patients who underwent ATAAD repair at Stanford University from 1967 through December 2019 were performed to further illustrate the Stanford experience in the management of ATAAD. While technical complexity increased over time, post-operative survival continued to improve. Further investigation is warranted to delineate factors associated with the improved outcomes observed in this study.

A much-loved small animal practitioner in Glasgow, he was a character and a real advocate for animals – it was he that brought contagious leukaemia in cats to the attention of researchers at the vet school.

A world-renowned investigative veterinary pathologist who made an outstanding contribution to education and research.

A vet whose journey took him from veterinary physiology, through pathology to sports science, a field in which he was world-renowned.

Partnering is a technique that has become the construction industry’s application of total quality management and enjoys widespread use throughout the industry. This paper details the results of a statistical analysis of over 400 Texas Department of Transportation construction projects worth a total investment of nearly $2.1 billion. Half the projects were completed under partnering agreements. After comparing the two groups of projects, the paper concludes that partnering promises to furnish a means to control the two prime project performance indicators—cost growth and time growth. Additionally, in a large construction program the continuous application of partnering will result in improved project performance across the entire program.

The review article gives historical insight to the developments in this area and where future activities should focus on as the industry moves forward with high temperature materials in a few select applications. Processing of the latest generation of partially fluorinated polyimides has improved significantly over the earlier generation, which had limited adoption of these materials primarily in aeroengine applications. Yet, challenges still remain in achieving higher durability while increasing the temperature capabilities of these materials. The developments over the last 30 years and how the current commercial systems have resolved the earlier technical challenges are discussed. Recent research and development efforts are reviewed and briefly discussed in terms of how they will improve the processing and performance of these materials. Keywords: phenylethynyl-terminated imides; fluorinated polyimides; high temperature composites; 2,2-bis(3,4-dicarboxy phenyl) hexa-fluoropropane dianhydride (6-FDA); condensation polyimides; cross-linked polyimides; nadic end-capped polyimides; Avimid® N polyimide composites; AFR-PEPA-N polyimides; HFPE-50 polyimide composites

SIR, — While commending the detailed and painstaking paper on ultrasonography of the haggis, by King and others ( VR , January 20, 2007, vol 160 pp 94-96), and recognising the authors' unique contribution to their field, my feelings are tempered with some sadness as I see yet another of the native

(1991). The Effect of Galvanic Attack on Composites. Materials and Processing Report: Vol. 6, No. 4-5, pp. 1-2.

Racemic methyl santolinate (5c) was synthesized stereoselectively in five steps from 3-methylbut-2-enal via the Claisen rearrangement of the allyl siloxyvinyl ether (4).

Racemic methyl santolinate (5c) was synthesized stereoselectively in five steps from 3-methylbut-2-enal via the Claisen rearrangement of the allyl siloxyvinyl ether (4).