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The current treatment paradigm of abdominal aortic aneurysms (AAA) focuses on observing patients until their disease reaches certain thresholds for intervention, with no preceding treatment available. There is an opportunity to develop novel therapies to prevent further aneurysmal growth and decrease the risk of a highly morbid rupture. We used a porcine model of aortic dilation to assess the ability of human adipose-derived mesenchymal stem cells (MSCs) to attenuate aortic dilation.Twelve Yorkshire pigs received periadventitial injections (collagenase and elastase) into a 4-cm segment of infrarenal aorta. Animals were treated with either 1 × 10All animals survived until POD 21. The mean aortic diameter was reduced in the aortic dilation + MSC treatment group compared to aortic dilation control animals (1.10 ± 0.126 versus 1.48 cm ± 0.151, P 0.001). Aortic media thickness was reduced in the aortic dilation group compared to the aortic dilation + MSC group (609.14 IQR 445.21-692.93 μm versus 643.55 IQR 560.91-733.88 μm, P = 0.0048). There was a significant decrease in the content of collagen and alpha-smooth muscle actin and elastin perturbation in the aortic dilation group as compared to the aortic dilation + MSC group. Immunohistochemistry demonstrated an increased level of vascular endothelial growth factor, tissue inhibitor of matrix metalloproteinase 1, and tissue inhibitor of matrix metalloproteinase 3 expression in the aorta of aortic dilation + MSC animals.Stem cell therapy suppressed the aortic dilation in a porcine model. Animals from the aortic dilation group showed more diseased gross features, histologic changes, and biochemical properties of the aorta compared to that of the aortic dilation + MSC treated animals. This novel finding should prompt further investigation into translatable drug and cell therapies for aneurysmal disease.

Social media offers potential for educator professional learning, but platforms' for-profit nature complicates this practice, especially for professional learning around justice-oriented pedagogies. This exploratory study investigated 551 publicly available Instagram posts shared by 11 purposefully sampled, justice-oriented education influencers over an 8-week period as the COVID-19 pandemic and renewed activism for racial justice unfolded in the United States. Qualitative analysis of post content indicated these influencers offered pandemic-related support, while also illustrating, enacting, and engaging culturally relevant and sustaining pedagogies. However, promotional content was abundantly layered within posts and a cohesive message of how to enact culturally sustaining pedagogies was largely absent. Reflecting some of the paradoxes of learning via social media, our findings suggest there is some opportunity for justice-oriented professional learning from social media, however education influencers' content is limited by platforms' opaque algorithms and for-profit business models, which govern what influencers post and what followers see.

The COVID-19 pandemic, and subsequent shift to emergency remote teaching, amplified teachers’ and schools’ heavy reliance on digital tools, apps, and platforms. While digital technologies can aid and empower teaching and learning, they can also generate new challenges, harms, and negative outcomes. Teacher educators and teachers can develop critical and ecological dispositions and practices to help make informed decisions regarding the use (or non-use) of digital technologies. These dispositions and practices are critical for protecting and supporting students, especially those who have traditionally been harmed by the way tools, apps, and platforms are designed, marketed, and used. In this paper, we offer a roadmap for how the field of teacher education can spur and scaffold such critical examination.

Background Mesenchymal stem cells have been proven to promote cellular recruitment and remodeling during healing. Considering challenges encountered in the healing process of esophageal injury, we sought to evaluate the effect of human adipose derived stem cells (hASC) on esophageal injury with stent and to assess the feasibility of submucosal hASC injection as a mechanism of delivery. Methods An intrabdominal esophagotomy was created in rodents with placement of an expandable fully covered metal esophageal stent. A submucosal injection of 2 × 106 hASC was delivered in experimental animals. Animals were sacrificed on postoperative day 3 (POD3) or 7 (POD7). Macroscopic, immunohistochemical and immunofluorescence analyses were conducted to assess for markers of healing and viability of transplanted cells. Results hASC were identified within submucosal and muscular layers with proliferation demonstrated in respective areas on anti-Ki67 stained sections. Lower adhesion and abscess scores were observed in hASC specimens without significant statistical difference. Prevalence of submucosal collagen was increased in samples treated with hASC compared to control, with abundant collagen deposition demonstrated within the POD7 group. Granulation tissue at the site of esophageal injury was more prominent in tissue sections treated with hASC compared to control, with significantly higher density at POD3 (control 1.94 versus hASC 2.83, P Conclusions Presence of hASC at the site of an esophageal injury may enhance wound healing predominantly through increased granulation and decreased inflammation in conjunction with esophageal stent placement. Targeted submucosal injection at the time of esophageal stent placement is an effective delivery method of hASC therapy.

TeachersPayTeachers.com (TpT) has emerged as an alternative to traditional curricular publishing houses; however, the critical investigation into this for-profit platform is limited. The aggregate ...

Giant cell arteritis (GCA) is a potentially devastating disease that may require treatment with high dose steroids. Traditionally, diagnosis requires patients to meet at least three of five clinical criteria, one of which is a positive temporal artery biopsy (TAB). Vascular surgeons are often asked to perform TAB though it is not necessarily required for diagnosis or management. This study aimed to determine if TAB results altered management of patients with a concern for GCA by changing steroid use post operatively in our healthcare system.A retrospective review at a single center tertiary care hospital was performed between 2007 and 2018. Inclusion criteria were patients greater than 18 years old with complete steroid treatment records who underwent a temporal artery biopsy due to concern for GCA. Steroid use and duration of treatment both pre- and post-operative were collected and analyzed.Eighty-three of 117 cases reviewed met inclusion criteria. Ninety-one percent (76) of patients had a negative biopsy. Twenty-nine percent (23) of negative biopsies met criteria for GCA prior to biopsy. Of those with a negative biopsy, steroids were continued in 68% (52) of patients after 30 days, 49% (37) after 90 days and 45% (34) after 180 days. Steroids were never started in 11% (6). One patient with a positive biopsy was discontinued on steroids due to intolerance. There was no statistically significant difference in duration of steroids between those with a positive and negative biopsy (average 610 and 787 days respectively; p=.682). Average follow up was 33 months.The duration of steroid use for patients with concern for GCA was not found to be altered by the performance of a TAB at our institution. Given the extremely low yield and absence of impact on steroid duration, TAB is not a useful diagnostic test at our institution. Similar reviews are recommended to determine the utility of TAB at other institutions that may differ in patient population or prescribing practices.

Surgical education has evolved over time to incorporate supplemental modalities of training beyond the operating room. Even with the utility of simulation software and didactic education, there is still a need to provide surgical residents with experience in live tissue dissection and tissue handling while maintaining patient safety. In our program, after two clinical years, residents participate in a year of translational research which uses porcine models for complex open abdominal procedures. During the porcine surgeries, our residents are guided by the supervising attending to perform key portions of the procedure typically reserved for those more senior trainees. We found in a survey that research residents after two clinical years found this experience with large animal surgeries helped them better navigate anatomic structures and would recommend this to future trainees. We believe this dual-purpose research-training model provides a valuable resource that can be adapted to other programs.

In response to the COVID-19 pandemic, nonemergent surgery was postponed in efforts to limit disease spread. To determine whether these changes affected vascular integrated resident (VR) and fellow (VF) operative volume, Accreditation Council for Graduate Medical Education (ACGME) case log data was reviewed. Case volume and standard deviation for each major category was for graduates of 2020 and 2021 were compared to the year prior to the pandemic, 2019. There were only 3 significant changes when comparing 2020/2021 to the prepandemic baseline of 2019, with increase in abdominal obstructive cases for VRs (8.1 in 2021 vs 5.9 in 2019, P = .021), an increase in upper extremity cases for VFs (18.9 in 2021 from 15.8 in 2019, P = .029), and a decrease in venous cases for VFs (39.6 in 2021 from 48.4 in 2019, P = .011). Postponing nonemergent surgery did not translate to significant changes in operative cases for graduating VRs and VFs.

We exploit the principles of choice architecture to evaluate interventions in the market for reloadable prepaid cards. Participants are randomized into three card menu presentation treatments—the market status quo, a regulation-inspired reform, or an enhanced reform designed to minimize attribute overload—and offered choices based on prior structural estimation of individual preferences. Consumers routinely choose incorrectly under the status quo, with tentative evidence that the regulation-inspired presentation may increase best card choice and clear evidence that the enhanced reform reduces worst card choice. Welfare analysis suggests the regulation-inspired presentation offers modest gains, while the enhanced policy generates substantial benefits.

While prior research suggests that many educators turn to social media to grow and enhance professional learning networks (PLNs) that extend beyond their schools, little is known about how PLNs shift over time. In this exploratory study, we investigated the nature of continuity and change in the PLNs of 192 K-12 and university educators from 17 countries. Participants responded to our request to comment on PLN descriptions they provided in a previous 2014 survey, and then identify continuity and change during the intervening years. Respondents overwhelmingly expressed that their PLNs had changed over the four years between the two surveys. The causes of PLN changes appeared to be diverse, dynamic, and interrelated. Various proximal and distal factors contributed to changes in professional activities. We frame the study through social ecological systems theory, discuss the significance of these findings, and consider implications for K-12 and higher education professional learning. Educators and those who lead and support their professional learning should reflect upon and attend to PLN change to ensure more educative results for teachers and students.

Background It is not uncommon for medical students seeking surgical residencies to apply to and rank two or more surgical specialties. Level of interest in a specialty is consistently cited as one of the most important factors for program directors when evaluating applicants for 0 + 5 integrated vascular surgery (IVS) programs. The purpose of this study was to examine trends in poly-specialty application submission to IVS and poly-specialty ranking of IVS to determine the percentage of applicants to IVS residencies with vascular surgery as their true preference. Methods Electronic Residency Application Service (ERAS) statistics for noninternational medical graduates from 2011 to 2017 were mined for trends in poly-specialty applications between IVS and other surgical disciplines. The poly-specialty application percentage, range, and standard deviation were determined. The National Resident Match Program (NRMP) results and data from 2011 to 2018 were also used to identify those U.S. seniors who ranked IVS programs as their preferred choice, defined as ranking vascular as the only choice or the first-choice specialty. This was compared with those who ranked a specialty other than vascular surgery first but had vascular surgery listed on their rank list. These data were also collected for applicants to orthopedic surgery, neurosurgery, otolaryngology, obstetrics and gynecology, integrated cardiothoracic surgery, and integrated plastic surgery. Results Between 2011 and 2017, applicants who submitted ERAS applications to IVS most often poly-specialty applied to IVS and general surgery (87%) followed by IVS and the following: preliminary surgery (71%), plastic surgery (22%), orthopedic surgery (19%), neurosurgery (17%), otolaryngology (16%), obstetrics and gynecology (12%), and urology (3%). The percentage of the applicant pool submitting rank lists with multiple specialties fell over the study period from 94% in 2011 to 67% in 2018. Between 2011 and 2018, an average of 14% of IVS applicants (n = 463), who submitted rank lists to the NRMP, ranked a specialty other than vascular as their true preference (range 7–23 SD 5). Only integrated cardiothoracic surgery had a higher percentage of applicants listing a different specialty as their true preference at 25% (range 18–36 SD 7). Nearly all (97–99%) applicants to orthopedic surgery, neurosurgery, otolaryngology, obstetrics and gynecology, and plastic surgery applied to that specialty as their true preference. Conclusions IVS residency applicants were most likely to apply for poly-specialty via the ERAS to general surgery and IVS. Compared to the other surgical specialties, those who submitted rank lists to the NRMP listing integrated cardiothoracic and IVS had the highest likelihood of ranking another specialty higher. Care must be taken when evaluating applications to IVS residencies to determine the applicant's level of interest in vascular surgery as a career.

Purpose: This study investigated the benefits and challenges described by physical educators who had actively used social media professionally for an average of more than 6 years. Method: The data were collected through semistructured individual and focus group interviews, with an international sample of physical educators (N = 48). The data were analyzed through an open coding process to develop themes. Results: Diverse benefits and challenges associated with social media use were identified and organized in alignment with a social ecological model. The benefits included enhanced knowledge, skills, teaching, student learning, and access to professional community. The challenges included managing the quantity of available content, the risks of context collapse, and navigating the cultures and discourse of online spaces. Discussion: A deeper understanding of the benefits and challenges of physical educators’ social media use can enable stakeholders to act in more strategic ways as they navigate the promise and the peril of social media.

Purpose: This descriptive study investigates the genesis and change in physical educators’ social media use for professional development and learning. Method: Data were collected through semistructured interviews with 48 physical educators who had actively used various social media professionally for an extended period of time. The data were analyzed inductively and aligned to the basic psychological needs defined by self-determination theory: relatedness, autonomy, and competence. Results: Building relationships with a trusted network of people and opportunities to express their autonomy were important drivers in the participants’ genesis and continued use of social media. Developing competence at both the start and throughout their social media journey was also critical. Discussion/Conclusions: The findings provide a starting point for in-depth research on the motivational characteristics underpinning physical educators’ reasons for starting and continuing to use social media for professional development and learning, and how these might change over time based on different psychological needs.

This chapter compares and contrasts the findings of the preceding empirical monograph chapters. The findings from these chapters are addressed in terms of how they illustrate the positives, negatives, and tensions that can be associated with social media use for professional development and learning. Across the various chapters, similarities in findings as well as apparent contradictions are discussed. By illuminating the potential and the perils of social media use and misuse, a pragmatic summary of the findings can inform wise use and nonuse of social media for professional development and learning by those involved in the field of physical education and sport pedagogy. Although prior literature and this monograph have begun to address some aspects of social media use in physical education and sport pedagogy, much remains to be explored. Topics, social media tools, methods, and theory that could be taken up or expanded upon in future research to advance the field are suggested.

Social media sites (e.g., Facebook, Twitter, Voxer, Instagram, etc.) have become platforms for self-directed professional development and learning (PDL) for many educators, including physical educators and sports coaches. The aim of this chapter is to provide an introduction to this current monograph on physical educators’ and sports coaches’ social media use for PDL by presenting key issues and relevant literature, and previewing the chapters to follow. The chapter begins with a background discussion of social media, followed by brief literature reviews of PDL research in education and physical education and sport pedagogy, and research on social media use for PDL. Next, an overview of key theories and concepts used within the monograph is provided. The chapter concludes with individual summaries of the six empirical chapters of the monograph.

Background Anastomotic leakage remains a dreaded complication after colorectal surgery. Stem-cell-based therapies have been shown to increase angiogenesis and cell proliferation. Objective The purpose of this research was to investigate the use of adipose-derived stem cells on the healing of ischemic colonic anastomoses in a rat model. Design This is an animal research study using xenotransplantation. Settings Male Wistar rats (300-400 g, n = 48) were purchased from a licensed breeder. Patients Adipose stem cells were isolated from the subcutaneous fat of healthy human donors. Interventions The rats underwent laparotomy with creation of an ischemic colorectal anastomosis created by ligation of mesenteric vessels. The animals were divided into 3 groups: control group with an ischemic anastomosis, vehicle-only group in which the ischemic anastomosis was treated with an absorbable gelatin sponge, and a treatment group in which the ischemic anastomosis was treated with an absorbable gelatin sponge plus adipose stem cells. Animals were killed at postoperative days 3 and 7. Main outcome measures Anastomotic leakage was defined as the finding of feculent peritonitis or perianastomotic abscess on necropsy. Rat mRNA expression was measured using real-time polymerase chain reaction. Results Adipose-derived stem cells significantly decreased anastomotic leakage when compared with control at both postoperative days 3 (25.0% vs 87.5%; p = 0.02) and 7 (25.0% vs 87.5%; p = 0.02). The use of an absorbable gelatin sponge alone had no effect on anastomotic leakage when compared with control and postoperative days 3 or 7. We found that stem cell-treated animals had a 5.9-fold and 7.4-fold increase in the expression of vascular endothelial growth factor when compared with control at 3 and 7 days; however, this difference was not statistically significant when compared with the absorbable gelatin sponge group. Limitations This is a preclinical animal research study using xenotransplantation of cultured stem cells. Conclusions Locally transplanted adipose stem cells enhance the healing of ischemic colorectal anastomoses and may be a novel strategy for reducing the risk of anastomotic leakage in colorectal surgery. See Video Abstract at http://links.lww.com/DCR/B203. EL TRANSPLANTE LOCAL DE CELULAS MADRE ADIPOSAS REDUCE LA FUGA ANASTOMOTICA EN LAS SUTURAS COLORRECTALES ISQUEMICAS: MODELO EN RATAS: Las fugas anastomoticas son una complicacion pusilanime despues de toda cirugia colorrectal. Se ha demostrado que el tratamiento con celulas madre aumenta la angiogenesis y la proliferacion celular.Investigar el uso de celulas madre derivadas de tejido adiposo en la cicatrizacion de una anastomosis colonica isquemica basada en ratas como modelo.Estudio de investigacion en animales utilizando xenotrasplantes.Adquisicion de tipicas ratas de laboratorio raza Wistar, todas machos (300-400 g, n = 48) de un criadero autorizado.Aislamiento de celulas madre de tipo adiposo del tejido celular subcutaneo en donantes humanos sanos.Las ratas se sometieron a laparotomia con la creacion de una anastomosis colorrectal isquemica obtenida mediante ligadura controlada de los vasos mesentericos correspondientes. Los animales se dividieron en tres grupos: grupo de control con anastomosis isquemica, grupo de vehiculo unico en el que la anastomosis isquemica se trato con una esponja de gelatina absorbible, y un grupo de tratamiento en el que la anastomosis isquemica se trato con una esponja de gelatina absorbible asociada a un vastago adiposo de celulas madre. Los animales fueron sacrificados el POD3 y el POD7.La fuga anastomotica fue definida como el hallazgo de peritonitis fecaloidea o absceso perianastomotico a la necropsia. La expresion de RNAm de las ratas se midio usando PCR en tiempo real.Las celulas madre derivadas de tejido adiposo disminuyeron significativamente la fuga anastomotica en comparacion con el grupo control tanto en el POD3 (25% frente a 87.5%, p = 0.02) como en el POD7 (25% frente a 87.5%, p = 0.02). El uso de una esponja de gelatina absorbible sola, no tuvo efecto sobre la fuga anastomotica en comparacion con los controles el POD3 o el POD7. Descubrimos que los animales tratados con celulas madre adiposas tenian un aumento de 5,9 y 7,4 veces en la expresion de VEGF en comparacion con el control a los 3 y 7 dias, respectivamente; sin embargo, esta diferencia no fue estadisticamente significativa en comparacion con el grupo de esponja de gelatina absorbible.Este es un estudio preclinico de investigacion en animales que utiliza xenotrasplantes de celulas madre adiposas cultivadas.Las celulas madre de tipo adiposo trasplantadas localmente mejoran la cicatrisacion en casos de anastomosis colorrectales isquemicas, y podrian convertirse en una nueva estrategia para reducir el riesgo de fugas anastomoticas en casos de cirugia colorrectal. Consulte Video Resumen en http://links.lww.com/DCR/B203. (Traduccion-Dr Xavier Delgadillo).

Objective The purpose of this study was to examine trends in application submission, rank lists, and applicant quality for vascular surgery integrated residency. Methods The National Resident Matching Program Results and Data reports and the Electronic Residency Application Service Statistics from 2007 to 2017 were compiled and mined for trends in terms of application submission and the number of applicants a program needed to rank to fill all residency positions. Applicant pool depth and percentage of programs applied to were calculated. Outcome data from the National Resident Matching Program were reviewed for 2014 and 2016 for United States Medical Licensing Examination Step scores and experiences. Results During the last 10 years, the number of vascular surgery integrated residency spots rose from 9 to 60 per year. Most programs offer one spot per year; none offer more than two. The average number of applications received by programs rose from 17 applications in 2008 to 63.8 in 2017. The average rank list depth needed by programs to fill the spots has not increased (range, 2.5-5.1; standard deviation, 0.73). The proportional depth of the applicant pool decreased from 4.6 U.S. and Canadian applicants for every one residency spot in 2008 to 1.7 applicants for every one residency spot in 2017. Applicant quality metrics were available for 2 years (2014 and 2016). Step 1 scores (237/239), Step 2 scores (250/250), research experiences (3.7/4.2), and volunteer experiences (5.9/5.5) remained nearly unchanged. The number of contiguous ranks for matched applicants remained stable (12.3/12.8). Conclusions The current system promotes multiple inefficiencies, resulting in application glut. Fewer applicants are flooding programs with an increasing number of applications. More money is being spent on Electronic Residency Application Service applications without changes in the number needed to rank by applicants or programs to achieve a match. There is no improvement in the quality of the applicant. Should these trends continue, they represent an unsustainable model for resident selection.

We exploit the largely exogenous character of abduction and displacement in northern Uganda during the recent civil war to estimate the effects of each on experimental measures of risk tolerance, altruism, trust and trustworthiness, as well as a survey measure of patience. Our analysis reveals the limitations of the ‘post-traumatic growth’ hypothesis. In most cases preferences are unaffected by these traumas and in the one domain in which we identify a significant effect, it is contrary to the hypothesis—people who were both abducted and displaced are 21 percentage points less likely to take a risk.

In the last decade, social media have become important tools for educator professional development, learning and community. While education has traditionally proven to be an isolating profession, t...