Search

Background: In the United States, a growing number of lung transplants are performed each year, necessitating an increased number of general and transplant pulmonologists skilled in the care of these complex patients. However, pulmonary and critical care medicine (PCCM) fellowships across the country do not universally have dedicated lung transplantation curricula, and there is scarce literature in this area. We describe the generation of a content outline for curriculum development created through modified electronic Delphi methodology., Objective: To identify "must know" topics in lung transplantation for a graduating PCCM fellows., Methods: We developed expert consensus on "must know" lung transplant topics and subtopics ("items") for a graduating fellow through three survey rounds from July 2023 to October 2023. Thirty-three panelists were asked to rank author-provided items as "must know," "nice to know," or "not necessary to know" and to generate new items in round 1 to be submitted for ranking in subsequent rounds. "Must know consensus" was defined as ≥50% must know responses., Results: Survey response and completion rates across rounds were 58-70% and 96-100%, respectively. In round 1, panelists were provided eight topics and 30 subtopics for initial ranking. Panelists generated 82 new items in this round, of which 19 were included in round 2 for ranking after author review, together with one item from round 1 that required reranking. From round 2, only two items required reranking, and these items comprised round 3. Seven topics were identified as "must know": transplant immunology, evaluation of a lung transplant candidate, surgical and peri/postoperative management, rejection, immunosuppression, infections, and other complications, together with 36 subtopics., Conclusion: Self-identified lung transplantation experts obtained consensus on seven "must know" topics and 36 subtopics in lung transplantation for graduating PCCM fellows. The findings serve as a starting point for future curriculum development., (Copyright © 2024 by the American Thoracic Society.)

Large language models are becoming ubiquitous in the editing and generation of written content and are actively being explored for their use in medical education. The use of artificial intelligence (AI) engines to generate content in academic spaces is controversial and has been meet with swift responses and guidance from academic journals and publishers regarding the appropriate use or disclosure of use of AI engines in professional writing. To date, there is no guidance to applicants of graduate medical education programs in using AI engines to generate application content-primarily personal statements and letters of recommendation. In this Perspective, we review perceptions of using AI to generate application content, considerations for the impact of AI in holistic application review, ethical challenges regarding plagiarism, and AI text classifiers. Finally, included are recommendations to the graduate medical education community to provide guidance on use of AI engines in applications to maintain the integrity of the application process in graduate medical education., (Copyright © 2024 by the American Thoracic Society.)

Transgenic plant production in monocotyledonous species has primarily relied on embryogenic callus induction from both immature and mature embryos as the pathway for plant regeneration. We have efficiently regenerated fertile transgenic wheat plants through organogenesis after Agrobacterium -mediated direct transformation of mechanically isolated mature embryos from field-grown seed. Centrifugation of the mature embryos in the presence of Agrobacterium was found to be essential for efficient T-DNA delivery to the relevant regenerable cells. The inoculated mature embryos formed multiple buds/shoots on high-cytokinin medium, which directly regenerated into transgenic shoots on hormone-free medium containing glyphosate for selection. Rooted transgenic plantlets were obtained within 10-12 weeks after inoculation. Further optimization of this transformation protocol resulted in significant reduction of chimeric plants to below 5%, as indicated by leaf GUS staining and T1 transgene segregation analysis. Direct transformation of wheat mature embryos has substantial advantages over traditional immature embryo-based transformation systems, including long-term storability of the mature dry explants, scalability, and greatly improved flexibility and consistency in transformation experiments., Competing Interests: The research activities in this report were conducted by teams at legacy Monsanto Company, now Bayer Crop Science, a manufacturer of seeds produced by conventional and biotechnology methods. The authors contributed to this research as employees. A relevant US patent application has been filed and assigned to Bayer Crop Science., (Copyright © 2023 Ye, Shrawat, Moeller, Rode, Rivlin, Kelm, Martinell, Williams, Paisley, Duncan and Armstrong.)

The ability to perform invasive bedside procedures (IBPs) safely and efficiently is a core skill set within critical care medicine. Fellowship training provides a pivotal time for learners to attain baseline proficiency in such procedures to decrease patient complications. The coronavirus disease 2019 pandemic has posed distinct challenges to the traditional model of teaching and supervising IBPs in the intensive care unit, including stewardship of personal protective equipment and limiting health care worker exposure to persons with coronavirus disease 2019. To address these challenges, we piloted a novel method of IBP supervision and teaching using a virtual monitoring system. In this virtual procedural supervision model, the supervising teacher is located outside the patient room, limiting personal protective equipment use and health care worker exposure. An audiovisual monitoring system allowed communication between the teacher and the learner as well as supervisor visualization of the procedural encounter. Virtual supervision was used for central line placement and bronchoscopy in the medical intensive care unit with no complications or instances of the supervisor needing to enter the patient room. Success was felt to depend on camera positioning and preprocedure planning and to be best for advanced learners who would not require tactile feedback. Upper level learners appreciated autonomy granted by this process. Virtual IBP supervision is felt to be a useful tool in specific situations. As with any tool, there are notable strengths and limitations. Success is felt to be optimized when attention is paid to procedural teaching best practices, learner selection, and technological logistics., (© 2021 THE AUTHORS.)

Background: Competence in ultrasonography is essential for pulmonary and critical care medicine (PCCM) fellows, but little is known about fellow-reported barriers to acquiring this crucial skill during fellowship training., Research Question: How do PCCM fellows acquire experience performing and interpreting ultrasonography during their training, what is their perspective on barriers to acquiring ultrasound expertise during fellowship, and what is their comfort with a range of ultrasound examinations?, Study Design and Methods: A 20-item survey including questions about procedural training and acquisition of ultrasound skills during PCCM fellowship was developed. The survey instrument was sent to PCCM fellowship program directors to distribute to their fellows at program directors' discretion., Results: Four hundred seventy-five responses were received. The most common method of learning ultrasonography was performing it independently at the bedside. Fellows reported that the greatest barrier to acquiring ultrasound skills was the lack of trained faculty experts, followed by lack of a formal curriculum. Fellow comfort was greatest with thoracic ultrasound and least with advanced cardiac ultrasound., Interpretation: Significant barriers to ultrasound training during PCCM fellowship exist, and future educational efforts should address these barriers at both program and institutional levels., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Inpatient bedside teaching rounds provide an opportunity to foster effective interprofessional collaboration between members of the healthcare team. Although effective interprofessional practice has been shown to improve patient satisfaction, patient outcomes, and job satisfaction, there is limited literature for successful implementation of interprofessional teaching rounds. To address this gap, we have compiled 12 tips for conducting effective interprofessional bedside teaching rounds. These tips offer strategies for creating a structured rounding system, with clear delineation of expectations, defined opportunities for learning across disciplines, and active engagement of and respect for all team members. By adopting and promoting this model of interprofessional collaborative practice, the quality and effectiveness of bedside teaching rounds can be improved for the benefit of patients, trainees, and the team as a whole.

Purpose: The aim of this cohort study was to evaluate the width of keratinized mucosa at implant sites of partially edentulous patients who were treated for generalized aggressive periodontitis., Materials and Methods: Dental implants were placed in 35 patients who were treated for generalized aggressive periodontitis and 18 periodontally healthy individuals (controls). At baseline, the keratinized mucosa of all implants was ≥ 2 mm. Follow-up examinations were conducted every 3 months over a 4-year period., Results: The implant survival rate was 97.3% in patients with generalized aggressive periodontitis and 100% in the control group. Four years after implant insertion, patients with generalized aggressive periodontitis had significantly higher clinical attachment levels at the teeth and implants compared with the controls. At all time points, in both groups the mean probing depth at the implants was significantly larger than at the teeth. The mean widths of keratinized mucosa and keratinized gingiva were not significantly different between the two groups. In both groups, the widths of keratinized mucosa and keratinized gingiva were significantly higher at the maxilla than at the mandible. Four years after baseline, the implants in the mandible showed the smallest keratinized mucosa (mean: ≤ 1 mm)., Conclusion: During the first 4 years after implant placement, no significant changes in the keratinized mucosa at implants could be shown, either in periodontally healthy patients or in patients treated for generalized aggressive periodontitis. The keratinized gingiva at the teeth was generally significantly wider than the keratinized mucosa at the implants.

Photocatalytic fuel cells (PFCs) are constructed from anodized photoanodes with the aim of effectively converting organic materials into solar electricity. The syntheses of the photoanodes (TiO2 , WO3 , and Nb2 O5 ) were optimized using the statistical 2(k) factorial design. A systematic study was carried out to catalog the influence of eleven types of organic substrate on the photocurrent responses of the photoanodes, showing dependence on the adsorption of the organic substrates and on the associated photocatalytic degradation mechanisms. Strong adsorbates, such as carboxylic acids, generated high photocurrent enhancements. Simple and short-chained molecules, such as formic acid and methanol, are the most efficient in the corresponding carboxylic acid and alcohol groups as a result of their fast degradation kinetics. The TiO2 -based PFC yielded the highest photocurrent and obtainable power, whereas the Nb2 O5 -based PFC achieved the highest open-circuit voltage, which is consistent with its most negative Fermi level., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

In the selection of Parkinson patients for deep brain stimulation (DBS) of the subthalamic nucleus (STN) a risk-benefit-analysis is performed regarding symptoms that commonly improve and symptoms that may deteriorate. Speech is among the symptoms that may deteriorate. In contrast, the differential effects of STN-DBS on swallowing are less clear. Here, we present a Parkinson patient with dysphagia from concomitant oculo-pharyngeal muscle dystrophy successfully treated by STN-DBS. The role of dysphagia in evaluating Parkinson patients for STN-DBS is discussed.

We report a patient in whom deep brain stimulation of the ventral intermediate nucleus of the thalamus (Vim) for treating dystonia reversibly induced stuttering at suboptimal stimulation parameters. Adjustments of stimulation parameters resulted in excellent control of dystonic motor symptoms and complete resolution of speech dysfluency. This is the first report on stuttering as an adverse effect of Vim stimulation which is primarily used to treat tremors of various etiologies.