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Antoinette C Spoto-Cannons,1 Deanna M Isom,2 Max Feldman,3 Kira K Zwygart,3 Rahul Mhaskar,4 Marna Rayl Greenberg5 1Department of Pediatrics, Morsani College of Medicine, University of Florida, Tampa, FL, USA; 2Department of Education, Morsani College of Medicine, University of Florida, Tampa, FL, USA; 3Department of Internal Medicine, Morsani College of Medicine, Unibversity of Florida, Tampa, FL, USA; 4Department of Family Medicine, Morsani College of Medicine, University of Florida, Tampa, FL, USA; 5Department of Emergency and Hospital Medicine, Lehigh Valley Campus, Morsani College of Medicine, University of South Florida, Bethlehem, PA, USACorrespondence: Marna Rayl GreenbergDepartment of Emergency and Hospital Medicine, Lehigh Valley Hospital, Morsani College of Medicine, University of South Florida, LVH-M-5th Floor EM Residency Suite, 2545 Schoenersville Road, Bethlehem, PA 2545, USAEmail mrgdo@ptd.netBackground: The skill of self-assessment is critical to medical students. We sought to determine whether there were differences between student self-assessments and their faculty assessments and if they were modified by gender. Additionally, we sought to determine the differences in these assessments between students in a traditional (core) versus an enhanced (SELECT) medical school curriculum.Methods: In this retrospective study, mid-term and final assessment and feedback forms from the first-year Doctoring 1 course were analyzed from three academic years: 2014–2015 through 2016–2017. Data were abstracted from the forms and de-identified for analysis. Class year, student gender, and class type were also abstracted from this “on the shelf” data from program assessment. The level of agreement between faculty and student assessments was investigated using Wilcoxon signed ranks test. The gender differences (male versus female students) between student assessments and their assessment by their faculty were investigated by using the Kruskal Wallis test.Results: Five hundred and thirty-five student self-assessments were analyzed. Fifty-six percent (301/535) were male while 44% (234/535) were female. Faculty assessments (P-value

Zachary Pruitt,1 Rahul Mhaskar,2 Bryan G Kane,3 Robert D Barraco,4 Deborah J DeWaay,2 Alex M Rosenau,3 Kristin A Bresnan,5 Marna Rayl Greenberg3 1Department of Health Policy and Management, College of Public Health, Morsani College of Medicine, University of South Florida, Tampa, FL, 2Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, 3Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Lehigh Valley Campus, Allentown, PA, 4Department of Surgery, Morsani College of Medicine, University of South Florida, Lehigh Valley Campus, Allentown, PA, 5Department of Family Medicine, Morsani College of Medicine, University of South Florida, Lehigh Valley Campus, Allentown, PA, USA Background: There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution.Methods: This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created to assess student health system competence. Student evaluation of course curriculum design, delivery, and assessment was provided through web-based surveys.Results: To meet competency standards for system-based practice, a health systems curriculum was developed and delivered across 4 years of medical school training. Each of the health system lectures and problem-based learning activities are described herein. The majority of first and second year medical students stated they gained working knowledge of health systems by engaging in these sessions. The majority of the 2016 graduating students (88.24%) felt that the course content, overall, prepared them for their career.Conclusion: A health systems curriculum in undergraduate medical education using a problem-based learning approach is feasible. The majority of students learning health systems curriculum through this format reported being prepared to improve individual patient care and optimize the health system’s value (better care and health for lower cost). Keywords: health systems, undergraduate medical, education

Background: Inadequate consumption of fish could be a risk factor for low birth weight (LBW). This study assessed fish intake and [omega]-3 LCPUFA intake and status for their association with LBW in a cohort of urban, south Indian pregnant women. Subjects/methods: In a prospective cohort study, data on maternal fish intake and [omega]-3 LCPUFA intake and status of 676 women were obtained at baseline (first trimester), the second and third trimesters of pregnancy. Infant birth weight was measured immediately following hospital delivery. The dropout rate was 7.6%. Results: Fifty-six percent of the study women consumed fish with low daily median intakes (3.4, 4.1 and 3.8 g [day.sup.-1] at the three trimesters, respectively). Consequently, the median intakes of EPA and DHA during pregnancy were also low at 2.1 and 10.1 mg [day.sup.-1], respectively. EPA and DHA intakes were associated with their status in erythrocyte membrane phospholipids during pregnancy (r=0.40 and 0.36, r=0.34 and 0.32 and r=0.37 and 0.41, at the three trimesters, respectively, all P Conclusions: Among low fish-eating pregnant women, fish intake in the third trimester was closely associated with birth weight. Supplementation with [omega]-3 LCPUFA during pregnancy may have important implications for fetal development in India. doi:10.1038/sj.ejcn.1602933; published online 24 October 2007 Keywords: low birth weight; pregnancy; fish; [omega]-3 fatty acids; DHA; India, Introduction Long-chain [omega]-3 polyunsaturated fatty acids ([omega]-3 LCPUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), play an important role during pregnancy as they are important structural constituents of [...]

Objective:To assess the maternal sociodemographic, anthropometric, dietary and micronutrient status in apparently healthy pregnant women in order to determine their associations with intrauterine growth retardation (IUGR).Design:Prospective observational study.Setting:Bangalore City, India.Subjects:A total of 478 women were recruited at 12.9±3.3 weeks of gestation and followed up at the first, second and third trimesters of pregnancy and at delivery. The dropout rate was 8.5%.Interventions:None.Main outcome measures:Birth weight was measured at hospital delivery.Results:The mean birth weight was 2.85±0.45 kg. In all, 28.6% of newborns were IUGR. There was a strong inverse relationship between maternal educational level and risk of IUGR. A low body weight at baseline was also associated with a high risk of IUGR. Compared with women in the highest quartile for second trimester weight gain, those in the lowest quartile had a significantly higher adjusted odds ratio (AOR: 3.98; 95% CI: 1.83, 8.65) for IUGR. Women in the lowest tertile for serum vitamin B12 concentration during each of the three trimesters of pregnancy had significantly higher risk of IUGR (AOR: 5.98, 9.28 and 2.81 for trimesters 1–3, respectively).Conclusions:The present study demonstrates associations between educational status, maternal weight and gestational weight gain with IUGR. Importantly, in a subsample, there were strong associations of vitamin B12 status with IUGR, suggesting that better socioeconomic conditions, improved nutritional status and early detection of vitamin B12 deficiency in pregnancy combined with appropriate interventions are likely to play an important role in reducing IUGR.Sponsorship:This research was partly supported by the GlaxoSmithKline Consumer Healthcare Ltd, India.European Journal of Clinical Nutrition (2006) 60, 791–801. doi:10.1038/sj.ejcn.1602383; published online 11 January 2006 [ABSTRACT FROM AUTHOR]

The standard of care trimodality therapy for resectable locally advanced esophageal adenocarcinoma is complex and necessitates multidisciplinary care and expertise. In this work, it is hypothesized that facility clinical volume and utilization of intensity-modulated radiotherapy (IMRT) may influence outcomes. The National Cancer Data Base was queried for patients with cT1-4-N0-3 M0 esophageal adenocarcinoma undergoing trimodality therapy from 2004 to 2013 (n  = 2445). All patients received chemoradiation followed by esophagectomy at a Commission on Cancer facility. The facility volume was categorized into tertiles: high-volume centers (HVCs) in the highest 25th percentile of cases per year, intermediate-volume centers (IVCs) with the next highest 25th percentile of cases, and low- and very low-volume centers (LVCs) in the lowest 50th percentile. Overall survival (OS) was estimated using Kaplan–Meier methods and Cox proportional hazard regression. Propensity score matching to balance patient characteristics between volume centers was performed. Subgroup analysis was done comparing IMRT versus 3D conformal radiotherapy. The median follow-up was 26 months. Treatment at an HVC (hazard ratio 0.63, 95% CI 0.49–0.81, P  < 0.001) was found to be independently associated with improved overall survival in multivariable analysis. Three-year OS was 58.4%, 46.2%, and 47.5% for HVCs, IVCs, and LVCs, respectively (P  < 0.001). Patients at HVCs were more likely to receive IMRT over 3D chemoradiation (CRT; OR 3.45, 95% CI 2.4–5.0, P  < 0.001). Patients treated using IMRT at HVCs had improved OS compared to those treated at IVCs or LVCs (HR 0.68, 95% CI 0.52–0.90, P  < 0.01), while patients treated with 3D CRT at HVCs had no survival advantage over those at IVCs or LVCs (P  = 0.28). Patients with locally advanced esophageal adenocarcinoma treated with IMRT and at HVCs appear to have improved survival. [ABSTRACT FROM AUTHOR]