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Background and Objectives: Successful clerkship directors (CDs) must exhibit a variety of leadership, administrative, educational, and interpersonal skills. This study investigates the professional development needs for family medicine CDs to be successful in their role, in relation to career stage, institutional support, and needed resources. Methods: A cross-sectional survey of CDs at qualifying United States and Canadian medical schools was performed between April 29, 2021 and May 28, 2021. Questions addressed specific training when beginning CD position, professional development activities that have contributed to success, additional professional development skills required to be a successful CD, and planned future development activities. We utilized χ2 square and Mann-Whitney U tests for comparisons. Results: Surveys were completed by 75 CDs, for a response rate of 48.8%. Only 33.3% of respondents reported receiving training specific to their role as CD. The majority of respondents cited informal mentoring and conference attendance as important to their professional development, but none identified graduate degrees as the most important method of professional development. Conclusions: These findings demonstrate the lack of formal training provided to CDs and highlight the importance of informal training and conference attendance for professional development.

Data driven, reduced order modelling has shown promise in tackling the challenges associated with computational and experimental hemodynamic models. In this work, we explore the use of Reduced Order Models (ROMs) to capture the main flow features in a patient-specific dissected aorta. We apply Proper Orthogonal Decomposition (POD) and Robust Principle Component Analysis (RPCA) on in vitro, hemodynamic data acquired by Particle Image Velocimetry and compare the decomposed flows to those derived from Computational Fluid Dynamics (CFD) data for the same geometry and flow conditions. The flow is reconstructed using different numbers of POD modes and the flow features obtained throughout the cardiac cycle are compared to the original Full Order Models (FOMs).RPCA has been found to enhance the quality of PIV data and to capture most of the kinetic energy of the flow in just two modes similar to the numerical data that are free from measurement noise. The reconstruction errors differ along the cardiac cycle with diastolic flows requiring more modes for accurate reconstruction. In general, modesΦ1-10 are found sufficient to represent the flow field. The results demonstrate that the coherent structures that characterise this aortic dissection flow are described by the first few POD modes suggesting that it is possible to represent the macroscale behaviour of aortic flow in a low-dimensional space; thus significantly simplifying the problem, and allowing for more computationally efficient flow simulations that can pave the way for translation of such models to the clinic.

This article critically analyses entrepreneurial orientation (EO) in family firms after a major crisis, to investigate how firms with equal initial levels of EO reach different levels over time. Based on two alternative hypotheses (stability and convergence), we analysed whether the EO of family firms remains intact, strengthens, or weakens after a crisis. Based on an examination of a database of 151 family firms collected in 2004 and 2017, our findings reveal that compared to firms with higher pre-crisis EO levels, those with lower levels saw a larger increase post crisis. Furthermore, unlike the latter group, the former was able to maintain high pre-crisis levels even after the crisis. In addition, we also we found this relationship between pre-crisis and post-crisis EO levels to be influenced by two key periodic discontinuities, namely, organisational decline and generational change contingencies. These findings advance our understanding of temporal aspects of EO and heterogeneous entrepreneurial behaviour among family firms with significant implications for both theory and practice.

Since about 2010, big data analysis has drastically changed the landscape of information management by becoming a central topic in the academic literature of several fields. Despite the significant contribution of family firms to the economic fabric worldwide and their unique decision-making processes, there is a lack of research investigating big data in family-owned businesses. To address this gap, this article draws on the socioemotional wealth (SEW) perspective and its FIBER model to conceptually investigate its role in family firms’ decision to implement big data. We introduce a set of propositions and a framework linking the FIBER dimensions to the likeliness of implementing big data in family firms. Our research thus contributes to a more fine-grained understanding of the decision-making process in family firms.

This paper explores how family-owned SMEs and their external stakeholders co-create value for end consumers. Our empirical data consists of 22 semi-structured interviews with the senior management of family-owned SMEs, supplemented by 1107 items of archival data. The findings shed light on precisely how contemporary family business practitioners can expand their business model (through external orientation and stakeholder collaborations). In doing so, we enrich SME literature by offering new empirical research findings from the unique perspective of how family-owned SMEs collaborate with specific stakeholder groups. We also expand the current business model literature by providing a more nuanced understanding of the SME business model construct, and advance service-dominant logic theory through the presentation of our theoretical model and propositions. Ultimately, this paper extends insights into value co-creation with stakeholders as an extension of the business model construct, whilst highlighting practical implications for family-owned SME practitioners.

Do kindergarten-aged children associate scientists with intelligence? Do they hold gender stereotypes about these topics? What is related to these stereotypes? Do they affect children’s choice of activity? This study asked 48 kindergarteners to choose “the smart one” or “the scientist” out of gender-balanced arrays. Both genders showed positive in-group biases, but girls did not relate the two concepts. Girls were also more willing to engage in activities for “smart” children, rather than for “little scientists.” Parental occupation had same-gender effects on each gender’s stereotypes about intelligence, but no cross-gender effects. Findings are analyzed using expectancy-value theory as a framework.

espanolThe European Journal of Family Business (EJFB) was founded in 2011 with the name Revista de Empresa Familiar, changing its name to the current EJFB in 2016. As a result, the year 2021 marks the 10th anniversary of this journal, which provides an appropriate occasion to share our vision for the direction of the journal, identifying some priorities for the coming years. We inherit a journal that wants to be a platform through which to explore new perspectives of family business research, enhancing the communication between academia and practice. We aim to support rigorous research with practical interest for family firms and entrepreneurial families while also nurturing new and overlooked lines of research that might deepen our understanding of the family firm field. We envision EJFB as a point of convergence where the rich heterogeneity of the family business realm presents competing perspectives, from which scholars and practitioners can question, enrich and extend the dialogue between academia and practice. We are also committed to fostering conversations in different fields that work in the broad domain of family business, welcoming scholarship from affiliated fields. In addition to research papers and reviews, we encourage the submission of articles that provide new ideas or perspectives by building upon existing or new theories to understand contemporary trends related to enterprises in general and family firms in particular, point/counterpoint debates, articles with a practical orientation and practitioner commentaries. Overall, we look forward to serving and bridging the gap between research and practice by facilitating communication in both directions. The journal will feature a new section entitled Commentary where family business practitioners can write about their experiences. We believe that their comments will help ‘theorists and researchers keep practice in mind when they do their work’ (Vought et al., 2008, p. 1112). The aim of this section is to enhance the research agenda by learning scientifically from practice and also applying ‘the theoretical and empirical research findings back to practice’ (Strike, 2012, p. 168). We believe this new editorial team is particularly well suited to the tasks of supporting research of family firms for its applicability to practice and helping practitioners advance family firms' knowledge from a research perspective. We therefore look forward to working with a global community of family business scholars and practitioners. In concluding this introduction, the Editorial Team of EJFB wants to thank the journal’s founder and outgoing editor, Dr. Vanesa Guzman-Parra, who saw the need for a journal dedicated to advancing research on family firms. We also extend a heartfelt thank you to the Editorial Board for the trust they have placed in us as the new Editorial Team. We would also like to thank our Managing Editor J. Roberto Vila and UMA Editorial for their continued and substantial assistance that has enabled the journal to reach a significant milestone: its 10-year anniversary! We also extend our gratitude to all our reviewers, readers and authors, occasional and regular, whose support of EJFB is acknowledged and greatly appreciated. We look forward to reading your insights in future issues. Editor-in-Chief Dr. Amaia Maseda, University of the Basque Country Deputy Editors Dr. Vanessa Diaz-Moriana, University of Balearic Islands Dr. Remedios Hernandez-Linares, University of Extremadura Dr. Valeriano Sanchez-Famoso, University of the Basque Country EnglishThe European Journal of Family Business (EJFB) was founded in 2011 with the name Revista de Empresa Familiar, changing its name to the current EJFB in 2016. As a result, the year 2021 marks the 10th anniversary of this journal, which provides an appropriate occasion to share our vision for the direction of the journal, identifying some priorities for the coming years. We inherit a journal that wants to be a platform through which to explore new perspectives of family business research, enhancing the communication between academia and practice. We aim to support rigorous research with practical interest for family firms and entrepreneurial families while also nurturing new and overlooked lines of research that might deepen our understanding of the family firm field. We envision EJFB as a point of convergence where the rich heterogeneity of the family business realm presents competing perspectives, from which scholars and practitioners can question, enrich and extend the dialogue between academia and practice. We are also committed to fostering conversations in different fields that work in the broad domain of family business, welcoming scholarship from affiliated fields. In addition to research papers and reviews, we encourage the submission of articles that provide new ideas or perspectives by building upon existing or new theories to understand contemporary trends related to enterprises in general and family firms in particular, point/counterpoint debates, articles with a practical orientation and practitioner commentaries. Overall, we look forward to serving and bridging the gap between research and practice by facilitating communication in both directions. The journal will feature a new section entitled Commentary where family business practitioners can write about their experiences. We believe that their comments will help ‘theorists and researchers keep practice in mind when they do their work’ (Vought et al., 2008, p. 1112). The aim of this section is to enhance the research agenda by learning scientifically from practice and also applying ‘the theoretical and empirical research findings back to practice’ (Strike, 2012, p. 168). We believe this new editorial team is particularly well suited to the tasks of supporting research of family firms for its applicability to practice and helping practitioners advance family firms' knowledge from a research perspective. We therefore look forward to working with a global community of family business scholars and practitioners. In concluding this introduction, the Editorial Team of EJFB wants to thank the journal’s founder and outgoing editor, Dr. Vanesa Guzman-Parra, who saw the need for a journal dedicated to advancing research on family firms. We also extend a heartfelt thank you to the Editorial Board for the trust they have placed in us as the new Editorial Team. We would also like to thank our Managing Editor J. Roberto Vila and UMA Editorial for their continued and substantial assistance that has enabled the journal to reach a significant milestone: its 10-year anniversary! We also extend our gratitude to all our reviewers, readers and authors, occasional and regular, whose support of EJFB is acknowledged and greatly appreciated. We look forward to reading your insights in future issues. Editor-in-Chief Dr. Amaia Maseda, University of the Basque Country Deputy Editors Dr. Vanessa Diaz-Moriana, University of Balearic Islands Dr. Remedios Hernandez-Linares, University of Extremadura Dr. Valeriano Sanchez-Famoso, University of the Basque Country

Differences in the prevalence and presentation of psychiatric illnesses in men and women suggest that neurobiological sex differences confer vulnerability or resilience in these disorders. Rodent behavioral models are critical for understanding the mechanisms of these differences. Reward processing and punishment avoidance are fundamental dimensions of the symptoms of psychiatric disorders. Here we explored sex differences along these dimensions using multiple and distinct behavioral paradigms. We found no sex difference in reward-guided associative learning but a faster punishment-avoidance learning in females. After learning, females were more sensitive than males to probabilistic punishment but less sensitive when punishment could be avoided with certainty. No sex differences were found in reward-guided cognitive flexibility. Thus, sex differences in goal-directed behaviors emerged selectively when there was an aversive context. These differences were critically sensitive to whether the punishment was certain or unpredictable. Our findings with these new paradigms provide conceptual and practical tools for investigating brain mechanisms that account for sex differences in susceptibility to anxiety and impulsivity. They may also provide insight for understanding the evolution of sex-specific optimal behavioral strategies in dynamic environments.

Aortic Dissection (AD) is a complex pathology that affects the aorta. Diagnosis, management and treatment remain a challenge as it is a highly patient-specific pathology and there is still a limited understanding of the fluid-mechanics phenomena underlying clinical outcomes. Although in vitro models can allow the accurate study of AD flow fields in physical phantoms, they are currently scarce and almost exclusively rely on over simplifying assumptions. In this work, we present the first experimental study of a patient-specific case of AD. An anatomically correct phantom was produced and combined with a state-of-the-art in vitro platform, informed by clinical data, employed to accurately reproduce personalised conditions. The complex AD haemodynamics reproduced by the platform was characterised by flow rate and pressure acquisitions as well as Particle Image Velocimetry (PIV) derived velocity fields. Clinically relevant haemodynamic indices, that can be correlated with AD prognosis - such as velocity, shear rate, turbulent kinetic energy distributions - were extracted in two regions of interest in the aortic domain. The acquired data highlighted the complex nature of the flow (e.g. recirculation regions, low shear rate in the false lumen) and was in very good agreement with the available clinical data and the CFD results of a study conducted alongside, demonstrating the accuracy of the findings. These results demonstrate that the described platform constitutes a powerful, unique tool to reproduce in vitro personalised haemodynamic conditions, which can be used to support the evaluation of surgical procedures, medical devices testing and to validate state-of-the-art numerical models.

BACKGROUND African Americans (AAs) experience greater sleep quality problems than non-Hispanic Whites (NHWs). Meditation may aid in addressing this disparity, although the dosage levels needed to achieve such benefits have not been adequately studied. Smartphone apps present a novel modality for delivering, monitoring, and measuring adherence to meditation protocols. OBJECTIVE This 6-month dose-response feasibility trial investigated the effects of a breathing awareness meditation (BAM) app, Tension Tamer, on the secondary outcomes of self-reported and actigraphy measures of sleep quality and the modulating effects of ethnicity of AAs and NHWs. METHODS A total of 64 prehypertensive adults (systolic blood pressure RESULTS At baseline, PSQI and actigraphy data indicated that AAs had shorter sleep duration, greater sleep disturbance, poorer efficiency, and worse quality of sleep (range P=.03 to PP=.01). Multimethod assessment showed a consistent pattern of NHWs exhibiting the most favorable responses to the 5-min dose; they reported greater improvements in sleep efficiency and quality as well as the PSQI global value than with the 10-min and 15-min doses (range P=.04 to PP=.03 and PP=.02 and PP=.03). CONCLUSIONS These findings indicate the need for further study of the potential modulating influence of ethnicity on the impact of BAM on sleep indices and user-centered exploration to ascertain the potential merits of refining the Tension Tamer app with attention to cultural tailoring among AAs and NHWs with pre-existing sleep complaints.

Bilingual children often show advanced executive functioning (EF) and false belief (FB) understanding compared to monolinguals. The latter has been attributed to their enhanced inhibitory control EF, although this has only been examined in a single study which did not confirm this hypothesis. The current study examined the relation of EF and language proficiency on FB reasoning in bilingual and monolingual preschoolers to answer two questions: (1) Are there differences in bilinguals’ and monolinguals’ FB, language proficiency, and EF? If so, (2) is there a differential role for language proficiency and EF in predicting FB reasoning in these two groups? Thirty-two Spanish–English bilinguals and 33 English monolinguals (three to five years old) were compared. While monolinguals outperformed bilinguals on language proficiency, after controlling for this, bilinguals outperformed monolinguals on FB reasoning, and marginally on EF. General language ability was related to FB performance in both groups, while short-term memory and inhibitory control predicted FB only for monolinguals.

MicroRNAs from the miR-200 family are commonly associated with the inhibition of the metastatic potential of cancer cells, following inhibition of ZEB transcription factors expression and epithelial-to-mesenchymal transition. However, previous studies performed in pancreatic adenocarcinoma revealed a more complex picture challenging this canonical model. To gain better insights into the role of miR-200 family members in this disease, we analyzed the expression of miR-200a, miR-200b, miR-200c, miR-141, miR-429, and miR-205, and ZEB1, ZEB2, and CDH1 in pancreatic tumors and matching normal adjacent parenchyma and patient-derived xenografts. We found that miR-200a, miR-429, and miR-205 are frequently overexpressed in pancreatic tumors, whereas CDH1 is downregulated, and ZEB1 and ZEB2 levels remain unchanged. Furthermore, we measured a positive correlation between miR-200 family members and CDH1 expression, and a negative correlation between ZEB1 and miR-200c, miR-141, and miR-205 expression, respectively. Interestingly, we identified significant changes in expression of epithelial-to-mesenchymal transition regulators and miR-200 members in patient-derived xenografts. Lastly, functional studies revealed that miR-141 and miR-429 inhibit the tumorigenic potential of pancreatic cancer cells. Taken together, this comprehensive analysis strongly suggests that miRNAs from the miR-200 family, and in particular miR-429, may act as a tumor suppressor gene in pancreatic cancer. Keywords: pancreatic cancer, patient-derived xenograft, miR-200 family, miR-429

This case study presents the story of Glennon Brothers, a third–generation family–owned sawmilling business in Ireland. As the firm evolved through the organizational life cycle and the complexity of firm operations increased, a different style of management was required to navigate the family business to the next stage. The brothers needed to move from being managers to managing managers. This case study highlights how coleaders can become comfortable with each other and unintentionally overlook the need to change their managerial priorities in line with the business's evolution.

Differences in the prevalence and presentation of psychiatric illnesses in men and women suggest that neurobiological sex differences confer vulnerability or resilience in these disorders. Rodent behavioral models are critical for understanding the mechanisms of these differences. Reward processing and punishment avoidance are fundamental dimensions of the symptoms of psychiatric disorders. Here we explored sex differences along these dimensions using multiple and distinct behavioral paradigms. We found no sex difference in reward-guided associative learning but a faster punishment-avoidance learning in females. After learning, females were more sensitive than males to probabilistic punishment but less sensitive when punishment could be avoided with certainty. No sex differences were found in reward-guided cognitive flexibility. Thus, sex differences in goal-directed behaviors emerged selectively when there was an aversive context. These differences were critically sensitive to whether the punishment was certain or unpredictable. Our findings with these new paradigms provide conceptual and practical tools for investigating brain mechanisms that account for sex differences in susceptibility to anxiety and impulsivity. They may also provide insight for understanding the evolution of sex-specific optimal behavioral strategies in dynamic environments.

Drawing on the transgenerational entrepreneurship perspective, we employ a multiple case study approach to investigate why multigenerational family firms innovate. The data collection process drew upon five in-depth cases comprising 42 semistructured interviews, 25 participant observations, and several thousand pages of historical data dating from 1916 to 2017. We find patterns on how the firms’ long-term view—embracing both the past and the future—influences the innovation motives of these firms. Specifically, we identify three innovation patterns: conserving, persisting and legacy-building. We introduce a set of propositions and a framework linking long-term orientation dimensions to innovation motives and innovation outcomes. Our research thus contributes to a more fine-grained understanding of innovation behavior in family firms.

Researchers have used a myriad of different definitions in seeking to explain the heterogeneity of family firms and their unique behavior; however, no widely accepted definition exists today. Definitional clarity in any field is essential to provide (1) the basis for the analysis of performance both spatially and temporally and (2) the foundation upon which theories, frameworks, and models are developed. We provide a comprehensive analysis of prior research and identify and classify 82 definitions of family business. We then review and evaluate five key theoretical perspectives in family business to identify how these have shaped and informed the definitions employed in the field and duly explain family firm heterogeneity. Finally, we provide a conceptual diagram to inform the choice of definition in different research settings.

Summary Non-alcoholic fatty liver disease (NAFLD) is a very common indication for liver transplantation. How fat-rich diets promote progression from fatty liver to more damaging inflammatory and fibrotic stages is poorly understood. Here, we show that disrupting phosphorylation at Ser196 (S196A) in the liver X receptor alpha (LXRα, NR1H3) retards NAFLD progression in mice on a high-fat-high-cholesterol diet. Mechanistically, this is explained by key histone acetylation (H3K27) and transcriptional changes in pro-fibrotic and pro-inflammatory genes. Furthermore, S196A-LXRα expression reveals the regulation of novel diet-specific LXRα-responsive genes, including the induction of Ces1f, implicated in the breakdown of hepatic lipids. This involves induced H3K27 acetylation and altered LXR and TBLR1 cofactor occupancy at the Ces1f gene in S196A fatty livers. Overall, impaired Ser196-LXRα phosphorylation acts as a novel nutritional molecular sensor that profoundly alters the hepatic H3K27 acetylome and transcriptome during NAFLD progression placing LXRα phosphorylation as an alternative anti-inflammatory or anti-fibrotic therapeutic target., Graphical Abstract, Highlights • LXRαS196A induces liver steatosis and prevents cholesterol accumulation • LXRαS196A reduces progression to hepatic inflammation and fibrosis • LXRαS196A modulates hepatic chromatin acetylation • LXRαS196A reveals unique dual LXRα phosphorylation and diet-responsive genes, Progression to inflammatory and fibrotic steatohepatitis is poorly understood. Becares et al. reveal that disrupting LXRα phosphorylation attenuates these processes by promoting a unique diet-induced transcriptome that prevents cholesterol accumulation and reduces hepatic inflammation and fibrosis. Mechanistically, phospho-deficient LXRα promotes chromatin modifications and alters protein-protein interactions in differentially expressed genes.

Purpose To quantify variability of in vitro and in vivo measurement of 3D device geometry using 3D and biplanar imaging. Methods Comparison of stent reconstruction is reported for in vitro coronary stent deployment (using micro-CT and optical stereo-photogrammetry) and in vivo pulmonary valve stent deformation (using 4DCT and biplanar fluoroscopy). Coronary stent strut length and inter-strut angle were compared in the fully deployed configuration. Local (inter-strut angle) and global (dog-boning ratio) measures of stent deformation were reported during stent deployment. Pulmonary valve stent geometry was assessed throughout the cardiac cycle by reconstruction of stent geometry and measurement of stent diameter. Results Good agreement was obtained between methods for assessment of coronary stent geometry with maximum disagreement of+/- 0.03 mm (length) and +/- 3 degrees (angle). The stent underwent large, non-uniform, local deformations during balloon inflation, which did not always correlate with changes in stent diameter. Three-dimensional reconstruction of the pulmonary valve stent was feasible for all frames of the fluoroscopy and for 4DCT images, with good correlation between the diameters calculated from the two methods. The largest compression of the stent during the cardiac cycle was 6.98% measured from fluoroscopy and 7.92% from 4DCT, both in the most distal ring. Conclusions Quantitative assessment of stent geometry reconstructed from biplanar imaging methods in vitro and in vivo has shown good agreement with geometry reconstructed from 3D techniques. As a result of their short image acquisition time, biplanar methods may have significant advantages in the measurement of dynamic 3D stent deformation.

Objective Subjective social status (SSS) may be a stronger determinant of health than objective measures of socioeconomic status. We sought to examine the effect of community and national SSS on symptoms of depression in a racially/ethnically diverse sample of adult women with noncancerous uterine conditions. Methods We conducted a secondary analysis of data obtained from 634 women who enrolled in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) in 2003 and 2004. SOPHIA was a longitudinal study of women aged 31 to 54 who were experiencing abnormal uterine bleeding, symptomatic fibroids, or pelvic pain. The primary outcome for this analysis consisted of symptoms suggesting major or other depressive disorder, as measured by the Patient Health Questionnaire-9, 2 years after study enrollment. We hypothesized that women who had low community and national SSS at baseline, as measured by the MacArthur SSS ladder, would be at higher risk of experiencing symptoms of depression at follow-up. Results Women with low community SSS had an increased odds of experiencing depression symptoms 2 years later compared with women with high SSS, after adjusting for age, pelvic problem impact and baseline depression (odds ratio, 2.93; 95% CI, 1.11–7.77). Odds remained elevated after further adjusting for income and education. Results for the national ladder were not significant. Conclusion Low perceived community social status is predictive of symptoms suggestive of major or other depressive disorder among women with noncancerous uterine conditions. Asking about perceived community social status can help clinicians to identify patients who may be at increased risk for depressive disorders. Asking about perceived national social status does not seem to add value beyond that provided by income and education.

While it is widely recognised that informal investors play a vital role in the development of new businesses, extent research on the nature of informal investment activity has focussed on large economies. There is little research about informal investment in small economies, including Ireland. This paper uses data from the Global Entrepreneurship Monitor to outline the extent and nature of informal venture capital activity in Ireland and to provide an estimate of the size of the informal venture capital market in Ireland. Results suggest that Family, Friends and Colleagues provided at least €195 million to new businesses in 2011, and Business Angels invested €80 million. We find that for every €1 of formal venture capital funding, there is approximately €5 of informal capital funds. We conclude by highlighting implications for policy and practice.

Current computational and mathematical tools are demonstrating the high value of using systems modeling approaches (e.g. Quantitative Systems Pharmacology) to understand the effect of a given compound on the biological and physiological mechanisms related to a specific disease. This review provides a short survey of the evolution of the mathematical approaches used to understand the effect of particular cholesterol-lowering drugs, from pharmaco-kinetic (PK) / pharmaco-dynamic (PD) models, through physiologically based pharmacokinetic models (PBPK) to QSP. These mathematical models introduce more mechanistic information related to the effect of these drugs on atherosclerosis progression and demonstrate how QSP could open new ways for stratified medicine in this field.

Early detection of pancreatic and periampullary neoplasms is critical to improve their clinical outcome. The present authors previously demonstrated that DNA hypermethylation of adenomatous polyposis coli (APC), histamine receptor H2 (HRH2), cadherin 13 (CDH13), secreted protein acidic and cysteine rich (SPARC) and engrailed-1 (EN-1) promoters is frequently detected in pancreatic tumor cells. The aim of the present study was to assess their prevalence in pancreatic juice of carcinomas of the pancreas and periampullary area. A total of 135 pancreatic juices obtained from 85 pancreatic cancer (PC), 26 ampullary carcinoma (AC), 10 intraductal papillary mucinous neoplasm (IPMN) and 14 chronic pancreatitis (CP) patients were analyzed. The methylation status of the APC, HRH2, CDH13, SPARC and EN-1 promoters was analyzed using methylation specific-melting curve analysis (MS-MCA). Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations were also tested with allele-specific quantitative polymerase chain reaction amplification. Out of the 5 promoters analyzed, APC (71%) and HRH2 (65%) were the most frequently methylated in PC juice. APC methylation was also detected at a high frequency in AC (76%) and IPMN (80%), but only occasionally observed in CP (7%). APC methylation had a high sensitivity (71-80%) for all types of cancer analyzed. The panel (where a sample scored as positive when ≥2 markers were methylated) did not outperform APC as a single marker. Finally, KRAS detection in pancreatic juice offered a lower sensitivity (50%) and specificity (71%) for detection of any cancer. APC hypermethylation in pancreatic juice, as assessed by MS-MCA, is a frequent event of potential clinical usefulness in the diagnosis of pancreatic and periampullary neoplasms.

International health experiences (IHEs) have been associated with improved clinical skills, altruistic attitudes, cross-cultural sensitivity, and exposure to community medicine for residents and medical students. Although an increasing number of family medicine residencies offer IHEs, there are currently no standardized competencies or guidelines for developing IHEs. The aim of this study was to examine the content of IHEs in order to provide an overview of the current landscape of global health training in family medicine residency programs.Residency programs self-identifying as offering IHEs on the American Medical Association's (AMA) FREIDA Online website were emailed an electronic survey with questions regarding IHE characteristics, resident selection criteria, faculty support, motivations for participation, challenges to implementation, and funding.Of the 153 programs that responded, 84% still offered IHEs. Most IHEs are 3--4 weeks (71.1%) and are funded by the resident (74.2%). Faculty from the resident's department or institution generally provide supervision (76.6%) and have undergone some type of specialized training in global health (65.6%). Being in good academic standing was the most important eligibility criteria for residents participating in an IHE (86.7%), and funding was reported as the most challenging aspect (62.5%) of offering IHEs.IHEs are increasing in number and receiving more funding, but the experiences are variable among residency programs. While most program directors believe residents participate in IHEs to gain exposure with underserved populations, only a small percentage (5.5%) include a commitment to community service as part of a requirement for participation in an IHE.

The Virtual Physiological Human is synonymous with a programme in computational biomedicine that aims to develop a framework of methods and technologies to investigate the human body as a whole. It is predicated on the transformational character of information technology, brought to bear on that most crucial of human concerns, our own health and well-being.