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A Process for Assessment and Quality Improvement of the Clerkship Curriculum Reliance on the apprenticeship model of education in the clerkship years of medical education persists despite concerns with variability in educational delivery and outcomes. Although many institutions are addressing this variability, there ne...	3,070,600	64330295	16
Although calls for change are occurring, they are slow. 1 The primary goal of the learning environment in these 2 years is working with students to practice situated cognition, in which students learn to apply what they previously learned in the classroom to actual patient care under the guidance of experienced physici...	3,070,601	64330295	16
Cardiology, Critical Care, Emergency Medicine, and Osteopathic Principles and Practice. The Clerkship Course Directors (CCDs) for these clerkship courses created the learning content and delivered it through the school's learning management system (LMS), Blackboard, so all students could easily access it from locations...	3,070,602	64330295	16
that ATSU-SOMA created in 2016 to evaluate the core clerkship courses and details how this work led to enhanced communication, encouraged stakeholder engagement, increased accountability of course directors, and effectively employed objective evaluation tools to determine what curricular changes were needed. Creating t...	3,070,603	64330295	16
seats on the Curriculum Committee to have a say in the process of curriculum evaluation. The chair of the Work Group was a clinical faculty representative of the Curriculum Committee who also happened to be a CCD. Members of the Work Group included 3 clinical faculty who were also CCDs of clerkship courses, 1 basic sci...	3,070,604	64330295	16
at ATSU-SOMA sites across the country. Thus, the Work Group used components of the course feedback survey from students as the primary and most efficient source of student input (Table 1). At this early stage of development, the ultimate stakeholders, the patients, were not involved in the initial course evaluation pro...	3,070,605	64330295	16
a document that described the committee's process for curricular evaluation of the clerkship courses and shared it with all CCDs, curriculum committee members, and administrators. This document provided clarity by describing the step-by-step process to evaluate clerkship courses and indicated who the responsible partie...	3,070,606	64330295	16
delineated by week; 4. Summative student feedback with comments from the Student Evaluation of the Rotation form; 5. Histogram of Level 2 national board examination scores with discipline subscores; 6. Anonymous student feedback comments. Depending on the goals and interests of any given institution, different data set...	3,070,607	64330295	16
biweekly meetings to evaluate courses using data from the prior academic year and current course documents. Recommendations for change delivered to the CCDs in December. January to June Mid-year data packets shared with CCDs in January. CCDs make changes to courses to prepare for start of the next academic year. Work G...	3,070,608	64330295	16
goals and interests of a given institution. Next, the Work Group created a course evaluation rubric to evaluate courses consistently and objectively (Table 3). Like the questionnaire, the rubric includes a portion of what ATSU-SOMA wanted to evaluate for this particular year and could be modified as needed. Identifying...	3,070,609	64330295	16
CCD provided suggestions for recommended changes for the next year; 3. Work Group members asked questions of the CCD as needed; 4. Work Group members shared and discussed their rubric ratings; 5. Work Group members made suggestions for changes to the clerkship course curriculum, which may have included or excluded reco...	3,070,610	64330295	16
were essential for keeping track of the Work Group responses and for thoroughly documenting procedures and recommendations for the Curriculum Committee, especially when questions arose. Google Forms were used to collect the ratings of each of the rubric items for individual Work Group members. This method ensured that ...	3,070,611	64330295	16
from each meeting and record attendance. The group's decision-making process was democratic and decisions made were kept in a separate tab in the Google Sheet with dates and times. what were the 3 most common positive themes expressed by students regarding the clerkship curriculum? (information may be gleaned from logs...	3,070,612	64330295	16
list Curriculum Committee recommendations from the last year and how they were or were not addressed. Any final remarks? CrE, clinical rotation evaluation; Gi, gastrointestinal; rDME, regional Director of Medical Education; SEr, student evaluation of the rotation; SOMA, School of Osteopathic Medicine in Arizona. Impact...	3,070,613	64330295	16
looked at which SOMA curricular goals were addressed by all parts of the clerkship curricula, we identified 1 goal of the 33 goals that was not addressed; the missing goal was in the area of systems-based practice. Furthermore, future steps will likely involve investigating how our curricula address the Entrustable Pro...	3,070,614	64330295	16
notes and had questions about the clerkships when we presented our findings to the Curriculum Committee. These discussions resulted in their offering solutions without having the Work Group's earlier input. In addition, the Work Group was not as empowered in evaluation and decision-making as it had initially presumed, ...	3,070,615	64330295	16
process, such as that described in this article. Subsequent evaluation and research at ATSU-SOMA is ongoing and will involve assessing the impact this process has had on student learning outcomes by monitoring score improvements on national board examinations, subject examinations, and preceptor evaluations of student ...	3,070,616	64330295	16
Trading Capsule for Increased Cytotoxin Production: Contribution to Virulence of a Newly Emerged Clade of emm89 Streptococcus pyogenes ABSTRACT Strains of emm89 Streptococcus pyogenes have become one of the major causes of invasive infections worldwide in the last 10 years. We recently sequenced the genome of 1,125 emm...	3,070,617	15711944	16
to control infectious diseases in humans, domesticated animals, and crops. The combination of population genomics, epidemiology, evolutionary biology, molecular genetics, and microbial pathogenesis makes it possible to precisely delineate these genetic changes at the nucleotide level. Streptococcus pyogenes (group A st...	3,070,618	15711944	16
emm89 strains studied lack the hasABC gene region containing hyaluronic acid (HA) capsule synthesis genes. We hypothesized that the genetic changes in the nga promoter region and capsule synthesis genes have altered the virulence phenotype of emm89 strains. To test this hypothesis, we constructed a panel of isogenic mu...	3,070,619	15711944	16
nga and slo transcripts and thereby SPN and SLO production. To test this idea, we first compared the secreted SPN (NADase) activities of 27 emm89 isolates belonging to clade 1, clade 2, and clade 3 (All 27 strains are wild type in transcriptional regulators known to control SPN, SLO production, and capsule production, ...	3,070,620	15711944	16
and variant 3 sequence. Consistent with the hypothesis, the isogenic mutant strain with the variant 3 sequence expressed significantly more nga and slo transcript and SPN and SLO proteins (Fig. 2D). In contrast, conversion to the variant 1 nga promoter sequence did not significantly alter the level of transcript or SLO...	3,070,621	15711944	16
transcriptional terminator (Fig. 3A). Consistent with this idea, we found that regardless of clade assignment, strains with the 38-bp deletion produce a higher level of capsule ( Fig. 1B and 3A). Falaleeva et al. showed that deletion of this transcriptional terminator region resulted in increased capsule production (27...	3,070,622	15711944	16
virulence in a mouse infection model (19). These data confirmed our hypothesis that increased toxin production is associated with increased virulence. However, strain MGAS26844 is acapsular, as are the isogenic mutant derivatives, which means that the effect of capsule loss on virulence in these strains was not determi...	3,070,623	15711944	16
increased virulence phenotype to the epidemic emm89 clade 3 organisms. HA capsule production is dispensable for full virulence in emm89 strains that produce high levels of SPN and SLO toxins. The data show that transition from low HA capsule production to complete absence of capsule did not result in decreased virulenc...	3,070,624	15711944	16
hasABC locus responsible for production of HA capsule. Capsule has been studied for more than 100 years and has long been considered an important virulence factor for S. pyogenes strains, in part because of its role in resisting phagocytosis and killing by human polymorphonuclear leukocytes (PMNs) (28)(29)(30). Many li...	3,070,625	15711944	16
phagocytic killing and increase intracellular survival (32,33). In the absence of HA capsule, a high level of SPN and SLO production could provide a critical defense against host immunity. In this regard, we note that for emm89 strains that are high producers of SPN and SLO, HA capsule production is dispensable for vir...	3,070,626	15711944	16
speculate that the key event immediately preceding the successful emergence of epidemic clade 3 organisms was gain of the variant 3 nga-slo region by horizontal gene transfer and homologous recombination in an emm89 strain that lacked the hasABC genes. It is possible that analysis of additional emm89 strains may identi...	3,070,627	15711944	16
main features of epidemic emm89 strains) is highly virulent in a mouse model of necrotizing fasciitis. In addition, our data show that HA capsule production is dispensable for virulence in emm89 strains that produce high levels of SPN and SLO cytotoxins. The sum of the data provide additional evidence to support the id...	3,070,628	15711944	16
Capsule-negative derivative strain 23530-V3-CapN was generated by deleting the has operon (hasA, hasB, and hasC) genes. Briefly, primer sets hasABCdel-1/2 and hasABCdel-3/4 ( Table 2) were used for overlap extension PCR to amplify and join the two DNA fragments upstream and downstream of the hasABC locus. PCR product w...	3,070,629	15711944	16
strains grown in THY broth. RNA prepared from S. pyogenes cultures grown to an optical density at 600 nm (OD 600 ) of 0.5 was extracted with an RNeasy minikit (Qiagen) and converted into cDNA using a highcapacity cDNA reverse transcription (RT) kit (Applied Biosystems). Quantitative RT-PCR (qRT-PCR) was performed with ...	3,070,630	15711944	16
the Houston Methodist Research Institute (AUP-0615-0041). Mice were randomly assigned to treatment groups and inoculated in the right hindlimb to a uniform depth with 2.5 ϫ 10 8 CFU of emm89 strains in 100 l phosphate-buffered saline (PBS). Stocks of each strain were prepared at known CFU and stored at Ϫ80°C. Inocula w...	3,070,631	15711944	16
the Wilcoxon rank sum test.	3,070,632	15711944	16
Predictors of Response to Oral Medications and Low-Histamine Diet in Patients with Chronic Urticaria Background Chronic urticaria (CU) is comprised of diverse phenotypes, and thus, a shift towards a precision medical approach is warranted in its management. Methods This study enrolled 78 patients with CU. Serum erythro...	3,070,633	247188594	16
the efficacy of chronic urticaria treatment. DAO could be a novel biomarker for predicting the efficacy not only of dietary intervention but also for antagonists of H1 and H2 receptors. Introduction Chronic urticaria (CU) has traditionally been defined as episodes of urticaria rash that occur almost daily for more than...	3,070,634	247188594	16
and serum histamine level was reported by Cho et al. [3]. However, the application of serum DAO levels in CU management has yet to be determined. Therefore, the aim of this study was to investigate the predictors of treatment efficacy for oral medications and dietary interventions for patients with CU. The role of seru...	3,070,635	247188594	16
Hospital, Buddhist Tzu Chi Medical Foundation (No. B10902014-2) or Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (No. 09-C-095). Measurement of Serum DAO and Laboratory Parameters. The following laboratory tests were performed as follows: serum erythrocyte sedimentation rate (ESR), hemoglobin (Hb) and he...	3,070,636	247188594	16
diet response. When the logistic regression model failed to converge for binary outcomes, firth logistic regression was used [4]. The procedure was implemented through the IBM SPSS extension command STATS FIRTHLOG. A p value < 0.05 was considered statistically significant. All statistical analyses were conducted using ...	3,070,637	247188594	16
5 reported having a poor response (45.5%). The results of the multiple logistic regression analysis showed that a significantly higher risk of montelukast response was observed in patients with CU who benefited from a low-histamine diet (aOR = 67:29, 95% CI 2.07-64667, p = 0:012). Of eight patients with available H 2 b...	3,070,638	247188594	16
had significantly lower DAO levels (mean 1.80 and SD 0.88 U/mL vs mean 3.58 and SD 1.11 U/mL, p = 0:004). The prevalence of angioedema was significantly higher in patients who had exacerbation of symptoms after consuming peanuts (3/5; 60% vs 10/73; 13.70%; p = 0:030). Patients with exacerbations after consuming plant-d...	3,070,639	247188594	16
factors may be useful in predicting the efficacy of treatment. Serum DAO levels may be useful when selecting patients with CU who are good candidates for a low-histamine diet. In clinical practice, the response to sgAH in patients with CU varies, even though it is the first-line treatment recommended in all phenotypes ...	3,070,640	247188594	16
levels with an insufficient sgAH response was observed in patients with CU who had an IgE level > 100 U/mL (OR = 1:00, 95% CI 1.00, 1.01; p = 0:029), suggesting that there may be a Ushaped relationship between IgE and insufficient sgAH response. In the present study, no association of insufficient sgAH response with el...	3,070,641	247188594	16
another marker of CU severity that results in resistance to corticosteroids at a lower dose prescribed. Unlike allergic diseases, an increased eosinophil count may not be helpful in selecting patients with CU who would be good candidates for corticosteroids. Even though LTRA has been recommended as a secondline treatme...	3,070,642	247188594	16
39.50 and SD 18.16 U/mL; p = 0:003). However, patients with CU were excluded from the study [15]. In our study, no differences in response to dietary intervention could be observed between groups when the manufacturer's recommended cutoff was used. However, when we used the median of DAO levels as the cutoff, the diffe...	3,070,643	247188594	16
number, and the level of DAO. Daschner et al. reported a significant correlation between IL-6, a proinflammatory cytokine, and DAO levels in patients with CU who were Anisakis sensitization (Rho = 0:57; p = 0:003) [15], which could be an alternative explanation for the significant correlation between DAO and ESR. While...	3,070,644	247188594	16
reported the most frequently in our study was shrimp. Shrimp is a commonly seen as food allergen, while shellfish has been reported as a histamine releaser, as well as being a source of histamine [18]. Pseudoallergic reaction was preferred to food allergy, based on the association of low-histamine diet efficacy with CU...	3,070,645	247188594	16
This is not surprising because DAO is the key enzyme in histamine metabolism. Furthermore, with appropriate patient selection, the efficacy of LTRA, H 2 blockers, and a low-histamine diet in patients with CU should be evaluated with additional studies. Data Availability The data used to support the findings of this stu...	3,070,646	247188594	16
Two weight commutators for Beurling--Ahlfors operator We establish the equivalent characterisation of the weighted BMO space on the complex plane $\mathbb{C}$ via the two weight commutator of the Beurling--Ahlfors operator with a BMO function. Our method of proofs relies on the explicit kernel of the Beurling--Ahlfors ...	3,070,647	119176755	16
the j-th Riesz transform on R n given by R j = ∂ ∂x j ∆ −1/2 , the weights λ 1 , λ 2 in the Muckenhoupt class A p , 1 < p < ∞, and the weight ν = λ the commutator of the Riesz transform R i and the function b ∈ BMO ν (R n ), i.e., the Muckenhoupt-Wheeden weighted BMO space (introduced in [8]). The main result in [7], T...	3,070,648	119176755	16
on C. For other works on the Beurling-Ahlfors operator, see for example [9] where they established a sharp weighted estimate of B, which is sufficient to prove that any weakly quasiregular map is quasiregular. We now recall the Muckenhoupt-Wheeden type weighted BMO space on C. For ν ∈ A 2 (C), BMO ν (C) is defined (see...	3,070,649	119176755	16
≈ g. Proof of the main theorem We first recall the definition and some basic properties of the Muckenhoupt A p (C) weights. where the supremum is taken over all cubes Q in C. We denote by [w] Ap the smallest constant C such that (2.1) holds. The class A 1 (C) consists of the weights w satisfying for some C > 0 that for...	3,070,650	119176755	16
I 1 , we obtain that where in the first inequality we use Holder's inequality with the index 1 p + 1 p ′ = 1, in the second inequality we use the boundedness of [b, B] from L p λ 1 (C) to L p λ 2 (C) and the fact that \|Γ Q (x)\| ≤ 1 for any x ∈ C, and in the last inequality we use the fundamental fact in (2.4). As for t...	3,070,651	119176755	16
and for 1 ≤ r ≤ 2, where b BMOν,r(C) := sup Proof. This duality result follows from a standard argument, see for example [3]. By completeness, we provide the proof as follows. We first show that In fact, for any g ∈ BMO ν (C), define where a is an ν-weighted (1, 2)-atom. Assume that a is supported in a cube Q. Then fro...	3,070,652	119176755	16
and ν ∈ A 2 (C), we see that for any c and any cube Q, Taking the infimum over c, we have that ϕ ∈ BMO ν (C) and ϕ BMO ν (C) ≤ C L . The main result of this section is as follows. Theorem 3.3. Suppose 1 < p < ∞, λ 1 , λ 2 ∈ A p (C) and ν = λ . For every f ∈ H 1 ν (C), there exist sequences {α k j } j ∈ ℓ 1 and function...	3,070,653	119176755	16
Prenatal diagnosis of ultrasound soft markers in a single medical center of mainland China Background There are a few studies on the chromosomal aberration of Ultrasound soft markers (USMs). The aim of this study was to determine the detection rate of clinically significant chromosomal abnormalities (CSCA) in fetuses w...	3,070,654	256702076	16

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