Explore the vast range of titles available.

As the US population continues to grow in racial and ethnic diversity, we also continue to see healthcare disparities across racial lines. Considerable attention has been given to creating a physician workforce that better reflects the population served by healthcare professionals. To address the low numbers of women and underrepresented minorities in procedural based specialties, Nth Dimensions has sought to address and eliminate healthcare disparities through strategic pipeline initiatives. This is a retrospective observational cohort study of 118 medical students from 29 accredited US medical schools, who were awarded a position in the Nth Dimensions Summer Internship program between 2005 and 2012. Overall, 84 NDSI scholars applied and 81 matched into procedure-based specialties; therefore the overall retention rate was 75% and the overall match rate across the eight cohorts was 72.3%. Through intervention-based change, the authors hypothesize that greater numbers in the residency training cohorts can lead to a greater number of physicians with diverse backgrounds and perspectives. Ultimately, this will enhance quality of care for all patients and improve decision making process that influence healthcare systems. Strategic pipeline programs increase successful recruit women and underrepresented minorities to apply and matriculate into procedure based residency programs. This is a retrospective observational cohort study of 118 medical students who completed the Nth Dimensions Summer Internship program between 2005 and 2012. Overall, 84 NDSI scholars applied and 81 matched into procedure-based specialties; therefore the overall retention rate was 75% and the overall match rate across the eight cohorts was 72.3%.

Background Women and minorities remain underrepresented in orthopaedic surgery. In an attempt to increase the diversity of those entering the physician workforce, Nth Dimensions implemented a targeted pipeline curriculum that includes the Orthopaedic Summer Internship Program. The program exposes medical students to the specialty of orthopaedic surgery and equips students to be competitive applicants to orthopaedic surgery residency programs. The effect of this program on women and underrepresented minority applicants to orthopaedic residencies is highlighted in this article. Questions/purposes (1) For women we asked: is completing the Orthopaedic Summer Internship Program associated with higher odds of applying to orthopaedic surgery residency? (2) For underrepresented minorities, is completing the Orthopaedic Summer Internship Program associated with higher odds of applying to orthopaedic residency? Methods Between 2005 and 2012, 118 students completed the Nth Dimensions/American Academy of Orthopaedic Surgeons Orthopaedic Summer Internship Program. The summer internship consisted of an 8-week clinical and research program between the first and second years of medical school and included a series of musculoskeletal lectures, hands-on, practical workshops, presentation of a completed research project, ongoing mentoring, professional development, and counselling through each participant’s subsequent years of medical school. In correlation with available national application data, residency application data were obtained for those Orthopaedic Summer Internship Program participants who applied to the match between 2011 through 2014. For these 4 cohort years, we evaluated whether this program was associated with increased odds of applying to orthopaedic surgery residency compared with national controls. For the same four cohorts, we evaluated whether underrepresented minority students who completed the program had increased odds of applying to an orthopaedic surgery residency compared with national controls. Results Fifty Orthopaedic Summer Internship scholars applied for an orthopaedic residency position. For women, completion of the Orthopaedic Summer Internship was associated with increased odds of applying to orthopaedic surgery residency (after summer internship: nine of 17 [35%]; national controls: 800 of 78,316 [1%]; odds ratio [OR], 51.3; 95% confidence interval [CI], 21.1–122.0; p < 0.001). Similarly, for underrepresented minorities, Orthopaedic Summer Internship completion was also associated with increased odds of orthopaedic applications from 2011 to 2014 (after Orthopaedic Summer Internship: 15 of 48 [31%]; non-Orthopaedic Summer Internship applicants nationally: 782 of 25,676 [3%]; OR, 14.5 [7.3–27.5]; p < 0.001). Conclusions Completion of the Nth Dimensions Orthopaedic Summer Internship Program has a positive impact on increasing the odds of each student participant applying to an orthopaedic surgery residency program. This program may be a key factor in contributing to the pipeline of women and underrepresented minorities into orthopaedic surgery. Level of Evidence Level III, therapeutic study.

Category: Ankle, Trauma Introduction/Purpose: Diagnoses of ankle injuries utilize plain radiographs in three views: anteroposterior (AP), lateral, and mortise. Mortise view has greater sensitivity and accuracy in assessment of the distal tibiofibular syndesmosis through visualization of the mortise clear space. Current radiologic diagnostic parameters, like medial tibiotalar clear space and tibiofibular clear space, are inconsistent and unreliable because no consensus exists to measure these parameters. However, the incisura fibularis (IF) is a consistent landmark in assessing syndesmotic stability. We believe that in ankles without fracture, dislocation, or syndesmotic disruption, the IF aligns with the lateral border of the talus when observed on mortise view radiographs. This study seeks to determine a novel, more reliable radiologic parameter in diagnosis of the ankle mortise by evaluating this alignment. Methods: We retrospectively reviewed adult patient charts from 2012-2017 and selected 100 mortise radiographs: 23 bimalleolar fractures, 14 trimalleolar fractures, 13 fibular fractures, and 50 that were negative for fracture, dislocation, and syndesmotic disruption. We analyzed preoperative radiographs (after closed reduction, if displacement occurred) and postoperative radiographs at least 3 months after open reduction/internal fixation. Mechanism of injury, laterality of radiograph, and gender of patient were not considered in this sample. We evaluated the IF and talus alignment by drawing a line from the proximal IF, through the inferior tibia, to the lateral border of the talus (IFT line in Figure 1). We considered alignments < 1 mm from our IFT line to have mortise congruence since mortise widening >/= 1 mm can decrease contact area of the tibiotalar joint and cause instability. Chi-squared analysis compared non- fracture radiographs to pre- and postoperative fracture radiographs to determine significance with p < 0.05. Results: Among radiographs without fracture, dislocation, and syndesmotic disruption, 46/50 showed alignment < 1 mm from the IFT line. 14/50 preoperative radiographs had alignment < 1 mm from the IFT line: 2 bimalleolar fractures, 4 trimalleolar fractures, and 8 fibular fractures. 43/50 postoperative radiographs had alignment < 1 mm from the IFT line: 19 bimalleolar fractures, 13 trimalleolar fractures, and 11 fibular fractures. Chi-squared analysis determined statistical significance in comparison of non-fracture radiographs with preoperative radiographs by chi-squared statistic = 42.6667 and p < 0.00001. Chi-squared test showed no significance (p > 0.05) in comparison of non- fracture radiographs with postoperative fracture radiographs by chi-squared statistic = 0.9193 and p = 0.337657. Chi-squared test did not show significance among the different types of fractures. Conclusion: We implemented a novel approach to determine a more reliable radiologic parameter in evaluation of the ankle mortise by assessment of the alignment of the IF with the lateral border of the talus on mortise view radiographs. Radiographs without fracture, dislocation, or syndesmotic disruption have alignment < 1 mm from the IFT line, which suggests mortise congruence. Alignment >/= 1 mm may indicate mortise incongruence, distal tibiofibular syndesmotic instability, and talar shift. We conclude that the IFT line can be utilized to appraise the ankle mortise in distal tibiofibular syndesmotic injuries on mortise view radiographs.

Herbaria contain an estimated 480 million specimens worldwide accumulated through the efforts of thousands of botanists for over four centuries and counting. These institutions were primarily established to serve as (1) a central resource for taxonomic and floristic studies, including species discovery and description; (2) a comprehensive archive to document biodiversity for medicinal, economic, or scientific purposes; (3) a means to verify species identification; and (4) an accessible repository to formally deposit vouchers to ensure botanical research is both verifiable and repeatable. These conventional functions of herbaria remain essential to botanical research: new species continue to be described, systematic relationships are always subject to revision, nomenclature is routinely updated, and the documentation and study of biodiversity is increasingly important as we enter an anthropogenic era of mass extinction. Here, Heberling and Isaac introduce the analogy of herbarium specimens as \"exaptations\"--that is, the current use of collections reaches far beyond their originally anticipated uses.

The scarcity of research on MA and its impact on access to surgery presents an exciting opportunity to pioneer research into this area with a focus on advocating for the medically underserved and vulnerable in our community. 4 Impact of MA penetration on rural America MA plans have gained recent popularity in rural America, with a nearly 4X growth in penetration since 2010. 9 With the concerns surrounding MA plans and their impact on access to surgery, more research is needed to ensure that Americans who are older and under resourced have access to quality surgical care especially when their complex medical and social determinants of health issues are at their peak. 6 Closing reflections MA plans now cover more of the Medicare eligible population than TM, and while a complex issue, the ability to identify inequalities will be an actionable first step towards closing any potential equity gaps between TM and MA beneficiaries. Potential areas of early focus are to: 1) thoroughly investigate the relationship between MA penetration, equitable access to surgical care, and patient outcomes along the rural-urban continuum, 2) identify any unintended consequences of increased MA penetration on vulnerable populations including older rural adults, minoritized individuals, and those who live in deprived areas, and 3) investigate the effects MA on access to surgery for older, poor Americans. The sponsors did not have a role in the study design, collection, analysis and interpretation of data, writing of the report, and decision to submit the article for publication.

Premise of the Study Innovative approaches to specimen collection and curation are needed to maximize the utility of natural history collections in a new era of data use. Associated data, such as digital images from the field, are routinely collected with recent herbarium specimens. However, these data often remain inaccessible and are rarely curated alongside the associated physical specimens, which limits future data use. Methods and Results We leveraged the widely used citizen science platform, iNaturalist, to permanently associate field‐collected data to herbarium specimens, including information not well preserved in traditional specimens. This protocol improves the efficiency and accuracy of all steps from the collecting event to specimen curation and enhances the potential uses of specimens. Conclusions iNaturalist provides a standardized and cost‐efficient enhancement to specimen collection and curation that can be easily adapted for specific research goals or other collection types beyond herbaria.

The Adolescent Brain Cognitive Development (ABCD) Study is an ongoing, nationwide study of the effects of environmental influences on behavioral and brain development in adolescents. The main objective of the study is to recruit and assess over eleven thousand 9-10-year-olds and follow them over the course of 10 years to characterize normative brain and cognitive development, the many factors that influence brain development, and the effects of those factors on mental health and other outcomes. The study employs state-of-the-art multimodal brain imaging, cognitive and clinical assessments, bioassays, and careful assessment of substance use, environment, psychopathological symptoms, and social functioning. The data is a resource of unprecedented scale and depth for studying typical and atypical development. The aim of this manuscript is to describe the baseline neuroimaging processing and subject-level analysis methods used by ABCD. Processing and analyses include modality-specific corrections for distortions and motion, brain segmentation and cortical surface reconstruction derived from structural magnetic resonance imaging (sMRI), analysis of brain microstructure using diffusion MRI (dMRI), task-related analysis of functional MRI (fMRI), and functional connectivity analysis of resting-state fMRI. This manuscript serves as a methodological reference for users of publicly shared neuroimaging data from the ABCD Study. •An overview of the MRI processing pipeline for the ABCD Study.•A discussion on the challenges of large, multisite population studies.•A methodological reference for users of publicly shared data from the ABCD Study.•Preliminary results from technical survey of baseline dataset.

1 Indeed, the SDOH of rural communities significantly impact population health, often outweighing the influence of local healthcare services. 2 Individual behaviors such as smoking and lower engagement in preventive care are often cited contributors of health inequities, but do not fully explain the wide rural-urban gap in surgical access and outcomes. [...]while rural populations may experience higher rates of chronic diseases linked to smoking, these behaviors can be driven by deeper social and structural factors such as limited health literacy, insufficient health system support, cultural norms, and limited public health policies. 3 Beyond individual-level behaviors, other key barriers exist beyond the control of rural individuals. 66.33 % of Primary Care Health Professional Shortage Areas are located in rural counties, where gaps in insurance coverage for low income, minoritized, and rural communities also persist. 4 Additionally, structural barriers, such as workforce shortages, geographic isolation, mistrust, and inadequate healthcare infrastructures play a critical role in these longstanding inequties. 1 , 5 Considering these challenges, a rigorous research framework is urgently needed to evaluate equity issues in rural surgery. Integrated analysis of survey and focus group data will inform iterative adjustments to the framework, with broader validation to follow with membership of the North American Rural Surgery Society and the American College of Surgeons. 3 Quality of care starts with equitable access to care: a unifying principle for surgery At the core of this framework is the principle of equitable quality, serving as a unifying force between patients, providers, and policymakers.

Huntington’s Disease (HD) is a rare inherited neurodegenerative disorder with a typical onset between the ages of 30 – 50. Juvenile onset Huntington’s Disease (JoHD), defined by the onset of symptoms before age 21, manifests differently from adult-onset HD. JoHD is thought to be present in approximately 5% of HD cases, although the exact prevalence is unknown. It has not been studied extensively. JOIN-HD is a prospective, observational, multi-national patient registry of individuals (both patients and caregivers) affected by JoHD. The primary objective of the registry is to identify individuals affected by JoHD and map their locations globally. Secondary objectives include supporting focused research for this population and identifying the unmet needs of JoHD families to improve advocacy, care and support. It is anticipated that JOIN-HD will serve as a tool to facilitate recruitment to future research and clinical trials by identifying potentially eligible participants. Pre-registration for JOIN-HD opened in Q1 2021, and Stage I launched in Q1 2022. Participants are invited to self-enrol and participate remotely via an electronic data capture portal. Stage I captures demographics and information about participants’ links with the HD community, with data collected since launch presented here. Two further stages of the registry are planned, with Stage II collecting data on medical history/experience of JoHD and Stage III incorporating a clinician-led interview.

Objective: This study examines the associations of childhood attention-deficit/hyperactivity disorder (ADHD) risk status with subsequent parental social network characteristics and caregiver strain in adolescence; and examines predictors of adolescent mental health service use. Methods: Baseline ADHD screening identified children at high risk (n = 207) and low risk (n = 167) for ADHD. At eight-year follow-up, parents reported their social network characteristics, caregiver strain, adolescents’ psychopathology and mental health service utilization, whereas adolescents self-reported their emotional status and ADHD stigma perceptions. Analyses were conducted using ANOVAs and nested logistic regression modeling. Results: Parents of youth with childhood ADHD reported support networks consisting of fewer spouses but more healthcare professionals, and lower levels of support than control parents. Caregiver strain increased with adolescent age and psychopathology. Increased parental network support, youth ADHD symptoms, and caregiver strain, but lower youth stigma perceptions were independently associated with increased service use. Conclusions: Raising children with ADHD appears to significantly impact parental social network experiences. Reduced spousal support and overall lower network support levels may contribute to high caregiver strain commonly reported among parents of ADHD youth. Parental social network experiences influence adolescent ADHD service use. With advances in social networking technology, further research is needed to elucidate ways to enhance caregiver support during ADHD care.