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OBJECTIVE In-training exams (ITEs) are administered annually to Obstetrics and Gynecology (OBGYN) residents and have been demonstrated to correlate with success on licensing examinations. Our study objective was to determine the impact of a question bank and mock exam on the performance of Council on Resident Education in Obstetrics and Gynecology (CREOG) ITEs. Secondarily, we investigated the correlation between the extent of question bank usage and performance on the exam. METHODS Pre–post intervention study of resident performance on CREOG ITE before and after implementation of the question bank and mock ITE at Indiana University in 2018. Performance was measured as year-to-year improvement in percent correct on ITE exams. Scores were excluded if a resident did not have a prequestion bank score report or if they did not sit for all eligible ITE exams. RESULTS There were 51 OBGYN residents at Indiana University during the study period, with 38 available for analysis (75%). Before implementation, average year-to-year improvement for PGY1-2, PGY2-3 and PGY3-4 classes were 0.60%, 1.0% and −1.6%, respectively. After implementation, all resident classes had significant improvements in ITE scores of 6.6% (P < .01), 9.0% (P < .01), and 7.2% (P < .01), respectively. There was a moderate program-wide correlation between the number of questions completed and the percent improvement on the ITE of R = 0.36 (P = .046). CONCLUSIONS Our study demonstrated that access to a question bank and mock ITE significantly improved CREOG ITE performance of OBGYN residents at Indiana University.

IntroductionNeoadjuvant chemotherapy for breast cancer treatment is prescribed to facilitate surgery and provide confirmation of drug-sensitive disease, and the achievement of pathological complete response (pCR) predicts improved long-term outcomes. Docosahexaenoic acid (DHA) has been shown to reduce tumour growth in preclinical models when combined with chemotherapy and is known to beneficially modulate systemic immune function. The purpose of this trial is to investigate the benefit of DHA supplementation in combination with neoadjuvant chemotherapy in patients with breast cancer.Methods and analysisThis is a double-blind, phase II, randomised controlled trial of 52 women prescribed neoadjuvant chemotherapy to test if DHA supplementation enhances chemotherapy efficacy. The DHA supplementation group will take 4.4 g/day DHA orally, and the placebo group will take an equal fat supplement of vegetable oil. The primary outcome will be change in Ki67 labelling index from prechemotherapy core needle biopsy to definitive surgical specimen. The secondary endpoints include assessment of (1) DHA plasma phospholipid content; (2) systemic immune cell types, plasma cytokines and inflammatory markers; (3) tumour markers for apoptosis and tumour infiltrating lymphocytes; (4) rate of pCR in breast and in axillary nodes; (5) frequency of grade 3 and 4 chemotherapy-associated toxicities; and (6) patient-perceived quality of life. The trial has 81% power to detect a significant between-group difference in Ki67 index with a two-sided t-test of less than 0.0497, and accounts for 10% dropout rate.Ethics and disseminationThis study has full approval from the Health Research Ethics Board of Alberta - Cancer Committee (Protocol #: HREBA.CC-18-0381). We expect to present the findings of this study to the scientific community in peer-reviewed journals and at conferences. The results of this study will provide evidence for supplementing with DHA during neoadjuvant chemotherapy treatment for breast cancer.Trial registration number NCT03831178

This article argues that small businesses that move in anticipation of or as a result of the economic impact of a construction project should be eligible for relocation benefits under the Uniform Relocation Assistance Act (URA). As currently written, the URA provides benefits to small businesses that are victims of a \"displacing activity.\" A construction project can be a \"displacing activity.\" That is, as a direct result of construction, some small businesses may be forced to move from their real property, not because of a physical taking of their property, but because of an economic taking: the loss of business revenue triggered by the impacts of construction. Using the lessons learned from the Central Corridor Light Rail Transit (CCLRT) Project in Saint Paul, MN, this article argues that the US Department of Transportation regulations to the URA should be amended to permit relocation benefits to small businesses that are economically displaced as a direct result of construction projects.

Elizabeth Stoddard's The Morgesons, “Lemorne Versus Huell,” and “Collected by a Valetudinarian” were written in the space of eight years. Over this short period of time, Stoddard's views of women's potential for independence changed drastically. Cass, the main character of The Morgesons, ultimately triumphs over her oppressors, gaining possession of a house and entering into a marriage of equals. On the other hand, Margaret and Alicia—the main characters of “Lemorne” and “Collected”—never gain such independence. They also become increasingly riddled with self-doubt and submit to great restrictions from men and women who are monitoring arms of patriarchal society. During these eight years, Stoddard was disappointed with the lack of critical and popular support of her work. This disappointment is mirrored in her fiction, particularly in the semi-autobiographical “Collected.” When analyzed through this approach, “Collected” becomes Stoddard's implication of women in her failure to reach a wide audience.

The study explored team and non-team employees' perceptions of why they stay with their employer. Additionally, this study set out to develop a greater understanding of the importance of individual employee and team retention in organizations. This research can be important and significant across industries because it will add to a broader understanding of why the organizational goal should focus on retaining not only individual employees but also teams. This study was conducted to explore whether employees working in team or non-team positions have different retention factors which keep them staying with their organization. The research design used for this study was a quantitative methodology. It utilized an inventory, which assessed whether there were differences between teams and non-team employees' perceptions for why they stay with their organization. A case study was conducted using a defense technology company based in Lexington, Massachusetts. Company XYZ employs more than 110,000 employees world wide and serves their customers in more than eighty countries. The participants were recruited from Division A of Company XYZ. There were 102 participants in the study. The recruiting of the participants was achieved by convenience sampling throughout Division D. Of the 102 participants, 44 were team members and 58 were non-team members. Both groups completed the 66 item “Intention to Stay” survey. Additionally, this dissertation collected new descriptive information about team and non-team employees' perceptions on retention factors that are not addressed by other retention surveys. Based the factor analysis which tested the original validity of scales from the “Intention to Stay” survey, new variables were chosen by the researcher. The study went from testing six hypotheses to five. Hypothesis one tested if there was a difference between team members and non-team employees on the retention factor ‘opportunity’. Hypothesis two tested if there was a difference between team members and non-team employees on the retention factor ‘benefits’. Hypothesis three tested if there was a difference between team members and non-team employees on the retention factor ‘work’. Hypothesis four tested if there was a difference between team members and non-team employees on the retention factor ‘co-workers’. Statistical significance was not supported for hypotheses 1–4. Hypothesis five tested to see if opportunity, work, co-workers, and benefits would significantly predict intention to stay. Work was the independent variable that contributed most to the prediction of intent to stay. The area of team retention is a new concept. Most of the literature indicates that companies across industries are struggling to retain their valued individual employees. Additionally, in tight labor markets, companies are developing strategies in order to satisfy the needs of their individual employees and to retain them.

In the past several decades, field studies have shown that woody plants can access substantial volumes of water from the pores and fractures of bedrock 1 – 3 . If, like soil moisture, bedrock water storage serves as an important source of plant-available water, then conceptual paradigms regarding water and carbon cycling may need to be revised to incorporate bedrock properties and processes 4 – 6 . Here we present a lower-bound estimate of the contribution of bedrock water storage to transpiration across the continental United States using distributed, publicly available datasets. Temporal and spatial patterns of bedrock water use across the continental United States indicate that woody plants extensively access bedrock water for transpiration. Plants across diverse climates and biomes access bedrock water routinely and not just during extreme drought conditions. On an annual basis in California, the volumes of bedrock water transpiration exceed the volumes of water stored in human-made reservoirs, and woody vegetation that accesses bedrock water accounts for over 50% of the aboveground carbon stocks in the state. Our findings indicate that plants commonly access rock moisture, as opposed to groundwater, from bedrock and that, like soil moisture, rock moisture is a critical component of terrestrial water and carbon cycling. Woody plants across the continental United States make extensive use of water stored in bedrock across diverse climates and biomes.

Checkpoint blockade therapies that reactivate tumour-associated T cells can induce durable tumour control and result in the long-term survival of patients with advanced cancers 1 . Current predictive biomarkers for therapy response include high levels of intratumour immunological activity, a high tumour mutational burden and specific characteristics of the gut microbiota 2 , 3 . Although the role of T cells in antitumour responses has thoroughly been studied, other immune cells remain insufficiently explored. Here we use clinical samples of metastatic melanomas to investigate the role of B cells in antitumour responses, and find that the co-occurrence of tumour-associated CD8 + T cells and CD20 + B cells is associated with improved survival, independently of other clinical variables. Immunofluorescence staining of CXCR5 and CXCL13 in combination with CD20 reveals the formation of tertiary lymphoid structures in these CD8 + CD20 + tumours. We derived a gene signature associated with tertiary lymphoid structures, which predicted clinical outcomes in cohorts of patients treated with immune checkpoint blockade. Furthermore, B-cell-rich tumours were accompanied by increased levels of TCF7 + naive and/or memory T cells. This was corroborated by digital spatial-profiling data, in which T cells in tumours without tertiary lymphoid structures had a dysfunctional molecular phenotype. Our results indicate that tertiary lymphoid structures have a key role in the immune microenvironment in melanoma, by conferring distinct T cell phenotypes. Therapeutic strategies to induce the formation of tertiary lymphoid structures should be explored to improve responses to cancer immunotherapy. The co-occurrence of tumour-associated CD8 + T cells and CD20 + B cells, and the formation of tertiary lymphoid structures, are linked with improved survival in cohorts of patients with metastatic melanoma.