small sampling volumes, minimal hydrodynamic focusing avoiding need for most sheath fluid for higher sample throughput, weight/power requirements using super-bright LEDs light sources, “top-hat” focusing optics minimizing cell-positioning requirements, small silicon photomultiplier sensors, with tightly-integrated electronics, all battery-powered and light-weight for portability. Smartphone technology includes CPU, touch-screen, digital speech recognition interface, telecommunications via phone and/or internet, GPS chip to mark the location of the patient using Motorola’s Moto Z3 Play, modular/open-architecture smartphone. The device is software-configurable from a Linux workstation running Android Studio IDE with Java and Python programming. Portable microfluidic-cytometry devices for measurements in the field requires a serious overall systems-level design to face the many engineering tradeoffs encountered for true portability, including: (1) sampling systems of small sample volumes with minimal need for sheath hydrodynamic focusing both to avoid the need for large amounts of sheath fluid and to enable higher volumes of actual sample, (2) weight/power requirements that dictate use of super-bright LEDs as light sources, integrated “top hat” focusing optics to minimize the need for cell positioning and very small silicon photomultiplier sensors, with tightly integrated electronics (3) powered by small batteries or regenerative power sources such as solar, and (4) light-weight and robust enough for portability in potentially extreme environments. Initial prototyping used Raspberry Pi credit-card sized microcomputers, but longer-term development is being geared toward smartphone technologies. Smartphone technology can provide a powerful CPU, touch-screen and digital speech recognition interface, telecommunications via phone and internet, with a GPS chip to mark the location of the patient in the field. We are now using Motorola’s new Moto Z3 Play, a dual 12-megapixel/5-megapixel rear camera with 8-megapixel front camera, modular and open-architecture smartphone which allows building custom applications using hot-swappable accessories via Moto Development Kit modules, including externally-mountable Li-battery packs to power linked cytometry optics and electronics modules and microSD card storage with 512GB addressable memory linkable to other special purpose modules via USB-C connections. The device is software-configurable from a Linux workstation running Android Studio IDE with Java and Python programming.

Design of multifunctional nanoparticles for multimodal in-vivo imaging and advanced targeting to diseased single cells for massive parallel processing nanomedicine approaches requires careful overall design, including particle shape, and a multilayered approach to match the multi-step targeting required. In addition to thermodynamically driven self-assembly, complex patterns can be produced by micro-palette and 3D printing approaches. Initial core materials can include nanomaterials that simultaneously serve as x-ray contrast agents for CAT scan imaging as well as T1 or T2 contrast agents for MRI imaging. Use of superparamagnetic iron oxide allows for convenient magnetic manipulation during manufacturing re-positioning inside the body as well as single-cell hyperthermia therapies. To permit real-time fluorescence-image-guided surgery, fluorescence molecules can also be included. Advanced cell targeting can be achieved by attaching antibodies, peptides, aptamers, or other targeting molecules to the nanoparticle in a multilayered approach mimicking the multi-step targeting required. Addition of “stealth” molecules (e.g. PEG or chitosan) to the outer surfaces of the nanoparticles can permit greatly enhanced circulation times. Nanoscale imaging of these manufactured, multifunctional nanoparticles can be achieved either directly through superresolution microscopy or indirectly through single nanoparticle zeta-sizing or x-ray correlation microscopy. Since these multifunctional nanoparticles are best analyzed by technologies permitting analysis in aqueous environments, superresolution microscopy is, in most cases, the preferred method. This review paper will discuss the importance of specific design criteria as well as advantages and disadvantages of each approach. The overall design required a system engineering approach to the problem.

Design of portable microfluidic-cytometry devices for measurements in the field (e.g. initial medical diagnostics and recommended actions for first responders and search and rescue teams) requires careful design in terms of power requirements and weight to allow for true portability. True portability with high-throughput microfluidic systems also requires sampling systems with minimal need for sheath hydrodynamic focusing both to avoid the need for large amounts of sheath fluid and to enable higher volumes of actual sample, rather than conventional sheath/sample combinations. Weight/power requirements dictate use of super-bright LEDs as light sources and very small silicon photomultiplier sensors, with tightly integrated electronics that can both be powered by small batteries or regenerative power sources such as solar. GPS-based positioning, and telecommunications (including possible satellite–based, if cellphone towers are not nearby) to export data to other medical facilities. Microfluidic-cytometry also requires judicious use of small sample volumes and appropriate statistical sampling to permit real-time (typically in less than 10-15 minutes) initial medical decisions, not just raw data, for first responders in the field who may need results which include on-board expert medical systems. The portable system should be robust for extreme environments and should be modular and flexible to allow for multiple applications and for plug-in repairs if subsystems should become damaged. For example, one or two drops of blood obtained by pin-prick should be able to provide statistically meaningful results for use in making real-time medical decisions without the need for blood fractionation, which is not realistic in the field.

Instructor evaluations are influenced by implicit age and gender bias, with lower ratings and negative feedback given to instructors believed to stray from stereotypical age and gender norms. Female instructors exhibiting typically male-associated qualities such as leadership and authority, are often negatively impacted. Implicit bias also influences evaluation of digital resources and instructors, regardless of students' positive learning outcomes. As digital learning resources become the norm in education, it is crucial to explore the impact of implicit bias at various educational levels. In this study, undergraduate and graduate students were randomly exposed to one of five digital tutorials; four experimental tutorials presenting identical anatomy content with narrators of different gender and age, and a control tutorial featuring origami (paper folding) instructions without audio. Learning outcomes were measured by pre-quiz vs. post-quiz comparisons using repeated measures MANOVA. Implicit bias was analyzed by evaluation response comparisons using repeated measures MANOVA and three-way MANOVA. Post-quiz scores increased significantly in the four experimental groups (P<0.05) but not in the control (P=0.99). The increased performance was not statistically different across the four experimental groups (P>0.26), suggesting that learning occurred irrespective of the instructor gender and age. Students' evaluations were consistently higher for the experimental resources than the control. There was no significant difference in evaluations across the four experimental groups but compared to the control, younger male and younger female narrators received significantly higher ratings for approachability, acceptance, inclusivity, and care for student learning. The study highlights important considerations for digital resources development and interpretation of student evaluations.

Design of portable microfluidic flow/image cytometry devices for measurements in the field (e.g. initial medical diagnostics) requires careful design in terms of power requirements and weight to allow for realistic portability. True portability with high-throughput microfluidic systems also requires sampling systems without the need for sheath hydrodynamic focusing both to avoid the need for sheath fluid and to enable higher volumes of actual sample, rather than sheath/sample combinations. Weight/power requirements dictate use of super-bright LEDs with top-hat excitation beam architectures and very small silicon photodiodes or nanophotonic sensors that can both be powered by small batteries. Signal-to-noise characteristics can be greatly improved by appropriately pulsing the LED excitation sources and sampling and subtracting noise in between excitation pulses. Microfluidic cytometry also requires judicious use of small sample volumes and appropriate statistical sampling by microfluidic cytometry or imaging for adequate statistical significance to permit real-time (typically in less than 15 minutes) initial medical decisions for patients in the field. This is not something conventional cytometry traditionally worries about, but is very important for development of small, portable microfluidic devices with small-volume throughputs. It also provides a more reasonable alternative to conventional tubes of blood when sampling geriatric and newborn patients for whom a conventional peripheral blood draw can be problematical. Instead one or two drops of blood obtained by pin-prick should be able to provide statistically meaningful results for use in making real-time medical decisions without the need for blood fractionation, which is not realistic in the doctor’s office or field.

Design of multifunctional nanoparticles for multimodal in-vivo imaging and advanced targeting to diseased single cells for massive parallel processing nanomedicine approaches requires careful overall design and a multilayered approach. Initial core materials can include non-toxic metals which not only serve as an x-ray contrast agent for CAT scan imaging, but can contain T1 or T2 contrast agents for MRI imaging. One choice is superparamagnetic iron oxide NPs which also allow for convenient magnetic manipulation during manufacturing but also for re-positioning inside the body and for single cell hyperthermia therapies. To permit real-time fluorescence-guided surgery, fluorescence molecules can be included. Advanced targeting can be achieved by attaching antibodies, peptides, aptamers, or other targeting molecules to the nanoparticle in a multilayered approach producing “programmable nanoparticles” whereby the “programming” means controlling a sequence of multi-step targeting methods. Addition of membrane permeating peptides can facilitate uptake by the cell. Addition of “stealth” molecules (e.g. PEG or chitosan) to the outer surfaces of the nanoparticles can permit greatly enhanced circulation times in-vivo which in turn lead to lower amounts of drug exposure to the patient which can reduce undesirable side effects. Nanoparticles with incomplete layers can be removed by affinity purification methods to minimize mistargeting events in-vivo. Nanoscale imaging of these manufactured, multifunctional nanoparticles can be achieved either directly through superresolution microscopy or indirectly through single nanoparticle zeta-sizing or x-ray correlation microscopy. Since these multifunctional nanoparticles are best analyzed by technologies permitting analysis in aqueous environments, superresolution microscopy is, in most cases, the preferred method.

Design of inexpensive and portable hand-held microfluidic flow/image cytometry devices for initial medical diagnostics at the point of initial patient contact by emergency medical personnel in the field requires careful design in terms of power/weight requirements to allow for realistic portability as a hand-held, point-of-care medical diagnostics device. True portability also requires small micro-pumps for high-throughput capability. Weight/power requirements dictate use of super-bright LEDs and very small silicon photodiodes or nanophotonic sensors that can be powered by batteries. Signal-to-noise characteristics can be greatly improved by appropriately pulsing the LED excitation sources and sampling and subtracting noise in between excitation pulses. The requirements for basic computing, imaging, GPS and basic telecommunications can be simultaneously met by use of smartphone technologies, which become part of the overall device. Software for a user-interface system, limited real-time computing, real-time imaging, and offline data analysis can be accomplished through multi-platform software development systems that are well-suited to a variety of currently available cellphone technologies which already contain all of these capabilities. Microfluidic cytometry requires judicious use of small sample volumes and appropriate statistical sampling by microfluidic cytometry or imaging for adequate statistical significance to permit real-time (typically < 15 minutes) medical decisions for patients at the physician’s office or real-time decision making in the field. One or two drops of blood obtained by pin-prick should be able to provide statistically meaningful results for use in making real-time medical decisions without the need for blood fractionation, which is not realistic in the field.

The objective of this work was to compare the accuracy of analyte concentration estimation when using transmission versus diffuse reflectance spectroscopy of a scattering medium. Monte Carlo ray tracing of light through the medium was used in conjunction with pure component absorption spectra and Beer-Lambert absorption along each ray's pathlength to generate matched sets of pseudoabsorbance spectra, containing water and six analytes present in skin. PLS regression models revealed an improvement in accuracy when using transmission compared to reflectance for a range of medium thicknesses and instrument noise levels. An analytical expression revealed the source of the accuracy degradation with reflectance was due both to the reduced collection efficiency for a fixed instrument etendue and to the broad pathlength distribution that detected light travels in the medium before exiting from the incident side.

Medical schools in the United States continue to undergo curricular change, reorganization, and reformation as more schools transition to an integrated curriculum. Anatomy educators must find novel approaches to teach in a way that will bridge multiple disciplines. The cadaveric extraction of the central nervous system (CNS) provides an opportunity to bridge gross anatomy, neuroanatomy, and clinical neurology. In this dissection, the brain, brainstem, spinal cord, cauda equina, optic nerve/tract, and eyes are removed in one piece so that the entire CNS and its gateway to the periphery through the spinal roots can be appreciated. However, this dissection is rarely, if ever, performed likely due to time constraints, perceived difficulty, and lack of instructions. The goals of this project were (i) to provide a comprehensive, step-by-step guide for an en bloc CNS extraction and (ii) to determine effective strategies to implement this dissection/prosection within modern curricula. Optimal dissection methods were determined after comparison of various approaches/tools, which reduced dissection time from approximately 10 to 4 hours. The CNS prosections were piloted in small group sessions with two types of learners in two different settings: graduate students studied wet CNS prosections within the dissection laboratory and medical students used plastinated CNS prosections to review clinical neuroanatomy and solve lesion localization cases during their neurology clerkship. In both cases, the CNS was highly rated as a teaching tool and 98% recommended it for future students. Notably, 90% of medical students surveyed suggested that the CNS prosection be introduced prior to clinical rotations. Anat Sci Educ 11: 185-195. © 2017 American Association of Anatomists.

There is a paucity of articles in the surgical literature demonstrating transfer validity (transfer of training). The purpose of this study was to assess whether skills learned on the ArthroSim virtual-reality arthroscopic knee simulator transferred to greater skill levels in the operating room. Postgraduate year-3 orthopaedic residents were randomized into simulator-trained and control groups at seven academic institutions. The experimental group trained on the simulator, performing a knee diagnostic arthroscopy procedure to a predetermined proficiency level based on the average proficiency of five community-based orthopaedic surgeons performing the same procedure on the simulator. The residents in the control group continued their institution-specific orthopaedic education and training. Both groups then performed a diagnostic knee arthroscopy procedure on a live patient. Video recordings of the arthroscopic surgery were analyzed by five pairs of expert arthroscopic surgeons blinded to the identity of the residents. A proprietary global rating scale and a procedural checklist, which included visualization and probing scales, were used for rating. Forty-eight (89%) of the fifty-four postgraduate year-3 residents from seven academic institutions completed the study. The simulator-trained group averaged eleven hours of training on the simulator to reach proficiency. The simulator-trained group performed significantly better when rated according to our procedural checklist (p = 0.031), including probing skills (p = 0.016) but not visualization skills (p = 0.34), compared with the control group. The procedural checklist weighted probing skills double the weight of visualization skills. The global rating scale failed to reach significance (p = 0.061) because of one extreme outlier. The duration of the procedure was not significant. This lack of a significant difference seemed to be related to the fact that residents in the control group were less thorough, which shortened their time to completion of the arthroscopic procedure. We have demonstrated transfer validity (transfer of training) that residents trained to proficiency on a high-fidelity realistic virtual-reality arthroscopic knee simulator showed a greater skill level in the operating room compared with the control group. We believe that the results of our study will stimulate residency program directors to incorporate surgical simulation into the core curriculum of their residency programs.