First Report Of Findings Research Articles

The Overview of the CLER Program: CLER National Report of Findings 2018.

Since its inception in 2012, the Clinical Learning Environment Review (CLER) Program has had at its core a commitment to formative assessment and feedback regarding graduate medical education (GME) engagement in 6 important, cross-cutting areas of focus—patient safety; health care quality; care transitions; supervision; fatigue management, mitigation, and duty hours; and professionalism. CLER's formative approach recognizes that, although there are shared elements, each hospital, medical center, and ambulatory care site that serves as a clinical learning environment (CLE) for resident and fellow physicians has a unique set of internal and external factors that influence the development and implementation of that CLE's strategic goals aimed at improving patient care.As in the CLER National Report of Findings 2016, the CLER Program continues to refer to CLEs as living and breathing entities—the embodiment of all of the individuals within these settings that influence and imprint upon these early learners. The CLER Program relies on the power of the information it provides to stimulate conversations and motivate CLEs to build upon their strengths and internally address opportunities for improvement.The CLER Program's primary link to accreditation is that every Sponsoring Institution (SI) must periodically complete a site visit. The 2016 National Report provided information on the CLER Program's background and structure.1In the second set of visits to SIs with 3 or more core residency programs, the structure of the site visit remained essentially unchanged. The site visitors met with GME and executive leadership and the CLE's leaders in patient safety and health care quality; held group interview sessions with residents and fellows, faculty physicians, and program directors; and had numerous conversations with various members of the clinical care team while on walking rounds within the CLE.For the second set of visits, the CLER Site Visitors used Protocol 2.0, which was similar but not identical to the version used in the first set of visits (ie, Protocol 1.0). Whereas the majority of the questions remained constant, Protocol 2.0 included new questions to explore important topics in greater depth. In addition, it included several other changes to enhance the quality of the information gathered as part of the CLER Program's commitment to a model of continual improvement:In Protocol 2.0, the CLER Evaluation Committee continued to provide oversight of and guidance for all aspects of program development. The committee is composed of members with expertise in patient safety and health care quality improvement, as well as GME and executive leadership of hospitals and medical centers (eg, chief medical officer, chief nursing officer). The committee also includes postgraduate physician representation and public members.For Protocol 2.0, the committee reviewed and provided guidance on the changes described in the previous section. They also reviewed the data resulting from the site visits and brought an external voice in response to the findings—presented here as overarching themes and challenges and opportunities. Their views and commentary on the significance of the overarching themes and the challenges and opportunities are reflected in the discussion sections of this report.This report includes data from the second set of visits to 287 participating sites of SIs accredited by the Accreditation Council for Graduate Medical Education with 3 or more core residency programs. Similar to the first report of findings, this report presents several different perspectives, including overarching themes, highlights of the challenges and opportunities in each of the 6 CLER Focus Areas, and detailed findings, as well as a new section that examines changes since the last set of CLER visits. The CLER Program will present the findings from the initial visits to SIs with 2 or fewer core residency programs in a separate report scheduled for release in 2019.

Acinic Cell Carcinoma of the Parotid Gland in Children and Adolescents.

Acinic cell carcinoma of the parotid gland is a rare low-grade malignant neoplasm. Data on children are sparse. For the present study, the database of a tertiary pediatric medical center was reviewed for all patients with parotid gland acinic cell carcinoma diagnosed and treated between 2004 and 2013. Clinical, histologic, treatment, and outcome parameters were collected from the medical files. Four patients were identified, 3 female and 1 male, aged 13.5 to 18 years (median 15.7) at diagnosis. One patient had a family history of parotid tumor and 1 of hypothyroidism/hyperthyroidism. Two patients had L-thyroxin-treated Hashimoto thyroiditis, and 1 had a thyroid nodule. All presented with a localized parotid mass and negative lymph nodes. Treatment consisted of partial parotidectomy, with no damage to the facial nerve. Histology confirmed the diagnosis of acinic cell carcinoma with low proliferation rate (Ki67 immunostaining 1% to 8%). No evidence of disease was found on any patient with a median follow-up at 83 months (range, 32 to 93 mo) from presentation. In our experience, the prognosis of pediatric parotid gland acinic cell carcinoma is good, and surgery alone is sufficient for treatment of early stage tumors. This is the first report of findings of a family history of thyroid disease and/or thyroid abnormalities in patients with parotid gland acinic cell carcinoma.

The Aptian–Cenomanian flora of the Razdolnaya coal Basin (Primorye region, Russia)

AbstractTaxonomic composition of the Aptian‐Cenomanian flora collected from the Razdolnaya coal Basin, Primorye, is described along with a geological description of sediments containing fossil plants. This is the first report of finding the fossil angiosperms Dicotylophyllum sp. and some indeterminable platanoids in the upper part of the Lipovtsy Formation (Late Lipovtsy floral assemblage), the age of which is determined as the Aptian‐Early Albian. The deposits of the overlying Korkino Group were paleobotanically characterized for the first time.

Dermoscopy of Poikilodermatous Mycosis Fungoides in Pigmented Skin

ABSTRACT Mycosis fungoides (MF) is one of the most common primary cutaneous T-cell lymphoma, whose early stages, especially patch stage poses a diagnostic challenge, as it presents quite similarly to other inflammatory skin diseases and chronic dermatoses. We present a case of a 31-year-old young male presented to us with complaints of generalized hyperpigmentation associated with mild itching since 4 years. On examination, generalized well-demarcated hyperpigmented poikilodermatous patches with focal atrophy were noted. The poikiloderma was more pronounced over the arms and legs. Dermoscopy of these patches displayed multiple well-demarcated irregular accentuation of pigment network with criss-cross white streaked (loss of pigment network) zones with microscaling, telangiectasia (reddish smudges), and black dots. Histopatho­logy showed interface dermatitis, epidermotropism of atypical lymphocytes, and tagging of lymphocytes along the basement membrane and Pautrier's micro- abscesses. These findings confirmed the diagnosis of poikilodermatous MF. This is the first report of findings of Poikilodermatous MF in pigmented skin. Thus, dermoscopy being a non-invasive tool with specific characteristics, may assume an supplementary role in the diagnosis of poikilodermatous MF. How to cite this article Bharti AH, Khopkar US. Dermoscopy of Poikilodermatous Mycosis Fungoides in Pigmented Skin. Int J Dermoscop 2017;1(1):28-31.

Effects of short-term continuous and intermittent feeding regimes on food consumption, growth, gonad production and quality of sea urchin Strongylocentrotus intermedius fed a formulated feed

Feeding regime is an important concern for sea urchin aquaculture. However, optimal feed regimes have not been established for land-based sea urchin ventures using a formulated feed. In this study, we investigated the effects of short-term continuous and intermittent feeding regimes on food consumption, growth, gonad production and quality of the sea urchin Strongylocentrotus intermedius (54.90 ± 2.28 mm of test diameter) fed a formulated feed. The results showed that (1) compared with initial conditions, all involved traits except a* (test diameter, test height, body weight, gonad weight, gonad index, gonad moisture, L* and b*) showed significant increase at the end of the experiments; (2) only the longest term feed regime tested in this trial (S2) significantly negatively affected growth and gonad production of S. intermedius fed a formulated feed; (3) there was a trend but this was not significant for inhibiting gonad development of S. intermedius in intermittent feeding regimes and there was no change in the gonad colour and sweetness; (4) S0.5 (fasting half day and then feeding half day) is the optimal intermittent feeding regime for S. intermedius fed a formulated feed. To our knowledge, the present study is the first report of finding an effective intermittent feeding regime for land-based cultured sea urchins of relatively large size, and thus has direct application potential in the field of aquaculture.

Genome-wide genetic variations are highly correlated with proximal DNA methylation patterns

5-methyl-cytosines at CpG sites frequently mutate into thymines, accounting for a large proportion of spontaneous point mutations. The repair system would leave substantial numbers of errors in neighboring regions if the synthesis of erased gaps around deaminated 5-methyl-cytosines is error-prone. Indeed, we identified an unexpected genome-wide role of the CpG methylation state as a major determinant of proximal natural genetic variation. Specifically, 507 Mbp (∼18%) of the human genome was within 10 bp of a CpG site; in these regions, the single nucleotide polymorphism (SNP) rate significantly increased by ∼50% (P < 10−566 by a two-proportion z-test) if the neighboring CpG sites are methylated. To reconfirm this finding in another vertebrate, we compared six single-base resolution methylomes in two inbred medaka (Oryzias latipes) strains with sufficient genetic divergence (3.4%). We found that the SNP rate also increased by ∼50% (P < 10−2170), and the substitution rates in all dinucleotides increased simultaneously (P < 10−441) around methylated CpG sites. In the hypomethylated regions, the “CGCG” motif was significantly enriched (P < 10−680) and evolutionarily conserved (P = ∼ 0.203%), and slow CpG deamination rather than fast CpG gain was seen, indicating a possible role of CGCG as a candidate cis-element for the hypomethylation state. In regions that were hypermethylated in germline-like tissues but were hypomethylated in somatic liver cells, the SNP rate was significantly smaller than that in hypomethylated regions in both tissues, suggesting a positive selective pressure during DNA methylation reprogramming. This is the first report of findings showing that the CpG methylation state is significantly correlated with the characteristics of evolutionary change in neighboring DNA.

Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN): Findings related to the oropharynx.

5585 Background: We present the first report of findings focused on the oropharynx (OP) from LORHAN, a prospective, observational national registry of head and neck carcinoma (HNC) patients (pts). The Registry is now sufficiently large to perform site-specific analyses. Methods: Pts with newly diagnosed HNC, scheduled to receive radiotherapy (RT) or chemotherapy (CT), ≥18 years of age and who have provided written informed consent are eligible for enrollment. Electronic records are locked once they have been reviewed and signed off by the investigator. Results: As of Jan. 3, 2010, 3525 pts have been enrolled in LORHAN. Nearly 100 community (Comm) and academic (Acad) sites from 35 states have enrolled pts in the registry. Of principal investigators participating in LORHAN, 22% designated their setting as Acad, 78% as Comm. Acad centers accrued 65% of pts. Of pts enrolled, there are 941 locked baseline and treatment records for pts with the primary diagnosis of OP cancer, representing 44% of locked records ...

VISCERAL BULLAE: A New Finding in Bart's Syndrome

Congenital localized absence of the skin (CLAS) has been observed in various subsets of inherited epidermolysis bullosa (EB). Pyloric atresia (PA) is a rare disorder that is associated with EB. Here, we describe three preterm male infants with PA, CLAS, and EB at birth, one of whom had multiple bullae and erosions on the stomach and pericardium. To the best of our knowledge, this is the first report of findings regarding a PA–EB–CLAS association.

Fecal and Molecular Survey of Neospora caninum in Farm and Household Dogs in Mashhad Area, Khorasan Province, Iran

Neospora caninum is an important cause of abortion in dairy cattle worldwide. Dog is the definitive host for N. caninum and can infect dairy cattle. The aim of this study is to determine the prevalence of Neospora oocysts in feces of dogs from dairy farms. A total of 174 fecal samples was collected from 89 farm dogs and 85 household dogs during 2006 and 2008. Fecal samples of dogs were microscopically examined for detecting Hammondia Neospora-like oocysts (HNLO) by Mini Parasep SF fecal parasite concentrator. HNLO were microscopically detected in 4 fecal samples (2.2%). The fecal samples with HNLO were examined by N. caninum-specific PCR. Two of the samples were positive for N. caninum. The 2 positive fecal samples were selected for inoculation to calves. Two inoculated calves were seronegative by ELISA for 4 months post-infection. This is the first report of finding N. caninum DNA in feces of farm dogs in Mashhad area, Iran.

Chiropractors as Safety Net Providers: First Report of Findings and Methods from a US Survey of Chiropractors

Objective This study evaluates the actual or potential contribution of the chiropractic profession in meeting US healthcare workforce needs. Methods The authors performed a descriptive cross-sectional mail survey of US chiropractors in 2002 to 2003. Results The amount of charity care provided by chiropractors closely approximates that of medical physicians; on a weekly basis, approximately 2 weekly hours of chiropractic care are provided for free, and 4 weekly hours are provided at a reduced fee. Conclusion Chiropractors serve a vital, though often overlooked, role in the US health care safety net.

Fecal and serological survey of Neospora caninum in farm dogs in Costa Rica

To detect oocysts of Neospora caninum in dog feces and to determine the excretion pattern in dogs from specialized dairy farms in Costa Rica, a total of 265 fecal samples from 34 dogs were collected at intervals from February to August 2005. Fecal samples were examined for N. caninum-like oocysts microscopically, by DNA detection using the polymerase chain reaction (PCR), and by bioassay. N. caninum DNA was detected by PCR in four fecal samples, twice from one dog, but oocysts were not detected microscopically in these dogs. Sera of 31 of 34 dogs were tested for antibodies to N. caninum by a competitive-inhibition ELISA (VMRD ®). Fifteen (48.4%) of 31 dogs had antibodies to N. caninum by ELISA. Seroconversion was not found in 28 dogs that were bled twice, 4 months apart (March and July 2005). Only one dog tested positive to N. caninum by both ELISA and PCR. This is the first report of finding N. caninum DNA in feces of naturally infected dogs in Costa Rican dairy farms.

Radiofrequency exposure and mortality from cancer of the brain and lymphatic/hematopoietic systems.

The proliferation of wireless communication technologies has raised public concern regarding potential health effects of radiofrequency (RF) exposures. This is the first report of findings from a large-cohort mortality study among employees of Motorola, a manufacturer of wireless communication products. We examined all major causes of mortality, with brain cancers, lymphomas, and leukemias as a priori outcomes of interest. Using job titles, we classified workers into high, moderate, low, and background RF exposure groups. A total of 195,775 workers contributed 2.7 million person-years during the 1976-1996 period. Using external comparisons, the standardized mortality ratios for RF-exposed workers were 0.53 [95% confidence interval (CI) = 0.21-1.09] and 0.54 (95% CI = 0.33-0.83) for central nervous system/brain cancers and all lymphomas/leukemias. Rate ratios calculated from Poisson regression models based on internal comparisons were near 1.0 for brain cancers and below 1.0 for all lymphomas and leukemias. These findings were consistent across cumulative, peak, and usual exposure classifications. We did not observe higher risk with increased exposure duration or latency. Although this study is limited by the use of a qualitative exposure matrix and the relatively young age of the cohort, our findings do not support an association between occupational RF exposure and brain cancers or lymphoma/leukemia.

Changing the protocol: A case report from the macular photocoagulation study

The first report of findings from the Senile Macular Degeneration Study (SMDS), one of several clinical trials carried out by the Macular Photocoagulation Study (MPS) Group, appeared in June 1982. Although the SMDS did not terminate with the change of protocol that precipitated release of the initial findings of the trial, activities prior to and immediately following the decision to halt recruitment and publish findings were disruptive to the operations of all centers and to the professional and personal lives of the individuals with greatest responsibility for implementing the change. The purpose of this report is to describe the experiences of the MPS investigators in the hope that others may learn from them. The issues that confronted the investigators are discussed. The decisions they made, a chronology of events, and activities leading to the decision to terminate patient enrollment in the SMDS and to release findings from the trial are described.

Introduction to "Recent Developments in the `Sociology of Mental Illness'"

T HIS special issue of the Journal of Health and Social Behavior focuses upon the Sociology of Mental Illness. The four sub-areas of the Sociology of Mental Illness operationalized for investigation within this issue were (1) estimates of the incidence and prevalence of mental illness in socioculturally defined populations; (2) investigations of sociocultural and social-psychological factors in the etiology of mental illness; (3) studies describing patterns of response by ill persons to their disorders, or those investigating sociocultural and social-psychological influences upon such responses; and (4) studies describing the responses of others (e.g., primary group members, psychiatrists, and public agencies) to the mentally ill, or those investigating sociocultural and social-psychological influences upon the nature of others' responses to mental illness. Four scholars widely acknowledged as experts within their particular fields were invited to submit papers dealing with recent developments in each sub-area. Thus, within this issue, Leo Srole, in considering the estimation of incidence and prevalence of mental disorder, describes changes in socio-psychiatric epidemiology he views as being in process since World War I I. The Midtown Manhattan Stuidy and the restudy of this population twenty years later are treated as a case history reflecting these changes. He also presents the first report of findings from his restudy. These findings include comparisons of the distributions of mental health ratings in the years 1954 and 1974 both for the total populations and for the respondent sub-cohorts 40-59 years of age in 1954 and 1974. Bi-rice Dohrenwend considers the etiological significance of sociocultural and social-psychological factors in the occurrence and distribution of functional psychiatric disorders through an examination of three bodies of evidence: (1) epidemiological studies of the true prevalence of psychiatric disorders; (2) literature dealing with individual reactions to extreme situations; and (3) investigations of relationships between psychopathology and more ordinary stressful life events. He aids our increasing understanding of the role of sociocultural and socialpsychological factors in the development of mental disorders by offering suggestions about the identification of quasiexperimental strategies, the adoption of unusual sampling plans, and the employment of prospective research designs. David Mechanic places the area of personal responses to psychological disorder within the broader context of the study of social selection, an aspect of sociological theory. He reviews four types of studies through which investigators seek understanding of the processes of individual responses to symptoms and select pathways for care, and considers methodological problems in executing studies about factors affecting personal responses to mental illness. He also evaluates the state of the relevant literature, and provides a frame of reference as a point of departure for further research. In the final paper, John Clausen and Carol Huffine offer a number of generalizations about social responses to mental illness. Those generalizations were based upon considerations of historical and anthropological evidence alnd of findings from systematic studies about fac-

Corrosion Test of Steel Piling in Sea Water

This paper describes an installation of pile-test specimens installed cooperatively by the National Bureau of Standards and the Coastal Engineering Research Center in 1967 to study corrosion and protection of steel piling installed in sea water. Ninety-six 8-in. cylindrical piles were installed in the ocean at Dam Neck, VA. The piles are installed in sets of three. The test includes bare piles, coated piles with sacrificial anodes. Data will be obtained on the piles by pulling one of each set of three at 5-year intervals for detailed analysis of corrosion and abrasion damage. Data is also gathered annually by visual inspection, photographs and electrical measurements. The first report of findings is scheduled for 1973. Information obtained obtained from this installation should aid in estimating the life of steel piling with and without various forms of protection in similar marine environments.

Industrial Noise and Hearing Loss in a Controlled Population: First Report of Findings

(1958). Industrial Noise and Hearing Loss in a Controlled Population—First Report of Findings. American Industrial Hygiene Association Journal: Vol. 19, No. 4, pp. 296-312.

Industrial noise and hearing loss in a controlled population; first report of findings.

(1958). Industrial Noise and Hearing Loss in a Controlled Population—First Report of Findings. American Industrial Hygiene Association Journal: Vol. 19, No. 4, pp. 296-312.

The Precipitin-Ring Test Applied to Fungi.

During a study of the phenomena of resistance and susceptibility of plants to pathic events, experiments have been made to determine whether serological techniques could be used as tools for the study of phytopathogenic microparasites, and of their parasitic and pathogenic relations to plants. In the course of experiments from 1925 to 1928 it was found that in many cases serological specificity of phytopathogenic schizomycetes as manifested in the agglutination test apparently is correlated with host, and even symptom specificity within the same host. Incidentally, Sharp made the first report of finding a smooth virulent, and a rough avirulent strain of a phytopathogenic bacterium, Phytomonus phaseoli sojense, which parasitizes the soy bean plant.1We chose next to determine whether serological techniques could be used in the study of phytopathogenic fungi and their nonpathogenic taxonomic allies.† To put the methods to severe test we chose to begin with members of the form genus Fusarium, phytopathogenica...