Large Program Research Articles

Implementation and Evaluation of a Pilot Narrative Medicine Curriculum for Internal Medicine Residents.

Background Narrative medicine has been integrated into medical training to enhance competencies such as observation, reflection, and self-care. However, few studies have assessed the impact of a single narrative medicine session using a pre- and post-test study design. The authors of this study sought to implement a pilot narrative medicine curriculum into a large internal medicine residency program and to evaluate its feasibility and impact. Methodology The curriculum consisted of a one-hour reading and writing workshop held during ambulatory academic half-days from 2021 to 2022. Resident participants completed a retrospective pre- and post-workshop survey evaluatingtheir interest and confidence in practicing narrative medicine skills, as well as their beliefs about theimpacts of narrative medicine on patient care and provider well-being. Descriptive statistics evaluated pre- and post-workshop differences using the Wilcoxon signed-rank test. Subgroup analyses were conducted based on postgraduate year, residency track, and workshop setting. Additionally, participants completed open-ended questions that were analyzed qualitatively. Results Of 218 resident participants, 152 (69.7%) completed the post-session survey. Participants noted significantly higher levels of confidence and interest in listening to patient stories, analyzing literary texts, and engaging in reflective writing after the workshop. They also expressed significantly higher levels of agreement that engaging in literary analysis and reflective writing could improve patient care, reduce provider burnout, and strengthen connectedness with colleagues. Qualitative analysis demonstrated that participants found the sessions to be worthwhile and appreciated how narrative medicine could enhance their medical practice. Conclusions Incorporating a brief narrative medicine curriculum into an internal medicine residency program is both feasible and valuable. A single narrative medicine session was practical and well-received by residents, as it promoted self-reflection, observational skills, and connection with colleagues. Future workshops should be customized for different training levels and residency tracks, and additional studies should evaluate whether the outcomespersist over time.

Real-World Cervical Cancer Screening Uptake and Predictors of Visual Inspection With Acetic Acid Positivity Among Women Living With HIV in Care Programs in Western Kenya.

To achieve the WHO cervical cancer elimination targets, countries globally must achieve 70% cervical cancer screening (CCS) coverage. We evaluated CCS uptake and predictors of screening positive at two public HIV care programs in western Kenya. From October 2007 to February 2019, data from the Family AIDS Care and Education Services (FACES) and Academic Model Providing Access to Healthcare (AMPATH) programs in western Kenya were analyzed. The study population included women age 18-65 years enrolled in HIV care. Screening uptake was calculated annually and overall, determining the proportion of eligible women screened. Multivariate logistic regression assessed predictors of positive screening outcomes. There were 57,298 women living with HIV (WLWHIV) eligible for CCS across both programs during the study period. The mean age was 31.4 years (IQR, 25.9-37.8), and 39% were on antiretroviral therapy (ART) at the first CCS-eligible visit. Of all eligible women, 29.4% (95% CI, 29.1 to 29.8) underwent CCS during the study period, 27.0% (95% CI, 26.5 to 27.4) in the AMPATH program, and 35.6% (95% CI, 34.9 to 36.4) in the FACES program. Annual screening uptake varied greatly in both programs, with coverage as low as 1% of eligible WLWHIV during specific years. Age at first screening, CD4 count within 90 days of screening, current use of ART, and program (AMPATH v FACES) were each statistically significant predictors of positive screening. CCS uptake at two large HIV care programs in Kenya fell short of the WHO's 70% screening target. Screening rates varied significantly on the basis of the availability of funding specific to CCS, reflecting the limitations of vertical funding programs.

Filamentary Network and Magnetic Field Structures Revealed with BISTRO in the High-mass Star-forming Region NGC 2264: Global Properties and Local Magnetogravitational Configurations

We report 850 μm continuum polarization observations toward the filamentary high-mass star-forming region NGC 2264, taken as part of the B-fields In STar forming Regions Observations large program on the James Clerk Maxwell Telescope. These data reveal a well-structured nonuniform magnetic field in the NGC 2264C and 2264D regions with a prevailing orientation around 30° from north to east. Field strength estimates and a virial analysis of the major clumps indicate that NGC 2264C is globally dominated by gravity, while in 2264D, magnetic, gravitational, and kinetic energies are roughly balanced. We present an analysis scheme that utilizes the locally resolved magnetic field structures, together with the locally measured gravitational vector field and the extracted filamentary network. From this, we infer statistical trends showing that this network consists of two main groups of filaments oriented approximately perpendicular to one another. Additionally, gravity shows one dominating converging direction that is roughly perpendicular to one of the filament orientations, which is suggestive of mass accretion along this direction. Beyond these statistical trends, we identify two types of filaments. The type I filament is perpendicular to the magnetic field with local gravity transitioning from parallel to perpendicular to the magnetic field from the outside to the filament ridge. The type II filament is parallel to the magnetic field and local gravity. We interpret these two types of filaments as originating from the competition between radial collapsing, driven by filament self-gravity, and longitudinal collapsing, driven by the region's global gravity.

Galaxy cluster mass bias from projected mass maps

The determination of the mass of galaxy clusters from observations is subject to systematic uncertainties. Beyond the errors due to instrumental and observational systematic effects, in this work we investigate the bias introduced by modelling assumptions. In particular, we consider the reconstruction of the mass of galaxy clusters from convergence maps employing spherical mass density models. We made use of THE THREE HUNDRED simulations, selecting clusters in the same redshift and mass range as the NIKA2 Sunyaev-Zel’dovich Large Programme sample: 3 ≤ M500/1014 M⊙ ≤ 10 and 0.5 ≤ z ≤ 0.9. We studied different modelling and intrinsic uncertainties that should be accounted for when using the single cluster mass estimates for scaling relations. We confirm that the orientation of clusters and the radial ranges considered for the fit have an important impact on the mass bias. The effect of the projection adds uncertainties to the order of 10–16% to the mass estimates. We also find that the scatter from cluster to cluster in the mass bias when using spherical mass models is less than 9% of the true mass of the clusters.

Near vision data and near correction requirements from community eye health programmes in nine countries.

Recent estimates of global prevalence of uncorrected presbyopia range from 510 to 826 million. There is a shortage of primary data regarding Near Visual Impairment (NVI) magnitude. Near visual acuity (NVA) and NVI data was collected from over 388,000 people aged 35 or over across 9 countries, within Community Eye Health programmes between January 2022 and June 2023. In Kenya (n = 34,328), dioptric power of required near correction was also recorded, and any association with age, gender or level of NVA was assessed via linear regression model. 146,801 of 388,939 people failed initial near vision screening (37.74%, 95% CI 37.59-37.89%), with significantly higher prevalence of NVI in Sub-Saharan Africa than South Asia. Of those with distance acuity 6/12 or better, 27.97% failed (95% CI 27.81-28.13%) with evidence of difference between genders (p < 0.001): 30.77% of women vs. 24.47% of men. The most commonly required dioptric powers of correction were +2.00D, +2.50D and +3.00D, and required power correlated with age and NVA. NVI remains common among Community Eye Health programme participants aged 35 and over. Data from large scale programmes such as these provide an opportunity to contribute to more accurate epidemiological estimates, and to guide future research, resource planning and intervention, ideally with improved standardisation of testing in the future.

Fiscal policy with an informal sector

On the eve of its sovereign debt crisis in 2010, Greece initiated a large fiscal consolidation program. By 2015, official GDP had fallen to 26% below its 2009 level. We feed the actual fiscal package in the DSGE model of the Bank of Greece, augmented to include an informal sector, to assess the contribution of the fiscal package as well as of its individual tax and spending components. The model explains the bulk of the cumulative reduction in economic activity, and attributes roughly half of the decline to government spending measures and the other half to tax increases. The interaction of a large fiscal adjustment with a large and elastic informal sector proved lethal. Our model predicts that had growth in shadow activities been contained, the vicious circle between fiscal adjustment, tax revenue and macroeconomic activity could have been significantly mitigated, resulting in a considerably milder downturn.

Solving Resource Allocation Problem in Wifi Network by Dantzig-Wolfe Decomposition Algorithm

Online advertising and advancements is a recent trend in marketing technology, in this context we consider a new form of contract which allows advertisers to specify in the Wifi system. Based on the structure of the system, we have to organize and manage resource allocation such that the guaranteed display is satisfied. We introduce a new mathematical model and develop an optimization framework that aims to optimize “fairness” of allocation each campaign over its targeted location. Because of large scale problem, the Dantzig-Wolfe decomposition is proposed for solving it. Dantzig-Wolfe decomposition is a technique for dealing with large scale linear programming and modified to solve linear integer programming, nonlinear programming. Especially, it is used mostly in linear programming when its size is very large, and its structure is appropriate. The technique has been successfully applied in a variety of contexts. In this paper, we introduce a new model of a resource allocation problem in Wifi network and represent Dantzig-Wolfe decomposition for solving this problem by dividing the number of advertisement impressions when users access the Wifi network. The numerical simulation shows the efficiency of our proposed method.

Compositional diversity in visual concept learning

Humans leverage compositionality to efficiently learn new concepts, understanding how familiar parts can combine together to form novel objects. In contrast, popular computer vision models struggle to make the same types of inferences, requiring more data and generalizing less flexibly than people do. Here, we study these distinctively human abilities across a range of different types of visual composition, examining how people classify and generate “alien figures” with rich relational structure. We also develop a Bayesian program induction model which searches for the best programs for generating the candidate visual figures, utilizing a large program space containing different compositional mechanisms and abstractions. In few shot classification tasks, we find that people and the program induction model can make a range of meaningful compositional generalizations, with the model providing a strong account of the experimental data as well as interpretable parameters that reveal human assumptions about the factors invariant to category membership (here, to rotation and changing part attachment). In few shot generation tasks, both people and the models are able to construct compelling novel examples, with people behaving in additional structured ways beyond the model capabilities, e.g. making choices that complete a set or reconfigure existing parts in new ways. To capture these additional behavioral patterns, we develop an alternative model based on neuro-symbolic program induction: this model also composes new concepts from existing parts yet, distinctively, it utilizes neural network modules to capture residual statistical structure. Together, our behavioral and computational findings show how people and models can produce a variety of compositional behavior when classifying and generating visual objects.

Making the EHR Work for You-Modifications of an Electronic Health Record System to Improve Tracking and Management of Patients Receiving Outpatient Parenteral Antibiotic Therapy.

Managing the complex needs of outpatient parenteral antibiotic therapy (OPAT) patients is challenging and time-consuming. We describe development of multimodal interventions to facilitate patient management within an Epic® (Epic Systems Corporation)-based electronic health record (EHR) platform. During 2016-2018, a multidisciplinary team created several modifications in our local EHR to improve gaps in OPAT care, including shared note templates, shared patient lists, automatically triggered notifications, and comprehensive order sets. A SmartForm was created, allowing collection of discrete, self-contained extractable data about each OPAT episode. We reviewed OPAT episodes from January 2019 through December 2022. The multimodal EHR interventions culminated in the creation of a patient report, the "OPAT Monitoring View" collating OPAT-relevant data from multiple sections of the chart onto 1 screen display. This view is accessible both within the patient chart and from multiple list-based, in-basket, and snapshot-anchored preview functions in the EHR. Implementation of the EHR bundle facilitated management of 3402 OPAT episodes from 2019 to 2022 (850 episodes/year), about 50% higher than anticipated based on 540 OPAT courses in 2016. The OPAT EHR bundle allowed efficient (<3 hours) multidisciplinary rounds for management of 130-145 patients each week, streamlining of care transitions, and increasing staff satisfaction. Bundled multimodal modifications to the local EHR increased patient care efficiency and staff satisfaction and facilitated data collection to support a large OPAT program. These modifications apply commonly available EHR functionalities to OPAT care and could be adapted to other settings with different EHR platforms.

Leveling the field: Development of an asynchronous interactive module series for genetic counseling trainees on molecular testing and variant interpretation.

The need for education focusing on genomic technologies and variant interpretation for genetic counseling trainees has prompted genetic counseling training programs to alter their curricula to incorporate this content. Given students' diverse experiences prior to matriculation into genetic counseling training programs, students' familiarity with these topics may vary. Following receipt of feedback from trainees at a large genetic counseling program regarding an existing course focused on molecular technologies, a three-part asynchronous module series was created as a prerequisite to this course as an opportunity to align knowledge. Designed to be completed by students on their own time and at their own pace, the modules allowed for additional instruction without increases in classroom time or credit hours. Content included a refresh on genetics concepts and an introduction to available genetics resources for developing a differential diagnosis as well as variant interpretation framework. Modules utilized a clinical scenario to anchor learning with interactive content, allowing students to progress at their own pace and explore content as they found necessary. Completion of this asynchronous module series was required by incoming first-year students prior to the start of the academic semester. Following completion, students were asked to provide feedback on the module series. Reviews were primarily positive with students indicating that while the content was not entirely new, they found the review valuable and would be likely to reference the modules later in their genetic counseling training. Areas identified for improvement included additional detail regarding genetic testing methods as well as adjusting the interactive content to ensure accessibility for all students and systems. Taken together, the development and implementation of this asynchronous series as an additional component to genetic counseling training was considered a success and this approach can be considered to address additional topics dependent on a programs' needs.

Preliminary Development of a Program ABSITE Dashboard (PAD) to Guide Curriculum Innovation

Medical Knowledge for general surgery residents' is assessed by the American Board of Surgery In- Training Examination (ABSITE). ASBITE score reports contain many metrics residency directors can utilize to assess resident progress and perform program evaluation. The purpose of this study was to develop a framework to evaluate program effectiveness in teaching specific subtest and subtopic areas of the ABSITE, using ABSITE score reports as an indicator. The aim is to demonstrate the identification of topic areas of weakness in program-wide performance on the ABSITE to guide proposed modification of the general surgery residency program curriculum, and to initiate development of a data visualizing dashboard to communicate these metrics. A single institution retrospective study was performed utilizing ABSITE score reports from general surgery residents at a large academic training program from 2017 to 2020. ABSITE performance metrics from 320 unique records were entered into a database; statistical analysis for linear trends and variance were conducted for standard scores, subtest standard scores, and incorrect subtest topics. Deviation from national average scores were calculated by subtracting the national average score from each subtest score for each trainee. Data were displayed as medians or proportions and are displayed to optimize visualization as a proof-of-concept for the development of a program dashboard. Trends and variance in general surgery program and cohort performance on various elements of the ABSITE were visualized using figures and tables that represent a prototype for a program dashboard. Figure A1 demonstrates one example, in which a heatmap displays the median deviation from national average scores for each subtest by program year. Boxplots show the distribution of the deviation from national average, range for national average scores, and the recorded scores for each subtest by program year. Trends in median deviation from the national average scores are displayed for each program year paneled by subtest or for each exam year paneled by cohort. Median change in overall test scores from one program year to another in a cohort is visualized as a table. Bar graphs show the most often missed topics across all program years and heatmaps were generated showing the proportion of times each topic was missed for each subtest and exam year. We demonstrate use of ABSITE reports to identify specific thematic areas of opportunities for curriculum modification and innovation as an element of program evaluation. In this study we demonstrate, through data analysis and visualization, feasibility for the creation of a Program ABSITE Dashboard (PAD) that enhances the use of ABSITE reports for formative program evaluation and can guide modifications to surgery program curriculum and educational practices.

The Impact of Completing X-Waiver Training and Clinical Addiction Exposure on Internal Medicine Residents Treating Patients With Opioid Use Disorder.

Treating opioid use disorder (OUD) with buprenorphine or methadone significantly reduces overdose and all-cause mortality. Prior studies demonstrate that clinicians and residents reported a lack of preparedness to diagnose or treat OUD. Little is known about how clinical exposure or buprenorphine X-waiver training impacts OUD care delivery by resident physicians. Distinguish the effects of X-waiver training and clinical exposure with OUD on resident's knowledge, attitudes, feelings of preparedness, and practices related to OUD treatment provision. From August 2021 to April 2022, we distributed a cross-sectional survey to internal medicine residents at a large academic training program. We analyzed associations between self-reported clinical exposure and X-waiver training across 4 domains: knowledge about best practices for OUD treatment, attitudes about patients with OUD, preparedness to treat OUD, and clinical experience with OUD. Of the 188 residents surveyed, 91 responded (48%). A majority of respondents had not completed X-waiver training (60%, n = 55) while many had provided clinical care to patients with OUD (65%, n = 59). Most residents had favorable attitudes about OUD treatment (97%). Both residents with clinical exposure to treating OUD and X-waiver training, and residents with clinical exposure without X-waiver training, felt more prepared to treat OUD (P < .0008) compared to residents with neither clinical exposure or X-waiver training or only X-waiver training. Residents with clinical exposure to treating OUD are more prepared to treat patients with OUD than those without clinical exposure. Greater efforts to incorporate clinical exposure to the treatment of OUD and education in internal medicine residency programs is imperative to address the opioid epidemic.

Sound power determination by intensity-Are field indicators and criteria in ISO 9614 meaningful?

The three parts of ISO 9614 describe methods for the determination of the sound power level of noise sources. According to these standards, measured sound power levels must be qualified by comparing several sound field indicators to given criteria. This procedure is investigated by analytical calculations with monopole and dipole sources. Their sound fields are superposed with extraneous free and diffuse sound fields. When the ISO 9614 method is applied to these cases, it turns out that the signed pressure intensity indicator is well suited to qualify the measured sound power level. In contrast to this, the unsigned pressure intensity indicator and the field non-uniformity indicator fail to describe the quality of the determined sound power level. This theoretical finding is verified by a large measurement program.

A Comparison of Large Language Models and Genetic Programming for Program Synthesis

A Comparison of Large Language Models and Genetic Programming for Program Synthesis

Innovative Integer Programming Software and Methods for Large-Scale Routing at DHL Supply Chain

DHL Supply Chain North America helped by the Ohio State University developed and implemented a suite of software called the Transportation Network Optimizer. The four modules relate to the same large scale vehicle routing integer programming including outsourcing. The software helped DHL save over $116M through improved bidding and outsourcing by reducing fuel and personnel costs.

The Effect of Flipped Interactive Learning (FIL) Based on ChatGPT on Students’ Skills in a Large Programming Class

Flipped Learning (FL) inverts traditional teaching by delivering content online outside the classroom, allowing class time for interactive, hands-on activities. This approach enhances student engagement and understanding. The integration of AI in education has revolutionized traditional teaching methods. Enhancing FL with AI has led to the emergence of what was labeled in this research paper as Flipped Interactive Learning (FIL), which integrates AI-driven tools to support and enrich interactive, personalized learning experiences. This study aimed to examine the impact of the FIL instructional model based on Chat Generative Pre-Trained Transformer (ChatGPT) on students’ programming skills in an undergraduate course. The participants in this study were 74 students. This study used a semi-experimental research design; the control group consisted of 36 students, while the experimental group consisted of 38 students. The experimental group received instruction using the FIL method while the control group received instruction using the conventional FL method. The analysis of the collected data showed that using FIL-based ChatGPT contributed significantly to improving students’ programming skills. Based on the findings of this study, educational institutions should adopt the FIL instructional model in academic settings in general and programming courses in particular, as it significantly improves student learning outcomes compared to conventional FL methods. In addition, institutions should also evaluate the FIL model’s scalability and allocate necessary resources, such as technology infrastructure and support staff, for successful implementation. Further research should identify the most effective components of the FIL model to refine it for broader use. Moreover, continuous student feedback is essential for iterative improvements to meet their needs.

ATOMIUM: Molecular inventory of 17 oxygen-rich evolved stars observed with ALMA

Context. The dusty winds of cool evolved stars are a major contributor of the newly synthesised material enriching the Galaxy and future generations of stars. However, the details of the physics and chemistry behind dust formation and wind launching have yet to be pinpointed. Recent spatially resolved observations show the importance of gaining a more comprehensive view of the circumstellar chemistry, but a comparative study of the intricate interplay between chemistry and physics is still difficult because observational details such as frequencies and angular resolutions are rarely comparable. Aims. Aiming to overcome these deficiencies, ATOMIUM is an ALMA Large Programme to study the physics and chemistry of the circumstellar envelopes of a diverse set of oxygen-rich evolved stars under homogeneous observing conditions at three angular resolutions between ~0.02″−1.4″. Here we summarize the molecular inventory of these sources, and the correlations between stellar parameters and molecular content. Methods. Seventeen oxygen-rich or S-type asymptotic giant branch (AGB) and red supergiant (RSG) stars have been observed in several tunings with ALMA Band 6, targeting a range of molecules to probe the circumstellar envelope and especially the chemistry of dust formation close to the star. We systematically assigned the molecular carriers of the spectral lines and measured their spectroscopic parameters and the angular extent of the emission of each line from integrated intensity maps. Results. Across the ATOMIUM sample, we detect 291 transitions of 24 different molecules and their isotopologues. This includes several first detections in oxygen-rich AGB/RSG stars: PO v = 1, SO2 v1 = 1 and v2 = 2, and several high energy H2O transitions. We also find several first detections in S-type AGB stars: vibrationally excited HCN v2 = 2,3 and SiS v = 4,5,6, as well as first detections of the molecules SiC, AlCl, and AlF in W Aql. Overall, we find strong correlations between the following molecular pairs: CS and SiS, CS and AlF, NaCl and KCl, AlO and SO, SO2 and SO, and SO2 and H2O; meaning both molecules tend to have more detected emission lines in the same sources. The measured isotopic ratios of Si and S are found to be consistent with previous measurements, except for an anomalously high 29Si/30Si ratio of 4 ± 1 in the RSG VX Sgr. Conclusions. This paper presents the overall molecular inventory and an initial analysis of the large ATOMIUM dataset, laying the groundwork for future work deriving molecular abundances and abundance profiles using radiative transfer modeling which will provide more rigorous tests for chemical models.

IRIS - The Italian research infrastructure on Applied Superconductivity for Particle Accelerators and Societal Applications

The Italian Minister for University and Research has recently funded a large program for an Innovative Research Infrastructure on applied Superconductivity (IRIS) in Italy. Based on the LASA laboratory in Milan, it is a partnership, in the form of a strongly coordinated work, of existing laboratories of various institutes: INFN (leader, participating with 4 labs: Frascati, Genoa, Milan, Salerno); CNR (SPIN institute in Genoa, Naples and Salerno); five Universities: Genoa, Milan, Naples, Salento and Salerno. IRIS will be an upgrade of existing infrastructures, with new state-of-the-art instruments, reinforcing the capability of Italy in the domain of superconductivity aimed to accelerators. IRIS foresees a strong coordination of the activity of the participating laboratories until 2035, at least, thus enhancing the participation of Italian laboratories to future projects requiring advanced superconducting technology, like FCC or the Muon-Collider, and also for developing societal applications of technologies, pursued for high-energy accelerators, especially for the energy domain and the medical sector. In this paper, we present the two novel demonstrators, part of the initial IRIS program: 1) a green superconducting line, 130 m long and designed for 40 kA current capability at 25 kV; 2) a 1 m long HTS dipole magnet with some characteristics similar to LHC dipoles: 10 T, 50 mm × 80 mm bore, but operating at 20 K rather than 1.9 K.

GC-MS based chemical fingerprinting large cardamom cultivars of Sikkim

Amomum subulatum Roxb, also known as large cardamom, is an herbaceous plant cultivated in Sikkim, India for its aromatic seeds with diverse applications in food, beverages, perfumery, and medicine. In this study, we aimed at Gas chromatography–mass spectrometry (GC-MS) based chemical fingerprinting through analyzing volatile compounds in seeds and assess the relatedness among seven large cardamom cultivars grown in the Sikkim hill region. We examined the phytochemical composition of large cardamom seed extract using GC/MS analysis. The results indicated significant differences in volatile compounds among the cultivars. The major bioactive components unravelled were 1,8-cineole (76.37-90.63%), α-terpineol (1.73-13.40%), α-terpinolene (0.23-11.51%), β-pinene (0.54-4.13%), γ-terpinolene (0.77-4.47%), and α-pinene (0.35-1.86%), which possess notable antioxidant, anti-inflammatory as well as antibacterial properties. Principal component analysis (PCA) and dendrogram analyses revealed similarity of large cardamom cultivar ICRI SKM-1 with ICRI SKM-2 and Seremna while showed close relatedness among the cultivars such as Ramsey, Ramla, and Sawney based on their phytochemical composition. These findings have important implications for large cardamom breeding programme. The findings of this study also elucidated the potentiality of large cardamom seed extracts for commercial applications in various industries, including medicine, food, and cosmetics.

Utilization of Metarhizium as an insect biocontrol agent and a plant bioinoculant with special reference to Brazil.

Brazil has a long history of using biological control and has the largest program in sugarcane agriculture to which a biocontrol program has been applied. This achievement is at least partly due to the utilization of the entomopathogenic fungus Metarhizium. This well-known fungal genus exhibits pathogenicity against a broad range of arthropod hosts and has been used globally as a biocontrol agent. This fungus is also a root symbiont, and in this capacity, it is a plant growth promoter. However, this feature (i.e., as a plant symbiont) has yet to be fully explored and implemented in Brazil, although the number of reports demonstrating Metarhizium's utility as a plant bioinoculant is increasing. The Brazilian bioproduct industry targets agricultural pests, and is limited to two Metarhizium species represented by four fungal isolates as active ingredients. Entomopathogenic fungi have also been successful in controlling arthropods of public health concern, as shown in their control of mosquitoes, which are vectors of diseases. The isolation of new indigenous Metarhizium isolates from a variety of substrates such as soil, insects, and plants shows the wide genetic diversity within this fungal genus. In this review, we emphasize the significance of Metarhizium spp. for the biological control of insects in Brazil. We also suggest that the experience and success of biological control with fungi in Brazil is an important resource for developing integrated pest management and sustainable strategies for pest control worldwide. Moreover, the future implementation prospects of species of Metarhizium being used as bioinoculants and possible new advances in the utility of this fungus are discussed.