摘要： More than 7% of medical students graduate from medical school with at least 1 nonspouse dependent, the majority of whom are likely children. However, there are no national studies on medical students who are parents, and very little is known about what medical schools are doing to support them. A growing literature on the experiences of residents and attending physicians who are parents has neglected to include those of medical students who are parents. It is possible that focusing on research and policy change for residents and attending physicians who are parents without considering medical students may bring about improvements that come too late for many. Further data are needed both on the available policies for students who are parents and on the experiences and needs of these students. Leading national organizations in medical education can help guide medical schools by leveraging their national networks to highlight existing best practices and to foster discussions about how best to support medical students who are parents.

关键词： focus groups   urinary tract infections   grounded theory   frustration   quality of life  

摘要： Purpose: We investigated the perspectives of women suffering from recurrent urinary tract infections using patient focus group discussions with an emphasis on patient attitudes toward the current prevention and treatment of urinary tract infection episodes. Materials and Methods: Twenty-nine women with recurrent urinary tract infections were recruited from a tertiary urology practice to participate in one of 6 focus groups. Participants were asked questions related to urinary tract infection knowledge, prevention strategies, treatment and impact on quality of life. Grounded theory methods were used to analyze focus group transcripts and identify preliminary themes that describe patient attitudes toward current management strategies for recurrent urinary tract infections. Results: The median age of participants was 46 years (range 20-81). The majority were Caucasian and held a college degree. The 7 preliminary themes identified during discussions fell into 2 categories: 1) negative impacts of taking antibiotics for prevention and treatment of recurrent urinary tract infections, and 2) resentment of the medical profession regarding their management of recurrent urinary tract infections. From the preliminary themes, the emergent concepts of "fear" and "frustration" became evident. Conclusions: Focus group discussions of women with recurrent urinary tract infections suggest that many women are fearful of the adverse effects of antibiotics and are frustrated with the medical profession for not addressing their fears and optimizing antibiotic stewardship. There is a need for physicians to modify management strategies to address these concerns and to devote more research efforts to improving the nonantibiotic options for prevention and treatment of recurrent urinary tract infections, as well as management strategies that better empower patients.

关键词： Multisystem inflammatory syndrome in children   MIS-C   COVID-19   SARS-CoV-2   whole exome sequencing  

摘要： Background: Multisystem inflammatory syndrome in children (MIS-C) is a pediatric complication of severe acute respiratory syndrome coronavirus 2 infection that is characterized by multiorgan inflammation and frequently by cardiovascular dysfunction. It occurs predominantly in otherwise healthy children. We previously reported haploinsufficiency of suppressor of cytokine signaling 1 (SOCS1), a negative regulator of type I and II interferons, as a genetic risk factor for MIS-C. Objectives: We aimed to identify additional genetic mechanisms underlying susceptibility to severe acute respiratory syndrome coronavirus 2-associated MIS-C. Methods: In a single-center, prospective cohort study, whole exome sequencing was performed on patients with MIS-C. The impact of candidate variants was tested by using patients' PBMCs obtained at least 7 months after recovery. Results: We enrolled 18 patients with MIS-C (median age = 8 years;interquartile range = 5-12.25 years), of whom 89% had no conditions other than obesity. In 2 boys with no significant infection history, we identified and validated hemizygous deleterious defects in XIAP, encoding X-linked inhibitor of apoptosis, and CYBB, encoding cytochrome b-245, beta subunit. Including the previously reported SOCS1 haploinsufficiency, a genetic diagnosis was identified in 3 of 18 patients (17%). In contrast to patients with mild COVID-19, patients with defects in SOCS1, XIAP, or CYBB exhibit an inflammatory immune cell transcriptome with enrichment of differentially expressed genes in pathways downstream of IL-18, oncostatin M, and nuclear factor KB, even after recovery. Conclusions: Although inflammatory disorders are rare in the general population, our cohort of patients with MIS-C was enriched for monogenic susceptibility to inflammation. Our results support the use of next-generation sequencing in previously healthy children who develop MIS-C.

关键词： Sambucus nigra   Elder   Flower   Berries   Influenza   Cold  

摘要： Common cold and flu are caused by common respiratory viral pathogens, which results in hospitalization and death in the world. Among the viral infections, influenza viruses have worldwide spread with major effects on health of societies. Change in antigenic structures of influenza viruses is associated with the lack of effective treatments. Therefore, the use of herbal medicine as alternative choice can be used for management of flu and cold. The flowers ofSambucus nigraor black elders have been approved by commission E for cold, and flu. Although, elders are used in different herbal formulates, but there is no comprehensive study. The subject of this review article was to summarize the efficacy of black elder in treatment of cold and flu. For preparing this manuscript, the electronic resources, books, and thesis were searched by key words of Sambucus, elder, cold, flu, and viral infections. The results of investigations exhibited that there are four clinical trials for elder berries, which it reduced the cold duration and severity (fever, pain, congestion, cough), while there is no clinical trial for elder flower on common cold and flu in spite of its approval by commission E. So, evaluating the efficacy of elder flowers in comparison with its berries and standard treatment on patients with viral respiratory infections should be the subject of large clinical studies.

摘要： The term "health systems science" (HSS) has recently emerged as a unifying label for competencies in health care delivery and in population and community health. Despite strong evidence that HSS competencies are needed in the current and future health care workforce, heretofore the integration of HSS into medical education has been slow or fragmented-due, in part, to a lack of evidence that these curricula improve education or population outcomes. The recent COVID-19 pandemic and the national reckoning with racial inequities in the United States further highlight the time-sensitive imperative to integrate HSS content across the medical education continuum. While acknowledging challenges, the authors highlight the unique opportunities inherent in an HSS curriculum and present an elaborated curricular framework for incorporating health care delivery and population health into undergraduate medical education. This framework includes competencies previously left out of medical education, increases the scope of faculty development, and allows for evidence of effectiveness beyond traditional learner-centric metrics. The authors apply a widely adopted 6-step approach to curriculum development to address the unique challenges of incorporating HSS. Two examples-of a module on quality improvement (health care delivery) and of an introductory course on health equity (population and community health)illustrate how the 6-step approach can be used to build HSS curricula. The Supplemental Digital Appendix (at http://***/ACADMED/B106) outlines this approach and provides specific examples and resources. Adapting these resources within local environments to build HSS curricula will allow medical educators to ensure future graduates have the expertise and commitment necessary to effect health systems change and to advocate for their communities, while also building the much-needed evidence for such curricula.

关键词： Mechanical Engineering  

摘要： Non-oriented electrical steel is a core component in the construction of rotating electrical machines for the targeted guidance and amplification of the magnetic flux. A strong magnetic coupling between rotor and stator flux is crucial for the maximization of the efficiency and power density of the electric drives. For this purpose, flux barriers are inserted into permanent magnet excited synchronous machines and synchronous reluctance machines in order to suppress leakage flux and to ensure targeted guidance of the magnetic flux. The flux barriers are typically implemented through cutouts in the rotor cross-section. The resulting filigree structures of the electrical steel lead to a mechanical weakening of the rotor and thus to lower achievable speeds and power densities. In this work an alternative approach for guiding the magnetic flux based on the Villari effect is presented. Locally changed magnetic material properties are achieved through increased residual stresses in the embossed material areas. The relationship between residual mechanical stresses introduced by the forming process and the reduced magnetic permeability of the electrical steel sheet is investigated using homogeneously embossed samples. Higher forming forces associated with increased mechanical stresses lead to a greater reduction in magnetic permeability. The functionality of these alternative magnetic flux barriers is shown using circular embossed patterns. In addition to showing the influence of varying stamping parameters on the magnetic properties of the electrical steel sheet, the reproducibility of the changed magnetic properties due to residual stresses caused by the forming process is demonstrated.