Descriptive statistics are used to summarize data in an organized manner by describing the relationship between variables in a sample or population. Calculating descriptive statistics represents a vital first step when conducting research and should always occur before making inferential statistical comparisons. Descriptive statistics include types of variables (nominal, ordinal, interval, and ratio) as well as measures of frequency, central tendency, dispersion/variation, and position. Since descriptive statistics condense data into a simpler summary, they enable health-care decision-makers to assess specific populations in a more manageable form. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.

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Maggot debridement therapy (MDT) has a long and well-documented history. Once a popular wound care treatment, especially prior to the discovery of antibiotics, modern dressings or debridement techniques, MDT fell out of favor after the 1940s. With the increasing prevalence of chronic medical conditions and associated complex and difficult-to-treat wounds, new approaches have become necessary to address emerging issues such as antibiotic resistance, bacterial biofilm persistence and the high cost of advanced wound therapies. The constant search for a dressing and/or medical device that will control pain, remove bacteria/biofilm, and selectively debride necrotic wound material, all while promoting the growth of healthy new tissue, remains elusive. On review of the current literature, MDT comes very close to addressing all of the previously mentioned factors, while at the same time remaining cost-effective. Complications of MDT are rare and side effects are minimal. If patients and providers can look past the obvious anxiety associated with the management and presence of larvae, they will quickly see the benefits of this underutilized modality for healing multiple types of wounds. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement.

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Stereolithography or three-dimensional printing (3DP) is a fast-growing field, with increasing number of health-care applications. As an industry, stereolithography is expected to grow from an estimated $700 million to nearly $9 billion in revenue over the next few years, mainly due to continued advancements and practical implementations of the technology. More established applications of 3DP in medicine involve the creation of wearable assist devices, prosthetics, and orthotics. Research is ongoing in the area of incorporating biologic (including genetic) implementations of 3DP technology, with the long-term goal of three-dimensional printing of organs and tissues that can be subsequently implanted into human body. Given that applications of 3DP in health-care have only recently begun to proliferate, there continues to be paucity of literature in this important and rapidly evolving area of research. In the current review, we sought to present a comprehensive and most current high-level overview of 3DP, with the goal of catalyzing better general understanding and promoting research in 3DP for biomedical applications. The following core competencies are addressed in this article: Medical knowledge, Systems-Based Practice.

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The nuclear pore complex (NPC) is an important functional entity of every eukaryotic cell's nuclear membrane. It enables selective transport of materials across the nuclear membrane in an organized and orderly fashion. Substances carried in and out of the nucleus by the NPC include three major groups of molecules: (a) Messenger ribonucleic acid molecules, (b) proteins, and (c) ribonucleoproteins (RNPs). The transport across the nuclear membrane involves adenosine triphosphate hydrolysis in the great majority of cases even though certain guanosine triphosphate-hydrolyzing mechanisms have also been identified. The understanding of the NPC appears crucial to our understanding of certain pathological processes. For example, it has been found that certain human viruses can “trick” our cells into transporting their RNPs into the nucleus using signal peptides similar to the human nuclear-localizing signals. The major challenge of today's research on the NPC resides in identification of over one hundred of its distinct polypeptide units and in determining their functions and interactions. To date, many of the structural proteins involved in the NPC have been identified, but the mechanism of their interactions still remains largely hypothetical. This project discusses the structure and function of the NPC. The following core competencies are addressed in this article: Medical knowledge. Republished with permission from: Stawicki SP, Steffen JM. The nuclear pore complex: A comprehensive review of structure and function. OPUS 12 Scientist 2007;1(2):39-87.

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Retained surgical items (RSIs) are much dreaded, preventable complications associated with surgical and other invasive procedures. Despite much effort going into eliminating these “never events” and the associated heavy burden for patients, providers, and institutions, RSIs continue to occur. This manuscript reviews fundamental concepts related to RSI, including risk factors, prevention strategies, technology-assisted detection, team strategies, and pertinent safety education. In addition, we performed a secondary review of a database of all published case reports and series of RSI between 1909 and 2015, focusing on clinical presentation, symptomatology, morbidity, diagnostic workup, pathology findings, and temporal characteristics. Despite a vast body of knowledge regarding RSIs, more needs to be done to help further reduce and prevent these occurrences. The following core competencies are addressed in this article: Patient care, Medical knowledge, Practice based learning and improvement, Systems based practice, Professionalism, and Interpersonal skills and communication

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As tattoos become more common, it is likely that practitioners will encounter adverse tattoo reactions with increasing frequency. While some tattoo-related complications (TRCs) may be nonspecific and challenging to diagnose, others present overtly and can be identified quickly by a well-informed practitioner. TRCs occur at both of these extremes, highlighting the need for better awareness and knowledge sharing regarding this heterogeneous group of morbidities. This review is a result of a compilation of the best available clinical evidence across various groupings of TRCs. The authors' intent was to provide the reader with a comprehensive overview of the topic while creating a rich repository of referenced knowledge for future investigations. From the standpoint of frontline health-care providers, effective recognition and management of TRCs require an open-mind, high degree of clinical suspicion, and nonjudgmental approach to a mainstream phenomenon that is still considered by many to be a taboo. The following core competencies are addressed in this article: Medical knowledge, Patient care, and Systems-based practice.

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Key points: (a) Reexpansion pulmonary edema-RxPE– is a rare form of acute lung injury, with an incidence of approximately 1% following evacuation of a pneumothorax; (b) RxPE usually follows rapid reinflation of collapsed lung parenchyma; (c) The most common factor associated with RxPE is the duration of lung collapse– more than 3 days seems to be the critical amount of time; (d) The pathophysiologic changes associated with RxPE are complex and not yet fully understood; (e) The pathologic process results from a combination of rapid pulmonary reexpansion with concurrent mechanical alveolar injury, decrease in surfactant and regional lung tissue hypoxemia, inflammatory cell migration and release of inflammatory mediators, and the resulting changes in capillary-alveolar barrier occurring concurrently with increased capillary/hydrostatic pressures; (f) Clinical manifestations of RxPE vary from minimal symptoms to life-threatening hypoxia and cardio-respiratory collapse; (g) The patient may experience dyspnea, thoracic pain, cough with or without pink/foamy sputum, cyanosis, rales and stertors on auscultation. Other clinical symptoms may include fever, nausea, vomiting, tachycardia, and hypotension; (h) The symptoms of RxPE usually appear within the first two hours following pulmonary reexpansion, but may be delayed by as many as 24-48 h; (i) RxPE usually lasts clinically for as long as 1-2 days, but may take anywhere from 5 to 7 days to resolve; (j) Critical care practitioners should be familiar with the most common factors involved in the pathogenesis of RxPE; (k) The knowledge of these predisposing factors and the ability to effectively treat RxPE are important to prevention and treatment of this potentially fatal condition. The following core competencies are addressed in this article: Medical knowledge, Patient care. Republished with permission from: Stawicki SP, Sarani B, Braslow BM. Reexpansion pulmonary edema. OPUS 12 Scientist2008;2(2):29-31.

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Discontinuation of mechanical ventilatory support represents a milestone in the progression to patient recovery in the Intensive Care Unit (ICU). Despite advances in mechanical ventilation and respiratory support, the science of determining if the patient is ready for extubation is still very imprecise. The goal of this article is to summarize key developments in this important clinical area. The following core competencies are addressed in this article: Medical knowledge and patient care. Republished with permission from: Stawicki SP. ICU Corner – Mechanical ventilation: Weaning and extubation. OPUS 12 Scientist 2007;1(2):13-16.

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As a key component of scientific research, hypothesis testing incorporates a null hypothesis (H₀) of no difference in a larger population and an alternative hypothesis (H₁or H_A) that becomes true when the null hypothesis is shown to be false. Two potential types of statistical error are Type I error (α, or level of significance), when one falsely rejects a null hypothesis that is true, and Type II error (β), when one fails to reject a null hypothesis that is false. To reduce Type I error, one should decrease the pre-determined level of statistical significance. To decrease Type II error, one should increase the sample size in order to detect an effect size of interest with adequate statistical power. Reducing Type I error tends to increase Type II error, and vice versa. Type III error, although rare, occurs when one correctly rejects the null hypothesis of no difference, but does so for the wrong reason. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.

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Background/Aim: Tsáchilas are an indigenous group living in a rural tropical rain forest of Western Ecuador. Few studies have been conducted in Ecuador where intestinal parasite infections (IPIs) and associated risk factors have been examined. Hence, the aim of this study was to examine the prevalence of IPIs and identify the associated risk factors in Tsáchilas populations. Subjects and Methods: A cross-sectional survey was conducted from August to October 2013 in seven Tsáchilas communities. The study consisted of 586 participants, and stool samples were examined microscopically using the formalin-ether concentration technique. Results: Protozoa infections were more common than helminth infections (54.9% vs. 34.1%), and 68.1% of samples were found to contain one or more parasites. Ascaris lumbricoides was the most prevalent (29.4%), with Giardia duodenalis, Blastocystis hominis, and Entamoeba histolytica/dispar showing a prevalence of 3.9%, 19.6%, and 12.5%, respectively. Ova of Amphimerus and Paragonimus, two unexpected liver and lung flukes, respectively, were also found. A logistic model with forward selection showed the following variables to predict parasite infection: age (6–10 years) (odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.5–5.1, P = 0.001), unclean water supply (OR = 1.16, 95% CI = 1.14–2.4, P = 0.01), handwashing practice (OR = 2.5, 95% CI = 1.27–4.97, P = 0.01), and not washing food before eating (OR = 1.6, 95% CI = 1.09–2.21, P = 0.01). Conclusions: The study shows that IPIs are highly prevalent among the Tsáchilas, which might be attributed to their low socioeconomic standards and poor hygienic habits. Educating the communities on risk factors which pose the highest risk of infection, in combination with a mandatory treatment program, would significantly lower the parasitic burden. The following Graduate Medical Education core competencies were addressed: Medical knowledge, Practice-based learning, Communication skills.

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Objective: Several decades of armed conflict at a time of incredible advances in medicine have led to an acknowledgment of the importance of cognitive workload and environmental stress in both war and the health care sector. Recent advances in portable neurophysiological monitoring technologies allow for the continuous real-time measurement and acquisition of key neurophysiological signals that can be leveraged to provide high-resolution temporal data indicative of rapid changes in functional state, (i.e., cognitive workload, stress, and fatigue). Here, we present recent coordinated proof of concept pilot project between private industry, the health sciences, and the USA government where a paper-based self-reporting of workload National Aeronautics and Space Administration Task Load Index Scale (NASA TLX) was successfully converted to a real-time objective measure through an automated cognitive load assessment for medical staff training and evaluation (ACLAMATE). Methods: These real-time objective measures were derived exclusively through the processing and modeling of neurophysiological data. This endeavor involved health care education and training with real-time feedback during high fidelity simulations through the use of this artificial modeling and measurement approach supported by Aptima Corporation's FuSE², SPOTLITE, and PM Engine technologies. Results: Self-reported NASA TLX workload indicators were converted to measurable outputs through the development of a machine learning-based modeling approach. Workload measurements generated by this modeling approach were represented as a NASA TLX anchored scale of 0–100 and were displayed on a computer screen numerically and visually as individual outputs and as a consolidated team output. Conclusions: Cognitive workloads for individuals and teams can be modeled through use of feed forward back-propagating neural networks thereby allowing healthcare systems to measure performance, stress, and cognitive workload in order to enhance patient safety, staff education, and overall quality of patient care. The following core competencies are addressed in this article: Medical Knowledge, Interpersonal Skills, Patient Care, and Professionalism.

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Aims and Objectives: The aim is to study the pattern of mobile phone usage among medical students. Materials and Methods: A cross-sectional study was conducted among medical students of 2^nd year MBBS at SMS Medical College, Jaipur, Rajasthan, India. A preformed, pretested questionnaire was used. Data were analyzed statistically by simple proportions. Results: The response rate was 92.13%. Of 164 students, 96 were male and 68 were female. The mean age of students was 20.04 ± 0.67. Almost 100% of respondents had smartphones. Nearly 48% of students had downloaded medical apps on their mobile phones. The most common age group of starting internet use among the respondents was 11–20 years. Daily use of the internet was 3–6 h/day by most of the medical students. Most of the students used mobile phones for the purpose of social networking (n = 76) followed by online shopping (n = 56). About 32.92% of students used mobile for academic purpose. Nearly 59.75% of students obtained 41%–60% of marks in spite of extensively using smartphones which shows that they are rationally using their phones in improving their academic performance. The association between time in hours spent on mobile phones and marks obtained in the examination held in the past 3 months was statistically nonsignificant (χ² = 10.369, degree of freedom = 9,P= 0.321). About 57.29% of students were suffering from nomophobia (NMP), 26.82% of students were at risk of NMP, and only 13.20% of students were having no NMP. Nearly 58.53% of students had ringxiety. Conclusion: Our study gives a brief idea about the addiction of mobile phones among medical students. There is a definite need of further studies in this field. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Interpersonal and communication skills, Professionalism.

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Background: Faculty turnover is a major problem at academic medical institutions. A minority of medical school graduates choose academic careers and those that do have a high rate of attrition. Methods: We conducted an in-depth review of the medical and business literature to determine high-frequency reasons for faculty attrition, and explored what strategies have been suggested or employed to reduce this trend. Results: Medical and business literature demonstrate that faculty morale, perceptions of work-life balance, support from the institution, faculty development, rewards, protected time, relationship with superiors, and role clarity all play a role in faculty decisions to leave an institution. Institutions have shown some success in reducing attrition through recruiting to retain, formal mentorship programs, novel reward programs tied to longevity, faculty development, and attention to faculty professional and personal goals. Conclusions: Academic medical centers should conduct retention analyses to determine commonly cited reasons for attrition at the global and departmental level. Measures to improve retention can be taken at every step of the recruitment, training, and seasoned employee level. Retention efforts are guided and enhanced by open and frequent communication between faculty and administration. The following core competencies are addressed in this article: Professionalism, Practice-based learning and improvement, Systems-based practice, Interpersonal skills and communication

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Introduction: Intentional ingestions of foreign objects (IIFO) continue to be prevalent among prisoners. Our previous research examined determinants of hospital admission, endoscopy, and surgery among prisoners who ingest foreign objects. However, little is known about the financial impact of these events on healthcare facilities that service the prisoner population. This study aims to fill this gap by examining hospital charges attributable to 435 prisoner episodes of IIFO. Methods: A retrospective review of all prisoners who presented to our medical center with the complaint of IIFO was conducted. Both Institutional Review Board and Bureau of Prisons approvals were obtained before data collection. All prisoners ages 18–75 were included between the dates of January 2004 and December 2011. Episodes were divided into three categories: (a) Unverified IIFO wherein ingested object was claimed by the patient but never identified; (b) verified IIFO wherein ingested object was clearly identified; (c) secondary events due to direct complications of previous IIFO episode (s). The temporal occurrence of IIFO was organized by increasing the number of episodes and grouped accordingly. Detailed list of hospital charges was obtained for every IIFO episode including: (a) emergency services, (b) procedures, (c) laboratory, (d) surgical supplies, (e) allied health services, (f) radiology studies, (g) anesthesiology charges, (h) pharmacy, and (h) intensive care costs. Descriptive statistics were used to analyze basic data. Kruskal–Wallis test was used to examine differences among nonnormally distributed variables and sub-groups. Statistical significance set at alpha = 0.05. Results: A total of 435 IIFO episodes occurred during the study period in a population of 125 patients (mean age 33.8 ± 11.7 years, median age 34 [range 19–75] years, 92.8% male). Hospital charges associated with these episodes totaled $6,209,557. There were 94 unverified IIFOs, 332 verified IIFOs, and 9 secondary events. Verified IIFOs were associated with significantly greater median charges ($5,860) than unverified IIFOs ($3,997) and secondary events carried lower cost ($3,501) than the former two (P < 0.01). We also observed a pattern of escalating costs associated with increasing number of sequential IIFO episodes, with the 1^st episode carrying median charges of $4,683 and episodes numbered 11+ carrying median charges of $7,698 (P < 0.01). Conclusions: Hospital charges associated with the care of prisoners who ingest foreign objects tend to escalate over time. Although charges in most of the categories demonstrated increases with greater numbers of ingestions, the largest contributors to this pattern of escalating charges included radiology, pharmacy, hospital room charges, and surgical services. These findings suggest that early intervention in the destructive cycle of IIFO may not only improve patient outcomes but also result in savings to the healthcare system. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice based learning and improvement, Systems based practice. Republished with permission from: Otey AJ, Houser JS, Jones C, Evans DC, Dalal P, Whitmill ML, Levine E, McKimmie R, Papadimos TJ, Steinberg SM, Bergese SD, Stawicki SP. Examination of financial charges associated with intentional foreign body ingestion by prisoners: A pattern of escalation. OPUS 12 Scientist 2014;8(1):6-8.

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Introduction: International Medical Graduates (IMGs) have been a significant proportion of the American physician workforce since the 1960s. Nearly, one-fourth of practicing physicians today are IMGs, and the total number of IMGs in graduate medical education is increasing. The purpose of this pilot project was to assess IMG perceptions in three major policy areas: (a) IMG impact on the United States (US) healthcare, (b) IMG impact on countries of origin, (c) bias/discrimination faced by IMGs. Methods: A survey was conducted of IMGs in an internal medicine residency program based at a Queens, New York Hospital. Results: Surveyed population (n = 27) was 41% PGY1, 30% PGY2, 22% PGY3, 7% PGY4. 55% were men, 78% were between 25 and 35 years old, and 70% had emigrated to the US within the last 10 years. Impact on US healthcare: 54% supported US policies favoring immigration of IMGs willing to practice in underserved areas. 70% believed that IMGs would provide care in these areas for a longer period than the US graduates, due to satisfaction in serving that patient population (57%) and lack of better opportunities (22%). Justifiable reasons to reduce IMG immigration were to avoid a physician surplus (58%), to reduce harms to countries of origin (21%), and to avoid overcrowding residency programs (13%). Impact on countries of origin: Eighty percent of the surveyed IMGs do not plan to return to their country of origin. Fifty-six percent reported that physician emigration is a detriment to their countries of origin; 84% felt no personal obligation to help reduce the negative effects. Two-thirds received loans or subsidies for education from countries of origin. Thirty-one percent supported policies for required subsidies repayment, 27% for required service after medical school graduation, 25% for more restrictive emigration policies, 19% for required return to the country of origin after residency training, and 12% for monetary compensation beyond subsidies repayment. Bias or Discrimination: Over one-third of respondents felt bias or discrimination in their work environment. Eighty-five percent felt that medical professional organizations do not adequately address issues specific to IMGs, and 77% reported a desire for greater involvement in such organizations. Conclusions: There is a growing debate in public policy over the status of IMG migration to the US. This pilot study was designed to explore IMG attitudes toward three major policy areas. A larger, multi-institutional study should be considered. The following core competencies are addressed in this article: Interpersonal skills and communication, Professionalism, Systems based practice. Republished with permission from: Agrawal S. International medical graduate perceptions of health policy: A pilot study. OPUS 12 Scientist 2008;2(1):9-12.

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Background: Emergency medicine (EM) as a specialty in India is at its infancy. Point-of-care ultrasound (POCUS) is an indispensable tool for the emergency physician (EP). We sought to determine the current experience and resources of POCUS training among EM teaching programs in India. Methods: At a national EM board review course, a survey was carried out among 41 residents from 15 different teaching institutes across seven states of India. The survey consisted of questions pertaining to their experience and knowledge in performing basic and advanced POCUS examinations and its utilization in their department. Results: Most residents (90.2%) were of the opinion that POCUS is an indispensable tool for the EP. All residents had access to an ultrasound (US) machine, with 90.2% having at least one dedicated machine in their department. 12.1% of the residents utilized POCUS less than five times a day while 14.6% reported using US more than twenty times a day. 68.5% of residents identified the major modality of learning POCUS was from a mentor, and about one-third were exclusively dependent on it. The least utilized sources were books and lectures (19%). Extended focused assessment with sonography in trauma (EFAST) was the most frequently performed examination (95%) and was performed with highest level of confidence. Among the advanced examinations, residents knew how to perform and interpret airway (53.7%) and renal sonography (53.7%) the most while they were least familiar with ocular sonography (19%). 70.1% residents reported that POCUS was utilized for facilitating vascular access, 53.7% for nerve blocks, and paracentesis around 19%. Only 46% reported that other departments rely on their findings to make clinical decisions. Conclusion: POCUS was utilized by the residents for different diagnostic examinations and interventions, with the most common being EFAST. The most common learning source of POCUS was from hands-on training by a mentor. There exists a need for guidelines or standardization of POCUS in the EM curriculum to achieve resident competency. The following core competencies are addressed in this article: Interpersonal skills and communication, Medical knowledge, Patient care, Systems-based practice.

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Renal failure, hepatic failure, and hepatorenal syndrome can be associated with clinically significant hypotension, a clinical state often referred to as vasoplegia or vasoplegic syndrome (VS). Vasoplegia is thought to be related to dysregulation of endothelial homeostasis and subsequent endothelial dysfunction due to direct and indirect effects of various inflammatory mediators. Vasoplegia has been observed in all age groups and in various clinical settings, including sepsis, hemorrhagic shock, hemodialysis, and cardiac surgery. Among mechanisms thought to be contributory to VS, the nitric oxide (NO)/cyclic guanosine monophosphate pathway appears to play a prominent role. Methylene blue (MB), an inhibitor of NO synthase and guanylate cyclase, has been found to improve the hypotension associated with various clinical states. Evidence also suggests that MB may be effective in improving systemic hemodynamics and vasoplegia associated with hepatic failure. We describe two cases of vasoplegia associated with concurrent hepatic and renal failure – both demonstrating a favorable hemodynamic response to MB without apparent side effects. A review of MB use in the setting of hepatic and renal failure then follows. The following core competencies are addressed in this article: Medical knowledge, Patient care. Republished with permission from: Bosoy D, Axelband J, Pursell RN, Lukaszczyk JJ, Stawicki SP. Utilization of methylene blue in the setting of hypotension associated with concurrent renal and hepatic failure: A concise review. OPUS 12 Scientist 2008;2(1):21-29.

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The phenomenon of “brain drain,” (BD) or the unanticipated and significant loss of skilled people and the talent they represent via voluntary turnover, continues to be a significant problem across many academic medical centers. This BD is a result of a multifactorial interplay between personal, professional, institutional, peer-driven, and socioeconomic factors and affects mainly academic healthcare organizations characterized by a specific set of leadership, economic, and competitive preconditions. Institutional impact of BD, both financial and nonfinancial, can be profound and is often underappreciated. Financial considerations of BD include loss of clinical and non-clinical income, contraction of institutional expertise, severance and recruitment expenses, as well as costs of onboarding new faculty. This article focuses on how to identify risk factors for BD at both institutional and personnel levels. Proposed steps for prevention and early intervention are outlined. The following core competencies are addressed in this article: Professionalism, Practice-based learning and improvement, Systems-based practice, Interpersonal skills, and Communication.

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