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OBJECTIVE Competency based medical education (CBME) requires novel approaches to surgical education. Significant investment has been made in laparoscopic simulation, which has been shown to foster skill development prior to patient encounters. However, research suggests variable voluntary use of these resources by residents, and little is known about the motivational factors that influence their utilization. The purpose of this study was to characterize factors that motivate residents to seek laparoscopic simulation experience outside of the formal curriculum. DESIGN We developed a questionnaire grounded in Expectancy Value Theory, an established psychological theory of motivation, by adapting validated measures to fit the study context. We conducted a cross sectional survey of Canadian obstetrics and gynecology residents. SETTING We invited residents enrolled in English-language obstetrics and gynecology training programs in Canada to participate. PARTICIPANTS All residents engaged in clinical duties during Winter 2018 were invited to complete the questionnaire. Forty-four Obstetrics and Gynecology (Ob/Gyn) residents participated in the study. RESULTS Residents reported limited use of simulation resources and identified multiple barriers including lack of time, access, and supervision. They expressed concern about development of bad habits during independent practice, and simulation use was positively correlated with perceived utility. Compared to junior residents, senior residents reported greater enjoyment of laparoscopic surgery, less emotional costs, and higher self-efficacy for learning laparoscopy. CONCLUSIONS Residents' perception of utility and barriers impede voluntary simulation use and overall use was limited. As programs undertake curricula redevelopment for CBME, mitigating barriers and improving perceived utility of laparoscopic simulation is vital to increase use and enhance skill development.OBJECTIVES Anemia is highly prevalent in chronic kidney disease patients; however, its identification and management have been reported to be suboptimal. In this study we aimed to describe the prevalence, severity, risk factors, and treatment of anemia in different nephrology centers, among chronic kidney disease patients who were not given renal replacement therapy. MATERIALS AND METHODS We performed a multicenter cross-sectional study in three different nephrology clinics. Adult (>18 years of age) chronic kidney disease patients with an estimated glomerular filtration rate (eGFR) below 60 ml/min, and who were not started dialysis were recruited. Demographic, clinical and laboratory data regarding anemia and its management were collected using a standard data form. Anemia was defined as a hemoglobin level below 12g/dL and severe anemia as a hemoglobin level below 10g/dl. RESULTS A total of 1066 patients were enrolled in the study. Anemia and severe anemia were present in 55.9% and 14.9% of the patients, respectively. The mean hemoglobin level for the whole cohort was 11.8±1.8 g/dL. Univariate analyses revealed that the mean hemoglobin level was significantly different among the centers. Moreover, the frequency of the presence of anemia stratified by severity was also significantly different among the centers. According to binary logistic regression analysis, gender, levels of eGFR and iron, ferritin ≥ 100 ng/mL, and the nephrology center were independent determinants of severe anemia. CONCLUSIONS We found a high prevalence of anemia among chronic kidney disease patients who were not on renal replacement therapy. Each center should determine the treatment strategy according to the patient's characteristics. According to our results, the center-specific management of anemia seems to be important.California's coastal climate is characterized by rainy winters followed by a dry summer season that is supplemented by frequent fog. While rising temperatures and drought caused massive tree mortality in central California during the 2011-2015 extreme drought, dying trees were less common in the central coast region. We hypothesized that cooler, maritime-ameliorated temperatures reduced the effects of drought stress on coastal vegetation. To test this, weekly measurements of water potential and stomatal conductance were made on two coast evergreen tree species, Arbutus menziesii and Quercus agrifolia, throughout the summer 2014 dry season. Water potential remained generally constant during this period but stomatal conductance declined in both species as the dry season progressed. Species' resistance to embolism was determined using the centrifuge method, and showed Q. agrifolia to be more vulnerable to embolism than A. menziesii. The stem vulnerability curves were consistent with species' seasonal water relations as well as their anatomy; the ring-porous Q. agrifolia had substantially larger conduits than the diffuse-porous A. menziesii. Leaf turgor loss points differed significantly as did other pressure-volume parameters but these data were consistent with the trees' seasonal water relations. Overall, the two species appear to employ differing water use strategies; A. read more menziesii is more profligate in its water use, while Q. agrifolia is more conservative, with a narrower safety margin against drought-induced loss of xylem transport capacity. Despite the extended drought, these species exhibited neither branch die-back nor any obvious symptoms of pronounced water-stress during the study period, implying that the maritime climate of California's central coast may buffer the local vegetation against the severe effects of prolonged drought.Regulatory T cells (Treg) play essential roles in maintaining immune homeostasis. Resident Treg in visceral adipose tissue (VAT-Treg) decrease in male obese mice, which leads to the development of obesity-associated chronic inflammations and insulin resistance. Although gender differences in immune responses have been reported, the effects of the difference in metabolic environment on VAT-Treg are unclear. We investigated the localization of VAT-Treg in female mice in comparison with that in male mice. On a high-fat diet (HFD), VAT-Treg decreased in male mice but increased in female mice. The increase was abolished in ovariectomized and HFD-fed mice, but was restored by estrogen supplementation. The IL33 receptor ST2, which is important for the localization and maturation of VAT-Treg in males, was reduced in CD4+CD25+ T cells isolated from gonadal fat of obese mice of both genders, suggesting that a different system exists for VAT-Treg localization in females. Extensive analysis of chemokine expression in gonadal fat and adipose CD4+CD25+T cells revealed several chemokine signals related to female-specific VAT-Treg accumulation such as CCL24, CCR6, and CXCR3.
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