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AbstractOver the course of training, physicians develop significant knowledge and expertise. We review dual-process theory, the dominant theory in explaining medical decision making: physicians use both heuristics from accumulated experience (System 1) and logical deduction (System 2). We then discuss how the accumulation of System 1 clinical experience can have both positive effects (e.g., quick and accurate pattern recognition) and negative ones (e.g., gaps and biases in knowledge from physicians’ idiosyncratic clinical experience). These idiosyncrasies, biases, and knowledge gaps indicate a need for individuals to engage in appropriate training and study to keep these cognitive skills current lest they decline over time. Indeed, we review converging evidence that physicians further out from training tend to perform worse on tests of medical knowledge and provide poorer patient care. This may reflect a variety of factors, such as specialization of a physician’s practice, but is likely to stem at least in part from cognitive factors. Acquired knowledge or skills gained may not always be readily accessible to physicians for a number of reasons, including an absence of study, cognitive changes with age, and the presence of other similar knowledge or skills that compete in what is brought to mind. Lastly, we discuss the cognitive challenges of keeping up with standards of care that continuously evolve over time.

<p>Differentially abundant microbial enzyme classes (EC) and metabolic pathways (MaAsLin2).</p>

Polycystic Ovarian Syndrome (PCOS) is an endocrinopathy with a complex metabolic disorder. PCOS is characterized by reproductive hormonal imbalances leading to the clinical presentation of hyperandrogenism and infertility. PCOS is also showing an increased prevalence of several other conditions such as obesity, dyslipidemia, hypertension, metabolic syndrome and type 2 diabetes mellitus (DM2) when compared with women without PCOS. The principal symptoms in patients with PCOS are irregular menstruation, acne, and excessive amounts of androgenic hormones. The Rotterdam PCOS consensus workshop has given specific criteria to establish PCOS diagnosis only after exclusion of other known disorders. Obesity is a common finding of women with PCOS, but it is not part of the diagnostic criteria. PCOS has metabolic characteristics that include prominent defects in insulin action and beta-cell function, defects that confer a substantially increased risk for obesity and type 2 diabetes mellitus. PCOS women have an increased level of luteinizing hormone (LH) and a decreased level of follicle-stimulating hormone (FSH), which leads to disorders in the regulation of the menstrual cycle. The values of LH and FSH are dependent on the day of the menstrual cycle in which the hormones are measured. Obesity also has an influence on these values.The objective of this study was to compare the hormonal and anthropometric parameters in women with PCOS and healthy control group.This study was carried out in the Department of Pathology, Dr. D Y Patil Medical College and Research Centre, Pune, Maharashtra. Fifty female patients aged 16-40 years diagnosed with PCOS by known criteria were included in the study and compared with 50 healthy control group females.Elevated levels of thyroid-stimulating hormone, LH, FSH, and prolactin along with increased body mass index and waist-to-hip ratio were predictors of PCOS and the early metabolic abnormalities.

Long-term cognitive dysfunction, or “chemobrain”, has been observed in cancer patients treated with chemotherapy. Mitoxantrone (MTX) is a topoisomerase II inhibitor that binds and intercalates with DNA, being used in the treatment of several cancers and multiple sclerosis. Although MTX can induce chemobrain, its neurotoxic mechanisms are poorly studied. This work aimed to identify the adverse outcome pathways (AOPs) activated in the brain upon the use of a clinically relevant cumulative dose of MTX. Three-month-old male CD-1 mice were given a biweekly intraperitoneal administration of MTX over the course of three weeks until reaching a total cumulative dose of 6 mg/kg. Controls were given sterile saline in the same schedule. Two weeks after the last administration, the mice were euthanized and their brains removed. The left brain hemisphere was used for targeted profiling of the metabolism of glutathione and the right hemisphere for an untargeted metabolomics approach. The obtained results revealed that MTX treatment reduced the availability of cysteine (Cys), cysteinylglycine (CysGly), and reduced glutathione (GSH) suggesting that MTX disrupts glutathione metabolism. The untargeted approach revealed metabolic circuits of phosphatidylethanolamine, catecholamines, unsaturated fatty acids biosynthesis, and glycerolipids as relevant players in AOPs of MTX in our in vivo model. As far as we know, our study was the first to perform such a broad profiling study on pathways that could put patients given MTX at risk of cognitive deficits.

Let $X$ be a smooth projective variety defined over an algebraically closed field of positive characteristic $p$ whose tangent bundle is nef. We prove that $X$ admits a smooth morphism $X \to M$ such that the fibers are Fano varieties with nef tangent bundle and $T_M$ is numerically flat. We also prove that extremal contractions exist as smooth morphisms. As an application, we prove that, if the Frobenius morphism can be lifted modulo $p^2$, then $X$ admits, up to a finite \'etale Galois cover, a smooth morphism onto an ordinary abelian variety whose fibers are products of projective spaces. Comment: 24 pages

An antiferromagnetic insulator (AFI) bearing a compensated interface to an adjacent conventional superconductor (S) has recently been predicted to generate N\'eel triplet Cooper pairs, whose amplitude alternates sign in space. Here, we theoretically demonstrate that such N\'eel triplets enable control of the superconducting critical temperature in an S layer via the angle between the N\'eel vectors of two enclosing AFI layers. This angle dependence changes sign with the number of S monolayers providing a distinct signature of the N\'eel triplets. Furthermore, we show that the latter mediate a similarly distinct exchange interaction between the two AFIs' N\'eel vectors. Comment: 7 pages, 4 figures

Introducing the SNP technology to pigeon breeding will enhance the competitiveness of a sector that produces one of the healthiest and best quality meats. The present study aimed to test the applicability of the Illumina Chicken_50K_CobbCons array on 24 domestic pigeon individuals from the Mirthys hybrids and Racing pigeon breeds. A total of 53,313 SNPs were genotyped. Principal component analysis shows a significant overlap between the two groups. The chip performed poorly in this data set, with a call rate per sample of 0.474 (49%). The low call rate was likely due to an increase in the evolutionary distance. A total of 356 SNPs were retained after a relatively strict quality control. We have demonstrated that it is technically feasible to use a chicken microarray chip on pigeon samples. Presumably, with a larger sample size and by assigning phenotypic data, efficiency would be improved, allowing more thorough analyses, such as genome-wide association studies.

<p>Western blot analysis of SIRT6 in 53 paired HCC tissues (T) and adjacent non-tumor liver tissues (N). β-actin was used as a loading control.</p>