Nash Community College

11166 Background: Recent advancements in cancer diagnosis, treatment, and supportive care increased the survivorship of cancer patients. However, the risk of secondary malignancy (SM), associated most commonly with side effects of radiation and chemotherapies, has emerged as a looming threat to childhood and adult-onset cancer survivors. Recognizing the recent trends in malignancy-related deaths and the risk factors associated could assist healthcare professionals and policymakers in constructing appropriate guidelines for timely diagnosis and individual patient-dependent treatment regimens. Hence, our CDC analysis focuses on highlighting trends in mortality from SM from “1999 to 2019”. Methods: Using the deidentified death certificate data from the CDC WONDER database, we analyzed mortality trends from 1999 to 2019 for SM. Age-adjusted mortality rates (AAMRs) per 100,000 people were calculated for the total population, stratified by gender, race, age, and site of SM. Annual percent change (APC) was calculated using the Joinpoint regression software. Results: A total of 1,499,108 deaths occurred from 1999 to 2019 in the US. The overall AAMR showed a decrease from 27.5 in 1999 to 18.83 in 2007 (APC: -4.71), remained at a relatively constant level of 19.11 till 2013 (APC: 0.48), followed by a rapid rise to 23.29 in 2017 (APC: 5.37), and finally a gradual rise to 24.29 in 2019 (APC: 1.97). Men showed consistently higher AAMR than women throughout the study period between 1999 (AAMR Men: 33.31 vs Women: 23.78) and 2019 (AAMR Men: 28.03 vs Women: 21.51). Moreover, Black (AAMR: 23.89) showed the highest mortality rate, followed by Whites (AAMR: 21.46). American Indian (AAMR: 13.93), Asian (AAMR: 13.89), and Hispanic (AAMR: 15.9) showing similar mortality trends. Furthermore, AAMR increased with age, showing the highest mortality rates in patients 75+ yrs (148.3), followed by 55-74 yrs (61.6), 35-54 yrs (9.23), 15-34 yrs (0.7), and ≤ 14 yrs (0.19). More recently the greatest rise in SM from 2013-2019 was observed in adrenal glands (APC: 11.8), bone and bone marrow (APC: 8.7), kidney and renal pelvis (APC: 7.6), and small intestine (APC: 6.9). Less prominent rise was seen in all other types of SM. Conclusions: Despite recent advances in cancer treatments, SM remains one of the most common causes of death in cancer survivors. Our analysis shows that age, gender, race, and site are important factors influencing the risk of SM-related mortality. Although the risk of SM varies across the spectrum of age, findings from one age group could be translated into preventive and screening strategies across other age groups. Guidelines for survivors should be taken into account based on prior treated malignancy and the risk of future ones. Large population based studies are imperative to understand factors behind the recent rise in SM-related mortalities from 2013 onwards.

The "mountain" dusky is a charismatic ecomorph of Dusky Salamander (Desmognathus): smaller (~20-50mm SVL), more terrestrial and montane woodland species, typically with round tails and extremely variable, often colorful patterns. Originally considered a single species (D. ochrophaeus), populations across the Appalachians are now divided into D. abditus, D. carolinensis, D. ochrophaeus, D. ocoee, and D. orestes, which do not form a clade but are instead scattered across the phylogeny of Desmognathus. A Coastal Plain species with a mountain dusky phenotype (D. apalachicolae) is also nested within a lineage related to D. ocoee. Within the current concept of D. ocoee, there are up to 8 genetically distinct geographic lineages which display significantly different but substantially overlapping morphologies. Recent studies have suggested that as many as six species could reasonably be delimited based on genetic data. We evaluate the strength of that evidence here and find support for five species in the D. apalachicolae + D. ocoee group. The first is D. apalachicolae in essentially its originally described form from the Coastal Plain. The second and third are D. adatsihi sp. nov. and D. balsameus sp. nov., endemic to the Great Smoky/Plott Balsam and Great Balsam Mountains, respectively. The fourth corresponds to the resurrected D. perlapsus for populations from the Alarka and Cowee Mountains in North Carolina, through the Chattahoochee River drainage to the Fall Line in the Piedmont of Georgia and Alabama. The fifth is D. ocoee, here restricted to populations in the Nantahala and Unicoi Mountains and southernmost Blue Ridge escarpment, along with previously recognized populations from the Cumberland Escarpment and Cumberland Plateau of south-central Tennessee and northeastern Alabama. This taxon concept of D. ocoee includes three deeply divergent geographic genetic segments that hybridize across two contact zones, while D. apalachicolae may be nested within some southern Blue Ridge populations of D. ocoee. The resurrected form of D. perlapsus also exhibits some admixture with the newly restricted D. ocoee. While this taxonomic arrangement is robust and stably derived from mitochondrial, morphological, and nuclear data, more sophisticated future analyses sampling additional populations and loci to estimate relationships may reach more subtle conclusions regarding the identity of some lineages within D. ocoee.

Article Response to “Comments on ‘Reported completion of the USMLE Step 1 and match outcomes among senior osteopathic students in 2020’” was published on October 1, 2022 in the journal Journal of Osteopathic Medicine (volume 122, issue 10).

The United States Medical Licensing Examination (USMLE) is not required for osteopathic students to match into postgraduate programs; however, it is unknown if taking the test improves their chances of matching. Our objective was to determine the association between taking the USMLE Step 1 and matching into the applicant's preferred specialty for senior osteopathic students applying to the 10 specialties to which students applied most in 2020. We performed a secondary analysis of the free and publicly available 2020 National Residency Match Program (NRMP) published match report for senior osteopathic students. First, we determined the number of senior osteopathic students that matched into their preferred specialty vs those that did not and stratified them by reported completion of the USMLE Step 1 within each specialty. Next, we calculated odds ratios (ORs) within each specialty for senior osteopathic students matching into their preferred specialty with and without the USMLE Step 1 utilizing the Fisher's exact test. Finally, we repeated the analysis with only senior osteopathic students who had reported USMLE Step 1 scores in ranges including or below the mean for those who matched in their specialty. For senior osteopathic students, reported completion of the USMLE Step 1 was associated with matching for those who applied to Internal Medicine (OR 3.3 [95% confidence interval 2.07 to 5.48]), Emergency Medicine (2.1 [1.35 to 3.17]), Pediatrics (4.4 [1.38 to 18.63]), Psychiatry (2.5 [1.34 to 4.98]), Anesthesiology (3.4 [1.57 to 7.32]), and General Surgery (3.1 [1.56 to 6.14]). After repeating the analysis with only senior osteopathic students who reported low USMLE Step 1 scores, the association remained significant for those who applied to Internal Medicine (2.5 [1.49 to 4.28]), Anesthesiology (2.6[1.17 to 5.54]), and General Surgery (2.5 [1.24 to 5.04]). In 2020, reported completion of the USMLE Step 1 by senior osteopathic students was associated with matching for those who applied to Internal Medicine, Emergency Medicine, Pediatrics, Psychiatry, Anesthesiology, and General Surgery. In addition, reported completion of the USMLE Step 1 with a low score was associated with matching for those who applied to Internal Medicine, Anesthesiology, and General Surgery.

Rails 5 + Webpack upg

Abstract Species that went extinct prior to the genomic era are typically out-of-reach for modern phylogenetic studies. We refer to these as “Alexandrian” extinctions, after the lost library of the ancient world. This is particularly limiting for conservation studies, as genetic data for such taxa may be key to understand extinction threats and risks, the causes of declines, and inform management of related, extant populations. Fortunately, continual advances in biochemistry and DNA sequencing offer increasing ability to recover DNA from historical museum specimens, including fluid-preserved natural history collections. Here, we report on success in recovering nuclear and mitochondrial data from the apparently-extinct subspecies Desmognathus fuscus carri (Neill 1951), a plethodontid salamander from spring runs in central Florida. The two specimens are 50 years old and were likely preserved in unbuffered formalin, but application of a recently derived extraction procedure yielded usable DNA and partially successful Anchored Hybrid Enrichment sequencing. These data suggest that the populations of D. f. carri from peninsular Florida are conspecific with the D. auriculatus A lineage as suggested by previous authors, but likely represented an ecogeographically distinct genetic segment that has now been lost. Genetic data from this Alexandrian extinction thus confirm the geographic extent of population declines and extirpations as well as their ecological context, suggesting a possibly disproportionate loss from sandy-bottom clearwater streams compared to blackwater swamps. Success of these methods bodes well for large-scale application to fluid-preserved natural history specimens from relevant historical populations, but the possibility of significant DNA damage and related sequencing errors in additional hurdle to overcome.

Jacob Green was born in 1790 to a prominent New Jersey family of scholars and theologians. He taught at the College of New Jersey (now Princeton University) from 1818 to 1822 before co-founding Jefferson Medical College (now Thomas Jefferson University) in 1825, where he taught Chemistry until his death in 1841. Between 1818 and 1831, he published a series of nine papers on lizards, salamanders, and snakes, authoring the original description of several well-known species of salamanders from the eastern United States. Many of his names are ambiguous; some have been adjudicated by the ICZN, while others are currently treated as nomina dubia. Here, we review all of Green's publications, report on newly re-discovered or re-interpreted material from several major natural history collections, and resolve most if not all remaining issues through a series of taxonomic actions. In particular, we first designate a neotype for Salamandra nigra Green, 1818. We then place S. sinciput-albida Green, 1818 and S. frontalis Gray in Cuvier, 1831 in synonymy with S. scutata Temminck in Temminck Schlegel, 1838 and invoke Reversal of Precedence under Article 23.9 to designate them nomina oblita. We also designate a lectotype for S. bislineata Green, 1818. Finally, we resurrect the name S. fusca Green, 1818 as the valid name for the species Desmognathus fuscus, assuming priority over Triturus fuscus Rafinesque, 1820, designating S. fusca Laurenti, 1768 a nomen oblitum, and placing S. nigra Green, 1818 in synonymy. While Green's herpetological legacy is not as expansive as that of some of his successors such as Holbrook, he is nonetheless a foundational early worker in salamanders, having described some of the most-studied species in the world.

Recently in this journal, F. Alemi (Qual Manage Health Care. 2004;13(4):216-221) proposed the use of Tukey's Control Chart because of the unique benefits associated with nonparametric inferential statistics including robust performance with (1) low N sizes, (2) nonnormal data, and (3) the presence of outliers, However, an assumption that applies to virtually all inferential statistical procedures (parametric and nonparametric) is that the observations in question are independent from each other. Unfortunately, there is good reason to suspect violation of this assumption when evaluating quality processes over time (as is often the case in health care settings). In this article, the power (ability to detect real changes in a data process) and type I error (probability of false positives) performance of Tukey's Control Chart technique is empirically evaluated. When observations are not independent, Tukey's Control Chart technique demonstrates unacceptable type I error performance. Additionally, regardless of whether observations are independent, the technique demonstrates low power to detect real effects unless the effects are quite large.