Vanderbilt Health

Military surgical residency programs face unique challenges in preparing residents for the operational demands of combat casualty care. Over the past decade, significant educational innovations have been implemented to improve clinical competence and deployment readiness. To evaluate advancements in U.S. military surgical residency training between 2015 and 2025, focusing on educational interventions and their impact on resident preparedness across multiple domains of surgical education. A systematic review of literature from PubMed and Scopus was performed using defined MeSH and keyword criteria. Studies were included if they evaluated educational interventions involving surgical residents in U.S. military GME programs, reporting outcomes such as competency, readiness, or skill acquisition. Fifteen studies met inclusion criteria. Key innovations included simulation-based training in trauma, OB/GYN, and urology; deployment readiness curricula; live tissue and cadaveric courses; mentorship frameworks; and the integration of research platforms for skill sustainment. These interventions led to measurable improvements in confidence, performance, and readiness indices across residency programs. The past decade has seen a paradigm shift in military surgical education. Evidence based innovations are helping to align training with future operational demands, but further standardization and longitudinal outcomes research are needed.

Dopamine is a monoamine neurotransmitter that regulates neuronal activity and synaptic transmission. While dopaminergic activity is known to suppress action potential-dependent glutamate release in certain brain regions, the modulatory effect of dopaminergic tone on spontaneous glutamate release is unclear. Here, we used primary rat ventral tegmental area-cortex co-cultures to assess how decreased dopaminergic tone affects spontaneous synaptic glutamate release using whole-cell patch-clamp electrophysiology. We found that an acute decrease in dopaminergic tone increases the frequency of spontaneous glutamate release, driven by a surge in basal presynaptic calcium. This presynaptic calcium surge results from disinhibition of voltage-gated calcium channels (VGCCs) due to reduced Gβγ subunit activity downstream of D2 receptor signaling. While acute reduction in dopaminergic tone has robust presynaptic effects, chronic reduction results in homeostatic synaptic plasticity, characterized by postsynaptic insertion of calcium-permeable α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, a process known as synaptic upscaling. Notably, chronic antagonism of both D1 and D2 receptors using selective antagonists, as well as long-term treatment with first- and second-generation antipsychotics haloperidol, chlorpromazine, olanzapine, clozapine, and aripiprazole, promoted robust synaptic upscaling. These findings reveal a novel mechanism of action for antipsychotic medications and suggest that antipsychotics do not solely act on counteracting hyperdopaminergia, but also tune glutamatergic neurotransmission by activating homeostatic plasticity mechanisms.

Abstract Industrial wastewaters with both high salinity and heavy metals are common, yet no existing process can achieve desalination and metal recovery in integrated technology platform. Conventional desalination processes do not distinguish background electrolyte generate toxic brines with heavy metals and miss the opportunities for resource recovery. In this work, we show that electrochemical ion pumping (EIP) has the unique feature to enable simultaneous desalination and metal recovery through programmable control of electrode potential. Because EIP transfers only a small amount of ions per half-cycle via high-frequency circuit switching, the electrode potential can be maintained within a narrow window throughout operation, which allows redox reactions to be selectively activated or suppressed without interrupting continuous ion transport. At potentials above the Cu²⁺/Cu reduction threshold, the system desalinates only capacitively with no metal deposition. Shifting the potential window below this threshold triggers selective copper electrodeposition on the electrode while performing desalination. In an asymmetric five-electrode EIP stack fed with a mixture of Cu²⁺, Ni²⁺, and Na+, positioning the potential window between the reduction potentials of the two metals yielded selective Cu²⁺ capture on the electrode. These findings establish electrode potential as a controllable operation parameter, providing an integrated platform for coupled water recycling with selective resource recovery from complex industrial brines.

Device usage in operating rooms consumes significant electricity, resulting in high hospital expenditure and emissions. Prior studies have evaluated institutional policy approaches toward this problem, but there is limited analysis of individual devices' energy consumption in US operating rooms. This study's objective was to quantify the energy expenditure of equipment commonly used in the operating room, serving as a foundation for future sustainability efforts. The 29 most commonly identified operating room devices at a tertiary academic medical center were categorized as structural (built into operating rooms) or procedural (brought in for procedures). Each device's electrical use was quantified in kilowatt-hours using standard technical ratings and estimated use times. Cost calculations using 2024 electrical prices were scaled to estimate those in average (7 operating rooms, as per literature) and large (69 operating rooms, as per literature) size hospitals. An average size hospital spends $19,207 annually on operating room equipment electricity; larger institutions spend around $189,327 annually. Stand-alone suction devices, x-ray generators of C-arm x-ray machines, and heated air devices were the highest energy consumers. Procedural devices accounted for 64% of total annual electrical costs. Annual electricity costs for operating room equipment at a large hospital equal that of 5 school buildings; an average size hospital equates to a warehouse. Stand-alone suction devices at a large hospital draws the equivalent as 5,120 electrical cars; even turning them off for 1 hour per day can save $4,650.56 per year. Incremental reforms in operating room equipment utilization can substantially reduce hospital expenses and carbon footprint.

Purpose: This article examines the legal feasibility of succession pacts in Brazil. It focuses on the formalization through public notarial deeds, considering constitutional limits on private autonomy and the protection of forced heirs rights. The succession pact models of Portugal and Germany are also brought up, as they follow a similar Romano-Germanic Brazilian legal system. Methodology: The research follows a theoretical exploratory qualitative approach. The analysis of doctrines in the specialized literature subsidizes arguments of the premise on the legality of administrative succession pacts. Jurisprudential sentences, a case study and the analysis of Portuguese and German legal frameworks wrap up succession pacts also help back up the use of extrajudicial via to this end. Findings: Although Article 426 of the Brazilian Civil Code expressly prohibits contracts relating to the inheritance of a living person, constitutional principles protecting the autonomy of individual rights and comparative experiences of positive legal systems support a flexible interpretation. The European models discussed demonstrate that succession agreements, under the safeguard of extrajudicial services, would work, preserving the rights of forced heirs and maintaining the legal certainty. Originality: The study contributes to contemporary debates on succession planning and dejudicialization in Brazil. It offers a critical reassessment of traditional unneeded prohibitions and proposes institutional pathways for a more functional and modern succession pacts framework in Brazil.

This research investigates the West Virginia Coal Wars (1912–1921) through the sociological lens of the backfire effect, focusing on how state repression of labor movements inadvertently strengthened collective action among coal miners. Utilizing key case studies such as the Paint Creek–Cabin Creek Strike, the Matewan Massacre, and the Battle of Blair Mountain, this paper examines the role of violent state intervention, media portrayals, and public perception in shaping early 20th-century labor movements. The findings reveal that repressive tactics, including evictions, imprisonment, and militarized suppression, often galvanized miner solidarity and drew national attention to their plight. Theoretical insights from scholars such as David Hess provide a framework for understanding the backfire effect: when repression is perceived as excessive and information is widely disseminated, public sympathy and support for the oppressed increase. However, media coverage, both national and local, played a dual role, either humanizing the miners or sensationalizing their struggles, thus influencing the scale of the backfire effect. Increased public sympathy often led to enhanced recruitment for the miners’ struggle. This study argues that the backfire effect was instrumental in fostering labor solidarity, culminating in significant union advances despite short-term setbacks. It further connects the events of the Coal Wars to broader labor policy reforms, suggesting their impact on the eventual establishment of federal protections for organized labor. This research contributes to labor history by illustrating how grassroots movements can leverage repression to achieve long-term systemic change.

Prostaglandins (PGs) are endogenous lipid signaling molecules that regulate diverse physiological and pathological processes, and their biosynthetic pathways are targets of widely used drugs such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)1-7. However, previous research of PG biosynthesis has focused on host metabolic pathways; as such, the contribution of gut microbiota remains unknown1. Here, we demonstrate a colonic pathway in which gut microbes directly participate in PG metabolism, thereby regulating intestinal PG levels and their biological effects. Comparison of germ-free and conventionally raised mice reveals that the gut microbiota markedly increase gut levels of multiple PGs. This effect is driven by bacterial β-glucuronidases (GUS), which hydrolyze host-derived PG glucuronides - less active or inactive conjugates - to regenerate bioactive, free-form PGs. Administration of purified GUS enzyme or mono-colonization with wild-type or GUS-deficient bacteria in germ-free mice demonstrates the critical role for microbial GUS in regulating intestinal PG levels and downstream biological responses. Together, these findings reveal a previously unrecognized function of the gut microbiota in PG metabolism and highlight microbial pathways as potential targets for modulating colonic PG signaling to prevent or treat gastrointestinal disease.

Active music engagement, that is, playing a musical instrument or singing, may be protective of motor function decline in aging. Although playing a musical instrument may transfer to benefits in motor function, it is also possible that the genetic architecture of motor behavior and the motor system brain structures may influence active music engagement. This study investigated whether polygenic scores (PGSs) for five behavioral motor traits, 12 structural brain traits, and seven rate-of-change in brain structure traits trained from existing genome-wide association studies predict active music engagement in four independent cohorts: the Canadian Longitudinal Study on Aging (CLSA; N = 22,198), Wisconsin Longitudinal Study (WLS; N = 4605), Vanderbilt's BioVU Repository (BioVU; N = 6150), and Vanderbilt's Online Musicality Study (OM; N = 1559). Results were meta-analyzed for each PGS main effect across outcomes and cohorts, revealing that PGS for a faster walking pace was associated with higher amounts of active music engagement. Within CLSA, a higher PGS for walking pace was associated with greater odds of engaging with music. Our findings suggest a shared genetic architecture between motor function and active music engagement. Future research should consider the genetic underpinnings of motor behavior when evaluating the effects of music engagement on motor function.