Licensing Examination (USMLE) cosponsors announced the adoption of reporting Step 1 pass/fail and the discontinuation of Step 2 Clinical Skills (CS), respectively. These changes were met with mixed reviews from program directors and medical students applying to residency. 1,2 In the National Resident Matching Program's (NRMP) 2018 survey, 78% of program directors (PD) reported that they cite Step 1/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 when reviewing applications, compared with 70% of PDs for Step 2 Clinical Knowledge (CK)/COMLEX 2 Performance Evaluation (PE) and 51% for Step 2 CS/COMLEX 2 Cognitive Evaluation (CE).Conversely, Step 2 CS was rated as slightly more important than Step 1 and Step 2 CK, supporting the discontinued examination's value when ranking applicants. However, with Step 1 now reported as pass/fail and Step 2 CS discontinued, there remains uncertainty regarding how PDs will tailor their review of applications. Understanding PDs' perspectives on these consequential changes can guide educators reshaping their curricula and students aiming to strengthen their candidacy for residency. MethodsThe authors (A.W., J.D.S., K.L.K.) manually queried a subset (1600 of more than 5000, outreach >50% for every medical specialty except internal medicine and family medicine) of valid PD emails through the Accreditation Council for Graduate Medical Education's public 2019 to 2020 List of Specialty Programs (n = 31) across all medical specialties. In rounds, PDs were allotted 3 months (January to April 2021) to respond to the survey, with a reminder email sent after the first week. The University of California at Los Angeles institutional review board deemed this study exempt from review and waived informed consent because it used deidentified data. This study followed the American Association for Public Opinion Research (AAPOR) reporting guideline.We created a 14-item anonymous online survey using the ExpertReview validation tool (Qualtrics XM operating system version X4 [Qualtrics International Inc]) (eTable 1 in the Supplement).The survey (using Qualtrics and Google Forms) included questions on PD demographics including age, gender, tenure, and residency program specialty. PD race and ethnicity data were not collected to preserve anonymity. PDs were prompted for their general perceptions regarding the impact of residency selection in the context of changes to USMLE Step 1 and Step 2 CS. Responses were recorded as binary (yes or no) or on 3-point Likert scales (disagree, neutral, or agree) or 5-point Likert scales (strongly disagree, disagree, neutral, agree, or strongly agree).Categorical variables were reported as counts and percentages. Derived 95% CIs were from the margin of errors of total sample (±3.1%) and subgroups (±4.3%) defined by AAPOR (eTable 1 in the Supplement). Subgroup analyses between regions and between Association of American Medical Colleges (AAMC)-defined primary care (internal medicine, family medicine, pediatrics, internal medicine/pediatrics) and nonpr...

Background MRI acquisition for pediatric pancreatic fat quantification is limited by breath‐holds (BH). Full segmentation (FS) or small region of interest (ROI) analysis methods may not account for pancreatic fat spatial heterogeneity, which may limit accuracy. Purpose To improve MRI acquisition and analysis for quantifying pancreatic proton‐density fat fraction (pPDFF) in children by investigating free‐breathing (FB)‐MRI, characterizing pPDFF spatial heterogeneity, and relating pPDFF to clinical markers. Study Type Prospective. Population A total of 34 children, including healthy (N = 16, 8 female) and overweight (N = 18, 5 female) subjects. Field Strength and Sequences 3 T; multiecho gradient‐echo three‐dimensional (3D) stack‐of‐stars FB‐MRI, multiecho gradient‐echo 3D Cartesian BH‐MRI. Assessment A radiologist measured FS‐ and ROI‐based pPDFF on FB‐MRI and BH‐MRI PDFF maps, with anatomical images as references. Regional pPDFF in the pancreatic head, body, and tail were measured on FB‐MRI. FS‐pPDFF, ROI‐pPDFF, and regional pPDFF were compared, and related to clinical markers, including hemoglobin A1c. Statistical Tests T‐test, Bland–Altman analysis, Lin's concordance correlation coefficient (CCC), one‐way analysis of variance, and Spearman's rank correlation coefficient were used. P < 0.05 was considered significant. Results FS‐pPDFF and ROI‐pPDFF from FB‐MRI and BH‐MRI had mean difference = 0.4%; CCC was 0.95 for FS‐pPDFF and 0.62 for ROI‐pPDFF. FS‐pPDFF was higher than ROI‐pPDFF (10.4% ± 6.4% vs. 4.2% ± 2.8%). Tail‐pPDFF (11.6% ± 8.1%) was higher than body‐pPDFF (8.9% ± 6.3%) and head‐pPDFF (8.7% ± 5.2%). Head‐pPDFF and body‐pPDFF positively correlated with hemoglobin A1c. Data Conclusion FB‐MRI pPDFF is comparable to BH‐MRI. Spatial heterogeneity affects pPDFF quantification. Regional measurements of pPDFF in the head and body were correlated with hemoglobin A1c, a marker of insulin sensitivity. Evidence Level 2 Technical Efficacy Stage 2

Elevated CHGA expression resulted in underlying bioenergetic dysfunction in ATP production despite higher mitochondrial mass. The outcome was unregulated negative feedback of LDCV exocytosis and secretion, resulting in elevated levels of circulating catecholamine and consequently the hypertensive phenotype.

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