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Background: 3D-time resolved flow (4DF) cardiovascular magnetic resonance (CMR) with retrospective analysis of atrioventricular valve regurgitation (AVVR) allows for internal validation by multiple direct and indirect methods. Limited data exist on direct measurement of AVVR by 4DF CMR in pediatric congenital heart disease (CHD). We aimed to validate direct measurement of the AVVR jet as accurate and reliable compared to the volumetric method (clinical standard by 2D CMR) and as a superior method of internal validation than the annular inflow method. Methods: We identified 44 consecutive patients with diverse CHD referred for evaluation of AVVR by CMR. 1.5 T or 3 T scanners, intravenous contrast, and a combination of parallel imaging and compressed sensing were used. Four methods of measuring AVVR volume (RVol) were used: volumetric method (VOL; the clinical standard) = stroke volume by 2D balanced steady-state free precessionsemilunar valve forward flow (SLFF); annular inflow method (AIM) = atrioventricular valve forward flow [AVFF]semilunar valve net flow (SLNF); and direct measurement (JET). AVFF was measured using static and retrospective valve tracking planes. SLFF, SLNF, AVFF, and JET were measured by 4DF phase contrast. Regurgitant fraction was calculated as [RVol/(RVol+SLNF)]× 100. Statistical methods included Spearman, Wilcoxon rank sum test/Student paired ttest, Bland Altman analysis, and intra-class coefficient (ICC), where appropriate.

Different landing surfaces may affect lower extremity biomechanical performance during athletic tasks. The magnitude of this effect on clinical screening measures such as jump-landings is unknown. This study determined the effect of court (CS), grass (GS), and tile (TS) surfaces on Landing Error Scoring System (LESS) grades. A repeated-measures design was used. Forty (21F, 19M; mean age = 23.8 ± 2.4 yr) recreational athletes performed a jump-landing task on three different landing surfaces. 2D videography recorded jump-landings in the frontal and sagittal planes. A 2 X 3 (sex by surface) mixed-model repeated-measures analysis of variance was used to examine main and interaction effects associated with surface and sex. No significant sex by landing surface interactions existed for LESS grades. No significant differences were observed on LESS grades for the main effect of surface (CS = 4.83 ± 1.31 points; GS = 5.01 ± 1.40 points; TS = 5.09 ± 1.86 points; all p>0.05). Correlations were found between LESS grades among different conditions (r range=0.587 to 0.611; all p <0.001). Commonly used jump-landing surfaces for clinical biomechanical evaluations do not affect LESS grades, suggesting generalisability as a screening tool for anterior cruciate ligament injury risk in different sport environments.

Drs Jacobs and Buzi drafted and revised the manuscript; Drs Vu, Mony, and Sofos provided further critical review and revisions; and all authors cared for this patient, approve the final manuscript as submitted, and agree to be accountable for all aspects of the work.

The ductus arteriosi (DA) are embryonic blood vessels found in amniotic vertebrates that shunt blood away from the pulmonary artery and lungs and toward the aorta. Here, we examine changes in morphology of the right and left DA (LDA), and right and left aorta (LAo) from embryonic and hatchling alligators. The developing alligator has two-patent DA that join the right and LAo. Both DA exhibit a muscular phenotype composed of an internal smooth muscle layer (2-4 cells thick). At hatching, the lumen diameter of both DA decreases as the vessels begin to close within the first 12 h of posthatch life. Between day 1 and day 12 posthatching, the vessel becomes fully occluded with endothelial and smooth muscle cells filling the lumen. A number of DA from hatchlings contained blood clots along their length. The lumen of the full term alligator DA is reduced in comparison with the full term chicken DA. The developing alligator embryo has an additional right-to-left shunt pathway in the LAo arising from the right ventricle. The embryonic LAo diameter is twice the diameter of either the right DA or LDA, providing a lower resistance pathway for blood leaving the right ventricle. On the basis of these findings, we propose that the paired DA of the embryonic alligator have a reduced role in the embryonic right-to-left shunt of blood from the right ventricle when compared with the avian DA.

Background Capstone, or bootcamp, courses have been shown to increase the knowledge, skills, and selfefficacy of students prior to starting intern year and have been recommended by the Alliance for Clinical Education (ACE) to be incorporated into the fourth-year medical school curricula. However, a paucity of research exists regarding the exploration of the student perspective on critical curricular content and teaching strategies in a capstone course. Self-efficacy, one's subjective task-specific judgment of capability, has served in the literature as a framework for capstone outcomes and is derived from four sources of experiences: practice, observation of others, feedback, and one's emotional reaction to difficult situations. Utilizing this framework, we aimed to evaluate the impact of our capstone curriculum on students' self-efficacy and to identify critical curricular content and teaching strategies that affected students' self-efficacy and their transition into residency.

A number of methods are currently available for measuring arterial stiffness. However, it is not known whether differences exist between measures made on the left vs. right side of the body. Recently, the new SphygmoCor Xcel has been developed that measures aortic pulse wave velocity (AoPWV) and augmentation index (AIx). The first objective of this study was to use the SphygmoCor Xcel to examine the relation between AoPWV and AIx measured on the left vs. right side of the body. The second objective was to assess the relation of AoPWV and AIx (SphygmoCor Xcel) compared with carotid arterial compliance, distensibility and beta stiffness index (high resolution ultrasonography and applanation tonometry). Twenty‐six adults participated in this study (16 men, 25 to 75 y). AoPWV and AIx measured on the left vs. right side of the body were not significantly different (mean difference: −0.15±0.1 m/s, P=0.2 and −0.29±0.7 %, P=0.7, respectively) and were strongly related (AoPWV: r=0.94, P<0.0001 and AIx: r=0.98, P<0.0001). AoPWV and AIx were positively related with beta stiffness index (r=0.44, P=0.04 and r=0.42, P=0.04, respectively), but were not related with arterial compliance or distensibility (P>;0.5). In conclusion, arterial stiffness measures from the left and right side of the body are similar and highly correlated. Compared to other measures, AoPWV and AIx are only significantly related with the beta stiffness index.

ACs readily accepted influenza vaccination at their child's pediatric primary care office. Increased vaccination acceptance occurred when ACs were female, had private insurance, if their child had a chronic illness and if the vaccination was offered the same day as their child's appointment. Likely reason for low acceptance in ACs with Medicaid insurance is high cost; thus, staff, well-aware of Medicaid's nonreimbursement, likely offered the vaccine less to these parents.