Flipped Classroom in Podiatric Medical Education.

BACKGROUND: The purpose of this study was to evaluate student learning outcomes in a flipped classroom versus a traditional classroom in a podiatric medical school. To date no published reports in podiatric medical schools have used the flipped classroom for the entirety of a medical school course. METHODS: Students from the class of 2017 completed the Emergency Medicine and Trauma course using traditional classroom lectures, and the class of 2018 used a flipped classroom approach. Each class took two assessments that contained 99 identical questions and completed a postcourse evaluation that contained student comments. A multivariate analysis of covariance was conducted to determine whether student performances were significantly affected by the differences in the teaching method. Student evaluation comments were analyzed using textual data analysis to determine the sentiments that students expressed regarding their exposure to the teaching method. RESULTS: The multivariate analysis of covariance results revealed that students scored slightly lower on assessments during the flipped classroom delivery compared with the traditional classroom delivery, when adjusted for Medical College Admission Test scores and grade point average, but not significantly (P = .4340). Similarly, the sentiment analysis of student comments indicated that the average positive sentiment score for the flipped classroom delivery was higher but was not significant (P = .08914). CONCLUSIONS: The analysis showed there was not a statistically significant change in examination scores based on teaching method. Sentiment analysis revealed that student sentiments were more positive with the flipped classroom group compared with the traditional lecture group, although not statistically significantly.

Brain gyrification in wild and domestic canids: Has domestication changed the gyrification index in domestic dogs?

Over the last 15 years, research on canid cognition has revealed that domestic dogs possess a surprising array of complex sociocognitive skills pointing to the possibility that the domestication process might have uniquely altered their brains; however, we know very little about how evolutionary processes (natural or artificial) might have modified underlying neural structure to support species-specific behaviors. Evaluating the degree of cortical folding (i.e., gyrification) within canids may prove useful, as this parameter is linked to functional variation of the cerebral cortex. Using quantitative magnetic resonance imaging to investigate the impact of domestication on the canine cortical surface, we compared the gyrification index (GI) in 19 carnivore species, including six wild canid and 13 domestic dog individuals. We also explored correlations between global and local GI with brain mass, cortical thickness, white and gray matter volume and surface area. Our results indicated that GI values for domestic dogs are largely consistent with what would be expected for a canid of their given brain mass, although more variable than that observed in wild canids. We also found that GI in canids is positively correlated with cortical surface area, cortical thickness and total cortical gray matter volumes. While we found no evidence of global differences in GI between domestic and wild canids, certain regional differences in gyrification were observed.

Latent Dirichlet Allocation in predicting clinical trial terminations.

BACKGROUND: This study used natural language processing (NLP) and machine learning (ML) techniques to identify reliable patterns from within research narrative documents to distinguish studies that complete successfully, from the ones that terminate. Recent research findings have reported that at least 10 % of all studies that are funded by major research funding agencies terminate without yielding useful results. Since it is well-known that scientific studies that receive funding from major funding agencies are carefully planned, and rigorously vetted through the peer-review process, it was somewhat daunting to us that study-terminations are this prevalent. Moreover, our review of the literature about study terminations suggested that the reasons for study terminations are not well understood. We therefore aimed to address that knowledge gap, by seeking to identify the factors that contribute to study failures. METHOD: We used data from the clinicialTrials.gov repository, from which we extracted both structured data (study characteristics), and unstructured data (the narrative description of the studies). We applied natural language processing techniques to the unstructured data to quantify the risk of termination by identifying distinctive topics that are more frequently associated with trials that are terminated and trials that are completed. We used the Latent Dirichlet Allocation (LDA) technique to derive 25 "topics" with corresponding sets of probabilities, which we then used to predict study-termination by utilizing random forest modeling. We fit two distinct models - one using only structured data as predictors and another model with both structured data and the 25 text topics derived from the unstructured data. RESULTS: In this paper, we demonstrate the interpretive and predictive value of LDA as it relates to predicting clinical trial failure. The results also demonstrate that the combined modeling approach yields robust predictive probabilities in terms of both sensitivity and specificity, relative to a model that utilizes the structured data alone. CONCLUSIONS: Our study demonstrated that the use of topic modeling using LDA significantly raises the utility of unstructured data in better predicating the completion vs. termination of studies. This study sets the direction for future research to evaluate the viability of the designs of health studies.

Neuropil Distribution in the Anterior Cingulate and Occipital Cortex of Artiodactyls.

Relatively little neuroscience research has been focused on artiodactyls. Recent observations of complex social interactions in domestic and wild species suggest that analyses of artiodactyl brain anatomy would be of comparative value. In this study, we examined how the distribution of cortical neuropil space (a proxy for connectivity) varies across representative members of this diverse clade. Using image analysis techniques, we quantified the neuropil space in the anterior cingulate cortex (ACC) and the occipital (putative primary visual) cortex (OC) of 12 artiodactyl species from adult specimens. Additionally, we conducted a preliminary investigation of variation in ACC neuropil space in a developmental series of five white-tailed deer (Odocoileus virginianus). Results indicate a consistent pattern of greater neuropil space in the ACC in comparison to the OC among all species, and a gradual increase in ACC neuropil space toward maturity in the white-tailed deer. Given the taxa that have the greatest cortical neuropil space, we hypothesize that such enhanced connectivity might be needed to support behaviors such as group foraging and attentiveness to conspecifics. These results help advance a broader understanding of diversity in neural circuitry in artiodactyls and point to the need for more in-depth comparisons of cortical neuron morphology and organization in this relatively understudied taxonomic group. Anat Rec, 301:1871-1881, 2018. © 2018 Wiley Periodicals, Inc.

Measuring patient satisfaction with medical services using social media generated data.

Purpose The purpose of this paper is to discuss the results of an effort to use social media generated data for measuring patient satisfaction with medical care services. Traditionally, scientifically designed patient satisfaction surveys are used to provide such measurements. The goal here is to evaluate the possibility of supplementing patient satisfaction surveys with social media generated patient satisfaction measurements such that the later can be used either as validation or replacement for the former. Although surveys are scientifically designed to yield dependable results, recent studies have revealed multiple factors relating to the methods currently used for survey data collection, that may be contributing to the limitations of many survey results. In light of such criticisms, this study explored the possibility of using the increasing popular and proactively generated consumer ratings through the pervasive social media as data source for satisfaction measurement. The average satisfaction scores created from such data are then used to compare levels of satisfaction among five types of health service businesses. Design/methodology/approach The data used in this research are garnered from the consumer review social media site called "Yelp!". Ratings and reviews that are related to health and medical services were extracted from the "Yelp!" DATABASE: The types of services that are identified by consumers are standardized to typologies that are traditionally used in health service research. Five types of services were targeted - general practice physician offices, physician specialty services, dentists, hospitals and physical therapy services. The "five-star" rating systems were re-coded to form a five-point ordinal scale variable to represent "satisfaction score". Findings The Yelp! data-based measurement of patient satisfaction produced an overall satisfaction score of 3.8 (SD=1.7) for the sampled services. The average satisfaction score per type of service ranged from 3.16 (SD=1.83) for specialty physicians to 4.52 (SD=1.57) for physical therapists. In general, dentists and physical therapists received higher average satisfaction scores as compared to the other medical services. Research limitations/implications Because this study was meant to evaluate the utility of social media generated data to measure satisfaction, in general, the estimates cannot be construed as representative of any underlying geographically defined population. They, however, do have a "cohort" interpretability. This limitation is not inherent to the use of the data source. If some geographically identifiable representation of the measurement data is desired, identifiable business data can be generated from the Yelp! system to specifically target relevant populations following the method that are tested in this study. Practical implications Under certain circumstances, such as the size and maturity of the gathered data, social media generated data can be a useful as a "fortuitous" alternative to satisfaction surveys for evaluating patient satisfaction with medical care. This is propitious as there have been some indication by studies that the advent of communication media in the twenty-first century may be undermining the reliability of scientifically designed surveys. Originality/value The use of social media generated data as "alternative" or "secondary" data source for research use is currently being widely investigated. To the author's knowledge, this is the only paper that evaluated the use of "Yelp!" data as a possible source for population-based formal satisfaction measurement for healthcare services.

Vaginismus Treatment: Clinical Trials Follow Up 241 Patients.

INTRODUCTION: Vaginismus is mostly unknown among clinicians and women. Vaginismus causes women to have fear, anxiety, and pain with penetration attempts. AIM: To present a large cohort of patients based on prior published studies approved by an institutional review board and the Food and Drug Administration using a comprehensive multimodal vaginismus treatment program to treat the physical and psychologic manifestations of women with vaginismus and to record successes, failures, and untoward effects of this treatment approach. METHODS: Assessment of vaginismus included a comprehensive pretreatment questionnaire, the Female Sexual Function Index (FSFI), and consultation. All patients signed a detailed informed consent. Treatment consisted of a multimodal approach including intravaginal injections of onabotulinumtoxinA (Botox) and bupivacaine, progressive dilation under conscious sedation, indwelling dilator, follow-up and support with office visits, phone calls, e-mails, dilation logs, and FSFI reports. MAIN OUTCOME MEASURES: Logs noting dilation progression, pain and anxiety scores, time to achieve intercourse, setbacks, and untoward effects. Post-treatment FSFI scores were compared with preprocedure scores. RESULTS: One hundred seventy-one patients (71%) reported having pain-free intercourse at a mean of 5.1 weeks (median = 2.5). Six patients (2.5%) were unable to achieve intercourse within a 1-year period after treatment and 64 patients (26.6%) were lost to follow-up. The change in the overall FSFI score measured at baseline, 3 months, 6 months, and 1 year was statistically significant at the 0.05 level. Three patients developed mild temporary stress incontinence, two patients developed a short period of temporary blurred vision, and one patient developed temporary excessive vaginal dryness. All adverse events resolved by approximately 4 months. One patient required retreatment followed by successful coitus. CONCLUSION: A multimodal program that treated the physical and psychologic aspects of vaginismus enabled women to achieve pain-free intercourse as noted by patient communications and serial female sexual function studies. Further studies are indicated to better understand the individual components of this multimodal treatment program. Pacik PT, Geletta S. Vaginismus Treatment: Clinical Trials Follow Up 241 Patients. Sex Med 2017;5:e114-e123.

The Use of Rubrics in the Clinical Evaluation of Podiatric Medical Students: Objectification of the Subjective Experience.

BACKGROUND: We assessed the differences in podiatric medical students' clinical professionalism objective scores (CPOSs) by comparing a previous nonrubric evaluation tool with a more recently implemented objective-centered rubric evaluation tool. This type of study has never been performed or reported on in the podiatric medical education literature. METHODS: We conducted a retrospective analysis of 89 third-year podiatric medical students between academic years 2010-2011 and 2011-2012. A Pearson correlation coefficient analysis was performed to compare CPOSs from the students' first (CPOS1) and second (CPOS2) rotations. A correlation analysis was performed comparing students' grade point averages (GPAs) with each of the individual CPOSs to verify the validity of the rubric evaluation tool. RESULTS: The Pearson correlation coefficients for the relationship between 2012 CPOS1 and CPOS2 and GPA were r = 0.233 (P ≤ .093) and r = 0.290 (P < .035) and for the relationship between 2013 CPOS1 and CPOS2 and GPA were r = 0.525 (P = .001) and r = 0.730 (P < .001). CONCLUSIONS: These findings suggest that the use of a rubric in the evaluation of podiatric medical students' CPOSs is correlated with their GPAs, and CPOS2 demonstrated a higher correlation than CPOS1. We believe that implementation of the rubric evaluation tool has increased the accuracy of the evaluation of podiatric medical students with respect to CPOSs.

Assessment of a Cultural Competency Program in Podiatric Medical Education.

BACKGROUND: Des Moines University College of Podiatric Medicine and Surgery (CPMS) is implementing a cultural competency program for third-year podiatric medical students. This study assessed the effectiveness of the new educational program on cultural competency at CPMS by comparing pretest and posttest scores of students from the CPMS graduating classes of 2013 and 2014. METHODS: Students from the class of 2013 completed a 10-week online course on cultural competency, and the class of 2014 students did not. A pretest and posttest survey was used to assess cultural competency. The questions were categorized to assess either knowledge acquisition or attitudinal change. The 2013 students completed the pretest before the course and a posttest after completing the course. Without taking the course, 2014 students completed the same pretest and posttest separated by 10 weeks. A repeated-measures analysis of variance was used to compare the knowledge acquisition scores and attitudinal change scores. RESULTS: The repeated-measures analysis of variance revealed a significant interaction effect of taking the attitudinal change course (F(1,77) = 15.2; P < .001). The course did not show a significant interaction on knowledge acquisition (F(1,77) = 0.72; P > .05). CONCLUSIONS: The analysis showed a statistically significant improvement in attitudinal change scores. The study suggests that there needs to be a greater knowledge acquisition component to the cultural competency course at CPMS.

The students' perspective in examining the use of high-fidelity simulators in a podiatric medical curriculum.

BACKGROUND: We sought to assess the perceptions that podiatric medical students had of the use of simulators after completing a third-year simulation rotation. This type of analysis has not been reported in the podiatric medicine educational literature. Another goal of this study was to influence the podiatric medical community to increase studies that help demonstrate the effectiveness of simulation in the podiatric medical curriculum. METHODS: Data from rotation evaluations of 44 students from the 2011-2012 academic year included student responses to 11 quantitative items and textual analysis of the students' written comments. Basic descriptive statistics of student responses to the quantitative items allowed for the analysis of central tendencies and variations. Textual analysis was performed on comments that were coded into themes based on similar properties and characteristics that the comments shared. RESULTS: The analysis revealed that the simulation sessions were well liked. All of the students who responded to the survey rated the overall simulation rotation as "superior." Textual analysis of the students' comments showed that students enjoy simulation as an educational tool because it helps enhance their clinical skills while also applying their didactic education to a practical experience. Clear evidence was presented that students want more cases and time to spend in the simulation laboratory to continue increasing their medical skills. CONCLUSIONS: The student perception of simulation is that it is an effective educational tool. Further testing is needed to prove simulation efficacy in a podiatric medical curriculum.

United States Guild Certified Feldenkrais Teachers®: a survey of characteristics and practice patterns.

BACKGROUND: Feldenkrais Method® teachers help students improve function and quality of life through verbally and manually guided lessons. The reasons people seek Feldenkrais® lessons are poorly understood. Similarly, little is known about practice characteristics and patterns. To address these knowledge gaps, we conducted an extensive survey of United States Guild Certified Feldenkrais Teachers®. METHODS: We invited all Feldenkrais Teachers to participate in this survey delivered in web-based or print formats. We obtained overall and question-specific response rates, descriptive statistics, chi-square tests of response bias, and performed qualitative thematic review of comments. RESULTS: Overall response rate was 30.5% (392/1287). Ninety percent of responders had college degrees in diverse fields; 12.5% had credentials outside health care, 36.9% held conventional health care licenses, and 23.1% had complementary and alternative medicine credentials. Mean age was 55.7 years; most teachers were women (83%). California (n = 100) and New York (n = 34) had the most teachers. Forty-five percent of teachers earned ≤ 20% of their gross income from their practices, while 26% earned > 80%. Most saw < 10 students/week for individual lessons and < 10 students/week for group lessons. Students were mostly women (71.1%) and 45-64 years old. The primary reason students sought Feldenkrais lessons was pain. A quarter of students self-referred, a fifth were referred by conventional health care providers, and two-thirds paid for services directly. Themes from comments included: beliefs that Feldenkrais training had important personal and professional benefits for teachers; recognition of the challenges of operating small businesses and succinctly describing the Feldenkrais Method; the variety of practice approaches; and a deep commitment to the Feldenkrais Method. CONCLUSIONS: Most Feldenkrais Teachers were well educated, often held additional credentials, were located in the West, were women, were older than 50 years, and had part-time practices. Most students were women, were adults, came from various referral sources, and paid directly for services. Teachers and students utilized the Feldenkrais Method in diverse settings and applications. These findings may foster practice development by Feldenkrais Teachers, improve communication between health care consumers and providers and assist decision-making, and stimulate more research concerning the Feldenkrais Method.

Enterococcus in surface waters from the Des Moines River (Iowa) watershed: location, persistence and vancomycin resistance.

The object of this study was to quantify vancomycin-resistant enterococci in surface water from Central Iowa obtained from April 2007 to August 2007. Water from established sampling sites in four watersheds was plated on bile-esculin agar. Presumptively identified enterococci were categorized as "above the level of concern" if the sample contained ≥ 107 CFU per 100 ml. Confirmation of isolates as enterococci was based on growth at elevated temperature in high salt and on Enterococcus agar. Isolates that grew on 6 µg/ml vancomycin agar were deemed resistant. PCR analysis of resistant strains characterized vancomycin resistance genes. 77.2% of surface water samples from Central Iowa contained enterococci. Among enterococcal isolates, 10.4% grew on media containing 6 µg/ml vancomycin. PCR analysis of resistance genes showed a preponderance of VanC2/C3 in the area studied and VanB was not detected. Vancomycin-resistant Enterococcus is present in Central Iowa surface waters but resistance rarely involved VanA genotypes. Nevertheless, the potential for community-acquired infections remains a risk.

The role of institutional selectivity in the prediction of podiatric medical school performance.

BACKGROUND: This pilot study explores the influence of preadmission data on podiatric medical school performance, specifically, the role of undergraduate institutional selectivity. This type of study has never been described in the podiatric medical education literature. We conducted a longitudinal analysis of preadmission data on 459 students from the graduating classes of 2000 to 2009 at the College of Podiatric Medicine and Surgery at Des Moines University. METHODS: Multivariate linear regression was used to assess the relationship between performance during the first year of podiatric medical school and a set of independent variables that represent certain preadmission student characteristics. Student demographic characteristics, such as race/ethnicity and sex, were also included in the regression analysis as control variables. RESULTS: The regression analysis revealed that ethnic origin, undergraduate grade point average, Medical College Admission Test biological science and verbal reasoning scores, and institutional selectivity together had a significant effect on the dependent variable (F = 18.3; P < .001). The variance for the independent variable/constant variables was 32%. Almost twice as many students were dismissed or withdrew in poor academic standing who attended undergraduate institutions in the lowest selectivity category. CONCLUSIONS: This analysis revealed that in the College of Podiatric Medicine and Surgery, some preadmission variables, such as institutional selectivity, undergraduate grade point average, ethnic origin, and Medical College Admission Test verbal reasoning and biological science scores, are statistically significant in predicting first-year podiatric medical school grade point average. The selectivity of a student's undergraduate institution should be considered when screening potential podiatric medical school applicants.

A comparison of vitamin D levels in nondiabetic and diabetic patient populations.

BACKGROUND: This study was designed to compare the vitamin D levels in a cohort of nondiabetic patients to populations of diabetic patients with and without Charcot neuroarthropathy. METHODS: A total of 41 participants (22 male, 19 female) with a mean +/- SD age of 59 +/- 9.43 years had serum 25-hydroxyvitamin D levels tested. Fifteen participants composed the nondiabetic group; 13, the group with diabetes but without Charcot neuroarthropathy; and 13, the group with both diabetes and Charcot neuroarthropathy. RESULTS: The results of the study showed that the vitamin D levels in both diabetic populations were significantly lower (P < .05) than the nondiabetic population. There was no statistical difference between the group with diabetes but without Charcot foot disease and the group with both diabetes and Charcot neuroarthropathy. CONCLUSIONS: Based on the results of this study, given the importance of vitamin D in bone metabolism and the osseous consequences associated with diabetes, as well as other systems affected by low levels of vitamin D in the diabetic patient, it appears that vitamin D levels should be monitored in diabetic patients.