Desmoglein-1 is a minor autoantigen in dogs with pemphigus foliaceus.

The majority of human patients with pemphigus foliaceus (PF) have circulating IgG autoantibodies that target conformational epitopes on the desmosomal cadherin desmoglein-1 (dsg1). Limited studies using immunoblot techniques suggested that the principal autoantigen in dogs with PF might also be dsg1. It was the objective of this study to test this hypothesis. A comprehensive survey of canine PF sera was conducted using a novel screening strategy that detects conformational epitopes. This method consists of the ectopic expression of canine dsg1 at the surface of human 293T epithelial kidney cells and their live screening, i.e. prior to fixation. Out of seven control human PF sera that bound to canine epidermis, three (57%) contained IgG autoantibodies that recognized ectopically expressed canine dsg1 with a membrane and punctate pattern. Out of 83 canine PF sera only five (6%) contained IgG that recognized canine dsg1. Consistent with findings for human PF sera obtained in this study, autoantibody binding was conformation- and glycosylation-dependent as demonstrated by calcium chelation with EDTA and tunicamycin or wheat germ agglutinin treatment, respectively. In conclusion, these studies establish canine dsg1 as a minor autoantigen for canine PF. Antigenic epitopes appear to be conformation- and glycosylation-dependent.

An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience.

A review of the development and implementation of a 4-year medical student integrated ultrasound curriculum is presented. Multiple teaching and assessment modalities are discussed as well as results from testing and student surveys. Lessons learned while establishing the curriculum are summarized. It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education.

Evaluation of medical student performance on objective structured clinical exams with standardized patients with and without disabilities.

PURPOSE: To investigate whether medical students' performance on a family medicine clerkship objective structured clinical exam (OSCE) differed when the standardized patient (SP) had a disability versus when the SP did not have a disability. METHOD: SPs with spinal cord injury (SP-SCI), SPs with intellectual disability (SP-ID), and SPs without a disability participated separately in two OSCE scenarios that were administered by the University of South Carolina School of Medicine's Department of Family and Preventive Medicine from 2007 to 2009. OSCE scores were determined based on the number of critical actions completed by the student, and scores were analyzed to determine differences among scenarios. RESULTS: Students scored lower in history, physical exam, lab tests, and interpersonal skills with an SP-SCI, and lower in history, physical exam, and lab tests with an SP-ID than did students interacting with SPs without a disability. The odds ratio for ordering a hemoglobin A1c in one scenario was 4.16 times higher in cases when the SP did not have a disability (95% confidence interval [CI] 1.78-9.17, P = .001). In the second scenario, the odds ratio was 3.08 times higher for ordering a urinalysis (95% CI 1.34-7.08, P = .006) and was 2.15 times higher for providing lifestyle counseling (95% CI 1.04-4.44, P = .038) in students interacting with SPs without a disability. CONCLUSIONS: Students performed better when the SP did not have a disability. This suggests that greater emphasis should be placed on teaching appropriate care of patients with a disability.

Teaching medical students about disability in family medicine.

We investigated whether a unique didactic focusing on delivering health care to patients with disabilities (PWDs) impacts medical students' knowledge of specific disabilities and related concerns, attitudes about barriers to this populations' health care, and behavior during typical primary care visits with PWDs. A 90-minute session for students during their third-year family medicine clerkship addressed clinical considerations for patients with mobility and cognitive impairments. Questionnaires were administered to students at the beginning and completion of the clerkship. Analyses of 71 matched questionnaires reveal that knowledge and attitudes were positively impacted.