CLOCK and TIMELESS regulate rhythmic occupancy of the BRAHMA chromatin-remodeling protein at clock gene promoters.

Circadian clock and chromatin-remodeling complexes are tightly intertwined systems that regulate rhythmic gene expression. The circadian clock promotes rhythmic expression, timely recruitment, and/or activation of chromatin remodelers, while chromatin remodelers regulate accessibility of clock transcription factors to the DNA to influence expression of clock genes. We previously reported that the BRAHMA (BRM) chromatin-remodeling complex promotes the repression of circadian gene expression in Drosophila. In this study, we investigated the mechanisms by which the circadian clock feeds back to modulate daily BRM activity. Using chromatin immunoprecipitation, we observed rhythmic BRM binding to clock gene promoters despite constitutive BRM protein expression, suggesting that factors other than protein abundance are responsible for rhythmic BRM occupancy at clock-controlled loci. Since we previously reported that BRM interacts with two key clock proteins, CLOCK (CLK) and TIMELESS (TIM), we examined their effect on BRM occupancy to the period (per) promoter. We observed reduced BRM binding to the DNA in clk null flies, suggesting that CLK is involved in enhancing BRM occupancy to initiate transcriptional repression at the conclusion of the activation phase. Additionally, we observed reduced BRM binding to the per promoter in flies overexpressing TIM, suggesting that TIM promotes BRM removal from DNA. These conclusions are further supported by elevated BRM binding to the per promoter in flies subjected to constant light and experiments in Drosophila tissue culture in which the levels of CLK and TIM are manipulated. In summary, this study provides new insights into the reciprocal regulation between the circadian clock and the BRM chromatin-remodeling complex.

Triarchic traits as risk versus protective factors for ADHD symptomatology: A prospective longitudinal investigation.

Attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with myriad adverse outcomes, including interpersonal difficulties, but factors that moderate the developmental course and functional impact of ADHD over time are not well understood. The present study evaluated developmental contributions of the triarchic neurobehavioral traits (boldness, meanness, and disinhibition) to ADHD symptomatology and its subdimensions from adolescence to young adulthood. Participants were twins and triplets assessed at ages 14, 17, and 19 (initial N = 1,185, 51.2% female). Path analyses using negative binomial regression revealed that boldness at age 14 was associated with more ADHD symptoms cross-sectionally (especially hyperactivity/impulsivity), but fewer symptoms (especially inattention) at age 19 in the prospective analysis. Notably, inclusion of interpersonal problems at ages 14 and 17 as covariates reduced the latter effect to nonsignificant. Disinhibition concurrently and prospectively predicted higher levels of ADHD symptoms, including both subdimensions, and the prospective effects were partially mediated by greater social impairment at age 17. Meanness prospectively (but not concurrently) predicted higher levels of hyperactivity/impulsivity symptoms. Sex moderated certain associations of meanness and disinhibition with ADHD symptoms. These findings highlight how fundamental neurobehavioral traits shape both psychopathology and adaptive outcomes in the developmental course of ADHD.

Predictors and Mechanisms of Resilience for High School Students with ADHD: A Prospective Longitudinal Study.

Attention-deficit/hyperactivity disorder (ADHD) has primarily been studied from a deficit-focused perspective. However, there are individuals with ADHD who exhibit resilience or a pattern of positive adaptation despite the risks associated with their diagnosis. The present study evaluated whether peer acceptance predicted resilience for adolescents with ADHD and if self-efficacy or a stress-is-enhancing mindset served as mechanisms of those relations. Participants included 113 comprehensively evaluated adolescents with ADHD (67% male) across three time-points (10th-12th grade). Mediation analyses revealed higher T1 peer acceptance significantly predicted higher resilience (ß = 0.24) 1.5-2 years later, with higher T2 self-efficacy (ß = 0.08) demonstrating a significant indirect effect of the association. A stress-is-enhancing mindset directly predicted resilience (ß = 0.15) but was not associated with peer acceptance nor mediated the association between peer acceptance and resilience. Present results are the first to provide longitudinal evidence for peer acceptance, self-efficacy, and a stress-is-enhancing mindset as important for promoting resilience among adolescents with ADHD.

S1P-Dependent trafficking of intracellular yersinia pestis through lymph nodes establishes Buboes and systemic infection.

Pathologically swollen lymph nodes (LNs), or buboes, characterize Yersinia pestis infection, yet how they form and function is unknown. We report that colonization of the draining LN (dLN) occurred due to trafficking of infected dendritic cells and monocytes in temporally distinct waves in response to redundant chemotactic signals, including through CCR7, CCR2, and sphingosine-1-phospate (S1P) receptors. Retention of multiple subsets of phagocytes within peripheral LNs using the S1P receptor agonist FTY720 or S1P1-specific agonist SEW2871 increased survival, reduced colonization of downstream LNs, and limited progression to transmission-associated septicemic or pneumonic disease states. Conditional deletion of S1P1 in mononuclear phagocytes abolished node-to-node trafficking of infected cells. Thus, Y. pestis-orchestrated LN remodeling promoted its dissemination via host cells through the lymphatic system but can be blocked by prevention of leukocyte egress from DLNs. These findings define a novel trafficking route of mononuclear phagocytes and identify S1P as a therapeutic target during infection.

PM2.5-Attributable Mortality Burden Variability in the Continental U.S.

Epidemiologic studies have consistently observed associations between fine particulate matter (PM2.5) exposure and premature mortality. These studies use air quality concentration information from a combination of sources to estimate pollutant exposures and then assess how mortality varies as a result of differing exposures. Health impact assessments then typically use a single log-linear hazard ratio (HR) per health outcome to estimate counts of avoided human health effects resulting from air quality improvements. This paper estimates the total PM2.5-attributable premature mortality burden using a variety of methods for estimating exposures and quantifying PM2.5-attributable deaths in 2011 and 2028. We use: 1) several exposure models that apply a wide range of methods, and 2) a variety of HRs from the epidemiologic literature that relate long-term PM2.5 exposures to mortality among the U.S. population. We then further evaluate the variability of aggregated national premature mortality estimates to stratification by race and/or ethnicity or exposure level (e.g., below the current annual PM2.5 National Ambient Air Quality Standards). We find that unstratified annual adult mortality burden incidence estimates vary more (e.g., ~3-fold) by HR than by exposure model (e.g., <10%). In addition, future mortality burden estimates stratified by race/ethnicity are larger than the unstratified estimates of the entire population, and studies that stratify PM2.5-attributable mortality HRs by an exposure concentration threshold led to substantially higher estimates. These results are intended to provide transparency regarding the sensitivity of mortality estimates to upstream input choices.

Urinary Tract Infection Epidemiology in NICUs in the United States.

OBJECTIVE: Our objective was to characterize the incidence, associated clinical factors, timing of infection, microbiology, and incidence of concordant blood culture of urinary tract infections (UTIs) in very low birth weight (VLBW <1,500g) infants. STUDY DESIGN: Multicenter observational cohort study of VLBW infants with gestational age (GA) ≤32 weeks, still hospitalized on postnatal day 7, and discharged 2010 to 2018 from Pediatrix Medical Group neonatal intensive care units. Demographic and clinical characteristics of infants with and without UTI were compared. Multivariable logistic regression evaluated adjusted odds of UTI diagnosis. RESULTS: Of 86,492 included infants, 5,988 (7%) had a UTI. The most common pathogen was Enterococcus spp. (20%), followed by Escherichia coli (19%) and Klebsiella spp. (18%). Candida spp. (6%) was the most common nonbacterial pathogen. Concordant-positive blood culture was present in 8% of infants with UTI diagnoses. UTI was associated with lower GA, male sex, vaginal delivery, prenatal steroid exposure, and longer duration of hospitalization. CONCLUSION: UTI is a common cause of infection in VLBW infants, especially among the smallest, most premature, male infants, and those with a longer duration of hospitalization. Neonatal clinicians should consider obtaining urine culture in the setting of late-onset sepsis evaluations in VLBW infants. KEY POINTS: · UTI is a common cause of LOS in VLBW infants.. · The most common pathogens are Enterococcus spp. and E. coli.. · UTI risk varies among different VLBW infant populations.. · Next steps should include evaluation of preventative measures..

Evaluating the Simple View of Reading for Children With Attention-Deficit/Hyperactivity Disorder.

The 'simple view of reading' is an influential model of reading comprehension which asserts that children's reading comprehension performance can be explained entirely by their decoding and language comprehension skills. Children with ADHD often exhibit difficulty across all three of these reading domains on standardized achievement tests, yet it is unclear whether the simple view of reading is sufficient to explain reading comprehension performance for these children. The current study was the first to use multiple indicators and latent estimates to examine the veracity of key predictions from the simple view of reading in a clinically-evaluated sample of 250 children with and without ADHD (ages 8-13, Mage=10.29, SD=1.47; 93 girls; 70% White/Non-Hispanic). Results of the full-sample structural equation model revealed that decoding and language comprehension explained all (R2=.99) of the variance in reading comprehension for children with and without ADHD. Further, multigroup modeling (ADHD, Non-ADHD) indicated that there was no difference in the quantity of variance explained for children with ADHD versus clinically-evaluated children without ADHD, and that the quantity of explained variance did not differ from 100% for either group. Sensitivity analyses indicated that these effects were generally robust to control for monomethod bias, time sampling error, and IQ. These findings are consistent with 'simple view' predictions that decoding and language comprehension are both necessary and together sufficient for explaining children's reading comprehension skills. The findings extend prior work by indicating that the 'simple view' holds for both children with ADHD and clinically-evaluated children without ADHD.

Veterinary Curriculum Leaders: Motivators, Barriers, and Attributes.

Curriculum leaders (individuals with responsibility for an institution's veterinary curriculum) play a vital role in driving local curriculum priorities, development, and accreditation. This study aimed to describe the career paths of curriculum leaders, and identify what motivates them, the barriers they face, and the knowledge, skills, and attributes they perceive as essential for the role. Self-determination theory was used to identify tensions experienced within the role. An international online survey targeted at those identifying as curriculum leaders was completed by 45 participants. 91% of participants held a doctoral level qualification and/or clinical Boards; 82% had additional training in leadership; 38% had additional formal training in education. Motivators included a desire to make a difference, personal satisfaction with teaching and working with students, and social influences. Participants experienced barriers relating to self-development and achievement of their curriculum goals; participants described essential knowledge (of the profession, educational theory, and wider higher education context) and skills (leading teams, change management, and communication). Attributes considered important related both to self (open-minded, patient, resilient, able to see the big picture as well as detail) and relationships with others (approachable, listener, respectful and respected, supportive, credible). Tensions arose in participants' need for autonomy (experiencing barriers to achieving their goals), in their social relatedness (achieving curriculum goals while working with colleagues with conflicting priorities), and in perceptions of necessary competence (a need, but lack of opportunity, for advanced training in educational theory). The findings may help institutions more effectively support and train current and future curriculum leaders.

Novel application of intravascular lithotripsy in stent under-expansion: A single-center experience.

INTRODUCTION: Stent under-expansion due to calcification is associated with a less durable result. The development of intravascular lithotripsy (IVL) has provided clinicians with a readily available, simple-to-use treatment option for coronary calcification, but the use of IVL within a previously stented segment is currently off-license. There are, however, developing data suggesting that the use of IVL can be an effective treatment option for patients with calcific stent under-expansion. METHOD: This was a single-center study of all patients treated with IVL for calcific stent under-expansion between January 2019 and June 2021. The impact of IVL on quantitative coronary angiography (QCA) stenosis and on the minimal stent area (MSA) derived from intracoronary imaging were recorded. The presence of periprocedural complications and adverse cardiovascular events was obtained from the clinical record during the study timeframe. RESULTS: Thirty-nine patients underwent IVL for calcific stent under-expansion during the study time frame with one patient treated with more than one lesion in the same session. In all lesions, there was an improvement in the QCA stenosis with 37 (92.5%) having a residual stenosis of ≤30%. The mean QCA stenosis pre-IVL was 68 ± 21% and following IVL the mean QCA was 18 ± 9% (p < 0.001). In all lesions, there was an improvement in the MSA, with 26 (92.9%) achieving an MSA of more than 4.5 mm2 . The mean MSA pre-IVL was 3.88 ± 1.51 mm2 and following IVL the mean MSA was 7.41 ± 2.34 mm2 (p < 0.001). There were no major procedural complications. Over a mean follow-up of 506 ± 277 days, one patient died from ventricular arrhythmia but there were no other major adverse cardiovascular events. CONCLUSION: This single-center study demonstrates that IVL is a safe and effective treatment for calcific stent under-expansion with good medium-term results.

"It's okay to not know " a qualitative exploration of faculty approaches to working with uncertainty.

BACKGROUND: Whilst it is recognised that a capacity to manage uncertainty is an essential aspect of working as a healthcare professional, there is little clear guidance on how to facilitate student learning in this domain. A lack of faculty development opportunities also suggests that health professions' educators may feel ill-equipped to assist students in developing effective approaches to uncertainty. The purpose of this study was to explore a faculty development intervention designed to help educators unpack students' experiences of uncertainty, and identify attributes which may help students to manage uncertain situations. METHODS: This qualitative study was informed by a constructivist methodological approach, where participants were encouraged to share meaning around the nature of uncertainty in health professions' education. Two 90-min faculty development sessions were held. These sessions invited participants to apply Han et al.'s taxonomy of uncertainty to role-played scenarios of student uncertainty within a focus group setting. Focus group data were collected, and examined using a two-stage, hybrid approach of deductive and inductive thematic analysis. RESULTS: Han et al.'s taxonomy helped participants to identify multiple sources and issues of uncertainty in the role played scenarios, thus unveiling the extent of uncertainties encountered by health professions' learners. Data analysis revealed four themes overall: "Sources of uncertainty", "Issues of uncertainty", "Uncertainty attributes", and "Learning environment." Participants also contributed to a list of attributes which they considered helpful to undergraduate health professions' students in managing uncertain situations. These included an awareness of the nature of uncertainty within healthcare practice, an ability to recognise uncertainty, and adopting attitudes of adaptability, positivity, and resilience. CONCLUSIONS: This study highlights the successful use of Han et al.'s taxonomy of uncertainty within a faculty development setting. Our findings suggest that the taxonomy is a practical and versatile tool that health professions' educators can use in shared reflections and conversations around uncertainty with students or colleagues.

Professional Identity of Pakistani Veterinary Students: Conceptualization and Negotiation.

Most work on the professional identity of veterinary and medical professionals has been conceptualized in the USA and Europe. It reports professional identity formation to be highly individualized, triggered by experiences of identity distress, and identity negotiation strategies to be generally focused around personal reflection. However, within Asia, important sociocultural differences exist that might influence professional identity and its development. Societal values may take precedence over individual ones, and some cultures consider the veterinary profession as stigmatized. With this background, we seek to understand professional identity and its construction in Pakistani veterinary students. We selected five students through purposive sampling and invited them for narrative interviews. Social identity theory and Maslow's theory of hierarchy of needs predominantly contributed to the theoretical framework, which together with principles of social phenomenology and narrative analysis informed qualitative analysis of the transcribed interviews using an in-depth approach. We found that students' professional identity was predominantly socially constructed, though their sense of their identity was not very well developed. Role models, social stigma, professional socialization in clinical settings, gender, and to some extent, cultural interpretations of religious messages seemed to mediate professional identity development. Students responded differently to their understanding of professional stigma, making sense of stigma through strategies such as denial or internalization. Since Pakistani veterinary students experience social and personal values differently compared to those from predominantly individualistic cultures, identity formation through reflecting on personal values may be less effective than strategies that emphasize social learning and beliefs.

Student Experience and Ethnic Diversity: The Experiences of Underrepresented Minority Students at a Veterinary University in the United Kingdom.

Despite a lack of diversity, studies on the experience of ethnically diverse (ED) students have not focused on veterinary education. This study used focus groups to explore the experience of ED veterinary students, their challenges, and their sources of support in this setting. Focus groups were held using two formats: a traditional, in-person approach, and online, via a social media group. Recruitment was by invitation and focus group allocation according to participant preference. Conversations were transcribed or downloaded, anonymized, and analyzed using a two-part narrative analysis, the aim of which was to understand the experiences of ED veterinary students at an in-depth level. Students experienced identity conflicts at multiple levels (self, others, profession), which appeared to relate to their ethnicity. Conflict between self and others resulted in a feeling of otherness arising from a White student majority, both within the university and on external placements, and professional identity conflicts arose between students' personal cultural values and their values as a veterinarian. Internal conflicts arose when students felt a wish to integrate but also perceived a need to segregate with similar others to obtain support and a sense of belonging to a group. These challenges have potential implications for mental well-being and career opportunities. For veterinary medicine to adapt to changing client demographics in an increasingly globalized world, a deeper understanding of the ED student experience may offer advantages in areas such as recruitment and profession retention, which will eventually support greater diversity within the professional population.

How Do Veterinary Students Engage When Using Creative Methods to Critically Reflect on Experience? A Qualitative Analysis of Assessed Reflective Work.

Critical reflection-the exploration and questioning of one's experience, beliefs, assumptions, and actions-supports resilience, empathy, the management of uncertainty, and professional identity formation. Yet for many students and educators, the techniques to engage in critical reflection are elusive. Creative methods that foster engagement with emotional and uncertain aspects of experience reportedly help some students to reflect at a more critical level than when they use reflective writing, and this study explores more deeply the experiences of such students, who used creative methods to critically reflect on challenging or troubling past events. A narrative methodology was utilized, in which researchers collaboratively co-constructed an understanding of students' experiences of reflection to identify the activities and steps they used. Creative methods did not inherently lead to critical reflection, but when this was achieved, the creative approaches seemed to facilitate a staging of reflection, which incorporated five sequential stages: preplanning creative depiction, experimenting with different ideas, deliberately completing the reflective piece, reflecting on creative work, and reflecting again on learning and development. This cyclic, repeated revisit to experience, as students engaged in each stage of their work, appeared to facilitate both a deep connection with the emotional elements of experience and a more distanced analysis. This ultimately led to a deepening of understanding of events, including the construction of students' own beliefs and empathy with others' views.

High-resolution analysis of differential gene expression during skeletal muscle atrophy and programmed cell death.

Skeletal muscles can undergo atrophy and/or programmed cell death (PCD) during development or in response to a wide range of insults, including immobility, cachexia, and spinal cord injury. However, the protracted nature of atrophy and the presence of multiple cell types within the tissue complicate molecular analyses. One model that does not suffer from these limitations is the intersegmental muscle (ISM) of the tobacco hawkmoth Manduca sexta. Three days before the adult eclosion (emergence) at the end of metamorphosis, the ISMs initiate a nonpathological program of atrophy that results in a 40% loss of mass. The ISMs then generate the eclosion behavior and initiate a nonapoptotic PCD during the next 30 h. We have performed a comprehensive transcriptomics analysis of all mRNAs and microRNAs throughout ISM development to better understand the molecular mechanisms that mediate atrophy and death. Atrophy involves enhanced protein catabolism and reduced expression of the genes involved in respiration, adhesion, and the contractile apparatus. In contrast, PCD involves the induction of numerous proteases, DNA methylases, membrane transporters, ribosomes, and anaerobic metabolism. These changes in gene expression are largely repressed when insects are injected with the insect steroid hormone 20-hydroxyecdysone, which delays death. The expression of the death-associated proteins may be greatly enhanced by reductions in specific microRNAs that function to repress translation. This study not only provides fundamental new insights into basic developmental processes, it may also represent a powerful resource for identifying potential diagnostic markers and molecular targets for therapeutic intervention.

Best Practice in Supporting Professional Identity Formation: Use of a Professional Reasoning Framework.

Professional identity and professionalism education are increasingly important to veterinary education, but many of the concepts remain intangible to veterinary students, and engagement is a persistent challenge. While whole-curriculum integration is recommended for a successful professional studies program, this is complicated by clinical faculty's discomfort with the content. Where professional studies education is centered around professional identity formation, a key element of this is the multi-perspective nature of veterinary work, with the veterinarian negotiating the needs of multiple stakeholders in animal care. Constructing teaching around a framework of professional reasoning, which incorporates the negotiation of different stakeholder needs, ethical decision making, communication, teamwork, and outcome monitoring, offers the potential to make professional identity a concept more visible to students in veterinary work, and guides students in the contextualization of taught material. A framework is presented for veterinary professional reasoning that signposts wider curriculum content and helps illustrate where material such as veterinary business studies, animal welfare, the human-animal bond, and professional responsibility, as well as attributes such as empathy and compassion, all integrate in the decisions and actions of the veterinary professional. The aims of this framework are to support students' engagement in professional studies teaching and help them use workplace learning experiences to construct an appropriate professional identity for competence and resilience in the clinic. For faculty involved in curriculum design and clinical teaching, the framework provides a tool to support the integration of professional identity concepts across the extended curriculum.

The Veterinary Identity: A Time and Context Model.

The nature of professionalism teaching is a current issue in veterinary education, with an individual's identity as a professional having implications for one's values and behaviors, as well as for his or her career satisfaction and psychological well-being. An appropriately formed professional identity imparts competence in making complex decisions-those that involve multiple perspectives and are complicated by contextual challenges. It enables an individual to act in a way that aligns with his or her professional values and priorities, and imparts resilience to situations in which one's actions are dissonant to these personal beliefs. There are challenges in professionalism teaching that relate to student engagement and faculty confidence in this area. However, these cannot be addressed without first defining the veterinary professional identity-in effect, the aim of professionalism teaching. In this article, existing identity models from the wider literature have been analyzed through a veterinary lens. This analysis was then used to construct a model of veterinary professional identity that incorporates the self (personal morals and values), social development (learning from the workplace environment), and professional behaviors. Individuals who form what we have termed self-environment-behavior connections are proposed to be able to use workplace learning opportunities to inform their identity development, such that environmental complexity does not obstruct the link between values and behaviors. Those who fail to connect with the environment in this way may perceive that environmental influences (e.g., the client, financial limitations) are obstructive to enacting their desired identity, and they may struggle with decision making in complex scenarios.

Sex-Specific Trends in Incidence and Mortality for Urban and Rural Ambulatory Patients with Heart Failure in Eastern Ontario from 1994 to 2013.

BACKGROUND: Differences in outcomes have previously been reported between urban and rural settings across a multitude of chronic diseases. Whether these discrepancies have changed over time, and how sex may influence these findings is unknown for patients with ambulatory heart failure (HF). We examined the temporal incidence and mortality trends by geography in these patients. METHODS AND RESULTS: We conducted a retrospective cohort study of 36,175 eastern Ontario residents who were diagnosed with HF in an outpatient setting from 1994 to 2013. The primary outcome was 1-year mortality. We examined temporal changes in mortality risk factors with the use of multivariable Cox proportional hazard models. The incidence of HF decreased in women and men across both rural and urban settings. Age-standardized mortality rates also decreased over time in both sexes but remained greater in rural men compared with rural women. CONCLUSIONS: The incidence of HF in the ambulatory setting was greater for men than women and greater in rural than urban areas, but mortality rates remained higher in rural men compared with rural women. Further research should focus on ways to reduce this gap in the outcomes of men and women with HF.

Assessing Human Health PM2.5 and Ozone Impacts from U.S. Oil and Natural Gas Sector Emissions in 2025.

Incomplete information regarding emissions from oil and natural gas production has historically made it challenging to characterize the air quality or air pollution-related health impacts for this sector in the United States. Using an emissions inventory for the oil and natural gas sector that reflects information regarding the level and distribution of PM2.5 and ozone precursor emissions, we simulate annual mean PM2.5 and summer season average daily 8 h maximum ozone concentrations with the Comprehensive Air-Quality Model with extensions (CAMx). We quantify the incidence and economic value of PM2.5 and ozone health related effects using the environmental Benefits Mapping and Analysis Program (BenMAP). We find that ambient concentrations of PM2.5 and ozone, and associated health impacts, are highest in a handful of states including Colorado, Pennsylvania, Texas and West Virginia. On a per-ton basis, the benefits of reducing PM2.5 precursor emissions from this sector vary by pollutant species, and range from between $6,300 and $320,000, while the value of reducing ozone precursors ranges from $500 to $8,200 in the year 2025 (2015$).

Reporting of CT cervical spine after office hours by radiology trainees-analysis of discrepancy rates and RADPEER scores.

PURPOSE: To review the errors made by radiology trainees in the reporting of cervical spine CTs (CCT) and to compare the discrepancy rates between the stages of training. METHODS: All CCTs reported by trainees after office hours between January 2015 and December 2015 were retrospectively reviewed by a team of five musculoskeletal consultants with experience ranging between 7 and 15 years. Discrepancies between the provisional report by the trainee and the findings by the musculoskeletal consultants were graded according to the RADPEER scoring system. Sensitivity and specificity of the trainees were assessed. RESULTS: Of 254 CCT provisional reports, there were 12 (4.7%) discrepancies, of which 5 (2.0%) discrepancies were likely to be clinically significant. We found a clinically significant difference between the stage of training of the trainee and RADPEER score (P = 0.023). The sensitivity and specificity of the senior radiology trainees were 97.0 and 98.1%, respectively, and that of the junior radiology trainees were 80 and 98.0% respectively (P = 0.039). Conditions misinterpreted as fractures include degenerative changes (n = 2) and nutrient vessel (n = 1). Other missed abnormalities include ossification of the posterior longitudinal ligament (n = 1), fracture of the foramen transversarium (n = 2), vertebral body fractures (n = 2), articular facet fractures (n = 2), and transverse process fractures (n = 2). CONCLUSION: Cervical spine CTs performed after office hours can be safely interpreted by senior radiology trainees to a reasonable degree, although a targeted intervention to improve diagnostic performance of junior radiology trainees may be of clinical benefit.

Improving Student Engagement in Veterinary Business Studies.

Improving Student Engagement in Veterinary Business StudiesIn a densely packed veterinary curriculum, students may find it particularly challenging to engage in the less overtly clinical subjects, yet pressure from industry and an increasingly competitive employment market necessitate improved veterinary student education in business and management skills. We describe a curriculum intervention (formative reflective assignment) that optimizes workplace learning opportunities and aims to provide better student scaffolding for their in-context business learning. Students were asked to analyze a business practice they experienced during a period of extra-mural studies (external work placement). Following return to the college, they were then instructed to discuss their findings in their study group, and produce a group reflection on their learning. To better understand student engagement in this area, we analyzed individual and group components of the assignment. Thematic analysis revealed evidence of various depths of student engagement, and provided indications of the behaviors they used when engaging at different levels. Interactive and social practices (discussing business strategies with veterinary employees and student peers) appeared to facilitate student engagement, assist the perception of relevance of these skills, and encourage integration with other curriculum elements such as communication skills and clinical problem solving.