Genetic Variants and Persistent Impairment Following Mild Traumatic Brain Injury: A Systematic Review.

OBJECTIVE: The purpose of this review is to systematically assess primary research publications on known genetic variants, which modify the risk for symptoms or dysfunction persisting 30 days or more following mild traumatic brain injury (mTBI). SUMMARY OF REVIEW: A search of PubMed and Embase from inception through June 2022 identified 42 studies that associated genetic variants with the presence of symptoms or cognitive dysfunction 30 days or more following mTBI. Risk of bias was assessed for each publication using the Newcastle Ottawa Scale (NOS). Fifteen of the 22 studies evaluating apolipoprotein E ( APOE ) ɛ4 concluded that it was associated with worse outcomes and 4 of the 8 studies investigating the brain-derived neurotrophic factor ( BDNF ) reported the Val66Met allele was associated with poorer outcomes. The review also identified 12 studies associating 28 additional variants with mTBI outcomes. Of these, 8 references associated specific variants with poorer outcomes. Aside from analyses comparing carriers and noncarriers of APOE ɛ4 and BDNF Val66Met, most of the reviewed studies were too dissimilar, particularly in terms of specific outcome measures but also in genes examined, to allow for direct comparisons of their findings. Moreover, these investigations were observational and subject to varying degrees of bias. CONCLUSIONS: The most consistent finding across articles was that APOE ɛ4 is associated with persistent post-mTBI impairment (symptoms or cognitive dysfunction) more than 30 days after mTBI. The sparsity of other well-established and consistent findings in the mTBI literature should motivate larger, prospective studies, which characterize the risk for persistent impairment with standardized outcomes in mTBI posed by other genetic variants influencing mTBI recovery.

Librarians Flip for Students: Teaching Searching Skills to Medical Students Using a Flipped Classroom Approach.

This article describes the development of a flipped classroom instructional module designed by librarians to teach first- and second-year medical students how to search the literature and find evidence-based articles. The pre-class module consists of an online component that includes reading, videos, and exercises relating to a clinical case. The in-class sessions, designed to reinforce important concepts, include various interactive activities. The specifics of designing both components are included for other health sciences librarians interested in presenting similar instruction. Challenges encountered, particularly in the live sessions, are detailed, as are the results of evaluations submitted by the students, who largely enjoyed the online component. Future plans are contingent on solving technical problems encountered during the in-class sessions.

The plagiarism project.

Plagiarism has been a problem plaguing academia for centuries. The Internet has made it easier than ever to copy material from one electronic document and paste it into another. Many cases are unintentional, as writers are unaware of the rules regarding plagiarism. This paper provides an overview of plagiarism and describes a project in which librarians partnered with the assistant dean of a graduate science program to educate students about the perils of plagiarism and encourage ethical writing practices.

Let me show you how it's done! Desktop sharing for distance learning from the D. Samuel Gottesman Library.

Due to the proliferation of electronic resources, fewer users visit the library. Traditional classroom instruction and in-person consultations are no longer sufficient in assisting library users. Librarians are constantly seeking new ways to interact with patrons and facilitate efficient use of electronic resources. This article describes the development, implementation, and evaluation of a project in which desktop-sharing software was used to reach out to users at remote locations. Various ways of using this tool are described, and challenges and implications for future expansion are discussed.

Comparing Region of Interest versus Voxel-Wise Diffusion Tensor Imaging Analytic Methods in Mild and Moderate Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

Diffusion tensor imaging is a magnetic resonance imaging technique that is uniquely capable of detecting microstructural tissue damage in mild and moderate traumatic brain injuries (TBIs). To date, it remains unknown if two common analytic techniques, region of interest (ROI) versus voxel-wise (VW) analyses, detect injury in similar locations. The purpose of this systematic review and meta-analysis was to directly compare the regions of abnormality elucidated by each method. Twenty-seven ROI and 11 VW studies met our inclusion criteria. Our ROI meta-analysis identified 11 regions, including the splenium of the corpus callosum, where fractional anisotropy (FA) was significantly decreased in TBI patients, compared with controls. Likewise, we identified higher mean diffusivity/apparent diffusivity constant in the genu, body, and splenium of the corpus callosum. Alternatively, our VW analysis identified one region of high FA in the right superior longitudinal fasciculus and seven regions of low FA, with the two largest located in the corpus callosum. High mean diffusivity and high radial diffusivity, both in the right inferior longitudinal fasciculus, also was revealed by our VW analysis. Moreover, we have shown that the magnitude of damage in the corpus callosum revealed by ROI analysis (z = -3.15) is greater than that demonstrated by VW analysis (z = -1.41). Overall, this study indicates that both ROI and VW analytic methods are sensitive to low FA in the corpus callosum; however, the ROI method has more power to detect the full extent of tissue abnormality in the corpus callosum. More research utilizing standardized methods and reporting is essential to fully characterize the extent to which ROI and VW analyses can concordantly detect other locations of pathology in mild and moderate TBI patients.

Trial Characteristics and Appropriateness of Statistical Methods Applied for Design and Analysis of Randomized School-Based Studies Addressing Weight-Related Issues: A Literature Review.

Objective: To evaluate whether clustering effects, often quantified by the intracluster correlation coefficient (ICC), were appropriately accounted for in design and analysis of school-based trials. Methods: We searched PubMed and extracted variables concerning study characteristics, power analysis, ICC use for power analysis, applied statistical models, and the report of the ICC estimated from the observed data. Results: N=263 papers were identified, and N=121 papers were included for evaluation. Overall, only a minority (21.5%) of studies incorporated ICC values for power analysis, fewer studies (8.3%) reported the estimated ICC, and 68.6% of studies applied appropriate multilevel models. A greater proportion of studies applied the appropriate models during the past five years (2013-2017) compared to the prior years (74.1% versus 63.5%, p=0.176). Significantly associated with application of appropriate models were a larger number of schools (p=0.030), a larger sample size (p=0.002), longer follow-up (p=0.014), and randomization at a cluster level (p < 0.001) and so were studies that incorporated the ICC into power analysis (p=0.016) and reported the estimated ICC (p=0.030). Conclusion: Although application of appropriate models has increased over the years, consideration of clustering effects in power analysis has been inadequate, as has report of estimated ICC. To increase rigor, future school-based trials should address these issues at both the design and analysis stages.

A Review of Contraception and Abortion Content in Family Medicine Textbooks.

BACKGROUND AND OBJECTIVES: Family physicians are critical providers of reproductive health care in the United States, and family physicians and trainees refer to textbooks as a source of clinical information. This study evaluates the coverage of reproductive health topics in current family medicine textbooks. METHODS: We identified 12 common family medicine textbooks through a computerized literature search and through the recommendations of a local family medicine clerkship and evaluated 24 areas of reproductive health content (comprising contraceptive care, management of early pregnancy loss, and provision of induced abortion) for accuracy and thoroughness using criteria that we created based on the latest guidelines. RESULTS: All contraceptive methods evaluated were addressed in more than half of the textbooks, though discrepancies existed by method, with intrauterine devices (IUDs), external (male) condoms, and diaphragms addressed most frequently (10/12 texts) and male and female sterilization addressed least frequently (8/12 texts). While most contraceptive methods, when addressed, were usually addressed accurately, IUDs were often addressed inaccurately. Coverage of early pregnancy loss management was limited to 7/12 texts, and coverage of early abortion methods was even more limited, with only 4/12 texts addressing the topic. CONCLUSIONS: Family medicine textbooks do not uniformly provide correct and thorough information on reproductive health topics relevant to family medicine, and attention is needed to ensure that family physicians are receiving appropriate information and training to meet the reproductive health needs of US women.