Values Clarification as a Reflective Practice for Preclerkship Medical Students.

Introduction: Values clarification is a structured, reflective process individuals engage in to better understand their own beliefs and priorities. We designed a workshop on values clarification to help preclerkship medical students anticipate and manage potential conflicts between their personal values and professional expectations. Methods: We assigned participating students a values clarification exercise as prework. The 2-hour workshop included introductory remarks, a presentation by two physicians on personal ethical challenges they had faced, and faculty-facilitated small groups. In the small groups, students discussed moral discomfort in the context of various health care scenarios. Students were invited to complete an optional postworkshop survey with Likert-scale and short-answer questions. We analyzed the qualitative data and formulated 10 emerging themes. Results: Thirty-eight of 180 participating students (21%) returned the survey. Of these, 30 (79%) agreed the workshop helped them appreciate that their values might come into conflict with professional obligations, 26 (68%) agreed they would be able to apply what they learned to future scenarios, and 30 (79%) agreed the workshop helped them understand their colleagues' values. The most prominent themes identified were that students found the physician panel especially meaningful and that the workshop helped students examine their own values and prepared them to better understand their future patients' values. Discussion: Our workshop is unique in that it does not focus on a single area in health care but addresses moral discomfort broadly. To the best of our knowledge, it is the first values clarification curricular initiative developed for preclerkship medical students.

Prediction of Neonatal Growth Restriction in Fetuses With Gastroschisis by Early Third Trimester Ultrasonography Utilizing Contemporary Birth Weight Percentiles.

OBJECTIVE: To identify the estimated fetal weight (EFW) formula and threshold for the optimal prediction of fetal growth restriction (FGR) at 26-34 weeks' in fetuses with gastroschisis. METHODS: Late second and third trimester ultrasound data were used to calculate the EFW utilizing eight different formulas: Hadlock I-IV, Honarvar, Shepard, Siemer, and Warsof. EFW and birth weight percentiles were assigned from US population growth curves. FGR and small for gestational age (SGA) were defined as EFW and birth weight less than the tenth percentile for gestational age; Receiver operating characteristic (ROC) curves were used to compare formula performance for FGR diagnosis at 26-34 weeks' to identify an SGA birth weight. RESULTS: There were 170 newborns with gastroschisis; 46 (27%) were SGA. The mean gestational age at the time of ultrasound was 30.8 ± 1.7 weeks. The mean gestational age at birth was 36.3 ± 1.7 weeks. ROC curve analysis found the Hadlock III formula had the largest area under the curve (AUC) of 0.813 closely followed by Hadlock IV (AUC = 0.811) and Hadlock II (AUC = 0.808) for diagnosis of FGR correlating to neonatal SGA diagnosis. Hadlock II, Hadlock III, and Hadlock IV had the highest diagnostic accuracies when compared to the other EFW formulas. CONCLUSIONS: The Hadlock II, Hadlock III, and Hadlock IV formulas have comparable predictive performance in the optimal identification of FGR in fetuses with gastroschisis at 26-34 weeks'. A threshold of an EFW less than the 25.2th percentile is suggested.

Risk for postpartum depressive symptoms among pregnant women in a tertiary care setting with and without a positive COVID-19 test.

OBJECTIVE: This study systematically examines risk for postpartum depressive symptoms based on COVID-19 positivity status during pregnancy. METHODS: This is a retrospective matched cohort study of pregnant patients admitted to labor and delivery units from March through December 2020. Patients were administered three depression screening questions followed by the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: 129 patients with positive COVID-19 tests (most with mild symptoms) were matched with 516 COVID-19 negative controls. We found no significant differences in rates of positive responses to screening questions (14/129, 10.9% vs. 72/516, 14.0%; p = .35) or EPDS scores >9 (6/97, 6.2% vs. 42/410, 10.2%; p = .22). Prior history of psychiatric illness was the only significant predictor of an EPDS score > 9 (adjOR 2.57, p = .002) or a positive brief screen for postpartum depressive symptoms (adjOR 2.93, p < .001). CONCLUSIONS: No significant differences in the rates for postpartum depressive symptoms were observed among pregnant women with and without a positive COVID-19 test during pregnancy, suggesting that testing positive for COVID-19 during pregnancy was not associated with an increased risk for the development of depressive symptoms during the acute postpartum period. Overall rates of postpartum depression symptoms were low, perhaps owing to the higher socioeconomic status of the sample.

A Pilot Study of Self-Regulation and Behavior Problems in Preschoolers with ASD: Parent Broader Autism Phenotype Traits Relate to Child Emotion Regulation and Inhibitory Control.

Little is known about the development of self-regulation processes during the preschool period in autism spectrum disorder (ASD). How parental characteristics such as the broader autism phenotype (BAP) relate to children's self-regulation is not well understood. Preschool-aged children with (n = 24) and without ASD (n = 21) completed an inhibitory control task and mothers reported on child emotion regulation and their own BAP traits. Children with ASD had lower emotion regulation, and emotion regulation was a protective factor in the association between ASD and internalizing behavioral concerns. Lability/negativity was highly overlapping with externalizing. Maternal BAP characteristics were differentially associated with all self-regulation outcomes across groups. Parental factors should be considered in emotion regulation interventions for young children with ASD.

Effects of fertilizer on inorganic soil N in East Africa maize systems: vertical distributions and temporal dynamics.

Fertilizer applications are poised to increase across sub-Saharan Africa (SSA), but the fate of added nitrogen (N) is largely unknown. We measured vertical distributions and temporal variations of soil inorganic N following fertilizer application in two maize (Zea mays L.)-growing regions of contrasting soil type. Fertilizer trials were established on a clayey soil in Yala, Kenya, and on a sandy soil in Tumbi, Tanzania, with application rates of 0-200 kg N/ha/yr. Soil profiles were collected (0-400 cm) annually (for three years in Yala and two years in Tumbi) to examine changes in inorganic N pools. Topsoils (0-15 cm) were collected every 3-6 weeks to determine how precipitation and fertilizer management influenced plant-available soil N. Fertilizer management altered soil inorganic N, and there were large differences between sites that were consistent with differences in soil texture. Initial soil N pools were larger in Yala than Tumbi (240 vs. 79 kg/ha). Inorganic N pools did not change in Yala (277 kg/ha), but increased fourfold after cultivation and fertilization in Tumbi (371 kg/ha). Intra-annual variability in NO-3 -N concentrations (3-33 µg/g) in Tumbi topsoils strongly suggested that the sandier soils were prone to high leaching losses. Information on soil inorganic N pools and movement through soil profiles can h vulnerability of SSA croplands to N losses and determine best fertilizer management practices as N application rates increase. A better understanding of the vertical and temporal patterns of soil N pools improves our ability to predict the potential environmental effects of a dramatic increase in fertilizer application rates that will accompany the intensification of African croplands.