Mechanisms of Near-Peer Learning in a Longitudinal Clerkship: A Grounded Theory Study.

PURPOSE: Many medical schools incorporate longitudinal clerkships, which promote continuity and may offer early clinical exposure during the preclinical curriculum. However, the mechanisms of near-peer learning and how it contributes to the development of clinical skills in longitudinal clinical experiences are less clear. The authors explored how peer-to-peer interactions among medical students influenced their developmental trajectories from nascent clinicians to more seasoned practitioners capable of juggling dual roles of clinical care and clinical supervision within longitudinal clerkships. METHOD: The Education-Centered Medical Home (ECMH) at Northwestern University Feinberg School of Medicine is a longitudinal clerkship that represents an ideal setting to explore peer learning. At ECMH continuity is established across all 4 years of medical school among small groups of students from each year, a preceptor, and a panel of outpatients. The authors conducted 6 focus groups and 9 individual interviews between March 2021 and February 2023 with medical students from all years. Using constructivist grounded theory, the authors collected and analyzed data iteratively using constant comparison to identify themes and explore their relationships. RESULTS: Within ECMH, peer relationships fostered an informal learning culture that enabled meaningful peer interactions while reinforcing the established culture. The authors identified 3 essential learning practices between senior and junior medical students: preparing for patient encounters, shifting roles dynamically during the joint encounter, and debriefing encounters afterwards. These practices strengthened learning relationships and supported students' developmental trajectories. CONCLUSIONS: Longitudinal peer learning relationships enabled meaningful peer interaction that influenced medical students' clinical development and capability for clinical supervision. Mutual trust, familiarity, and continuity facilitate targeted feedback practices and growth at the edge of junior students' capabilities. Optimizing this peer learning environment and seeking new opportunities to use longitudinal peer learning in clinical environments could promote psychological safety and professional identity formation for medical students.

Aquarium Tank Design Is Integral to the Elimination of Mantle Abrasion in the Captive Curled Octopus (Eledone cirrhosa): A Case Study at Macduff Marine Aquarium.

Macduff Marine Aquarium is a native species aquarium situated on the Moray Firth coastline and houses the curled octopus, Eledone cirrhosa, for public display. Historically, the designated octopus display tank has been in-keeping with the overall theme of the aquarium, consisting of artificially created rock work mimicking the local rocky coastline, within an angular glass tank. This tank was not originally designed for housing octopus and as a consequence, if individuals on display exhibited jetting behavior mantle abrasion occurred. In 2016, a new bespoke octopus tank was designed and installed. Since then 14 different octopuses have been individually housed and maintained within the tank, with none having experienced mantle abrasion. This paper highlights the importance of aquarium design for the ethical maintenance of an intelligent and challenging species.

Multi-omics of a pre-clinical model of diabetic cardiomyopathy reveals increased fatty acid supply impacts mitochondrial metabolic selectivity.

The incidence of type 2 diabetes (T2D) is increasing globally, with long-term implications for human health and longevity. Heart disease is the leading cause of death in T2D patients, who display an elevated risk of an acute cardiovascular event and worse outcomes following such an insult. The underlying mechanisms that predispose the diabetic heart to this poor prognosis remain to be defined. This study developed a pre-clinical model (Rattus norvegicus) that complemented caloric excess from a high-fat diet (HFD) and pancreatic ß-cell dysfunction from streptozotocin (STZ) to produce hyperglycaemia, peripheral insulin resistance, hyperlipidaemia and elevated fat mass to mimic the clinical features of T2D. Ex vivo cardiac function was assessed using Langendorff perfusion with systolic and diastolic contractile depression observed in T2D hearts. Cohorts representing untreated, individual HFD- or STZ-treatments and the combined HFD + STZ approach were used to generate ventricular samples (n = 9 per cohort) for sequential and integrated analysis of the proteome, lipidome and metabolome by liquid chromatography-tandem mass spectrometry. This study found that in T2D hearts, HFD treatment primed the metabolome, while STZ treatment was the major driver for changes in the proteome. Both treatments equally impacted the lipidome. Our data suggest that increases in ß-oxidation and early TCA cycle intermediates promoted rerouting via 2-oxaloacetate to glutamate, γ-aminobutyric acid and glutathione. Furthermore, we suggest that the T2D heart activates networks to redistribute excess acetyl-CoA towards ketogenesis and incomplete ß-oxidation through the formation of short-chain acylcarnitine species. Multi-omics provided a global and comprehensive molecular view of the diabetic heart, which distributes substrates and products from excess ß-oxidation, reduces metabolic flexibility and impairs capacity to restore high energy reservoirs needed to respond to and prevent subsequent acute cardiovascular events.

Strangulated internal hernia due to defect in broad ligament: a case report.

Small bowel obstruction is a relatively common disease process accounting for up to 16 percent of surgical admissions and more than 300,000 operations annually in the United States. Approximately 5-8 percent of small bowel obstructions can be attributed to internal hernias. A slightly lower percentage, roughly 4-7 percent, of these internal hernias are noted to originate from a defect in the broad ligament of the uterus. A majority of broad ligaments defects causing a small bowel obstruction are not diagnosed preoperatively due to the equivocal imaging findings as well as the infrequency of this etiology. To date, there are very few case reports describing this disease process. This case report describes a 70-year-old female who was found to have a defect in her broad ligament causing a small bowel obstruction leading to subsequent strangulated bowel.

Using implementation science to mitigate worsening health inequities in the United States during the COVID-19 pandemic.

With the threat of coronavirus disease 2019 (Covid-19) enduring in the United States, effectively and equitably implementing testing, tracing, and self-isolation as key prevention and detection strategies remain critical to safely re-opening communities. As testing and tracing capacities increase, frameworks are needed to inform design and delivery to ensure their effective implementation and equitable distribution, and to strengthen community engagement in slowing and eventually stopping Covid-19 transmission. In this commentary, we highlight opportunities for integrating implementation research into planned and employed strategies in the United States to accelerate reach and effectiveness of interventions to more safely relax social distancing policies and open economies, schools, and other institutions. Implementation strategies, such as adapting evidence-based interventions based on contextual factors, promoting community engagement, and providing data audit and feedback on implementation outcomes, can support the translation of policies on testing, tracing, social distancing, and public mask use into reality. These data can demonstrate how interventions are put into practice and where adaptation in policy or practice is needed to respond to the needs of specific communities and socially vulnerable populations. Incorporating implementation research into Covid-19 policy design and translation into practice is urgently needed to mitigate the worsening health inequities in the pandemic toll and response. Applying rigorous implementation research frameworks and evaluation systems to the implementation of evidence-based interventions which are adapted to contextual factors can promote effective and equitable pandemic response and accelerate learning both among local stakeholders as well as between states to further inform their varied experiences and responses to the pandemic.

Ischemic appendicitis due to pelvic adhesions: a case report.

Acute appendicitis is one of the most common etiologies of a surgical abdomen. The lifetime risk is estimated to be 7%. Over 300 000 appendectomies occur annually in the USA. The pathophysiology of appendicitis in most patients is believed to be caused by outflow obstruction of the appendiceal lumen leading to increased intraluminal pressure, venous congestion and mucosal ischemia. This can occur due to a variety of internal obstructive causes such as a fecalith, lymphoid hyperplasia, parasites or a tumor. To date, no case reports describing appendicitis secondary to external compression of the appendix leading to outflow obstruction been documented in the literature. This case report describes a 61-year-old female who had a thick, adhesive band compressing the base of her appendix, which created external outflow obstruction leading to the development of appendicitis.

Parent and Child Preferences and Styles of Communication About Cancer Diagnoses and Treatment.

Communication challenges frequently occur among families and health care providers of children with life-threatening conditions. These obstacles compound concerns related to children's diagnoses and treatment, the family's quality of life, and delivery of care. Developmentally appropriate and validated methods of addressing the communication preferences of families with chronically ill children are limited. This study used six focus groups to determine child and parent preferences and styles of communication centering on new diagnoses and changes in prognosis. Hypothetical situations were used to minimize feelings of self-consciousness among school-aged and adolescent participants. Qualitative analyses (interrater reliability 75%) of child and parent responses revealed 3 categories and 11 subcategories or themes. The category of Characteristics of Communication Exchange included (1) how to tell, (2) who should tell, (3) when to tell, (4) who should be included, and (5) what to tell. The Knowledge and Understanding category included themes of (1) side effects of treatment, (2) what children understand, and (3) questions when being diagnosed. The category of Feelings and Emotions included themes of (1) feelings about changes in prognosis, (2) children's feelings on being informed, and (3) coping and emotional regulation. Results reveal a need for developmentally appropriate, evidence-based education to inform parents on how, what, and when to communicate information concerning their child's disease, as well as instructions around facilitating those discussions. Moreover, a need for professional education and training programs for providers is demonstrated by some parental dissatisfaction with bedside manner and disclosure of information. The data collected from this study lay a foundation for future research in communication as a principal factor in quality of life for pediatric patients and their families.

Knowledge, attitudes and practices with regard to schistosomiasis prevention and control: Two cross-sectional household surveys before and after a Community Dialogue intervention in Nampula province, Mozambique.

BACKGROUND: The Community Dialogue Approach is a promising social and behaviour change intervention, which has shown potential for improving health seeking behaviour. To test if this approach can strengthen prevention and control of schistosomiasis at community level, Malaria Consortium implemented a Community Dialogue intervention in four districts of Nampula province, Mozambique, between August 2014 and September 2015. METHODOLOGY/PRINCIPAL FINDINGS: Cross-sectional household surveys were conducted before (N = 791) and after (N = 792) implementation of the intervention to assess its impact on knowledge, attitudes and practices at population level. At both baseline and endline, awareness of schistosomiasis was high at over 90%. After the intervention, respondents were almost twice as likely to correctly name a risk behaviour associated with schistosomiasis (baseline: 18.02%; endline: 30.11%; adjusted odds ratio: 1.91; 95% confidence interval: 1.14-2.58). Increases were also seen in the proportion of people who knew that schistosomiasis can be spread by infected persons and who could name at least one correct transmission route (baseline: 25.74%; endline: 32.20%; adjusted odds ratio: 1.36; 95% confidence interval: 1.01-1.84), those who knew that there is a drug that treats the disease (baseline: 29.20%, endline: 47.55%; adjusted odds ratio: 2.19; 95% confidence interval: 1.67-2.87) and those who stated that they actively protect themselves from the disease and cited an effective behaviour (baseline: 40.09%, endline: 59.30%; adjusted odds ratio: 2.14; 95% confidence interval: 1.40-3.28). The intervention did not appear to lead to a reduction in misconceptions. In particular, the belief that the disease is sexually transmitted continued to be widespread. CONCLUSIONS/SIGNIFICANCE: Given its overall positive impact on knowledge and behaviour at population level, Community Dialogue can play an important role in schistosomiasis prevention and control. The intervention could be further strengthened by better enabling communities to take suitable action and linking more closely with community governance structures and health system programmes.

Acute GI bleed due to leiomyoma of the jejunum: a case report.

Neoplasms of the small intestine are rare. Leiomyomas are the one of the benign neoplasms that can be found in the small intestine. These lesions usually remain asymptomatic and are often found incidentally; however, they can become symptomatic if obstruction occurs or the tumor outgrows its blood supply resulting mucosa. Their clinical manifestations can include abdominal pain, diarrhea, melena, a palpable abdominal mass and weight loss. Due to their vague presentation, leiomyomas of the small intestine are typically diagnosed after failed conservative therapy for other pathologies such as duodenal ulcers and diverticulosis. This case report describes a 34-year-old male who developed an acute GI bleed due to a symptomatic leiomyoma of the jejunum. He was initially treated with non-operative conservative management; however, his symptoms remained unresolved and he went on to require surgical intervention.

Mechanical Ventilation in Patients with the Acute Respiratory Distress Syndrome and Treated with Extracorporeal Membrane Oxygenation: Impact on Hospital and 30 Day Postdischarge Survival.

Mechanical ventilation support for acute respiratory distress syndrome (ARDS) patients involves the use of low tidal volumes and positive end-expiratory pressure. Nevertheless, the optimal ventilator strategy for ARDS patients undergoing extracorporeal membrane oxygenation (ECMO) therapy remains unknown. A retrospective analysis of a consecutive series of adult ARDS patients treated with V-V ECMO from October 2012 to May 2015 was performed. Mechanical ventilation data, as well as demographic and clinical data, were collected. We assessed the association between ventilator data and outcomes of interest. The primary outcome was hospital survival. Secondary outcome was 30 day survival posthospital discharge. Sixty-four ARDS patients were treated with ECMO. Univariate analysis showed that plateau pressure was independently associated with hospital survival. Tidal volume, positive end-expiratory pressure (PEEP), and plateau were independently associated with 30 day survival. Multivariate analysis, after controlling for covariates, revealed that a 1 unit increase in plateau pressure was associated with a 21% decrease in the odds of hospital survival (95% confidence interval [CI] = 6.39-33.42%, p = 0.007). In regards to 30 day survival postdischarge, a 1 unit increase in plateau pressure was associated with a 14.4% decrease in the odds of achieving the aforementioned outcome (95% CI = 1.75-25.4%, p = 0.027). Also, a 1 unit increase in PEEP was associated with a 36.2% decrease in the odds of 30 day survival (95% CI = 10.8-54.4%, p = 0.009). Among ARDS patients undergoing ECMO therapy, only plateau pressure is associated with hospital survival. Plateau pressure and PEEP are both associated with 30 day survival posthospital discharge.

Using Social Media for Actionable Disease Surveillance and Outbreak Management: A Systematic Literature Review.

OBJECTIVE: Research studies show that social media may be valuable tools in the disease surveillance toolkit used for improving public health professionals' ability to detect disease outbreaks faster than traditional methods and to enhance outbreak response. A social media work group, consisting of surveillance practitioners, academic researchers, and other subject matter experts convened by the International Society for Disease Surveillance, conducted a systematic primary literature review using the PRISMA framework to identify research, published through February 2013, answering either of the following questions: Can social media be integrated into disease surveillance practice and outbreak management to support and improve public health?Can social media be used to effectively target populations, specifically vulnerable populations, to test an intervention and interact with a community to improve health outcomes?Examples of social media included are Facebook, MySpace, microblogs (e.g., Twitter), blogs, and discussion forums. For Question 1, 33 manuscripts were identified, starting in 2009 with topics on Influenza-like Illnesses (n = 15), Infectious Diseases (n = 6), Non-infectious Diseases (n = 4), Medication and Vaccines (n = 3), and Other (n = 5). For Question 2, 32 manuscripts were identified, the first in 2000 with topics on Health Risk Behaviors (n = 10), Infectious Diseases (n = 3), Non-infectious Diseases (n = 9), and Other (n = 10). CONCLUSIONS: The literature on the use of social media to support public health practice has identified many gaps and biases in current knowledge. Despite the potential for success identified in exploratory studies, there are limited studies on interventions and little use of social media in practice. However, information gleaned from the articles demonstrates the effectiveness of social media in supporting and improving public health and in identifying target populations for intervention. A primary recommendation resulting from the review is to identify opportunities that enable public health professionals to integrate social media analytics into disease surveillance and outbreak management practice.

Application of a Comprehensive Unit-based Safety Program in critical care: the royal exchange.

This article discusses the history of the Comprehensive Unit-based Safety Program (CUSP) and how it is used to foster a culture of safety. CUSP involves interdisciplinary teamwork and empowers nurses at all levels to pioneer changes and develop leadership skills. A case study is presented to show how CUSP was used effectively in critical care to create a standardized handover of patients from the operating room to the intensive care unit.

Hematologic parameters and hemoparasites of nonmigratory Canada geese (Branta canadensis) from Greensboro, North Carolina, USA.

Large flocks of wild, nonmigratory Canada geese (Branta canadensis) have established permanent residence throughout the eastern United States and have become a public concern. Few studies have assessed the hematologic parameters for these populations, which could provide useful information for monitoring individual and population health of Canada geese. This study measured the hematologic parameters and detected the presence of hemoparasites from 146 wild, nonmigratory Canada geese in central North Carolina, USA, during their annual molt. The age class, sex, and weight of each bird were recorded at capture. Values for packed cell volume (PCV), estimated white blood cell count, white blood cell differentials, and heterophil: lymphocyte ratios were calculated for each bird. Adults and female geese had higher estimated white blood cell counts compared with juveniles and males, respectively. The PCV increased with weight and age class. Adult geese had higher percentages of heterophils and heterophil: lymphocyte ratios, whereas juvenile geese had higher percentages of lymphocytes. Relative eosinophil counts in adults increased with decreasing bird weight, and relative monocyte counts in juveniles increased with increasing weight. Three percent of geese were infected with species of Hemoproteus blood parasites. Atypical lymphocyte morphology, including pseudopods, split nuclei, and cytoplasmic granules, was observed in 5% of the birds. The hematologic values reported for adult and juvenile nonmigratory Canada geese in this study may serve as reference intervals for ecological studies and veterinary care of wild and captive Canada geese.

The role of post-translational modifications in acute and chronic cardiovascular disease.

Cardiovascular disease (CVD) in one of the leading causes of mortality and morbidity worldwide, accounting for both primary diseases of the heart and vasculature and arising as a co-morbidity with numerous pathologies, including type 2 diabetes mellitus (T2DM). There has been significant emphasis on the role of the genome in CVD, aiding in the definition of 'at-risk' patients. The extent of disease penetrance however, can be influenced by environmental factors that are not detectable by investigating the genome alone. By targeting the transcriptome in response to CVD, the interplay between genome and environment is more apparent, however this implies the level of protein expression without reference to proteolytic turnover, or potentially more importantly, without defining the role of PTMs in the development of disease. Here, we discuss the role of both brief and irreversible PTMs in the setting of myocardial ischemia/reperfusion injury. Key proteins involved in calcium regulation have been observed as differentially modified by phosphorylation/O-GlcNAcylation or phosphorylation/redox modifications, with the level of interplay dependent on the physiological or pathophysiological state. The ability to modify crucial sites to produce the desired functional output is modulated by the presence of other PTMs as exemplified in the T2DM heart, where hyperglycemia results in aberrant O-GlcNAcylation and advanced glycation end products. By using the signalling events predicted to be critical to post-conditioning, an intervention with great promise for the cardioprotection of the ischemia/reperfusion injured heart, as an example, we discuss the level of PTMs and their interplay. The inability of post-conditioning to protect the diabetic heart may be regulated by aberrant PTMs influencing those sites necessary for protection.

Humoral immune response of the small-spotted catshark, Scyliorhinus canicula.

Cartilaginous fishes are the oldest group in which an adaptive immune system based on immunoglobulin-superfamily members is found. This manuscript compares humoral immune function in small-spotted catshark (Scyliorhinus canicula) with that described for spiny dogfish (Squalus acanthias), another member of the Squalomorphi superorder, and nurse shark, the model for humoral immunity in elasmobranchs and a member of the Galeomorphi superorder. Although small-spotted catshark and nurse shark are separated by over 200 million years we found that immunoglobulin isoforms are well conserved between the two species. However, the plasma protein profile of small-spotted catshark was most similar to that of spiny dogfish, with low levels of pentameric IgM, and IgNAR present as a multimer in plasma rather than a monomer. We show that an antigen-specific monomeric IgM response, with a profile similar to that described previously for nurse sharks, can be raised in small-spotted catshark. Lacking polyclonal or monoclonal antibody reagents for detecting catshark IgNAR we investigated phage-display and recombinant Fc-fusion protein expression as alternative methods to look for an antigen-specific response for this isotype. However, we could find no evidence of an antigen-specific IgNAR in the animals tested using either of these techniques. Thus, unlike nurse sharks where antigen-specific monomeric IgM and IgNAR appear together, it seems there may be a temporal or complete 'uncoupling' of these isotypes during a humoral response in the small-spotted catshark.

Characterization of the immunoglobulin repertoire of the spiny dogfish (Squalus acanthias).

The cartilaginous fish (chimeras, sharks, skates and rays) are the oldest group relative to mammals in which an adaptive immune system founded upon immunoglobulins has been found. In this manuscript we characterize the immunoglobulins of the spiny dogfish (Squalus acanthias) at both the molecular and expressed protein levels. Despite the presence of hundreds of IgM clusters in this species the serum levels of this isotype are comparatively low. However, analysis of cDNA sequences and serum protein suggests microheterogeneity in the IgM heavy chains and supports the proposal that different clusters are preferentially used in the two forms (monomer or pentamer) of this isotype. We also found that the IgNAR isotype in this species exists in a previously unknown multimeric format in serum. Finally, we identified a new form of the IgW isotype (the shark IgD orthologue), in which the leader is spliced directly to the first constant domain, resulting in a molecule lacking an antigen-binding domain.

Reducing the gender achievement gap in college science: a classroom study of values affirmation.

In many science, technology, engineering, and mathematics disciplines, women are outperformed by men in test scores, jeopardizing their success in science-oriented courses and careers. The current study tested the effectiveness of a psychological intervention, called values affirmation, in reducing the gender achievement gap in a college-level introductory physics class. In this randomized double-blind study, 399 students either wrote about their most important values or not, twice at the beginning of the 15-week course. Values affirmation reduced the male-female performance and learning difference substantially and elevated women's modal grades from the C to B range. Benefits were strongest for women who tended to endorse the stereotype that men do better than women in physics. A brief psychological intervention may be a promising way to address the gender gap in science performance and learning.

Environmental and physiological factors contributing to outbreaks of cryptosporidium in Coquerel's sifaka (Propithecus coquereli) at the Duke Lemur Center: 1999-2007.

This population-based, retrospective study examined the susceptibility of a prosimian primate, Coquerel's sifaka (Propithecus coquereli), to Cryptosporidium spp. over a 9-yr period from 1999 to 2007 at the Duke Lemur Center (DLC) located in Durham, North Carolina. The investigation examined potential epidemiologic risk factors that could be correlated to infectious outbreaks at the center, such as prevalence, signalment (species, age, and sex), seasonality of occurrence, recurrence rate, family lineage, parturition, clinical signs, and concurrent diseases or health conditions. Findings included Propithecus spp. being the only lemur species at the DLC showing clinical signs of infection, with age being an important factor in susceptibility, and showing a strong correlation between temperature and seasonality with shedding of Cryptosporidium oocysts. These findings present new information regarding cryptosporidiosis in captive prosimians.