Quality not quantity: Deficient juvenile play experiences lead to altered medial prefrontal cortex neurons and sociocognitive skill deficits.

Reduced play experience over the juvenile period leads to adults with impoverished social skills and to anatomical and physiological aberrations of the neurons found in the medial prefrontal cortex (mPFC). Even rearing rats from high-playing strains with low-playing strains show these developmental consequences. In the present study, we evaluated whether low-playing rats benefit from being reared with higher playing peers. To test this, we reared male Fischer 344 rats (F344), typically thought to be a low-playing strain, with a Long-Evans (LE) peer, a relatively high-playing strain. As juveniles, F344 rats reared with LE rats experienced less play and lower quality play compared to those reared with another F344. As adults, the F344 rats reared with LE partners exhibited poorer social skills and the pyramidal neurons of their mPFC had larger dendritic arbors than F344 rats reared with same-strain peers. These findings show that being reared with a more playful partner does not improve developmental outcomes of F344 rats, rather the discordance in the play styles of F344 and LE rats leads to poorer outcomes.

Multidisciplinary care for patients with persistent symptoms following concussion: a systematic review.

PURPOSE: To systematically characterize and assess the effectiveness of multidisciplinary care for patients with persistent post-concussion symptoms (PPCS). MATERIALS AND METHODS: Only studies describing multidisciplinary treatment, defined as intervention provided by no less than 2 healthcare disciplines, each with independent scopes of practice, for patients with PPCS were considered. RESULTS: A total of 8 of the 1357 studies identified were included. The studies were comprised of heterogenous patient populations, care delivery systems, healthcare providers, treatment approaches, and outcomes. CONCLUSIONS: Findings suggest multidisciplinary care, using a needs-based approach with individual- or group-based interventions, may be more beneficial than usual care to; 1) immediately reduce concussion-related symptom complaints and improve mood and quality of life in adolescents following sports-related concussion (SRC) and, 2) may produce immediate and lasting improvements in symptom complaints of young, primarily female, adults following a non-SRC. Future studies should clearly describe the decision-making processes used to deliver care through a needs-based approach and prioritize the inclusion of objective, performance-based measures to assess outcomes.Implications for RehabilitationMultidisciplinary care using a needs-based approach with the individual- and group-based interventions, may be more beneficial than usual care.Younger populations, particularly females, seem to benefit most from multidisciplinary care to decrease the burden of post-concussion symptoms.Multidisciplinary care teams should consider providing psychological support and education combined with cognitive retraining and pharmacologic intervention to address persistent post-concussion symptoms.

Play fighting and the development of the social brain: The rat's tale.

The benefits gained by young animals engaging in play fighting have been a subject of conjecture for over a hundred years. Progress in understanding the behavioral development of play fighting and the underlying neurobiology of laboratory rats has produced a coherent model that sheds light on this matter. Depriving rats of typical peer-peer play experience during the juvenile period leads to adults with socio-cognitive deficiencies and these are correlated with physiological and anatomical changes to the neurons of the prefrontal cortex, especially the medial prefrontal cortex. Detailed analysis of juvenile peer play has shown that using the abilities needed to ensure that play fighting is reciprocal is critical for attaining these benefits. Therefore, unlike that which was posited by many earlier hypotheses, play fighting does not train specific motor actions, but rather, improves a skill set that can be applied in many different social and non-social contexts. There are still gaps in the rat model that need to be understood, but the model is well-enough developed to provide a framework for broader comparative studies of mammals from diverse lineages that engage in play fighting.

Supporting the Spectrum Scholarship Program: perspectives from the Northern California and Nevada Medical Library Group.

The immediate past presidents and current president of the Northern California and Nevada Medical Library Group write to raise awareness of the American Library Association Spectrum Scholarship Program, share their approach to supporting Scholars in their region, and encourage Medical Library Association (MLA) chapters and MLA at large to build stronger infrastructures to support Black, Indigenous, and People of Color librarians who are in school and recently graduated.

Teaching medicine interns minimum geriatrics competencies within a "4 + 2" schedule.

The increased ambulatory training time in an "X + Y" (inpatient + ambulatory) residency schedule affords more opportunities to teach geriatrics principles of care. We describe our internal medicine (IM) residency program's experience in teaching the IM-family medicine (FM) minimum geriatrics competencies (MGC) during a longitudinal geriatrics rotation embedded within interns' yearlong "4 + 2" schedule. Interns spend 1 day of the ambulatory block in a geriatrics outpatient setting (Program of All-Inclusive Care for the Elderly, house calls, nursing home), during which geriatrics division faculty members give core didactic seminars. We revamped core seminars to address MGC related to medication management, cognitive health, complex chronic illnesses, end of life care, and ambulatory care. Three consecutive intern cohorts completed anonymous surveys pre- and postrotation, rating their confidence level in MGC addressed by the curriculum on a 5-point Likert scale. On postrotation surveys, they also rated the curriculum's contribution to geriatrics skills enhancement. Interns who completed both surveys (N = 22, 92%) reported statistically significant improved confidence ratings on all items, with the greatest point gains seen in performance of functional assessment (1.56), practice of optimal geriatric pharmacotherapy (1.78), and identification of older patients eligible for skilled (1.71) and unskilled home-based services (1.65). They rated geriatrics curricular components as being more helpful than other rotations and conferences in enhancing their geriatric skills. In conclusion, we developed a longitudinal geriatrics curriculum within the context of our "4 + 2" immersion schedule which other programs can easily adapt. Aligning curricular content with the MGC has resulted in interns' improved confidence in several important geriatrics skills.

Using the 'stranger test' to assess social competency in adult female Long Evans rats reared with a Fischer 344 partner.

Rats reared with limited access to a play partner during the juvenile period develop into adults with impairments in various cognitive, emotional, and social skills. The present study assesses the consequences of play deprivation on adult social skills in female Long Evans (LE) rats that were reared with a low-playing Fischer 344 rat over the juvenile period. As adults, their social skills were assessed using the stranger paradigm, by pairing the deprived LE rats with a novel LE partner in a neutral arena. While the deprived rat engages its partner in play there were alterations in key aspects of play, such as reduced pinning and a longer latency to begin playing, that suggest there are impairments in the social ability of the deprived rat. Most notable were the changes in the behaviour of the typically reared partner, a reduction in the amount of play it initiated and fewer actions that produced reciprocal and prolonged interactions. The changes in the behaviour of the normally reared partner suggest that it detected subtle changes in the play deprived LE rats. These findings support the hypothesis that peer-peer play experiences during the juvenile period are important for the development of socio-cognitive skills.

Methodological Considerations for Auditory Training Interventions for Adults With Hearing Loss: A Rapid Review.

Purpose The aim of this study was to evaluate literature on auditory training published since 2013. Method A rapid review or a streamlined approach to systematically identify and summarize relevant studies was performed. Selected health sciences databases were searched using a search strategy developed with the PICO (population, intervention, comparison, and outcome) framework. Studies eligible for inclusion had older adult participants with hearing loss and utilized technology-based auditory training in laboratory or home settings. Results The study quality of most studies was found to be low to moderate, with concentrations between low and moderate. Major issues were related to study design and reporting, such as the need for blinding and a control group, larger sample sizes, and a follow-up for long-term outcomes of auditory training interventions. Wide variability in training approaches, participant backgrounds (e.g., audiograms, hearing aid use), and outcome measures are also noted. Conclusions Evidence on the effectiveness of auditory training is mixed. Future research should include high-quality randomized controlled trials with representative populations; follow-up periods to study long-term effects; and exploration of behavioral, electrophysiological, and self-reported outcome measures. Recommendations for study designs and methodologies are also discussed.

Avocado toast and pot roast: exploring perceptions of generational communication differences among health sciences librarians.

OBJECTIVE: This research explored health sciences librarians' perceptions of intergenerational communication in the workplace. METHODS: The authors developed and sent a survey to health sciences librarians through email discussion lists from August 2018 to September 2018. A chi-square test was performed to determine whether one's length of employment as a librarian was associated with belief that age and/or generation impacts communication in the workplace. RESULTS: A total of 150 respondents from 5 countries completed the survey. There was no significant association between length of employment as a librarian and respondents' belief that age and/or generation impacts communication in the workplace. However, regardless of length of employment, most respondents indicated that generational differences do have an impact on communication in the workplace. Also, most respondents expressed interest in institutional initiatives to foster intergenerational communication. CONCLUSION: The authors found that health sciences librarians believe that differences among generations impact communication in the workplace. Librarians, managers, and library organizations should consider providing training and other opportunities for health sciences librarians to improve their intergenerational communication skills.

Development of ultrasonic calls in rat pups follows similar patterns regardless of isolation distress.

Ultrasonic vocalizations (USVs) emitted by rat pups have been extensively studied in the context of isolation from their mother and littermates. The heightened call rate of isolation-induced USVs indicates increased anxiety, whereas other acoustic parameters, such as frequency and call duration, are thought to be useful in reflecting developmental changes, which by weaning have developed into their adult form. However, it is possible that stress can affect the quality as well as the quantity of calls, and that as the pups become more mobile, the effects of the stress may change. Therefore, in the present study rats were tested in a test arena either in isolation or with littermates, so as to assess the effects of isolation stress on the developmental changes reported in the literature. Rat pups of both sexes were tested on multiple days from postnatal day (PND) 7 to weaning. Overall, the main changes in the frequency, duration, and types of calls were accounted for by age. The effects of isolation were minor, as were sex differences. This study indicates that the development of USVs in infant rats is a robust process and seemingly resistant to the effects of isolation-induced stress.

"Game on!" Teaching gamification principles for library instruction to health sciences information professionals using interactive, low-tech activities and design-thinking modalities.

BACKGROUND: Gamification is correlated with increased motivation and engagement of learners and is increasingly being incorporated into library instruction. Opportunities for librarians to learn and practice principles of gamification can be helpful for those desiring to incorporate gamification into instruction. This report describes the development and delivery of an interactive special content session at MLA '18, the 2018 Medical Library Association annual meeting in Atlanta, Georgia, focusing on principles of low-tech game design for health sciences library classroom instruction. CASE PRESENTATION: The special content session, titled "Design, Play, Learn: A Special Content Session to Design a Game for Database Instruction," was designed and delivered using multimodal instruction (e.g., flipped classroom, didactic component, active learning) that also incorporated principles of design thinking. A pre- and post-survey was given to all participants at the beginning and end of the session to measure confidence and desire to incorporate gamification into instruction and as a formative feedback indicator for instructors. Participants reported increased confidence and desire to use games for library instruction after participating in the session. A selection of games was uploaded to a shared content folder designed for course participants as an ongoing repository for ideas and communication. CONCLUSIONS: For librarians who are interested in incorporating principles of gamification into library instruction, attending a relatively short hands-on workshop can facilitate learning and confidence around prototyping and creating games for use in library instruction. We intend to improve upon the workshop and offer it again in additional contexts, based on direct observations of the session and participant feedback.

Sex differences in rat decision-making: The confounding role of extraneous feeder sampling between trials.

Although male and female rats appear to perform differently in some tasks, a clear picture of sex differences in decision-making has yet to develop. This is in part due to significant variability arising from differences in strains and tasks. The aim of this study was to characterize the effects of sex on specific response elements in a reinforcement learning task so as to help identify potential explanations for this variability. We found that the primary difference between sexes was the propensity to approach feeders out of the task context. This extraneous feeder sampling affects choice on subsequent trials in both sexes by promoting a lose-shift response away from the last feeder sampled. Female rats, however, were more likely to engage in this extraneous feeder sampling, and therefore exhibited a greater rate of this effect. Once trials following extraneous sampling were removed, there were no significant sex differences in any of the tested measures. These data suggest that feeder approach outside of the task context, which is often not recorded, could produce a confound in sex-based differences of reinforcement sensitivity in some tasks.

Medication Reconciliation in the Hospital: An Interactive Case-Based Session for Internal Medicine Residents.

Introduction: Medication reconciliation is a complex process of creating and maintaining the most accurate medication list for a patient to help guide therapy. Done incorrectly, the process of medication reconciliation can lead to medical error and result in adverse events for patients. Medication reconciliation on inpatient medicine service is often done by internal medicine residents. However, published reports of educational interventions for residents are limited. Methods: We created a 1-hour session that was experiential, case based, and targeted to the level of a first-year resident. In total, 31 internal medicine residents completed the curriculum, which involved either a 1-hour classroom group activity or an individual virtual activity. The curriculum was evaluated using standard forms with qualitative feedback regarding learner satisfaction, pre- and postsession confidence survey, and pre- and postsession patient chart audits. Results: Qualitative feedback demonstrated residents' positive experiences. There was no significant change in residents' confidence in portions of the medication reconciliation process. One month following the educational intervention, 100% of inpatient charts audited for review of the medication list were accurate, as compared to 67%-83% accuracy prior to the session. Discussion: This novel case-based medication reconciliation teaching session, targeted at learners in an internal medicine residency, can easily be implemented at other institutions using the institution-specific electronic health record. The session was well received by residents, and we observed improved accuracy in the medication reconciliation process done by residents.

Training Internal Medicine Residents in Social Medicine and Research-Based Health Advocacy: A Novel, In-Depth Curriculum.

PROBLEM: Health disparities are pervasive worldwide. Physicians have a unique vantage point from which they can observe the ways social, economic, and political factors impact health outcomes and can be effective advocates for enhanced health outcomes and health equity. However, social medicine and health advocacy curricula are uncommon in postgraduate medical education. APPROACH: In academic year (AY) 2012, the Cambridge Health Alliance internal medicine residency program transformed an elective into a required social medicine and research-based health advocacy curriculum. The course has three major innovations: it has a yearlong longitudinal curriculum, it is required for all residents, and all residents complete a group research-based health advocacy project within the curricular year. The authors describe the structure, content, and goals of this curriculum. OUTCOMES: Over the last four years (AYs 2012-2015), residents (17/32; 53%) have rated the overall quality of the course highly (mean = 5.2, where 6 = outstanding; standard deviation = 0.64). In each year since the new course has been implemented, all scholarly work from the course has been presented at conferences by 31 resident presenters and/or coauthors. The course seems to enhance the residency program's capacity to recruit high-caliber residents and faculty members. NEXT STEPS: The authors are collecting qualitative and quantitative data on the impact of the course. They will use their findings to advocate for a national health advocacy competency framework. Recommendations about how to initiate or further develop social medicine and health advocacy curricula are offered.

Primary care training and the evolving healthcare system.

With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians.