Assessment of Learning Climate in Dietetic Clinical Facilities: An Evaluation of Instrument

Assessment of learning climate in major clinical facilities utilized in Coordinated Undergraduate Programs in Dietetics by graduating seniors assists the faculty of the program and the personnel in the facility in determining the course of study and in planning experiences for the future students. An instrument was developed to assess learning climate by identifying, classifying, and validating the learning incidents or climate indicators that affect the students\u27 ability to apply concepts learned from both didactic and clinical experiences. The identification process was accomplished through the use of Nominal Group Technique meetings. Six groups of graduating seniors and graduates of one year were utilized from two university coordinated programs in dietetics to identify 120 experiential incidents. Use of individual brainstorming with group discussion and prioritization are the main features of Nominal Group Technique. Three clinical instructors from one university program classified the incidents as supportive (successful) or nonsupportive (unsuccessful or not allowed) of student learning, to areas of subject matter, and as to duplication of incidents previously identified. This classification was used as the basis for a checklist developed for the assessment of learning climate. The checklist was reviewed by the three clinical instructors and four 1977 Coordinated Undergraduate Programs in Dietetics graduates who made suggestions for revisions. For validation, the revised checklist was mailed to 158 of the 1978 graduates from 11 selected accredited coordinated dietetic programs. The return rate was 82%. In summarizing the results, some commonalities were found in the climate indicators that lead to success including: (a) confidence of the registered dietitian in the student and/or support and backing of the registered dietitian; (b) receptiveness and/or cooperation of employees; (c) support of the administration, confidence of the administration in the student, and/or necessity for the experience as seen by the administration; (d) cooperation of supervisors; and vi (e) self-confidence of the student. Indicators leading to unsuccessful incidents were the opposites of the ones for successful experiences noted above with the addition of an indicator showing lack of student authority. Concomitantly, indicators relating to incidents where experiences were not allowed included: (a) lack of administrative confidence in the student; (b) lack of cooperation of the employees; and (c) necessity for the experience for the students not seen by the administration. Benefits to the students indicated by the incidents were increased ability to take responsibility, increased variety of experiences, increased confidence in decision making ability, and possible practical application of previously learned concepts. Problems that the students found related to the incidents were lack of communication with clinical instructors, lack of professional supervision, and lack of application of concepts. In conclusion, the Nominal Group Technique was considered an effective method of identifying incidents affecting learning climate in clinical facilities and comments in response to the checklists indicated that the students did not accept the role of motivating patients or employees to make desirable behavior changes. Additional training for the dietetic students in understanding and application of principles of motivation should be incorporated in the curriculum. The developed instrument could be of general use in all coordinated programs with a generalist emphasis. The clinical instructors can assist the students to utilize their perceptions of the clinical facilities to further development as effective dietitians

Age-Related Differences in Cortical Thickness Vary by Socioeconomic Status

Recent findings indicate robust associations between socioeconomic status (SES) and brain structure in children, raising questions about the ways in which SES may modify structural brain development. In general, cortical thickness and surface area develop in nonlinear patterns across childhood and adolescence, with developmental patterns varying to some degree by cortical region. Here, we examined whether age-related nonlinear changes in cortical thickness and surface area varied by SES, as indexed by family income and parental education. We hypothesized that SES disparities in age-related change may be particularly evident for language- and literacy-supporting cortical regions. Participants were 1148 typically-developing individuals between 3 and 20 years of age. Results indicated that SES factors moderate patterns of age-associated change in cortical thickness but not surface area. Specifically, at lower levels of SES, associations between age and cortical thickness were curvilinear, with relatively steep age-related decreases in cortical thickness earlier in childhood, and subsequent leveling off during adolescence. In contrast, at high levels of SES, associations between age and cortical thickness were linear, with consistent reductions across the age range studied. Notably, this interaction was prominent in the left fusiform gyrus, a region that is critical for reading development. In a similar pattern, SES factors significantly moderated linear age-related change in left superior temporal gyrus, such that higher SES was linked with steeper age-related decreases in cortical thickness in this region. These findings suggest that SES may moderate patterns of age-related cortical thinning, especially in language- and literacy-supporting cortical regions

Imaging the Impact of Prenatal Alcohol Exposure on the Structure of the Developing Human Brain

Prenatal alcohol exposure has numerous effects on the developing brain, including damage to selective brain structure. We review structural magnetic resonance imaging (MRI) studies of brain abnormalities in subjects prenatally exposed to alcohol. The most common findings include reduced brain volume and malformations of the corpus callosum. Advanced methods have been able to detect shape, thickness and displacement changes throughout multiple brain regions. The teratogenic effects of alcohol appear to be widespread, affecting almost the entire brain. The only region that appears to be relatively spared is the occipital lobe. More recent studies have linked cognition to the underlying brain structure in alcohol-exposed subjects, and several report patterns in the severity of brain damage as it relates to facial dysmorphology or to extent of alcohol exposure. Future studies exploring relationships between brain structure, cognitive measures, dysmorphology, age, and other variables will be valuable for further comprehending the vast effects of prenatal alcohol exposure and for evaluating possible interventions

Facial Curvature Detects and Explicates Ethnic Differences in Effects of Prenatal Alcohol Exposure

Background Our objective is to help clinicians detect the facial effects of prenatal alcohol exposure by developing computer-based tools for screening facial form. Methods All 415 individuals considered were evaluated by expert dysmorphologists and categorized as (i) healthy control (HC), (ii) fetal alcohol syndrome (FAS), or (iii) heavily prenatally alcohol exposed (HE) but not clinically diagnosable as FAS; 3D facial photographs were used to build models of facial form to support discrimination studies. Surface curvature-based delineations of facial form were introduced. Results (i) Facial growth in FAS, HE, and control subgroups is similar in both cohorts. (ii) Cohort consistency of agreement between clinical diagnosis and HC-FAS facial form classification is lower for midline facial regions and higher for nonmidline regions. (iii) Specific HC-FAS differences within and between the cohorts include: for HC, a smoother philtrum in Cape Coloured individuals; for FAS, a smoother philtrum in Caucasians; for control-FAS philtrum difference, greater homogeneity in Caucasians; for control-FAS face difference, greater homogeneity in Cape Coloured individuals. (iv) Curvature changes in facial profile induced by prenatal alcohol exposure are more homogeneous and greater in Cape Coloureds than in Caucasians. (v) The Caucasian HE subset divides into clusters with control-like and FAS-like facial dysmorphism. The Cape Coloured HE subset is similarly divided for nonmidline facial regions but not clearly for midline structures. (vi) The Cape Coloured HE subset with control-like facial dysmorphism shows orbital hypertelorism. Conclusions Facial curvature assists the recognition of the effects of prenatal alcohol exposure and helps explain why different facial regions result in inconsistent control-FAS discrimination rates in disparate ethnic groups. Heavy prenatal alcohol exposure can give rise to orbital hypertelorism, supporting a long-standing suggestion that prenatal alcohol exposure at a particular time causes increased separation of the brain hemispheres with a concomitant increase in orbital separation

Adolescent Brain Cognitive Development (ABCD) Study Linked External Data (LED): Protocol and practices for geocoding and assignment of environmental data

Our brain is constantly shaped by our immediate environments, and while some effects are transient, some have long-term consequences. Therefore, it is critical to identify which environmental risks have evident and long-term impact on brain development. To expand our understanding of the environmental context of each child, the Adolescent Brain Cognitive Development (ABCD) Study® incorporates the use of geospatial location data to capture a range of individual, neighborhood, and state level data based on the child\u27s residential location in order to elucidate the physical environmental contexts in which today\u27s youth are growing up. We review the major considerations and types of geocoded information incorporated by the Linked External Data Environmental (LED) workgroup to expand on the built and natural environmental constructs in the existing and future ABCD Study data releases. Understanding the environmental context of each youth furthers the consortium\u27s mission to understand factors that may influence individual differences in brain development, providing the opportunity to inform public policy and health organization guidelines for child and adolescent health

Structural, Metabolic, and Functional Brain Abnormalities as a Result of Prenatal Exposure to Drugs of Abuse: Evidence from Neuroimaging

Prenatal exposure to alcohol and stimulants negatively affects the developing trajectory of the central nervous system in many ways. Recent advances in neuroimaging methods have allowed researchers to study the structural, metabolic, and functional abnormalities resulting from prenatal exposure to drugs of abuse in living human subjects. Here we review the neuroimaging literature of prenatal exposure to alcohol, cocaine, and methamphetamine. Neuroimaging studies of prenatal alcohol exposure have reported differences in the structure and metabolism of many brain systems, including in frontal, parietal, and temporal regions, in the cerebellum and basal ganglia, as well as in the white matter tracts that connect these brain regions. Functional imaging studies have identified significant differences in brain activation related to various cognitive domains as a result of prenatal alcohol exposure. The published literature of prenatal exposure to cocaine and methamphetamine is much smaller, but evidence is beginning to emerge suggesting that exposure to stimulant drugs in utero may be particularly toxic to dopamine-rich basal ganglia regions. Although the interpretation of such findings is somewhat limited by the problem of polysubstance abuse and by the difficulty of obtaining precise exposure histories in retrospective studies, such investigations provide important insights into the effects of drugs of abuse on the structure, function, and metabolism of the developing human brain. These insights may ultimately help clinicians develop better diagnostic tools and devise appropriate therapeutic interventions to improve the condition of children with prenatal exposure to drugs of abuse