Behavior Prioritization In Drosophila

Animals must prioritize their needs to decide how to act in a way that meets their physiological needs and matches their environmental context. Since behaviors are often carried out at the expense of others, it is important to understand how these binary options are evaluated and prioritized in an animal’s nervous system. We aim to understand how internal states such as hunger are signaled to the brain. Further, we ask, how does an organism integrate multiple signals and ultimately decide how to respond? When a pair of Drosophila melanogaster males are placed in a small chamber with a high-quality food source, they have three options: feed, explore, or fight. When a male is starved, we hypothesize that a high-need hunger signal is sent from the gut to the brain. This signal should bump feeding to the top of the priority list, resulting in the fly eating before engaging in other behaviors. Our data indicates that starved flies feed earlier than fed flies, suggesting that they respond to internal signals telling them to feed rather than explore. Previous work in the Certel lab has determined that neurons that express the octopamine (OA) adrenergic receptor OAα2R innervate the gut. Preliminary data suggests OAα2R expressed in enteroendocrine (EE) cells is necessary for aggression. We hypothesize that OA binding to OAα2R inhibits the release of neuropeptides in EE cells. This, in turn, inhibits feeding behavior and promotes aggression in flies. Here, we predict that a reduction in EE cell OAα2R expression will result in fed flies feeding sooner. Using OAα2R Knockdown and UAS-Gal4 control flies, we starved or let male flies feed ad libitum for 24 hours. Subsequently, the flies were aspirated into the chamber with a nutritive food resource to be both fed on and fought over. To score flies’ behavior, lunges toward their counterparts were recorded as a metric of aggression. To test our hypotheses, we quantified flies’ latency to lunge and latency to feed (the time between aspiration into the chamber and the first act of aggression or feeding) under fed or starved internal states. Our preliminary analysis suggests that OAα2R does not inhibit feeding. Based on these results we will test a revised hypothesis: OAα2R inhibits the release of neuropeptides, thus promoting the transition from feeding to fighting. A greater understanding of decision prioritization will help map the internal codes of social behavior and dynamics as well as reveal therapeutic targets that could modulate aggression

Quality of Systematic Reviews of Treatment Studies in Neurogenic Communication Disorders

To support evidence based clinical practice, efforts have been initiated to complete systematic reviews of the treatment literature. We searched the literature for systematic reviews of treatment research in neurogenic communication disorders and evaluated the quality of those reviews for 27 criteria (Auperin et al., 1997). Two examiners coded 15 studies identified (6 aphasia, 6 dysarthria, 3 apraxia of speech). Reviews tended to provide good information pertaining to study identification and description. Weaknesses across reviews involved lack of statistical analyses and methods to avoid selection bias. Results of our study suggest ways to improve the quality of future systematic reviews

Sinonasal undifferentiated carcinoma and esthesioneuroblastoma recurring as nonintestinal adenocarcinoma

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97478/1/lary23746.pd

Antibiotic prophylaxis in anterior skull‐base surgery: a survey of the North American Skull Base Society

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151867/1/alr22396.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151867/2/alr22396_am.pd

The Leadership Inventory for Medical Education (LIME): A Novel Assessment of Medical Students’ Leadership Skills

Purpose: We sought to develop a novel measurement instrument for leadership knowledge, skills and behaviors of medical students as part of the program evaluation for a curriculum redesign. Method: The Leadership subgroup of our curriculum redesign process generated a definition of leadership consisting of four domains: 1) leading teams, 2) systems based practice, 3) influence and communication, and 4) problem solving. The definition of each domain was used to generate a 12-item instrument (the Leadership Inventory for Medical Education, or LIME) with items rated on a 4-point frequency scale. 315 medical students from two cohorts at a large midwestern university medical school completed the instrument at matriculation and at the end of the M1 and M2 year with an abbreviated version of the Ways of Coping Scale. The 4 domain structure of the LIME was tested using Confirmatory Factor Analysis and correlations of LIME subscores with 8 Ways of Coping were computed as evidence of construct validity. Results: The LIME showed acceptable unidimensionality with Cronbach’s alpha = .79 and a four-factor structure closely matching the four target domains. Subscores were derived from the observed factor structure: Analysis, Culture, Policy, and Communication. LIME scores increased slightly but non-significantly from matriculation to the end of M1 except for Communication scores which rose significantly (t(141) = 2.13, p < 0.05). LIME scores correlated positively with proactive coping styles (Seeking Social Support and Planful Problem-Solving) and negatively with emotional, passive styles (Distancing). Conclusions: Given the growing importance of teamwork and the rapidly shifting landscape of healthcare, medical students will need strong leadership skills to be clinically effective in their careers. Despite this need, little work has been done to research the effectiveness of curricular strategies for developing leadership. The LIME may be a useful tool for measuring and tracking students’ leadership skills during their professional development.http://deepblue.lib.umich.edu/bitstream/2027.42/115886/1/MEDC24LeadershipScale- 3.24.15.docxhttp://deepblue.lib.umich.edu/bitstream/2027.42/115886/3/AAMC2015-LIME-poster.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/115886/4/Leadership.pdfDescription of MEDC24LeadershipScale- 3.24.15.docx : AbstractDescription of AAMC2015-LIME-poster.pdf : Poster at AAMC/RIME 2015Description of Leadership.pdf : The Leadership Inventory for Medical Education (LIME

Implementation of a novel otolaryngology clinic for indigent patients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99640/1/lary23880.pd

A first‐year leadership programme for medical students

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152529/1/tct13005.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152529/2/tct13005_am.pd

Documentation of Contraception and Pregnancy Intention In Medicaid Managed Care

Context: Clinical guidelines recommend the documentation of pregnancy intention and family planning needs during primary care visits. Prior to the 2014 Medicaid expansion and release of these guidelines, the documentation practices of Medicaid managed care providers are unknown. Methods: We performed a chart review of 1054 Medicaid managed care visits of women aged 13 to 49 to explore client, provider, and visit characteristics associated with documentation of immediate or future plans for having children and contraceptive method use. Five managed care plans used Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes to identify providers with at least 15 women who had received family planning or well-woman care in 2013. We conducted multilevel logistic regression analyses with documentation of contraceptive method and pregnancy intention as outcome variables and clinic site as the level 2 random effect. Results: Only 12% of charts had documentation of pregnancy intention and 59% documented contraceptive use. Compared to women with a family planning visit reason, women with an annual, reproductive health, or primary care reason for their visit were significantly less likely to have contraception documented (odds ratio [OR] = 11.0; 95% confidence interval [CI] = 6.8-17.7). Age was also a significant predictor with women aged 30 to 49 (OR = 0.6; 95% CI = 0.4-0.9), and women aged 13 to 19 (OR = 0.2; 95% CI = 0.1-0.6) being less likely to have a note about pregnancy intention in their chart. Pregnancy intention was more likely to be documented in multispecialty clinics (OR = 15.5; 95% CI = 2.7-89.2). Conclusions: Interventions to improve routine medical record documentation of contraception and pregnancy intention regardless of patient age and visit characteristics are needed to facilitate the provision of family planning in managed care visits and, ultimately, achieving better maternal infant health outcomes and reduced costs

Documentation of Contraception and Pregnancy Intention In Medicaid Managed Care

Context: Clinical guidelines recommend the documentation of pregnancy intention and family planning needs during primary care visits. Prior to the 2014 Medicaid expansion and release of these guidelines, the documentation practices of Medicaid managed care providers are unknown. Methods: We performed a chart review of 1054 Medicaid managed care visits of women aged 13 to 49 to explore client, provider, and visit characteristics associated with documentation of immediate or future plans for having children and contraceptive method use. Five managed care plans used Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes to identify providers with at least 15 women who had received family planning or well-woman care in 2013. We conducted multilevel logistic regression analyses with documentation of contraceptive method and pregnancy intention as outcome variables and clinic site as the level 2 random effect. Results: Only 12% of charts had documentation of pregnancy intention and 59% documented contraceptive use. Compared to women with a family planning visit reason, women with an annual, reproductive health, or primary care reason for their visit were significantly less likely to have contraception documented (odds ratio [OR] = 11.0; 95% confidence interval [CI] = 6.8-17.7). Age was also a significant predictor with women aged 30 to 49 (OR = 0.6; 95% CI = 0.4-0.9), and women aged 13 to 19 (OR = 0.2; 95% CI = 0.1-0.6) being less likely to have a note about pregnancy intention in their chart. Pregnancy intention was more likely to be documented in multispecialty clinics (OR = 15.5; 95% CI = 2.7-89.2). Conclusions: Interventions to improve routine medical record documentation of contraception and pregnancy intention regardless of patient age and visit characteristics are needed to facilitate the provision of family planning in managed care visits and, ultimately, achieving better maternal infant health outcomes and reduced costs