The use of 'Precision Teaching' in enhancing medical students’ dermatological diagnostic skills

This article was migrated. The article was not marked as recommended. BackgroundEducators have been challenged to provide more effective dermatology teaching methods. Drawing from the discipline of Applied Behaviour Analysis, Precision Training (PT) (e.g. using flashcards during timed learning sessions) can promote fluency i.e. accuracy and speed in a particular skill. We aimed to determine the impact of PT on medical students' dermatology diagnostic skills.MethodsA between-groups controlled interventional study was conducted. Third year medical students were allocated to an intervention (PT + traditional teaching) or control (traditional teaching) group. For the PT group, we designed 50 dermatological image flashcards. Flashcard practice (using the Say All Fast Minute Each Day Shuffle method) took place 2-3 times/day and students' data on accuracy recorded over 5 days. Pre / post-training tests were carried out to determine the impact of PT on students' diagnostic skills.ResultsIn total, 70 students (intervention group) / 65 (control group). Analysis of covariance was used to calculate the change score (comparing pre- and post-test). A statistically significant improvement of 8.8% (95% CIs; 4.9-12.7, p&lt;0.001) was detected in the intervention group.ConclusionsThe findings of this study demonstrated a positive effect of PT on medical students' dermatology diagnostic skills. This study signals new pedagogical opportunities for PT in undergraduate dermatology teaching.</ns4:p

Advancing national animal health and welfare policy

The University College Dublin (UCD) School of Veterinary Medicine has a broad research agenda covering areas such as veterinary public health, epidemiology and national disease control, herd health management, drug delivery, pharmacology, parasitology, and One Health research. We work with national and international collaborators and, with the support of Zoetis, have a longstanding “UCD Squared” partnership with the University of California-Davis, which has established an ambitious program of research, drawing on expertise from a diverse community of veterinary and medical scientists and clinicians.Unusual, not sure if it can be called Journal Article or should be under another type perhap

A new multiplex SARS-CoV-2 antigen microarray showed correlation of IgG, IgA, and IgM antibodies from patients with COVID-19 disease severity and maintenance of relative IgA and IgM antigen binding over time

Zoonotic spillover of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to humans in December 2019 caused the coronavirus disease 2019 (COVID-19) pandemic. Serological monitoring is critical for detailed understanding of individual immune responses to infection and protection to guide clinical therapeutic and vaccine strategies. We developed a high throughput multiplexed SARS-CoV-2 antigen microarray incorporating spike (S) and nucleocapsid protein (NP) and fragments expressed in various hosts which allowed simultaneous assessment of serum IgG, IgA, and IgM responses. Antigen glycosylation influenced antibody binding, with S glycosylation generally increasing and NP glycosylation decreasing binding. Purified antibody isotypes demonstrated a binding pattern and intensity different from the same isotype in whole serum, probably due to competition from the other isotypes present. Using purified antibody isotypes from naïve Irish COVID-19 patients, we correlated antibody isotype binding to different panels of antigens with disease severity, with binding to the S region S1 expressed in insect cells (S1 Sf21) significant for IgG, IgA, and IgM. Assessing longitudinal response for constant concentrations of purified antibody isotypes for a patient subset demonstrated that the relative proportion of antigen-specific IgGs decreased over time for severe disease, but the relative proportion of antigen-specific IgA binding remained at the same magnitude at 5 and 9 months post-first symptom onset. Further, the relative proportion of IgM binding decreased for S antigens but remained the same for NP antigens. This may support antigen-specific serum IgA and IgM playing a role in maintaining longer-term protection, important for developing and assessing vaccine strategies. Overall, these data demonstrate the multiplexed platform as a sensitive and useful platform for expanded humoral immunity studies, allowing detailed elucidation of antibody isotypes response against multiple antigens. This approach will be useful for monoclonal antibody therapeutic studies and screening of donor polyclonal antibodies for patient infusions

Sagittal plane motion of the lumbar spine during ergometer and single scull rowing

Lumbar spine injury in rowers is common and ergometer rowing has been cited as a risk factor for this injury. The purpose of this study is to compare lumbar kinematics between ergometer and single scull rowing and to examine the effect of fatigue on kinematics. The sagittal lumbar spine motion of 19 elite male rowers (lumbar spine injury free in the previous six months) was measured with an electrogoniometer during a 'step test' on an ergometer and in a single sculling boat. Maximum range of lumbar flexion was recorded in standing for reference. Power output and heart rate were recorded during the ergometer tests. Heart rate was used as a surrogate for power output in the sculling test. Maximum lumbar flexion increased during the step test and was significantly greater on the ergometer (4.4 degrees +/- 0.9 degrees change), compared with the boat (+1.3 degrees +/- 1.1 degrees change), (3.1 degrees difference, p = 0.035). Compared to the voluntary range of motion, there is an increase of 11.3% (ergometer) and 4.1% (boat). Lumbar spine flexion increases significantly during the course of an ergometer trial while changes in a sculling boat were minimal. Such differences may contribute to the recent findings linking ergometer use to lower-back injury

The effect of rowing to exhaustion on frontal plane angular changes in the lumbar spine of elite rowers.

Lumbar spine injury is common in rowers and examination of spinal kinematics may improve the understanding of this injury's prevalence. This study aimed to examine the range of frontal plane angular displacement (AD) in the lumbar spine at L3 during ergometer rowing and to investigate the effect of exhaustion on lumbar kinematics. Twelve elite male rowers completed an incremental test on a concept 2 ergometer. Lumbar AD at L3 was measured continually throughout the rowing trial using a Spectrotilt Inclinometer and blood lactate was sampled at 3-minute intervals. AD of between 4.7° and 8.8° was recorded at L3. There was a significant increase in AD between the first and last stage of the test (mean increase = 4.1 ± 1.94°, 95% Confidence Interval [CI], 2.9 to 5.3°, t = 7.36, P = 0.000014). Incremental rise in AD was associated with an incremental rise in blood lactate but regression confirmed that only stroke rate was a significant predictor for increasing angle. Thus there is a statistically significant increase in frontal plane AD at L3 over the course of an incremental exercise test although it cannot be confirmed if this is as a result of exhaustion. The values of AD confirm that there is motion in the frontal plane in ergometer rowing

A 12-month prospective cohort study of injury in international rowers

Objective: In this study, the injury incidence and association with type and volume of training in international rowers were described. Design: A prospective cohort design was used over a 12-month period. Patients: 20 international rowers who were competing as part of the Irish Amateur Rowing Union squad system. Methods: The rowers were interviewed monthly, and data were collected regarding their training and competition exposure as well as their injury experience. Results A mean injury rate of 3.67 per 1000 exposure hours was reported with a total of 44 injuries reported in a 12-month period. The mean number of injuries sustained per athlete was 2.2 (1.24) over the 12-month period. The area where the greatest number of injuries were reported was the lumbar spine (31.82% of total injuries, 95% CI 20 to 50) (fig 2) followed by the knee (15.91% of total injuries, 95% CI 10 to 30) and the cervical spine (11.36% of total injuries, 95% CI 5 to 24). Half of the injuries (22 injuries, 50% of total reported injuries) were to the spine (χ2 = 30.8, df = 9, p = 0.0003). Ergometer training load was the most significantly associated with injury risk (r = 0.68, p = 0.01). Conclusion: International rowers are at higher risk of injury than most non-contact sports and some contact sports. The high risk of lumbar spine injury and the significant association of high volume of ergometer training merit further research to reduce time and competition lost to injury

Acute stress symptoms 1-2 weeks after stroke predict the subsequent development of post-traumatic stress symptoms: A prospective cohort study.

ObjectiveTo date no research has examined the potential influence of acute stress symptoms (ASD) on subsequent development of post-traumatic stress disorder (PTSD) symptoms in stroke survivors. Our objective was to examine whether acute stress symptoms measured 1-2 weeks post-stroke predicted the presence of post-traumatic stress symptoms measured 6-12 weeks later.DesignProspective within-groups study.MethodsFifty four participants who completed a measure of acute stress disorder at 1-2 weeks following stroke (time 1) and 31 of these participants completed a measure of posttraumatic stress disorder 6-12 weeks later (time 2). Participants also completed measures of stroke severity, functional impairment, cognitive impairment, depression, anxiety, pre-morbid intelligence and pain across both time points.ResultsSome 22% met the criteria for ASD at baseline and of those, 62.5% went on to meet the criteria for PTSD at follow-up. Meanwhile two of the seven participants (28.6%) who met the criteria for PTSD at Time 2, did not meet the ASD criteria at Time 1 (so that PTSD developed subsequently). A hierarchical multiple regression analysis indicated that the presence of acute stress symptoms at baseline was predictive of post-traumatic stress symptoms at follow-up (R2 = .26, p ConclusionsThe results highlight the importance of early assessment and identification of acute stress symptoms in stroke survivors as a risk factor for subsequent PTSD. Both ASD and PTSD were prevalent and the presence of both disorders should be assessed

The impact of changing the cut-off threshold of the interferon-gamma (IFN-γ) assay for diagnosing bovine tuberculosis in Ireland

In Ireland, the interferon-gamma (IFN-γ) assay is routinely used as an ancillary test interpreted in parallel with the single intradermal comparative tuberculin test (SICTT) to maximize the detection of bovine tuberculosis (bTB) infected animals. Up until 2018, a positive test result was recorded in the IFN-γ ELISA assay following whole blood stimulation with purified protein derivative (PPD)-bovine (B), PPD-avian (A) and nil sample (N), using the interpretation criteria, B-N > 50 optical density units (OD), B > 100 and B-A > 0. Following a review of available data, the threshold of the B-A component changed to B-A > 80. As predicting the impact of changing the cut-off thresholds for the IFN-γ test de novo is challenging, the aims of this study were to follow animals that initially tested negative using the new IFN-γ assay interpretation criteria and investigate their future risk of disclosure with bTB, with a focus on animals that otherwise would have been removed when using the older interpretation criteria (0 < B-A ≤ 80). Enrolled animals (n = 28,669 cattle from 527 herds) were followed up for two years (2019–2021), or to point of bTB detection or death. At the end of follow-up, 1151 (4.0%) of enrolled animals were bTB cases. The majority of these cases were diagnosed using SICTT (80.5%). The cumulative number of positive animals that would have been removed if the old cut-off (0 < B-A ≤ 80) was used amounted to 1680 cattle (5.9% of the enrolled cohort). Of these, 127 (7.5%) were diagnosed with bTB during follow-up. In contrast, 1024 of the 1151 cattle which subsequently tested positive during the study period following a negative IFN-γ test would not have been identified with the old or new IFN-γ cut-off criteria. Survival analysis showed that animals that would have been removed under the old interpretation criteria were at increased risk of a positive diagnosis with bTB during follow-up compared to other test negative animals. A newly developed risk prediction model (using a Cox proportional hazard model) showed that age, animal number of SICTT tests, number of inconclusive SICTT tests, B-A (IFN-γ assay), B-N (IFN-γ assay), animals from store herds and the percentage of the rest of the herd that were positive during the breakdown were statistically significantly associated with bTB detection. However, inclusion of the IFN-γ OD variables did not show added value in terms of prediction performance of the model.</p