The implementation of a mobile problem-specific electronic CEX for assessing directly observed student—patient encounters

Background: Facilitating direct observation of medical students' clinical competencies is a pressing need. Methods: We developed an electronic problem-specific Clinical Evaluation Exercise (eCEX) based on a national curriculum. We assessed its feasibility in monitoring and recording students' competencies and the impact of a grading incentive on the frequency of direct observations in an internal medicine clerkship. Students (n=56) at three clinical sites used the eCEX and comparison students (n=56) at three other clinical sites did not. Students in the eCEX group were required to arrange 10 evaluations with faculty preceptors. Students in the second group were required to document a single, faculty observed ‘Full History and Physical’ encounter with a patient. Students and preceptors were surveyed at the end of each rotation. Results: eCEX increased students' and evaluators' understanding of direct-observation objectives and had a positive impact on the evaluators' ability to provide feedback and assessments. The grading incentive increased the number of times a student reported direct observation by a resident preceptor. Conclusions: eCEX appears to be an effective means of enhancing student evaluation

Do environmental effects indexed by parental genetic variation influence common psychiatric symptoms in childhood?

Parental genes may indirectly influence offspring psychiatric outcomes through the environment that parents create for their children. These indirect genetic effects, also known as genetic nurture, could explain individual differences in common internalising and externalising psychiatric symptoms during childhood. Advanced statistical genetic methods leverage data from families to estimate the overall contribution of parental genetic nurture effects. This study included up to 10,499 children, 5990 mother–child pairs, and 6,222 father–child pairs from the Norwegian Mother Father and Child Study. Genome-based restricted maximum likelihood (GREML) models were applied using software packages GCTA and M-GCTA to estimate variance in maternally reported depressive, disruptive, and attention-deficit hyperactivity disorder (ADHD) symptoms in 8-year-olds that was explained by direct offspring genetic effects and maternal or paternal genetic nurture. There was no strong evidence of genetic nurture in this sample, although a suggestive paternal genetic nurture effect on offspring depressive symptoms (variance explained (V) = 0.098, standard error (SE) = 0.057) and a suggestive maternal genetic nurture effect on ADHD symptoms (V = 0.084, SE = 0.058) was observed. The results indicate that parental genetic nurture effects could be of some relevance in explaining individual differences in childhood psychiatric symptoms. However, robustly estimating their contribution is a challenge for researchers given the current paucity of large-scale samples of genotyped families with information on childhood psychiatric outcomes

Genetic Associations Between Childhood Psychopathology and Adult Depression and Associated Traits in 42 998 Individuals: A Meta-Analysis

Importance: Adult mood disorders are often preceded by behavioural and emotional problems in childhood. It is yet unclear what explains the associations between childhood psychopathology and adult traits. Objective: To investigate whether genetic risk for adult mood disorders and related traits influence childhood disorders. Design: This cohort study meta-analysed data from seven ongoing longitudinal birth and childhood cohorts. The starts of data collection varied, ranging from July 1985 to April 2002. Data analysis was performed from September 2017 to May 2019. Setting: Seven population-based cohorts from the UK, the Netherlands, Sweden, Norway and Finland. Participants: 42,998 participants were repeatedly assessed for childhood psychopathology from age 6 to 17 years. Exposures: Individual polygenic scores (PGS) were constructed in children based on well-powered genome-wide association studies (GWAS) of adult major depression (MD) and bipolar disorder (BD), as well as subjective well-being (SWB), neuroticism, insomnia, educational attainment (EA), and body mass index (BMI). Main Outcomes and Measures: We used regression meta-analyses to test the associations between the PGS and symptoms of attention-deficit/hyperactivity disorder (ADHD), internalizing problems, and social problems, measured repeatedly across childhood and adolescence, and whether these associations were dependent on childhood phenotype, age, and rater. Results: We obtained a sample size of 42,998 unique participants aged 6 to 17. The percentage of male participants ranged from 43% to 52% across all cohorts. PGS of adult MD, neuroticism, BMI, and insomnia were positively associated with childhood psychopathology (beta estimates ranged from 0.023 – 0.042, C.I = 0.017 – 0.049) while associations with PGS of SWB and EA were negative (-0.026 – -0.046 (-0.020 – -0.057)). BD PGS did not show any association. We found no effect of age, type of childhood phenotype or rater on the associations except for BMI PGS and EA PGS. We report stronger associations between EA PGS and ADHD compared to internalizing and social problems, and between BMI PGS and social problems and ADHD compared to internalizing. Furthermore, the association between EA PGS and ADHD increased with age. Conclusions and Relevance: Results from this study suggest the existence of a set of genetic factors influencing a range of traits across the lifespan with stable effects present throughout childhood. Knowledge of underlying mechanisms may impact treatment and long-term outcomes of individuals with psychopathology

Origin and ecological selection of core and food-specific bacterial communities associated with meat and seafood spoilage

The microbial spoilage of meat and seafood products with short shelf lives is responsible for a significant amount of food waste. Food spoilage is a very heterogeneous process, involving the growth of various, poorly characterized bacterial communities. In this study, we conducted 16S ribosomal RNA gene pyrosequencing on 160 samples of fresh and spoiled foods to comparatively explore the bacterial communities associated with four meat products and four seafood products that are among the most consumed food items in Europe. We show that fresh products are contaminated in part by a microbiota similar to that found on the skin and in the gut of animals. However, this animal-derived microbiota was less prevalent and less abundant than a core microbiota, psychrotrophic in nature, mainly originated from the environment (water reservoirs). We clearly show that this core community found on meat and seafood products is the main reservoir of spoilage bacteria. We also show that storage conditions exert strong selective pressure on the initial microbiota: alpha diversity in fresh samples was 189 +/- 58 operational taxonomic units (OTUs) but dropped to 27 +/- 12 OTUs in spoiled samples. The OTU assemblage associated with spoilage was shaped by low storage temperatures, packaging and the nutritional value of the food matrix itself. These factors presumably act in tandem without any hierarchical pattern. Most notably, we were also able to identify putative new clades of dominant, previously undescribed bacteria occurring on spoiled seafood, a finding that emphasizes the importance of using culture-independent methods when studying food microbiota