Factors that Contribute to Resident Teaching Effectiveness

Background One of the key components of residency training is to become an educator. Resident physicians teach students, advanced practice providers, nurses, and even faculty on a daily basis. Objective The goal of this study was to identify the objective characteristics of residents, which correlate with perceived overall teaching effectiveness. Methods We conducted a one-year, retrospective study to identify factors that were associated with higher resident teaching evaluations. Senior emergency medicine (EM) teaching residents are evaluated by medical students following clinical teaching shifts. Eighteen factors pertaining to resident teaching effectiveness were chosen. Two items from the medical students' evaluations were analyzed against each factor: teaching effectiveness was measured on a five-point Likert scale and an overall teaching score (1-75). Results A total of 46 EM residents and 843 medical student evaluations were analyzed. The ACGME milestones for systems-based practice (p = 0.02) and accountability (p = 0.05) showed a statistically significant association with a rating of "five" on the Likert scale for teaching effectiveness. Three other ACGME milestones, systems-based practice (p = 0.01), task switching (p = 0.04), and team management (p = 0.03) also showed a statically significant association of receiving a score of 70 or greater on the overall teaching score. Conclusion Residents with higher performance associated with system management and accountability were perceived as highly effective teachers. USMLE and in-service exams were not predictive of higher teaching evaluations. Our data also suggest that effective teachers are working in both academic and community settings, providing a potential resource to academic departments and institutions

Narrative Financial Therapy: Integrating a Financial Planning Approach with Therapeutic Theory

The article serves as one of the first attempts to develop an integrated theoretical approach to financial therapy that can be used by practitioners from multiple disciplines. The presented approach integrates the components of the six-step financial planning process with components of empirically-supported therapeutic methods. This integration provides the foundation for a manualized approach to financial therapy, shaped by the writings of narrative theorists and select cognitive-behavioral interventions that can be used both by mental health and financial professionals

Induction of strain-transcendent antibodies to placental-type isolates with VAR2CSA DBL3 or DBL5 recombinant proteins

<p>Abstract</p> <p>Background</p> <p>Pregnancy associated malaria is a severe clinical syndrome associated with sequestration of <it>Plasmodium falciparum</it>-infected erythrocytes in the placenta. Placental binding is mediated by VAR2CSA, which adheres to chondroitin sulphate A (CSA). VAR2CSA is a large and polymorphic protein that has six Duffy binding-like (DBL) domains. There is still limited understanding as to how effective individual VAR2CSA domains are at generating inhibitory antibodies or the number of domain variants needed for universal vaccine coverage.</p> <p>Methods</p> <p>To investigate the immunogenic properties of single domain VAR2CSA recombinant proteins, rats or rabbits were immunized with five of the six VAR2CSA domains produced in <it>Pichia pastoris</it>. Immune plasma was analysed against a geographically diverse panel of CSA-binding lab lines to assess antibody breadth and inhibitory activity.</p> <p>Results</p> <p>Of the five domains, DBL3, and to a lesser extent DBL5, induced antibodies that cross-reacted on five diverse CSA-binding parasite lines by flow cytometry. By comparison, anti-DBL6 antibodies were highly strain-specific and anti-DBL1 and anti-DBL4 antibodies were poorly reactive by flow cytometry. From this series of recombinant proteins, adhesion-blocking activity was restricted to a single rat immunized against a DBL4 recombinant protein.</p> <p>Conclusions</p> <p>Single domain VAR2CSA recombinant proteins produced in <it>P. pastoris </it>had limited efficacy in eliciting adhesion blocking antibody responses, but VAR2CSA DBL3 and DBL5 domains contain strain-transcendent epitopes that can be targeted by vaccination and may have application for vaccine development.</p

Anxiety and Depression During Childhood and Adolescence: Testing Theoretical Models of Continuity and Discontinuity

The present study sought to clarify the trajectory (i.e., continuous vs. discontinuous) and expression (i.e., homotypic vs. heterotypic) of anxiety and depressive symptoms across childhood and adolescence. We utilized a state-of-the-science analytic approach to simultaneously test theoretical models that describe the development of internalizing symptoms in youth. In a sample of 636 children (53% female; M age = 7.04; SD age = 0.35) self-report measures of anxiety and depression were completed annually by youth through their freshman year of high school. For both anxiety and depression, a piecewise growth curve model provided the best fit for the data, with symptoms decreasing until age 12 (the “developmental knot”) and then increasing into early adolescence. The trajectory of anxiety symptoms was best described by a discontinuous homotypic pattern in which childhood anxiety predicted adolescent anxiety. For depression, two distinct pathways were discovered: A discontinuous homotypic pathway in which childhood depression predicted adolescent depression and a discontinuous heterotypic pathway in which childhood anxiety predicted adolescent depression. Analytical, methodological, and clinical implications of these findings are discussed

Quantitative single molecule analysis of podoplanin clustering in fibroblastic reticular cells uncovers CD44 function

Upon initial immune challenge, dendritic cells (DCs) migrate to lymph nodes and interact with fibroblastic reticular cells (FRCs) via C-type lectin-like receptor 2 (CLEC-2). CLEC-2 binds to the membrane glycoprotein podoplanin (PDPN) on FRCs, inhibiting actomyosin contractility through the FRC network and permitting lymph node expansion. The hyaluronic acid receptor CD44 is known to be required for FRCs to respond to DCs but the mechanism of action is not fully elucidated. Here, we use DNA-PAINT, a quantitative single molecule super-resolution technique, to visualize and quantify how PDPN clustering is regulated in the plasma membrane of FRCs. Our results indicate that CLEC-2 interaction leads to the formation of large PDPN clusters (i.e. more than 12 proteins per cluster) in a CD44-dependent manner. These results suggest that CD44 expression is required to stabilize large pools of PDPN at the membrane of FRCs upon CLEC-2 interaction, revealing the molecular mechanism through which CD44 facilitates cellular crosstalk between FRCs and DCs

Social innovation in diagnostics: three case studies.

BACKGROUND: Diagnostics are essential for identifying and controlling diseases. However, limited access to diagnostics hinders public health efforts in many settings. Social innovation may provide a framework for expanding access to diagnostics in the global south. Here social innovation is defined as implementing a known public health tool via a novel, community-driven technique. MAIN BODY: In this article, we discuss three diverse cases that show the potential for using social innovation in diagnostics. The cases chosen for inclusion here demonstrate the importance of social innovation in diagnostics across different geographic, cultural, and health system contexts. They include malaria testing via schools in Malawi, cervical human papillomavirus (HPV) sample self-collection in Peru, and crowdsourcing human immunodeficiency virus (HIV) testing in China. For each case, we present the public health problem and the impact of using social innovation to increase accessibility of diagnostics. We discuss implications of each diagnostic approach and the importance of social innovation in creating these potential solutions. We argue that social innovation is useful in improving the delivery of essential diagnostic tools in low- and middle-income countries. CONCLUSIONS: Interventions in Malawi, Peru, and China suggest social innovation increases uptake of diagnostics. The same tools and principles utilized in these cases can be adapted for use in other contexts. Such diagnostic innovations may help improve identification of and linkage to care for many diseases. The approach presents a unique opportunity to better address public health issues and increase accessibility in LMIC health systems

A controlled study of virtual reality in first-year magnetostatics

Stereoscopic virtual reality (VR) has experienced a resurgence due to flagship products such as the Oculus Rift, HTC Vive and smartphone-based VR solutions like Google Cardboard. This is causing the question to resurface: how can stereoscopic VR be useful in instruction, if at all, and what are the pedagogical best practices for its use? To address this, and to continue our work in this sphere, we performed a study of 289 introductory physics students who were sorted into three different treatment types: stereoscopic virtual reality, WebGL simulation, and static 2D images, each designed to provide information about magnetic fields and forces. Students were assessed using preliminary items designed to focus on heavily-3D systems. We report on assessment reliability, and on student performance. Overall, we find that students who used VR did not significantly outperform students using other treatment types. There were significant differences between sexes, as other studies have noted. Dependence on students' self-reported 3D videogame play was observed, in keeping with previous studies, but this dependence was not restricted to the VR treatment.Comment: 6 pages, 4 figures, submitted to the 2019 Physics Education Research Conferenc

For Whom, and for What, is Experience Sampling More Accurate Than Retrospective Report?

The experience sampling method (ESM) is often used in research, and promoted for clinical use, with the rationale that it avoids problematic inaccuracies and biases that attend retrospective measures of mental phenomena. Research suggests that averaged scores from ESM data are more accurate than retrospective ratings. However, it is not known how well individuals can remember information about momentary (rather than averaged) mental states, nor how accurately they estimate the dynamic covariation of these states. Individual differences in retrospective accuracy are also poorly understood. In two pre-registered studies, we examined differences between retrospective memory for stress and self-esteem and data gathered via experience sampling and examined whether alexithymia predicted accuracy. Results of both studies revealed substantial discrepancies between retrospective ratings and ESM ratings, especially for momentary states and their covariation. Alexithymia was positively related to recognition of stress means and variability but unrelated to recall of either stress or self-esteem, their variability, or their covariation. These findings suggest that experience sampling may be more useful than self-report when precise information is needed about the timing of mental states and dynamics among them

ASCA and contemporaneous ground-based observations of the BL Lacertae objects 1749+096 and 2200+420 (BL Lac)

We present ASCA observations of the radio-selected BL Lacertae objects 1749+096 (z=0.32) and 2200+420 (BL Lac, z=0.069) performed in 1995 Sept and Nov, respectively. The ASCA spectra of both sources can be described as a first approximation by a power law with photon index Gamma ~ 2. This is flatter than for most X-ray-selected BL Lacs observed with ASCA, in agreement with the predictions of current blazar unification models. While 1749+096 exhibits tentative evidence for spectral flattening at low energies, a concave continuum is detected for 2200+420: the steep low-energy component is consistent the high-energy tail of the synchrotron emission responsible for the longer wavelengths, while the harder tail at higher energies is the onset of the Compton component. The spectral energy distributions from radio to gamma-rays are consistent with synchrotron-self Compton emission from a single homogeneous region shortward of the IR/optical wavelengths, with a second component in the radio domain related to a more extended emission region. For 2200+420, comparing the 1995 Nov state with the optical/GeV flare of 1997 July, we find that models requiring inverse Compton scattering of external photons provide a viable mechanism for the production of the highest (GeV) energies during the flare. An increase of the external radiation density and of the power injected in the jet can reproduce the flat gamma-ray continuum observed in 1997 July. A directly testable prediction of this model is that the line luminosity in 2200+420 should vary shortly after (~1 month) a non-thermal synchrotron flare.Comment: 28 pages,6 figures, 5 tables; LaTeX document. accepted for publication in the Astrophysical Journa