Development of a pre-operative scoring system for predicting risk of post-operative paediatric cerebellar mutism syndrome

BACKGROUND: Despite previous identification of pre-operative clinical and radiological predictors of post-operative paediatric cerebellar mutism syndrome (CMS), a unifying pre-operative risk stratification model for use during surgical consent is currently lacking. The aim of the project is to develop a simple imaging-based pre-operative risk scoring scheme to stratify patients in terms of post-operative CMS risk. METHODS: Pre-operative radiological features were recorded for a retrospectively assembled cohort of 89 posterior fossa tumour patients from two major UK treatment centers (age 2-23yrs; gender 28 M, 61 F; diagnosis: 38 pilocytic astrocytoma, 32 medulloblastoma, 12 ependymoma, 1 high grade glioma, 1 pilomyxoid astrocytoma, 1 atypical teratoid rhabdoid tumour, 1 hemangioma, 1 neurilemmoma, 2 oligodendroglioma). Twenty-six (29%) developed post-operative CMS. Based upon results from univariate analysis and C4.5 decision tree, stepwise logistic regression was used to develop the optimal model and generate risk scores. RESULTS: Univariate analysis identified five significant risk factors and C4.5 decision tree analysis identified six predictors. Variables included in the final model are MRI primary location, bilateral middle cerebellar peduncle involvement (invasion and/or compression), dentate nucleus invasion and age at imaging >12.4 years. This model has an accuracy of 88.8% (79/89). Using risk score cut-off of 203 and 238, respectively, allowed discrimination into low (38/89, predicted CMS probability <3%), intermediate (17/89, predicted CMS probability 3-52%) and high-risk (34/89, predicted CMS probability ≥52%). CONCLUSIONS: A risk stratification model for post-operative paediatric CMS could flag patients at increased or reduced risk pre-operatively which may influence strategies for surgical treatment of cerebellar tumours. Following future testing and prospective validation, this risk scoring scheme will be proposed for use during the surgical consenting process

Integrating sequence and array data to create an improved 1000 Genomes Project haplotype reference panel

A major use of the 1000 Genomes Project (1000GP) data is genotype imputation in genome-wide association studies (GWAS). Here we develop a method to estimate haplotypes from low-coverage sequencing data that can take advantage of single-nucleotide polymorphism (SNP) microarray genotypes on the same samples. First the SNP array data are phased to build a backbone (or 'scaffold') of haplotypes across each chromosome. We then phase the sequence data 'onto' this haplotype scaffold. This approach can take advantage of relatedness between sequenced and non-sequenced samples to improve accuracy. We use this method to create a new 1000GP haplotype reference set for use by the human genetic community. Using a set of validation genotypes at SNP and bi-allelic indels we show that these haplotypes have lower genotype discordance and improved imputation performance into downstream GWAS samples, especially at low-frequency variants. © 2014 Macmillan Publishers Limited. All rights reserved

The empathic capital of pre-medical students

https://kent-islandora.s3.us-east-2.amazonaws.com/node/17663/87813-thumbnail.jpgLiterature on the professional and emotional socialization of medical trainees in the US tends to focus on students who have already matriculated into medical school, leaving pre-medical student experiences largely understudied. Specifically, little is known about how these students develop and understand empathy during their pre-medical years. We draw on qualitative interviews with 25 pre-medical students at Midwest University and find that students at this stage possess considerable empathic capital, a resource that they will likely draw on in medical school and beyond. Specifically, pre-medical students understand empathy in cognitive, affective, and action-oriented ways; recall instances of empathic action in their everyday lives; and view empathy as a learned emotional state, shaped in the context of social relationships and the pre-medical curriculum. These understandings of empathy reflect a crucial stage in the development of students\u27 empathy careers (Ruiz-Junco, 2017), as they shift from primary (home and family) to secondary (education, peers) emotional socialization. It behooves medical educators and researchers to understand the empathic capital that medical students “bring to the table” so that empathy training can better incorporate or challenge learners’ existing conceptualizations.</p