Are Our Students Teachers?

Background: Though the practical and philosophical importance of teaching educational skills to students of medicine has been widely acknowledged, the principle accrediting bodies of resident and medical student training in the U.S. do not require medical schools to offer formal training in how to teach. Both recognize resident teaching in their competencies: the Accreditation Council for Graduate Medical Education (ACGME) requires all residencies to have a formal program in teaching; the Liaison Committee on Medical Education (LCME) mandates that all residents and faculty charged with teaching medical students “be prepared for their roles in teaching and assessment.” But many medical students begin to teach their peers and junior students during medical school. In a 2008 poll of 130 accredited, M.D.-granting US medical schools, all 99 responding institutions reported using their students as teachers, though less than half offered formal curriculum in teaching, and among them, the majority of curricula reached only a fraction of graduating students, usually toward the end of their final year. In addition, students teach patients from early in their training, and formal teaching skills may support this activity and thus enhance patient care. Despite favorable argument for the value and efficacy of such programs in the literature of the past three decades, U.S. medical education has largely deferred the formal instruction of educational skills to the postgraduate level. UMMS offers its students a patchwork of peer and patient educational opportunities without presently offering formal background in evidence-based teaching skills. While this type of scattered elective experience can be immensely valuable to students, further formalization may better prepare UMMS students to satisfy the institutional competency of “assuming the role of teacher when appropriate.” The introduction and refinement of teaching skills may in turn benefit the quality of the educational program, the wider institutional and interprofessional learning environment, and patient care and health education across the Commonwealth. Many UMMS students stay on to become teaching residents and faculty, and remain – or later return – to the state to practice and teach. In a demanding era of expanding biomedical complexity, reduced resident duty hours, collaborative health care delivery, and patient-centered decision-making, offering or requiring relevant educational training to our clinicians early in their development may provide substantial benefit to our health care system and patients. Objectives: The objectives of this project were: 1) Quantify the existence of peer and patient teaching opportunities within and outside the formal UMMS educational program at all levels of the curriculum; 2) Describe the receptiveness of faculty and students toward institution of a formal program preparing all UMMS students to teach both peers and patients in a variety of settings common to residency and clinical practice in any field; 3) Report arguments for and against such a program from the vantage of faculty and students, including barriers specific to UMMS; and 4) Propose a blueprint for such a program based on the opportunities already offered, new ideas from faculty and students, and models culled both from the educational literature and from other institutions. Methods: Short online surveys were sent to course-directing faculty and to all currently enrolled UMMS students in years 1-4 of the curriculum using a combination of Likert-scale and open response items. Per the IRB, the survey did not require a formal approval or exemption process. Results: FACULTY: 58% of all course and clerkship faculty responded; 48% stated that their courses already offer some opportunity in peer and patient teaching, though only in select cases do students receive formal training in educational methodology and thorough feedback on their performance as educators. Often, these programs do not apply to all students. 50% of faculty were most (4-5 on a 5-point scale) “interested in incorporating a formal student teaching component into [their] course,” and when asked whether they had particular “ideas for how students might practice their peer education or patient teaching skills within [their] course?” 67% answered “yes,” posing a variety of possibilities for peer and patient education, both familiar and innovative. Students: 143 responses (28%) were received from currently enrolled students, constituting 17.6% of MS1, 25.4% of MS2, 26.9% of MS3, and 39.6% of MS4 and extending students. Self-reported comfort as a peer and patient educator increased modestly over class years, when expressed as an average of responses on a 1-5 Likert scale (Peer: MS1 3.00, MS2 3.13, MS3 3.13, MS4 3.47, MS4 extended 3.57; Patient: MS1 3.32, MS2 3.75, MS3 3.88, MS4 3.95, MS4 extended 4.21). 30.8% of students identified some opportunity to teach within the formal curriculum; outside the formal curriculum, 28.7% of students listed no opportunity, while the rest listed different amounts and frequencies ranging from daily to once a year, depending on how they defined teaching. 75.6% of responding students emphasized the value of “learn[ing] formal teaching skills - small group, lecture, bedside - in medical school” and 77.7% emphasized the value of opportunities to “practice formal teaching skills” (4-5 on a 5-point scale). 41.3% indicated that they would “actively create time to learn, practice, and refine these skills prior to residency if it were not included in the formal academic program.” Conclusion: Though teaching opportunities exist at UMMS, most are not formalized, and those offered reach less than a third of students. While comfort with peer and patient teaching increases across the educational continuum from first to fourth year, the increase remains modest. 84% of graduates report that they felt prepared to teach as interns based on their 2011 AAMC graduation questionnaire responses, but given the importance of teaching in many aspects of medicine, we see room for improvement. Overall, there is a strong call both from both faculty and students at UMMS for formally incorporating educational training into the curriculum, with a particular focus on teaching practice. Free-response items emphasized dramatic differences in student and faculty understanding and recognition of teaching as a professional role among both peers and patients. These discrepancies highlight a need for increased awareness of the teaching responsibilities of medical students, and of the possibilities that are open to them during medical school. A structured approach to medical student teaching skills across the continuum of undergraduate medical education is the first step in this process

Single-Base Resolution Mapping of 5-Hydroxymethylcytosine Modifications in Hippocampus of Alzheimer\u27s Disease Subjects

Epigenetic modifications to cytosine have been shown to regulate transcription in cancer, embryonic development, and recently neurodegeneration. While cytosine methylation studies are now common in neurodegenerative research, hydroxymethylation studies are rare, particularly genome-wide mapping studies. As an initial study to analyze 5-hydroxymethylcytosine (5-hmC) in the Alzheimer’s disease (AD) genome, reduced representation hydroxymethylation profiling (RRHP) was used to analyze more than 2 million sites of possible modification in hippocampal DNA of sporadic AD and normal control subjects. Genes with differentially hydroxymethylated regions were filtered based on previously published microarray data for altered gene expression in hippocampal DNA of AD subjects. Our data show significant pathways for altered levels of 5-hmC in the hippocampus of AD subjects compared to age-matched normal controls involved in signaling, energy metabolism, cell function, gene expression, protein degradation, and cell structure and stabilization. Overall, our data suggest a possible role for the dysregulation of epigenetic modifications to cytosine in late stage AD

The Rich Get Richer: Enabling Conditions for Knowledge Use in Organizational Work Teams

Individuals on the periphery of organizational knowledge sharing networks, due to inexperience, location, or lack of social capital, may struggle to access useful knowledge at work. An electronic knowledge repository (KR) has the potential to help peripheral individuals gain access to valuable knowledge because a KR is universally and constantly available and can be used without social interaction. However, for it to serve this equalizing function, those on the periphery of the organization must actually use it, possibly overcoming barriers to doing so. In this paper, we develop a multi-level model of knowledge use in teams and show that individuals whose experience and position already provide them access to vital knowledge use a KR more frequently than individuals on the organizational periphery. We argue that this occurs because the KR – despite its appearance of equivalent accessibility to all – is actually more accessible to central than peripheral players due to their greater experience and access to colleagues. Thus, KR use is not driven primarily by the need to overcome limited access to other knowledge sources. Rather KR use is enabled when actors know how to reap value from the KR, which ironically improves with increasing access to other sources of knowledge. Implications for both team effectiveness and knowledge management research are offered. We conclude that KRs are unlikely to serve as a knowledge equalizer without intervention

Methods and Systems for Prognosis and Diagnosis of Brain Damage

The presently-disclosed subject matter includes methods and devices for diagnosing, prognosing, and treating brain damage in a subject, including brain damage caused by stroke or a traumatic brain injury (TBI). The methods can comprise providing a sample obtained from the subject, exposing the sample to an antibody selective for a visinin-like protein, detecting the presence of a complex that includes the antibody and the visinin-like protein, and diagnosing and/or prognosing the subject as having brain damage if there is the presence of the complex. Embodied methods can also comprise administering a treatment for brain damage if the subject includes the presence of the visinin-like protein

A Simple Method to Reduce Interpretation Error of Ages Estimated from Otoliths

We designed and tested a novel otolith viewing apparatus termed the otolith illumination device (OID) to ascertain if its use would result in a reduction of interpretation error as determined by increased precision of age estimates obtained from otoliths of walleye Sander vitreus and smallmouth bass Micropterus dolomieu. Clarity of annuli on otolith sections viewed with the OID was generally greater than clarity of annuli on sections viewed with an alternative method. OID-based age estimates were equally as, and in some instance more precise than ages estimated using the alternative method. Additionally, no systematic differences in coefficients of variation across ages were detected between the OID and alternative methods of fish age estimation. Results suggest that the OID may be useful for inexperienced readers and is a viable option for reducing interpretation error, which may improve reader efficiency and accuracy and precision in estimating fish ages

Post-transcriptional regulation of satellite cell quiescence by TTP-mediated mRNA decay.

Skeletal muscle satellite cells in their niche are quiescent and upon muscle injury, exit quiescence, proliferate to repair muscle tissue, and self-renew to replenish the satellite cell population. To understand the mechanisms involved in maintaining satellite cell quiescence, we identified gene transcripts that were differentially expressed during satellite cell activation following muscle injury. Transcripts encoding RNA binding proteins were among the most significantly changed and included the mRNA decay factor Tristetraprolin. Tristetraprolin promotes the decay of MyoD mRNA, which encodes a transcriptional regulator of myogenic commitment, via binding to the MyoD mRNA 3' untranslated region. Upon satellite cell activation, p38α/β MAPK phosphorylates MAPKAP2 and inactivates Tristetraprolin, stabilizing MyoD mRNA. Satellite cell specific knockdown of Tristetraprolin precociously activates satellite cells in vivo, enabling MyoD accumulation, differentiation and cell fusion into myofibers. Regulation of mRNAs by Tristetraprolin appears to function as one of several critical post-transcriptional regulatory mechanisms controlling satellite cell homeostasis

Optogenetic Release of ACh Induces Rhythmic Bursts of Perisomatic IPSCs in Hippocampus

Acetylcholine (ACh) influences a vast array of phenomena in cortical systems. It alters many ionic conductances and neuronal firing behavior, often by regulating membrane potential oscillations in populations of cells. Synaptic inhibition has crucial roles in many forms of oscillation, and cholinergic mechanisms regulate both oscillations and synaptic inhibition. In vitro investigations using bath-application of cholinergic receptor agonists, or bulk tissue electrical stimulation to release endogenous ACh, have led to insights into cholinergic function, but questions remain because of the relative lack of selectivity of these forms of stimulation. To investigate the effects of selective release of ACh on interneurons and oscillations, we used an optogenetic approach in which the light-sensitive non-selective cation channel, Channelrhodopsin2 (ChR2), was virally delivered to cholinergic projection neurons in the medial septum/diagonal band of Broca (MS/DBB) of adult mice expressing Cre-recombinase under the control of the choline-acetyltransferase (ChAT) promoter. Acute hippocampal slices obtained from these animals weeks later revealed ChR2 expression in cholinergic axons. Brief trains of blue light pulses delivered to untreated slices initiated bursts of ACh-evoked, inhibitory post-synaptic currents (L-IPSCs) in CA1 pyramidal cells that lasted for 10's of seconds after the light stimulation ceased. L-IPSC occurred more reliably in slices treated with eserine and a very low concentration of 4-AP, which were therefore used in most experiments. The rhythmic, L-IPSCs were driven primarily by muscarinic ACh receptors (mAChRs), and could be suppressed by endocannabinoid release from pyramidal cells. Finally, low-frequency oscillations (LFOs) of local field potentials (LFPs) were significantly cross-correlated with the L-IPSCs, and reversal of the LFPs near s. pyramidale confirmed that the LFPs were driven by perisomatic inhibition. This optogenetic approach may be a useful complementary technique in future investigations of endogenous ACh effects

Measurement errors in body size of sea scallops (Placopecten magellanicus) and their effect on stock assessment models

Body-size measurement errors are usually ignored in stock assessments, but may be important when body-size data (e.g., from visual sur veys) are imprecise. We used experiments and models to quantify measurement errors and their effects on assessment models for sea scallops (Placopecten magellanicus). Errors in size data obscured modes from strong year classes and increased frequency and size of the largest and smallest sizes, potentially biasing growth, mortality, and biomass estimates. Modeling techniques for errors in age data proved useful for errors in size data. In terms of a goodness of model fit to the assessment data, it was more important to accommodate variance than bias. Models that accommodated size errors fitted size data substantially better. We recommend experimental quantification of errors along with a modeling approach that accommodates measurement errors because a direct algebraic approach was not robust and because error parameters were diff icult to estimate in our assessment model. The importance of measurement errors depends on many factors and should be evaluated on a case by case basis

Antigen-Drug Conjugates as a Novel Therapeutic Class for the Treatment of Antigen-Specific Autoimmune Disorders

This document is the Accepted Manuscript version of a Published Work that appeared in final form in Molecular Pharmaceutics, copyright © American Chemical Society after peer review and technical editing by the publisher. To access the final edited and published work see doi.org/10.1021/acs.molpharmaceut.9b00063.Multiple sclerosis represents the world’s most common cause of neurological disability in young people and is attributed to a loss of immune tolerance toward proteins of the myelin sheath. Typical treatment options for MS patients involve immunomodulatory drugs, which act non-specifically, resulting in global immunosuppression. The study discussed herein aims to demonstrate the efficacy of antigen-specific immunotherapies involving conjugation of disease causing auto-antigen, PLP139–151, and a potent immunosuppressant, dexamethasone. Antigen-drug conjugates (AgDCs) were formed using copper-catalyzed azide-alkyne cycloaddition chemistry with the inclusion of a hydrolyzable linker to maintain activity of released dexamethasone. Subcutaneous administration of this antigen-drug conjugate to SJL mice induced with experimental autoimmune encephalomyelitis protected the mice from symptom onset throughout the 25-day study, demonstrating enhanced efficacy in comparison to dexamethasone treatment. These results highlight the benefits of co-delivery of auto-antigens with immunosuppressant drugs as AgDCs for the treatment of autoimmune diseases.National Institutes of Health Graduate Training Program in Dynamic Aspects of Chemical Biology Grant (T32 GM008545)Howard Rytting pre-doctoral fellowship from the Department of Pharmaceutical Chemistry at the University of KansasNational Institutes of Health Biotechnology Training Grant (NIH0073415)NIH Shared Instrumentation Grant # S10RR024664NSF Major Research Instrumentation Award # 162592

Contemporary visions of progress in ecology and thoughts for the future

Although ecological research is progressing rapidly, the answers to certain key questions continue to elude us. This paper considers several of the contemporary challenges facing ecology. (1) Terminology is voluminous and often poorly defined, resulting in inefficient communication. (2) The concept of scale affects our inferences about system structure and function, requiring us to continue an almost heuristic investigation of breaks, domains, and integration. New tools that more explicitly incorporate scalar issues will need to be developed for progress to take place in the field of ecology. (3) Increasingly, it is expected that applied questions will be solved in less than a year. This demand for solutions from ecologists often produces short-term and inadequate responses. (4) How can ecologists improve communication between subdisciplines, with undergraduate students, and with the public? How will ecology be done in the future, and by whom? We provide some background to these observations and questions, and offer some potential solutions from the viewpoint of young practicing ecologists