A Cloud With a Silver Lining: Helping Students Learn About Professionalism

Problem: Educators face many challenges in teaching professionalism. Despite attempts to define professionalism, it remains abstract for students and often not fully appreciated until they are in clinic. Without a way to make it personally relevant, students will likely be less motivated to learn. Intervention: We used student-generated word clouds to facilitate reflection and discussions, thereby helping students make their perceptions of professionalism more explicit. Group discussion was followed by a 5-minute written reflection. Word clouds created in Semesters 1 and 7 enabled students to compare perceptions at two points in the curriculum. Context: The George Washington University Doctor of Physical Therapy Program is a 3-year, 8-semester, 109-credit postgraduate program that includes 34 weeks of clinical practice. Reflection is foundational to the curriculum, and students reflect on their learning and professional growth each semester. Historically, students were introduced to professionalism in Semester 1 using explicit instructional strategies. Despite the wealth of resources, readings, and discussions, engagement remained challenging. Outcome: Student-generated word clouds created a personally relevant visual from which uniquely designed prompts were created to facilitate discussion. Having students compare word clouds across semesters enabled them to identify what, when, how, and where they learned about professionalism. Word clouds, categorized words, and 5-minute written reflections provided evidence of individual and collective changes in student perceptions. Lessons Learned: Students will engage in rich discussions on professionalism if it is personally relevant. Anonymity can foster discussion on personal characteristics and biases. Visualization of student-generated, narrative data enhanced reflection and discussion. Comparing word clouds from two points in time helped students articulate changes in their perceptions of professionalism. A 5-minute reflection can be a powerful learning tool for students and faculty. Outcomes demonstrated the value of designing interventions grounded in the educational principles.     

The likelihood of adverse outcomes in triplet pregnancies estimated by pregravid maternal characteristics

OBJECTIVE: To estimate the likelihood of adverse outcomes in triplet pregnancies by a score comprising pregravid maternal characteristics. DESIGN: A cross-sectional study. SETTING: Triplets database collected by Matria Healthcare, Inc. PATIENT(S): A scoring system was constructed, assigning 1 point for the presence of a risk factor (nulliparity, stature <165 cm, and age <35 years) and 0 for the absence of a risk factor. Data related to 2,887 triplet sets were analyzed. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Total triplet birth weight <4,500 and delivery at 27-32 weeks. RESULT(S): We identified 18% of triplets' mothers (score 3) in whom the likelihood for adverse results is 50%-90% higher and the likelihood for optimal results is 40% to 70% lower than background rates. CONCLUSION(S): A pregravid maternal profile could estimate the likelihood of adverse outcomes and be used for consulting patients at risk of having or carrying a triplet pregnancy.     

Lumbar fractures in adult blunt trauma: axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films

BACKGROUND: Our hypothesis was that abdominal and pelvic computed tomographic (AP-CT) scans are equivalent to portable two-view plain films in detecting lumbar spine fractures in adults. Since many trauma patients often undergo AP-CT scanning to evaluate for possible intra-abdominal injuries, using the AP-CT scan to screen for lumbar fractures could make the trauma evaluation process more efficient. METHODS: The institutional trauma registry at a Level I trauma center was used to identify all blunt lumbar fractures during a 6-year period. Medical records were reviewed. RESULTS: A total of 7,216 adult blunt trauma patients were evaluated, and 115 patients were identified as having a lumbar fracture, for an incidence rate of 1.6%. Missed fracture rates were high for both AP-CT scans (23.2%, 13 of 56) and portable two-view films (12.7%, 14 of 110, = 0.08). Fifty-two patients had both AP-CT scans and plain films. In this group, AP-CT scans missed 23.1% (12 of 52) of the lumbar fractures and plain films missed 15.4% (8 of 52). However, the combination of the two diagnostic methods did not miss any fractures (0 of 52). The missed fractures required surgery or brace in 50% (7 of 14) patients who had fractures missed by plain films and 46% (6 of 13) patients whose fractures were missed by AP-CT scanning. CONCLUSION: Both AP-CT scans and plain films failed to diagnose significant lumbar fractures that required therapy. When screening for lumbar fractures, obtaining both AP-CT scans and portable two-view plain films may decrease missed lumbar fractures in blunt adult trauma.     

How to simplify the CT diagnosis of Le Fort fractures

OBJECTIVE: The numerous components seen in the Le Fort fractures make classification difficult. Our objective is to simplify the task of classifying Le Fort fractures. CONCLUSION: Each of the Le Fort fractures has at least one unique component that is easily recognizable: I, the anterolateral margin of the nasal fossa; II, the inferior orbital rim; and III, the zygomatic arch. Classification of the Le Fort fractures is simplified by using these unique components to establish a tentative classification that is then confirmed.     

HLA-DPβ and susceptibility to multiple sclerosis: An analysis of caucasoid and Japanese patient populations

Nonradioactive sequence-specific oligonucleotide (SSO) probes specific for the HLA-DPβ locus have been used in a simple dot-blot assay to DPβ-type samples amplified by the polymerase chain reaction (pcr) from Caucasoid (n = 24) and Japanese (n = 23) patients with multiple sclerosis (ms) as well as ethnically matched controls. In contrast to previous reports, no DPβ allele was found to be increased in either patient population. However, the results do show a dramatic difference in the allele frequencies between the two control populations, further emphasizing the need for ethnically matched controls in studies of HLA and disease.     

Dominant CTL-inducing epitopes on GAD65 are adjacent to or overlap with dominant Th-inducing epitopes

Immune responses to GAD65 are associated with progression to T1D in NOD mice and humans. Our previous data suggested that dominant CTL-inducing and Th-inducing determinants might preferentially occur in proximal GAD65 sequences. Using a panel of 192 GAD65 peptides we discovered that four of the eight CTL-inducing peptides, including those most biologically relevant, were proximal to previously described I-A(g7)-restricted determinants that characterize natural islet autoimmunity in NOD mice. The CTL determinants 546-554 and 88-98 were presented by GAD65-expressing cells and were displayed on pancreatic LNC, along with 268-278, following beta cell damage. p546-554-specific CTL were detectable in young naive mice and transferred significant islet inflammation into NOD.scid mice. These findings demonstrate that unique regions of GAD65 may be favored during antigen processing, such that diverse dominant epitopes are produced from overlapping sequences, which can engage distinct T cell subsets. Additionally, cross-presentation may enhance GAD65-specific CTL responses in T1D.