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BACKGROUND AND OBJECTIVES: Pressures on academic physician educators to generate clinical revenue or research grants may threaten faculty engagement as teachers. Neurology has historically prized its outstanding educators, but programs that provide financial support for teaching are lacking. We developed an opt-in, financial, teaching incentive program in an academic neurology department and evaluated its impact on faculty experience, motivation, and identity. METHODS: We applied a change management framework and conducted a National and local needs assessment before designing an education value unit (EVU) system using time-based metrics and rates reflecting impact on clinical revenue. Activities essential for graduation of students and residents that reduced clinical revenue generation were included. Faculty self-reported teaching through an online platform and received an incentive payment at the end of each year. Following a 6-month pilot, faculty participated in a 3-year implementation phase followed by an evaluation through faculty survey and semistructured interviews. RESULTS: In the first 3 years of the program, 42, 56, and 54 faculty enrolled, representing 28% of faculty by year 3. Faculty reported an average of 1,488 hours of teaching annually, drew from 13 divisions, and included all ranks (51% assistant, 29% associate, and 20% full). Fifty-five percent of participating faculty (N = 30) completed a survey to evaluate the incentive program. The majority agreed or somewhat agreed that the program had met its goals (80%-92%), reduced barriers to teaching (56%), and the department highly valued teaching (93%). Semistructured interviews with 11 participating faculty identified 5 themes regarding the impact of the program on faculty experience, including (1) supporting the choice of faculty to teach even when time is scarce, (2) making teaching visible to oneself and others, (3) directing faculty toward eligible teaching opportunities, (4) communicating the departments commitment to education, and (5) reinforcing educator identity and sense of belonging. DISCUSSION: The development of a teaching incentive program at an academic neurology center is feasible with benefits extending beyond the incentive payment itself. Although EVU programs are not without limitations, faculty experienced the program as reflective of the department valuing its educators, which reinforced their educator identity and engagement in teaching.

ProblemMedical educators recognize that partnering actively with health system leaders closes significant health care experience, quality, and outcomes gaps. Medical schools have explored innovations training physicians to care for both individual patients and populations while improving systems of care. Yet, early medical student education fails to include systems improvement as foundational skills. When health systems science is taught, it is often separated from core clinical skills.ApproachThe Clinical Microsystems Clerkship at the University of California, San Francisco School of Medicine, launched in 2016, integrates clinical skills training with health systems improvement from the start of medical school. Guided by communities of practice and workplace learning principles, it embeds first-year and second-year students in longitudinal clinical microsystems with physician coaches and interprofessional clinicians one day per week. Students learn medical history, physical examination, patient communication, interprofessional teamwork, and health systems improvement. Assessments include standardized patient examinations and improvement project reports. Program outcome measures include student satisfaction and attitudes, clinical skills performance, and evidence of systems improvement learning, including dissemination and scholarship.OutcomesStudents reported high satisfaction (first-year, 4.10; second-year, 4.29, on a scale of 1-5) and value (4.14) in their development as physicians. Clinical skills assessment accuracy was high (70%-96%). Guided by interprofessional clinicians across 15 departments, students completed 258 improvement projects in 3 health systems (academic, safety net, Veterans Affairs). Sample projects reduced disparities in hypertension, improved opiate safety, and decreased readmissions. Graduating students reported both clinical skills and health systems knowledge as important to physician success, patient experience, and clinical outcomes (4.73). Most graduates discussed their projects in residency applications (85%) and disseminated related papers and presentations (54%).Next stepsIntegrating systems improvement, interprofessional teamwork, and clinical skills training can redefine early medical student education. Health system perspectives, long-term outcomes, and sustainability merit further exploration.

In response to the COVID-19 pandemic, we developed and implemented a theory-informed process to adapt a comprehensive pre-clerkship medical school curriculum to run in the virtual learning environment utilizing sociocultural learning theory and cognitive load theory. Of 124 student respondents, 45% rated virtual learning as very or extremely effective, and 49% as moderately effective. Positive aspects of virtual learning included effectiveness of chat moderators, displaying pronouns on Zoom, active learning technology, and captioning and transcription. Negative aspects included access to technology and feeling isolated from community. Overall course ratings, examination performance, and work hours did not differ pre- and post-implementation.

The article reports research aimed at identifying factors relating to retention in English intellectual disability services, drawing on a study of the social care workforce. The research involved two rounds of interviews with social care managers and staff between 2009 and 2014. The study uses social exchange theory, particularly the idea of 'reciprocity' and the mechanism of 'hope', as a conceptual framework to aid interpretation of the themes relating to retention identified in the interview analysis: 'pay', 'support', 'morale', and 'training' (related to reciprocity) and 'improving quality of life' and 'supporting personal development' (related to hope). Both groups of themes are identified as being particularly appropriate to intellectual disability services. The study concludes that reciprocity and hope seem to interact in factors related to staff retention, although the study suggests that reciprocity rather than hope is directly connected with retention.

Feedback is at the heart of debates over student satisfaction and academic workload, an issue likely to increase in importance as the tertiary sector responds to the funding crisis sparked by the COVID-19 pandemic. In this light, the development of approaches to improve feedback is essential for teaching and learning, with many approaches involving some form of peer-review. Almost universally, peer-review is shown to be beneficial for participants, who recognize those benefits and appreciate the opportunity. Approaches to peer-review, though, presently involve extensive academic time and resources in the form of oversight, control, and analysis, suggesting a need to bridge resource-intensive development with the realities of implementation, workloads, and decreasing resources. In response, this paper reports on an effort to encourage student-led peer-review, asking: if left to decide whether to participate, what are the impacts of peer-review on student grades? Our mixed methods analysis confirms the benefits of peer-review and associated student satisfaction, while demonstrating that these benefits (can) occur without substantial workload for educators. The findings, though, are tempered by rates of participation and the differentiated capacities of students. The full approach is provided for readers to amend and apply if desired.

Purpose: A case study was undertaken to evaluate the use of self-reflection in enterprise education in a UK university, where the taught content was tailored to ensure relevance to the students who were from a variety of subject disciplines. Design/methodology/approach: Enterprise taught content was established in masters level 7 programmes across a range of subject disciplines. Taught content was designed using problem based learning, and evaluated using self-reflective methodologies. The paper reflects on the current position of enterprise education and asks the research question of whether the use of self-reflective teaching methodologies are valid for enterprise education. Findings: Results suggest that the students appreciated the introduction of enterprise into their course and in the main did not view it as disjointed or irrelevant to their wider aims. More so, the students commented favourably towards the integration of enterprise into their primary discipline, and noted an enhanced learning experience because of this integration. Research limitations/implications: For the University: A novel approach to enterprise teaching has been developed at a UK university, focusing on teaching non-business students how to be more valuable to a business within their degree subject context. This has empowered the students with an enhanced understanding of commercial issues and increased employability (Rae 2007; Huq and Gilbert 2017). This has also led to enhanced relationships with industry and given students a wider understanding of their degree area. Practical implications: For the educator: The use of self-reflective teaching methodologies (Hayward 2000) are noted to be vital in order to deliver enterprise education in a way that is relevant to the student cohort body. By reflecting on one's teaching style and delivery method, the authors were able to engage non-business students in enterprise education, and receive a high level of student satisfaction. It is noted that self-reflection was a valuable process for delivery to each degree discipline. By employing problem based learning and self-reflective teaching methodologies, an increased synergy between the business taught elements and the science subjects was created. Originality/value: This approach is shown to empower the students with an enhanced understanding of commercial issues and an increased employability. This has led to enhanced relationships between academia and industry, and given students a wider understanding of their degree area; the enhanced relationships with industry offer students a wider commercial understanding of their degree area. A gap in the current knowledge base in enterprise education has been identified: enterprise education with the aim of educating the student to be more valuable to a business as opposed to starting a business. The use of self-reflective methodologies has offered a novel approach to enterprise teaching in a UK university.

Insulin-like growth factor 1 (IGF-I) has been associated with insulin resistance. Genome-wide association studies (GWASs) of fasting insulin (FI) identified single-nucleotide variants (SNVs) near the IGF1 gene, raising two hypotheses: (1) these associations are mediated by IGF-I levels and (2) these noncoding variants either tag other functional variants in the region or are directly functional. In our study, analyses including 5141 individuals from population-based cohorts suggest that FI associations near IGF1 are not mediated by IGF-I. Analyses of targeted sequencing data in 3539 individuals reveal a large number of novel rare variants at the IGF1 locus and show a FI association with a subset of rare nonsynonymous variants (PSKAT=5.7 × 10(-4)). Conditional analyses suggest that this association is partly explained by the GWAS signal and the presence of a residual independent rare variant effect (Pconditional=0.019). Annotation using ENCODE data suggests that the GWAS variants may have a direct functional role in insulin biology. In conclusion, our study provides insight into variation present at the IGF1 locus and into the genetic architecture underlying FI levels, suggesting that FI associations of SNVs near IGF1 are not mediated by IGF-I and suggesting a role for both rare nonsynonymous and common functional variants in insulin biology.

The risk profile of extraoperative electrocorticography (ECoG) is documented almost exclusively by case series from a limited number of academic medical centers. These studies tend to underreport minor complications, like urinary tract infections (UTIs) and deep venous thromboses (DVTs), that nevertheless affect hospital cost, length of stay, and the patient's quality of life. Herein, we used data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) to estimate the rate of adverse events in extraoperative ECoG surgeries. NSQIP is a validated dataset containing nearly 3 million procedures from over 600 North American hospitals, and uses strict criteria for the documentation of complications. Major complications occurred in 3.4% of 177 extraoperative ECoG cases, while minor complications occurred in 9.6%. The most common minor complication was bleeding requiring a transfusion in 3.4% of cases, followed by sepsis, DVT, and UTI each in 2.3% of cases. No mortality was reported. Overall, in a national database containing a heterogeneous population of hospitals, major complications of extraoperative ECoG were rare (3.4%). Complications such as UTI and DVT tend to be underreported in retrospective case series, yet make up a majority of minor complications for ECoG patients in this dataset.

ObjectivePolymicrogyria (PMG) is a malformation of cortical development characterized by formation of an excessive number of small gyri. Sixty percent to 85% of patients with PMG have epilepsy that is refractory to medication, but surgical options are usually limited. We characterize a cohort of patient with polymicrogyria who underwent epilepsy surgery and document seizure outcomes.MethodsA retrospective study of all patients with PMG who underwent epilepsy surgery (focal seizure foci resection and/or hemispherectomy) at our center was performed by review of all clinical data related to their treatment.ResultsWe identified 12 patients (7 males and 5 female) with mean age of 18 (ranging from 3 months to 44 years) at time of surgery. Mean age at seizure onset was 8 years, with the majority (83%) having childhood onset. Six patients had focal, five had multifocal, and one patient had diffuse PMG. Perisylvian PMG was the most common pattern seen on magnetic resonance imaging (MRI). Eight patients had other cortical malformations including hemimegalencephaly and cortical dysplasia. Scalp electroencephalography (EEG) often showed diffuse epileptic discharges that poorly lateralized but were focal on intracranial electrocorticography (ECoG). Eight patients underwent seizure foci resection and four underwent hemispherectomy. Mean follow-up was 7 years (ranging from one to 19 years). Six patients (50%) were seizure-free at last follow-up. One patient had rare seizures (Engel class II). Three patients were Engel class III, having either decreased seizure frequency or severity, and two patients were Engel class IV. Gross total resection of the PMG cortex trended toward good seizure control.SignificanceOur study shows that even in patients with extensive or bilateral PMG malformations, some may still be good candidates for surgery because the epileptogenic zone may involve only a portion of the malformation. Intracranial ECoG can provide additional localizing information compared to scalp EEG in guiding resection of epileptogenic foci.

Repair of DNA interstrand crosslinks requires action of multiple DNA repair pathways, including homologous recombination. Here, we report a de novo heterozygous T131P mutation in RAD51/FANCR, the key recombinase essential for homologous recombination, in a patient with Fanconi anemia-like phenotype. In vitro, RAD51-T131P displays DNA-independent ATPase activity, no DNA pairing capacity, and a co-dominant-negative effect on RAD51 recombinase function. However, the patient cells are homologous recombination proficient due to the low ratio of mutant to wild-type RAD51 in cells. Instead, patient cells are sensitive to crosslinking agents and display hyperphosphorylation of Replication Protein A due to increased activity of DNA2 and WRN at the DNA interstrand crosslinks. Thus, proper RAD51 function is important during DNA interstrand crosslink repair outside of homologous recombination. Our study provides a molecular basis for how RAD51 and its associated factors may operate in a homologous recombination-independent manner to maintain genomic integrity.

BackgroundCommon variation at the 11p11.2 locus, encompassing MADD, ACP2, NR1H3, MYBPC3, and SPI1, has been associated in genome-wide association studies with fasting glucose and insulin (FI). In the Cohorts for Heart and Aging Research in Genomic Epidemiology Targeted Sequencing Study, we sequenced 5 gene regions at 11p11.2 to identify rare, potentially functional variants influencing fasting glucose or FI levels.Methods and resultsSequencing (mean depth, 38×) across 16.1 kb in 3566 individuals without diabetes mellitus identified 653 variants, 79.9% of which were rare (minor allele frequency 2 independent signals at 11p11.2. One predicted regulatory variant, chr11:47227430 (hg18; minor allele frequency=0.00068), contributed 20.6% to the overall sequence kernel association test score at NR1H3, lies in intron 2 of NR1H3, and is a predicted binding site for forkhead box A1 (FOXA1), a transcription factor associated with insulin regulation. In human HepG2 hepatoma cells, the rare chr11:47227430 A allele disrupted FOXA1 binding and reduced FOXA1-dependent transcriptional activity.ConclusionsSequencing at 11p11.2-NR1H3 identified rare variation associated with FI. One variant, chr11:47227430, seems to be functional, with the rare A allele reducing transcription factor FOXA1 binding and FOXA1-dependent transcriptional activity.

Target onsets in dynamically changing displays can be predicted when contingencies exist between different stimulus states over time. In the present study, we examined predictive monitoring when participants searched dynamically changing displays of numbers and colored squares for a color target, a number target, or both. Stimuli were presented in both contiguous and discrete spatial configurations. Response time (RT) and accuracy were recorded, and evidence of predictive monitoring was assessed via first fixations and refixations of target-predictive stimuli. RTs to target onsets and evidence of predictive monitoring were reduced in dual-target, relative to single-target, conditions. Further, predictive monitoring did not speed RTs but was influenced by display configuration. In particular, discrete displays impaired monitoring for number targets in the dual-target condition. Implications exist for real-world visual tasks involving multiple target categories and for visual display design.

ImportanceEpileptic activity associated with Alzheimer disease (AD) deserves increased attention because it has a harmful impact on these patients, can easily go unrecognized and untreated, and may reflect pathogenic processes that also contribute to other aspects of the illness. We report key features of AD-related seizures and epileptiform activity that are instructive for clinical practice and highlight similarities between AD and transgenic animal models of the disease.ObjectiveTo describe common clinical characteristics and treatment outcomes of patients with amnestic mild cognitive impairment (aMCI) or early AD who also have epilepsy or subclinical epileptiform activity.DesignRetrospective observational study from 2007 to 2012. SETTING Memory and Aging Center, University of California, San Francisco.PatientsWe studied 54 patients with a diagnosis of aMCI plus epilepsy (n = 12), AD plus epilepsy (n = 35), and AD plus subclinical epileptiform activity (n = 7).Main outcomes and measuresClinical and demographic data, electroencephalogram (EEG) readings, and treatment responses to antiepileptic medications.ResultsPatients with aMCI who had epilepsy presented with symptoms of cognitive decline 6.8 years earlier than patients with aMCI who did not have epilepsy (64.3 vs 71.1 years; P = .02). Patients with AD who had epilepsy presented with cognitive decline 5.5 years earlier than patients with AD who did not have epilepsy (64.8 vs 70.3 years; P = .001). Patients with AD who had subclinical epileptiform activity also had an early onset of cognitive decline (58.9 years). The timing of seizure onset in patients with aMCI and AD was nonuniform (P

Corneal astigmatism refers to refractive abnormalities and irregularities in the curvature of the cornea, and this interferes with light being accurately focused at a single point in the eye. This ametropic condition is highly prevalent, influences visual acuity, and is a highly heritable trait. There is currently a paucity of research in the genetic etiology of corneal astigmatism. Here we report the results from five genome-wide association studies of corneal astigmatism across three Asian populations, with an initial discovery set of 4,254 Chinese and Malay individuals consisting of 2,249 cases and 2,005 controls. Replication was obtained from three surveys comprising of 2,139 Indians, an additional 929 Chinese children, and an independent 397 Chinese family trios. Variants in PDGFRA on chromosome 4q12 (lead SNP: rs7677751, allelic odds ratio = 1.26 (95% CI: 1.16-1.36), P(meta) = 7.87×10(-9)) were identified to be significantly associated with corneal astigmatism, exhibiting consistent effect sizes across all five cohorts. This highlights the potential role of variants in PDGFRA in the genetic etiology of corneal astigmatism across diverse Asian populations.

This study investigated the mental health problems of 89 deaf and hard-of-hearing (DHH) adolescents in New South Wales, Tasmania, and Western Australia. Participants completed the written (for oral students) or signed version for competent Australian Sign Language (Auslan) users version of the Youth Self Report (YSR). Students were educated in a range of educational settings, had varying degrees of hearing loss, and used a range of communication modes. Results showed that, overall, DHH students reported increased levels of mental health problems compared with hearing peers. The broadband syndromes were more than 3 times more likely to be reported, while the narrowband syndromes were between 2 and 7 times more likely. A binary logistic regression analysis showed that the language used at home was a significant predictor of mental health problems. The implications of these findings for the social, emotional, and mental well-being of DHH students and the training of professionals are discussed.

This study investigated mental health problems in 54 deaf adolescents between 11 and 18 years of age residing in the states of New South Wales and Tasmania in Australia. Mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). The SDQ Self Report was translated into Australian Sign Language (Auslan; Johnston, 1989) using a rigorous iterative process of translation and back-translation. Both the written and Auslan Self Report versions of the instrument were administered to establish test-retest reliability and internal consistency of the signed version. Parent and teacher reports were also obtained. Results showed acceptable levels of reliability and internal consistency for the Auslan version of the self-report commensurate with those obtained for the written version on a normative hearing sample. Modest correlations were found between some of the syndrome scales in the two versions. Modest to strong correlations emerged between parent and teacher reports, parent and child written versions, and for some of the syndrome scales between teacher and child self-reports and between the parent and Auslan Self Report version. The prevalence rates yielded by the different respondents differed with parents reporting higher prevalence than teachers or children. Differences also emerged between the rates identified using the different versions of the Child Self Report. The implications of these findings are discussed. (Contains 4 tables.)

The Thatcher illusion (Thompson, 1980) is considered to be a prototypical illustration of the notion that face perception is dependent on configural processes and representations. We explored this idea by examining the relative contributions of perceptual and decisional processes to the ability of observers to identify the orientation of two classes of forms--faces and churches--and a set of their component features. Observers were presented with upright and inverted images of faces and churches in which the components (eyes, mouth, windows, doors) were presented either upright or inverted. Observers first rated the subjective grotesqueness of all of the images and then performed a complete identification task in which they had to identify the orientation of the overall form and the orientation of each of the interior features. Grotesqueness ratings for both classes of image showed the standard modulation of rated grotesqueness as a function of orientation. The complete identification results revealed violations of both perceptual and decisional separability but failed to reveal any violations of within-stimulus (perceptual) independence. In addition, exploration of a simple bivariate Gaussian signal detection model of the relationship between identification performance and judged grotesqueness suggests that within-stimulus violations of perceptual independence on their own are insufficient for producing the illusion. This lack of evidence for within-stimulus configurality suggests the need for a critical reevaluation of the role of configural processing in the Thatcher illusion. (Contains 13 figures, 7 tables, and 12 footnotes.)

Partnerships between nursing education and health service providers can provide financial benefits, bridge the theory/practice gap, and cultivate collegial interdisciplinary relationships. To realize benefits may require creation of more formal partnership strategies. (SK)