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Multisystem inflammatory syndrome in children (MIS-C), a new condition related to coronavirus disease 2019 (COVID-19) in the pediatric population, was recognized by physicians in the United Kingdom in April 2020. Given those up to the age of 21 years can be affected, pregnant adolescents and young adults are susceptible. However, there is scant information on how MIS-C may affect pregnancy and whether the presentation differs in the pregnant population. We report a case of a pregnant adolescent with COVID-19 and MIS-C with a favorable outcome. This case highlights the considerations in managing a critically ill pregnant patient with a novel illness and the importance of a multidisciplinary team in coordinating care.

ABSTRACTStudent evaluations of curricular experiences and instructors are employed by institutions to obtain feedback and guide improvement. However, to be effective, evaluations must prompt faculty action. Unfortunately, evaluative comments that engender strong reactions may undermine the process by hindering innovation and improvement steps. The literature suggests that faculty interpret evaluation feedback as a judgment not just on their teaching ability but on their personal and professional identity. In this context, critical evaluations, even when constructively worded, can result in disappointment, hurt, and shame. The COVID pandemic has challenged institutions and faculty to repeatedly adapt curricula and educational practices, heightening concerns for faculty burnout. In this context, the risk of ‘words that hurt’ is higher than ever. This article offers guidance for faculty and institutions to support effective responses to critical feedback and ameliorate counterproductive effects of learner evaluations.

The purpose of this study was to identify plasma metabolites associated with superior endurance running performance. In 2016, participants at the Western States Endurance Run (WSER), a 100-mile (161-km) foot race, underwent non-targeted metabolomic testing of their post-race plasma. Metabolites associated with faster finish times were identified. Based on these results, runners at the 2017 WSER underwent targeted metabolomics testing, including lipidomics and choline levels. The 2017 participants' plasma metabolites were correlated with finish times and compared with non-athletic controls. In 2016, 427 known molecules were detected using non-targeted metabolomics. Four compounds, all phosphatidylcholines (PCs) were associated with finish time (False Discovery Rate (FDR) < 0.05). All were higher in faster finishers. In 2017, using targeted PC analysis, multiple PCs, measured pre- and post-race, were higher in faster finishers (FDR < 0.05). The majority of PCs was noted to be higher in runners (both pre- and post-race) than in controls (FDR < 0.05). Runners had higher choline levels pre-race compared to controls (p < 0.0001), but choline level did not differ significantly from controls post-race (p = 0.129). Choline levels decreased between the start and the finish of the race (p < 0.0001). Faster finishers had lower choline levels than slower finishers at the race finish (p = 0.028).

Increasingly, undergraduate institutions are incorporating original research into the curriculum as a matter of best practice. However, while the practice of science has grown more collaborative, undergraduate research has remained largely confined to single-institution studies. Incorporating long-term, distributed research projects into the undergraduate research experience can better prepare students to interpret and engage in science of the future. The Decomposition in Aquatic and Terrestrial Invaded Systems (DATIS) project within the Ecological Research as Education Network (EREN) offers a good model for examining how to minimize challenges and maximize opportunities associated with classroom use of long-term, collaborative research projects. Eleven key challenges are identified, and practical solutions are provided for each. By modeling this scientific approach in primarily undergraduate institutions, we are preparing graduates who will have the tools and knowledge to work collaboratively and create their own distributed research networks. Our goal is that the decomposition project we describe here can inform and inspire others seeking to engage in research at the undergraduate level, either as potential research coordinators or as collaborators in an existing network.

Multisite, course-based undergraduate research experiences (CUREs) in the Ecological Research as Education Network (EREN) were assessed for impacts on student learning of collaborative science skills using a survey that could serve as a starting point for a validated assessment instrument for multisite CUREs. Pretests/posttests were administered across multiple courses and institutions, capturing effects of diverse EREN projects and pedagogies on collaborative knowledge. Students' scientific collaboration and data management skills improved most in small, upper-level courses. The amount of EREN content in a course was positively associated with posttest scores for 60 to 86 percent of assessment survey questions. However, no learning gains were seen for some questions, and some cases of low competency and effects of timing and place of assessment testing were observed in student scores. EREN CUREs need further development to maximize their potential.

Leaf litter decomposition plays an important role in nutrient cycling in both terrestrial and aquatic systems. Decay rates vary based on species, habitat, climate, and local environmental conditions. Invasive plants alter decomposition processes; however, there is a lack of research exploring patterns at regional and continental scales. In this study we examined the decomposition of both native and nonnative, invasive woody plant leaf litter and mixtures of the two, in both terrestrial and aquatic habitats at nine locations in the eastern and midwestern U.S.A. There was significant variation among locations, which was not clearly related 10 either average air temperature or precipitation. Unexpectedly, in locations with multiple years of data, there were higher rates of decomposition in years with lower temperatures and precipitation in both terrestrial and aquatic habitats. We found decay rates were generally higher in aquatic than terrestrial habitats and leaf litter from nonnative invasive species generally decayed faster than that of native species in both terrestrial and aquatic systems. Differences in litter decay rates among invasive species were significant in both terrestrial and aquatic habitats; whereas no differences were found among native species in either habitat. In mixed litter bags, decay rates were lower than what was predicted based on the relative amounts of native and invasive litter in each bag, possibly indicating the presence of native leaf litter slows the decomposition of invasive leaf litter. Additionally, there may have been threshold effects in the mixed litter bags, especially in aquatic systems. While this study supported several generalizations about leaf decomposition rates (invasive > native, aquatic > terrestrial), the variability in the decay rates from different locations and habitats indicates combinations of different species and local conditions may overshadow other general trends related to litter decomposition., INTRODUCTION Leaf litter decomposition is a critical process that mediates nutrient availability, accumulation of organic matter, and ecosystem carbon storage (Prescott, 2010; Gessner et al., 2010; Salinas et al., 2018). [...]

Summary: Background: SJ733, a newly developed inhibitor of P. falciparum ATP4, has a favorable safety profile and rapid antiparasitic effect but insufficient duration to deliver a single-dose cure of malaria. We investigated the safety, tolerability, and pharmacokinetics of a multidose SJ733 regimen and a single-dose pharmacoboost approach using cobicistat to inhibit CYP3A4, thereby increasing exposure. Methods: Two multidose unboosted cohorts (n = 9) (SJ733, 300 mg and 600 mg daily for 3 days) followed by three single-dose boosted cohorts combining SJ733 (n = 18) (75-, 300-, or 600-mg single dose) with cobicistat (150-mg single dose) as a pharmacokinetic booster were evaluated in healthy volunteers (ClinicalTrials.gov: NCT02661373). Findings: All participants tolerated SJ733 well, with no serious adverse events (AEs), dose-limiting toxicity, or clinically significant electrocardiogram or laboratory test findings. All reported AEs were Grade 1, clinically insignificant, and considered unlikely or unrelated to SJ733. Compared to unboosted cohorts, the SJ733/cobicistat-boosted cohorts showed a median increase in area under the curve and maximum concentration of 3·9 × and 2·6 ×, respectively, and a median decrease in the ratio of the major CYP3A-produced metabolite SJ506 to parent drug of 4·6 × . Incorporating these data in a model of parasite dynamics indicated that a 3-day regimen of SJ733/cobicistat (600 mg/150 mg daily) relative to a single 600-mg dose ± cobicistat would increase parasite clearance from 106 to 1012 parasites/µL. Interpretation: The multidose and pharmacoboosted approaches to delivering SJ733 were well-tolerated and significantly increased drug exposure and prediction of cure. This study supports the further development of SJ733 and demonstrates an innovative pharmacoboost approach for an antimalarial. Funding: Global Health Innovative Technology Fund, Medicines for Malaria Venture, National Institutes of Health, and American Lebanese Syrian Associated Charities.

Collaborations between basic science educators (BE) and clinical educators (CE) in medical education are common and necessary to create integrated learning materials. However, few studies describe experiences of or processes used by educators engaged in interdisciplinary teamwork. We use the lens of boundary crossing to explore processes described by BE and CE that support the co-creation of integrated learning materials, and the impact that this work has on them. We conducted qualitative content analysis on program evaluation data from 27 BE and CE who worked on 12 teams as part of a multi-institutional instructional design project. BE and CE productively engaged in collaboration using boundary crossing mechanisms. These included respecting diverse perspectives and expertise and finding efficient processes for completing shared work that allow BE and CE to build on each other's contributions. BE and CE developed confidence in connecting clinical concepts with causal explanations, and willingness to engage in and support such collaborations at their own institutions. BE and CE report the use of boundary crossing mechanisms that support collaboration in instructional design. Such practices could be harnessed in future collaborations between BE and CE. [ABSTRACT FROM AUTHOR]

BackgroundThe new UCSF Bridges Curriculum aims to prepare students to succeed in today's health care system while simultaneously improving it. Curriculum redesign requires assessment strategies that ensure that graduates achieve competence in enduring and emerging skills for clinical practice.AimTo design entrustable professional activities (EPAs) for assessment in a new curriculum and gather evidence of content validity.SettingUniversity of California, San Francisco, School of Medicine.ParticipantsNineteen medical educators participated; 14 completed both rounds of a Delphi survey.Program descriptionAuthors describe 5 steps for defining EPAs that encompass a curricular vision including refining the vision, defining draft EPAs, developing EPAs and assessment strategies, defining competencies and milestones, and mapping milestones to EPAs. A Q-sort activity and Delphi survey involving local medical educators created consensus and prioritization for milestones for each EPA.Program evaluationFor 4 EPAs, most milestones had content validity indices (CVIs) of at least 78 %. For 2 EPAs, 2 to 4 milestones did not achieve CVIs of 78 %.DiscussionWe demonstrate a stepwise procedure for developing EPAs that capture essential physician work activities defined by a curricular vision. Structured procedures for soliciting faculty feedback and mapping milestones to EPAs provide content validity.

The purpose of this study was to enrich understanding about the perceived benefits and drawbacks of constructed response short-answer questions (CR-SAQs) in preclerkship assessment using Norcini's criteria for good assessment as a framework. This multi-institutional study surveyed students and faculty at three institutions. A survey using Likert scale and open-ended questions was developed to evaluate faculty and student perceptions of CR-SAQs using the criteria of good assessment to determine the benefits and drawbacks. Descriptive statistics and Chi-square analyses are presented, and open responses were analyzed using directed content analysis to describe benefits and drawbacks of CR-SAQs. A total of 260 students (19%) and 57 faculty (48%) completed the survey. Students and faculty report that the benefits of CR-SAQs are authenticity, deeper learning (educational effect), and receiving feedback (catalytic effect). Drawbacks included feasibility, construct validity, and scoring reproducibility. Students and faculty found CR-SAQs to be both acceptable (can show your reasoning, partial credit) and unacceptable (stressful, not USMLE format). CR-SAQs are a method of aligning innovative curricula with assessment and could enrich the assessment toolkit for medical educators. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the interaction between work role overload, work-to-family conflict, and departmental/division culture conducive to women's academic success. Methods: All women assistant and associate professors eligible for promotion from the Departments of Family Medicine, Internal Medicine, and Pediatrics were invited to complete a validated web-based survey that measured work-to-family conflict, work hours, work role overload, and culture conducive to women's academic success (Westring et al., 2012). Results: With 88 survey respondents, high work role overload was associated with increased levels of work-to-family conflict while those who reported a higher culture conducive to women's academic success reported less work-to-family conflict. Culture conducive to women's academic success did not moderate the impact of work demand on work-to-family conflict. Conclusions: While departmental/division culture was important, it was not sufficient to completely mitigate work-to-family conflict. Work demand appears to impact work-to-family conflict related to strain, in which women report being too stressed by work to focus on their family and their own health and wellness. Employers can greatly impact work culture by reducing the strain of work demands that interfere with women pursuing promotion, increase burnout, and contribute to women faculty deciding to work part-time.

Learning objectives are a critical step in the creation and implementation of a radiology curriculum. Their use is mandated by the Liaison Committee on Medical Education, the Accreditation Council on Graduate Medical Education, and the Accreditation Council on Continuing Medical Education, but more importantly they can have a significant beneficial impact on quality of radiology education programs. Learning objectives guide student learning, help clarify our teaching goals, and simplify learner testing and evaluation. This article will review the components of a proper learning objective and provide a simple, straightforward approach to writing them effectively.

Saprotrophic microbes are typically credited with producing extracellular enzymes that recycle organic matter, though roots and mycorrhizal fungi also can contribute and may compete with the saprotrophs. We examined extracellular enzyme activity associated with the mycorrhizospheres of arbuscular mycorrhizal, ectomycorrhizal, dual-colonized (arbuscular and ectomycorrhizal), and ericoid mycorrhizal plants in a fire chronosequence in Alaska. Bulk soil and soil from beneath host plants were gathered in July 2004 and assayed for five enzymes that target organic C, P, and N substrates. Compared to bulk soil, activities of the C-targeting enzymes β-1,4-glucosidase and peroxidase were lower in arbuscular mycorrhizospheres and ericoid mycorrhizospheres, respectively. Moreover, extracellular enzyme activity varied among mycorrhizosphere types. Specifically, N-targeting leucine aminopeptidase was highest in arbuscular mycorrhizospheres, followed by ericoid and ectomycorrhizal/dual-colonized mycorrhizospheres; β-1,4-glucosidase had the reverse pattern. In addition, enzymatic stoichiometry suggested that extracellular enzyme producers invested more in C-acquisition than in N-acquisition in recent fire scars compared to mature forests. These data extend previous findings that roots and mycorrhizal fungi compete with saprotrophs by showing that the strength of this effect varies by mycorrhizal host. As a result the community composition of mycorrhizal host plants might mediate enzymatic activity in boreal soils. © 2011 Elsevier GmbH.

Background Advances in genetic screening can identify patients at high risk for common genetic conditions early in pregnancy and can facilitate early diagnosis and early abortion. Less common abnormalities might only be diagnosed with invasive testing is performed after structural abnormalities are identified. Objective Our objective was to compare gestational age (GA) at diagnosis and abortion for genetic abnormalities identified based on screening with abnormalities that were not discovered after screening. Study Design All prenatal diagnostic procedures from 2012 to 2017 were reviewed, and singleton pregnancies terminated following diagnosis of genetic abnormalities were identified. Cases diagnosed as the result of screening tests were compared with remaining cases. Conditions were considered “screened for” if they can be suspected by cell-free DNA testing, biochemistry, carrier screening, or if the patient was a known carrier of a single-gene disorder. When abnormal karyotype, microarray, or Noonan's syndrome was associated with abnormal NT, these cases were considered “screened for.” GA at abortion was the primary outcome. Fisher's exact test and Mann–Whitney's U test were used for statistical comparison. Results In this study, 268 cases were included. A total of 227 (85%) of abortions were performed for “screened for” disorders, with 210 (93%) of these for karyotype abnormalities, 5 (2%) for microarray abnormalities, and 12 (5%) for single-gene disorders. Forty-one (15%) of abortions were performed for conditions not included in screening, with 8 (19%) of those for karyotype abnormalities, 25 (61%) for microarray abnormalities, and 8 (19%) for single-gene disorders. Invasive testing and abortion occurred at earlier median GA for those with conditions that were screened for: 122/7 versus 155/7 weeks, p ≤0.001 and 135/7 versus 200/7 weeks; p ≤0.001. Conclusion Most abortions were for abnormalities that can be suspected early in pregnancy. As many structural abnormalities associated with rare conditions are not identifiable until the mid-trimester, prenatal diagnosis and abortion occurred significantly later. Physicians and patients should be aware of the limitations of genetic screening.