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The virtual age of learning is no longer a concern of the future. It is here. The Fall 2021 Webinar Audio Series (WAS) of the International Association of Medical Science Educators (IAMSE), titled "Back to the Future: Maximizing Student Learning and Wellbeing in the Virtual Age," was designed to help health science educators equip themselves with tools to teach the next generation of health care professionals successfully. From September 2, 2021 to September 30, 2021, the Fall 2021 Series was broadcast live to audiences at academic institutions worldwide in five weekly webinars. This five-part webinar series explored theories and best practices in delivering content over virtual and online media while simultaneously promoting a positive learning environment and enhanced student wellbeing.

Medical education has reported a shortage of anatomy educators since the 1960s. While the faculty pipeline has recently been explored, insights into retirement intentions, a key driver of faculty turnover, have yet to be investigated. With the mean age of anatomists rising, knowledge of retirement intentions among current educators is essential to understanding the anatomy educator shortage. This study explored the retirement intentions of current anatomy educators and their likely effects on the workforce. Surveys were distributed to department heads and the American Association for Anatomy (AAA) membership to inquire about job postings from 2018-2020 and retirement intentions, respectively. Department heads sought to fill open positions due to faculty retirements (36%, 15 of 42), faculty relocations/sabbaticals/new responsibilities (31%), and brand new positions (24%). The retirement intentions survey revealed that 61% (23 of 38) of faculty '55 and older' intend to retire within five years. Based on the extrapolation of AAA membership data, estimates suggest that almost twice as many anatomy faculty could retire per year (n = 40) over the next five years compared to the estimated number of annual PhD graduates (n = 22) likely to enter the workforce. Factors driving retirement intentions were overwhelmingly age and finances, followed by job satisfaction and family. The creation of new anatomy educator positions to address increased student enrollments and new health sciences programs is likely to place even greater strain on workforce demands.

Dominantly inherited Alzheimer's disease (DIAD) causes predictable biological changes decades before the onset of clinical symptoms, enabling testing of interventions in the asymptomatic and symptomatic stages to delay or slow disease progression. We conducted a randomized, placebo-controlled, multi-arm trial of gantenerumab or solanezumab in participants with DIAD across asymptomatic and symptomatic disease stages. Mutation carriers were assigned 3:1 to either drug or placebo and received treatment for 4-7 years. The primary outcome was a cognitive end point; secondary outcomes included clinical, cognitive, imaging and fluid biomarker measures. Fifty-two participants carrying a mutation were assigned to receive gantenerumab, 52 solanezumab and 40 placebo. Both drugs engaged their Aβ targets but neither demonstrated a beneficial effect on cognitive measures compared to controls. The solanezumab-treated group showed a greater cognitive decline on some measures and did not show benefits on downstream biomarkers. Gantenerumab significantly reduced amyloid plaques, cerebrospinal fluid total tau, and phospho-tau181 and attenuated increases of neurofilament light chain. Amyloid-related imaging abnormalities edema was observed in 19.2% (3 out of 11 were mildly symptomatic) of the gantenerumab group, 2.5% of the placebo group and 0% of the solanezumab group. Gantenerumab and solanezumab did not slow cognitive decline in symptomatic DIAD. The asymptomatic groups showed no cognitive decline; symptomatic participants had declined before reaching the target doses.

The Winter 2021 Webinar Audio Series (WAS) of the International Association of Medical Science Educators (IAMSE), titled, "USMLE Step-1 is Going to Pass/Fail, Now what do we do?" was broadcast live to audiences at academic institutions worldwide in five weekly webinars from January 7, 2021, to February 4, 2021. Recognized experts from various stakeholder groups discussed the impact of the decision to score the United States Medical Licensing Examination (USMLE) Step 1 exam Pass/Fail (P/F). The speakers identified challenges to their respective programs and explored creative ways to address potential consequences. Sessions included the perspectives of allopathic and osteopathic residency program directors, basic science faculty, undergraduate medical education curriculum designers, clinical educators, and programs for international medical students matriculating to the United States. On February 25, 2021, a bonus session provided cutting-edge updates from a co-chair of the Coalition for Physician Accountability Undergraduate Medical Education (UME) to Graduate Medical Education (GME) Review Committee (UGRC).

Interprofessional training, social sciences curricula, service-learning, pre-clerkship integration, and self-directed learning are all cornerstones of medical education and closely align with accreditation elements for most accreditation bodies within health professions education. As a sequel to the Winter 2022 series, the Spring 2022 Webcast Audio Seminar (WAS) of the International Association of Medical Science Educators (IAMSE) continued to examine the evolving roles of basic science educators. From March 3 to March 31, 2022, the five-part webinar series was broadcast live to audiences at academic institutions worldwide; recordings are available on the IAMSE website. This series built a framework through which basic scientists can leverage their content to meet various accreditation standards.

INTRODUCTION: Machine learning models were used to discover novel disease trajectories for autosomal dominant Alzheimer's disease. METHODS: Longitudinal structural magnetic resonance imaging, amyloid positron emission tomography (PET), and fluorodeoxyglucose PET were acquired in 131 mutation carriers and 74 non-carriers from the Dominantly Inherited Alzheimer Network; the groups were matched for age, education, sex, and apolipoprotein e4 (APOE e4). A deep neural network was trained to predict disease progression for each modality. Relief algorithms identified the strongest predictors of mutation status. RESULTS: The Relief algorithm identified the caudate, cingulate, and precuneus as the strongest predictors among all modalities. The model yielded accurate results for predicting future Pittsburgh compound B (R2 = 0.95), fluorodeoxyglucose (R2 = 0.93), and atrophy (R2 = 0.95) in mutation carriers compared to non-carriers. DISCUSSION: Results suggest a sigmoidal trajectory for amyloid, a biphasic response for metabolism, and a gradual decrease in volume, with disease progression primarily in subcortical, middle frontal, and posterior parietal regions.

Faculty qualified to teach in the anatomical sciences are growing scarce just as the need for trained anatomists is greater than ever. Enrollments are surging in anticipation of a large physician shortfall; meanwhile, many anatomists are reaching retirement age. Who will fill the teaching gap? This study assessed trends in doctorates awarded in Anatomy and related fields within the United States (US) since 1969 and evaluated modern graduate education in the anatomical sciences. Data were compiled from the National Science Foundation Survey of Earned Doctorates. The total number of doctorates in the anatomical sciences and number of doctorates by sex and race/ethnicity were plotted for trend analysis. The number of PhD anatomy training programs within US medical schools was also assessed. Curricula and major characteristics of all active programs were evaluated through website searches and program director interviews. While doctorates in cell biology, developmental biology, and neuroscience have grown, the number of PhDs awarded in Anatomy has declined, on average, by 3.1 graduates per year to a 50-year low of only 8 graduates in 2017. Currently, 21 active doctoral programs in anatomy operate within US medical schools and fall into three general categories: anatomy education (n = 8), classic anatomy (n = 8), and anthropology/evolutionary anatomy (n = 5). Without a concerted effort by stakeholders to address the shortage, anatomists may face extinction. Expansion of the anatomy education doctoral degree may represent a necessary evolution of the field to meet job market needs and to thwart the extinction threat.

Frontotemporal dementia and amyotrophic lateral sclerosis are clinically and pathologically overlapping disorders with shared genetic causes. We previously identified a disease locus on chromosome 16p12.1-q12.2 with genome-wide significant linkage in a large European Australian family with autosomal dominant inheritance of frontotemporal dementia and amyotrophic lateral sclerosis and no mutation in known amyotrophic lateral sclerosis or dementia genes. Here we demonstrate the segregation of a novel missense variant in CYLD (c.2155A>G, p.M719V) within the linkage region as the genetic cause of disease in this family. Immunohistochemical analysis of brain tissue from two CYLD p.M719V mutation carriers showed widespread glial CYLD immunoreactivity. Primary mouse neurons transfected with CYLDM719V exhibited increased cytoplasmic localization of TDP-43 and shortened axons. CYLD encodes a lysine 63 deubiquitinase and CYLD cutaneous syndrome, a skin tumour disorder, is caused by mutations that lead to reduced deubiquitinase activity. In contrast with CYLD cutaneous syndrome-causative mutations, CYLDM719V exhibited significantly increased lysine 63 deubiquitinase activity relative to the wild-type enzyme (paired Wilcoxon signed-rank test P = 0.005). Overexpression of CYLDM719V in HEK293 cells led to more potent inhibition of the cell signalling molecule NF-κB and impairment of autophagosome fusion to lysosomes, a key process in autophagy. Although CYLD mutations appear to be rare, CYLD’s interaction with at least three other proteins encoded by frontotemporal dementia and/or amyotrophic lateral sclerosis genes (TBK1, OPTN and SQSTM1) suggests that it may play a central role in the pathogenesis of these disorders. Mutations in several frontotemporal dementia and amyotrophic lateral sclerosis genes, including TBK1, OPTN and SQSTM1, result in a loss of autophagy function. We show here that increased CYLD activity also reduces autophagy function, highlighting the importance of autophagy regulation in the pathogenesis of frontotemporal dementia and amyotrophic lateral sclerosis.

Objectives The F386L PSEN1 variant has been reported in 1 Japanese family with limited clinical information. We aimed to prove that F386L is pathogenic by demonstrating that it segregates with early-onset Alzheimer disease (AD). Methods Eight individuals in a South Asian family provided DNA for genetic testing and underwent a neurologic examination. Results The female proband was diagnosed with AD at age 45 years and died at age 49 years. She had a CSF biomarker profile consistent with AD, and her florbetaben PET scan was amyloid positive with high uptake in the striatum. Her MRI showed no prominent white matter disease. Her affected relatives had an age at onset range of 38–57 years and had imaging and biomarker profiles similar to hers. Discussion The results presented here, in conjunction with the prior report, confirm the pathogenicity of F386L. Furthermore, our study highlights the importance of studying families from underrepresented populations to identify or confirm the pathogenicity of rare variants that may be specific to certain genetic ancestries.

Introduction The aim of this study was to anatomically compare distal clavicle and coracoid autografts and their potential to augment anterior-inferior glenoid bone loss. Methods Ten millimeters of distal clavicle and 20 mm of coracoid were harvested bilaterally from 32 cadavers. Length, weight, and height were measured and surface area and density were calculated. For each graft, ipsilateral measurements were compared and the ability to restore corresponding glenoid bone loss was calculated. Results Distal clavicle grafts were larger than coracoid grafts with respect to length (22.3 mm versus 17.7 mm; p 3 versus 1.96 cm3; p = 0.002). Coracoid grafts had larger widths (14.56 mm versus 10.52 mm; p 3 versus 1.18 g/cm3; p 2 versus 1.5 cm2; p 2 versus 1.5 cm2; p Discussion Distal clavicle grafts were larger and restored larger bony defects but had greater variability and lower density than coracoid grafts. Clinical studies are needed to compare these graft options.

In 2002, a widely publicized report projected an anatomy educator shortage based on department chairpersons' perceptions. Now, 17 years later, the question lingers: “Does an anatomy educator shortage persist and, if so, how severe is the shortage?” Trends in the number, type, and fill rate of anatomy educator job openings were explored by analyzing job posting in the United States over the past two years. A survey was distributed to leaders of anatomy‐related departments in the United States, Canada, and European Union. Most departmental leaders who responded (65% or more) from the United States/Canada (n = 81) and the European Union (n = 52) anticipate they will have “moderate” to “great” difficulty hiring anatomy educators in gross anatomy, histology, and embryology over the next five years. Within the United States, the number of anatomy educator job postings at medical schools more than doubled from at least 21 postings in 2017 to 52 postings in 2018. Twenty‐one percent of postings between 2017 and 2018 were never filled. While the number of anatomy educator openings within the United States/Canada is perceived to remain in a steady state for the next five years, the European Union estimates a five‐fold increase in the number of openings. Departmental leaders prioritize anatomy educator applicants who have teaching experience (mean ± SD = 4.64 ± 0.84 on five‐point Likert scale), versatility in teaching multiple anatomy disciplines (3.93 ± 1.07), and flexibility in implementing various teaching pedagogies (3.69 ± 1.17). Collectively, these data suggest the shortage of anatomy educators continues in the United States/Canada and the European Union.

Introduction Quantitative in vivo measurement of brain amyloid burden is important for both research and clinical purposes. However, the existence of multiple imaging tracers presents challenges to the interpretation of such measurements. This study presents a direct comparison of Pittsburgh compound B–based and florbetapir-based amyloid imaging in the same participants from two independent cohorts using a crossover design. Methods Pittsburgh compound B and florbetapir amyloid PET imaging data from three different cohorts were analyzed using previously established pipelines to obtain global amyloid burden measurements. These measurements were converted to the Centiloid scale to allow fair comparison between the two tracers. The mean and inter-individual variability of the two tracers were compared using multivariate linear models both cross-sectionally and longitudinally. Results Global amyloid burden measured using the two tracers were strongly correlated in both cohorts. However, higher variability was observed when florbetapir was used as the imaging tracer. The variability may be partially caused by white matter signal as partial volume correction reduces the variability and improves the correlations between the two tracers. Amyloid burden measured using both tracers was found to be in association with clinical and psychometric measurements. Longitudinal comparison of the two tracers was also performed in similar but separate cohorts whose baseline amyloid load was considered elevated (i.e., amyloid positive). No significant difference was detected in the average annualized rate of change measurements made with these two tracers. Discussion Although the amyloid burden measurements were quite similar using these two tracers as expected, difference was observable even after conversion into the Centiloid scale. Further investigation is warranted to identify optimal strategies to harmonize amyloid imaging data acquired using different tracers.

Author(s): Keret, Ophir; Staffaroni, Adam M; Ringman, John M; Cobigo, Yann; Goh, Sheng-Yang M; Wolf, Amy; Allen, Isabel Elaine; Salloway, Stephen; Chhatwal, Jasmeer; Brickman, Adam M; Reyes-Dumeyer, Dolly; Bateman, Randal J; Benzinger, Tammie LS; Morris, John C; Ances, Beau M; Joseph-Mathurin, Nelly; Perrin, Richard J; Gordon, Brian A; Levin, Johannes; Voglein, Jonathan; Jucker, Mathias; la Fougere, Christian; Martins, Ralph N; Sohrabi, Hamid R; Taddei, Kevin; Villemagne, Victor L; Schofield, Peter R; Brooks, William S; Fulham, Michael; Masters, Colin L; Ghetti, Bernardino; Saykin, Andrew J; Jack, Clifford R; Graff-Radford, Neill R; Weiner, Michael; Cash, David M; Allegri, Ricardo F; Chrem, Patricio; Yi, Su; Miller, Bruce L; Rabinovici, Gil D; Rosen, Howard J; Dominantly Inherited Alzheimer Network | Abstract: IntroductionAsymptomatic and mildly symptomatic dominantly inherited Alzheimer's disease mutation carriers (DIAD-MC) are ideal candidates for preventative treatment trials aimed at delaying or preventing dementia onset. Brain atrophy is an early feature of DIAD-MC and could help predict risk for dementia during trial enrollment.MethodsWe created a dementia risk score by entering standardized gray-matter volumes from 231 DIAD-MC into a logistic regression to classify participants with and without dementia. The score's predictive utility was assessed using Cox models and receiver operating curves on a separate group of 65 DIAD-MC followed longitudinally.ResultsOur risk score separated asymptomatic versus demented DIAD-MC with 96.4% (standard errorn=n0.02) and predicted conversion to dementia at next visit (hazard ration=n1.32, 95% confidence interval [CI: 1.15, 1.49]) and within 2 years (area under the curven=n90.3%, 95% CI [82.3%-98.2%]) and improved prediction beyond established methods based on familial age of onset.DiscussionIndividualized risk scores based on brain atrophy could be useful for establishing enrollment criteria and stratifying DIAD-MC participants for prevention trials.

ObjectivesThe F386L PSEN1 variant has been reported in 1 Japanese family with limited clinical information. We aimed to prove that F386L is pathogenic by demonstrating that it segregates with early-onset Alzheimer disease (AD).MethodsEight individuals in a South Asian family provided DNA for genetic testing and underwent a neurologic examination.ResultsThe female proband was diagnosed with AD at age 45 years and died at age 49 years. She had a CSF biomarker profile consistent with AD, and her florbetaben PET scan was amyloid positive with high uptake in the striatum. Her MRI showed no prominent white matter disease. Her affected relatives had an age at onset range of 38–57 years and had imaging and biomarker profiles similar to hers.DiscussionThe results presented here, in conjunction with the prior report, confirm the pathogenicity of F386L. Furthermore, our study highlights the importance of studying families from underrepresented populations to identify or confirm the pathogenicity of rare variants that may be specific to certain genetic ancestries.

Background: The etiology of frontotemporal dementia (FTD) is poorly understood. To identify genes with predicted expression levels associated with FTD, we integrated summary statistics with external reference gene expression data using a transcriptome-wide association study approach. Methods: FUSION software was used to leverage FTD summary statistics (all FTD: n = 2154 cases, n = 4308 controls; behavioral variant FTD: n = 1337 cases, n = 2754 controls; semantic dementia: n = 308 cases, n = 616 controls; progressive nonfluent aphasia: n = 269 cases, n = 538 controls; FTD with motor neuron disease: n = 200 cases, n = 400 controls) from the International FTD-Genomics Consortium with 53 expression quantitative loci tissue type panels (n = 12,205; 5 consortia). Significance was assessed using a 5% false discovery rate threshold. Results: We identified 73 significant gene–tissue associations for FTD, representing 44 unique genes in 34 tissue types. Most significant findings were derived from dorsolateral prefrontal cortex splicing data (n = 19 genes, 26%). The 17q21.31 inversion locus contained 23 significant associations, representing 6 unique genes. Other top hits included SEC22B (a gene involved in vesicle trafficking), TRGV5, and ZNF302. A single gene finding (RAB38) was observed for behavioral variant FTD. For other clinical subtypes, no significant associations were observed. Conclusions: We identified novel candidate genes (e.g., SEC22B) and previously reported risk regions (e.g., 17q21.31) for FTD. Most significant associations were observed in dorsolateral prefrontal cortex splicing data despite the modest sample size of this reference panel. This suggests that our findings are specific to FTD and are likely to be biologically relevant highlights of genes at different FTD risk loci that are contributing to the disease pathology.

Funder: QingLan Research Project of Jiangsu for Outstanding Young Teachers, Funder: Project funded by Postdoctoral Science Foundation of Xuzhou Medical University, Funder: Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD) for Xuzhou Medical University, We employed Mendelian randomization (MR) to evaluate the causal relationship between leukocyte telomere length (LTL) and amyotrophic lateral sclerosis (ALS) with summary statistics from genome-wide association studies (n = ~ 38,000 for LTL and ~ 81,000 for ALS in the European population; n = ~ 23,000 for LTL and ~ 4,100 for ALS in the Asian population). We further evaluated mediation roles of lipids in the pathway from LTL to ALS. The odds ratio per standard deviation decrease of LTL on ALS was 1.10 (95% CI 0.93–1.31, p = 0.274) in the European population and 0.75 (95% CI 0.53–1.07, p = 0.116) in the Asian population. This null association was also detected between LTL and frontotemporal dementia in the European population. However, we found that an indirect effect of LTL on ALS might be mediated by low density lipoprotein (LDL) or total cholesterol (TC) in the European population. These results were robust against extensive sensitivity analyses. Overall, our MR study did not support the direct causal association between LTL and the ALS risk in neither population, but provided suggestive evidence for the mediation role of LDL or TC on the influence of LTL and ALS in the European population.

Background Iatrogenic or traumatic injury to the spinal accessory nerve is a rare but debilitating injury. An effective treatment, known as the Eden-Lange modification triple-tendon transfer procedure, involves the transfer of the rhomboid major (RM), rhomboid minor (Rm), and levator scapulae (LS). Careful detachment of their insertions is necessary to avoid injury of the dorsal scapular nerve (DSN). This study evaluated the surgical anatomy and safety of the DSN relative to this procedure. Methods The study used 12 cadavers (22 shoulders). The RM, Rm, and LS were detached from their insertions, and the DSN was dissected. Measurements were taken to evaluate the anatomy of each relative to the triple-tendon transfer procedure. Additional measurements were taken to identify “danger zones” for DSN injury, regarding detachment of RM, Rm, and LS from their respective insertions. Results Measurements of the 22 shoulders included in the study showed wide variation in anatomy. The minimum distance between the scapula and the DSN at the vertebral scapular border was 0.7 cm, suggesting that care and precision are needed to perform this technique. The region where the DSN crosses the superior border of the Rm was shown to be the greatest “danger zone” of this technique, with a mean distance to the scapula of 1.61 ± 0.53 cm Conclusions This study provides insight into the surgical anatomy of the DSN relative to a rare but successful procedure used to treat trapezius paralysis. The results of this study can inform the surgeon regarding potential anatomic considerations when performing the triple-tendon transfer.

Anatomical sciences are foundational to the health professions, yet little is known about the qualifications of anatomy educators at the graduate and professional level in the United States. Moreover, there is concern that the number of qualified anatomy educators being trained may be insufficient to meet the growing demand posed by new and expanded programs in medicine and allied health specialties. The authors surveyed anatomists from across the country to (i) characterize the educational credentials of current anatomy educators and (ii) assess the perceived need for education-focused postdoctoral positions or formal mentorships to prepare anatomists for teaching-intensive faculty positions. To probe the survey responses more deeply, one-on-one interviews were conducted with eight individuals selected to represent a diverse sample of respondents in terms of institution, gender, and academic rank. Results indicate that 30-40% of educators at the graduate level and approximately 60% of those at the undergraduate level lack graduate coursework in histology, embryology, and neuroanatomy. Forty-five percent of respondents had completed a postdoctoral fellowship. Eighty-six percent replied "yes/maybe" to the question of whether an anatomy education postdoctoral fellowship would benefit doctoral graduates. The top 3 reasons for this recommendation were to (i) establish independent educational research, (ii) improve a publication record, and (iii) gain additional teaching experience. Notable weaknesses of education-focused postdoctoral training were related to finances, fear of exploitation, and undervaluing of teaching. Moving forward, postdoctoral fellowships and other forms of postgraduate training may represent a key strategy for training anatomists in the current educational climate. Anat Sci Educ 00: 000-000. © 2018 American Association of Anatomists.

Objectives To investigate medical students’ perceptions of lecture and non-lecture-based instructional methods and compare preferences for use and quantity of each during preclinical training. Methods We administered a survey to first- and second-year undergraduate medical students at the University of Alabama School of Medicine in Birmingham, Alabama, USA aimed to evaluate preferred instructional methods. Using a cross-sectional study design, Likert scale ratings and student rankings were used to determine preferences among lecture, laboratory, team-based learning, simulation, small group case-based learning, large group case-based learning, patient presentation, and peer teaching. We calculated mean ratings for each instructional method and used chi-square tests to compare proportions of first- and second-year cohorts who ranked each in their top 5 preferred methods. Results Among participating students, lecture (M=3.6, SD=1.0), team based learning (M=4.2, SD=1.0), simulation (M=4.0, SD=1.0), small group case-based learning (M=3.8, SD=1.0), laboratory (M=3.6, SD=1.0), and patient presentation (M=3.8, SD=0.9) received higher scores than other instructional methods. Overall, second-year students ranked lecture lower (χ2(1, N=120) =16.33, p

Gross anatomy, often considered the cornerstone of medicine, lays the necessary foundation upon which students in the health professions can develop and hone their specialties. Fundamentally, training up a supply of high-caliber gross anatomy educators is imperative to provide quality instruction to a wide variety of future clinicians. Since the turn of the twenty-first century, there has been a shortage of gross anatomy educators. To address the dearth of qualified anatomists, a variety of formal training programs and professional development opportunities have been developed, each targeting one of three academic training levels including graduate education, postdoctoral training, and continuing education for practicing professionals. Key features of anatomy education training programs include a focused mission, unique programmatic features, and financial sustainability. When planning new programs, it is useful to conduct a needs assessment, develop a sound business plan, engage with communications and marketing staff, and capitalize on available resources.