Hearing Loss in Children: Critical Medical Education Delivered as Massive Open Online Course (MOOC).

Purpose: Although early identification of pediatric hearing loss is crucial, a formal online training course has not been freely accessible to a global audience. In response, we created a novel course for health professionals worldwide. Method: Course development occurred from February 2019 to May 2020. Seventeen multidisciplinary experts provided video lectures and demonstrations, including a tour of ear anatomy, operating footage of cochlear implant insertion, and demonstrations of children undergoing hearing testing. Content also included steps for interpreting audiograms, an overview of early screening programs, interviews with Deaf/Hard of Hearing children, and an introduction to public health/educational infrastructure. The course was hosted on Coursera and launched on May 4, 2020. Results: The course was approved for 11.5 Continuing Medical Education (CME) and American Board of Pediatrics Maintenance of Certification (MOC)-Part 2 credits and spanned five modules comprised of 50 video learning segments: 1) Ear Anatomy, 2) Hearing Loss and Assessments, 3) Hearing Loss Diagnosis and Impact on Speech and Language Development, 4) Interventions for Hearing Loss, 5) Pediatric Vestibular System and Balance. Since its launch, 6,556 learners have enrolled and 1,540 have fully completed the course; Fifty percent were 25-34 years old, 62% were female, and 43% were from Asia. Average rating was 4.9/5 (n=180 reviews). Conclusions: We created a freely accessible course for a global audience that provides a broad overview of pediatric hearing loss. Our multidisciplinary approach addresses an educational gap and can serve as a model for developing other online courses.

Creating a 'choose your topic' massive open online course: an innovative and flexible approach to delivering injury prevention education.

BACKGROUND: A pediatric injury prevention course has not been available as a massive open online course (MOOC). Creating a comprehensive topic course is particularly challenging because the traditional, week-by-week linear curriculum design is often a barrier to learners interested in only specific topics. We created a novel, flexible course as both a 'choose your topic' MOOC for the public learner and a Small Private Online Course (SPOC) for medical students. METHODS: We describe creating 'Injury Prevention for Children and Teens', a course of 59 video learning segments within eight modules taught by a multidisciplinary panel of 25 nationally-recognized experts. Completion tracking and course evaluations were collected. RESULTS: In 2.5 years, 4,822 learners from 148 countries have enrolled. Two-thirds of learners were female. Median age of learners was 31 years. For engagement, 19.3% (n = 932) of learners attempted quizzes, and 5.2% (n = 252) participated in online forum discussions. Medical professionals (n = 162) claimed an average of 13 credit hours per learner. Over 200 senior medical students have taken the SPOC. CONCLUSION: 'Injury Prevention for Children and Teens' is a novel approach to injury prevention education that is broad, science-based, accessible, and not cost-prohibitive for a diverse group of global learners.

Definitions of Palliative Care Terms: A Consensus-Oriented Decision-Making Process.

Background: Lack of consistency in palliative care language can serve as barriers when designing, delivering, and accessing high-quality palliative care services. Objective: To develop a consensus-driven and evidence-based palliative care glossary for the Health Standards Organization Palliative Care Services National Standard of Canada (CAN/HSO 13001:2020). Design: Content analysis of the Palliative Care Services standard was used to refine a list of terms. Environmental scan and rapid review were used for identification of concepts and definitions. Two meetings of consultation based on the modified Delphi approach took place among a working committee consisting of 12 health care providers, administrators, academics, and patient/family representatives. Results: Palliative approach to care, quality of life, pain and symptom management, caregivers, palliative care, life-limiting illness, and serious illness were defined by modification/adoption of existing definitions. Conclusion: A glossary of key palliative care terms was developed and included in the HSO Palliative Care Services standard, which will facilitate communication using consistent language across care settings.

The Role of Medical Student Government in Responding to COVID-19.

The COVID-19 outbreak has sown clinical and administrative chaos at academic health centers throughout the country. As COVID-19-related burdens on the health care system and medical schools piled up, questions from medical students far outweighed the capacity of medical school administrators to respond in an adequate or timely manner, leaving students feeling confused and without clear guidance. In this article, incoming and outgoing executive leaders of the University of Michigan Medical School Student Council and medical school deans outline the specific ways they were able to bridge the gap between medical students and administrators in a time of crisis. To illustrate the value of student government during uncertain times, the authors identify the most pressing problems faced by students at each phase of the curriculum-preclerkship, clerkship, and postclerkship-and explain how Student Council leadership partnered with administrators to find creative solutions to these problems and provide guidance to learners. They end by reflecting on the role of student government more broadly, identifying 3 guiding principles of student leadership and how these principles enable effective student representation.

Validity, reliability and use of a Kuwait child nutrition knowledge assessment questionnaire.

BACKGROUND: Little is known about the nutritional knowledge of children in Kuwait and school-based nutrition interventions are scarce. No validated tool to assess the nutrition knowledge of schoolchildren in Kuwait is available. AIMS: This study determined the validity and reliability of a nutrition knowledge questionnaire in Kuwaiti primary-school children, and measured children's nutrition knowledge before and after a nutrition awareness intervention. METHODS: The questionnaire included five questions to measure nutritional knowledge. The face and content validity were assessed by nutrition and paediatric experts. To assess questionnaire reliability and nutrition knowledge, 642 schoolchildren (8-12 years) were assigned to an intervention, control or reliability group. Each group completed the questionnaire twice, one or two weeks apart. Students in the intervention group attended a nutrition knowledge presentation before completing the questionnaire the second time. Independent and paired samples t-tests were used to assess score differences between and within the intervention and control groups for changes in nutrition knowledge. Pearson correlation coefficients were used to measure score consistency in the reliability group. RESULTS: Overall, the questionnaire had good content validity and moderate to strong reliability (r = 0.44, P < 0.001). Students in the intervention group had significantly higher mean nutritional knowledge scores after the intervention (from 3.65 (SD 1.03) to 4.20 (SD 1.02); P = 0.17). Control group scores were mostly unchanged. CONCLUSIONS: The Kuwait child nutrition knowledge questionnaire is a valid and reliable tool to assess nutritional knowledge in schoolchildren in Kuwait. Nutrition knowledge of Kuwaiti schoolchildren should be improved using age-appropriate interventions in school.

New onset alcohol use disorder following bariatric surgery.

BACKGROUND: Bariatric surgery is the most effective treatment for morbid obesity; however, there may be significant unanticipated psychosocial effects following surgery. Prior studies have identified a threefold increase in the incidence of alcohol use disorder (AUD) after Roux-en-Y gastric bypass (RYGB). With sleeve gastrectomy (SG) now comprising over 50% of primary bariatric operations, the degree to which patients who undergo SG develop AUD remains unknown. We sought to characterize the patients and incidence of AUD following SG compared to RYGB. METHODS: This study used prospectively collected data from a state-wide quality collaborative. The presence of AUD was determined using the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C), with a score ≥ 4 in men and ≥ 3 in women suggestive of AUD. We used bivariate Chi-square tests for categorical variables and independent samples t tests for continuous variables. We used multivariable logistic regression to identify patient characteristics that may predispose patients to development of AUD at 1 and 2 years after surgery. RESULTS: The overall prevalence of AUD in our population (n = 5724) was 9.6% preoperatively, 8.5% at 1 year postoperatively, and 14.0% at 2 years postoperatively. The preoperative, 1-year, and 2-year prevalence of AUD for SG were 10.1%, 9.0%, and 14.4%, respectively. The preoperative, 1-year, and 2-year postoperative prevalence of AUD for RYGB were 7.6%, 6.3%, and 11.9%, respectively. Predisposing patient factors to AUD development included higher educational level (p < 0.01) and higher household income (p < 0.01). CONCLUSIONS: This is first large, multi-institutional study of AUD following SG. The prevalence of alcohol use disorder in patients undergoing SG and RYGB was similar pre- and postoperatively. The majority of patients developed AUD following their second postoperative year. Understanding the timing and incidence of alcohol use disorder in patients undergoing SG-the most commonly performed bariatric operation in the United States-is critical to providing appropriate counseling and treatment.

Validity and Reliability of a Nutrition Knowledge Questionnaire in an Adult Student Population.

OBJECTIVE: To assess the validity and reliability of the Kuwait Adult Nutrition Knowledge Questionnaire (KANKQ) in adult students as an initial step to validation in the general adult population. METHODS: Participants (n = 253; aged ≥21 years) were categorized based on academic background and designated into groups known to differ in nutrition knowledge. Participants completed the questionnaire twice. Independent-samples t test, Pearson correlation coefficients, and Cronbach α were used to assess reliability and validity (P < .05). RESULTS: Participants with health-related (n = 144) and nutrition-training backgrounds (n = 58) scored significantly higher than did those without them (n = 109 and 178, respectively; P < .001), indicating good construct validity of the KANKQ. Test-retest reliability (r = .67; P < .001) and internal consistency (α = .81) of the questionnaire were moderate to high. CONCLUSIONS AND IMPLICATIONS: Further testing of the KANKQ in workplaces and public areas is required for validation in the general adult population. Applicability to neighboring countries of similar background is warranted.

Functional role of delta and theta band oscillations for auditory feedback processing during vocal pitch motor control.

The answer to the question of how the brain incorporates sensory feedback and links it with motor function to achieve goal-directed movement during vocalization remains unclear. We investigated the mechanisms of voice pitch motor control by examining the spectro-temporal dynamics of EEG signals when non-musicians (NM), relative pitch (RP), and absolute pitch (AP) musicians maintained vocalizations of a vowel sound and received randomized ± 100 cents pitch-shift stimuli in their auditory feedback. We identified a phase-synchronized (evoked) fronto-central activation within the theta band (5-8 Hz) that temporally overlapped with compensatory vocal responses to pitch-shifted auditory feedback and was significantly stronger in RP and AP musicians compared with non-musicians. A second component involved a non-phase-synchronized (induced) frontal activation within the delta band (1-4 Hz) that emerged at approximately 1 s after the stimulus onset. The delta activation was significantly stronger in the NM compared with RP and AP groups and correlated with the pitch rebound error (PRE), indicating the degree to which subjects failed to re-adjust their voice pitch to baseline after the stimulus offset. We propose that the evoked theta is a neurophysiological marker of enhanced pitch processing in musicians and reflects mechanisms by which humans incorporate auditory feedback to control their voice pitch. We also suggest that the delta activation reflects adaptive neural processes by which vocal production errors are monitored and used to update the state of sensory-motor networks for driving subsequent vocal behaviors. This notion is corroborated by our findings showing that larger PREs were associated with greater delta band activity in the NM compared with RP and AP groups. These findings provide new insights into the neural mechanisms of auditory feedback processing for vocal pitch motor control.

Energy and material flows of megacities.

Understanding the drivers of energy and material flows of cities is important for addressing global environmental challenges. Accessing, sharing, and managing energy and material resources is particularly critical for megacities, which face enormous social stresses because of their sheer size and complexity. Here we quantify the energy and material flows through the world's 27 megacities with populations greater than 10 million people as of 2010. Collectively the resource flows through megacities are largely consistent with scaling laws established in the emerging science of cities. Correlations are established for electricity consumption, heating and industrial fuel use, ground transportation energy use, water consumption, waste generation, and steel production in terms of heating-degree-days, urban form, economic activity, and population growth. The results help identify megacities exhibiting high and low levels of consumption and those making efficient use of resources. The correlation between per capita electricity use and urbanized area per capita is shown to be a consequence of gross building floor area per capita, which is found to increase for lower-density cities. Many of the megacities are growing rapidly in population but are growing even faster in terms of gross domestic product (GDP) and energy use. In the decade from 2001-2011, electricity use and ground transportation fuel use in megacities grew at approximately half the rate of GDP growth.

Effective connectivity associated with auditory error detection in musicians with absolute pitch.

It is advantageous to study a wide range of vocal abilities in order to fully understand how vocal control measures vary across the full spectrum. Individuals with absolute pitch (AP) are able to assign a verbal label to musical notes and have enhanced abilities in pitch identification without reliance on an external referent. In this study we used dynamic causal modeling (DCM) to model effective connectivity of ERP responses to pitch perturbation in voice auditory feedback in musicians with relative pitch (RP), AP, and non-musician controls. We identified a network compromising left and right hemisphere superior temporal gyrus (STG), primary motor cortex (M1), and premotor cortex (PM). We specified nine models and compared two main factors examining various combinations of STG involvement in feedback pitch error detection/correction process. Our results suggest that modulation of left to right STG connections are important in the identification of self-voice error and sensory motor integration in AP musicians. We also identify reduced connectivity of left hemisphere PM to STG connections in AP and RP groups during the error detection and corrections process relative to non-musicians. We suggest that this suppression may allow for enhanced connectivity relating to pitch identification in the right hemisphere in those with more precise pitch matching abilities. Musicians with enhanced pitch identification abilities likely have an improved auditory error detection and correction system involving connectivity of STG regions. Our findings here also suggest that individuals with AP are more adept at using feedback related to pitch from the right hemisphere.

Left-hemisphere activation is associated with enhanced vocal pitch error detection in musicians with absolute pitch.

The ability to process auditory feedback for vocal pitch control is crucial during speaking and singing. Previous studies have suggested that musicians with absolute pitch (AP) develop specialized left-hemisphere mechanisms for pitch processing. The present study adopted an auditory feedback pitch perturbation paradigm combined with ERP recordings to test the hypothesis whether the neural mechanisms of the left-hemisphere enhance vocal pitch error detection and control in AP musicians compared with relative pitch (RP) musicians and non-musicians (NM). Results showed a stronger N1 response to pitch-shifted voice feedback in the right-hemisphere for both AP and RP musicians compared with the NM group. However, the left-hemisphere P2 component activation was greater in AP and RP musicians compared with NMs and also for the AP compared with RP musicians. The NM group was slower in generating compensatory vocal reactions to feedback pitch perturbation compared with musicians, and they failed to re-adjust their vocal pitch after the feedback perturbation was removed. These findings suggest that in the earlier stages of cortical neural processing, the right hemisphere is more active in musicians for detecting pitch changes in voice feedback. In the later stages, the left-hemisphere is more active during the processing of auditory feedback for vocal motor control and seems to involve specialized mechanisms that facilitate pitch processing in the AP compared with RP musicians. These findings indicate that the left hemisphere mechanisms of AP ability are associated with improved auditory feedback pitch processing during vocal pitch control in tasks such as speaking or singing.