The rebel, the professor, and the entrepreneur: Qualitative study to explore creator stories of FOAM.

Introduction: The free open access medical education (#FOAMed, or FOAM) movement creates educational content intended to inform medical education and clinical practice and is distributed in an unrestricted fashion (e.g., open access website). The who, what, and in particular the how of FOAM has raised important questions about the sustainability of the movement. Methods: We recruited a diverse research team that included educational researchers, FOAM contributors, a business academician, and medical trainees to design and conduct a qualitative study exploring the work of FOAM creators. We analyzed the transcripts of interviews with 11 participants from top FOAM websites in emergency medicine and critical care. The team met frequently to iteratively identify and discuss emergent themes (major and minor) until saturation of concepts was achieved. Results: Creators of FOAM could be categorized using three archetypes: the rebel, the professor, and the entrepreneur. The rebel was categorized as distinctly rejecting "traditional academic structures" yet was compelled to deliver educational content via alternative routes. The professor retained a traditional academic role, instead creating FOAM to supplement academic activities (teaching courses, disseminating scholarship, promotion). Entrepreneurs focused on creating a sustainable entity in an effort to supplement their income and reduce clinical obligations. Conclusion: While all FOAM creators appear unified in their passion to create, promote, and distribute educational material with unfettered access to educators, their motivations for creating content could be differentiated. Given the grassroots nature of FOAM, creators share concerns related to financing, time commitments, and threats to sustainability of these businesses. The longevity of FOAM and what business models are best suited to support them are uncertain. Further exploration of the implications could investigate the best ways to engage with and support the different FOAM creator archetypes and develop models of sustainability.

Mechanosensitive brain tumor cells construct blood-tumor barrier to mask chemosensitivity.

Major obstacles in brain cancer treatment include the blood-tumor barrier (BTB), which limits the access of most therapeutic agents, and quiescent tumor cells, which resist conventional chemotherapy. Here, we show that Sox2+ tumor cells project cellular processes to ensheathe capillaries in mouse medulloblastoma (MB), a process that depends on the mechanosensitive ion channel Piezo2. MB develops a tissue stiffness gradient as a function of distance to capillaries. Sox2+ tumor cells perceive substrate stiffness to sustain local intracellular calcium, actomyosin tension, and adhesion to promote cellular process growth and cell surface sequestration of ß-catenin. Piezo2 knockout reverses WNT/ß-catenin signaling states between Sox2+ tumor cells and endothelial cells, compromises the BTB, reduces the quiescence of Sox2+ tumor cells, and markedly enhances the MB response to chemotherapy. Our study reveals that mechanosensitive tumor cells construct the BTB to mask tumor chemosensitivity. Targeting Piezo2 addresses the BTB and tumor quiescence properties that underlie treatment failures in brain cancer.

What Faculty Want: Academic and Community Emergency Physicians' Perceptions of Learner Feedback.

Introduction Faculty development is often deployed by central medical schools, with little guidance from end-users. How and what faculty members can use to improve their performance requires a deeper understanding from this user group. This study aims to explore how faculty perceive learners' feedback about their performance as educators. Methods This study is an explanatory mixed-method research, wherein community- and academic-based emergency medicine faculty members from nine regional hospitals were surveyed about their perceptions of various outcome measures for faculty development. Selected participants were invited to follow-up interviews. We analyzed the physicians' perceptions toward teaching and performance feedback data based on faculty's gender, role as academic or community physician, and work experience. Results The quantitative phase has 104 participants, and 15 of these were followed up with interviews. The gender of faculty does not have statistical or practical differences regarding their perceptions of learner feedback. Type of practice contains meaningful insights about the perception of learner feedback although it does not have a statistical difference. Moreover, an inverse trend exists between the physicians' years of experience and their perceived value of learner feedback. Kruskal-Wallis test showed a significant difference in the faculty's experience level and their perceived value for the metric "quantity of feedback commentary compared to their peer group" (H(4) = 12.21, p = 0.02), specifically between junior and senior faculty (p = 0.007). Some faculty stated that experienced faculty may perceive they have a very well-established style. Conclusions Diversifying feedback sources and delivery may be useful for different groups of faculty members. Junior physicians are more interested in gaining feedback about the quantity of their written feedback to students compared to more senior physicians. Learner feedback holds promise to trigger continuous improvement in community sites for those who fall behind compared to the academic sites.

Clozapine and tardive dyskinesia in patients with schizophrenia: A systematic review.

BACKGROUND: It is commonly recommended that a switch to clozapine be implemented in the face of tardive dyskinesia, even if current treatment involves another "atypical" agent. However, reports do indicate clozapine carries a liability for tardive dyskinesia. AIMS: This review sought to evaluate clozapine in relation to tardive dyskinesia in the context of available evidence. METHODS: Medline, Embase, and PsycINFO databases were searched for studies published in English, using the keywords: clozapine AND tardive dyskinesia OR TD. References from major review articles were searched for additional relevant publications. Studies were included if they investigated: tardive dyskinesia in clozapine-treated patients diagnosed with schizophrenia spectrum disorders, and reported on two or more assessments of tardive dyskinesia severity measured by the Abnormal Involuntary Movement Scale; or clozapine's tardive dyskinesia liability. RESULTS: In total, 513 unique citations were identified and 29 reports met the inclusion criteria. Thirteen studies suggest clozapine reduces dyskinetic symptoms over time (n=905 clozapine-treated participants); however, the minimum required dose and effect of withdrawal requires further investigation. The majority of reports which address clozapine's liability for tardive dyskinesia are case studies (11 of 14 reports, 79%), and clozapine was only the first-line treatment in one of the remaining three studies reporting treatment-emergent dyskinetic symptoms with clozapine in 12% of patients. No significant between-drug differences were identified comparing clozapine's risk to other atypical antipsychotics. CONCLUSIONS: Research to date supports switching to clozapine for the purpose of reducing tardive dyskinesia risk and/or treating existing tardive dyskinesia, but prospective randomized controlled trials are necessary if we are to substantiate existing recommendations.