Genetic mapping and prediction for novel lesion mimic in maize demonstrates quantitative effects from genetic background, environment and epistasis.

KEY MESSAGE: A novel locus was discovered on chromosome 7 associated with a lesion mimic in maize; this lesion mimic had a quantitative and heritable phenotype and was predicted better via subset genomic markers than whole genome markers across diverse environments. Lesion mimics are a phenotype of leaf micro-spotting in maize (Zea mays L.), which can be early signs of biotic or abiotic stresses. Dissecting its inheritance is helpful to understand how these loci behave across different genetic backgrounds. Here, 538 maize recombinant inbred lines (RILs) segregating for a novel lesion mimic were quantitatively phenotyped in Georgia, Texas, and Wisconsin. These RILs were derived from three bi-parental crosses using a tropical pollinator (Tx773) as the common parent crossed with three inbreds (LH195, LH82, and PB80). While this lesion mimic was heritable across three environments based on phenotypic ([Formula: see text] = 0.68) and genomic ([Formula: see text] = 0.91) data, transgressive segregation was observed. A genome-wide association study identified a single novel locus on chromosome 7 (at 70.6 Mb) also covered by a quantitative trait locus interval (69.3-71.0 Mb), explaining 11-15% of the variation, depending on the environment. One candidate gene identified in this region, Zm00001eb308070, is related to the abscisic acid pathway involving in cell death. Genomic predictions were applied to genome-wide markers (39,611 markers) contrasted with a marker subset (51 markers). Population structure explained more variation than environment in genomic prediction, but other substantial genetic background effects were additionally detected. Subset markers explained substantially less genetic variation (24.9%) for the lesion mimic than whole genome markers (55.4%) in the model, yet predicted the lesion mimic better (0.56-0.66 vs. 0.26-0.29). These results indicate this lesion mimic phenotype was less affected by environment than by epistasis and genetic background effects, which explain its transgressive segregation.

Transcriptome Analysis of Developing Grains from Wheat Cultivars TAM 111 and TAM 112 Reveal Cultivar-Specific Regulatory Networks.

Wheat flour's end-use quality is tightly linked to the quantity and composition of storage proteins in the endosperm. TAM 111 and TAM 112 are two popular cultivars grown in the Southern US Great Plains with significantly different protein content. To investigate regulatory differences, transcriptome data were analyzed from developing grains at early- and mid-filling stages. At the mid-filling stage, TAM 111 preferentially upregulated starch metabolism-related pathways compared to TAM 112, whereas amino acid metabolism and transporter-related pathways were over-represented in TAM 112. Elemental analyses also indicated a higher N percentage in TAM 112 at the mid-filling stage. To explore the regulatory variation, weighted correlation gene network was constructed from publicly available RNAseq datasets to identify the modules differentially regulated in TAM 111 and TAM 112. Further, the potential transcription factors (TFs) regulating those modules were identified using graphical least absolute shrinkage and selection operator (GLASSO). Homologs of the OsNF-Y family members with known starch metabolism-related functions showed higher connectivities in TAM 111. Multiple TFs with high connectivity in TAM 112 had predicted functions associated with ABA response in grain. These results will provide novel targets for breeders to explore and further our understanding in mechanisms regulating grain development.

A behaviorally anchored assessment tool for bedside teaching in the emergency department.

Evaluating a resident's development as a bedside educator in the emergency department (ED) is challenging. Teaching consults, where trainees are observed and assessed in their teaching skills, have been used to improve bedside teaching. Within emergency medicine, there are a few assessment tools to evaluate a clinician's bedside teaching, with the majority focusing on faculty. A user-friendly assessment tool adapted to the ED that emphasizes behaviorally anchored, milestone-based evaluations for residents has yet to be developed. We sought to develop such an assessment tool for evaluating residents' bedside teaching in the ED. Using a nominal-group consensus-building technique, we derived the bedside teaching assessment tool. The consensus-building panel was composed of clinician-educators with extensive experience in resident education. The teaching consult process consisted of the consultant, a faculty member with a focus in medical education, directly observing a resident's bedside teaching throughout their shift while filling out the evaluation form based on observed behaviors. A total of 35 consults were provided to 30 individual residents. The mean (±SD) scores for the 35 consults for the learning climate, content teaching, supervision, feedback and evaluation, and self-assessment were 3.84 (±0.75), 3.56 (±0.58), 3.70 (±0.60), 3.64 (±0.77), and 3.92 (±0.45), respectively. The median scores for the above domains were 4, 3.5, 4, 3.5, and 4, respectively. The tool has acceptable internal consistency with a Cronbach's alpha of 0.723 (95% CI 0.469-0.839). Eleven of 13 (85%) residents who provided feedback agreed or strongly agreed that the quantitative feedback provided by the assessment tool was useful. Twelve of 13 (92%) residents found the consultation process to be unobtrusive to their clinical performance. In conclusion, this novel behaviorally anchored assessment tool for bedside teaching can serve as a useful adjunct to a teaching consult and provide useful feedback for the development of residents' bedside teaching skills.

Peer coaching increases emergency medicine faculty ability to perform and teach awake fiberoptic intubation.

OBJECTIVES: This study sought to evaluate the impact of peer coaching as a continuing medical education (CME) modality to improve faculty performance and teaching of a low-frequency, high-complexity procedure, awake fiberoptic intubation (AFOI). METHODS: Academic emergency medicine faculty at a single tertiary care, Level I trauma center participated in a prospective pre-/postinterventional assessment of a peer coaching educational intervention. Participants completed a preintervention online survey to identify comfort and previous experience with performing and teaching AFOI. The participants reviewed presession materials and then completed a 25-min didactic session with a peer coach. Participants were then broken into dyads where they initially each practiced the procedure and then attempted to teach the procedure to their colleague. An institutional standardized checklist for AFOI was utilized to assess participants procedural competency. Postintervention online surveys were compared to the preintervention surveys. RESULTS: A total of 15 faculty members were recruited for the study and completed pre- and postintervention surveys. All participants showed ability to perform AFOI as proven by successful completion of the procedural checklist. There was a statistically significant increase for self-perceived efficacy in performing (p < 0.001, 95% confidence interval [CI] = 1.34 to 3.06) and teaching AFOI (p < 0.001, 95% CI = 1.56 to 3.05). All participants felt more likely to attempt AFOI after a single peer coaching session and most (14/15, 93.3%) were more likely to teach AFOI. Participants identified peer coaching as more effective at instilling confidence to perform and teach the skill than other CME activities that they have experienced. CONCLUSION: This study demonstrates that peer coaching increases practicing faculty's ability to perform and teach a low-frequency, high-complexity procedure, AFOI. Peer coaching may offer an opportunity to improve the utility of learning compared to more traditional didactic-based CME initiatives.

Case Report: Paucisymptomatic College-Age Population as a Reservoir for Potentially Neutralization-Resistant Severe Acute Respiratory Syndrome Coronavirus 2 Variants.

To better understand the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant lineage distribution in a college campus population, we carried out viral genome surveillance over a 7-week period from January to March 2021. Among the sequences were three novel viral variants: BV-1 with a B.1.1.7/20I genetic background and an additional spike mutation Q493R, associated with a mild but longer-than-usual COVID-19 case in a college-age person, BV-2 with a T478K mutation on a 20B genetic background, and BV-3, an apparent recombinant lineage. This work highlights the potential of an undervaccinated younger population as a reservoir for the spread and generation of novel variants. This also demonstrates the value of whole genome sequencing as a routine disease surveillance tool.

Development and Validation of a Lecture Assessment Tool for Emergency Medicine Residents.

BACKGROUND: Delivering quality lectures is a critical skill for residents seeking careers in academia yet no validated tools for assessing resident lecture skills exist. OBJECTIVES: The authors sought to develop and validate a lecture assessment tool. METHODS: Using a nominal group technique, the authors derived a behaviorally anchored assessment tool. Baseline characteristics of resident lecturers including prior lecturing experience and perceived comfort with lecturing were collected. Faculty and senior residents used the tool to assess lecturer performance at weekly conference. A postintervention survey assessed the usability of the form and the quantity and quality of the feedback. Analysis of variance was used to identify relationships in performance within individual domains to baseline data. Generalizability coefficients and scatterplots with jitter were used to assess inter-rater reliability. RESULTS: Of 64 residents assessed, most (68.8%) had previous lecturing experience and 6.3% had experience as a regional/national speaker. There was a significant difference in performance within the domains of Content Expertise (p < 0.001), Presentation Design/Structure (p = 0.014), and Lecture Presence (p = 0.001) for first-year versus fourth-year residents. Residents who had higher perceived comfort with lecturing performed better in the domains of Content Expertise (p = 0.035), Presentation Design/Structure (p = 0.037), and Lecture Presence (p < 0.001). We found fair agreement between raters in all domains except Goals and Objectives. Both lecturers and evaluators perceived the feedback delivered as specific and of adequate quantity and quality. Evaluators described the form as highly useable. CONCLUSIONS: The derived behaviorally anchored assessment tool is a sufficiently valid instrument for the assessment of resident-delivered lectures.

Social Determinants of Health: A Missing Link in Emergency Medicine Training.

The health of a population depends upon several factors, including disease, public health initiatives, and the social determinants of health (SDH). These factors often converge in the emergency department (ED) where the impact of social conditions such as homelessness, low-literacy, and poverty lead to recidivism and may contribute to provider burnout. Inclusion of SDH topics in EM residency curricula can provide needed background information and effective strategies for coping with these patients in the clinical setting. Exercises that simulate poverty, the development of and familiarity with meaningful community partnerships, and inclusion of SDH topics in standard ED conferences (e.g., mortality and morbidity conference) can promote understanding and outline a detailed plan for treating patients facing these challenges. By incorporating educational interventions aimed at identifying and intervening on issues of SDH in the ED we may be able to better serve those patients who need us the most.

Self-reported evaluation of competencies and attitudes by physicians-in-training before and after a single day legislative advocacy experience.

BACKGROUND: Advocacy is increasingly being recognized as a core element of medical professionalism and efforts are underway to incorporate advocacy training into graduate and undergraduate medical school curricula. While limited data exist to quantify physician attitudes toward advocacy, even less has been done to assess the knowledge, skills, and attitudes of future physicians. The purpose of this study was to assess students' experiences and attitudes toward legislative advocacy, cutting out using a convience sample. METHODS: A paper survey based on previously validated surveys was administered to a convenience sample of premedical and medical student participants attending a National Advocacy Day in Washington, DC, in March 2011, both before and after their advocacy experiences. Responses were anonymous and either categorical ( or ordinal, using a 5-point Likert scale. Data were analyzed statistically to evaluate demographics and compare changes in pre- and post-experience attitude and skills. RESULTS: Data from 108 pre-advocacy and 50 post-advocacy surveys were analyzed yielding a response rate of 46.3%. Following a single advocacy experience, subjects felt they were more likely to contact their legislators about healthcare issues (p = 0.03), to meet in person with their legislators (p < 0.01), and to advocate for populations' health needs (p = 0.04). Participants endorsed an increased perception of the role of a physician advocate extending beyond individual patients (p = 0.03). Participants disagreed with the statement that their formal curricula adequately covered legislative healthcare advocacy. Additionally, respondents indicated that they plan to engage in legislative advocacy activities in the future (p < 0.01). CONCLUSIONS: A one-time practical advocacy experience has a positive influence on students' knowledge, skills and attitudes towards legislative advocacy. Practical experience is an important method of furthering medical education in advocacy and further research is necessary to assess its impact in a broader population.