A Comparison of Parent Reports, the Mental Synthesis Evaluation Checklist (MSEC) and the Autism Treatment Evaluation Checklist (ATEC), with the Childhood Autism Rating Scale (CARS).

This study compares two parent reports, the Mental Synthesis Evaluation Checklist (MSEC) and the Autism Treatment Evaluation Checklist (ATEC), with the Childhood Autism Rating Scale (CARS). The ATEC consists of four subscales, as follows: (1) expressive language, (2) sociability, (3) sensory awareness, and (4) health. The MSEC is complementary to the ATEC in measuring complex language comprehension. The parents of 143 autistic children, from 2 to 22 years of age (mean 6.7 ± 5.1 years), completed the MSEC and the ATEC questionnaires and a clinician assessed their CARS score. The CARS score correlated strongly with all parent reports, the complex language comprehension MSEC (r = 0.60, p < 0.0001), expressive language (r = 0.66, p < 0.0001), sociability (r = 0.58, p < 0.0001), sensory awareness (r = 0.71, p < 0.0001), and health (r = 0.53, p < 0.0001), as well as the total ATEC score (r = 0.75, p < 0.0001). The strongest correlation was between the CARS score and the composite of all five parent-reported scores (total ATEC + MSEC, r = 0.77, p < 0.0001). These results suggest a high fidelity of the MSEC and ATEC parent reports and especially of their composite score, total ATEC + MSEC.

Direct kinetic fingerprinting and digital counting of single protein molecules.

The sensitive and accurate quantification of protein biomarkers plays important roles in clinical diagnostics and biomedical research. Sandwich ELISA and its variants accomplish the capture and detection of a target protein via two antibodies that tightly bind at least two distinct epitopes of the same antigen and have been the gold standard for sensitive protein quantitation for decades. However, existing antibody-based assays cannot distinguish between signal arising from specific binding to the protein of interest and nonspecific binding to assay surfaces or matrix components, resulting in significant background signal even in the absence of the analyte. As a result, they generally do not achieve single-molecule sensitivity, and they require two high-affinity antibodies as well as stringent washing to maximize sensitivity and reproducibility. Here, we show that surface capture with a high-affinity antibody combined with kinetic fingerprinting using a dynamically binding, low-affinity fluorescent antibody fragment differentiates between specific and nonspecific binding at the single-molecule level, permitting the direct, digital counting of single protein molecules with femtomolar-to-attomolar limits of detection (LODs). We apply this approach to four exemplary antigens spiked into serum, demonstrating LODs 55- to 383-fold lower than commercially available ELISA. As a real-world application, we establish that endogenous interleukin-6 (IL-6) can be quantified in 2-µL serum samples from chimeric antigen receptor T cell (CAR-T cell) therapy patients without washing away excess serum or detection probes, as is required in ELISA-based approaches. This kinetic fingerprinting thus exhibits great potential for the ultrasensitive, rapid, and streamlined detection of many clinically relevant proteins.

A Novel Peer-Directed Curriculum to Enhance Medical Ethics Training for Medical Students: A Single-Institution Experience.

BACKGROUND: The best pedagogical approach to teaching medical ethics is unknown and widely variable across medical school curricula in the United States. Active learning, reflective practice, informal discourse, and peer-led teaching methods have been widely supported as recent advances in medical education. Using a bottom-up teaching approach builds on medical trainees' own moral thinking and emotion to promote awareness and shared decision-making in navigating everyday ethical considerations confronted in the clinical setting. OBJECTIVE: Our study objective was to outline our methodology of grassroots efforts in developing an innovative, student-derived longitudinal program to enhance teaching in medical ethics for interested medical students. METHODS: Through the development of a 4-year interactive medical ethics curriculum, interested medical students were provided the opportunity to enhance their own moral and ethical identities in the clinical setting through a peer-derived longitudinal curriculum including the following components: lunch-and-learn didactic sessions, peer-facilitated ethics presentations, faculty-student mentorship sessions, student ethics committee discussions, hospital ethics committee and pastoral care shadowing, and an ethics capstone scholarly project. The curriculum places emphasis on small group narrative discussion and collaboration with peers and faculty mentors about ethical considerations in everyday clinical decision-making and provides an intellectual space to self-reflect, explore moral and professional values, and mature one's own professional communication skills. RESULTS: The Leadership through Ethics (LTE) program is now in its fourth year with 14 faculty-clinician ethics facilitators and 65 active student participants on track for a distinction in medical ethics upon graduation. Early student narrative feedback showed recurrent themes on positive curricular components including (1) clinician mentorship is key, (2) peer discussion and reflection relatable to the wards is effective, and (3) hands-on and interactive clinical training adds value. As a result of the peer-driven initiative, the program has been awarded recognition as a graduate-level certification for sustainable expansion of the grassroots curriculum for trainees in the clinical setting. CONCLUSIONS: Grassroots medical ethics education emphasizes experiential learning and peer-to-peer informal discourse of everyday ethical considerations in the health care setting. Student engagement in curricular development, reflective practice in clinical settings, and peer-assisted learning are strategies to enhance clinical ethics education. The Leadership through Ethics program augments and has the potential to transform traditional teaching methodology in bioethics education for motivated students by offering protected small group discussion time, a safe environment, and guidance from ethics facilitators to reflect on shared experiences in clinical ethics and to gain more robust, hands-on ethics training in the clinical setting.

Concerns of Female Adolescents About Menarche and First Sexual Intercourse: Mixed Methods Analysis of Social Media Questions.

BACKGROUND: Adolescents use social media for information on medical and social aspects of maturation. OBJECTIVE: The aim of this study was to investigate the concerns and information needs of adolescents regarding menarche and first sexual intercourse. METHODS: Questions about menarche or first sexual intercourse were obtained from Yahoo Answers, a community-based social media question-and-answer website. A total of 1226 questions were analyzed. We focused on 123 question pairs made by users who asked questions on both topics and reported their ages at each. Quantitative and qualitative analyses were performed on these question pairs. RESULTS: Qualitative analysis identified uncertainty as a significant theme for both menarche and first intercourse. Quantitative analysis showed that uncertainty was expressed in 26% (13/50) of menarche questions and 14% (7/50) of intercourse questions. Lack of communication was expressed in 4% (2/50) of menarche questions, compared with 8% (4/50) of intercourse questions. Ages at menarche and at first sexual intercourse were correlated, with women reporting menarche at the age of 13 years or younger being 2.6 times more likely to experience first sexual intercourse before the age of 16 years (P<.001, chi-square test). Older age at menarche was associated with greater lack of communication with parents (analysis of variance, P=.002). CONCLUSIONS: The questions of adolescents on the topics of menarche and first sexual intercourse express anxiety and uncertainty and are associated with a lack of information and deficient communication with parents. The more normative and expected a behavior, the less these factors appear. Therefore, parents and educators should, to the extent possible, improve communication around these topics, especially when they occur at less typical ages.

Congenital bronchial artery to pulmonary artery fistula presenting as hemoptysis.

A 51-year-old male presented with 2 weeks of hemoptysis. Pulmonary angiography was performed and identified a bronchial artery to pulmonary artery fistula of the right upper lobe. Despite angioembolization, the hemoptysis recurred 1 year later. It was hypothesized that the recurrence occurred due to retrograde filling from the pulmonary arterial side of the abnormality. Right upper lobectomy was performed and resulted in resolution of hemoptysis. We present a case report of a rare, congenital bronchial artery to pulmonary artery fistula.

Creating an active-learning environment in an introductory acoustics course.

Research in physics education has indicated that the traditional lecture-style class is not the most efficient way to teach introductory physical science courses at the university level. Current best teaching practices focus on creating an active-learning environment and emphasize the students' role in the learning process. Several of the recommended techniques have recently been applied to Brigham Young University's introductory acoustics course, which has been taught for more than 40 years. Adjustments have been built on a foundation of establishing student-based learning outcomes and attempting to align these objectives with assessments and course activities. Improvements have been made to nearly every aspect of the course including use of class time, assessment materials, and time the students spend out of the classroom. A description of the progress made in improving the course offers suggestions for those seeking to modernize or create a similar course at their institution. In addition, many of the principles can be similarly applied to acoustics education at other academic levels.

The effect of inharmonic partials on pitch of piano tones.

Piano tones have partials whose frequencies are sharp relative to harmonic values. A listening test was conducted to determine the effect of inharmonicity on pitch for piano tones in the lowest three octaves of a piano. Nine real tones from the lowest three octaves of a piano were analyzed to obtain frequencies, relative amplitudes, and decay rates of their partials. Synthetic inharmonic tones were produced from these results. Synthetic harmonic tones, each with a twelfth of a semitone increase in the fundamental, were also produced. A jury of 21 listeners matched the pitch of each synthetic inharmonic tone to one of the synthetic harmonic tones. The effect of the inharmonicity on pitch was determined from an average of the listeners' results. For the nine synthetic piano tones studied, pitch increase ranged from approximately two and a half semitones at low fundamental frequencies to an eighth of a semitone at higher fundamental frequencies.

Evidence based physical activity for school-age youth.

OBJECTIVES: To review the effects of physical activity on health and behavior outcomes and develop evidence-based recommendations for physical activity in youth. STUDY DESIGN: A systematic literature review identified 850 articles; additional papers were identified by the expert panelists. Articles in the identified outcome areas were reviewed, evaluated and summarized by an expert panelist. The strength of the evidence, conclusions, key issues, and gaps in the evidence were abstracted in a standardized format and presented and discussed by panelists and organizational representatives. RESULTS: Most intervention studies used supervised programs of moderate to vigorous physical activity of 30 to 45 minutes duration 3 to 5 days per week. The panel believed that a greater amount of physical activity would be necessary to achieve similar beneficial effects on health and behavioral outcomes in ordinary daily circumstances (typically intermittent and unsupervised activity). CONCLUSION: School-age youth should participate daily in 60 minutes or more of moderate to vigorous physical activity that is developmentally appropriate, enjoyable, and involves a variety of activities.

Screening for Heart Murmurs.

In brief In preparticipation screening, auscultation is a key component of a rapid but thorough cardiovascular exam. A systematic approach allows an examiner to identify the normal murmurs that occur among young athletes as well as the sounds that might signify underlying cardiac pathology. Keeping in mind the factors that influence murmur audibility helps ensure accurate differentiation between normal and pathologic murmurs. The goals are to identify athletes at risk for sudden death, to flag those who may need treatment for other cardiac conditions, and to allow athletes who have normal murmurs to remain active.

Does the sympathetic block outlast sensory block: a thermographic evaluation.

A study to evaluate the duration of sympathetic and sensory block in the L2 and L5 dermatome distributions using thermography and pinprick was conducted. Twenty patients received epidural block using 2% lidocaine with epinephrine. Onset and duration of the sensory and sympathetic blocks were determined and compared statistically. There was no difference between the duration of sensory and sympathetic block over the L2 dermatome, but sympathetic block was significantly longer than sensory block in the L5 dermatome. This study demonstrates that the duration of sympathetic block can be either longer or shorter than sensory block in L2 and L5 dermatomes. This has important implications for interpretation of results of differential epidural studies in that one cannot predict the duration of sympathetic block based on duration of sensory block.