Be in the Digital Room Where it Happens, Part II: Social Media for Neurology Educators

Social media has changed the way we communicate and interact. Unsurprisingly, it has also changed how we teach and learn. Younger generations of learners have transitioned from traditional educational sources to digital ones. Medical educators need to adapt to trends in medical education and develop fluency in the digital methods used by medical learners today. This is part two of a two-part series on social media and digital education in neurology. This article provides an overview of how social media can be used as a teaching tool in medical education and provides an overview in which it is grounded. We offer practical strategies on how social media can promote lifelong learning, educator development, educator support, and foster educator identity with accompanying neurology-specific examples. We also review considerations for incorporating social media into teaching and learning practices and future directions for integrating these tools in neurology education.

Engaging teaching strategies in neurology: the flipped classroom and simulation training

Just as neurology continues to expand its diagnostic and therapeutic modalities, so too does neurology education continue to expand in its pedagogical modalities. In this article, we describe two educational techniques-the flipped classroom and simulation-that we have incorporated in our teaching of neurology to students and doctors in training, with some practical tips for their successful implementation.

Characterization of human disease phenotypes associated with mutations in TREX1, RNASEH2A, RNASEH2B, RNASEH2C, SAMHD1, ADAR, and IFIH1

Aicardi-Goutières syndrome is an inflammatory disease occurring due to mutations in any of TREX1, RNASEH2A, RNASEH2B, RNASEH2C, SAMHD1, ADAR or IFIH1. We report on 374 patients from 299 families with mutations in these seven genes. Most patients conformed to one of two fairly stereotyped clinical profiles; either exhibiting an in utero disease-onset (74 patients; 22.8% of all patients where data were available), or a post-natal presentation, usually within the first year of life (223 patients; 68.6%), characterized by a sub-acute encephalopathy and a loss of previously acquired skills. Other clinically distinct phenotypes were also observed; particularly, bilateral striatal necrosis (13 patients; 3.6%) and non-syndromic spastic paraparesis (12 patients; 3.4%). We recorded 69 deaths (19.3% of patients with follow-up data). Of 285 patients for whom data were available, 210 (73.7%) were profoundly disabled, with no useful motor, speech and intellectual function. Chilblains, glaucoma, hypothyroidism, cardiomyopathy, intracerebral vasculitis, peripheral neuropathy, bowel inflammation and systemic lupus erythematosus were seen frequently enough to be confirmed as real associations with the Aicardi-Goutieres syndrome phenotype. We observed a robust relationship between mutations in all seven genes with increased type I interferon activity in cerebrospinal fluid and serum, and the increased expression of interferon-stimulated gene transcripts in peripheral blood. We recorded a positive correlation between the level of cerebrospinal fluid interferon activity assayed within one year of disease presentation and the degree of subsequent disability. Interferon-stimulated gene transcripts remained high in most patients, indicating an ongoing disease process. On the basis of substantial morbidity and mortality, our data highlight the urgent need to define coherent treatment strategies for the phenotypes associated with mutations in the Aicardi-Goutières syndrome-related genes. Our findings also make it clear that a window of therapeutic opportunity exists relevant to the majority of affected patients and indicate that the assessment of type I interferon activity might serve as a useful biomarker in future clinical trials.

Self-organisation of size-selected CoxPt1−x clusters on graphite

Submonolayer thin films morphologies obtained by deposition of size-selected Co_xPt_1−x clusters on graphite have been analyzed for different values of x. We put into evidence that the introduction of platinum atoms in the incident particles drastically changes the interaction between clusters and a local self-organization of size selected magnetic nanoparticles can be achieved.

Temporal trends in early clinical manifestations of perinatal HIV infection in a population-based cohort

CONTEXT

The effect of early antiretroviral therapy (ART) on the early progression of perinatal human immunodeficiency virus (HIV) infection is not well defined.

OBJECTIVE

To examine early disease progression and survival in a population-based cohort with perinatal HIV infection in relation to year of birth and use of ART.

DESIGN, SETTING, AND PATIENTS

Retrospective study of temporal trends in early progression of perinatal HIV infection among 205 HIV-infected children in Northern California born between January 1, 1988, and December 31, 2001, and followed up through age 3 years.

MAIN OUTCOME MEASURES

Prevalence of and age at progression to a first US Centers for Disease Control and Prevention category C diagnosis relative to year of birth, type of ART, and age at initiation of therapy.

RESULTS

Of 205 children, 134 (65%) received ART and/or Pneumocystis jiroveci pneumonia prophylaxis. By age 3 years, 81 (40%) progressed to a category C diagnosis, 41 (51%) of whom died. Untreated children were significantly more likely to progress to a category C diagnosis (62% [44/71] untreated vs 28% [37/134] treated children, P<.001); none of 23 infants who received triple ART progressed to category C. However, even without triple ART, very early mono/dual ART (by age 2 months vs 3-4 months) was associated with delayed and decreased progression to category C (P = .02). Of 33 children born between January 1, 1996, and December 31, 2001, only 7 (21%) progressed to category C (P = .02 compared with 1988-1995), 6 of 7 of whom received no therapy. More recent year of birth and more advanced therapy were associated with improved survival.

CONCLUSIONS

This population-based cohort demonstrated decreased early HIV progression and improved survival at age 3 years, associated with more advanced therapy. Although limited by small sample size, the findings suggest that very early treatment, even without triple ART, was associated with improved outcome.

[Evaluation of practices in surgical antimicrobial prophylaxis in the Franche-Comté before and after implementation of an information program]

OBJECTIVES

To assess the practices of surgical antimicrobial prophylaxis in the Franche-Comté region of France before and after the implementation of information program.

STUDY DESIGN

Prospective multicenter transversal study type before/after. The information program included a feedback on the observed results during the period before and a meeting with opinion leaders.

PATIENTS AND METHODS

Data were collected by 28 pairs of surgeons/anaesthetists. Prescriptions were analysed to answer five questions about antibiotic prophylaxis practices in surgery: did the surgical procedure require antibiotic prophylaxis and was this carried out? Was the appropriate antibiotic used? Was the timing of the first injection optimal? Was the total duration of the treatment correct? Was the dose correct? Our data were compared to national recommendations (updated in 1999).

RESULTS

The overall frequency of conformity was about 40% both before and after the implementation of an information/awareness campaign. Only the conformity of the total duration of the prophylaxis was significantly higher after the action, but only for interventions that lasted less than two hours. [RR = 2.09 (1.32-3.31), p = 0.001]. This improvement in the total duration of regulation seemed to be related to the more frequent use of written protocols in the surgical units.

CONCLUSION

Our study confirms that information campaign have little effect within the framework of the good use of antibiotics. We agree with the experts who claim that only an overall strategy including organization, education and restriction will really improve the frequency of conformity of the practices of surgical prophylaxis.

[Antibiotic prophylaxis and surgery. Prescription compliance in Franche-Comté with the national reference system]

AIM OF THE STUDY

To evaluate the practice of antibiotic prophylaxis for surgery in the Franche-Comté region of France.

MATERIALS AND METHODS

A total of 36 surgical teams (72 pairs surgeons/anaesthesists) participated in data collection. Five variables describing practices concerning antibiotic prophylaxis for surgery were compared to national recommendations: did the surgical procedure require antibiotic prophylaxis and was it carried out? Was the antibiotic used appropriately? Was the timing of the first injection optimal? Was the total duration of the treatment correct? Was the dose correct?

RESULTS

Among the 687 operations for which data were collected, 513 (74.7%) that corresponded to class 1 or 2 Altemeier operations for which the Société Française d'Anesthésie et Réanimation (SFAR) had drawn up recommendations were analysed in order to answer these questions. The overall frequency of conformity with the regulations was 40% for these 513 operations. Of the 156 patients who did not receive the recommended antibiotic, 133 (85.5%) received an antibiotic with an activity range wider than that of the recommended antibiotic. The duration of prophylaxis was longer than recommended in 80 (87.9%) out of the 91 patients for whom the duration of antibiotic prophylaxis did not respect the recommendations.

CONCLUSIONS

This prospective surveillance showed that less than 50% of patients received an antibiotic prophylaxis that was conformed to the regulations. To ensure the efficiency of prophylaxis and to prevent deleterious effects, such as the emergence of antibiotic-resistant bacteria, the recommendations must be regularly respected. Frequent audits of practices should be carried out by the teams responsible for fighting nosocomial infections.

Protein kinase activity in hepatitis B virus

Protein kinase activity was found in hepatitis B virions (Dane particles) purified from the plasma of hepatitis B virus-infected patients, in virion cores, and in hepatitis B core antigen particles purified from hepatitis B virus-infected hepatic tissue and was not found in purified hepatitis B surface antigen particle preparations free of Dane particles. Only a fraction of the major polypeptide (apparent size, 19,700 daltons) in Dane particle cores and hepatitis B core antigen particles from infected liver appeared to be phosphorylated, and phosphorylation changed the electrophoretic mobility in sodium dodecyl sulfate-polyacrylamide gels to that expected for a polypeptide of 20,600 daltons. Five minor polypeptides with apparent sizes between 38,000 and 63,000 daltons were phosphorylated in Dane particles and Dane particle core preparations but were not detected in hepatitis B core antigen particles from infected liver. None of these had electrophoretic mobilities corresponding to those of known hepatitis B surface antigen polypeptides. Prolonged storage of purified hepatitis B core antigen particles or incubation with human immunoglobulin G preparations containing antibody to the hepatitis B core antigen with or without antibody to the hepatitis B e antigen resulted in the conversion of the polypeptide with an apparent size of 20,600 daltons to ones with apparent sizes of 14,700 and approximately 6,000 daltons, suggesting proteolytic cleavage of the 20,600-dalton polypeptide under these conditions.