Objective: To examine student perspectives on the evolution of the pediatric clerkship at New York Medical College (NYMC) in response to the Coronavirus disease 2019 (COVID-19) pandemic.We investigated three distinct clerkship models: traditional, virtual, and hybrid.Student perspectives were reviewed with consideration to achieving objectives, attaining clinical skills, and overall wellness.Methods: Forty-eight medical students who completed the pediatric clerkship at NYMC responded to an online Qualtrics survey.Responses were grouped and compared based on clerkship model attended (traditional, prior to COVID-19; virtual and hybrid, during COVID-19).In addition, standard post-clerkship evaluation forms were analyzed and reviewed for themes.Results: Survey results revealed that students identified deficiencies in the virtual model compared to the traditional model.These deficiencies were largely perceived to have been improved in the hybrid model.Five key themes emerged from analysis of post-clerkship evaluations including: (1) Participation in interdisciplinary teams, (2) Direct patient care, (3) Virtual learning material as supplements to clinical experiences, (4) Faculty teaching, feedback, and support, and (5) Self-directed study time.Conclusion: The pediatric clerkship at NYMC evolved throughout the COVID-19 pandemic.The hybrid curriculum model was perceived by students to be superior to a virtual curriculum.
A previous study evaluating receptive language after unilateral brain damage in childhood hypothesized lateralized attention and memory deficits without direct measurement. Our study directly measured attention, memory, and language in order to evaluate empirically the severity and laterality of sequelae. The performances of 11 individuals with a unilateral ischemic-lesion (7 right and 4 left hemisphere) were compared to controls matched on age, sex, and socioeconomic status. Results suggest subtle but persistent deficits in verbal memory, functional memory, and speed of processing after a lesion to either hemisphere. Lesions sustained before two years of age were associated with the lowest IQ scores. Our findings provide support for a configural representation of language that can to some extent compensate for inefficient or damaged components (Bates, 1994), and the middle-ground lateralization position (Thal et al., 1991) that asserts initial hemispheric specialization with the potential for reorganization.
Mobile technology is ubiquitous, but its impact on family life has not been thoroughly addressed in the scientific literature or in clinical practice guidelines. We aimed to understand parents' views regarding mobile technology use by young children, aged 0 to 8 years, including perceived benefits, concerns, and effects on family interactions, with the goal of informing pediatric guidelines.
METHODS
We conducted 35 in-depth, semistructured group and individual interviews with English-speaking caregivers of diverse ethnic backgrounds, educational levels, and employment statuses. After thematic saturation, results were validated through expert triangulation and member checking.
RESULTS
Participants included 22 mothers, 9 fathers, and 4 grandmothers; 31.4% were single parents, 42.9% were of nonwhite race or ethnicity, and 40.0% completed high school or less. Participants consistently expressed a high degree of tension regarding their child's mobile technology use, from which several themes emerged: (1) effects on the child—fear of missing out on educational benefits vs concerns about negative effects on thinking and imagination; (2) locus of control—wanting to use digital devices in beneficial ways vs feeling that rapidly evolving technologies are beyond their control (a tension more common in low-income caregivers); and (3) family stress—the necessity of device use in stressed families (eg, to control a child's behavior or as an inexpensive learning/entertainment tool) vs its displacement of family time.
CONCLUSIONS
Caregivers of young children describe many novel concepts regarding use of mobile technology, raising issues not addressed by current anticipatory guidance. Guidance may be more effectively implemented if it takes into account parents' uncertainties, locus of control, and functional uses of mobile devices in families.
Objectives: The utility of continuous theta-burst stimulation (cTBS) as index of cortical plasticity is limited by inadequate characterization of its test-retest reliability. Thus, we evaluated the reliability of cTBS aftereffects, and explored the roles of age, and brain-derived neurotrophic factor (BDNF) and apolipoprotein E (APOE) polymorphisms. Methods: 28 healthy adults (age range 21–65) underwent two identical cTBS sessions (median interval = 9.5 days) targeting the motor cortex. Intraclass correlation coefficients (ICCs) of the log-transformed, baseline-corrected amplitude of motor evoked potentials (ΔMEP) at 5–60 minutes post-cTBS (T5–T60) were calculated. Results: ΔMEP at T50 was the most-reliable cTBS measure in the whole sample (ICC = 0.53). Area under-the-curve (AUC) of ΔMEPs was most reliable when calculated over the full 60 minutes post-cTBS (ICC = 0.40). cTBS measures were substantially more reliable in younger participants (< 35 yr) and those with BDNF Val66Val and APOE ε4– genotypes. Conclusions: cTBS aftereffects are most reliable when assessed 50 minutes post-cTBS, or when cumulative ΔMEP measures are calculated over 30–60 minutes post-cTBS. Reliability of cTBS aftereffects is influenced by age, and BDNF and APOE polymorphisms. Reliability coefficients are used to adjust effect-size calculations for interpretation and planning of cTBS studies.
Parent use of mobile devices (e.g., smartphones, tablets) while around their young children may be associated with fewer or more negative parent-child interactions, but parent perspectives regarding this issue have not been explored. We aimed to understand parent views regarding their mobile device use to identify actionable targets of potential intervention.We conducted 35 in-depth semi-structured group and individual interviews with English-speaking caregivers of children 0 to 8 years old, purposively sampled from diverse ethnic backgrounds, educational levels, and employment statuses. Following thematic saturation, results were validated through expert triangulation and member checking.Participants included 22 mothers, 9 fathers, and 4 grandmothers; 31% were single parents, 43% nonwhite race/ethnicity, and 40% completed high school or less. Participants consistently expressed a high degree of internal tension regarding their own mobile technology use, which centered around 3 themes relevant to intervention planning: (1) Cognitive tensions (multitasking between work and children, leading to information/role overload), (2) emotional tensions (stress-inducing and reducing effects), and (3) tensions around the parent-child dyad (disrupting family routines vs serving as a tool to keep the peace).Caregivers of young children describe many internal conflicts regarding their use of mobile technology, which may be windows for intervention. Helping caregivers understand such emotional and cognitive responses may help them balance family time with technology-based demands.
Objectives: A neurophysiologic biomarker for autism spectrum disorder (ASD) is highly desirable and can improve diagnosis, monitoring, and assessment of therapeutic response among children with ASD. We investigated the utility of continuous theta-burst stimulation (cTBS) applied to motor cortex (M1) as a biomarker for children and adolescents with high-functioning (HF) ASD compared to their age- and gender-matched typically developing (TD) controls. We also compared the developmental trajectory of long-term depression- (LTD-)like plasticity in the two groups. Finally, we explored the influence of a common BDNF polymorphism on cTBS aftereffects in a subset of the ASD group. Methods: Twenty-nine children and adolescents (age range 10–16) in ASD (n=11) and TD (n=18) groups underwent M1 cTBS. Changes in MEP amplitude at 5–60 minutes post-cTBS and their cumulative measures in each group were calculated. We also assessed the relationship between age and maximum cTBS-induced MEP suppression (∆MEPMax) in each group. Finally, we compared cTBS aftereffects in BDNF Val/Val (n=4) and Val/Met (n=4) ASD participants. Results: Cumulative cTBS aftereffects were significantly more facilitatory in the ASD group than in the TD group (PFDR's 0.18). Conclusions: The results support the utility of cTBS measures of cortical plasticity as a biomarker for children and adolescents with HF ASD and an aberrant developmental trajectory of LTD-like plasticity in ASD.
Objective: To examine the personality profiles of adults with autism spectrum disorder (ASD) using a standard personality assessment and to investigate the association between personality, ASD-related face memory deficit (FMD), and theory of mind (ToM). In a broader context, to examine whether there are distinct clinical phenotypes in the ASD population that have implications for personality development and treatment. Method: Fifty-five adults with ASD and 22 neurotypical (NT) adults underwent a battery of neuropsychological tests, including measures of personality, face memory, and ToM. We compared ASD and NT groups in terms of their Personality Assessment Inventory (PAI) profiles. Additional analyses focused on the association between specific PAI scales and FMD. Performance on the Eyes Test was compared across groups and was examined in relation to FMD. Results: Adults with ASD demonstrated significant elevations on several PAI scales compared with NT adults. The presence of FMD was associated with differing PAI profiles among the ASD adults. The ASD adults with FMD scored significantly higher on scales that are sensitive to positive impression management and treatment rejection and significantly lower on scales that are sensitive to borderline personality, anxiety, depression, schizophrenia, and stress. There was a significant association between performance on the Eyes Test and FMD in the ASD group. Conclusion: Adults with ASD have a unique personality profile. Further, ASD adults with FMD have reduced insight into their difficulties with emotional processing and may not be as sensitive as ASD adults without FMD to the emotions of others.
