Citations

Introduction Research on note-taking strategies in the higher education setting has been in existence since the 1920s. While both pros and cons exist for handwritten and digital note-taking techniques, recent research has focused on novel ways to optimize digital note-taking. With more students using laptops or tablets with a stylus, educators need to be equipped to coach students on evidenced-based ways to improve their digital note-taking. Methods PubMed, ERIC, and CINAHL databases were searched on January 6, 2025, using combinations of the following key words: digital, technology, analogue, note-taking, cognition, memory, laptop, stylus, and tablet. Studies were included if they were performed with adult learners in the higher education setting with a primary focus on note-taking. Results Three hundred thirty records were screened with 25 included in final review. Thematic analysis identified three emerging themes: (1) collaborative/group note-taking, (2) outlines, and (3) mind mapping, concept maps, or matrixes. Discussion Physician assistant/associate faculty can educate students on ways to conduct collaborative or group note-taking, create outlines, and generate mind maps, concept maps, or matrixes. These evidence-based digital note-taking strategies can be conducted independently or as a group. By supplementing these strategies with basic retrieval practices outside of the classroom, students will increase their likelihood of academic success.

Abstract Microglia are resident immune cells critical in maintaining brain homeostasis via their surveillance and phagocytosis function. Under disease contexts such as seizures and epilepsy, microglial phagocytic signalling is activated in response to both inflammatory and non‐inflammatory cell death. This process involves a range of well‐characterized ‘find me’ and ‘eat me’ signals, phagocytic receptors, and less well‐characterized intracellular signalling pathways. In addition, epigenetic and transcriptional regulators orchestrate microglial responses to seizures, including the integration of phagocytic and inflammatory pathways. Interestingly, although inhibiting phagocytosis has been shown to improve neuronal survival and cognitive performance after seizures, it paradoxically increases the risk of developing spontaneous recurrent seizures. Reconciling these dual effects requires a deeper understanding the spatiotemporal dynamics of microglial phagocytosis. The objective of this review is to examine the mechanisms and impact of microglial phagocytosis in the context of epilepsy and to highlight unresolved questions that warrant further investigation in this emerging field. image

Background Electronic health records (EHRs) serve as a critical tool for clinical documentation, yet their complexity has raised concerns about readability and usability for healthcare providers and patients. Readability scores, such as the Flesch-Kincaid (FK) Grade Level, offer a quantitative method to assess documentation clarity. In this study, the authors evaluated the impact of an EHR transition on the readability of clinical notes across multiple medical specialties. Methods All clinical notes recorded between 2016 and 2019 at a large healthcare organization were evaluated across specialties. The organization transitioned EHR systems during the study period, in May 2018. FK Grade Level scores were calculated for each clinical consultation note and stratified by specialty and EHR. Results Across 10 medical specialties, 630,246 clinical notes were evaluated. The median FK grade levels from notes composed in the new EHR were similar to those composed in the previous EHR (8.228 vs 8.240; p=0.58). The variation in FK grade level as measured by standard deviation was lower in the new EHR compared with the old EHR (1.405 vs 1.764; p <0.01). Conclusions Calculation of FK grade level of clinical notes is a feasible method to assess clinical note readability. Study results showed that clinical documentation readability may not be strongly associated with underlying EHR. Migrating to a new EHR alone should not be expected to improve readability of clinical notes.

Importance The role and safety of transcranial electrical stimulation (tES) for treating depressive disorders remain under evaluation. Objective To evaluate tES treatment in patients with major depressive disorder (MDD) and comorbid depressive conditions. Data Sources A search of MEDLINE, Embase, Cochrane, APA PsycINFO, and Scopus databases was conducted from inception to September 17, 2024. Study Selection Randomized clinical trials (RCTs) of adults with MDD, depression with psychiatric comorbidities (DPC), or depression with medical comorbidities (DMC), treated with transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), or transcranial random noise stimulation (tRNS), compared with sham or other treatments were included. Data Extraction and Synthesis Independent reviewers extracted data in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, with random-effects meta-analysis used for pooling. Main Outcomes and Measures Primary outcomes were depression severity, response and remission rates, and adverse events. Standardized mean differences (SMDs) were reported for continuous outcomes, and odds ratios (ORs) were reported for categorical outcomes. Quality of evidence (QOE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria. Results The meta-analysis included 5522 participants from 114 study groups from 88 RCTs (3198 female [58.9%]; mean [range] age, 43.1 [19.4-76.9] years). Most studies (104 study groups from 79 RCTs [91.2%]) evaluated tDCS, while 7 study groups from 6 RCTs (6.1%) evaluated tACS, and 3 study groups from 3 RCTs (2.7%) evaluated tRNS. tES was associated with reduced depressive symptoms (SMD = −0.59; 95% CI, −0.83 to −0.35; low QOE) and improvement in DMC (SMD = −1.05; 95% CI, −1.67 to −0.43; low QOE) and DPC (SMD = −0.78; 95% CI, −1.27 to −0.29; low QOE) compared with MDD (SMD = −0.22; 95% CI, −0.44 to 0.01; low QOE). tDCS was associated with reduced depression in DMC (SMD = −1.05; 95% CI, −1.70 to −0.40; very low QOE) and DPC (SMD = −0.88; 95% CI, −1.40 to −0.36; low QOE) but not MDD. tACS was associated with improved MDD symptoms (SMD = −0.58; 95% CI, −0.96 to −0.20; high QOE) and response rates (OR, 2.07; 95% CI, 1.34 to 3.19; high QOE). Combined tDCS and medication was associated with reduced symptoms (SMD = −0.51; 95% CI, −0.90 to −0.13; moderate QOE) and increased response (OR, 2.25; 95% CI, 1.08 to 4.65; high QOE) in MDD. tDCS combined with psychotherapy was not associated with improvement. Subgroup analysis showed that anodal left dorsolateral prefrontal cortex DCS was associated with improved outcomes. Mild to moderate adverse events were more frequent in tES groups. Conclusions and Relevance In this systematic review and meta-analysis, tDCS was associated with improvement in depression among patients with DMC and DPC (with smaller benefits in MDD), tACS was associated with improved MDD outcomes (while tRNS had insufficient evidence) in smaller samples, and combined tDCS and medication was associated with improvement in depression. These findings suggest that tES is well-tolerated overall, with only mild to moderate adverse events, and that future research should optimize stimulation parameters and individualize tES interventions.

Abstract Langerhans cell histiocytosis (LCH) is a rare histiocytic disorder infrequently complicated by delayed-onset pituitary disease. A 41-year-old female presented with papular, acneiform skin lesions. Shave biopsy demonstrated a superficial dermal epithelioid cell proliferation with S100, CD1a, and langerin positivity on immunohistochemistry and a BRAF p.N486_P490del inframe deletion-gain of function pathogenic variant on next-generation sequencing. The skin lesions spontaneously resolved. One year later, she developed progressive fatigue, fevers, anorexia, menstrual irregularities, polyuria, and polydipsia. Laboratory workup was consistent with panhypopituitarism. Pituitary magnetic resonance imaging noted mass-like thickening and enhancement of the infundibulum extending toward the hypothalamus. After treatment with cobimetinib, magnetic resonance imaging findings resolved but endocrinopathies persisted, requiring indefinite hormone therapy. This case demonstrates the full spectrum of endocrinopathies of LCH-induced pituitary disease and is an unusual circumstance of LCH with delayed-onset panhypopituitarism.

ABSTRACT Background Membranous nephropathy (MN) associated with phospholipase A2 receptor (PLA2R) antibodies is the most common cause of nephrotic syndrome in non-diabetic adult patients. This study investigated the relationship between clinical phenotypes and renal outcomes in this population, emphasizing the potential for phenotype-based treatment stratification. Methods We conducted a retrospective, multi-center cohort study of PLA2R-positive MN. Unsupervised cluster analysis grouped patients based on clinicopathological characteristics. Primary outcomes included complete or partial remission within 2 years of biopsy and end-stage kidney disease (ESKD) or death during follow-up. Results Among 178 patients, three distinct clusters emerged (n = 89, 70, and 19). Within 2 years of biopsy, 102 patients (57%) achieved complete or partial remission. Cluster 1, characterized by the mildest disease markers, including the lowest body mass index, serum anti-PLA2R titer, serum creatinine, proteinuria, and triglycerides, had the highest remission rate of 72%, compared with 50% in cluster 2 and 54% in cluster 3. Cluster 2 had significantly lower remission compared to cluster 1 (HR 0.64, 95% CI 0.42–0.96, P = .03); results were similar in cluster 3, albeit not statistically significant (HR 0.50, 95% CI 0.23–1.09, P = .08). Elevated anti-PLA2R levels (&gt;100 U/ml) and proteinuria (&gt;8 g/24-hour) predicted reduced remission (HR 0.56, 95% CI 0.36–0.88, P = .01; HR 0.43, 95% CI 0.26–0.73, P = .002, respectively), while high high-density lipoprotein levels were protective (HR 1.01, 95% CI 1.00–1.02, P = .048). Overall, 21 patients (12%) developed ESKD or died. ESKD-free survival differed significantly across clusters (log-rank test P = .04). Conclusions Unsupervised clustering identified distinct clinical phenotypes in PLA2R-positive MN, each associated with different renal prognoses. Phenotype-based risk stratification could enhance treatment precision, improve patient outcomes, and potentially reduce treatment-related adverse effects.

Abstract Context Endothelial dysfunction and altered psychological measures have been identified in women with functional hypothalamic amenorrhea (FHA). Estradiol (E2) replacement, a known vasodilator, may potentially reverse vascular dysfunction and improve psychological health. Objective To evaluate 12 weeks of physiologic E2 replacement on vascular, hormonal, and psychological outcomes in women with FHA. Methods A randomized, double-blind, placebo-controlled trial was conducted in 29 women with FHA with 0.1 mg/day transdermal E2 (n = 14) or placebo patch (n = 15) twice weekly for 12 weeks. FHA was defined as amenorrhea ≥3 consecutive months, E2 &lt; 50 pg/mL, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) &lt;10 mIU/L, LH:FSH &lt;1, excluding other etiologies. Endothelial dysfunction (reactive hyperemic index ≤ 1.67) was assessed, as were hormonal and psychological measures. Results Women with FHA had a mean age of 26.2 ± 6.3 years, body mass index of 21.5 ± 3.3 kg/m2, with 63% being non-Hispanic White. Baseline characteristics did not differ between groups. After 12 weeks, E2 levels were significantly higher in the E2 group (112.0 vs 36.5 pg/mL, P = .0002). However, there were no significant differences in vascular, hormonal, or psychological outcomes between E2 and placebo groups at week 12. Cortisol levels showed a near-significant decrease in the E2 group compared to an increase with placebo (−.4 vs 3.1 µg/dL, P = .05). Conclusion In women with FHA, 12 weeks of transdermal E2 increased serum E2 levels but did not improve vascular or psychological health measures. Further studies with larger sample sizes and longer follow-up are needed to explore the long-term effects of E2 therapy on cardiovascular and mental health outcomes in this population.