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BackgroundIn the rapidly changing landscape of undergraduate medical education (UME), the roles and responsibilities of clerkship directors (CDs) are not clear.ObjectiveTo describe the current roles and responsibilities of Internal Medicine CDs.DesignNational annual Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey.ParticipantsOne hundred twenty-nine clerkship directors at all Liaison Committee on Medical Education accredited US medical schools with CDIM membership as of September 1, 2017.Main measuresResponsibilities of core CDs, including oversight of other faculty, and resources available to CDs including financial support and dedicated time.Key resultThe survey response rate was 83% (107/129). Ninety-four percent of the respondents oversaw the core clerkship inpatient experience, while 47.7% (n = 51) and 5.6% (n = 6) oversaw the outpatient and longitudinal integrated clerkships respectively. In addition to oversight, CDs were responsible for curriculum development, evaluation and grades, remediation, scheduling, student mentoring, and faculty development. Less than one-third of CDs (n = 33) received the recommended 0.5 full-time equivalent (FTE) support for their roles, and 15% (n = 16) had less than 20% FTE support. An average 0.41 FTE (SD .2) was spent in clinical work and 0.20 FTE (SD .21) in administrative duties. Eighty-three percent worked with other faculty who assisted in the oversight of departmental UME experiences, with FTE support varying by role and institution. Thirty-five percent of CDs (n = 38) had a dedicated budget for managing their clerkship.ConclusionsThe responsibilities of CDs have increased in both number and complexity since the dissemination of previous guidelines for expectations of and for CDs in 2003. However, resources available to them have not substantially changed.

We evaluated whether spike ripples, the combination of epileptiform spikes and ripples, provide a reliable and improved biomarker for the epileptogenic zone compared with other leading interictal biomarkers in a multicentre, international study. We first validated an automated spike ripple detector on intracranial EEG recordings. We then applied this detector to subjects from four centres who subsequently underwent surgical resection with known 1-year outcomes. We evaluated the spike ripple rate in subjects cured after resection [International League Against Epilepsy Class 1 outcome (ILAE 1)] and those with persistent seizures (ILAE 2–6) across sites and recording types. We also evaluated available interictal biomarkers: spike, spike-gamma, wideband high frequency oscillation (HFO, 80–500 Hz), ripple (80–250 Hz) and fast ripple (250–500 Hz) rates using previously validated automated detectors. The proportion of resected events was computed and compared across subject outcomes and biomarkers. Overall, 109 subjects were included. Most spike ripples were removed in subjects with ILAE 1 outcome (P < 0.001), and this was qualitatively observed across all sites and for depth and subdural electrodes (P < 0.001 and P < 0.001, respectively). Among ILAE 1 subjects, the mean spike ripple rate was higher in the resected volume (0.66/min) than in the non-removed tissue (0.08/min, P < 0.001). A higher proportion of spike ripples were removed in subjects with ILAE 1 outcomes compared with ILAE 2–6 outcomes (P = 0.06). Among ILAE 1 subjects, the proportion of spike ripples removed was higher than the proportion of spikes (P < 0.001), spike-gamma (P < 0.001), wideband HFOs (P < 0.001), ripples (P = 0.009) and fast ripples (P = 0.009) removed. At the individual level, more subjects with ILAE 1 outcomes had the majority of spike ripples removed (79%, 38/48) than spikes (69%, P = 0.12), spike-gamma (69%, P = 0.12), wideband HFOs (63%, P = 0.03), ripples (45%, P = 0.01) or fast ripples (36%, P < 0.001) removed. Thus, in this large, multicentre cohort, when surgical resection was successful, the majority of spike ripples were removed. Furthermore, automatically detected spike ripples localize the epileptogenic tissue better than spikes, spike-gamma, wideband HFOs, ripples and fast ripples. [ABSTRACT FROM AUTHOR]

Hibernation is a life history strategy for conservation of energy during adverse conditions, primarily of temperature or resource availability. Whilst energy conservation is beneficial in itself, it is less clear whether hibernation confers wider conservation benefits or mitigates or exacerbates a wide range of threats.We briefly review how hibernation manifests in mammalian biology, primarily through energy budgets, activity levels and resource requirements, but then ask how these interact with existing pressures to affect conservation risk. We also explore conservation actions that could alleviate the negative relations between some pressures and hibernation biology and review the available evidence for these measures.Hibernation can convey some protection from disease and predation, though there are notable exceptions, for example white‐nose syndrome. There is well‐established evidence that hibernators are prone to hazards of disturbance during hibernation, necessitating careful mitigation. Hibernators exhibit diverse responses to the pressures related to climate change, including temperature variability and phenological and range mismatches. Yet for each aspect, there are examples of species and populations responding negatively, such as with reduced survival, which suggests that hibernation could exacerbate the negative consequences of climate change.Though there are times when hibernators do not respond as expected, we find several positive conservation actions, such as modern grilles and regulations reducing the disturbance of cave‐hibernating bat species. Understanding and working with hibernation biology can, therefore, successfully mitigate the additional risks it confers. [ABSTRACT FROM AUTHOR]