Objectives Altered brain iron homeostasis with regional iron deficiency has been previously reported in several studies of restless legs syndrome patients. Inconsistencies still exist, however, in the reported iron changes in different brain regions and different restless legs syndrome phenotypes. The purpose of this study was to assess differences in brain iron concentrations compared to healthy controls and their relation to disease severity and periodic limb movements during sleep in idiopathic restless legs syndrome patients. Methods Assessment of brain iron was done using quantitative magnetic susceptibility measurement, which has been shown to correlate well with tissue iron content in brain gray matter. Thirty-nine restless legs syndrome patients and 29 age-matched healthy controls were scanned at 7 Tesla. Magnetic susceptibilities in substantia nigra, thalamus, striatum and several iron-rich gray matter regions were quantified and compared with related clinical measures. Results Compared to healthy controls, restless legs syndrome patients showed significantly decreased magnetic susceptibility in the thalamus and dentate nucleus. No significant difference was found in the substantia nigra between restless legs syndrome patients and healthy controls, but a significant correlation was observed between magnetic susceptibility in substantia nigra and the periodic limb movements during sleep measure. Conclusions Using quantitative magnetic susceptibility as an in vivo indicator of brain iron content, the present study supports the general hypothesis of brain iron deficiency in restless legs syndrome and indicates its possible link to periodic limb movements during sleep.

The rise in social media use among emerging adults in the United States has been well-documented, but researchers are still working on identifying how the type—not just the frequency—of use impacts psychological well-being. We identified “profiles” of social media use among young adults based on the frequency and purposes of use, and examined their associations with benefits and harms to psychosocial well-being, using data from 2828 incoming undergraduate students (Mage = 18.29 years; age range: 17 to 25 years). Using Latent Profile Analysis, we identified three unique profiles of individuals who used social media with varying levels of intensity across different purposes: Active Users (32.4%), Passive Users (25.3%), and Average Users (42.4%). Each profile was associated with varying levels of beneficial and harmful psychosocial outcomes. Compared to Average Users, (a) Active Users reported significantly better psychosocial well-being, but also more harmful outcomes; and (b) Passive Users experienced significantly lower levels of perceived social media benefits and social connectedness, while also reporting less problematic social media use and social media stress. Implications of these findings for research and practice are discussed.

Objective: To define medical student goals in the neurology clerkship and explore the association between goal setting and student performance, clerkship satisfaction, self-directed learning (SDL), and interest in neurology.Methods: A 4-year prospective study of consecutive second-to fourth-year medical students rotating through a required 4-week neurology clerkship was conducted. A goal-generating cohort (first 2 years) was enrolled to describe the breadth of student-derived goals. A goal-evaluating cohort (second 2 years) was used to evaluate the frequency of goal achievement and assess associations with performance (e.g., National Board of Medical Examiners [NBME], examination), satisfaction, and SDL behaviors (both based on 5-point Likert scale).Results: Of 440 evaluable students, 201 were goal-generating and 239 goal-evaluating. The top 3 goals were (1) improvement in neurologic examination, (2) understanding neurologic disease, and (3) deriving a differential diagnosis. More than 90% (n 5 216/239) of students reported achieving goals. Achievers reported significantly higher clerkship satisfaction (4.2 6 0.8 vs 2.8 6 1.0, p , 0.0001), greater interest in neurology (71% vs 35%, p 5 0.001), and higher observed tendency toward SDL (4.5 6 0.5 vs 4.1 6 0.8, p , 0.0001). After adjusting for age and training, NBME scores were 1.7 points higher in achievers (95% confidence interval 0.1-3.2, p 5 0.04). Conclusion:Students consistently generated similar goals for a required neurology clerkship.Goal achievers had better adjusted standardized test scores, higher satisfaction, and greater tendency toward SDL. This student-generated, goal-setting program may be particularly appealing to clinicians, educators, and researchers seeking resource-lean mechanisms to improve student experience and performance in the clinical clerkships. Neurology ® 2016;86:684-691 GLOSSARY CI 5 confidence interval; NBME 5 National Board of Medical Examiners; NCC 5 neurology core clerkship; SDL 5 selfdirected learning.Goal setting is an essential component of medical practice. Physicians and patients routinely set treatment goals, therapists and physiatrists begin rehabilitation with shared team goal setting, health care teams work to establish goals of care, and numerous practitioners use goal setting to change social and behavioral habits to improve health. Goal setting is also an important component of medical education. Goal-setting theory has influenced student, teacher, and curricular design for more than 4 decades. 1 The importance of goal setting is not new to education. Learning objectives in the clerkships have long represented instructor-generated expectations and provide the basis for assessment.2,3 Student-derived goals also provide a crucial method for self-reflection, motivation, and verbalization of student expectations. 4 Numerous studies have evaluated the effects of goal setting on nonmedical learners, 4,5 firstyear and senior medical students, and residents. [6][7][8][9][10][11] Two studies evaluating goal setting in ...

Objective To characterize features of medical student exposure to difficult conversations during a neurology core clerkship. MethodsThis was a cross-sectional concurrent nested mixed methods study, and all students rotating through a required neurology clerkship between 2014 and 2015 were enrolled. Data collection included an electronic communication tracker, baseline and end-of-clerkship surveys, and 4 facilitated focus groups. Students were asked to log exposure to patient-clinician conversations about (1) new disability, (2) poor prognosis, (3) prognostic uncertainty (4), terminal diagnosis, and (5) end-of-life care. ResultsA total of 159 students were enrolled and 276 conversations were tracked. Most (70%) students observed at least 1 difficult conversation, and conversations about poor prognosis, new disability, and prognostic uncertainty were most commonly logged. At clerkship end, most students (87%) desired additional bedside training in communication skills. Exposure to one of the predefined conversation types did not improve student perceived preparedness to lead difficult conversations in the future. In focus groups, students noted that the educational value of observation of a difficult conversation could be optimized with preconversation planning and postconversation debriefing. ConclusionsDifficult conversations are common in neurology, and represent a valuable opportunity to provide communication skills training on the wards. Future curricula should consider ways to leverage these existing opportunities to enhance communication skills training.