The lateral hypothalamic area (LHA) coordinates an array of fundamental behaviors, including sleeping, waking, feeding, stress and motivated behavior. The wide spectrum of functions ascribed to the LHA may be explained by a heterogeneous population of neurons, the full diversity of Reprints and permissions information is available at www.nature.com/reprints.

The lateral hypothalamic area (LHA) lies at the intersection of multiple neural and humoral systems and orchestrates fundamental aspects of behavior. Two neuronal cell types found in the LHA are defined by their expression of hypocretin/orexin (Hcrt/Ox) and melanin-concentrating hormone (MCH) and are both important regulators of arousal, feeding, and metabolism. Conflicting evidence suggests that these cell populations have a more complex signaling repertoire than previously appreciated, particularly in regard to their coexpression of other neuropeptides and the machinery for the synthesis and release of GABA and glutamate. Here, we undertook a single-cell expression profiling approach to decipher the neurochemical phenotype, and heterogeneity therein, of Hcrt/Ox and MCH neurons. In transgenic mouse lines, we used single-cell quantitative polymerase chain reaction (qPCR) to quantify the expression of 48 key genes, which include neuropeptides, fast neurotransmitter components, and other key markers, which revealed unexpected neurochemical diversity. We found that single MCH and Hcrt/Ox neurons express transcripts for multiple neuropeptides and markers of both excitatory and inhibitory fast neurotransmission. Virtually all MCH and approximately half of the Hcrt/Ox neurons sampled express both the machinery for glutamate release and GABA synthesis in the absence of a vesicular GABA release pathway. Furthermore, we found that this profile is characteristic of a subpopulation of LHA glutamatergic neurons but contrasts with a broad population of LHA GABAergic neurons. Identifying the neurochemical diversity of Hcrt/Ox and MCH neurons will further our understanding of how these populations modulate postsynaptic excitability through multiple signaling mechanisms and coordinate diverse behavioral outputs.

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Introduction Point-of-care ultrasound training beginning in undergraduate medical education reinforces anatomy and physical examination skills and enhances clinical care. Implementation in an overcrowded curriculum requires strategic planning to overcome barriers including lack of faculty and equipment. Using Kern’s six-step model as a framework, our study question was whether a longitudinal point-of-care ultrasound curriculum threaded through four years of medical school and using a novel combination of evidence-based strategies was feasible, acceptable, and resulted in students achieving ultrasound competencies by graduation. Materials and methods From 2016 to 2020, a required, vertical point-of-care ultrasound curriculum was created across all four undergraduate medical education class years, spearheaded by a single ultrasound fellowship-trained emergency physician with support from two basic anatomy faculty. We utilized strategies including handheld ultrasound devices, near-peer teaching, flipped classroom with virtual learning modules, staggered station rotations, and gamification to optimize student-instructor ratios and faculty time. Surveys and timed objective structured clinical assessments evaluated the curriculum. Results Students from the class of 2022 (n=99, 100% of class) participated in all curricular elements. Senior students answered more survey knowledge questions correctly when compared to pretest questions answered by first- and second-year students. Among 84 students who completed the survey, 75 (89%) rated their ultrasound curriculum as superior or above average. Objective structured clinical examination scores recorded for 53 students (54% of the class) demonstrated students correctly identified a median of 11-18 structures (interquartile range: 9.5-13) using point-of-care ultrasound. Conclusion Evidence-based strategies allowed faculty to develop a four-year required ultrasound curriculum that was highly acceptable by students and improved their knowledge and skills at graduation. At low cost and with few faculty, this program has been sustained for over six years.

Introduction: As the significance of social workers (SW) in improving healthcare delivery in the emergency department (ED) continues to expand, emergency physicians will increasingly be expected to effectively partner with SWs in both academic and community settings. In this scoping review we sought to provide evidence-based recommendations for effective emergency clinician educational interventions on how to incorporate SWs in the ED to address health-related social needs while also identifying directions for future research. Methods: We conducted a systematic literature review of publications in PubMed, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and APA PsycINFO. A search strategy was designed in accordance with Peer Review of Electronic Search Strategies (PRESS) guidelines. Using the scoping review framework by Arksey and O’Malley, we applied consensus-based inclusion and exclusion criteria to guide study selection. A Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) flow chart delineating the selection process was generated using Covidence. Results: Our search strategy identified nine qualifying articles for further analysis out of an initial sample of 2,119 articles. Of the nine articles that underwent full text review, 89% (8/9) evaluated a short educational didactic with or without a hands-on component to reinforce learning. Barriers to successful implementation of curricula discussed in all articles included time constraints, lack of buy-in from clinical faculty, lack of knowledge of appropriate referral sources once a problem is identified, and perceived distraction of the training from more standard clinical topics. Facilitators of curricula implementation and training success included the presence of a pre-existing and structured weekly conference schedule, ability to complete the training in a relatively short time frame or during intern orientation, presence of simulation resources, and residents’ overall perceived interest in the topics. Conclusion: Ultimately, we found that interdisciplinary learning with SWs is generally well received by participants, and we offer various suggestions on incorporation into student and resident education. Moving forward, we recommend that a standardized curriculum of working with SWs be developed using didactic sessions, simulation, and/or direct observation with feedback.