Removal and monitoring of residual nucleic acids from core streptavidin inclusion bodies for increased refolding yield.

Commercial production of recombinant streptavidin (SAV) using soluble expression route is cost-prohibitive, resulting from its inherent toxicity toward commercially available Escherichia coli hosts (such as BL21) and low productivity of existing manufacturing processes. Quality challenges can also result from binding of streptavidin in the host cells. One way to overcome these challenges is to allow formation of inclusion bodies (IBs). Nevertheless, carried-over cellular contaminants during IBs preparation can hinder protein refolding and application of SAV in nucleic acid-based applications. Hence, removing associated contaminants in recombinant IBs is imperative for maximum product outcomes. In this study, the IBs isolation method from our group was improved to remove residual DNA found in refolded core SAV (cSAV). The improvements were attained by incorporating quantitative real-time polymerase chain reactions (qPCR) for residual DNA monitoring. We attained 99 % cellular DNA removal from cSAV IBs via additional wash and sonication steps, and the addition of benzonase nuclease during lysis. A 10 % increment of cSAV refolding yield (72 %) and 83 % reduction of residual DNA from refolding of 1 mg cSAV IBs were observed under extensive sonication. Refolding of cSAV was not affected and its activity was not compromised. The optimized process reported here highlights the importance of obtaining cSAV IBs with minimal contaminants prior to refolding to increase product yield, and the usefulness of the qPCR method to monitor nucleic acid removed from each step of the process.

[Promoting Equity, Diversity, and Inclusion in Healthcare: An Example of the COVID-19 Pandemic].

Healthcare systems must embody equity, diversity, and inclusion (EDI) and, in the event of unfairness, appropriate policies / countermeasures should be enacted. The healthcare system response to the COVID-19 pandemic not only highlighted how socioeconomic disparities affect mortality risk but also posed significant challenges to the successful practice of EDI in healthcare. In light of this, this article was written to provide an overview of EDI, analyze the international efforts to promote it, and suggest strategies for promoting EDI in infectious disease healthcare using COVID-19 as an example. In healthcare settings, equity centers on ensuring patients receive fair treatment regardless of race, gender, age, or socioeconomic status; diversity centers on healthcare providers understanding the uniqueness of patients from different cultural backgrounds and the health barriers they face; and inclusion centers on ensuring patients are treated with respect and given the attention they deserve. During pandemics, social determinants of health (SDOH) greatly impact patient health outcomes and hinder the practice of EDI. Reflecting on the impact of COVID-19, healthcare systems can actively apply EDI in clinical practice to provide to all patients equitable access to healthcare opportunities and outcomes. Practical strategies include establishing EDI committees within healthcare systems, monitoring relevant data, conducting staff training, and continuously addressing the SDOH and needs of marginalized groups to achieve EDI in healthcare.

Fibroadenoma With Multiple Epidermal Inclusion Cysts Masquerading as Malignancy: An Underreported Entity With Review of Literature.

Fibroadenomas in postmenopausal women are quite uncommon, and so are epidermal inclusion cysts in the breast. The coexistence of both is very rare, and very limited literature is available about this occurrence. We report a postmenopausal female patient with complaints of breast lump masquerading as malignancy on triple assessment which upon subsequent histopathological evaluation was confirmed to be fibroadenoma with intervening multiple epidermal inclusion cysts. In addition, the epidermal inclusions cysts were seen within the fibroadenoma without any association with the overlying skin and adnexa, adding to its rarity. So far, this is probably the fourth such case report to be documented in the literature with such coexistence and the first of its kind to be reported in a postmenopausal woman.

Inclusion, reporting and analysis of demographic variables in chronobiology and sleep research.

Many aspects of sleep and circadian physiology are sensitive to participant-level characteristics. While recent research robustly highlights the importance of considering participant-level demographic information, the extent to which this information is consistently collected, and reported in the literature, remains unclear. This article investigates study sample characteristics within the published sleep and chronobiology research over the past 40 years. 6,777 articles were identified and a random sample of 20% was included. The reporting of sample size, age, sex, gender, ethnicity, level of education, socio-economic status, and profession of the study population was scored, and any reported aggregate summary statistics for these variables were recorded. We observed a significant upward trend in the reporting and analysis of demographic variables in sleep and chronobiology research. However, we found that while > 90% of studies reported age or sex, all other variables were reported in < 25% of cases. Reporting quality was highly variable, indicating an opportunity to standardize reporting guidelines for participant-level characteristics to facilitate Meta analyses.

Association of Double-Blind Reviews with Increases in Women as First Authors: An Initial Report from the Journal of Cardiac Failure.

INTRODUCTION: Women continue to remain under-represented in academic publishing in cardiology. Some evidence suggests that double-blind peer reviews may mitigate the impact of gender bias. In July 2021, the Journal of Cardiac Failure implemented a process for the conduct of double-blind reviews after previously utilizing single-blind reviews with the aim of improving author diversity. The purpose of the current manuscript was to examine the association between changes in authorship characteristics and implementation of double-blind reviews. METHODS: Manuscripts were stratified into 3 eras: March - September 2021 (Era 1 - prior to double blind reviews), March - September 2022 (Era 2), and March - September 2023 (Era 3). All article types except invited editorials were included. Data were abstracted, including names, genders, ranks, and discipline of first and senior authors. RESULTS: A total of 310 manuscripts were included in the analysis. The proportion of women first authors increased from 24% in Era 1 to 34% in Era 2 to 39% in Era 3 while the percentage of women authors serving in a senior authorship role remained fairly stable over time around 21-22%. Even after adjusting for region, article type, first author discipline, and last author gender, there was an increase in female first author over time (p= 0.015). Manuscripts with a female senior author were significantly more likely to have a female first author. CONCLUSIONS: Our findings suggest that double-blind peer review may contribute to increased gender diversity of first authors and highlight areas for future improvement for JCF and academic publishing.

Inclusion as a multi-level concept.

Research on inclusion has proliferated in the last twenty years yielding over 188 articles [1] as both academics and practitioners have come to recognize that inclusion provides an opportunity for people of different backgrounds and identities to work together successfully. Inclusion research is wide-ranging and includes multiple actors from different levels of an organization. Studies of inclusion climate, leader inclusion, workgroup inclusion and interpersonal inclusion are reviewed as these inclusionary approaches help to create environments where employees feel like they belong and are valued for their uniqueness [2]. We highlight recent trends in the inclusion literature that intersect with diversity.

Advancing Cultural Competency and Equity in Surgical Specialties (ACCESS): A Model for a Combined Resident and Faculty DEI Initiative.

BACKGROUND: Committees dedicated to diversity, equity, and inclusion (DEI) are not commonplace within departments of surgery. Even rarer are joint initiatives for residents and faculty. We aim to describe the creation of a collaborative committee within a department of surgery to better foster and advance the ideals of DEI. METHODS: An informal needs-assessment was performed amongst the general surgery residency, advanced practice practitioners, and faculty. Other DEI groups throughout the institution were engaged for feedback and interdisciplinary collaboration. RESULTS: Gaps were identified in social support for those from diverse backgrounds, advocacy and recruitment, general DEI education, and research. Three pillars were formed: Social Support, Education and Advocacy, and Research. The overall group and each pillar are co-led by residents and faculty. In less than a year, the group has launched a cultural complications morbidity and mortality curriculum, hosted the first city-wide LGTBQ+ in surgery event, created a safe space for discussion and support, and advocated for recruitment DEI initiatives. So far, the group consists of 48 residents, faculty, advanced practice practitioners, and staff. CONCLUSIONS: An intentional, collaborative effort between residents and faculty in a department of surgery can successfully result in an effective partnership to advance DEI initiatives.

A Brief Pro-Diversity Social Marketing Intervention Improves Grades and Well-Being of Students From Marginalized Groups.

Despite much research on improving intergroup relations, the evidence for long-term effects in real-world settings is mixed. We used the social marketing approach to create an "Inclusivity Page" that could be added to course syllabi. The page contained three targeted pro-diversity messages based on social norms, personal benefits, and concrete behavioral recommendations. We tested our intervention in a large randomized controlled trial in university classrooms (Nstudents = 1,799). We obtained students' course grades and overall college GPAs several years later. A subset of students also completed an outcome survey three months after the intervention. Students from underrepresented racial groups exposed to the intervention early in college had better course grades and GPAs. We also observed an enhanced sense of belonging and better emotional and physical health among students from all marginalized groups. Our research demonstrates the utility of employing a targeted approach to improve experiences of members of marginalized groups.

The criticality of language: Exploring STEM education evaluators conceptualizations of equity, diversity, and inclusion and the influence on their roles and practice.

Language is critical in evaluation. It influences understanding of goal attainment, judgments made about the quality of a program, interactions between stakeholder groups, interpretation of findings, and future actions. This paper reports research on language that unearths complexities related to the agenda of diversifying STEM and the utilization of evaluation in achieving its goal through an examination of STEM education evaluators' conceptualizations of diversity, equity, and inclusion and the implications for their practice. Data was collected via semi-structured interviews. Findings revealed (1) the multifaceted nature of terms such as equity, diversity, and inclusion, (2) the role of an evaluator is not singular, and (3) the importance of surfacing the ways in which language is both value-laden and socially shaping for potentially disrupting one's knowledge of status quo injustices.

Empowering Women in Imaging Informatics: Confronting Imposter Syndrome, Addressing Microaggressions, and Striving for Work-Life Harmony.

For the past 6 years, the Society for Imaging Informatics in Medicine (SIIM) annual meeting has provided a forum for women in imaging informatics to discuss the unique challenges they face. These sessions have evolved into a platform for understanding, sharing experiences, and developing practical strategies. The 2023 session was organized into three focus groups devoted to discussing imposter syndrome, workplace microaggressions, and work-life balance. This paper summarizes these discussions and highlights the significant themes and narratives that emerged. We aim to contribute to the larger conversation on gender equity in the informatics field, emphasizing the importance of understanding and addressing the challenges faced by women in informatics. By documenting these sessions, we seek to inspire actionable change towards a more inclusive and equitable future for everyone in imaging informatics.

The status of diversity in the heart transplant workforce.

Cardiac surgery and cardiology consistently have the lowest representation of women and racial minorities among all the specialties. The poor representation of minorities and women in cardiology and cardiac surgery is compounded by the fact that heart failure risk continues to rise in the United States (US) and disproportionately affects non-white patients. Inclusion in academia is imperative in diversifying the workforce and in turn, in improving the care we provide to all of our patients.

Dependence of the crystal structure on the d-units amount in semi-crystalline poly(lactic acid).

The study investigates the impact of the d-lactic acid units content on the crystallinity and crystal structure of commercial poly(lactic acid) (PLA) grades, which are copolymers of poly(l-lactic acid) (PLLA) containing a minor amount of d-units. As the d-units content increases, a detectable decrease in crystallinity was observed along with a simultaneous rise in mobile amorphous fraction (MAF) and a reduction in rigid amorphous fraction (RAF). The percentage of d-units was found not to significantly affect RAF thickness, suggesting that the d-units are not completely excluded from the crystals. The inclusion of d-units as defects in the PLA crystal lattice was confirmed by XRD analysis, which disclosed that the crystal phase gets gradually richer of d-units as the crystallization time evolves. FT-IR analysis proved that the incorporation of d-units in the crystal phase is promoted by the formation of local CH3···O=C interactions, similar to those massively active between PLLA and poly(d-lactic acid) (PDLA) in the stereocomplex. The establishment of these interactions leads to a contraction of the interplanar distances and a decrease in the crystal cell volume with increasing the crystallization time and the d-units percentage. In summary, the study proves that for PLA copolymers containing a d-units percentage at least up to about 8 %, d-units are included in the crystal lattice.

"You Are the Expert of Your Own Experience": A Thematic Analysis of Experiences of Autism and Gender Diversity in Adulthood.

Background: Autistic people are more likely to report gender dysphoric traits, and transgender and gender-expansive individuals frequently report higher scores on self-report measures of autistic traits. Despite the clear association between autism and gender diversity, there is a dearth of qualitative research exploring the lived experiences of autistic adults. Methods: This study contributes to the evidence base by exploring the strengths and challenges of the intersectional experiences of autism and gender diversity in adulthood. Twelve transgender/gender-expansive autistic people participated in an online semi-structured interview or an open-ended survey, and reflexive thematic analysis was used to analyze the data. Results: Three main themes were identified: (1) Navigating a gender journey, (2) The impact of social context on self, and (3) Provision of health care. Conclusion: The findings highlight the importance of acknowledging the unique experiences of being both an autistic and transgender/gender-expansive person to further understand the intersection between autism and gender diversity.

Why is this an important issue? Qualitative research investigating the experiences of autistic people who identify as transgender and gender-expansive (TGE) is limited. However, the overlap between autism and gender diversity is evident. Transgender and gender-expansive people often score higher on measures of autistic traits, and autistic people score higher on measures of gender dysphoric traits. The lack of qualitative research investigating this overlap needs to be addressed to understand how individuals navigate being an autistic transgender/gender-expansive (ATGE) adult. What was the purpose of this study? We aimed at identifying the experiences and needs of an underserved community. The questions developed for this study aimed at capturing an understanding of the intersection of autism and gender diversity in adulthood, beyond gender dysphoria. By focusing on the needs and preferences of ATGE adults within health care, this study aimed at informing future policy, research, and clinical practice. What did the researchers do? We recruited 12 ATGE adults through social media. Participants answered questions about their experiences of being an ATGE adult through a semi-structured interview or an online open-ended survey. We then analyzed their interviews and identified patterns and themes in what they said. All the data was then combined to tell the story of this sample of ATGE adults. What were the results of the study? The adults in this study said that exploring their gender identity as an autistic person was a different journey to neurotypical cisgender people. Some described how being autistic had led them to differences in understanding gender, and many participants described how being a part of two marginalized groups led to increased discrimination and invalidation. Despite this, participants described a strong desire to be their authentic selves regardless of societal expectations. Having access to friendships with ATGE peers was useful for reducing isolation and providing a safe outlet for discussion. These friendships were essential, as many spoke about their strained relationships with familial and romantic/intimate bonds. Participants described their frustration with the health care system when working with ATGE adults and expressed their desires for good health care. What do these findings add to what was already known? The study adds to our understanding of the experiences of ATGE adults; in particular, the impact that being ATGE can have on intimate/romantic relationships. The ATGE adults also describe increased resilience against the effects of dual marginalization. Some participants also felt that their understanding of their gender identity was not impacted by being an autistic person. What are potential weaknesses in the study? A key weakness of this study was the lack of ethnic/racial diversity of the sample. The use of qualitative surveys could be considered a potential weakness. However, by offering participation through an online semi-structured interview or an online open-ended survey, this study promoted the inclusion of autistic adults in research. How will these findings help autistic adults now or in the future? Our findings show that it is important for medical providers and academics to listen to ATGE adults. Their voices should also be highlighted within academic research to further understand the overlap between autism and gender diversity. Participants said that they were happy that people were talking and willing to learn more. This helped them understand themselves more, which, in turn, can help other autistic people to understand themselves.

Crystal structure and supra-molecular features of a host-guest inclusion complex based on A1/A2-hetero-difunctionalized pillar[5]arene.

A host-guest supra-molecular inclusion complex was obtained from the co-crystallization of A1/A2-bromo-but-oxy-hy-droxy difunctionalized pillar[5]arene (PilButBrOH) with adipo-nitrile (ADN), C47H53.18Br0.82O10·C6H8N2. The adipo-nitrile guest is stabilized within the electron-rich cavity of the pillar[5]arene host via multiple C-H⋯O and C-H⋯π inter-actions. Both functional groups on the macrocyclic rim are engaged in supra-molecular inter-actions with an adjacent inclusion complex via hydrogen-bonding (O-H⋯N or C-H⋯Br) inter-actions, resulting in the formation of a supra-molecular dimer in the crystal structure.

Socio-ethical challenges and opportunities for advancing diversity, equity, and inclusion in digital medicine.

Digitalization in medicine offers a significant opportunity to transform healthcare systems by providing novel digital tools and services to guide personalized prevention, prediction, diagnosis, treatment and disease management. This transformation raises a number of novel socio-ethical considerations for individuals and society as a whole, which need to be appropriately addressed to ensure that digital medical devices (DMDs) are widely adopted and benefit all patients as well as healthcare service providers. In this narrative review, based on a broad literature search in PubMed, Web of Science, Google Scholar, we outline five core socio-ethical considerations in digital medicine that intersect with the notions of equity and digital inclusion: (i) access, use and engagement with DMDs, (ii) inclusiveness in DMD clinical trials, (iii) algorithm fairness, (iv) surveillance and datafication, and (v) data privacy and trust. By integrating literature from multidisciplinary fields, including social, medical, and computer sciences, we shed light on challenges and opportunities related to the development and adoption of DMDs. We begin with an overview of the different types of DMDs, followed by in-depth discussions of five socio-ethical implications associated with their deployment. Concluding our review, we provide evidence-based multilevel recommendations aimed at fostering a more inclusive digital landscape to ensure that the development and integration of DMDs in healthcare mitigate rather than cause, maintain or exacerbate health inequities.

Incorporating multiracial and multiethnic experiences into genetic counseling practice and research: A necessary opportunity.

The conflation of race and genetic ancestry can have harmful consequences. Biological conceptualizations of race have long been used to justify inequities and distract from social structures that afford opportunities to some that are unjustly denied to others. Despite recent efforts within the scientific community to distinguish between the sociopolitical constructs of race and ethnicity and the biological constructs of genetic ancestry and genetic similarity, their conflation continues to influence genomic research and its translation into clinical care. One overlooked aspect of this problematic conflation is the extent to which discrete monoracial and monoethnic categorization systems persist and perpetuate unequal benefit-sharing in the clinical translation of genomic technologies. In genetic service delivery, reliance on discrete racial and ethnic categories undermines the clinical translation of genomic technologies for large segments of the global population. For multiracial and multiethnic individuals, who have complex identities that defy discrete categorization systems, the potential benefits of genomic discoveries are especially elusive. Scholars have recently begun to call for the inclusion of multiracial, multiethnic, and admixed individuals in race, ethnicity, and ancestry frameworks in genetics and genomics. However, little work has been done to explore and address the unique challenges and opportunities posed by multiracial/multiethnic individuals in genetic counseling specifically. We discuss how conceptualizing diversity along discrete racial and ethnic lines perpetuates inequitable patient care and limits efforts to increase inclusion and belonging within genetic counseling. Moreover, we argue that ongoing efforts to mitigate racial inequity must actively challenge the paradigm of monoracial and monoethnic categories to accomplish their goal.

Strategically communicating inclusion efforts at hospitals: Trust-signalling for community engagement.

Trust is a challenging and complex concept and takes on particular significance in the context of community engagement and communication in healthcare. For the purpose of making health services more inclusive and of tackling discrimination where it occurs, there is a need to articulate a vision for inclusion that communities of historically disadvantaged or stigmatised patients can trust. This article considers examples of diversity and inclusion 'signals' on the public websites of two large public hospitals in Melbourne, Australia. We suggest that there is value in public communications reaffirming respect for diversity and a commitment to inclusion in health services. We also make the case for interdisciplinary research into how trust-signalling strategies, that is, rhetorical strategies employed to reassure or convince, are developed by and for health services for the purposes of community engagement, and the specific effects that they may engender. Websites' framing of messages that affirm institutional commitments to fostering an inclusive environment and addressing barriers can serve as a means of explicitly encouraging patients and healthcare workers from marginalised communities to overcome potential obstacles to fuller healthcare engagement and workforce participation respectively.