Exploring accommodations along the education to employment pathway for deaf and hard of hearing healthcare professionals.

BACKGROUND: Deaf and hard of hearing (DHH) people are an underserved population and underrepresented among healthcare professionals. A major barrier to success for DHH healthcare professionals is obtaining effective accommodations during education and employment. Our objective: describe DHH individuals' experiences with accommodations in healthcare education. METHODS: We used an online survey and multipronged snowball sampling to recruit participants who identify as DHH and who had applied to a U.S. health professional school (regardless of acceptance status). One hundred forty-eight individuals representing multiple professions responded; 51 had completed their training. Over 80% had been accepted to, were currently enrolled, or had completed health professions schools or residency programs, and/or were employed. The survey included questions addressing experiences applying to health professions programs and employment; satisfaction with accommodations in school and training; having worked with a disability resource professional (DRP); and depression screening. RESULTS: Use and type of accommodation varied widely. While in school, respondents reported spending a mean of 2.1 h weekly managing their accommodations. Only 50% were highly satisfied with the accommodations provided by their programs. Use of disability resource providers (DRPs) for accommodations was highest during school (56%) and less frequent during post-graduate training (20%) and employment (14%). Respondents who transitioned directly from school to employment (versus via additional training) were more satisfied with their accommodations during school and were more likely to find employment (p = 0.02). Seventeen respondents screened positive for risk of depression; a positive screen was statistically associated with lower school accommodation satisfaction. CONCLUSIONS: DHH people study and practice across many health professions. While respondents were mostly successful in entering health professions programs, accommodation experiences and satisfaction varied. Satisfaction with accommodations was related to successful employment and wellness. Low satisfaction was associated with higher likelihood of depression symptoms. To increase representation in the workforce, healthcare professional schools, training programs, and employers should enhance support for the learning and working climates for people with disabilities.

Radiomic biomarkers informative of cancerous transformation in neurofibromatosis-1 plexiform tumors.

BACKGROUND: This study explores whether objective, quantitative radiomic biomarkers derived from magnetic resonance (MR), positron emission tomography (PET), and computed tomography (CT) may be useful in reliably distinguishing malignant peripheral nerve sheath tumors (MPNST) from benign plexiform neurofibromas (PN). METHODS: A registration and segmentation pipeline was established using a cohort of NF1 patients with histopathological diagnosis of PN or MPNST, and medical imaging of the PN including MR and PET-CT. The corrected MR datasets were registered to the corresponding PET-CT via landmark-based registration. PET standard-uptake value (SUV) thresholds were used to guide segmentation of volumes of interest: MPNST-associated PET-hot regions (SUV≥3.5) and PN-associated PET-elevated regions (2.0

A phenotype intermediate between Desbuquois dysplasia and diastrophic dysplasia secondary to mutations in DTDST.

We describe a child whose original clinical and radiologic manifestations led to a diagnosis of Desbuquois dysplasia. Subsequent development of features including cervical kyphosis and cystic ears caused us to reconsider the original diagnosis. The new complement of features in this patient fell in a range between Desbuquois dysplasia and diastrophic dysplasia. Molecular testing showed that she is a compound heterozygote for mutations in the diastrophic dysplasia sulfate transporter gene (DTDST). This finding confirms that there is locus heterogeneity in apparent Desbuquois dysplasia. It also expands the phenotypic spectrum of disorders caused by mutations in DTDST.

Mitochondrial DNA mutations, oxidative stress, and apoptosis in mammalian aging.

Mutations in mitochondrial DNA (mtDNA) accumulate in tissues of mammalian species and have been hypothesized to contribute to aging. We show that mice expressing a proofreading-deficient version of the mitochondrial DNA polymerase g (POLG) accumulate mtDNA mutations and display features of accelerated aging. Accumulation of mtDNA mutations was not associated with increased markers of oxidative stress or a defect in cellular proliferation, but was correlated with the induction of apoptotic markers, particularly in tissues characterized by rapid cellular turnover. The levels of apoptotic markers were also found to increase during aging in normal mice. Thus, accumulation of mtDNA mutations that promote apoptosis may be a central mechanism driving mammalian aging.

Quinolone resistance. Susceptibility data from a 300-bed community hospital.

Introduction of the fluoroquinolones has altered physician prescribing practices in the treatment of infectious diseases for both inpatients and outpatients. To evaluate the impact of unrestricted prescribing of these agents, the antimicrobial susceptibility of clinical isolates to ciprofloxacin and other commonly used antibiotics was prospectively studied in a 300-bed community teaching hospital. Only 0.6 percent (nine of 1,454 isolates) of fresh clinical isolates were resistant to ciprofloxacin (minimal inhibitory concentration value greater than 2 micrograms/ml) in an initial study conducted between 1984 and 1985. A similar pattern was observed in the second half of 1987 (0.5 percent, or five of 940 isolates), just prior to the release of ciprofloxacin. Throughout 1988, however, as quinolone usage rose, the incidence of ciprofloxacin resistance rose, reaching a peak of 4.0 percent in the last quarter of 1988. Of 63 ciprofloxacin-resistant isolates in 1988, 22 were Pseudomonas and 28 were staphylococci, representing resistance rates of 6.5 and 4.2 percent, respectively. Enterobacteriaceae remained exquisitely susceptible with only five of 1,720 isolates (0.3 percent) resistant to ciprofloxacin. Seventy-two percent of ciprofloxacin-resistant isolates were recovered from patients who had received a fluoroquinolone within the previous month. If these isolates are subtracted from the total number of resistant micro-organisms recovered, baseline fluoroquinolone resistance did not change significantly from 1984 to 1988. Soft-tissue infections (50 percent) represented the greatest source of ciprofloxacin-resistant organisms, including osteomyelitis, but urinary tract infections (26 percent), all associated with instrumentation, were also a significant source. Although the fluoroquinolones are extremely valuable antimicrobial agents, the emergence of drug resistance may be promoted when these drugs are used for treatment of chronic infections or when poorly drained abscesses, necrotic tissue, or indwelling foreign bodies are present.