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1.
J Interprof Care ; 37(3): 392-399, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-35880787

RESUMO

Many resident physicians struggle with effective interprofessional collaboration (IPC), but characterization of their challenges is not well known. This study examines gaps in IPC skills for graduating medical students entering residency. A needs assessment was completed to evaluate factors that impact resident physicians' ability to effectively collaborate with other healthcare professionals. This study included online surveys of 123 recent medical school graduates, 21 semi-structured interviews of residency program directors, and 3 focus groups of healthcare professionals who interacted with residents. Survey results were analyzed for means and narratives from surveys, interviews, and focus groups were analyzed for themes. We found that graduates felt they did not have a strong understanding of other providers' roles and did not feel well prepared to handle conflict with other providers or navigate interprofessional team dynamics. Themes emerging from narrative data generally aligned with the Interprofessional Education Collaborative core competencies including understanding team roles, communicating effectively, and working effectively in a team, but these interviews also elucidated an additional theme, overcoming system barriers. Data from this work can inform curricula in preparation for the transition to residency. The authors also offer an educational framework for learning effective IPC as a new team member.


Assuntos
Relações Interprofissionais , Médicos , Humanos , Avaliação das Necessidades , Pessoal de Saúde , Grupos Focais
2.
Pediatr Radiol ; 52(9): 1743-1748, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35316338

RESUMO

Gender diversity in radiology has centered on the societal construct of the gender binary, with significant work focused on increasing the number of women in radiology. Along with this critically important goal, it is imperative that we acknowledge gender is more expansive than a binary category because it represents a spectrum of gender identities. The discussion of this spectrum is lacking in our conversations around gender diversity and equity in radiology. Addressing equity for people of all gender identities is beneficial for us all. We define three key areas of focus: (1) improving fundamental knowledge about gender diversity and application of this knowledge in education, (2) recruiting and retaining gender-diverse physicians and (3) specific diversity, equity and inclusion (DEI) policy to support gender-affirming environments. Improved understanding and inclusion of the full spectrum of gender in these areas will improve diversity and equity, and, in turn, enhance creativity and innovation in radiology.


Assuntos
Médicos , Radiologia , Feminino , Identidade de Gênero , Humanos
3.
J Interprof Care ; 36(6): 941-945, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34757858

RESUMO

Interprofessional experiences during medical school are often delivered during pre-clinical years, but less is known about the value of clinical students. Our institution implemented a specialty-specific interprofessiona curriculum during Residency Preparation Courses (RPCs) for senior students including didactics, clinical experiences, and a simulated paging curriculum. Our aim was to determine whether this intervention improved perceptions of interprofesiona roles. We distributed anonymous surveys before (pre-survey) and after (post-survey, collected within 2 weeks of course completion) the RPC to 90 students with questions related to interprofessional roles using a 5-point scale (1 = strongly disagree, 5 = strongly agree). Three months after the start of residency, we sent follow-up surveys inquiring about the usefulness of RPC components (1 = not at all useful, 5 = extremely useful). Response rates were 84.4% pre-survey, 63.3% post-survey, and 41.1% follow-up survey. Post-surveys indicated improvement in self-reported ability in all domains: understanding one's contributions to interprofessional teams (3.9 to 4.4, p < .0001), understanding other team members' contributions (3.9 to 4.4, p < .0001), learning from interprofessional team members (4.2 to 4.6, p = .0002), accounting for interprofessional perspectives (4.2 to 4.6, p < .0001), and co-developing effective care plans (3.9 to 4.4, p < .0001). Follow-up surveys rated clinical experiences as slightly-to-moderately useful (2.3 ± 1.0) and paging curriculum very-to-extremely useful (4.3 ± 1.0). This study demonstrates the value of interprofessional education for advanced students.


Assuntos
Internato e Residência , Estudantes de Medicina , Humanos , Faculdades de Medicina , Projetos Piloto , Relações Interprofissionais
4.
J Hepatol ; 69(2): 385-395, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29572095

RESUMO

BACKGROUND AND AIMS: Although the majority of patients with non-alcoholic fatty liver disease (NAFLD) have only steatosis without progression, a sizeable fraction develop non-alcoholic steatohepatitis (NASH), which can lead to cirrhosis and hepatocellular carcinoma (HCC). Many established diet-induced mouse models for NASH require 24-52 weeks, which makes testing for drug response costly and time consuming. METHODS: We have sought to establish a murine NASH model with rapid progression of extensive fibrosis and HCC by using a western diet (WD), which is high-fat, high-fructose and high-cholesterol, combined with low weekly dose of intraperitoneal carbon tetrachloride (CCl4), which serves as an accelerator. RESULTS: C57BL/6J mice were fed a normal chow diet ±â€¯CCl4 or WD ±â€¯CCl4 for 12 and 24 weeks. Addition of CCl4 exacerbated histological features of NASH, fibrosis, and tumor development induced by WD, which resulted in stage 3 fibrosis at 12 weeks and HCC development at 24 weeks. Furthermore, whole liver transcriptomic analysis indicated that dysregulated molecular pathways in WD/CCl4 mice and immunologic features were similar to those of human NASH. CONCLUSIONS: Our mouse NASH model exhibits rapid progression of advanced fibrosis and HCC, and mimics histological, immunological and transcriptomic features of human NASH, suggesting that it will be a useful experimental tool for preclinical drug testing. LAY SUMMARY: A carefully characterized model has been developed in mice that recapitulates the progressive stages of human fatty liver disease, from simple steatosis, to inflammation, fibrosis and cancer. The functional pathways of gene expression and immune abnormalities in this model closely resemble human disease. The ease and reproducibility of this model make it ideal to study disease pathogenesis and test new treatments.


Assuntos
Dieta Ocidental , Fígado Gorduroso , Cirrose Hepática , Neoplasias Hepáticas , Camundongos Endogâmicos C57BL , Animais , Tetracloreto de Carbono/farmacologia , Modelos Animais de Doenças , Progressão da Doença , Fígado Gorduroso/etiologia , Fígado Gorduroso/imunologia , Fígado Gorduroso/patologia , Perfilação da Expressão Gênica/métodos , Inflamação/patologia , Cirrose Hepática/etiologia , Cirrose Hepática/imunologia , Cirrose Hepática/patologia , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/patologia , Camundongos , Reprodutibilidade dos Testes
5.
Nanomedicine ; 13(1): 37-47, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27562211

RESUMO

Bone-targeted drug delivery is an active research area because successful clinical applications of this technology can significantly advance the treatment of bone injuries and disorders. Molecules with bone-targeting potential have been actively investigated as promising moieties in targeted drug delivery systems. In general, bone-targeting molecules are characterized by their high affinity for bone and their predisposition to persist in bone tissue for prolonged periods, while maintaining low systemic concentrations. Proteins, such as monoclonal antibodies, have shown promise as bone-targeting molecules; however, they suffer from several limitations including large molecular size, high production cost, and undesirable immune responses. A viable alternative associated with significantly less side effects is the use of small molecule-based targeting moieties. This review provides a summary of recent findings regarding small molecule compounds with bone-targeting capacity, as well as nanoscale targeted drug delivery approaches employing these molecules.


Assuntos
Osso e Ossos/efeitos dos fármacos , Sistemas de Liberação de Medicamentos , Nanopartículas/química , Humanos
6.
Nucleic Acids Res ; 42(2): 804-21, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24137009

RESUMO

We report that homology-directed repair of a DNA double-strand break within a single copy Green Fluorescent Protein (GFP) gene in HeLa cells alters the methylation pattern at the site of recombination. DNA methyl transferase (DNMT)1, DNMT3a and two proteins that regulate methylation, Np95 and GADD45A, are recruited to the site of repair and are responsible for selective methylation of the promoter-distal segment of the repaired DNA. The initial methylation pattern of the locus is modified in a transcription-dependent fashion during the 15-20 days following repair, at which time no further changes in the methylation pattern occur. The variation in DNA modification generates stable clones with wide ranges of GFP expression. Collectively, our data indicate that somatic DNA methylation follows homologous repair and is subjected to remodeling by local transcription in a discrete time window during and after the damage. We propose that DNA methylation of repaired genes represents a DNA damage code and is source of variation of gene expression.


Assuntos
Metilação de DNA , Reparo de DNA por Recombinação , Transcrição Gênica , Proteínas Estimuladoras de Ligação a CCAAT/metabolismo , Proteínas de Ciclo Celular/metabolismo , DNA (Citosina-5-)-Metiltransferases/metabolismo , Quebras de DNA de Cadeia Dupla , DNA Metiltransferase 3A , Proteínas de Fluorescência Verde/genética , Células HeLa , Humanos , Proteínas Nucleares/metabolismo , Ubiquitina-Proteína Ligases
7.
Hosp Pediatr ; 14(8): 690-699, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39005135

RESUMO

Jasmine is an 18-year-old Black female bringing her infant to the pediatrician for a newborn weight check. She asks her pediatrician's opinion about hormonal contraceptive injections, sharing that they were strongly recommended after she gave birth. The recommending health care provider told her, "We don't want you to end up back here any time soon." Rosita, a 16-year-old Latina female, visits her pediatrician for a well check. She reports a history of vaginal sex with 2 male partners and agrees to have a hormonal subcutaneous implant placed to avoid pregnancy. After 4 months of bothersome spotting, Rosita returns to have the implant removed. Rosita's provider strongly counsels against removal. Jasmine and Rosita are members of populations that have been systematically marginalized throughout American history. Their stories are derived from real cases and reveal how structural racism impacts modern contraceptive care. Specifically, their cases are examples of statistical discrimination, wherein the tendency to disproportionately recommend long-acting reversible contraception to historically marginalized communities does not follow the central tenants of sexual and reproductive justice, including acknowledging historical harms in health care and honoring bodily autonomy for all people. By sharing Jasmine and Rosita's stories, we use a reproductive justice lens to (1) examine the historical roots of disproportional prescription of long-acting reversible contraception to historically marginalized individuals, (2) discuss provider bias related to sexual and reproductive health care, and (3) illustrate how trauma-informed care with a recognition of historical trauma and the use of individuation can facilitate positive and equitable health outcomes.


Assuntos
Contracepção Reversível de Longo Prazo , Humanos , Feminino , Adolescente , Racismo , Hispânico ou Latino , Implantes de Medicamento , Negro ou Afro-Americano
8.
Transgend Health ; 9(3): 264-268, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39109254

RESUMO

Purpose: To compare risk of problematic internet use (PIU) and importance of digital media interactions for transgender and cisgender adolescents. Methods: A nationally representative group of adolescents took an online survey that included a measure of PIU (Problematic and Risky Internet Use Screening Scale-3 [PRIUSS-3]) and technology interactions (Adolescent Digital Technology Interactions and Importance scale). We compared mean scores for these scales and their subscales and rates of positive screens for PIU for transgender and cisgender adolescents. Results: Of 4575 adolescents participating, 53 (1.2%) were transgender, nonbinary, and gender-diverse (TNG) adolescents. TNG adolescents had higher PRIUSS-3 scores and higher mean scores for importance of technology to explore identity/go outside their offline environment. Conclusions: TNG adolescents report higher PIU risk, which may relate to differences in technology importance for this group.

9.
Clin Teach ; 21(1): e13630, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37632215

RESUMO

BACKGROUND: Medical trainees are expected to perform complex tasks while experiencing interruptions, which increases susceptibility to errors of omission. In our study, we examine whether documentation of clinical encounters increases reflective thinking and reduces errors of omission among novice learners in a simulated setting. METHODS: In 2021, 56 senior medical students participated in a simulated paging curriculum involving urgent inpatient cross-cover scenarios (sepsis and atrial fibrillation). Students responded to pages from standardized registered nurses (SRNs) via telephone, gathered history, and discussed clinical decision-making. Following the phone encounter, students documented a brief note (documentation encounter). A 'phone' score (number of checklist items completed in the phone encounter) and a 'combined' score (number of checklist items completed in the phone and documentation encounters) were calculated. Data were analyzed for differences between the phone scores (control) and combined scores using T-tests and McNemar test of symmetry. FINDINGS: Fifty-four students (96%) participated. Combined scores were higher than phone scores for sepsis (72.8 ± 11.3% vs. 67.9 ± 11.9%, p < 0.001) and atrial fibrillation (74.0 ± 10.1% vs. 67.6 ± 10.0%, p < 0.001) cases. Important items, such as ordering blood cultures for sepsis (p = 0.023) and placing the patient on telemetry for atrial fibrillation (p = 0.013), were more likely to be present when a note was documented. DISCUSSION: This study suggests that documentation provides a mechanism for learners to reflect, which could increase important diagnostic and therapeutic interventions. CONCLUSION: Documentation by novice medical learners may improve patient care by allowing for reflection and reducing errors of omission.


Assuntos
Fibrilação Atrial , Sepse , Estudantes de Medicina , Humanos , Currículo , Sepse/diagnóstico , Competência Clínica
10.
bioRxiv ; 2024 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-38915689

RESUMO

Vaccines are an indispensable public health measure that have enabled the eradication, near elimination, and prevention of a variety of pathogens. As research continues and our understanding of immunization strategies develops, subunit vaccines have emerged as exciting alternatives to existing whole vaccine approaches. Unfortunately, subunit vaccines often possess weak antigenicity, requiring delivery devices and adjuvant supplementation to improve their utility. Peptide amphiphile micelles have recently been shown to function as both delivery devices and self-adjuvanting systems that can be readily associated with molecular adjuvants to further improve vaccine-mediated host immunity. While promising, many design rules associated with the plethora of underlying adjustable parameters in the generation of a peptide amphiphile micelle vaccine have yet to be uncovered. This work explores the impact micellar adjuvant complexation method and incorporated antigen type have on their ability to activate dendritic cells and induce antigen specific responses. Interestingly, electrostatic complexation of CpG to micelles resulted in improved in vitro dendritic cell activation over hydrophobic association and antigen|adjuvant co-localization influenced cell-mediated, but not antibody-mediated immune responses. These exciting results complement those previously published to build the framework of a micelle vaccine toolbox that can be leveraged for future disease specific formulations.

12.
ACS Biomater Sci Eng ; 9(5): 2663-2671, 2023 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-37075323

RESUMO

Engineered scaffolds are commonly used to assist in cellular transplantations, providing crucial support and specific architecture for a variety of tissue engineering applications. Photopolymerization as a fabrication technique for cell scaffolds enables precise spatial and temporal control of properties and structure. One simple technique to achieve a two-dimensional structure is the use of a patterned photomask, which results in regionally selective photo-cross-linking. However, the relationships between photopolymerization parameters like light intensity and exposure time and outcomes like structural fidelity and mechanical properties are not well-established. In this work, we used photopolymerization to generate degradable polycaprolactone triacrylate (PCLTA) scaffolds with a defined microstructure. We examined the impact of light intensity and exposure time on scaffold properties such as shear modulus and micropore structure. To assess feasibility in a specific application and determine the relationship between parameter-driven properties and cell loading, we cultured retinal progenitor cells on the PCLTA scaffolds. We found that light intensity and polymerization time directly impact the scaffold stiffness and micropore structure, which in turn influenced the cell loading capacity of the scaffold. Because material stiffness and topography are known to impact cell viability and fate, understanding the effect of scaffold fabrication parameters on mechanical and structural properties is critical to optimizing cell scaffolds for specific applications.


Assuntos
Engenharia Tecidual , Alicerces Teciduais , Alicerces Teciduais/química , Engenharia Tecidual/métodos , Células-Tronco
13.
Vet Clin Pathol ; 51(2): 252-257, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35224767

RESUMO

BACKGROUND: Bacterial sepsis is a relatively common, life-threatening condition with a high case fatality rate. The current primary diagnostic tools for detecting bacterial infection in fluids are bacterial culture and fluid cytology. While culture is the gold standard, it can take up to several days for results to be made available to clinicians, which can delay recognition of bacterial sepsis and negatively impact patient outcomes. OBJECTIVES: The aim of this study was to evaluate the diagnostic accuracy of cytology for detecting bacterial infection in body fluids. METHODS: We retrospectively reviewed 10 years of medical records at the Ohio State University's Veterinary Medical Center for mammalian patients with both cytology and bacterial culture of fluid samples, including body cavity fluids (abdominal and thoracic effusion), blood, joint fluid, and CSF. The overall sensitivity and specificity of cytology relative to the reference method of bacterial culture was recorded, as well as among the subcategories of fluid type. RESULTS: The overall sensitivity and specificity of cytology for the diagnosis of sepsis were 42.6% and 93.0%, respectively. Individual sensitivities and specificities were also calculated for each fluid type. Thoracic fluid cytology had relatively high sensitivity and low specificity, in contrast to the other fluid types analyzed. CONCLUSIONS: Overall, cytology is poorly sensitive but highly specific for the detection of bacterial infection in fluid samples. The results from this study will allow a better comparison between the diagnostic accuracy of cytology and emerging diagnostic tests for the detection of bacterial sepsis in mammalian patients.


Assuntos
Infecções Bacterianas , Sepse , Animais , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/veterinária , Citodiagnóstico/métodos , Citodiagnóstico/veterinária , Humanos , Mamíferos , Estudos Retrospectivos , Sensibilidade e Especificidade , Sepse/veterinária
14.
Tissue Eng Part B Rev ; 28(4): 813-829, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34409870

RESUMO

Regenerative engineering strategies for the oral mucoperiosteum, as may be needed following surgeries, such as cleft palate repair and tumor resection, are underdeveloped compared with those for maxillofacial bone. However, critical-size tissue defects left to heal by secondary intention can lead to complications, such as infection, fistula formation, scarring, and midface hypoplasia. This review describes current clinical practice for replacing mucoperiosteal tissue, including autografts and allografts. Potentially paradigm-shifting experimental regenerative engineering strategies for mucoperiosteal wound healing, such as hybrid grafts and engineered matrices, are also discussed. Throughout the review, the advantages and disadvantages of each replacement or regeneration strategy are outlined in the context of clinical outcomes, quality of life for the patient, availability of materials, and cost of care. Finally, future directions for research and development in the area of mucoperiosteum repair are proposed, with an emphasis on identifying globally available and affordable solutions for promoting mucoperiosteal regeneration. Impact statement Unassisted oral mucoperiosteal wound healing can lead to severe complications such as infection, fistulae, scarring, and developmental abnormalities. Thus, strategies for promoting wound healing must be considered when mucoperiosteal defects are incident to oral surgery, as in palatoplasty or tumor resection. Emerging mucoperiosteal tissue engineering strategies, described in this study, have the potential to overcome the limitations of current standard-of-care donor tissue grafts. For example, the use of engineered mucoperiosteal biomaterials could circumvent concerns about tissue availability and immunogenicity. Moreover, employment of tissue engineering strategies may improve the equity of oral wound care by increasing global affordability and accessibility of materials.


Assuntos
Fissura Palatina , Neoplasias , Cicatriz , Fissura Palatina/cirurgia , Humanos , Qualidade de Vida
15.
Cell Transplant ; 31: 9636897221104451, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35758274

RESUMO

Loss of photoreceptor cells is a primary feature of inherited retinal degenerative disorders including age-related macular degeneration and retinitis pigmentosa. To restore vision in affected patients, photoreceptor cell replacement will be required. The ideal donor cells for this application are induced pluripotent stem cells (iPSCs) because they can be derived from and transplanted into the same patient obviating the need for long-term immunosuppression. A major limitation for retinal cell replacement therapy is donor cell loss associated with simple methods of cell delivery such as subretinal injections of bolus cell suspensions. Transplantation with supportive biomaterials can help maintain cellular integrity, increase cell survival, and encourage proper cellular alignment and improve integration with the host retina. Using a pig model of retinal degeneration, we recently demonstrated that polycaprolactone (PCL) scaffolds fabricated with two photon lithography have excellent local and systemic tolerability. In this study, we describe rapid photopolymerization-mediated production of PCL-based bioabsorbable scaffolds, a technique for loading iPSC-derived retinal progenitor cells onto the scaffold, methods of surgical transplantation in an immunocompromised rat model and tolerability of the subretinal grafts at 1, 3, and 6 months of follow-up (n = 150). We observed no local or systemic toxicity, nor did we observe any tumor formation despite extensive clinical evaluation, clinical chemistry, hematology, gross tissue examination and detailed histopathology. Demonstrating the local and systemic compatibility of biodegradable scaffolds carrying human iPSC-derived retinal progenitor cells is an important step toward clinical safety trials of this approach in humans.


Assuntos
Células-Tronco Pluripotentes Induzidas , Degeneração Retiniana , Retinose Pigmentar , Animais , Materiais Biocompatíveis/farmacologia , Humanos , Células-Tronco Pluripotentes Induzidas/transplante , Ratos , Retina/patologia , Degeneração Retiniana/patologia , Degeneração Retiniana/terapia , Retinose Pigmentar/terapia , Transplante de Células-Tronco/métodos , Suínos
16.
Brain Inj ; 25(2): 179-91, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21219090

RESUMO

PRIMARY OBJECTIVE: This study examined the construct and concurrent validity of ImPACT, a computerized neuropsychological test battery used for evaluating sports-related concussion. RESEARCH DESIGN: Approximately 100 neurologically intact undergraduates completed ImPACT and a battery of traditional neuropsychological tests utilized by the National Football League (NFL). METHODS AND PROCEDURES: Participants completed the two batteries in a counterbalanced order. Factor analyses examined the component structure of ImPACT and the NFL battery's factor structure. Correlational analyses assessed relationships among variables within and across the two batteries. MAIN RESULTS: A four-factor solution explaining 70% of variance was found with the NFL battery, including general memory, mental processing speed, verbal memory and processing speed and auditory and verbal working memory. A five-factor solution explaining 69% of variance was found with the ImPACT battery, with components assessing forced choice efficiency, verbal and visual memory, inhibitory cognitive abilities, visual processing abilities with a memory component and a factor with a single loading from Colour Match Total Commissions. Correlations revealed a range of significant and non-significant correlations between the two batteries. CONCLUSIONS: While both batteries overlap regarding their assessed constructs (e.g. memory, inhibitory cognitive abilities) notable differences in their factor structures were present as well.


Assuntos
Traumatismos em Atletas/psicologia , Concussão Encefálica/psicologia , Testes Neuropsicológicos/normas , Desempenho Psicomotor/fisiologia , Adulto , Análise de Variância , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Masculino , Tempo de Reação , Reprodutibilidade dos Testes
17.
Appl Neuropsychol ; 18(4): 291-7, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22074068

RESUMO

In an effort to identify four-subtest Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) short forms valid for estimating Full-Scale IQ (FSIQ) among individuals with traumatic brain injury (TBI), seven tetrad versions of the WAIS-III were evaluated in a convenience sample of patients referred for neuropsychological assessment (n = 176). Estimated FSIQ scores were compared to actual FSIQ scores via correlation analyses, repeated-measures analyses of variance (ANOVAs), and frequency analyses. All short form-estimated FSIQ scores correlated highly with actual scores (all rs > .91, ps < .001). Repeated-measures ANOVAs identified no significant differences between actual and short form-estimated FSIQ scores for two of the seven short forms. These same two short forms had the highest percentage of scores within ±5 points of actual FSIQ scores (75.6% and 71.6%). Thus, two tetrad versions were consistently superior to others in accuracy of estimating FSIQ; these may be helpful when time constraints or other issues necessitate use of an abbreviated battery for estimating FSIQ among individuals with TBI.


Assuntos
Lesões Encefálicas/diagnóstico , Lesões Encefálicas/psicologia , Escalas de Wechsler/estatística & dados numéricos , Adulto , Análise de Variância , Feminino , Humanos , Masculino
18.
JMIR Pediatr Parent ; 4(3): e25801, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34398792

RESUMO

BACKGROUND: Transgender, nonbinary, and gender-diverse (TNG) youth encounter barriers to psychosocial wellness and also describe exploring identities and communities on the web. Studies of cisgender youth connect increased digital technology use with lower well-being, parent relationships, and body image scores as well as increased loneliness and fear of missing out (FOMO). However, little is known about the psychosocial factors associated with digital technology use among TNG compared with cisgender youth. OBJECTIVE: This study aims to examine the associations between psychosocial measures and digital technology use and its importance for cisgender and TNG youth. METHODS: We surveyed a nationally representative sample of adolescents (aged 13-18 years) about psychosocial wellness and digital technology use. Psychosocial measures included assessment of well-being, parental relationships, body image, loneliness, and FOMO. Digital media use assessments included the short Problematic and Risky Internet Use Screening Scale-3 and the Adolescent Digital Technology Interactions and Importance (ADTI) scale and subscales. We compared psychosocial measures between gender identity groups. We also compared stratified correlations for psychosocial measures (well-being, parent relationships, body image, loneliness, and FOMO) with ADTI and Problematic and Risky Internet Use Screening Scale-3 scores between gender identity groups. All comparisons were adjusted for age, race, and ethnicity. RESULTS: Among 4575 adolescents, 53 (1.16%) self-identified as TNG youth. TNG youth had lower scores for well-being (23.76 vs 26.47; P<.001), parent relationships (19.29 vs 23.32; P<.001), and body image (13.50 vs 17.12; P<.001), and higher scores for loneliness (9.28 vs 6.55; P<.001) and FOMO (27.93 vs 23.89; P=.004), compared with cisgender peers. In a pattern different from that of their cisgender peers, better well-being scores and body image for TNG youth predicted higher problematic internet use (PIU) scores (correlation coefficients of 0.32 vs -0.07; P=.004 and 0.26 vs -0.21; P=.002, respectively). FOMO was a stronger positive predictor of higher ADTI total and subscale scores for cisgender youth compared with TNG youth. CONCLUSIONS: Overall, this study supports previously demonstrated disparities in the psychosocial wellness of TNG youth and adds that these disparities include loneliness and FOMO. This study shows prediction of PIU by both higher well-being and better body image, indicating that PIU may not be unilaterally driven by problematic factors among TNG youth. We suggest that this may be because of the specific digital media functions that TNG youth engage with as a disenfranchised population.

19.
Clin Teach ; 18(3): 280-284, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33465836

RESUMO

BACKGROUND: Educational handovers can provide competency information about graduating medical students to residency program directors post-residency placement. Little is known about students' comfort with this novel communication. OBJECTIVE: To examine graduated medical students' perceptions of educational handovers. METHODS: The authors created and distributed an anonymous survey to 166 medical students at a single institution following graduation in the spring of 2018. Within this cohort, 40 students had an educational handover sent to their future program director. The survey explored comfort level with handovers (1=very uncomfortable; 5=very comfortable) and ideal content (e.g., student strengths, areas for improvement, goals, grades received after residency application). Respondents self-reported their performance in medical school and whether a handover was sent. Correlation analyses examined relationships between performance and other variables. T-tests examined differences between students who did and did not have a handover letter sent. RESULTS: The survey response rate was 40.4% (67/166) - 47.8% of students felt comfortable with handovers, 19.4% were neutral, and 32.8% were uncomfortable. There was no correlation between self-reported medical school performance and comfort level. Respondents felt most strongly that strengths should be included, followed by goals. Those who had a handover letter sent expressed significantly higher comfort level (3.8 ± 1.0 vs. 2.6 ±1.3, p=0.003) with this communication. CONCLUSION: Medical students reported varying levels of comfort with educational handovers; however, those who had handovers sent had more positive perceptions. In order to improve the education continuum, it is essential to engage students in the development of this handover communication.


Assuntos
Internato e Residência , Estudantes de Medicina , Comunicação , Humanos , Percepção , Faculdades de Medicina
20.
J Ocul Pharmacol Ther ; 36(1): 42-55, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31414943

RESUMO

Purpose: Widely used approaches for retinal disease modeling and in vitro therapeutic testing can be augmented by using tissue-engineered scaffolds with a precise 3-dimensional structure. However, the materials currently used for these scaffolds are poorly matched to the biochemical and mechanical properties of the in vivo retina. Here, we create biopolymer-based scaffolds with a structure that is amenable to retinal tissue engineering and modeling. Methods: Optimal two-photon polymerization (TPP) settings, including laser power and scanning speed, are identified for 4 methacrylated biopolymer formulations: collagen, gelatin, hyaluronic acid (HA), and a 50/50 mixture of gelatin/HA, each with methylene blue as a photoinitiator. For select formulations, fabrication accuracy and swelling are determined and biocompatibility is evaluated by using human induced pluripotent stem cells and rat postnatal retinal cells. Results: TPP is feasible for each biopolymer formulation, but it is the most reliable for mixtures containing gelatin and the least reliable for HA alone. The mean size of microscaffold pores is within several microns of the intended value but the overall structure size is several times greater than the modeled volume. The addition of HA to gelatin scaffolds increases cell viability and promotes neuronal phenotype, including Tuj-1 expression and characteristic morphology. Conclusion: We successfully determined a useful range of TPP settings for 4 methacrylated biopolymer formulations. When crosslinked, these extracellular matrix-derived molecules support the growth and attachment of retinal cells. We anticipate that when combined with existing patient-specific approaches, this technique will enable more efficient and accurate retinal disease modeling and therapeutic testing in vitro than current techniques allow.


Assuntos
Matriz Extracelular/metabolismo , Gelatina/metabolismo , Ácido Hialurônico/metabolismo , Células-Tronco Pluripotentes Induzidas/metabolismo , Impressão Tridimensional , Retina/metabolismo , Animais , Sobrevivência Celular , Células Cultivadas , Matriz Extracelular/química , Gelatina/química , Humanos , Ácido Hialurônico/química , Células-Tronco Pluripotentes Induzidas/citologia , Fótons , Polimerização , Ratos , Ratos Sprague-Dawley , Retina/citologia , Engenharia Tecidual
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