Interprofessional perspectives on ACEs: Results from a statewide interprofessional training program.

BACKGROUND: Adverse childhood experiences (ACEs) are pervasive and well-recognized as having lasting deleterious effects on the physical and mental health of those who experience them, particularly with accumulated exposure. OBJECTIVE: This study seeks to identify the perspectives of interprofessional health providers on their personal and professional experiences with ACEs, ACEs screening, how to work with people with ACEs, and make recommendations for the field. PARTICIPANTS AND SETTING: Sixty-two health professionals and PhD students who completed at least one module of an online course and at least one of the accompanying discussion board sub-prompts. METHODS: Responses to five course discussion board assignments, each with multiple sub-prompts, were coded to determine and refine major themes and merged with demographic and other background data. From the 561 responses, six themes were identified and used to analyze response patterns. RESULTS: Twenty-nine percent of responses reflected a macro perspective on ACEs; 29 % of responses reflected workplace experiences; 28 % of responses reflected ACEs complexity, 8 % of responses reflected a personal relationship to ACEs, 3 % reflected perspectives on resilience; and 3 % were related to the course. Participants communicated complex understandings of ACEs, demonstrating the relevance and importance of the topic for public health training. CONCLUSIONS: Integrating ACEs training into the practice setting provides opportunities to improve the health and lives of those suffering from ACEs, especially when incorporating provider voice and perspectives.

Narratives, Sensemaking, and Didactic Relationships in Longitudinal Integrated Clerkship Education.

OBJECTIVE: To understand what longitudinal integrated clerkship (LIC) participants found meaningful and valuable about their experiences while grounded in a communicated narrative sensemaking (CNSM) framework. METHODS: Semi-structured interviews were conducted with a cohort of 3 LIC students and 7 of their 12 preceptors. Interviews were designed to elicit narratives ie time-ordered accounts of events, experiences, or reflections. Narratives were identified and coded to understand aspects of experiences. RESULTS: Participants made sense of their experiences by narrating stories of LIC length allowing relationships to grow over time in a way that gave students a holistic perspective on patient care, built deep relationships between students and preceptors, and grew student confidence. CONCLUSION: Participants value longitudinal integration in LICs because it allows for unique perspectives on patient care and builds deep meaningful mentor relationships with preceptors. Relationships in LICs must be managed carefully because much LIC learning is facilitated by relationships. The clerkship is a crucial aspect of medical education of which sense will be made by physicians during their whole lives.

Experience and Impact of COVID-19 on a Newly Formed Rural University Medical Office: Survey Study.

BACKGROUND: The COVID-19 pandemic had large social effects, particularly in the fields of medicine and medical education. Medical organizations in the United States operate in overlapping contexts with interrelated goals inside multiple organizations, and the context of work strongly influenced how organizations were able to respond to COVID-19 restrictions. OBJECTIVE: This research examines the experience and impact of COVID-19 on the implementation of a Health Resources and Services Administration grant in a newly formed university medical office with the interrelated goals of health policy, health outreach, and medical education. The goal is to understand how COVID-19 created different experiences and challenges for leaders and their collaborators working in medical education compared to those working in public health outreach or health policy. METHODS: A survey about COVID-19 opportunities and challenges was administered to work unit leaders and their project collaborators. The most common experiences and challenges are shown, direct educational and other respondents' experiences and challenges are compared, and open-ended comment segments are analyzed. RESULTS: Helping others adjust to digital work, remoteness, and coordination were common experiences during COVID-19. Common challenges include coordination and an inability to make comparisons to previous program years. On average, respondents had 11.3 (SD 7.8) experiences and 8.3 (SD 6.9) challenges considered in the survey. While all units were influenced by COVID-19 restrictions, medical education units had more experiences and challenges. Those involved directly in medical education experienced 69% (18.6/27) of their possible experiences and 54% (14.7/27) of their possible challenges on average compared to 35% (7/20) and 21% (4.2/20) among other respondents (P<.001). COVID-19 restrictions increased the complexity of project work and presented challenges, especially in terms of coordinating responses and access to locations. CONCLUSIONS: The findings suggest that COVID-19 made the overall administration of programs more complex and drew attention from other medical and public health programs. While remoteness is appropriate for some medical education tasks, it is less appropriate for clinical learning. Remoteness presents an especially large challenge to clinical education. Employees now have expectations for remoteness to be built into programs and workplaces. Program administrators will have to integrate remoteness' benefits and drawbacks into their organization for the foreseeable future.

Iberiotoxin-sensitive and -insensitive BK currents in Purkinje neuron somata.

Purkinje cells have specialized intrinsic ionic conductances that generate high-frequency action potentials. Disruptions of their Ca or Ca-activated K (KCa) currents correlate with altered firing patterns in vitro and impaired motor behavior in vivo. To examine the properties of somatic KCa currents, we recorded voltage-clamped KCa currents in Purkinje cell bodies isolated from postnatal day 17-21 mouse cerebellum. Currents were evoked by endogenous Ca influx with approximately physiological Ca buffering. Purkinje somata expressed voltage-activated, Cd-sensitive KCa currents with iberiotoxin (IBTX)-sensitive (>100 nS) and IBTX-insensitive (>75 nS) components. IBTX-sensitive currents activated and partially inactivated within milliseconds. Rapid, incomplete macroscopic inactivation was also evident during 50- or 100-Hz trains of 1-ms depolarizations. In contrast, IBTX-insensitive currents activated more slowly and did not inactivate. These currents were insensitive to the small- and intermediate-conductance KCa channel blockers apamin, scyllatoxin, UCL1684, bicuculline methiodide, and TRAM-34, but were largely blocked by 1 mM tetraethylammonium. The underlying channels had single-channel conductances of ∼150 pS, suggesting that the currents are carried by IBTX-resistant (ß4-containing) large-conductance KCa (BK) channels. IBTX-insensitive currents were nevertheless increased by small-conductance KCa channel agonists EBIO, chlorzoxazone, and CyPPA. During trains of brief depolarizations, IBTX-insensitive currents flowed during interstep intervals, and the accumulation of interstep outward current was enhanced by EBIO. In current clamp, EBIO slowed spiking, especially during depolarizing current injections. The two components of BK current in Purkinje somata likely contribute differently to spike repolarization and firing rate. Moreover, augmentation of BK current may partially underlie the action of EBIO and chlorzoxazone to alleviate disrupted Purkinje cell firing associated with genetic ataxias.

Differential processing of metacognitive evaluation and the neural circuitry of the self and others in schizophrenia: a pilot study.

BACKGROUND: Impaired awareness of the self and others (i.e., metacognitive evaluations) are seen in schizophrenia. We compared patterns of activation in schizophrenia (SZ) and nonclinical subjects during a functional magnetic resonance imaging (fMRI) task of metacognitive evaluations that has been demonstrated to engage the neural circuitry of the self in healthy subjects. METHODS: Eleven SZ subjects (7 males, mean age 26.6+/-8) and 10 healthy control subjects (4 males, mean age 29.6+/-8.4) were enrolled. Participants completed two runs of a metacognitive evaluation task (self vs. other vs. word meaning). fMRI data was obtained using a full body Bruker MedSped 4.0Tesla system. Group contrasts were performed using an uncorrected p<0.005 with a 50voxel extent threshold. RESULTS: We observed a significant hypoactivation in the left superior temporal sulcus (STS) during metacognitive evaluations of others (OE) vs. semantic positivity evaluations (SPE) and a trend toward significant hypoactivation in the OE vs. self evaluations (SE) in the SZ group. Significant hypoactivation was also seen in the right inferior temporal gyrus (ITG) in the OE vs. SE contrasts in the SZ group. A trendworthy hypoactivation was seen in the SZ group in the right middle frontal gyrus and pole of the left STS during OE vs. SPE and SE contrasts respectively. CONCLUSIONS: These results extend previous findings of impaired metacognitive evaluative processes in schizophrenia to aberrations of the neural circuitry implicated in self/other awareness among SZ patients. Greater understanding of the neural basis of deficits of self/other awareness in early schizophrenia may contribute to improvements in the identification and treatment of individuals at risk for the illness.

Stabilization of Ca current in Purkinje neurons during high-frequency firing by a balance of Ca-dependent facilitation and inactivation.

Purkinje neurons fire spontaneous action potentials at ∼50 spikes/sec and generate more than 100 spikes/sec during cerebellum-mediated behaviors. Many voltage-gated channels, including Ca channels, can inactivate and/or facilitate with repeated stimulation, raising the question of how these channels respond to regular, rapid trains of depolarizations. To test whether Ca currents are modulated during firing, we recorded voltage-clamped Ca currents, predominantly carried by P-type Ca channels, from acutely dissociated mouse Purkinje neurons at 30-33°C (1 mM Ca). With 0.5 mM intracellular EGTA, 1-second trains of either spontaneous action potential waveforms or brief depolarizing steps at 50 Hz evoked Ca tail currents that were stable, remaining within 5% of the first tail current throughout the train. Higher frequency trains (100 and 200 Hz) elicited a maximal inactivation of <10%. To test whether this stability of Ca currents resulted from a lack of modulation or from an equilibrium between facilitation and inactivation, we manipulated the permeant ion (Ca vs. Ba) and Ca buffering (0.5 vs. 10 mM EGTA). With low buffering, Ba accelerated the initial inactivation evoked by 1-second trains, but reduced its extent at 200 Hz, consistent with an early calcium-dependent facilitation (CDF) and late calcium-dependent inactivation (CDI) at high frequencies. Increasing the Ca buffer favored CDF. These data suggest that stable Ca current amplitudes result from a balance of CDF, CDI, and voltage-dependent inactivation. This modest net Ca-dependent modulation may contribute to the ability of Purkinje neurons to sustain long periods of regular firing and synaptic transmission.

Cortical activation during menopausal hot flashes.

OBJECTIVE: To determine regions of brain activation associated with menopausal hot flashes and sweating. DESIGN: Controlled laboratory study. SETTING: University medical center. PATIENT(S): Symptomatic postmenopausal women and asymptomatic eumenorrheic women. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Brain activation measured by functional magnetic resonance imaging. RESULT(S): Significant (P<.001) areas of activation during hot flashes in symptomatic women included the insula and anterior cingulate cortex. Sweating in the eumenorrheic women was associated (P<.001) with activity in the anterior cingulate and superior frontal gyrus. CONCLUSION(S): Activation of the insular cortex is associated with the "rush of heat" described during menopausal hot flashes. Thermoregulation in humans appears to be represented in a distributed cortico-subcortical network rather than in a single localized structure.