The rod synapse in aging wildtype and Dscaml1 mutant mice.

The retina is an intricately organized neural tissue built on cone and rod pathways for color and night vision. Genetic mutations that disrupt the proper function of the rod circuit contribute to blinding diseases including retinitis pigmentosa and congenital stationary night blindness (CSNB). Down Syndrome cell adhesion molecule like 1 (Dscaml1) is expressed by rods, rod bipolar cells (RBCs), and sub-populations of amacrine cells, and has been linked to a middle age onset of CSNB in humans. However, how Dscaml1 contributes to this visual deficit remains unexplored. Here, we probed Dscaml1's role in the maintenance of the rod-to-RBC synapse using a loss of function mouse model. We used immunohistochemistry to investigate the anatomical formation and maintenance of the rod-to-RBC synapse in the young, adult, and aging retina. We generated 3D reconstructions, using serial electron micrographs, of rod spherules and RBCs to measure the number of invaginating neurites, RBC dendritic tip number, and RBC mitochondrial morphology. We find that while rod-to-RBC synapses form and are maintained, similar to wildtype, that there is an increase in the number of invaginating neurites in rod spherules, a reduction in RBC dendritic tips, and reduced mitochondrial volume and complexity in the Dscaml1 mutant retina compared to controls. We also observed precocious sprouting of RBC dendrites into the outer nuclear layer (ONL) of the Dscaml1 mutant retina compared to controls. These results contribute to our knowledge of Dscaml1's role in rod circuit development and maintenance and give additional insight into possible genetic therapy targets for blinding diseases and disorders like CSNB.

Student remote and distance research in neuroanatomy: Mapping Dscaml1 expression with a LacZ gene trap in mouse brain.

Undergraduate student engagement in research increases retention and degree completion, especially for students who are underrepresented in science. Several approaches have been adopted to increase research opportunities including curriculum based undergraduate research opportunities (CUREs), in which research is embedded into course content. Here we report on efforts to tackle a different challenge: providing research opportunities to students engaged in remote learning or who are learning at satellite campuses or community colleges with limited research infrastructure. In our project we engaged students learning remotely or at regional centers to map gene expression in the mouse brain. In this project we mapped expression of the Down syndrome cell adhesion molecule like 1 (Dscaml1) gene in mouse brain using a LacZ expression reporter line. Identifying where Dscaml1 is expressed in the brain is an important next step in determining if its roles in development and function in the retina are conserved in the rest of the brain. Students working remotely reconstruct brain montages and annotated Dscaml1 expression in the brain of mice carrying one or two copies of the gene trap. We built on these findings by further characterizing Dscaml1 expression in inhibitory neurons of the visual pathway. These results build on and extend previous findings and demonstrate the utility of including distance learners in an active research group for both the student learners and the research team. We conclude with best practices we have developed based on this and other distance learner focused projects.

Stigma, isolation, and depression among older adults living with HIV in rural areas.

There is a growing population of ageing individuals living with acquired immunodeficiency syndrome (HIV). Older adults living with HIV often contend with intersecting stigmas including HIV stigma, ageism, and for some, homonegativity and/or racism. Although the HIV stigma literature is quite robust, research on the relationship between HIV stigma, social support, and mental well-being among older adults living with HIV is limited. This study begins to address this gap by examining how intersectional stigma affects social support and mental wellbeing among rural-dwelling older adults living with HIV. Qualitative interviews were conducted by phone with 29 older adults living with HIV, over the age of 50, living in rural areas of the United States. Interviews were transcribed verbatim and analyzed using thematic content analysis in MAXQDA qualitative analysis software. Analysis revealed three primary themes. The first had to do with gossip and non-disclosure of HIV status, which intersected with ageism and homonegativity to exacerbate experiences that fell within the remaining themes of experiences of physical and psychological isolation and loneliness, and shame and silence surrounding depression. The prevalence of social isolation and the effects of limited social support among older adults living with HIV are prominent and indicate a need for tailored interventions within the HIV care continuum for older adults living with HIV.

A Qualitative Application of Diffusion of Innovations to Adolescents' Perceptions of Long-Acting Reversible Contraception's Attributes.

STUDY OBJECTIVE: Long-acting reversible contraceptive (LARC) methods are the most effective forms of reversible contraception but adolescents often opt for other, less effective methods. In this study we explored how adolescents viewed LARC as an innovation to be adopted or rejected, and how their assessment of innovation attributes affected their decisions about LARC. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Sexually active adolescents between 15 and 22 years old (n = 22) participated in semistructured qualitative interviews. The data underwent a content analysis informed by constructs of the diffusion of innovations and emergent interview themes. RESULTS: Data analysis indicated 3 subgroups of participants on the basis of their inclination to use LARC and the mutability of that position: positive/persuaded (n = 7), negative/low knowledge (n = 10), and negative/adamant (n = 5). Participants' perceptions of the relative advantage, compatibility, complexity, trialability, and observability of LARC cohered around subgroup membership. Perceived complexity entailed in obtaining LARC and fears about LARC were observed across all participants. All participants believed that one has to try LARC to know how it will work for her, personally. This led the positive/persuaded group to be undeterred by others' negative experiences with LARC and the negative/low knowledge and negative/adamant groups to decide LARC was too risky to try. CONCLUSION: Adolescents engage in nuanced evaluations of LARC, weighing competing information about LARC while receiving anecdotal and empirical information about LARC from various valid sources. To reduce the uncertainty about LARC that prohibits trying these methods, adolescents require straightforward information about LARC that directly addresses the advantages of LARC over other methods coupled with candid acknowledgement of the potential disadvantages of LARC.

Interdependent Barriers to Providing Adolescents with Long-Acting Reversible Contraception: Qualitative Insights from Providers.

STUDY OBJECTIVE: Long-acting reversible contraceptive (LARC) methods are the most effective form of reversible contraception but are underutilized by adolescents. The purpose of this study was to identify the context-specific barriers to providing adolescents with LARC that are experienced by pediatricians, family medicine physicians, and advanced practice nurses (APNs). DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: Pediatricians, family medicine providers, and APNs (n = 16) who care for adolescents participated in semistructured qualitative interviews. Interview data were analyzed using a modified grounded theory approach. MAIN OUTCOME MEASURES: Pediatricians, family medicine physicians, and APNs self-reported attitudes and practices regarding LARC provision to adolescents. RESULTS: Provider confidence in LARC, patient-centered counseling on LARC, and instrumental supports for LARC all work interdependently either in support of or in opposition to provision of LARC to adolescents. Low provider confidence in LARC for adolescents was characterized by confusion about LARC eligibility criteria and perceptions of LARC insertion as traumatic for adolescents. Patient-centered counseling on LARC required providers' ability to elicit patient priorities, highlight the advantages of LARC over other methods, and address patients' concerns about these methods. Instrumental support for LARC included provider training on LARC, access to and financial support for LARC devices, and opportunity to practice LARC insertion and counseling skills. CONCLUSION: Although none of the identified essential components of LARC provision to adolescents exist in isolation, instrumental support like provider training on LARC and access to LARC devices have the most fundamental effect on the other components and on providers' attitudes and practices regarding LARC for adolescents.