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1.
PLoS One ; 15(10): e0234673, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002006

RESUMO

While flow is known to be a major driver of estuarine ecosystems, targeted flow manipulations are rare because tidal systems are extremely variable in space and time, and because the necessary infrastructure is rarely available. In summer 2018 we used a unique water control structure in the San Francisco Estuary (SFE) to direct a managed flow pulse into Suisun Marsh, one of the largest contiguous tidal marshes on the west coast of the United States. The action was designed to increase habitat suitability for the endangered Delta Smelt Hypomesus transpacificus, a small osmerid fish endemic to the upper SFE. The approach was to operate the Suisun Marsh Salinity Control Gates (SMSCG) in conjunction with increased Sacramento River tributary inflow to direct an estimated 160 x 106 m3 pulse of low salinity water into Suisun Marsh during August, a critical time period for juvenile Delta Smelt rearing. Three-dimensional modeling showed that directing additional low salinity water into Suisun Marsh ("Flow Action") substantially increased the area of low salinity habitat for Delta Smelt that persisted beyond the period of SMSCG operations. Field monitoring showed that turbidity and chlorophyll were at higher levels in Suisun Marsh, representing better habitat conditions, than the upstream Sacramento River region throughout the study period. The Flow Action had no substantial effects on zooplankton abundance, nor did Suisun Marsh show enhanced levels of these prey species in comparison to the Sacramento River. Fish monitoring data suggested that small numbers of Delta Smelt colonized Suisun Marsh from the Sacramento River during the 2018 Flow Action. Comparison of the salinity effects of the Flow Action to historical catch data for Suisun Marsh further supported our hypothesis that the Flow Action would have some benefit for this rare species. Our study provides insight into both the potential use of targeted flow manipulations to support endangered fishes such as Delta Smelt, and into the general response of estuarine habitat to flow management.


Assuntos
Monitorização de Parâmetros Ecológicos , Estuários , Osmeriformes , Animais , Ecossistema , Espécies em Perigo de Extinção , Microcystis/crescimento & desenvolvimento , Osmeriformes/crescimento & desenvolvimento , Rios , Salinidade , São Francisco , Áreas Alagadas , Zooplâncton/crescimento & desenvolvimento
3.
J Interprof Care ; 34(5): 694-697, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32917114

RESUMO

This report describes an interprofessional rotation for pharmacy and medical students focused on telehealth outreach to patients at high risk for delays in care due to the COVID-19 pandemic. The curriculum was designed around core competencies of interprofessional education. Student activities included participating in interprofessional huddles, collaborating on patient interviews, and practicing interprofessional communication. Three pharmacy students and two medical students completed the rotation. Evaluation was conducted via survey and exit interview. All students successfully increased their knowledge of their own and others' professional roles and demonstrated interprofessional communication and collaboration through telehealth.


Assuntos
Comportamento Cooperativo , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Encaminhamento e Consulta , Estudantes de Medicina , Estudantes de Farmácia , Telemedicina , Betacoronavirus , Currículo , Humanos , São Francisco , Inquéritos e Questionários
4.
West J Emerg Med ; 21(5): 1095-1101, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970560

RESUMO

The unprecedented COVID-19 pandemic has resulted in rapidly evolving best practices for transmission reduction, diagnosis, and treatment. A regular influx of new information has upended traditionally static hospital protocols, adding additional stress and potential for error to an already overextended system. To help equip frontline emergency clinicians with up-to-date protocols throughout the evolving COVID-19 crisis, our team set out to create a dynamic digital tool that centralized and standardized resources from a broad range of platforms across our hospital. Using a design thinking approach, we rapidly built, tested, and deployed a solution using simple, out-of-the-box web technology that enables clinicians to access the specific information they seek within moments. This platform has been rapidly adopted throughout the emergency department, with up to 70% of clinicians using the digital tool on any given shift and 78.6% of users reporting that they "agree" or "strongly agree" that the platform has affected their management of COVID-19 patients. The tool has also proven easily adaptable, with multiple protocols being updated nearly 20 times over two months without issue. This paper describes our development process, challenges, and results to enable other institutions to replicate this process to ensure consistent, high-quality care for patients as the COVID-19 pandemic continues its unpredictable course.


Assuntos
Betacoronavirus , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/terapia , Sistemas de Apoio a Decisões Clínicas , Serviços Médicos de Emergência/métodos , Pneumonia Viral/terapia , Atitude do Pessoal de Saúde , Protocolos Clínicos , Árvores de Decisões , Eficiência , Emergências , Humanos , Internet , Pandemias , Padrões de Prática em Enfermagem/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Desenvolvimento de Programas , São Francisco
5.
PLoS Comput Biol ; 16(9): e1007833, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32881872

RESUMO

Since 2015, we have run a free 9-week summer program that provides non-computer science (CS) undergraduates at San Francisco State University (SFSU) with experience in coding and doing research. Undergraduate research experiences remain very limited at SFSU and elsewhere, so the summer program provides opportunities for many more students beyond the mentoring capacity of our university laboratories. In addition, we were concerned that many students from historically underrepresented (HU) groups may be unable to take advantage of traditional summer research programs because these programs require students to relocate or be available full time, which is not feasible for students who have family, work, or housing commitments. Our program, which is local and part-time, serves about 5 times as many students as a typical National Science Foundation (NSF) Research Experiences for Undergraduates (REU) program, on a smaller budget. Based on our experiences, we present 10 simple rules for busy faculty who want to create similar programs to engage non-CS HU undergraduates in computational research. Note that while some of the strategies we implement are based on evidence-based publications in the social sciences or education research literature, the original suggestions we make here are based on our trial-and-error experiences, rather than formal hypothesis testing.


Assuntos
Metodologias Computacionais , Educação/métodos , Universidades , Humanos , Ciência da Informação/educação , Ciência da Informação/organização & administração , Internet , Desenvolvimento de Programas , São Francisco , Estudantes
6.
Waste Manag ; 118: 369-379, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32927390

RESUMO

The Commercial and Industrial (C&I) waste stream is complex due to the diversity of material generated and variation in businesses by activity and size. Businesses in England generate more waste than households but despite this the C&I waste stream has historically been overlooked in waste policy. Many Small and Medium Enterprises (SMEs) do not segregate dry recyclable materials and biowaste for separate collection leading to resources being wasted. Implementing smarter systems for managing waste from SMEs will be a key component of developing circular cities. In England the government has pledged to improve the management of waste from businesses - however it is uncertain what interventions, if any, it will make. This paper evaluates the mandatory requirement for businesses to separate out dry recyclable materials and biowaste in 42 global cities. The results highlight the patchwork of legislation towards C&I waste with 27 cities having no mandatory requirement for businesses to segregate material. Where the requirement was mandatory, the approach varied from being fully mandated to having exemptions based on the type and size of business, and levels of waste generated. From the legislation in these cities eight scenarios were modelled to assess what impact these interventions could have in England based on waste data collected from 62 SMEs. Mandatory separation of dry recyclable materials and biowaste for all SMEs based on the approach in San Francisco would have the biggest impact leading to 67.2% additional waste being separated - an average of 31.1 kg/week for the SMEs sampled.


Assuntos
Eliminação de Resíduos , Gerenciamento de Resíduos , Cidades , Inglaterra , Reciclagem , São Francisco
7.
Nat Commun ; 11(1): 4698, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943630

RESUMO

Given the limited availability of serological testing to date, the seroprevalence of SARS-CoV-2-specific antibodies in different populations has remained unclear. Here, we report very low SARS-CoV-2 seroprevalence in two San Francisco Bay Area populations. Seroreactivity was 0.26% in 387 hospitalized patients admitted for non-respiratory indications and 0.1% in 1,000 blood donors in early April 2020. We additionally describe the longitudinal dynamics of immunoglobulin-G (IgG), immunoglobulin-M (IgM), and in vitro neutralizing antibody titers in COVID-19 patients. The median time to seroconversion ranged from 10.3-11.0 days for these 3 assays. Neutralizing antibodies rose in tandem with immunoglobulin titers following symptom onset, and positive percent agreement between detection of IgG and neutralizing titers was >93%. These findings emphasize the importance of using highly accurate tests for surveillance studies in low-prevalence populations, and provide evidence that seroreactivity using SARS-CoV-2 anti-nucleocapsid protein IgG and anti-spike IgM assays are generally predictive of in vitro neutralizing capacity.


Assuntos
Anticorpos Neutralizantes/sangue , Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Anticorpos Antivirais/imunologia , Técnicas de Laboratório Clínico , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/imunologia , São Francisco/epidemiologia , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , Testes Sorológicos/métodos
8.
PLoS One ; 15(8): e0238361, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866211

RESUMO

The San Francisco Bay outflow creates a tidally influenced low-salinity plume that affects adjacent coastal sites. In the study region, Anthopleura elegantissima (Cnidaria; Anthozoa) hosts a single symbiont, the dinoflagellate Breviolum muscatinei. Salinity, temperature, and aerial stress induce a bleaching response similar to corals where symbionts are expelled, causing further energetic stress. Using field observations of environmental conditions and symbiont abundance at sites on a gradient of exposure to estuarine outflow, along with a fully crossed multifactorial lab experiment, we tested for changes in symbiont abundance in response to various combinations of three stressors. Lab experiments were designed to mimic short term outflow events with low salinity, high temperature, and aerial exposure treatments. The lab aerial exposure treatment was a statistically significant factor in suppressing symbiont repopulation (ANOVA, p = .017). In the field, symbiont density decreased with increasing tidal height at the site closest to freshwater outflow (ANOVA, p = .007), suggesting that aerial exposure may affect symbiont density more than sea surface temperature and salinity. Unanticipated documentation of survival in 9 months of sand burial and subsequent repopulation of symbionts is reported as a six-month extension to past observations, exemplifying strong tolerance to environmental insult in this Cnidarian mutualism. The study of this symbiosis is useful in examining predicted changes in ocean conditions in tidepool communities and considering relative sources of stress.


Assuntos
Antozoários/fisiologia , Dinoflagelados/fisiologia , Anêmonas-do-Mar/fisiologia , Simbiose/fisiologia , Animais , Água Doce , Temperatura Alta , São Francisco , Temperatura
9.
Science ; 370(6516): 575-579, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-32972991

RESUMO

Actions taken to control the coronavirus disease 2019 (COVID-19) pandemic have conspicuously reduced motor vehicle traffic, potentially alleviating auditory pressures on animals that rely on sound for survival and reproduction. Here, by comparing soundscapes and songs across the San Francisco Bay Area before and during the recent statewide shutdown, we evaluated whether a common songbird responsively exploited newly emptied acoustic space. We show that noise levels in urban areas were substantially lower during the shutdown, characteristic of traffic in the mid-1950s. We also show that birds responded by producing higher performance songs at lower amplitudes, effectively maximizing communication distance and salience. These findings illustrate that behavioral traits can change rapidly in response to newly favorable conditions, indicating an inherent resilience to long-standing anthropogenic pressures such as noise pollution.


Assuntos
Infecções por Coronavirus/epidemiologia , Ruído , Pneumonia Viral/epidemiologia , Aves Canoras/fisiologia , Vocalização Animal , Acústica , Animais , Betacoronavirus , Veículos Automotores , Pandemias , São Francisco
10.
AIDS Patient Care STDS ; 34(9): 392-398, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32813571

RESUMO

Transgender women share more in common with cisgender women, with respect to sociocultural context and factors influencing HIV risk and outcomes, than they do with "men who have sex with men", a behavioral risk category in which they often are included. However, it is not yet clear whether both transgender and cisgender women would find integrated, all-women HIV programs and services desirable and beneficial. We Are All Women was a qualitative study conducted in the San Francisco Bay Area from April 2016 to January 2017, using a conceptual framework based on gender affirmation and trauma-informed care, to explore barriers and facilitators to inclusion of transgender women in HIV treatment and support services traditionally focused on cisgender women. Thirty-eight women (10 trans, 25 cis, and 3 "other" gender) participated in six semistructured, facilitated focus groups. In addition, five HIV care providers participated in semistructured, in-depth interviews. Both trans and cis women identified the desire for gender affirmation, a feeling of safety (specifically space without men), and potential community building within a care and healing context as powerful facilitators of an inclusive all-women care environment. At the same time, they recognized that tensions do exist between idealized visions of such an environment, deep-seated sentiments and behaviors among some cis women toward trans women, and the practical realities of creating the optimal spaces for all women. Opportunities for dialog between trans and cis women to mitigate gender-associated phobias and misperceptions are a valuable first step in creating HIV care environments that serve all women.


Assuntos
Assistência à Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Acesso aos Serviços de Saúde , Pessoas Transgênero , Transexualidade , Adolescente , Adulto , Atitude do Pessoal de Saúde , Feminino , Identidade de Gênero , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Preconceito , Pesquisa Qualitativa , São Francisco , Adulto Jovem
11.
Water Res ; 185: 116259, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32798889

RESUMO

Passive sampling and bioaccumulation assessments were used to evaluate the performance of activated carbon (AC) remediation of polychlorinated biphenyl (PCB) contaminated sediment offshore in Parcel F of the former Hunters Point Naval Shipyard (HPNS) (San Francisco, California). Two different composite AC materials, AquaGate+PAC™ (86 tons) and SediMite™ (24 tons) were placed on the sediment surface covering an area of 3200 m2. PCB tissue concentrations in the clam Macoma nasuta were reduced 75 to 80% in pilot amendment areas after 8 months and 84-87% in non-lipid normalized tissues after 14 months during in situ monitoring, confirming the effectiveness of the AC at reducing bioavailability of the PCBs. Polydimethylsiloxane (PDMS) passive samplers were applied to evaluate and monitor freely dissolved concentrations (Cfree) of PCBs in sediment porewater before AC placement (i.e., during baseline) and at 8 months, 14 months and 26 months following placement. Although AC composite materials were placed only at the surface, 80% reductions were observed to a depth of 16 cm after 8 months and up to 26 cm after 26 months in AquaGate+PAC treatment area. Total PCB porewater concentrations in surface sediments (1-6 cm) were reduced 89 and 91% in the AquaGate+PAC and SediMite areas during final sampling. Ex situ passive sampling showed porewater concentrations 2-5 times larger than in situ measurements due to the absence of hyporheic exchange in laboratory measurements and near equilibration between sediment and porewater. Estimated post placement ex situ porewater concentrations were more consistent with a model of bioaccumulation using the octanol-water partition coefficient (KOW) as a bioaccumulation factor leading to a hypothesis that the bioaccumulation factor in the deposit feeding clam is better estimated by equilibrium ex situ porewater measurements.


Assuntos
Bifenilos Policlorados , Poluentes Químicos da Água , Animais , Disponibilidade Biológica , Carvão Vegetal , Monitoramento Ambiental , Sedimentos Geológicos , Bifenilos Policlorados/análise , São Francisco , Poluentes Químicos da Água/análise
12.
PLoS One ; 15(8): e0237241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764800

RESUMO

BACKGROUND: Despite being one of the wealthiest nations, disparities in adverse birth outcomes persist across racial and ethnic lines in the United States. We studied the association between historical redlining and preterm birth, low birth weight (LBW), small-for-gestational age (SGA), and perinatal mortality over a ten-year period (2006-2015) in Los Angeles, Oakland, and San Francisco, California. METHODS: We used birth outcomes data from the California Office of Statewide Health Planning and Development between January 1, 2006 and December 31, 2015. Home Owners' Loan Corporation (HOLC) Security Maps developed in the 1930s assigned neighborhoods one of four grades that pertained to perceived investment risk of borrowers from that neighborhood: green (grade A) were considered "Best", blue (grade B) "Still Desirable", yellow (grade C) "Definitely Declining", and red (grade D, hence the term "redlining") "Hazardous". Geocoded residential addresses at the time of birth were superimposed on HOLC Security Maps to assign each birth a HOLC grade. We adjusted for potential confounders present at the time of Security Map creation by assigning HOLC polygons areal-weighted 1940s Census measures. We then employed propensity score matching methods to estimate the association of historical HOLC grades on current birth outcomes. Because tracts graded A had almost no propensity of receiving grade C or D and because grade B tracts had low propensity of receiving grade D, we examined birth outcomes in the three following comparisons: B vs. A, C vs. B, and D vs. C. RESULTS: The prevalence of preterm birth, SGA and mortality tended to be higher in worse HOLC grades, while the prevalence of LBW varied across grades. Overall odds of mortality and preterm birth increased as HOLC grade worsened. Propensity score matching balanced 1940s census measures across contrasting groups. Logistic regression models revealed significantly elevated odds of preterm birth (odds ratio (OR): 1.02, 95% confidence interval (CI): 1.00-1.05), and SGA (OR: 1.03, 95% CI: 1.00-1.05) in the C vs. B comparison and significantly reduced odds of preterm birth (OR: 0.93, 95% CI: 0.91-0.95), LBW (OR: 0.94-95% CI: 0.92-0.97), and SGA (OR: 0.94, 95% CI: 0.92-0.96) in the D vs. C comparison. Results differed by metropolitan area and maternal race. CONCLUSION: Similar to prior studies on redlining, we found that worsening HOLC grade was associated with adverse birth outcomes, although this relationship was less clear after propensity score matching and stratifying by metropolitan area. Higher odds of preterm birth and SGA in grade C versus grade B neighborhoods may be caused by higher-stress environments, racial segregation, and lack of access to resources, while lower odds of preterm birth, SGA, and LBW in grade D versus grade C neighborhoods may due to population shifts in those neighborhoods related to gentrification.


Assuntos
Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido Pequeno para a Idade Gestacional , Los Angeles/epidemiologia , Masculino , Gravidez , Pontuação de Propensão , Características de Residência , Estudos Retrospectivos , São Francisco/epidemiologia , Segregação Social , Fatores Socioeconômicos , Adulto Jovem
15.
Environ Pollut ; 266(Pt 3): 115116, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32673972

RESUMO

Polybrominated diphenyl ethers (PBDEs) are a family where each congener possesses different physicochemical properties, persistence and/or toxicity. Biodegradation can selectively change the abundance of congeners. These warrant modeling of individual congeners by considering biodegradation pathways together with fate and transport (F&T) mechanisms. Accordingly, this study aims to develop a F&T model (Fate and Transport model for Hydrophobic Pollutants - FTHP) that integrates congener specific biodegradation of PBDEs in sediments. The model is tested using sediment data from a location representing the Lower South Bay of San Francisco. Results demonstrated settling, resuspension, and biodegradation as important mechanisms. FTHP is then used to predict congener concentrations in a period of 20 years for two cases (constant and time-dependent water column concentrations) and four alternative scenarios: no intervention (i.e., natural attenuation, also serves as the base case), no degradation, dredging and biostimulation. The greatest impact on the reduction of total PBDE concentrations was achieved by a reduction in water column concentrations, i.e. source control, and dredging. On the other hand, biostimulation coupled with source control was the most effective in reducing bioaccumulative PBDE congener concentrations and almost as effective as dredging for the rest of congeners. Proposed FTHP model can distinguish between congeners and help devise informed management plans which focus on decreasing risks associated with persistent and bioaccumulative compounds in contaminated sediments.


Assuntos
Éteres Difenil Halogenados/análise , Poluentes Químicos da Água/análise , Sedimentos Geológicos , São Francisco
16.
Am J Ophthalmol ; 218: 261-267, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32574772

RESUMO

PURPOSE: To describe applicant characteristics and outcomes associated with the ophthalmology fellowship match. DESIGN: Retrospective case-control study. METHODS: This study took place in San Francisco and matched data for ophthalmology fellowship applicants in the USA. The study population was registrants for the 2010-2017 ophthalmology fellowship match cycles. The match rate took place during the 8-year study period. Applicant characteristics were stratified by match status and factors associated with matching to ophthalmology fellowship positions. RESULTS: Between 2010 and 2017, most applicants (2,558/3,471; 73.7%) were matched into ophthalmology fellowship programs. No difference over time in the proportion of applicants that matched for fellowship was identified (P = .41). On average, ophthalmology residents who were matched into fellowships had higher step 1 (difference: 9; 99% confidence interval [CI]: 6.8-10.9; P < .001), step 2 (difference: 9.5; 99% CI: 7-12; P < .001), and step 3 (difference: 7.4; 99% CI: 5-9.7; P <.001) scores than those who did not match. Applicants who matched also had a greater number of application distributions (difference: 9.6; 99% CI: 7.9-11.2; P < .001), and ranked programs on the match list (difference: 6.2; 99% CI: 5.8-6.7; P < .001). Among applicants who matched, 15% matched at the same institute, 29% matched in the same state, and 45% matched in the same region. On multivariable analysis, factors associated with an increased likelihood of matching into an ophthalmology fellowship program included graduates from the US versus graduates from non-US residency programs (odds ratio [OR]: 2.09; 99% CI: 1.27-3.44; P <.001), increasing percentage of applications ranked (number of ranked programs and/or number of applications distributed) (OR: 1.02; 99% CI: 1.02-1.03; P < .001) as well as having ranked more programs (OR: 1.24; 99% CI: 1.17-1.31; P < .001). Medical graduate status outside of the US (OR: 0.58; 99% CI: 0.36-0.93; P < .001) was associated with decreased odds of matching for fellowship. CONCLUSIONS: From 2010 to 2017, approximately three-quarters of residents applying for an ophthalmology fellowship position matched. Factors associated with increased likelihood of matching included the applicant's graduating from a U.S. residency, graduating from a U.S. medical school, ranking more programs, and having a higher percentage of applications ranked (number of programs ranked by applicant and/or number of applications distributed). The information gained from this study may help applicants as they consider applying to fellowship programs.


Assuntos
Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Oftalmologia/educação , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Masculino , Estudos Retrospectivos , São Francisco , Critérios de Admissão Escolar
17.
PLoS One ; 15(6): e0234345, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32544185

RESUMO

BACKGROUND: Mentorship plays an essential role in enhancing the success of junior faculty. Previous evaluation tools focused on specific types of mentors or mentees. The main objective was to develop and provide validity evidence for a Mentor Evaluation Tool (MET) to assess the effectiveness of one-on-one mentoring for faculty in the academic health sciences. METHODS: Evidence was collected for the validity domains of content, internal structure and relationship to other variables. The 13 item MET was tested for internal structure evidence with 185 junior faculty from Schools of Dentistry, Medicine, Nursing, and Pharmacy. Finally, the MET was studied for additional validity evidence by prospectively enrolling mentees of three different groups of faculty (faculty nominated for, or winners of, a lifetime achievement in mentoring award; faculty graduates of a mentor training program; and faculty mentors not in either of the other two groups) at the University of California San Francisco (UCSF) and asking them to rate their mentors using the MET. Mentors and mentees were clinicians, educators and/or researchers. RESULTS: The 13 MET items mapped well to the five mentoring domains and six competencies described in the literature. The standardized Cronbach's coefficient alpha was 0.96. Confirmatory factor analysis supported a single factor (CFI = 0.89, SRMR = 0.05). The three mentor groups did not differ in the single overall assessment item (P = 0.054) or mean MET score (P = 0.288), before or after adjusting for years of mentoring. The mentorship score means were relatively high for all three groups. CONCLUSIONS: The Mentor Evaluation Tool demonstrates evidence of validity for research, clinical, educational or career mentors in academic health science careers. However, MET did not distinguish individuals nominated as outstanding mentors from other mentors. MET validity evidence can be studied further with mentor-mentee pairs and to follow prospectively the rating of mentors before and after a mentorship training program.


Assuntos
Tutoria/métodos , Mentores/psicologia , Avaliação de Programas e Projetos de Saúde/métodos , Adulto , Docentes de Medicina/classificação , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Pesquisadores/educação , São Francisco
18.
PLoS One ; 15(6): e0233904, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479509

RESUMO

Racial and ethnic minorities are at higher risk for a variety of diseases. While sociodemographic and lifestyle factors contribute to racial/ethnic health disparities, the biological processes underlying these associations remain poorly understood. Stress and its biological consequences through the glucocorticoid receptor (GR) have been hypothesized to mediate adverse disease outcomes. In fasting morning samples of 503 control women from the San Francisco Bay Area Breast Cancer Study, we used a sensitive Chemical-Activated LUciferase gene eXpression (CALUX) assay to examine the association of sociodemographic and lifestyle factors with plasma glucocorticogenic (G) activity in three racial/ethnic groups. The G activity is a sensitive measure that reflects biological activity of total plasma glucocorticoids including cortisol and glucocorticoid-like compounds. Associations between G activity and sociodemographic and lifestyle factors were examined using multivariable linear regression models. Latina and non-Latina Black (NLB) women had 9% (P = 0.053) and 14% (P = 0.008) lower morning G activity than non-Latina White (NLW) women, respectively. Additionally, we replicated a previously reported association between G activity and alcohol intake (women who drank >10gms had 19% higher G activity than non-drinkers, P = 0.004) in Latina and NLB women. Further research should assess the association between G activity and health outcomes in a prospective cohort so as to characterize the relationship between total plasma G activity in pre-disease state and disease outcomes across different racial/ethnic populations.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Disparidades nos Níveis de Saúde , Estilo de Vida/etnologia , Receptores de Glucocorticoides/sangue , Saúde da Mulher/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Estudos Prospectivos , São Francisco/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários/estatística & dados numéricos
19.
Proc Natl Acad Sci U S A ; 117(24): 13421-13427, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32482858

RESUMO

Although the backlog of untested sexual assault kits in the United States is starting to be addressed, many municipalities are opting for selective testing of samples within a kit, where only the most probative samples are tested. We use data from the San Francisco Police Department Criminalistics Laboratory, which tests all samples but also collects information on the samples flagged by sexual assault forensic examiners as most probative, to build a standard machine learning model that predicts (based on covariates gleaned from sexual assault kit questionnaires) which samples are most probative. This model is embedded within an optimization framework that selects which samples to test from each kit to maximize the Combined DNA Index System (CODIS) yield (i.e., the number of kits that generate at least one DNA profile for the criminal DNA database) subject to a budget constraint. Our analysis predicts that, relative to a policy that tests only the samples deemed probative by the sexual assault forensic examiners, the proposed policy increases the CODIS yield by 45.4% without increasing the cost. Full testing of all samples has a slightly lower cost-effectiveness than the selective policy based on forensic examiners, but more than doubles the yield. In over half of the sexual assaults, a sample was not collected during the forensic medical exam from the body location deemed most probative by the machine learning model. Our results suggest that electronic forensic records coupled with machine learning and optimization models could enhance the effectiveness of criminal investigations of sexual assaults.


Assuntos
Vítimas de Crime , Ciências Forenses/economia , Aplicação da Lei/métodos , Delitos Sexuais , Manejo de Espécimes/economia , Adulto , Análise Custo-Benefício , Vítimas de Crime/estatística & dados numéricos , DNA/análise , Bases de Dados de Ácidos Nucleicos , Feminino , Ciências Forenses/estatística & dados numéricos , Humanos , Aprendizado de Máquina , Masculino , São Francisco , Delitos Sexuais/estatística & dados numéricos , Manejo de Espécimes/estatística & dados numéricos
20.
Acad Med ; 95(7): 1057-1065, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32576764

RESUMO

PURPOSE: Feedback is important for medical students' development. Recent conceptualizations of feedback as a dialogue between feedback provider and recipient point to longitudinal relationships as a facilitator of effective feedback discussions. This study illuminates how medical students experience feedback within a longitudinal relationship with a physician coach. METHOD: In this qualitative study, second-year medical students from the University of California, San Francisco, School of Medicine participated in semistructured interviews that explored their experiences discussing feedback within longitudinal, nonevaluative coaching relationships. Interviews occurred between May and October 2018. Interview questions addressed students' experiences receiving feedback from their coach, how and when they used this feedback, and how their relationship with their coach influenced engagement in feedback discussions. Interviews were analyzed using constructivist grounded theory. RESULTS: Seventeen students participated. The authors identified 3 major themes. First, students' development of a feedback mindset: Over time, students came to view feedback as an invaluable component of their training. Second, setting the stage for feedback: Establishing feedback routines and a low-stakes environment for developing clinical skills were important facilitators of effective feedback discussions. Third, interpreting and acting upon feedback: Students described identifying, receiving, and implementing tailored and individualized feedback in an iterative fashion. As students gained comfort and trust in their coaches' feedback, they reported increasingly engaging in feedback conversations for learning. CONCLUSIONS: Through recurring feedback opportunities and iterative feedback discussions with coaches, students came to view feedback as essential for growth and learning. Longitudinal coaching relationships can positively influence how students conceptualize and engage in feedback discussions.


Assuntos
Retroalimentação , Aprendizagem/fisiologia , Tutoria/métodos , Aprendizagem Baseada em Problemas/estatística & dados numéricos , Estudantes de Medicina/psicologia , Adulto , Competência Clínica/estatística & dados numéricos , Comunicação , Educação de Graduação em Medicina/métodos , Feminino , Humanos , Entrevistas como Assunto , Masculino , Tutoria/estatística & dados numéricos , Pesquisa Qualitativa , São Francisco/epidemiologia , Universidades/estatística & dados numéricos
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