Factors Influencing Physician Assistant Students' Attitudes Toward Deservingness of Care for Undocumented Mexicans.

PURPOSE: Attitudes regarding health-related deservingness of care for vulnerable patient populations can impact the quality of services provided. This study was aimed at identifying the influences that shape these attitudes among physician assistant (PA) students. METHODS: The study focused on PA students' perspectives toward care for a particularly vulnerable population, undocumented Mexican immigrants. An in-person survey was administered to first- and second-year PA students (n = 75). Multiple regression was used to assess whether familiarity, stereotyping, language skills, cultural preparedness, societal views, and background characteristics of PA students influenced attitudes toward deservingness of care. RESULTS: Results suggested that cultural preparedness among PA students was associated with positive views toward deservingness of both emergency services (ß = 0.38, p < .001) and primary care (ß = -0.211, p = .05) for undocumented Mexicans. Negative societal views toward this population predicted an unwillingness to endorse emergency care (ß = -0.43, p < .001) and primary care (ß = -0.45, p < .001). CONCLUSIONS: Demographic projections indicate continued trends toward increasingly diverse patient populations, with dramatic growth among Hispanics. The findings of this study suggest that greater cultural preparedness is needed for future PAs. Furthermore, strategies for increasing PA students' self-awareness of how their broader societal views shape service delivery are warranted to ensure equitable care.

Imaging islets labeled with magnetic nanoparticles at 1.5 Tesla.

We have developed a magnetic resonance imaging (MRI) technique for imaging Feridex (superparamagnetic iron oxide [SPIO])-labeled islets of Langerhans using a standard clinical 1.5-Tesla (T) scanner and employing steady-state acquisition imaging sequence (3DFIESTA). Both porcine and rat islets were labeled with SPIO by a transfection technique using a combination of poly-l-lysine and electroporation. Electron microscopy demonstrated presence of SPIO particles within the individual islet cells, including beta-cells and particles trapped between cell membranes. Our labeling method produced a transfection rate of 860 pg to 3.4 ng iron per islet, dependent on the size of the islet. The labeling procedure did not disrupt either the function or viability of the islets. In vitro 3DFIESTA magnetic resonance images of single-labeled islets corresponded with their optical images. In vivo T2*-weighted scan using 1.5 T detected as few as 200 SPIO-labeled islets transplanted under rat kidney capsule, which correlated with immunohistochemistry of the transplant for insulin and iron. Ex vivo 3DFIESTA images of kidneys containing 200, 800 or 2,000 SPIO-labeled islet isografts showed good correlation between signal loss and increasing numbers of islets. These data provide evidence that islets can be labeled with SPIO and imaged using clinically available 1.5- T MRI.

Repair of cytokine-induced DNA damage in cultured rat islets of Langerhans.

Treatment of cultured rat pancreatic islets of Langerhans with the combined cytokines interleukin-1beta (IL-1beta), interferon gamma (IFN gamma) and tumour necrosis factor alpha (TNF alpha) leads to DNA damage including strand breakage. We have investigated the nature of this damage and its repairability. When islets are further incubated for 4 h in fresh medium, the level of cytokine-induced strand breakage remains constant. If the nitric oxide synthase inhibitor N(G)-monomethyl-L-arginine (NMMA) is present during cytokine treatment, then strand breakage is prevented. If NMMA is added following, rather than during,the cytokine treatment and islets are incubated for 4 h, further nitric oxide synthesis is prevented and most cytokine-induced strand breaks are no longer seen. To investigate DNA repair following cytokine treatment, cells were transferred to fresh medium and incubated for 4 h in the presence of hydroxyurea (HU) and 1-beta-D-arabinosyl cytosine (AraC), as inhibitors of strand rejoining. In the presence of these inhibitors there was an accumulation of strand breaks that would otherwise have been repaired. However, when further nitric oxide synthesis was inhibited by NMMA, significantly less additional strand breakage was seen in the presence of HU and AraC. We interpret this, as indicating that excision repair of previously induced base damage did not contribute significantly to strand breakage. Levels of oxidised purines, as indicated by formamidopyrimidine glycosylase (Fpg) sensitive sites, were not increased in cytokine-treated islets. We conclude that in these primary insulin-secreting cells: (a) the DNA damage induced by an 18h cytokine treatment is prevented by an inhibitor of nitric oxide synthase, (b) much of the damage is in the form of apparent strand breaks rather than altered bases such as oxidised purines, (c) substantial repair is ongoing during the cytokine treatment and this repair is not inhibited in the presence of nitric oxide.