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A Big Dream, But Are WE Competent? Health Sciences Librarian Preparation for the Movement Toward Greater Standardization and Assessment of Competency-Based Health Sciences Education
No full textThis poster was recognized at the SCC/MLA Annual Business Meeting on October 29, 2024, as the recipient of the Second Place Award for Posters in the 2024 Elizabeth K. Eaton, Ph.D. Research Awards.OBJECTIVE: Movement toward competency-based education in health sciences disciplines is documented in the literature as an initiative that best prepares health professionals for practice. It is imperative that health sciences librarians not only recognize how these changes impact the disciplines, but also our role in ensuring our education efforts help meet these competencies. METHODS: A comprehensive literature review was undertaken for two purposes: 1. identify current movements toward competency definitions and standardization in the various health disciplines and 2. inform practice and identify potential challenges for helping students meet competencies, including information seeking and appraisal skills, assessment, and EBP. RESULTS: Thematic coding illustrated challenges in the current landscape of competency-based health sciences education, including lack of diversity among those involved in competency framework development, extreme variance in honors designations and grading schemes (pass/fail versus traditional tiered grading), and limited data on how to assess students for achievement of competency. CONCLUSIONS: Health sciences librarians should remain diligent in following national-level discussions around standardizing the way competencies are defined and evaluated. This study is a call to action to actively participate in the development of frameworks and assessment of competencies as part of their service as embedded experts within the health professions
Development and Validation of a New Naming Task: The Southwestern Item Fluency Test (SWIFT)
Get PDFTests of confrontation naming play an important role in the clinical assessment of language. Commonly used naming tests have a variety of limitations including ceiling effects, outdated stimuli, differential item functioning across groups, and often ignore speed of word retrieval even though this is a prominent component of word-finding difficulties (WFD). The aim of the current study was to develop and validate a brief, psychometrically sound naming task that is sensitive to WFD. One-hundred items were selected from the Bank of Standardized Stimuli (BOSS) (Brodeur et al., 2014), an open-source collection of high-definition photographs, to create the Southwestern Item Fluency Test (SWIFT). All items were normed on visual characteristics and selected items were required to (1) be easily recognizable, (2) represent a range of semantic categories, (3) be high in object-name agreement, and (4) span a range of difficulty. Phase I (Test Development) -Phase I of the study involved development and analysis of the SWIFT, where it was hypothesized that (1) confrontation naming item difficulty could be predicted by psycholinguistic characteristics, and (2) using the most predictive psycholinguistic characteristics to rank SWIFT items would result in four stimulus pages with similar visual and psycholinguistic characteristics. Psycholinguistic predictors of Age of Acquisition and Lexical Frequency were found to best predict item difficulty based on previously published difficulty indices on the Boston Naming Test (BNT). SWIFT items were ranked by predicted difficulty and divided into 4 groups of 25 items that contained an equal distribution of semantic categories and level of difficulty. ANOVAs comparing the SWIFT pages on visual and psycholinguistic characteristics found no statistical differences, showing strong initial psychometric support for the SWIFT development. As a result, four SWIFT stimulus pages were created, each containing 25 items presented in 5x5 rows. Administration of the SWIFT consists of a timed portion, where participants have 30 seconds per page to name as many objects as quickly as possible, and an untimed portion that ensures each item is administered. Phase II explored the utility of the SWIFT in a clinical sample (N=53). The SWIFT was hypothesized to demonstrate: (1) a single underlying "naming ability" factor, (2) adequate internal consistency (≥.70), (3) convergent validity with other tests of word retrieval, (4) acceptable discriminant classification of individuals with impaired word-finding ability, (5) greater sensitivity to Clinician-Rated WFD (CRWFD) compared to the Boston Naming Test (BNT). Statistical Analyses included (1) Principal Components Analysis (PCA), (2) Cronbach's alpha, (3) Spearman's rho Coefficient Correlations, and (4) Receiver Operating Characteristic (ROC) curve analysis with Area Under the Curve (AUC). Patients had a variety of neurological, general medical, and psychiatric diagnoses. The PCA demonstrated that a single component best explained the SWIFT variance with very high internal consistency (Cronbach's alpha = 0.976). Both SWIFT total scores demonstrated convergent validity with word-retrieval tests, specifically the BNT, and divergent validity with visuospatial tests. It was more closely associated with speeded tasks (WAIS-IV Coding) and tests of executive functions (TMT Part A and B) compared with the BNT. Both SWIFT total scores were successful in classifying individuals with objective impairments on tasks of word-retrieval (AUC = 0.834 - 0.835) and were categorically better than the BNT (AUC = 0.646) at classifying individuals with CRWFD (AUC = 0.707 - 0.724). The SWIFT appears to be a promising new naming tool with good sensitivity to WFD in clinical samples and may prove valuable to clinicians when speed of naming is of particular interest in the assessment of naming abilities
An Optical Flow Based Methodology for Visualizing Dynamic Subcellular Organization Demonstrated Through Profilin and Rho GTPase Microdomains
Get PDFLive cell imaging has enabled the collection of movies of subcellular protein dynamics at a submicron resolution. Statistical time series analysis can greatly expand our understanding of subcellular interactions in minimally perturbed systems. This was previously achieved for the leading edge of migrating cells in select cases. Importantly no strategy existed to simultaneously analyze every subcellular location. Building on existing optical flow based non-linear image registration we developed an approach to remap a migrating cell to a common cell footprint while preserving the characteristics of our signal of interest at a spatial granularity necessary for understanding micron scale biological interactions. This tool enabled us to discover that Profilin fluctuations are organized in living cells. This organization was found to be dependent on cell polarization and actin binding capability. Expanding on this ability to query all subcellular locations, we developed a feature set and feature projection strategy to map molecular biosensor movies of Rho GTPase signaling into micron scale regions of internally consistent signaling dynamics or "microdomains". Microdomains of GTPases match literature descriptions of signaling organization and in an optogenetic study were found to almost precisely match the perturbation footprint
Single-Cell Functional Genomics of Cervical Remodeling
Get PDFThe cervical epithelium undergoes continuous changes in proliferation, differentiation, and function that are critical before pregnancy to ensure fertility and during pregnancy to provide a physical and immunoprotective barrier for pregnancy maintenance. Barrier disruption can lead to the ascension of pathogens that elicit inflammatory responses and preterm birth. Here, I identify cervical epithelial subtypes in nonpregnant, pregnant, and in-labor mice using single-cell transcriptome and spatial analysis. I identify heterogeneous subpopulations of epithelia displaying spatial and temporal specificity. Notably, two goblet cell subtypes with distinct transcriptional programs and mucosal networks were dominant in pregnancy. Untimely basal cell proliferation and goblet cells with diminished mucosal integrity characterize barrier dysfunction in mice lacking hyaluronan. These data demonstrate how the cervical epithelium undergoes continuous remodeling to maintain dynamic states of homeostasis in pregnancy and labor, and provide a framework to understand perturbations in epithelial health and host-microbe interactions that increase risk of premature birth
FishATLAS: Assessment of Organotropism Determination Through Imaging Informatics of Xenografted Zebrafish
Get PDFEwing sarcoma patients with metastatic disease have a 5-year survival rate of approximately 28%. The hallmark of this disease is an aberrant transcription factor made by a fusion of Chromosomes 11 and 22 called EWSFLI1. EWSFLI1 expression levels have been correlated with differing responses in cell metastatic propensity, but much remains to be elucidated. Indeed, many current models fail to meet the statistical rigor that is needed for exceedingly spontaneous, rare events like metastasis. To address this need, FishATLAS utilizes zebrafish human cancer cell xenograft images after high fidelity registration using a novel diffeomorphic transformation to display metastatic hot spots of different cancer cell conditions to begin to grasp the deeper underpinnings of organotropism in vivo with individual cancers. Utilizing a suite of statistical tests, FishATLAS determines at a global whole-fish scale and the local microenvironment, if there are statistically different cell hotspots when comparing two or more different conditions. As it stands, data for EWSFLI1, its target SOX6, a non-transformed cell line NIH3T3, TC32 subclones, and melanoma cell lines have all shown unique distributions of metastatic hot spots. These findings serve as a tool for drug discovery and later environmental re-mapping in FishATLAS by allowing transgenic fish images (such as vasculature and lymphatics) to be overlayed onto any historical data set. These can then be used to determine a given microenvironment's contributions to secondary sites of metastasis. In the case of EWSFLI1 and its target SOX6, there was a marked difference upon shRNA-mediated knockdown that removed a population of hotspots in the upper somitic veins while some were persistent post genetic perturbation. SOX6 shRNA KD data indicates that the somite and inter-somitic arteries are more sensitive for metastatic colonization. Previous studies and our current accumulator data suggest these to be regions with higher oxidative stress, guiding insights for oxidative-mechanistic therapy. These and other conditional accumulations of sparse metastatic hotspots demonstrate the power of FishATLAS as a longitudinal assay of cellular and genetic conditions across all cancers
A Rubber Tower
Get PDFThe author submitted this entry in the Open Verse Poetry category (Amateur division) for the 2024 On My Own Time (OMOT) Art Show.Brushing the eraser marks off a piece of paper, I became curious about where all that erased rubber would end up. Where did all of my eraser marking end up? This piece is a daydream on where they could have gone
Impact of Quality Improvement Curriculum on Intensive Care Unit Upgrades by Resident Physicians
Get PDFBACKGROUND: Patients admitted to the hospital ward from the emergency department (ED) can decompensate rapidly and require transfer to the intensive care unit (ICU). These patients may benefit from identification of critical illness in the ED and earlier admission to the ICU. This could reduce delays in care, improve patient outcomes, and reduce healthcare expenses. The 66 emergency medicine (EM) residents at a single academic medical center are part of a quality improvement curriculum known as Residents Enhancing Safety and Quality (RES-Q). The "ICU upgrades" group in the curriculum evaluates patients who require transfer from the inpatient floor to the ICU within 12 hours of admission from the ED. For a period of 6 months, residents participate in structured case review of qualifying patient encounters and attempt to determine the root causes for ICU upgrades.
LOCAL PROBLEM: The Parkland Hospital ED has one of the largest patient volumes in the country.1 Given the busy nature of the department, learning and following-up on patient visits by the EM residents can take the backburner. A dedicated quality analysis curriculum, called RES-Q, was enacted in 2014 to help improve the residents' education. RES-Q consists of four major groups for review: ICU upgrades, 72-hour patient return visits, intubations, ED mortalities. Two additional groups are added on a year-to-year basis depending on resident interest. Residents evaluate patient cases in these groups each month and determine if there were any issues or learning points. These analyses are then presented during the monthly EM resident conference. Participation in each group is rotated every six months over three-year span of the residents' training to allow involvement in all groups. The ICU upgrades group evaluates patients that are dispositioned to the floor but decompensate within 12 hours and subsequently get "upgraded" to an ICU bed.
METHODS: A retrospective analysis was performed to determine the effectiveness of this quality improvement program in reducing the number of clinical ICU upgrades. This took place at a large, urban, county hospital with over 200,000 ED visits per year. The initial analysis compared second-year EM residents who participated in the ICU upgrades curriculum during their first year to second-year EM residents who did not participate in the curriculum during their first year. The method of maximum likelihood was estimated by fitting a generalized Poisson linear regression model to the data.
INTERVENTIONS: The primary intervention consisted of a quality improvement curriculum that involved structured case review of qualifying patient encounters, focusing on resident education and exposure to common causes of intensive care unit upgrades. This was complemented by a survey of the resident physicians that participated in the program, providing insight into their perceived value of the program and the general time commitment required to complete the program.
RESULTS: Analysis of the 242 qualifying ICU upgrade cases from July 2019 - December 2021 showed 19 second-year EM residents who completed the curriculum were responsible for 19 ICU upgrades, and 26 second-year EM residents who had not yet completed the curriculum were responsible for 40 ICU upgrades. The incidence rate ratio of ICU upgrade cases for second-year residents who didn't complete the curriculum was 1.54 (95% CI: 0.89-2.66; p=0.122) compared to second-year residents who completed the curriculum.
CONCLUSION: Initial analysis suggests that completion of the RES-Q ICU upgrades curriculum may improve resident proficiency in recognizing and appropriately dispositioning critical patients from the ED. This is associated with reduced number of patients requiring transfer from the inpatient floor to the ICU within 12 hours of admission. A limitation to this study is that all residents participated in the monthly RES-Q conference which presents data and learning points of all groups. Additional time periods and residency classes are currently under review to better determine the effect of the RES-Q ICU upgrades curriculum
Control of Regulatory Element Function by Histone H3.3
Get PDFIn eukaryotic cells, DNA is wrapped around histone proteins to form nucleosomes, the fundamental repeating unit of chromatin. While chromatin functions in part to organize a large amount of genomic material within the confines of the nucleus, regulatory DNA sequences consequently become masked to transcription machinery. Such regulatory sequences are enriched in specific histone variants and post-translational modifications (PTMs). The histone variant H3.3 is enriched at transcriptionally active regulatory elements such as promoters and enhancers. While recent studies have revealed a role for H3.3 in silencing repetitive elements and repressing developmentally regulated promoters, it is unclear how H3.3 contributes to chromatin states at active promoters and enhancers. In this study, we performed genomic analyses of chromatin features associated with active regulatory elements in mouse embryonic stem cells (ESCs) and found evidence of subtle yet widespread dysregulation in the absence of H3.3. Loss of H3.3 or HIRA- the chaperone responsible for H3.3 deposition to transcriptionally active regions- reduces chromatin accessibility and transcription factor (TF) footprinting at promoters. Further, H3.3 KO ESCs show reduced promoter enrichment of p300- a transcriptional coactivator responsible for H3 acetylation at lysine 27 (H3K27ac). Consequently, H3.3 KO ESCs show reduced H3K27ac at promoters, along with reduced enrichment of the acetyllysine reader BRD4.
Despite the enrichment of H3.3 at both promoters and enhancers, it appears to play distinct roles at these regions. ESCs lacking H3.3 or HIRA are able to maintain both accessibility and TF footprinting at enhancers, but still show reduced H3K27ac. Unlike promoters, enhancers show no deficit of p300 enrichment in the absence of H3.3. The loss of H3K27ac observed at enhancers of H3.3 KO ESCs can be attributed to reduced catalytic activity of p300. In particular, phosphorylation of Ser31, the only residue unique to the N-terminal tail of H3.3, facilitates p300 activity and H3K27ac enrichment.
In spite of extensive chromatin dysregulation and reduced active RNA polymerase II (RNAPII) engagement, ESCs maintain transcription from ESC-specific genes in the absence of H3.3. However, H3.3 KO ESCs are unable to initiate lineage-specific transcription upon undirected differentiation. In line with their differentiation defect, H3.3 KO ESCs retain footprinting of ESC-specific TFs and fail to generate footprints of lineage-specific TFs. Further, H3.3 KO ESCs fail to "open" and acetylate developmentally regulated enhancers. Overall, our study shows that H3.3 facilitates the establishment of transcriptionally permissive chromatin at regulatory elements, with context-dependent outcomes for transcriptional output. While H3.3 is not required for maintaining transcription in ESCs, it plays a key role in activating promoters and enhancers during differentiation
Hope
Get PDFThe author submitted this entry in the 10-Word Story category (Amateur division) for the 2024 On My Own Time (OMOT) Art Show.This one was inspired from watching a bird in a cage. Reflecting on the thoughts of what the bird might be thinking. "Hope" is a big word that provides assurance to face any adversity and live on
Human evolution in the 21st century: a novel genetic variant reveals a contemporary heterozygous advantage
Get PDFDetailed formal protocol with illustrations and extensive bibliography.A recording of the protocol presentation is available on UT Southwestern's Mediasite. Note: Access to the video is restricted to authorized UT Southwestern users only.UT Southwestern--Internal Medicin