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National Practices, Attitudes, and Training Surrounding Long-Acting Reversible Contraception Procedures for Adolescents
Get PDFBACKGROUND: Primary care for adolescents in the United States is predominantly provided by pediatricians. For these patients, sexual health and contraception are important parts of primary care. Despite this, pediatricians are often less comfortable providing contraceptive counseling and lack training to administer long-acting reversible contraception (LARC), a highly effective form of contraception. Medically- and socially- complex patients access to contraception is additionally limited, as they often receive much of their medical care in the hospital setting. Training pediatricians and pediatric hospitalists to effectively administer LARC in both outpatient and inpatient settings would increase adolescent access to sexual health care, including LARC.
OBJECTIVE: This mixed-methods study aims (1) to quantitatively describe national practices and training for providing sexual health services, including LARC, in the inpatient setting and (2) to qualitatively characterize the attitudes of clinicians about the appropriateness of and training surrounding LARC procedures for adolescents in the inpatient setting to generate strategies to improve training for pediatricians.
METHODS: For aim 1, pediatric providers across the nation were invited to complete an online REDCap survey to assess current LARC services at their institution, attitudes about desiring LARC services, and interest in LARC training. Descriptive frequencies were reported. For aim 2, focus group interviews of a subsample of survey participants were facilitated on Zoom to assess barriers and facilitators to sexual health services and training for these sexual health services in pediatric hospitals. Interviews were transcribed and coded using Nvivo. Discordance was resolved by consensus and thematic analysis was performed.
RESULTS: Survey data (n = 610) indicated that inpatient LARC services are currently limited (12% and 19% of participants reporting IUDs and implants, respectively, administered inpatient at their hospital site). Among those at hospitals not currently placing LARC, many wished this service was available (43% for IUD and 37% for implant) and over half were willing to learn how to place LARC (49% for IUD and 56% for implant). From the interview data (n = 32), beliefs in the appropriateness of administering LARC to adolescents varied, but many believed it was appropriate in all settings, including inpatient as "every hospitalization is an opportunity to review healthcare maintenance, and contraception- that's healthcare maintenance for a teenager." Regarding training, lack of willingness to learn how to place LARC centered around lack of knowledge, skills, and resources for pediatricians and pediatric hospitalists. Although training opportunities are often available, they are usually elective and at inopportune times. Those who have successfully received training reported it occurring during scheduled training blocks and including instructions on confidentiality and billing.
CONCLUSION: Some of the limited availability of LARC for adolescent patients can be attributed to limited contraceptive training for pediatricians and pediatric hospitalists. To expand access, training opportunities for pediatric trainees should be scheduled as part of mandatory didactics and include didactic, simulation, and clinical practice components that touch on logistic aspects including acquiring equipment, confidential counseling, and billing and documentation
I Am
No full textThe author submitted this entry in the Creative Non-Fiction category (Amateur division) for the 2024 On My Own Time (OMOT) Art Show.I wrote this piece as an introduction to debate-style writing. I wanted to experiment with taking an ardent stance on a position and defending it absolutely. I hope that reading this inspires some thoughts in your mind, whether you agree or not. In fact, if you disagree, I hope you will reach out to me, and we can have an engaging conversation on the topic. Read on to learn more
Coaching for competency: cultivating agency and improving learning outcomes in post-graduate education
No full textDetailed 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
Multiphase Coalescence Mediates Hippo Pathway Activation
Get PDFThe formation of biomolecular condensates facilitates spatiotemporal control of biochemical reactions inside cells, and this process is often reversed by the dissolution of condensates. Whether the function of condensates can be suppressed without condensate dissolution remains unknown. Here we show that upstream regulators of the Hippo signaling pathway form functionally antagonizing condensates, and the coalescence of these distinct condensates into a common phase provides a novel mode of counteracting the function of biomolecular condensates without condensate dissolution. Specifically, the negative regulator SLMAP forms Hippo-inactivating condensates to facilitate pathway inhibition by the STRIPAK phosphatase complex. In response to cell-cell contact or osmotic stress, the positive regulators AMOT and KIBRA form Hippo-activating condensates to facilitate pathway activation. The functionally antagonizing SLMAP and AMOT/KIBRA condensates further coalesce into a common phase to inactivate STRIPAK function by excluding SIKE, an essential STRIPAK subunit that is normally enriched in the Hippo-inactivating SLMAP condensates. These findings provide a new paradigm for restricting the activity of biomolecular condensates without condensate dissolution, shed light on the molecular principles of multiphase organization, and offer a new conceptual framework for understanding upstream regulation of the Hippo signaling pathway
Development of Metal-Catalyzed and Photochemical Approaches to Carbon-Carbon Bond Forming Reactions
Get PDFThe development of methods to construct carbon-carbon bonds is fundamental to synthetic organic chemistry. This transformation provides access to a variety of organic compounds including medicinal and pharmaceutical agents, agrochemicals, and polymers. There is a growing interest in practical and efficient catalytic approaches to construct carbon-carbon bonds allowing access to valuable organic molecules. This manuscript describes a review of catalytic methods for onium ylide rearrangements in aromatic systems, our studies on catalyst-controlled rearrangements of onium ylides in indole systems, and our approaches toward photocatalytic asymmetric coupling of imines and alkylarenes.
In the first chapter, an overview of the known synthetic approaches for metal-catalyzed onium ylide rearrangements in aromatic systems is discussed. Various catalytic examples from the recent literature show onium ylides undergoing dearomative [2,3]-rearrangement to give alkylated aromatic compounds as final products. The influence of substrate and solvent effects in the selectivity of rearrangements has been demonstrated through several examples.
The second chapter describes our studies in the development of catalytic rearrangements of indole-based onium ylides. Our approach allows regiodivergent rearrangements of oxonium ylides in a catalyst-controlled manner to access substituted indole compounds. This method shows the impact of transition-metal catalysis in governing the selectivity of chemical transformations. We also present various experimental and theoretical studies to analyze the mechanistic pathways involved in the methodology. The development of the methodology has also allowed further functionalization of the products resulting in the total synthesis and structural revision of an indole alkaloid.
In the third chapter, we describe our approaches in exploiting photocatalysis to perform the functionalization of feedstock chemicals to access enantioenriched chiral amines. Our synthetic strategy leverages the known photophysical properties of compounds to rationally design and develop a catalytic transformation in an enantioselective fashion. The challenges associated with realizing this transformation and our approaches to solving them are discussed
A hard nut to crack: unraveling novel food allergy therapies
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
My Thyme
No full textThe author submitted this entry in the AI Literature category (Amateur division) for the 2024 On My Own Time (OMOT) Art Show.This piece was inspired by the clock ticking away while I was cooking. Reading the poem out loud should make the connection clear. I used AI assistance for rhyme and meter
Changes in MRSA (Methicillin-Resistant Staphylococcus) Infection Rates in a Community NICU (Neonatal Intensive Care Unit) with the COVID-19 Pandemic
No full textThe 62nd Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 30, 2024, 3-6 p.m., D1.700 Lecture Hall)BACKGROUND: Methicillin-Resistant Staphylococcus aureus (MRSA) infections represent a significant healthcare challenge, particularly in neonatal intensive care units (NICUs) where patients experience increased morbidity and mortality. MRSA transmission has not been well studied in the setting of enhanced infection precautions (EIP) taken during the COVID-19 pandemic - such as universal masking and enhanced hand hygiene.
OBJECTIVE: This retrospective cohort study compared rates of MRSA infection in a community NICU during two distinct time periods: January 2016 to March 2020 (Pre-EIP: before EIP was instituted) and April 2020 to December 2022 (With-EIP: after EIP was instituted).
METHODS: During the study period, 74 neonates admitted to the NICU tested positive for MRSA (56 Pre-EIP and 18 With-EIP). MRSA cases were collected using laboratory and electronic medical record review. Cases were reported as infections per 1,000 patient days (IP-1000). Statistical analysis with two-sample t-tests assuming unequal variance and chi squared tests for independence were performed.
RESULTS: There was a significant decrease in MRSA IP-1000 from 1.90 Pre-EIP to 0.93 With-EIP (p=0.0006). The prevalence of MRSA clusters, defined as three infections within a 30-day period, decreased from 0.27 Pre-EIP compared to 0.03 With-EIP (p=0.0004). However, The Pre-EIP cohort had a younger average gestational age (30.2 vs 33.8 weeks, p=0.001), higher rates of very low birth weight (59% vs 28%, p=0.021), and fewer inborn neonates (88% vs 100%, p=0.115) - factors known to increase risk of MRSA infection.
CONCLUSION: These findings suggest that EIP may have contributed to the reduction in MRSA clusters observed in this community NICU. Findings are limited by differences in cohort risk factors, small study population, variabilities in infection precautions throughout the pandemic, and the inherent bias of retrospective cohort analysis. This underscores the importance of prevention strategies and highlights the potential benefits of continued enhanced infection precautions in reducing the transmission of MRSA in vulnerable inpatient populations.Southwestern Medical Foundatio
Life
No full textThe author submitted this entry in the Open Verse Poetry category (Amateur division) for the 2024 On My Own Time (OMOT) Art Show.This was inspired and written during a phase of my life that I was trying to understand
Search for Insulin Secretion Modulators, Novel Functions of WNK Signaling and Intramolecular Signal Transduction in ERK2
No full textIn this dissertation, the regulation of insulin secretion from pancreatic beta cells, WNK1 pathway involvement in cell migration, angiogenesis, breast cancer, and other processes, as well as ERK2 intradomain communication are discussed. Each chapter is dedicated to a separate project, but the common denominators for these projects are protein kinases involved in the WNK or ERK pathway. Through an assay developed in the lab to detect compounds that have an extended action on insulin secretion, novel insulin secretion modulators were discovered. Using a bioinformatics platform, previously unknown downstream effectors of the WNK pathway were identified. Depletion of WNK1 in endothelial cells and breast cancers further defined WNK1-sensitive processes involved in cell migration and metastasis of breast cancer. Finally, ERK2 mutants were characterized to explore allosteric regulation between substrate binding sites and the ERK activation mechanism