27941 research outputs found
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Evaluating implementation by rural clinics of evidence-based interventions to promote HPV vaccination
No full textPurpose: Despite the well-established link between vaccination against human papillomavirus (HPV) and a decreased risk of cancer, HPV vaccine uptake in rural communities is low. Evidence-based interventions (EBIs) to promote HPV vaccination exist but are not universally implemented in rural settings due to various challenges. To understand the support needed by rural clinics in implementing EBIs, the University of Iowa partnered with the American Cancer Society (ACS) to evaluate an ACS HPV Vaccinating Adolescents against Cancers Quality Improvement Learning Collaborative that was delivered to six clinics in two rural health systems. The study aimed to assess the effectiveness of the learning collaborative approach for helping rural clinics implement EBIs aimed at increasing HPV vaccine uptake.
Methods: Semistructured interviews were conducted with clinic staff at six time points throughout the 2-year intervention. Interviews were conducted over the phone and were recorded and transcribed. Members of the research team coded the interviews using codebooks informed by the interview guides. The analysis compared the health systems and identified the changes they made in response to assistance provided by the collaborative.
Results: Clinic staff implemented the following EBIs: utilizing the immunization registry, strong provider recommendation, and provider education. Implementation of scheduling next dose fluctuated during the intervention. Differences were noted in the two health systems' implementation using electronic health records for patient and provider reminders.
Conclusion: Small, rural clinics can implement effective EBIs, given proper support. This is important as such EBIs can increase HPV vaccination rates and help prevent HPV-associated cancers.No embarg
"QuickStainer": a rapid negative staining device for improved preservation of molecular structure [preprint]
No full textThis article is a preprint. Preprints are preliminary reports of work that have not been certified by peer review.Negative staining is a widely used technique for observing macromolecules and their assemblies by transmission electron microscopy. It is commonly employed to optimize specimens for cryo-EM. The stain, typically a uranyl salt, surrounds the structure, providing an outline view at about 20 Å resolution. Many macromolecules are relatively stable and rigid, and negative stain images provide a good representation of their structure. However, some are labile or flexible and their structure or assembly state is altered by binding to the carbon substrate on the grid before specimen staining. In these cases, the negatively stained appearance does not faithfully represent the structure in solution. This problem is reduced when samples are incubated on the carbon surface for short times (5 s) rather than typical times (30-60 s) before staining. To reduce disruption to a minimum, we have developed a rapid negative staining device (QuickStainer) using 3D-printed components, a stepper motor for precisely timed movements, and an Arduino-controlled interface to execute commands. QuickStainer produces consistent, reproducible results, achieving sample incubation times as low as 10 ms before staining. Tests show rapid adherence of molecules to the grid and greatly improved structural preservation of labile specimens compared with standard preparation protocols. The design of QuickStainer can accommodate inclusion of additional steps, such as timed incubation with enzyme substrate, before staining.No embarg
The neurohormone tyramine stimulates the secretion of an insulin-like peptide from the Caenorhabditis elegans intestine to modulate the systemic stress response
No full textThe DAF-2/insulin/insulin-like growth factor signaling (IIS) pathway plays an evolutionarily conserved role in regulating reproductive development, life span, and stress resistance. In Caenorhabditis elegans, DAF-2/IIS signaling is modulated by an extensive array of insulin-like peptides (ILPs) with diverse spatial and temporal expression patterns. However, the release dynamics and specific functions of these ILPs in adapting to different environmental conditions remain poorly understood. Here, we show that the ILP, insulin-3 (INS-3), plays a crucial role in modulating the response to various environmental stressors in C. elegans. ins-3 mutants display increased resistance to heat, oxidative stress, and starvation; however, this advantage is countered by slower reproductive development under favorable conditions. We find that ins-3 expression is downregulated in response to environmental stressors, whereas, the neurohormone tyramine, which is released during the acute flight response, increases ins-3 expression. We show that tyramine induces intestinal calcium (Ca2+) transients through the activation of the TYRA-3 receptor. Our data support a model in which tyramine negatively impacts environmental stress resistance by stimulating the release of INS-3 from the intestine via the activation of a TYRA-3-Gαq-IP3 pathway. The release of INS-3 systemically activates the DAF-2 pathway, resulting in the inhibition of cytoprotective mechanisms mediated by DAF-16/FOXO. These studies offer mechanistic insights into a brain-gut communication pathway that weighs adaptive strategies to respond to acute and long-term stressors.No embarg
UMCCTS Newsletter, June 2025
Full text linkThis is the June 2025 issue of the UMass Center for Clinical and Translational Science Newsletter containing news and events of interest.Supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grants UL1 TR001453, TL1 TR001454 and KL2 TR001455.No embarg
Exploring Optimal Group Sizes for Learning in Medical Simulation: A Systematic Review
No full textObjectives: Simulation is an effective teaching method that improves learner competence and confidence. Optimizing group size balances efficiency without sacrificing efficacy. While simulation technology is widely used in medical education, no standard for learner group size exists. This study investigates the optimal group size for simulation, aiming to identify best practices that maximize efficiency and efficacy in learning environments.
Methods: This systematic review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A team of emergency medicine educators screened citations and reviewed relevant full-text articles. Inclusion criteria focused on group sizes with the best outcomes. Quality assessment employed the Medical Education Research Study Quality Instrument approach to evaluate evidence.
Results: Thirty-four articles were identified; 17 were deemed relevant for full-text review. The studies varied in methods, including prospective and retrospective reviews, mixed methods, and randomized controlled trials. Smaller groups improved outcomes, with an ideal size dependent on learning objectives. Five studies suggested groups of up to 4 learners were optimal, with mixed results on the exact number. One study identified 6 as the ideal group size. Debriefing was effective in larger groups, while procedural skills were best taught in groups of 2 to 4 learners.
Conclusion: This review suggests smaller group sizes are more effective for efficiency, knowledge, and confidence. For procedural skills, groups of 2 to 4 are most effective, and effectiveness declines with more than 6 participants. Smaller groups allow for more hands-on learning and cognitive engagement. While clinical skills can be taught in larger groups, learners favor smaller groups for debriefing and complex scenarios. Effective curriculum planning should account for available resources, the type of simulation, and the material being taught, with group sizes adjusted to optimize learning outcomes.No embarg
Executive functioning and processing speed as predictors of global cognitive decline in Alzheimer's disease
No full textBackground: Better cognitive tools to predict disease progression in mild cognitive impairment (MCI) and Alzheimer's disease (AD) are needed.
Objective: In this prospective longitudinal cohort, we are testing if changes in the cognitive domains of executive functioning and processing speed can predict global cognitive decline.
Methods: We assessed patients with MCI, AD, and cognitively healthy controls (cHC) using NIH toolbox assessments for processing speed and executive functioning and overall cognitive decline by the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog).
Results: Among 184 participants over a median follow-up of 540 days, both between- and within-subjects variance in NIH toolbox and ADAS-Cog assessments increased from cHC to MCI to AD patients. Among patients with AD (n = 24), pattern comparison processing speed (PCPS) and dimensional change card sort tests (DCCS) declined at 3 and 6 months prior to global cognitive decline (p = 0.008 and 0.0012). A 5-point decrease in either PCPS or DCCS increased risk of global cognitive decline (HR 1.32 (1.08-1.60) and 1.62 (1.16-2.26)).
Conclusions: Testing for cognitive domains of processing speed and executive functioning may predict subsequent global cognitive.No embarg
Trends In, and Factors Associated With, Adolescent Metabolic and Bariatric Surgery (MBS): An MBSAQIP Analysis
No full textBackground:
Access to metabolic and bariatric surgery (MBS) for adolescents who are markedly obese remains limited, though recent policy changes in 2018 and 2022 have been created reduce barriers to obtaining MBS in appropriately chosen pediatric patients. Understanding how these policy changes may have affected MBS utilization, patient demographic characteristics, and short-term outcomes is critical to advancing equitable care for adolescents who may benefit from MBS.
Methods:
Adolescents aged 10–18 years who underwent MBS between 2017–2023 were identified using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use Files. Patient demographics, temporal trends, and in-hospital and 30-day outcomes were analyzed using univariate comparisons, linear regression, and multivariable adjusted logistic regression analysis
Results:
The study sample consisted of 4,940 adolescents aged 13-18 years old. The majority (71%) of the study population were female, white (60%), and were a mean age of 17.1 years. Asian, American Indian, and Pacific Islander patients accounted for only 1.5% of all cases. Case volume declined during the COVID-19 pandemic but increased rapidly thereafter at nearly an additional 75 cases performed annually. The proportion of surgeries using the laparoscopic approach decreased by nearly 4% per year, while robotic-assisted surgery increased at 4% annually during the period under study. Black patient representation in the study sample rose from 14% 2017 to 24% in 2023, while Hispanic representation grew from 24% to 38%. Younger, Black, and Hispanic adolescents presented with higher rates of comorbidities, including diabetes, sleep apnea, hypertension, and hyperlipidemia. The overall 30-day complication rate was 3.5%, with dehydration being the most common. Multivariable adjusted regression analysis showed an increased odds of complications and emergency department visits among female patients (aOR 1.54 (95% CI: 1.05 – 2.25) and 2.74 (95% CI: 1.93 – 3.90)) and Hispanic patients (aOR 1.32 (1.01 – 1.72) for emergency department visits).
Conclusions:
Our findings demonstrate that adolescent MBS is increasing, but disparities in access and comorbidity burden persist, especially among younger, Black, and Hispanic patients. Despite policy changes, most procedures remain concentrated among older, white female adolescents. However, surgical complication rates remain low among all groups, reinforcing the short-term safety of these procedures.Biochemistry and Molecular BiotechnologyNo embarg
Roadmap for Evaluating Perinatal Psychiatry Access Programs
Full text linkPerinatal Psychiatry Access Programs aim to improve workforce capacity to address mental health and substance use needs during pregnancy and postpartum. This Roadmap offers guidance for evaluating and advancing the mission of these programs, drawing on insights from patients, professionals, and Access Program team members across the United States.This work was primarily supported by the Centers for Disease Control and Prevention (CDC) through an award [Grant number: # 6 U48DP006381-03-01] to UMass Chan Medical School.No embarg
A Mind-Blowing Ingestion: Intentional Plastic Explosive Consumption Resulting in Seizures
No full textIntroduction: C4 is a plastic explosive commonly used in military applications, and is predominantly composed of cyclonite or RDX (Royal Demolition Explosive). C4 toxicity is a documented but not commonly known cause of altered mental status and recurrent seizures.
Case reports: We describe two cases of military personnel who ingested C4 as part of a hazing ritual who presented to the emergency department with witnessed seizure, tremor and petechial rash. One of the patients had a second witnessed seizure within hours of ingestion. They were treated with intravenous benzodiazepines acutely, then with levetiracetam for 48 hours. Both patients were observed in the intensive care unit and discharged with no neurologic sequelae.
Discussion: C4 is a common military-grade explosive containing cyclonite which functions as a non-competitive, reversible GABAA antagonist and a rare but clinically significant cause of altered mental status and seizures when ingested. Management is primarily supportive with airway protection and treatment with GABAergic medication.No embarg
Gosling Designer: a Platform to Democratize Construction and Sharing of Genomics Data Visualization Tools [preprint]
Full text linkThis article is a preprint. Preprints are preliminary reports of work that have not been certified by peer review.Analysis of genomics data is central to nearly all areas of modern biology. Despite significant progress in artificial intelligence (AI) and computational methods, these technologies require significant human oversight to generate novel and reliable biological insights. Consequently, the genomics community has developed a substantial number of diverse visualization approaches and a proliferation of tools that biologists rely on in their data analysis workflows. While there are a few commonly used visualization tools for genomics data, many tools target specific use cases for genomics data interpretation and offer only a limited, predefined set of visualization types. Moreover, static visualizations often fail to support exploratory analysis. Developing interactive visualizations and tools typically requires significant time and technical expertise, even when supported by modern LLM-powered coding assistants, and the resulting visualizations can be difficult to share among collaborators. We developed Gosling Designer, an all-in-one platform for editing, exploring, and sharing visualizations of genomics data. Gosling Designer addresses four key challenges observed in existing genomics visualization tools: (1) limited versatility, (2) difficulty of visualization authoring, (3) complexity of data management, and (4) barriers to sharing and collaboration.No embarg