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Why do I need to belong? Black women and Latinas navigate medical education beyond belonging toward rightful presence
No full textBackground: Medical education research indicates that students of color face discrimination affecting their sense of belonging within historically white institutions (HWIs) of academic medicine. This is especially true for the students with intersectional identities such as Black women and Latinas, who continue to make up a small percentage of medical school matriculants each year.
Methods: In 2021, we initiated a virtual community of seven Black women and Latina medical students from around the midwestern United States. Over a two-year period, participants engaged in online message boards and research interviews discussing their experiences for the purpose of promoting a sense of belonging. Using the data collected from the virtual community, we implemented a composite narrative methodology undergirded by theoretical frameworks Black Feminist Thought (BFT) and Latina Chicana Feminism (LCFT) to answer our research question. The purpose of the study was to understand the impact of a sense of belonging on participant experiences in medical school, while also protecting their anonymity.
Results: The findings for this study are illustrated via composite narratives that are organized as a conversation between a Black woman and a Latina medical student named Moon and Star. The composite narratives highlight experiences had among the seven participants demonstrating how minoritized identity development is inconsistent with belonging and the need for HWIs of academic medicine to establish a rightful presence beyond belonging. Rightful presence is a concept where the qualities and characteristics of an individual are accepted in an environment and therefore, do not require the individual to adjust for purposes of belonging.
Conclusion: This study identified rightful presence as a way to engage Black women and Latina students in medical education. Based on the findings from this study we encourage moving beyond a sense of belonging approach toward welcoming the unique contributions of Black women and Latinas starting with their right to be in medical education spaces.
Supplementary Information: The online version contains supplementary material available at 10.1186/s12909-025-07781-9
Looped Audiovisual Health Education Talk Reduces Vaccine Clinic Wait Time in Nigeria
No full textBackground: Wait time at vaccine clinics is a barrier to routine childhood vaccinations in low- and middle-income countries (LMICs). Waiting for a critical mass of clients to accrue before conducting the vaccine health education talk prolongs clinic time.
Methods: We implemented a workflow change, including a looped audiovisual vaccine education talk on a solar-powered television. We compared clients' average clinic time using a before-and-after study, time-motion design, and surveyed providers and clients on their perspectives on the workflow change.
Results: In the post-implementation phase, compared to the pre-implementation phase, the average clinic time for all clients and the subgroup who presented before 9:00 AM was significantly reduced by 13 and 31 min, respectively (p = 0.006 and < 0.000). Providers and clients were positive about the workflow change.
Conclusion: A looped audiovisual vaccine education talk significantly reduces client vaccine clinic wait time and is acceptable to providers. Research on the impact of workflow change with alternate vaccine health talk delivery mode on vaccine uptake and completion is required
Prevention of preterm birth in twin pregnancy: international Delphi consensus
No full textObjective: To use the Delphi method to gain insight into approaches to prenatal diagnosis and management of preterm birth (PTB) in twin pregnancies, including complications such as twin-to-twin transfusion syndrome (TTTS) and a short and/or dilated cervix.
Methods: A three-round Delphi process was conducted among an international panel of experts to assess their approach to prevention, monitoring and management strategies for PTB in twin pregnancies. Experts were selected based on their publication record or membership of related organizations. Response options were multiple-choice answers or a five-point Likert scale. A priori, a cut-off of ≥ 70% agreement was used to define consensus.
Results: A total of 117 experts participated in the first round, of whom 94/117 (80.3%) completed all subsequent rounds. Representatives came from at least 22 countries (across five continents), most commonly the USA (50.4%) and the UK (12.0%). Over 70% of experts performed routine screening of cervical length (CL) using transvaginal ultrasound at 18-23 weeks' gestation, using CL ≤ 25 mm to diagnose short cervix in twin pregnancies, regardless of a history of PTB. In twin pregnancies with a short non-dilated cervix, most experts offered vaginal progesterone rather than pessary or cervical cerclage, regardless of a history of PTB. In twin pregnancies with asymptomatic dilated cervix, consensus was reached (88.3% agreement) for placement of cervical cerclage, performed up to 24 weeks' gestation (67.5% agreement; no consensus). Similarly, 96.1% of experts agreed that performing serial transvaginal ultrasound measurements of CL at 16-24 weeks' gestation was warranted in women with a current singleton pregnancy who had a previous twin pregnancy that required physical examination-indicated cerclage; these patients should be considered high risk for PTB (83.1% agreement). In twin pregnancies with TTTS, laser surgery is offered by most experts, regardless of preoperative CL. In patients with TTTS and short CL, most experts would recommend cervical cerclage (71.9%) or vaginal progesterone (65.6%) rather than pessary or expectant management. However, no consensus was reached on measures to prevent PTB in cases of TTTS with cervical dilation.
Conclusions: This Delphi consensus study highlights practice variations among healthcare providers worldwide in the evaluation and management of PTB in twin pregnancies, which often differ from recommendations given by national and international societies
A cross-sectional survey of community health workers and their roles in Indiana
No full textBackground: In the US, there is a lack of information about the community health worker (CHW) workforce, which is critical to inform workforce policy, development, and training initiatives. In this manuscript, we report the results of a cross-sectional workforce survey of CHWs in Indiana.
Methods: We conducted a statewide electronic survey of CHWs in Indiana. Eligible participants were self-reported CHWs and over the age of 18. The survey was adapted from an existing tool and included questions about CHWs' demographics, employer, compensation, and roles and responsibilities. The survey was pilot-tested and distributed in partnership with the state's CHW professional association. Data were collected anonymously using REDCap. Bivariate correlations were examined between salary and demographics, employer type, training, and length of employment. Analyses were conducted using SAS version 9.4.
Results: Among 282 participants that met eligibility, a majority were female (92%) with 39% identifying as Black/African American, 38% as White, and 13% as Hispanic/Latino. Over 40% held at least a Bachelor's degree, and 20% were multilingual. CHWs worked under various job titles - only half reported that their official job title was as a CHW - and for a variety of organizations with about half working for either a health system or academic employer. Respondents had a median of 2 years of experience as a CHW. The majority of CHWs were employed full-time (85%) and had completed a training program (83%). Their scopes of practice varied but CHWs were most engaged in activities related to culturally relevant communication, care coordination, coaching, and social support. Lower salary was significantly associated with less education and working as a CHW for less than one year, but not with other demographic characteristics, employer type, or having completed a training program.
Conclusion: This study offers a snapshot of Indiana's CHW workforce, highlighting that it is predominantly female but diverse demographically, in employment setting, job title, and roles played. The findings provide insights to guide workforce development and planning efforts by employers, professional associations, health departments, and policymakers to strengthen and expand this essential workforce in Indiana and beyond
External validation of a genomic signature for oligometastatic non-small cell lung cancer
No full textObjective: We previously presented a genomic signature predictive of both oligometastatic disease state and oligoprogression in patients with brain metastases. We sought to validate this oligometastatic genomic signature using an independent dataset of patients without brain metastases.
Methods: Patients with non-small cell lung cancer (NSCLC) and liquid biopsy-based genomic profiling (Guardant Health) were identified in our departmental database. Those with brain metastases were excluded. Patients were assigned an oligometastatic risk score based on the previously derived genomic signature. Oligometastatic disease was defined as ≤5 metastases without diffuse single-organ involvement. For oligometastatic patients, we performed a competing risk analysis for the cumulative incidence of oligoprogression. Cox regression was used to determine association between oligometastatic risk score and oligoprogression.
Results: A total of 225 patients met inclusion criteria for this validation dataset. 158 patients (70%) had oligometastatic disease. Patients with positive and neutral/negative risk scores had a 70 vs 48% likelihood of oligometastatic disease, respectively (p = 0.03 from Fisher's exact test). Patients with positive risk scores more frequently experienced oligoprogression with a hazard ratio of 1.72 (p = 0.11). Overall survival for patients with positive and neutral/negative risk scores was 92% vs 79% at 6 months; 46% vs 60% at 12 months; 23% vs 34% at 24 months (p = 0.25).
Conclusion: In this independent dataset, our genomic signature predicted oligometastatic disease state and showed a trend towards prediction of oligoprogression. With further study, our findings may suggest a biomarker with future potential to direct local therapies in oligometastatic NSCLC patients
Charles Hohensee and Joanne Lobato (Eds.). Transfer of learning: progressive perspectives for mathematics education and related fields
No full textInhibition of soluble TNFa in conjunction with anti‐amyloid immunotherapy
No full textBackground:
The approval of anti‐amyloid beta immunotherapies have showcased breakthroughs in our understanding and treatment of Alzheimer's disease (AD). While promising, anti‐amyloid beta (Aß) immunotherapies may lead to the development of ARIA (Amyloid Related Imaging Abnormalities). ARIA presents as cerebral edema (ARIA‐E) or hemorrhages (ARIA‐H), and no clear mechanism has been established. Neuroinflammation is a key etiology of AD that may contribute to the development of ARIA, particularly inflammation at the neurovascular unit. Thus, we hypothesize that inhibition of soluble TNFα (sTNFα) in combination with immunotherapy will reduce systemic inflammation and development of ARIA‐H.
Method:
In animal models, we can reliably recapitulate ARIA‐H with administration of 3D6, an Aß targeting antibody. Aged (19 mo) APPSAA mice, a humanized Ab knock‐in model, received weekly injections of 3D6 (or IgG control) as well as a sTNFα inhibitor (or saline) over the course of 3 months. We used Congo red staining to quantify total, parenchymal, and vascular amyloid, flow cytometry to assess systemic inflammation via platelet activation, and Prussian blue to quantify microhemorrhage occurrence.
Result:
Administration of 3D6 reduced the average Congo positive vessel size as expected, however there were no significant differences in total Congo staining or percent of Congo at the vasculature between our groups. Administration of 3D6 increases superficial, cortical, and hippocampal bleeding compared to IgG controls following treatment from 19‐22 months of age. Interestingly, inhibition of sTNFα rescued 3D6‐driven hippocampal bleeds in these animals (p = 0.059). Additionally, platelets from 3D6 treated mice had higher surface levels of p‐selectin, a marker of activation, while sTNFα inhibition prevented this activation.
Conclusion:
Inhibition of sTNFα is promising as a potential combination therapy with anti‐Aß antibodies for reduction of systemic inflammation and microhemorrhage development, supporting future studies exploring this target
348 Real-time data synchronization: Assessing the implementation of REDCap CDIS (Clinical Data Interoperability Service) for EHR systems
No full textObjectives/Goals: This study tests the REDCap Clinical Data Interoperability Service (CDIS) for streamlined data extraction from electronic health records (EHRs) for research. Managed by Clinical and Translational Science Institute, IU Health, and Eskenazi Health, CDIS offers real-time data syncing, automated workflows, and HIPAA-compliant data security. Methods/Study Population: The REDCap CDIS uses the Fast Health Interoperability Resource (FHIR) Application Programming Interface (API) to extract data from EHRs. It includes the Clinical Data Pull (CDP), which automatically pulls EHR data into user-defined REDCap fields, and the Clinical Data Mart (CDM), which collects longitudinal patient data. Three use cases were selected to assess the CDIS’s effectiveness in extracting data from the IUH Cerner and Eskenazi Epic EHR systems. The technical team set up clinical data mapping and adjudication processes, simplifying complex manual data extraction. Results/Anticipated Results: The CDIS successfully achieved real-time data synchronization during pilot testing with each EHR system. We extracted demographics, drugs, procedures, labs, and conditions. The mapping interface supports many-to-one data point mapping for the study data dictionary, and the adjudication process ensures data quality before integration into the REDCap database. The CDIS also improved data security and HIPAA compliance. An implementation intake process was developed for Indiana University investigators, allowing them to use the service for affordable clinical data extraction from EHR systems. Discussion/Significance of Impact: The implementation and testing of the REDCap CDIS demonstrates its effectiveness in streamlining EHR data extraction for research. The CDIS facilitates real-time data synchronization, automated workflows, and enhanced data security, offering a cost-effective solution through collaborative oversight with research teams
Shelter-in-place during the COVID-19 pandemic: Impact on secondary health conditions, anxiety, loneliness, social isolation, social connectedness, and positive affect and well-being
No full textContext/objective: The objective of this study was to examine the implications of shelter-in-place (SIP) during the COVID-19 pandemic on secondary health conditions (SHC), loneliness, social isolation, social connectedness, anxiety, and positive affect and well-being (PAWB) among community-dwelling adults with spinal cord injury (SCI).
Design: An online exploratory cross-sectional descriptive design.
Participants: 131 community-dwelling adults with SCI.
Outcome measures: UCLA Loneliness Scale, SCI-QOL - Anxiety and PAWB.
Results: Respondents were approximately 33 years old, mostly male and Caucasian. More than half reported being married, living with their spouse in a home with modifications, or living in a household of three or more people. More than half reported experiencing more pain during SIP but not experiencing more of any other SHC than before SIP. On average, participants experienced a moderate level of loneliness, severe anxiety, and higher levels of PAWB during SIP.
Conclusion: Respondents reported that they experienced more pain, loneliness, and anxiety while at the same time reporting higher PAWB. Future research should focus on understanding the nuances of the seemingly counterintuitive relationship described here to develop better ways to support community-dwelling adults with SCI during public health emergencies and SIP
Revolutionizing OSCE Preparation Through AI-Driven Synthetic Patients
No full textRevolutionizing OSCE Preparation Through AI-Driven Synthetic Patients
Chandler Lutz¹, Liam Hobson1, David Rodgers2
¹Indiana University School of Medicine, 2Indiana University School of Medicine, Department of Medicine and Interprofessional Simulation Center
Background:
Objective Structured Clinical Examination (OSCE) preparation is a key component of medical student training. Traditional methods like standardized patient (SP) encounters and peer-to-peer practice provide valuable experience but are limited by inconsistent feedback, access issues, and time constraints. To support OSCE preparation, we developed AI-driven synthetic patients that offer students a flexible, accessible, and consistent practice tool. Using ChatGPT-4o and core clinical competencies expected of first-year students at Indiana University School of Medicine (IUSM), we piloted virtual patients that simulate realistic encounters—enabling conversational interviews with immediate, structured feedback.
Methods:
Five interactive synthetic patient cases were created to reflect common OSCE scenarios. Each case included a computerized door note, dynamic dialogue, realistic patient responses, and downloadable feedback modeled after IUSM OSCE grading rubrics. We recruited 14 rising second-year medical students at IUSM–Bloomington to interview the synthetic patients. A pre-interview survey assessed students' prior OSCE preparation, while a post-interview survey evaluated the tool’s realism, usefulness, and convenience, and gathered qualitative feedback.
Results:
The pre-interview survey revealed that a majority of students (9 of 14) desired additional tools to support history-taking practice for the OSCE. In the post-interview survey (n=6), students rated the tool an average of 7.5 for usefulness, 7.5 for realism, and 9.5 for convenience on a 10-point Likert scale. Participants appreciated the ability to engage with the tool independently and at their own pace, simulating the structure of a real OSCE. All participants recommended integrating the tool into first-year OSCE preparation and expressed strong interest in expanding its use for second-year OSCE preparation.
Conclusion and Future Directions:
This pilot demonstrates strong student support for AI-based OSCE preparation. Full implementation is planned for Fall 2025 at IUSM–Bloomington, where we will compare OSCE outcomes between users and non-users