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Building Family Partnerships Toward Equitable Community Engagement and Integration in STEM Education
Get PDFIn their quest to further their understanding of the power of plática (authentic dialogue) in community engagement efforts, the researchers/practitioners embedded themselves in deep, critical conversations with family leaders from a community-based organization on issues of equity and excellence in education. A family-centered theory of change developed by trusting relationships and partnerships with students, their families, and educators, was incorporated in the professional development of STEM faculty, revision of STEM curricula, and the transformation of teaching practices. This study advances the body of knowledge on the operationalization of servingness and provides insight on the utilization of sense of belonging metrics to assess the impact of equitable, community engagement efforts.
Two-way ANOVA on baseline data (N=779) showed that female undergraduate students have a statistically significant (α=0.05) higher sense of belonging than males throughout their first three years of college. Using a mixed-methods research design, the researchers/practitioners took a critical ethnographic approach to assess the impact of their community engagement efforts. Through critical reflection and reflexivity, the researchers used sense of belonging and student success metrics to assess the impact of the internal processes and methods of a family-centered theory of change which led to equitable outcomes among participants.
Keywords: theory of change, servingness, sense of belonging, STEM education, community engagemen
Through a Different Lens: Assessing Patient and Clinician Diversity in Medical Education Clinical Practice Media
Get PDFBackground: As demands grow for inclusivity and representation in the workplace, schools, and various other settings, an increased focus has been placed on the lack of diversity in health multimedia. Specifically, textbooks utilized in medical school curriculum often lack photos that depict diverse skin tones, body shapes, sexes, and genders. However, past studies did not analyze the most recent clinical textbooks or emerging clinical video databases. This research focuses on examining patient and clinician clinical diversity in two clinical education resources: Bates’ Guide to Physical Examination and History Taking 13th edition (2021 e-text) and Bates’ Visual Guide to Physical Examination (video series).
Methods: We developed a coding scheme for photos and videos based on previous literature that analyzes age, gender, sex, health state, skin tone, hair texture, body composition, SES, and the presence of tattoos and/or piercings. The coding scheme underwent 2 rounds of testing and subsequent modifications with a smaller sample. The final validated scheme was used to assess 576 photos and videos.
Results: Of the photos and videos, only 18% exhibited individuals with curly or wavy hair, 1% included individuals with a darker skin tone, and 0.3% of individuals had a larger body type. There were no intersex or nonbinary individuals included. None of the individuals had tattoos, and all the piercings displayed were earlobe piercings, with all but 1 of the individuals being female.
Conclusions/Implications: These findings reflect conclusions from previous studies, demonstrating that diversity and representation in medical textbooks can still be improved. Although there was some diversity in the photos and videos, several of the same models were used throughout the sources, which limits the application of such images to a range of diverse individuals. By advancing the diversity of medical school curriculum materials, students can provide more competent and compassionate care
Genetics of Early-Onset Alzheimer’s Disease: Investigation of Rare Variants in the LEADS Cohort
Get PDFIntroduction: Early-Onset Alzheimer’s Disease (EOAD) is a neurodegenerative disease (NDD) with marked heritability, the majority of which is unexplained by known pathogenic variants. We hypothesize that a portion of the genetic etiology of EOAD may be due to rare pathogenic variants in genes associated with other NDDs, including Parkinson Disease (PD), Frontotemporal Dementia (FTD), and Amyotrophic Lateral Sclerosis (ALS).
Methods: First, we constructed a gene set comprised of 31 loci commercially screened for both dementia and another NDD, captured by ten commercial dementia and four commercial NDD genetic test panels. We performed gene ontology analysis of this 31-gene set. We then conducted SKAT-O testing for pathway-level enrichment of rare functional variants in whole exome sequencing (WES) data from participants in the Longitudinal Early-Onset Alzheimer’s Disease Study (LEADS) (n = 303) and age-matched controls from the Parkinson’s Progression Markers Initiative (n = 193), with pathways defined by NDD gene panel. We performed post-hoc gene-set tests for individual genes in significant pathway results.
Results: SKAT-O analysis showed LEADS participants were enriched in functional SNPs compared to controls within genes in panels for PD and Parkinsonism (p=0.0003) and FTD (p=0.0119). Post-hoc testing revealed significant enrichment in FUS (p = 0.0098), from the FTD panel, and ATP7B (p = 0.0002), from the PD and Parkinsonism panel. Ontology analysis revealed that numerous neurodegeneration-associated biological processes, including mitochondrial organization and function, autophagy, proteasomal catabolism, and oxidative stress were statistically enriched in the original 31-gene set.
Conclusion and Scientific Impact: Functional SNP enrichment in PD- and FTD-associated genes in the LEADS cohort suggests shared etiology amongst NDDs. The genes and pathways identified are promising for targeted research capable of detection of specific variants responsible for the missing heritability of clinical EOAD, which would improve diagnostic timeliness and accuracy. 
Update and Expansion of an Interprofessional Education Search Strategy Validation Study for NLM PubMed, Ovid MEDLINE, and Elsevier Embase
Get PDFUpdate and Expansion of an Interprofessional Education Search Strategy Validation Study for NLM PubMed, Ovid MEDLINE, and Elsevier Embas
Redefining Measures of Career Success: A Holistic View of Post-Graduation Success
Get PDFTraditional measures of career success—primarily salary and job titles—offer a limited and often misleading view of post-graduation outcomes. These narrow metrics fail to capture the complexity of career trajectories and provide little actionable insight for institutions seeking to improve student preparedness. This paper advocates for a holistic approach to measuring career success by incorporating objective indicators, such as cost of living and industry trends, and subjective measures, such as alumni perceptions of job satisfaction and career fulfillment. Examples and strategies for measuring career success beyond salary and first-destination outcomes are provided. Lessons learned from collecting these measures are shared, including leadership commitment, community building, stakeholder engagement, and the use of technology and analytics. Additionally, it is important to integrate data collection into curricula, foster industry collaboration, and establish feedback loops to align academic programs with workforce needs. By redefining career success beyond traditional metrics, this study offers a framework for institutions to assess and enhance graduate outcomes more effectively in an evolving job market
Difficult Cannulations in Neonatal and Pediatric ECMO: Illuminating an Obstruction to Timely Therapy
Get PDFBackground and Objective: ECMO is a vital intervention for neonatal and pediatric patients requiring cardiorespiratory support, yet unanticipated difficulties with peripheral cannulation can hinder timely therapy. Research concerning challenging cannulations is limited, and protocols guiding surgeons to consider alternative approaches in cases of potential difficulty are lacking. The purpose of this study was to identify reasons for cannulation difficulty and pinpoint predisposing diagnostic, anatomical, and operative features of this population.
Methodology: We conducted a single-center, five-year retrospective review of neonatal and pediatric patients encountering challenging peripheral cannulations or multiple cannulations for ECMO. Variables included patient demographics, ECMO indications, prior cannulation attempts, surgical challenges encountered, alternative vascular anatomy, and outcomes from cannulation to discharge.
Results: An analysis of 65 cannulations (38 subjects, median cannulations per subject=1, range 1-4) revealed that venous cannulations posed challenges more often (n=28) than arterial cannulations (n=11). Intraoperative cannulation challenges were predominantly attributed to small vessel size (43.5%) and unspecified catheter advancement obstructions (23.1%). A substantial proportion of patients in this cohort exhibited congenital heart anomalies (81.6%), and 50.8% of cannulations occurred in the setting of post-procedural support, often postcardiotomy. Alternate neck or groin vascular anatomy was identified in 19 cannulations. The rate of unsuccessful peripheral cannulation was 20.5% (n=8) and patient mortality associated with difficulty cannulating onto ECMO was 15.4% (n=6).
Conclusions and Impact: These findings suggest that neonatal and pediatric patients with congenital heart anomalies or a history of recent surgery may face an increased risk of challenging cannulations and poorer ECMO outcomes. Pre-operative neck and groin ultrasound could help surgeons better anticipate and address difficulties like small vessel size or obstruction. Early evaluation of risk factors for challenging cannulations will enhance surgical decision-making regarding cannulation approach and ultimately improve outcomes for children requiring ECMO
Assessing a Community-based, Group Care Program Adapted for Pregnant and Parenting Adolescents in Western Kenya: An Acceptability and Feasibility Study
Get PDFBackground: An estimated 21 million adolescent pregnancies occur worldwide, predominantly in low- and middle-income countries (LMICs). These pregnancies often result in poor health outcomes due to low health literacy and limited healthcare interaction. Furthermore, many adolescent parents face disproportionate stigma and are unable to complete their education or seek employment due to parenting obligations. The Chamas for Change program, an existing community-based group care program in Kenya targeted to adult mothers, shows promise in improving maternal, newborn, and child health (MNCH) outcomes in adolescents. This study evaluates the acceptability and feasibility of an adapted Chamas model tailored for pregnant and parenting adolescents.
Methods: This mixed-methods study investigated the acceptability and feasibility of an adapted Chamas program for pregnant adolescents in rural Western Kenya. Likert scale surveys (ranging 1-5, 5 = “completely agree”) were conducted at baseline and endline to quantitively assess acceptability of the program. Program attendance, barriers to attendance, and intention to re-enroll were used to assess feasibility. Two Focus Group Discussions (FGDs) conducted at endline were analyzed through a thematic framework to qualitatively assess acceptability and feasibility.
Results: Over the course of the study, 85% of participants had attended at least half of the adapted program sessions. At endline, 99% of adolescents reported the program is acceptable and 95% reported it is feasible (score ≥ 4 on the Likert scale). Additionally, 99% indicated they would re-enroll in the program for another cycle and 71% would attend even if no transportation and snacks are offered. Through thematic analysis of FGDs, strong themes of greater peer support and health literacy were noted.
Conclusion and Potential Impact: The adolescent Chamas pilot demonstrated strong acceptability and feasibility, with MNCH outcomes being equivalent or better with the intervention. As such, there is potential to scale-up and expand the adapted Chamas program.
Association of Post-Traumatic Epilepsy on Recovery from Severe Traumatic Brain Injury: Sliding Scale Approach
Get PDFBackground: Post-Traumatic Epilepsy (PTE) affects one-third of severe traumatic brain injury (TBI) patients and is associated with poor functional outcomes. While TBI is characterized by continued recovery years after injury, the trajectory of functional recovery in PTE patients is not well understood. Using a novel sliding scale, we hypothesized that PTE acts as a ‘second hit’ after TBI, slowing recovery over time.
Methods: We performed a retrospective analysis of severe TBI patients (Glasgow Coma Scale (GCS) ≤ 8) treated from 2002 to 2018 at a Level 1 trauma center. We used the International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) model to assign a sliding scale score. This score was based on the difference between the expected threshold for an unfavorable outcome (Glasgow Outcome Scale (GOS) = 1-3) and the actual score. Hence, a sliding score captures the magnitude of change between levels on the GOS according to each patient’s baseline prognosis. Scores ranged from -3 to +2, with positive scores denoting improvement compared to baseline prognosis, as expected in most TBI patients. Thus, a sliding scale score serves as a marker of a patient’s expected recovery over time. We used the Wilcoxon Rank-Sum test to compare the change in sliding scores over time for patients with and without PTE.
Results: We had 392 patients with a median age of 33 (interquartile range (IQR)=23-47.5) Improvement for patients with PTE on the sliding scale was less (25.42% compared to 32.62% without PTE) over two years post-injury. PTE patients show a significant decline in functional outcomes compared to non-PTE patients during the 6 to 24-month follow-up period (p=0.04.)
Conclusion: Post-traumatic epilepsy is associated with delayed recovery after severe TBI. Future PTE clinical trials should consider a sliding scale approach to explore if early, aggressive treatment improves functional outcomes
