Pilot test of a large-scale, first-hand research opportunity for medical students

Purpose and background: While VCU is an R1 university, many students graduate without first-hand research experience. We sought to create a new learning opportunity for second year medical students (M2s) through access to real-world clinical data from a federated research network of healthcare organizations, TriNetX. TriNetX gives users access to millions of de-identified patient records for a wide variety of purposes: cohort discovery; determining possible enrollment rates for clinical trials; evaluating outcomes; and evaluating disparities. Several VCU researchers have published studies using TriNetX data [i]. Prior to our project, TriNetX access and instruction had not been pushed out to medical students. Our project offered access and instruction in TriNetX to M2 students in the Population Health & Evidence-Based Medicine (PopHealth) course, and we encouraged them to use TriNetX to fulfill a research project requirement. Innovative Practice: We automated access to TriNetX for all 185 M2s students before their first PopHealth session in early August. We developed and delivered instructional sessions on TriNetX including demonstrations and an in-depth review of a TriNetX study conducted by VCU researchers [ii]. We re-designed the self-directed research project to allow students to choose either the traditional research proposal or a TriNetX-based mini-study. We aligned the project deliverables for the two pathways to make them equitable. Mid-semester, we reviewed teams’ descriptions of their intended project and offered support and suggestions. Results: Eight teams (20%) conducted a mini-study using TriNetX. All of them made use of additional faculty meeting time for help. Topics included: Outcomes of new drug for chronic Hepatitis-C Heart failure outcomes in pediatric populations Disparities in advanced HIV disease End-of-semester evaluations regarding TriNetX were mixed: “I was also really excited to learn about TriNetX. I didn’t know databases like that existed before I took this class. It is definitely a component of the course that should be included for next year’s M2s. Even though my group did not end up using this for our project, I hope to use TriNetX in the future.” “I enjoyed using TRINETX for the assignment!” “I think having a [full] class dedicated to TriNetX could be helpful and might address the disparity in groups choosing research proposal over TriNetX.” “I feel like we should have had more sessions on how to use trinex” Conclusion: Professionalism in medicine today requires the ability to access, interrogate, and evaluate data in order to provide evidence-based care to all patients. Health professionals should know how to access secondary datasets to evaluate quality of care, conduct independent research, determine feasibility of clinical trial enrollment, detect disparities, and evaluate real-world implementation of new treatments. Our own reflections on this experiment are largely concordant with the students’ feedback. Our plans for modifying our approach include: Set aside more classroom time for TriNetX instruction, demonstration, and student practice. Divide the class into smaller groups for student-led explorations of TriNetX. Develop worksheets to guide self-directed learning outside of the classroom. Future research: We will conduct a survey of the M2 students to get additional feedback. We will create and offer an elective for medical students on using TriNetX for research, and will evaluate students’ experience. We believe that other Health Sciences schools could explore similar innovations, perhaps in an inter-professional context, on which we would enthusiastically collaborate

Fashioning Appropriate Regulation of Opioids for Palliative Care

Palliative care specialists, who care for patients with serious, life-limiting illnesses such as cancer, are experts in evaluating and managing acute pain. Amid concerns of substance abuse and diversion in patients with cancer, including those near the end of life, regulations and training for providers should encourage the development and use of distinct assessment and management guidelines for palliative care situations

Funding models in palliative care: lessons from international experience

Background:Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them.Aim:To assess national models and methods for financing and reimbursing palliative care.Design:Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms.Results:Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following:Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision.Funding is frequently characterised as a mixed system of charitable, public and private payers.The basis on which providers are paid for services rarely reflects individual care input or patient needs.Conclusion:Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest

Episodic Radiations in the Fly Tree of Life

Flies are one of four superradiations of insects (along with beetles, wasps, and moths) that account for the majority of animal life on Earth. Diptera includes species known for their ubiquity (Musca domestica house fly), their role as pests (Anopheles gambiae malaria mosquito), and their value as model organisms across the biological sciences (Drosophila melanogaster). A resolved phylogeny for flies provides a framework for genomic, developmental, and evolutionary studies by facilitating comparisons across model organisms, yet recent research has suggested that fly relationships have been obscured by multiple episodes of rapid diversification. We provide a phylogenomic estimate of fly relationships based on molecules and morphology from 149 of 157 families, including 30 kb from 14 nuclear loci and complete mitochondrial genomes combined with 371 morphological characters. Multiple analyses show support for traditional groups (Brachycera, Cyclorrhapha, and Schizophora) and corroborate contentious findings, such as the anomalous Deuterophlebiidae as the sister group to all remaining Diptera. Our findings reveal that the closest relatives of the Drosophilidae are highly modified parasites (including the wingless Braulidae) of bees and other insects. Furthermore, we use micro-RNAs to resolve a node with implications for the evolution of embryonic development in Diptera. We demonstrate that flies experienced three episodes of rapid radiation—lower Diptera (220 Ma), lower Brachycera (180 Ma), and Schizophora (65 Ma)—and a number of life history transitions to hematophagy, phytophagy, and parasitism in the history of fly evolution over 260 million y

Project MERCI (Medical Emergency Response Care Initiative)

This project proposed a program intended to foster a greater sense of community, shared responsibility, and mutual aid within Virginia Commonwealth University. The group members saw an opportunity to develop the expectation that students, faculty and staff will come to one another’s aid, and to provide the tools necessary to help ensure our mutual safety and health. The medical emergencies as an initial project were selected, focusing their research on the current status of CPR and first-aid training and the placement of automated external defibrillators (AEDs) at VCU

Phylogenomics reveals the history of host use in mosquitoes

Mosquitoes have profoundly affected human history and continue to threaten human health through the transmission of a diverse array of pathogens. The phylogeny of mosquitoes has remained poorly characterized due to difficulty in taxonomic sampling and limited availability of genomic data beyond the most important vector species. Here, we used phylogenomic analysis of 709 single copy ortholog groups from 256 mosquito species to produce a strongly supported phylogeny that resolves the position of the major disease vector species and the major mosquito lineages. Our analyses support an origin of mosquitoes in the early Triassic (217 MYA [highest posterior density region: 188–250 MYA]), considerably older than previous estimates. Moreover, we utilize an extensive database of host associations for mosquitoes to show that mosquitoes have shifted to feeding upon the blood of mammals numerous times, and that mosquito diversification and host-use patterns within major lineages appear to coincide in earth history both with major continental drift events and with the diversification of vertebrate classes. © 2023, Springer Nature Limited

Funding models in palliative care: Lessons from international experience

Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest

Dark sectors 2016 Workshop: community report

This report, based on the Dark Sectors workshop at SLAC in April 2016, summarizes the scientific importance of searches for dark sector dark matter and forces at masses beneath the weak-scale, the status of this broad international field, the important milestones motivating future exploration, and promising experimental opportunities to reach these milestones over the next 5-10 years

Single-copy nuclear genes resolve the phylogeny of the holometabolous insects

Background: Evolutionary relationships among the 11 extant orders of insects that undergo complete metamorphosis, called Holometabola, remain either unresolved or contentious, but are extremely important as a context for accurate comparative biology of insect model organisms. The most phylogenetically enigmatic holometabolan insects are Strepsiptera or twisted wing parasites, whose evolutionary relationship to any other insect order is unconfirmed. They have been controversially proposed as the closest relatives of the flies, based on rDNA, and a possible homeotic transformation in the common ancestor of both groups that would make the reduced forewings of Strepsiptera homologous to the reduced hindwings of Diptera. Here we present evidence from nucleotide sequences of six single-copy nuclear protein coding genes used to reconstruct phylogenetic relationships and estimate evolutionary divergence times for all holometabolan orders. Results: Our results strongly support Hymenoptera as the earliest branching holometabolan lineage, the monophyly of the extant orders, including the fleas, and traditionally recognized groupings of Neuropteroidea and Mecopterida. Most significantly, we find strong support for a close relationship between Coleoptera (beetles) and Strepsiptera, a previously proposed, but analytically controversial relationship. Exploratory analyses reveal that this relationship cannot be explained by long-branch attraction or other systematic biases. Bayesian divergence times analysis, with reference to specific fossil constraints, places the origin of Holometabola in the Carboniferous (355 Ma), a date significantly older than previous paleontological and morphological phylogenetic reconstructions. The origin and diversification of most extant insect orders began in the Triassic, but flourished in the Jurassic, with multiple adaptive radiations producing the astounding diversity of insect species for which these groups are so well known. Conclusion: These findings provide the most complete evolutionary framework for future comparative studies on holometabolous model organisms and contribute strong evidence for the resolution of the 'Strepsiptera problem', a long-standing and hotly debated issue in insect phylogenetics