Centering Health Equity and Structural Racism in Health Sciences Curriculum

This paper overviews scientific evidence and some of the local Richmond, Virginia history related to structural racism and health disparities. The paper then describe recent demands for racial justice and curriculum transformation that have been made by Virginia Commonwealth University (VCU) health sciences students, faculty and community members as well as the action steps the university has taken to address these demands. The paper concludes by calling on VCU health sciences faculty members to take action in the following three ways: (a) by participating in professional conversations about the intersections of health equity, structural racism, and health sciences education, (b) by familiarizing themselves with available institutional resources for creating inclusive and social justice oriented curriculum and learning environments, and (c) by considering participation in new systemic racism and implicit bias faculty learning communities offered by the VCU Office of the Senior Vice President for Health Sciences

Collection and processing of shipboard ADCP velocities from the Barents Sea Polar Front Experiment

The Barents Sea Polar Front Experiment was a combined physical oceanography and acoustic tomography field study which took place from 6-26 August 1992. Both shipboard and moored data were collected in a 80 x 70 km experimental region on the south flank of Sptisbergen Bank about 60 km east of Bear Island. Of principal interest in this report are the data from an Acoustic Doppler Current Profier (ADCP) which was operated continuously during the experimental period as a part of the shipboard instrumentation aboard the USNS Barlett. The data from eight current meters deployed on three moorings in the experimental region are used to supplement the ADCP analysis. Preliminary results showed that velocities in the experimental region were dominated by semi-diurnal tides. The strong tidal oscilations dictated the use of a tide removal scheme to extract a steady flow component from the space-time grid of ADCP velocities. This report describes the configuration and operation of the ADCP, the space-time sampling grid on which the data were collected, the determination of absolute velocity from the ADCP measurements, and the application and results of a tide removal technique which allowed estimation of the sub-tidal flow.Funding was provided by the Office of Naval Research under Grant No. NOOOI4-90-J-1359

Challenges of measuring diurnal cortisol concentrations in a large population-based field study

Longitudinal examinations of associations between daily stress, diurnal cortisol concentrations, and physiological parameters in population-based studies are needed. This study evaluates issues related to consent, collection, and protocol adherence for a low-burden saliva collection protocol

Rationale for and design of the "POSTA" study: Evaluation of neurocognitive outcomes after immediate adenotonsillectomy compared to watchful waiting in preschool children

Background: IQ deficits are linked to even mild obstructive sleep apnoea (OSA) in children. Although OSA is commonly first diagnosed in the pre-school age group, a randomised trial is still needed to assess IQ outcomes after adenotonsillectomy in the pre-school age-group. This randomised control trial (RCT) will primarily determine whether adenotonsillectomy improves IQ compared to no adenotonsillectomy after 12 months, in preschool (3–5 year-old) children with mild to moderate OSA. Methods: This protocol is for an ongoing multi-centred RCT with a recruitment target of 210 subjects (105 in each arm). Children age 3–5 years with symptoms of OSA, are recruited through doctor referral, at the point of referral to the Ear Nose and Throat (ENT) services. Screening is initially with a questionnaire (Paediatric Sleep Questionnaire, PSQ) for symptoms of obstructive sleep apnoea (OSA). Where questionnaires are positive (suggestive of OSA) and ENT surgeons recommend them for adenotonsillectomy, they are invited to participate in POSTA. Baseline testing includes neurocognitive testing (IQ and psychometric evaluation with the neuropsychologist blinded to randomisation) and overnight polysomnography (PSG). Where the Obstructive Apnoea-Hypopnea Index (OAHI) from the PSG is <10/h per hour, consent for randomisation is sought; children with severe OSA (OAHI ≥ 10/h) are sent for immediate treatment and excluded from the study. After consent is obtained, participants are randomised to early surgery (within 2 months) or to surgery after a usual wait time of 12 months. Follow-up studies include repeat neurocognitive testing and PSG at 12 (with the waiting list group studied before their surgery) and 24 months after randomisation. Analysis will be by intention to treat. The primary outcome is IQ at 12 months’ follow-up. Discussion: If IQ deficits associated with OSA are reversible 12 months after adenotonsillectomy compared to controls, future clinical practice advise would be to undertake early surgery in young children with OSA. The study could provide data on whether a window of opportunity exists for reversing IQ deficits linked to OSA in the pre-school age-group. Trial registration: Australian and New Zealand Clinical Trials Registration Number ACTRN12611000021976.Karen A. Waters, Jasneek Chawla, Margaret-Anne Harris, Carolyn Dakin, Helen Heussler, Robert Black, Alan Cheng, Hannah Burns, John D. Kennedy and Kurt Lushingto

The effect of A1 and A2 reactive astrocyte expression on hydrocephalus shunt failure

BACKGROUND: The composition of tissue obstructing neuroprosthetic devices is largely composed of inflammatory cells with a significant astrocyte component. In a first-of-its-kind study, we profile the astrocyte phenotypes present on hydrocephalus shunts. METHODS: qPCR and RNA in-situ hybridization were used to quantify pro-inflammatory (A1) and anti-inflammatory (A2) reactive astrocyte phenotypes by analyzing C3 and EMP1 genes, respectively. Additionally, CSF cytokine levels were quantified using ELISA. In an in vitro model of astrocyte growth on shunts, different cytokines were used to prevent the activation of resting astrocytes into the A1 and A2 phenotypes. Obstructed and non-obstructed shunts were characterized based on the degree of actual tissue blockage on the shunt surface instead of clinical diagnosis. RESULTS: The results showed a heterogeneous population of A1 and A2 reactive astrocytes on the shunts with obstructed shunts having a significantly higher proportion of A2 astrocytes compared to non-obstructed shunts. In addition, the pro-A2 cytokine IL-6 inducing proliferation of astrocytes was found at higher concentrations among CSF from obstructed samples. Consequently, in the in vitro model of astrocyte growth on shunts, cytokine neutralizing antibodies were used to prevent activation of resting astrocytes into the A1 and A2 phenotypes which resulted in a significant reduction in both A1 and A2 growth. CONCLUSIONS: Therefore, targeting cytokines involved with astrocyte A1 and A2 activation is a promising intervention aimed to prevent shunt obstruction

Seasonal phosphorus and carbon dynamics in a temperate shelf sea (Celtic Sea)

The seasonal cycle of resource availability in shelf seas has a strong selective pressure on phytoplankton diversity and the biogeochemical cycling of key elements, such as carbon (C) and phosphorus (P). Shifts in carbon consumption relative to P availability, via changes in cellular stoichiometry for example, can lead to an apparent ‘excess’ of carbon production. We made measurements of inorganic P (Pi) uptake, in parallel to C-fixation, by plankton communities in the Celtic Sea (NW European Shelf) in spring (April 2015), summer (July 2015) and autumn (November 2014). Short-term (<8 h) Pi-uptake coupled with dissolved organic phosphorus (DOP) release, in parallel to net (24 h) primary production (NPP), were all measured across an irradiance gradient designed to typify vertically and seasonally varying light conditions. Rates of Pi-uptake were highest during spring and lowest in the low light conditions of autumn, although biomass-normalised Pi-uptake was highest in the summer. The release of DOP was highest in November and declined to low levels in July, indicative of efficient utilization and recycling of the low levels of Pi available. Examination of daily turnover times of the different particulate pools, including estimates of phytoplankton and bacterial carbon, indicated a differing seasonal influence of autotrophs and heterotrophs in P-dynamics, with summer conditions associated with a strong bacterial influence and the early spring period with fast growing phytoplankton. These seasonal changes in autotrophic and heterotrophic influence, coupled with changes in resource availability (Pi, light) resulted in seasonal changes in the stoichiometry of NPP to daily Pi-uptake (C:P ratio); from relatively C-rich uptake in November and late April, to P-rich uptake in early April and July. Overall, these results highlight the seasonally varying influence of both autotrophic and heterotrophic components of shelf sea ecosystems on the relative uptake of C and P

Characterization of a multicenter pediatric-hydrocephalus shunt biobank

BACKGROUND: Pediatric hydrocephalus is a devastating and costly disease. The mainstay of treatment is still surgical shunting of cerebrospinal fluid (CSF). These shunts fail at a high rate and impose a significant burden on patients, their families and society. The relationship between clinical decision making and shunt failure is poorly understood and multifaceted, but catheter occlusion remains the most frequent cause of shunt complications. In order to investigate factors that affect shunt failure, we have established the Wayne State University (WSU) shunt biobank. METHODS: To date, four hospital centers have contributed various components of failed shunts and CSF from patients diagnosed with hydrocephalus before adulthood. The hardware samples are transported in paraformaldehyde and transferred to phosphate-buffered saline with sodium azide upon deposit into the biobank. Once in the bank, they are then available for study. Informed consent is obtained by the local center before corresponding clinical data are entered into a REDCap database. Data such as hydrocephalus etiology and details of shunt revision history. All data are entered under a coded identifier. RESULTS: 293 shunt samples were collected from 228 pediatric patients starting from May 2015 to September 2019. We saw a significant difference in the number of revisions per patient between centers (Kruskal-Wallis H test, p value \u3c 0.001). The leading etiology at all centers was post-hemorrhagic hydrocephalus, a fisher\u27s exact test showed there to be statistically significant differences in etiology between center (p = 0.01). Regression showed age (p \u3c 0.01), race (p = 0.038) and hospital-center (p \u3c 0.001) to explain significant variance in the number of revisions. Our model accounted for 31.9% of the variance in revisions. Generalized linear modeling showed hydrocephalus etiology (p \u3c 0.001), age (p \u3c 0.001), weight and physician (p \u3c 0.001) to impact the number of ventricular obstructions. CONCLUSION: The retrospective analysis identified that differences exist between currently enrolled centers, although further work is needed before clinically actionable recommendations can be made. Moreover, the variables collected from this chart review explain a meaningful amount of variance in the number of revision surgeries. Future work will expand on the contribution of different site-specific and patient-specific factors to identify potential cause and effect relationships

Prospectus, May 10, 1984

COPIES ARE AVAILABLE FOR \u27IMAGES\u27; StuGo election results; Staerkel talks about scholarships; News Digest; Letter to the editor: Separate Women\u27s Program vital for the women who have invested so much in you; PC Happenings; Hard work recognized by Dean; Letter from the editor: Human element was always there; Editor says goodbye; \u27Intellectual Freedom Begins Here\u27; Student art exhibit displayed variety; Everyone enjoys four-day week during summer session; Law clerk tells how the judicial system really works; Eddie Albert plots ready to grow; Cribbet to speak at Commencement; Students and organizations honored at awards banquet; Creative Corner...Especially for you!!; Freedom; Cathy; This is Dedicated to Amy; Too Late; Almost There; Unwritten; The Life and Death of a Friendship; Parkland\u27s year the was--83/84--awards, scholarships, sports and fun; Classifieds; Did you know...; International songwriters competition; College Bowl National; Pretenders release latest and Rock Goddess their first; \u27Sixteen Candles\u27 burns out; Films show promise this summer; Winter wind blows hot; \u27Indiana Jones\u27 and \u27Spock\u27 lead the way at movies; Instructor receives award; Spring Out; StuGo purchases new van; Sports Digest; N.A.I.A. kills plan; 1984 Parkland outdoor track bests; L.A. students try to trust the Olympics; Baseball team ends season; 1984 Graduates and Candidates for Graduationhttps://spark.parkland.edu/prospectus_1984/1021/thumbnail.jp

Five years of experience in the Epigenetics and Chromatin Clinic : what have we learned and where do we go from here?

Funding Information: None of the authors had specific funding for this publication, but JRH is supported by grants from the NIH/NICHD 1K23HD101646, the Kabuki Syndrome Foundation, the Rubinstein-Taybi Syndrome Children’s Foundation, the Sekel-Breidenstein Family Fund, and the Kennedy Krieger IDDRC NIH P50HD103538. HTB is supported by the Louma G. Foundation, the Icelandic Research Fund (#217988, #195835, #206806) and the Icelandic Technology Development Fund (#2010588), and JAF is supported by the National Institutes of Health, specifically the National Institute for Child Health and Human Development (NICHD; K08HD086250), the Maryland Stem Cell Research Fund (2022-MSCRFL-5846), and a Johns Hopkins Catalyst Award. CWG receives support from NIH T32GM136577. Publisher Copyright: © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.The multidisciplinary Epigenetics and Chromatin Clinic at Johns Hopkins provides comprehensive medical care for individuals with rare disorders that involve disrupted epigenetics. Initially centered on classical imprinting disorders, the focus shifted to the rapidly emerging group of genetic disorders resulting from pathogenic germline variants in epigenetic machinery genes. These are collectively called the Mendelian disorders of the epigenetic machinery (MDEMs), or more broadly, Chromatinopathies. In five years, 741 clinic visits have been completed for 432 individual patients, with 153 having confirmed epigenetic diagnoses. Of these, 115 individuals have one of 26 MDEMs with every single one exhibiting global developmental delay and/or intellectual disability. This supports prior observations that intellectual disability is the most common phenotypic feature of MDEMs. Additional common phenotypes in our clinic include growth abnormalities and neurodevelopmental issues, particularly hypotonia, attention-deficit/hyperactivity disorder (ADHD), and anxiety, with seizures and autism being less common. Overall, our patient population is representative of the broader group of MDEMs and includes mostly autosomal dominant disorders impacting writers more so than erasers, readers, and remodelers of chromatin marks. There is an increased representation of dual function components with a reader and an enzymatic domain. As expected, diagnoses were made mostly by sequencing but were aided in some cases by DNA methylation profiling. Our clinic has helped to facilitate the discovery of two new disorders, and our providers are actively developing and implementing novel therapeutic strategies for MDEMs. These data and our high follow-up rate of over 60% suggest that we are achieving our mission to diagnose, learn from, and provide optimal care for our patients with disrupted epigenetics.Peer reviewe

The Edinburgh Cognitive and Behavioral ALS Screen (ECAS) in frontotemporal dementia

To examine the usefulness of the Edinburgh Cognitive and Behavioral Amyotrophic Lateral Sclerosis (ALS) Screen (ECAS) as a cognitive screening tool for the detection of behavioral variant frontotemporal dementia (bvFTD). A secondary aim was to determine whether people with FTD combined with ALS (ALS-FTD) exhibit a similar ECAS profile to that of people with bvFTD alone. Methods: Patients with ALS-FTD and bvFTD and healthy controls were recruited. Participants were administered the ECAS, which comprises tests of language, verbal fluency, executive functions, memory, and visual-spatial functions. They also carried out analogous, full-length cognitive tests that examine naming, spelling, sentence completion, and social cognition skills. Results: The study cohort comprised 20 ALS-FTD patients, 23 with bvFTD, and 30 controls. Highly significant group differences were elicited for all cognitive domains, reflecting poorer performance in patients compared to controls. No significant differences in overall test scores were found between ALS-FTD and bvFTD patients, although ALS-FTD patients showed a higher frequency of impairment on verbal fluency. Correlative analyses revealed inter-relationships in patients (but not controls) between scores in different domains, most marked in bvFTD. There were strong correlations between performance on ECAS subtests and analogous cognitive tasks. Conclusion: The ECAS is a sensitive and valuable tool for the assessment of FTD. Executive, language and behavioral breakdown may, however, compromise performance in other cognitive domains, reducing the specificity of the ‘frontotemporal’ cognitive profile. Subtle differences observed between ALS-FTD and bvFTD raise questions regarding the precise relationship between bvFTD with and without ALS