Resident Participation: A Community-Building Strategy in Low-Income Neighborhoods

Resident participation has been an area of community development aimed at increasing involvement of tenants in housing development, management and community-building. The precise roles and mechanisms of resident participation are not well understood, however. This paper explores the role of resident participation and its interaction with other factors that drive community revitalization. By understanding the necessary conditions, factors and other variables that strengthen resident participation, public policies can help low-income populations manifest their power and make a difference in their communities. The research presented here (1) describes the challenges and benefits of resident participation; (2) identifies examples of residents successfully contributing to the development and management of their homes; (3) details the conditions necessary for success; and (4) addresses the issue of assessing effectiveness. For those seeking to encourage resident participation, the are three major challenges include time and money; limited options due to economics; and limited community capacity. Examples of successful resident participation are presented, such as the Demonstration Disposition in Boston -- one of the most notable examples of resident participation in development in the past 10 years. Building management has also been an arena for various levels and types of resident participation, and many community development corporations have developed creative ways of involving residents in community-building efforts. The interplay of external and internal factors together creates conditions for resident participation. This paper identifies four major factors: impetus, politics, resources and values, describing the internal and external resources affected by each. To connect these external and internal resources, bridging resources of trust, community organizing, strategic partnerships and organizational capacity are necessary. Community planning and education make up a noteworthy bridging resource that allows for the necessary learning process to take place. Community education and planning happen in three phases: building a foundation, teaching skills, and following through. While there is general support for resident participation in housing development, management and community-building, measuring its effectiveness has received limited research attention. This paper describes the effectiveness of resident participation looking at the individual, building and community levels. These testimonials will be strengthened if hard measures of resident participation are developed and used to study its effects

Artificial Intelligence and Medical Trainees - Valuable Tool or Learning Impediment?

Background ● Artificial intelligence (AI) assisted clinical documentation tools are becoming increasingly available across outpatient clinical settings ● Voice to text recognition programs collect audio from patient-provider interactions and use AI to automatically generate notes documenting the encounter ● These notes can then be made available in the electronic health record within minutes ● Though these tools are available to attending physicians, there has been no research on attitudes regarding when such tools should be made available to medical trainees, such as medical students and residents ● We surveyed US medical students, residents, and attending physicians regarding when such tools should be introduced to learners, if at all, and concerns around such tools Study Design ● Cross-sectional survey ● Setting: Single institution in the Pacific region ● Study population: Medical students, resident physicians, fellows, and attending physicians (179 respondents) ● Study timeline: Survey available 5/9/24-6/10/24 ● Data collection: ○ Administered 15 question RedCap survey ○ Assessed respondents demographic and professional characteristics, including gender, highest level of training, percent of time spent in outpatient practice, time spent on patient interactions, and time spent on clinical documentation ● Study outcomes: ○ Relationship between respondents’ demographic and professional characteristics and what level of training they felt that AI-assisted clinical documentation tools should be available to trainees, should enter the medical record, and specific concerns with regard to their use (not meeting documentation milestones, detriment to patient-provider experience, accuracy, bias, violation of patient privacy, detriment to forming differential diagnoses, detriment to forming plans, and concerns about using personal devices) ● Statistical analysis: ○ Chi-squared analysis to determine association between demographic/professional characteristics and outcomes with significance level set at p < 0.05 ○ Cramer’s values calculated to determine strength of association ○ Descriptive characterisation of respondents Results 40% of female attending physicians believed that AI tools should not be available to trainees at all, compared to 25% of attending physicians overall and 17% of respondents in general Female respondents were far more likely to agree with the statement “I am concerned about AI-assisted clinical documentation violating patient privacy” and far less likely to agree with running the software on a personal device Summary ● Attending physicians, particularly female attending physicians, felt that AI assisted clinical documentation tools should be introduced to trainees later on and were more likely to believe that trainees should not be able to generate notes using such tools ● Female respondents were far more likely to have concerns about these tools adversely affecting trainees in achieving clinical documentation milestones and were far more likely to have concerns about privacy and use of personal devices surrounding these tools ● Respondents who spent more time with patients (P = 0.01, Cramer’s value = 0.19) and more time writing notes (P = 0.03, Cramer’s value = 0.20) were less likely to believe that that AI-assisted clinical documentation tools should be available to trainees Limitations ● Single institution survey ● Responses restricted to provided survey options ● Data not collected on experience with ambient clinical documentation tools within cohort Discussion ● Previous research has shown that physicians and medical students have positive attitudes and a willingness to learn about AI tools in healthcare ● However, our data suggests that attending physicians and female respondents in general have more concerns about privacy with regard to AI for clinical documentation tools and favor later introduction of such tools to trainees ● While trainees are amenable to learning about AI tools, faculty may recommended delaying the introduction of these tools to residency or later ● More research is needed to better understand why female physicians are more concerned about privacy with regard to AI tools and how these tools should be introduced to medical trainees ● Next steps: conducting interviews with respondents for more nuanced recommendations/understanding of concerns References AlZaabi A, AlMaskari S, AalAbdulsalam A. Are physicians and medical students ready for artificial intelligence applications in healthcare? DIGITAL HEALTH. 2023;9. doi:10.1177/20552076231152167 Giavina-Bianchi M, Amaro Jr E, Machado BS, Medical Expectations of Physicians on AI Solutions in Daily Practice: Cross-Sectional Survey Study, JMIRx Med 2024;5:e50803, doi: 10.2196/50803 Waheed MA, Liu L, Perceptions of Family Physicians About Applying AI in Primary Health Care: Case Study From a Premier Health Care Organization, JMIR AI 2024;3:e40781, doi: 10.2196/4078

Quantitatively Imaging Chromosomes by Correlated Cryo-Fluorescence and Soft X-Ray Tomographies

AbstractSoft x-ray tomography (SXT) is increasingly being recognized as a valuable method for visualizing and quantifying the ultrastructure of cryopreserved cells. Here, we describe the combination of SXT with cryogenic confocal fluorescence tomography (CFT). This correlative approach allows the incorporation of molecular localization data, with isotropic precision, into high-resolution three-dimensional (3-D) SXT reconstructions of the cell. CFT data are acquired first using a cryogenically adapted confocal light microscope in which the specimen is coupled to a high numerical aperture objective lens by an immersion fluid. The specimen is then cryo-transferred to a soft x-ray microscope (SXM) for SXT data acquisition. Fiducial markers visible in both types of data act as common landmarks, enabling accurate coalignment of the two complementary tomographic reconstructions. We used this method to identify the inactive X chromosome (Xi) in female v-abl transformed thymic lymphoma cells by localizing enhanced green fluorescent protein-labeled macroH2A with CFT. The molecular localization data were used to guide segmentation of Xi in the SXT reconstructions, allowing characterization of the Xi topological arrangement in near-native state cells. Xi was seen to adopt a number of different topologies with no particular arrangement being dominant

Sprouty2 loss‐induced IL6 drives castration‐resistant prostate cancer through scavenger receptor B1

Metastatic castration‐resistant prostate cancer (mCRPC) is a lethal form of treatment‐resistant prostate cancer and poses significant therapeutic challenges. Deregulated receptor tyrosine kinase (RTK) signalling mediated by loss of tumour suppressor Sprouty2 (SPRY2) is associated with treatment resistance. Using pre‐clinical human and murine mCRPC models, we show that SPRY2 deficiency leads to an androgen self‐sufficient form of CRPC. Mechanistically, HER2‐IL6 signalling axis enhances the expression of androgen biosynthetic enzyme HSD3B1 and increases SRB1‐mediated cholesterol uptake in SPRY2‐deficient tumours. Systemically, IL6 elevated the levels of circulating cholesterol by inducing host adipose lipolysis and hepatic cholesterol biosynthesis. SPRY2‐deficient CRPC is dependent on cholesterol bioavailability and SRB1‐mediated tumoral cholesterol uptake for androgen biosynthesis. Importantly, treatment with ITX5061, a clinically safe SRB1 antagonist, decreased treatment resistance. Our results indicate that cholesterol transport blockade may be effective against SPRY2‐deficient CRPC

Sleeping Beauty screen reveals Pparg activation in metastatic prostate cancer

Prostate cancer (CaP) is the most common adult male cancer in the developed world. The paucity of biomarkers to predict prostate tumor biology makes it important to identify key pathways that confer poor prognosis and guide potential targeted therapy. Using a murine forward mutagenesis screen in a Pten-null background, we identified peroxisome proliferator-activated receptor gamma (Pparg), encoding a ligand-activated transcription factor, as a promoter of metastatic CaP through activation of lipid signaling pathways, including up-regulation of lipid synthesis enzymes [fatty acid synthase (FASN), acetyl-CoA carboxylase (ACC), ATP citrate lyase (ACLY)]. Importantly, inhibition of PPARG suppressed tumor growth in vivo, with down-regulation of the lipid synthesis program. We show that elevated levels of PPARG strongly correlate with elevation of FASN in human CaP and that high levels of PPARG/FASN and PI3K/pAKT pathway activation confer a poor prognosis. These data suggest that CaP patients could be stratified in terms of PPARG/FASN and PTEN levels to identify patients with aggressive CaP who may respond favorably to PPARG/FASN inhibition

Analysis of Nkx3.1:Cre-driven Erk5 deletion reveals a profound spinal deformity which is linked to increased osteoclast activity

Extracellular signal-regulated protein kinase 5 (ERK5) has been implicated during development and carcinogenesis. Nkx3.1-mediated Cre expression is a useful strategy to genetically manipulate the mouse prostate. While grossly normal at birth, we observed an unexpected phenotype of spinal protrusion in Nkx3.1:Cre;Erk5fl/fl (Erk5fl/fl) mice by ~6–8 weeks of age. X-ray, histological and micro CT (µCT) analyses showed that 100% of male and female Erk5fl/fl mice had a severely deformed curved thoracic spine, with an associated loss of trabecular bone volume. Although sex-specific differences were observed, histomorphometry measurements revealed that both bone resorption and bone formation parameters were increased in male Erk5fl/fl mice compared to wild type (WT) littermates. Osteopenia occurs where the rate of bone resorption exceeds that of bone formation, so we investigated the role of the osteoclast compartment. We found that treatment of RANKL-stimulated primary bone marrow-derived macrophage (BMDM) cultures with small molecule ERK5 pathway inhibitors increased osteoclast numbers. Furthermore, osteoclast numbers and expression of osteoclast marker genes were increased in parallel with reduced Erk5 expression in cultures generated from Erk5fl/fl mice compared to WT mice. Collectively, these results reveal a novel role for Erk5 during bone maturation and homeostasis in vivo

Female athlete experiences of seeking and receiving treatment for an eating disorder

Clinical eating disorders are common among athletes; however research has yet to explore the process of seeking and receiving treatment for an eating disorder in this population. Semi-structured interviews were conducted with 13 female athletes currently receiving treatment for an eating disorder. A total of three themes emerged: challenges to treatment seeking, feeling out of place, and coping with exercise transitions. Athletes reported low levels of eating disorder literacy and lacked motivation to engage with therapy due to a lack of perceived relevance. Athletes found it challenging to relinquish exercise behaviours in treatment and expressed concerns around managing a return to sport. It may be necessary to provide additional support to athletes when embarking on and leaving treatment programs, particularly with regards to managing expectations about exercise

Sodium-Glucose Cotransporter 2 Inhibitors and the Risk of Pneumonia and Septic Shock

CONTEXT: Individuals with type 2 diabetes mellitus (DM) have an increased risk of pneumonia and septic shock. Traditional glucose-lowering drugs have recently been found to be associated with a higher risk of infections. It remains unclear whether sodium-glucose cotransporter 2 inhibitors (SGLT2is), which have pleiotropic/anti-inflammatory effects, may reduce the risk of pneumonia and septic shock in DM. METHODS: MEDLINE, Embase, and ClinicalTrials.gov were searched from inception up to May 19, 2022, for randomized, placebo-controlled trials of SGLT2i that included patients with DM and reported outcomes of interest (pneumonia and/or septic shock). Study selection, data extraction, and quality assessment (using the Cochrane Risk of Bias Assessment Tool) were conducted by independent authors. A fixed-effects model was used to pool the relative risk (RRs) and 95% CI across trials. RESULTS: Out of 4568 citations, 26 trials with a total of 59 264 patients (1.9% developed pneumonia and 0.2% developed septic shock) were included. Compared with placebo, SGLT2is significantly reduced the risk of pneumonia (pooled RR 0.87, 95% CI 0.78-0.98) and septic shock (pooled RR 0.65, 95% CI 0.44-0.95). There was no significant heterogeneity of effect size among trials. Subgroup analyses according to the type of SGLT2i used, baseline comorbidities, glycemic control, duration of DM, and trial follow-up showed consistent results without evidence of significant treatment-by-subgroup heterogeneity (all P(heterogeneity) > .10). CONCLUSION: Among DM patients, SGLT2is reduced the risk of pneumonia and septic shock compared with placebo. Our findings should be viewed as hypothesis generating, with concepts requiring validation in future studies

Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery:Long-Term Prognostic Implications for Death and Heart Failure

BACKGROUND: Strategies to improve long-term prediction of heart failure and death in valvular surgery are urgently needed because of an increasing number of procedures globally. This study sought to report the prevalence, changes, and prognostic implications of concomitant hepatorenal dysfunction and malnutrition in valvular surgery. METHODS AND RESULTS: In 909 patients undergoing valvular surgery, 3 groups were defined based on hepatorenal function (the modified model for end-stage liver disease excluding international normalized ratio score) and nutritional status (Controlling Nutritional Status score): normal hepatorenal function and nutrition (normal), hepatorenal dysfunction or malnutrition alone (mild), and concomitant hepatorenal dysfunction and malnutrition (severe). Overall, 32%, 46%, and 19% of patients were classified into normal, mild, and severe groups, respectively. Over a 4.1-year median follow-up, mild and severe groups in-curred a higher risk of mortality (hazard ratio [HR], 3.17 [95% CI, 1.40–7.17] and HR, 9.30 [95% CI, 4.09– 21.16], respectively), cardiovascular death (subdistribution HR, 3.29 [95% CI, 1.14– 9.52] and subdistribution HR, 9.29 [95% CI, 3.09– 27.99]), heart failure hospitalization (subdistribution HR, 2.11 [95% CI, 1.25– 3.55] and subdistribution HR, 3.55 [95% CI, 2.04– 6.16]), and adverse outcomes (HR, 2.11 [95% CI, 1.25– 3.55] and HR, 3.55 [95% CI, 2.04– 6.16]). Modified model for end-stage liver disease excluding international normalized ratio and controlling nutritional status scores improved the predictive ability of European System for Cardiac Operative Risk Evaluation (area under the curve: 0.80 versus 0.73, P<0.001) and Society of Thoracic Surgeons score (area under the curve: 0.79 versus 0.72, P=0.004) for all-cause mortality. One year following surgery (n=707), patients with persistent concomitant hepatorenal dysfunction and malnutrition (severe) experienced worse outcomes than those without.  CONCLUSIONS: Concomitant hepatorenal dysfunction and malnutrition was frequent and strongly linked to heart failure and mortality in valvular surgery

Comparison of dot chromosome sequences from D. melanogaster and D. virilis reveals an enrichment of DNA transposon sequences in heterochromatic domains

BACKGROUND: Chromosome four of Drosophila melanogaster, known as the dot chromosome, is largely heterochromatic, as shown by immunofluorescent staining with antibodies to heterochromatin protein 1 (HP1) and histone H3K9me. In contrast, the absence of HP1 and H3K9me from the dot chromosome in D. virilis suggests that this region is euchromatic. D. virilis diverged from D. melanogaster 40 to 60 million years ago. RESULTS: Here we describe finished sequencing and analysis of 11 fosmids hybridizing to the dot chromosome of D. virilis (372,650 base-pairs) and seven fosmids from major euchromatic chromosome arms (273,110 base-pairs). Most genes from the dot chromosome of D. melanogaster remain on the dot chromosome in D. virilis, but many inversions have occurred. The dot chromosomes of both species are similar to the major chromosome arms in gene density and coding density, but the dot chromosome genes of both species have larger introns. The D. virilis dot chromosome fosmids have a high repeat density (22.8%), similar to homologous regions of D. melanogaster (26.5%). There are, however, major differences in the representation of repetitive elements. Remnants of DNA transposons make up only 6.3% of the D. virilis dot chromosome fosmids, but 18.4% of the homologous regions from D. melanogaster; DINE-1 and 1360 elements are particularly enriched in D. melanogaster. Euchromatic domains on the major chromosomes in both species have very few DNA transposons (less than 0.4 %). CONCLUSION: Combining these results with recent findings about RNAi, we suggest that specific repetitive elements, as well as density, play a role in determining higher-order chromatin packaging