One School: Using Teach-Throughs to Ensure Consistency

Presented as a Poster Presentation at 2020 IUSM Education Day

Video modules for online learning: Creating content for the new normal.

15-minute Webinar PresentationIn order to supplement the Evidence based medicine (EBM) curriculum that Ruth Lilly Medical Library teaches to 1st and 2nd year medical undergraduates, two librarians created four short videos on EBM topics. Join us for this interactive session focused on teaching the skills and techniques used in video creation such as: modified story-boarding for script creation and presentation software design, calculation of video length as well as methods used to practice and record the videos. We will provide lessons learned and also have ample time for questions from the audience.ACRL Health Sciences Interest Grou

Information Atrocities: Records and Memory in Post-Dictatorship Latin America

In the latter half of the twentieth century, many countries in Latin America experienced brutal dictatorships marked by state-sponsored violence, persecution of left-leaning individuals and institutions, and most pertinent to this paper, suppression of ideas and information. After the fall of these dictatorships, cultural institutions struggled to administer to the needs of a population looking for answers and a way to move forward. With many "official" records destroyed or altered fundamentally, cultural institutions were forced to employ alternate methods of collection building, assessment, and sharing. These three case studies speak to the efforts employed by these institutions to adjust their policies and service to accommodate a different political landscape and patron base to achieve the goals of recreating public trust and moving forward as a nation in the wake of a dictatorship

Integrating evidence-based medicine skills into a medical school curriculum: a quantitative outcomes assessment

Objectives: This research project aims to determine the potential differential impact of two curricular approaches to teaching evidence-based medicine (EBM) on student performance on an EBM assignment administered during the first year of clerkship. A meaningful result would be any statistically significant difference in scores on the assignment given to measure student performance. Design: In order to assess and compare student learning under the different curricula, the PI and a team of five faculty members blinded to assignment date and other possibly identifying details used a modified version of the previously validated Fresno rubric to retrospectively grade three years’ worth of EBM assignments given to students in clerkship rotations 1-3 (n = 481) during the Internal Medicine clerkship. Specifically, EBM performance in three separate student cohorts were examined. Setting: The study took place at a large Midwestern medical school with nine campuses across the state of Indiana. Participants: Study participants were four hundred eighty-one students who attended the medical school and completed the Internal Medicine clerkship between 2017-2019. Interventions: Prior to the inception of this study, our institution had been teaching EBM within a discrete 2-month time period during medical students’ first year. During a large-scale curricular overhaul, the approach to teaching EBM was changed to a more scaffolded, integrated approach with sessions being taught over the course of two years. In this study, we assess the differential impact of these two approaches to teaching EBM in the first two years of medical school. Main Outcome Measures: We used clerkship-level EBM assignment grades to determine whether there was a difference in performance between those students who experienced the old versus the new instructional model. Clerkship EBM assignments given to the students used identical questions each year in order to have a valid basis for comparison. Additionally, we analyzed average student grades across the school on the EBM portion of Step 1. Results: Four hundred and eighty-one assignments were graded. Mean scores were compared for individual questions and cumulative scores using a one-way Welch ANOVA test. Overall, students performed .99 of a point better on the assignment from Year One (Y1), prior to EBM curriculum integration, to Year Three (Y3), subsequent to EBM integration (p= <.001). Statistically significant improvement was seen on questions measuring students’ ability to formulate a clinical question and critically appraise medical evidence. Additionally, on USMLE Step 1, we found that student scores on the EBM portion of the exam improved from Y1 to Y3. Conclusions: Results of this study suggest that taking a scaffolded, curriculum-integrated approach to EBM instruction during the pre-clinical years increases, or at the very least does not lessen, student retention of and ability to apply EBM concepts to patient care. Although it is difficult to fully attribute students’ retention and application of EBM concepts to the adoption of a curricular model focused on scaffolding and integration, the results of this study show that there are value-added educational effects to teaching EBM in this new format. Overall, this study provides a foundation for new research and practice seeking to improve EBM instruction. Trial Registration: IRB approval (Protocol #1907054875) was obtained for this study

Ocular Point-of-Care Ultrasonography to Diagnose Posterior Chamber Abnormalities: A Systematic Review and Meta-analysis

Importance: Diagnosing posterior chamber ocular abnormalities typically requires specialist assessment. Point-of-care ultrasonography (POCUS) performed by nonspecialists, if accurate, could negate the need for urgent ophthalmologist evaluation. Objective: This meta-analysis sought to define the diagnostic test characteristics of emergency practitioner-performed ocular POCUS to diagnose multiple posterior chamber abnormalities in adults. Data sources: PubMed (OVID), MEDLINE, EMBASE, Cochrane, CINAHL, and SCOPUS were searched from inception through June 2019 without restrictions. Conference abstracts and trial registries were also searched. Bibliographies of included studies and relevant reviews were manually searched, and experts in the field were queried. Study selection: Included studies compared ocular POCUS performed by emergency practitioners with a reference standard of ophthalmologist evaluation. Pediatric studies were excluded. All 116 studies identified during abstract screening as potentially relevant underwent full-text review by multiple authors, and 9 studies were included. Data extraction and synthesis: In accordance with PRISMA guidelines, multiple authors extracted data from included studies. Results were meta-analyzed for each diagnosis using a bivariate random-effects model. Data analysis was performed in July 2019. Main outcomes and measures: The outcomes of interest were diagnostic test characteristics of ocular POCUS for the following diagnoses: retinal detachment, vitreous hemorrhage, vitreous detachment, intraocular foreign body, globe rupture, and lens dislocation. Results: Nine studies (1189 eyes) were included. All studies evaluated retinal detachment, but up to 5 studies assessed each of the other diagnoses of interest. For retinal detachment, sensitivity was 0.94 (95% CI, 0.88-0.97) and specificity was 0.94 (95% CI, 0.85-0.98). Sensitivity and specificity were 0.90 (95% CI, 0.65-0.98) and 0.92 (95% CI, 0.75-0.98), respectively, for vitreous hemorrhage and were 0.67 (95% CI, 0.51-0.81) and 0.89 (95% CI, 0.53-0.98), respectively, for vitreous detachment. Sensitivity and specificity were high for lens dislocation (0.97 [95% CI, 0.83-0.99] and 0.99 [95% CI, 0.97-1.00]), intraocular foreign body (1.00 [95% CI, 0.81-1.00] and 0.99 [95% CI, 0.99-1.00]), and globe rupture (1.00 [95% CI, 0.63-1.00] and 0.99 [95% CI, 0.99-1.00]). Results were generally unchanged in sensitivity analyses of studies with low risk of bias. Conclusions and relevance: This study suggests that emergency practitioner-performed ocular POCUS is an accurate test to assess for retinal detachment in adults. Its utility in diagnosing other posterior chamber abnormalities is promising but needs further study

Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis

Importance: The ε4 allele of the apolipoprotein E (APOE) gene and lower apolipoprotein E (apoE) protein levels in plasma are risk factors for Alzheimer disease, but the underlying biological mechanisms are not fully understood. Half of plasma apoE circulates on high-density lipoproteins (HDLs). Higher apoE levels in plasma HDL were previously found to be associated with lower coronary heart disease risk, but the coexistence of another apolipoprotein, apoC3, modified this lower risk. Objective: To investigate associations between the presence of apoE in different lipoproteins with cognitive function, particularly the risk of dementia. Design, Setting, and Participants: This prospective case-cohort study embedded in the Ginkgo Evaluation of Memory Study (2000-2008) analyzed data from 1351 community-dwelling participants 74 years and older. Of this group, 995 participants were free of dementia at baseline (recruited from September 2000 to June 2002) and 521 participants were diagnosed with incident dementia during follow-up until 2008. Data analysis was performed from January 2018 to December 2019. Exposures: Enzyme-linked immunosorbent assay–measured concentration of apoE in whole plasma, HDL-depleted plasma (non-HDL), HDL, and HDL subspecies that contain or lack apoC3 or apoJ. Main Outcomes and Measures: Adjusted hazard ratios for risk of dementia and Alzheimer disease during follow-up and adjusted differences (β coefficients) in Alzheimer Disease Assessment–Cognitive Subscale (ADAS-cog) and Modified Mini-Mental State Examination scores at baseline. Results: Among 1351 participants, the median (interquartile range) age was 78 (76-81) years; 639 (47.3%) were women. The median (interquartile range) follow-up time was 5.9 (3.7-6.5) years. Higher whole plasma apoE levels and higher apoE levels in HDL were associated with better cognitive function assessed by ADAS-cog (whole plasma, β coefficient, −0.15; 95% CI, −0.24 to −0.06; HDL, β coefficient, −0.20; 95% CI, −0.30 to −0.10) but were unassociated with dementia or Alzheimer disease risk. When separated by apoC3, a higher apoE level in HDL that lacks apoC3 was associated with better cognitive function (ADAS-cog per SD: β coefficient, 0.17; 95% CI, −0.27 to −0.07; Modified Mini-Mental State Examination score per SD: β coefficient, 0.25; 95% CI, 0.07 to 0.42) and lower risk of dementia (hazard ratio per SD, 0.86; 95% CI, 0.76 to 0.99). In contrast, apoE levels in HDL that contains apoC3 were unassociated with any of these outcomes. Conclusions and Relevance: In a prospective cohort of older adults with rigorous follow-up of dementia, the apoE level in HDL that lacked apoC3 was associated with better cognitive function and lower dementia risk. This finding suggests that the cardioprotective associations of this novel lipoprotein extend to dementia

A circumplanetary disk around PDS70c

Funding: This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No. 101002188 and No. 832428). J.B. acknowledges support by NASA through the NASA Hubble Fellowship grant #HST-HF2-51427.001-A awarded by the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Incorporated, under NASA contract NAS5-26555. S.F. acknowledges an ESO Fellowship. S.A. acknowledges support from the National Aeronautics and Space Administration under grant No. 17-XRP17 2-0012 issued through the Exoplanets Research Program. A.I. acknowledges support from the National Science Foundation under grant No. AST1715719 and from NASA under grant No. 80NSSC18K0828. J.M.C. acknowledges support from the National Aeronautics and Space Administration under grant No. 15XRP15_20140 issued through the Exoplanets Research Program. N.T.K. and P.P. acknowledge support provided by the Alexander von Humboldt Foundation in the framework of the Sofja Kovalevskaja Award endowed by the Federal Ministry of Education and Research.PDS 70 is a unique system in which two protoplanets, PDS 70 b and c, have been discovered within the dust-depleted cavity of their disk, at ~22 and 34 au, respectively, by direct imaging at infrared wavelengths. Subsequent detection of the planets in the Hα line indicates that they are still accreting material through circumplanetary disks. In this Letter, we present new Atacama Large Millimeter/submillimeter Array (ALMA) observations of the dust continuum emission at 855 μm at high angular resolution (~20 mas, 2.3 au) that aim to resolve the circumplanetary disks and constrain their dust masses. Our observations confirm the presence of a compact source of emission co-located with PDS 70 c, spatially separated from the circumstellar disk and less extended than ~1.2 au in radius, a value close to the expected truncation radius of the circumplanetary disk at a third of the Hill radius. The emission around PDS 70 c has a peak intensity of ~86 ± 16 μJy beam-1, which corresponds to a dust mass of ~0.031 M⊕ or ~0.007 M⊕, assuming that it is only constituted of 1 μm or 1 mm sized grains, respectively. We also detect extended, low surface brightness continuum emission within the cavity near PDS 70 b. We observe an optically thin inner disk within 18 au of the star with an emission that could result from small micron-sized grains transported from the outer disk through the orbits of b and c. In addition, we find that the outer disk resolves into a narrow and bright ring with a faint inner shoulder.Publisher PDFPeer reviewe

miR-23b regulates cytoskeletal remodeling, motility and metastasis by directly targeting multiple transcripts

Uncontrolled cell proliferation and cytoskeletal remodeling are responsible for tumor development and ultimately metastasis. A number of studies have implicated microRNAs in the regulation of cancer cell invasion and migration. Here, we show that miR-23b regulates focal adhesion, cell spreading, cell-cell junctions and the formation of lamellipodia in breast cancer (BC), implicating a central role for it in cytoskeletal dynamics. Inhibition of miR-23b, using a specific sponge construct, leads to an increase of cell migration and metastatic spread in vivo, indicating it as a metastatic suppressor microRNA. Clinically, low miR-23b expression correlates with the development of metastases in BC patients. Mechanistically, miR-23b is able to directly inhibit a number of genes implicated in cytoskeletal remodeling in BC cells. Through intracellular signal transduction, growth factors activate the transcription factor AP-1, and we show that this in turn reduces miR-23b levels by direct binding to its promoter, releasing the pro-invasive genes from translational inhibition. In aggregate, miR-23b expression invokes a sophisticated interaction network that co-ordinates a wide range of cellular responses required to alter the cytoskeleton during cancer cell motility

Promotoras as Mental Health Practitioners in Primary Care: A Multi-Method Study of an Intervention to Address Contextual Sources of Depression

We assessed the role of promotoras—briefly trained community health workers—in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention’s impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p < .05); logistic regression revealed housing and food insecurity as the most important predictors (odds ratios both 2.40, p < .05). Unexpected challenges arose in the intervention’s implementation, involving infrastructure at the health centers, boundaries of the promotoras’ roles, and “turf” issues with medical assistants. In the quantitative assessment, the intervention did not lead to statistically significant improvements in depression (odds ratio 4.33, confidence interval overlapping 1). Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders, including patients, promotoras, PCPs, non-professional staff workers, administrators, and community advisory board members. Due to continuing unmet mental health needs, we favor further assessment of innovative roles for community health workers

Speech Communication

Contains table of contents for Part IV, table of contents for Section 1 and reports on five research projects.Apple Computer, Inc.C.J. Lebel FellowshipNational Institutes of Health (Grant T32-NS07040)National Institutes of Health (Grant R01-NS04332)National Institutes of Health (Grant R01-NS21183)National Institutes of Health (Grant P01-NS23734)U.S. Navy / Naval Electronic Systems Command (Contract N00039-85-C-0254)U.S. Navy - Office of Naval Research (Contract N00014-82-K-0727