Advancing Health Policy and Advocacy Education in Medical School through a Student-run Elective

Introduction: Training medical students in the policy topics of healthcare economics, delivery systems, disparities, and reform helps to prepare them for the growing role of advocacy in medicine. We used a near-peer educational model to create an elective to advance learners’ policy knowledge and advocacy skills, while simultaneously offering student directors hands-on experience in educational program development. Methods: The 4-week elective for fourth year medical students included weekly readings, policy seminars, advocacy workshops, and journal clubs. Longitudinally, students prepared for a policy debate and prepared a research project or Op-Ed article on a healthcare disparity topic of their choice. The elective was designed, coordinated, and implemented by a team of first, second, third, and fourth-year medical students with faculty adviser oversight. Pre- and post-surveys were utilized to assess student learners’ knowledge of subject material and their perceptions of the effectiveness of the curriculum. Student directors self-assessed their confidence with the subject material and acquired skill in educational program development. Results: Student learners (n=6) noted significant improvement in their knowledge of health policy (P=0.0002) and advocacy (P=0.0064). They also reported improvement in several subtopics under policy and advocacy, with significant improvements seen in healthcare reform (P=0.0131) and writing skills (P=0.0099). Student directors (n=4) reported improved skills in curriculum development, educational evaluation, and leadership. Discussion: This novel student-run elective provided effective training in health policy and advocacy that extends beyond traditional curricula in medical school. Employing a near-peer model, the elective offers a sustainable system to educate interested students in these subjects and provide student directors unique experience in medical education. Further evaluation of future iterations will help determine the effectiveness of the curriculum in advancing individual policy and advocacy subtopics to guide future curricular modifications

Heterogeneous Nuclear Ribonuclear Protein U Associates with YAP and Regulates Its Co-activation of Bax Transcription

Although initially described as a cytosolic scaffolding protein, YAP (Yes-associated protein of 65 kDa) is known to associate with multiple transcription factors in the nucleus. Using affinity chromatography and mass spectrometry, we show that YAP interacts with heterogeneous nuclear ribonuclear protein U (hnRNP U), an RNA- and DNA-binding protein enriched in the nuclear matrix that also plays a role in the regulation of gene expression. hnRNP U interacts specifically with the proline-rich amino terminus of YAP, a region of YAP that is not found in the related protein TAZ. Although hnRNP U and YAP localize to both the nucleus and the cytoplasm, YAP does not translocate to the nucleus in an hnRNP U-dependent manner. Furthermore, hnRNP U and YAP only interact in the nucleus, suggesting that the association between the two proteins is regulated. Co-expression of hnRNP U attenuates the ability of YAP to increase the activity of a p73-driven Bax-luciferase reporter plasmid. In contrast, hnRNP U has no effect when co-expressed with a truncated YAP protein lacking the hnRNP U-binding site. Because YAP is distinguished from the homologue TAZ by its proline-rich amino terminus, the YAP-hnRNP U interaction may uniquely regulate the nuclear function(s) of YAP. The YAP-hnRNP U interaction provides another mechanism of YAP transcriptional regulation

A model for the break-up of a tuft of fibers

A simple model for the forces acting on a single fiber as it is withdrawn from a tangled fiber assembly is proposed. Particular emphasis is placed on understanding the dynamics of the reptating fiber with respect to the entanglement of fibers within the tuft. The resulting two-parameter model captures the qualitative features of experimental simulation. The model is extended to describe the break-up of a tuft. The results show good agreement with experiment and indicate where a fiber is most likely to fracture based on the density of fiber end-points

Insulin Responsiveness in Metabolic Syndrome after Eight Weeks of Cycle Training

Introduction Insulin resistance in obesity is decreased after successful diet and exercise. Aerobic exercise training alone was evaluated as an intervention in subjects with the metabolic syndrome. Methods Eighteen nondiabetic, sedentary subjects, 11 with the metabolic syndrome, participated in 8 wk of increasing intensity stationary cycle training. Results Cycle training without weight loss did not change insulin resistance in metabolic syndrome subjects or sedentary control subjects. Maximal oxygen consumption (V˙O2max), activated muscle AMP-dependent kinase, and muscle mitochondrial marker ATP synthase all increased. Strength, lean body mass, and fat mass did not change. The activated mammalian target of rapamycin was not different after training. Training induced a shift in muscle fiber composition in both groups but in opposite directions. The proportion of type 2x fibers decreased with a concomitant increase in type 2a mixed fibers in the control subjects, but in metabolic syndrome, type 2x fiber proportion increased and type 1 fibers decreased. Muscle fiber diameters increased in all three fiber types in metabolic syndrome subjects. Muscle insulin receptor expression increased in both groups, and GLUT4 expression increased in the metabolic syndrome subjects. The excess phosphorylation of insulin receptor substrate 1 (IRS-1) at Ser337 in metabolic syndrome muscle tended to increase further after training in spite of a decrease in total IRS-1. Conclusions In the absence of weight loss, the cycle training of metabolic syndrome subjects resulted in enhanced mitochondrial biogenesis and increased the expression of insulin receptors and GLUT4 in muscle but did not decrease the insulin resistance. The failure for the insulin signal to proceed past IRS-1 tyrosine phosphorylation may be related to excess serine phosphorylation at IRS-1 Ser337, and this is not ameliorated by 8 wk of endurance exercise training

Peer Feedback on Teaching for Health Professions Lectures

The Peer Feedback on Teaching Rubric was developed to support health professions educators in assessing their teaching. It provides a rubric of meaningful feedback to individuals to make improvements in learning and engagement. The rubric can be used to evaluate both in-person and online lectures. Educators can use the rubric in three ways: For self-reflection to assess their own teaching To observe a master teacher to identify important teaching techniques and see how they are effectively implemented To receive peer feedback by having a fellow educator evaluate a live teaching sessionhttps://digitalcommons.unmc.edu/iae_tools/1000/thumbnail.jp

An improved synthesis, crystal structures, and metallochromism of salts of [Ru(tolyl-terpy)(CN)(3)](-)

The previously reported complex [Ru(ttpy)(CN)(3)] [ttpy = 4'(p-tolyl)-2,2':6',2"-terpyridine] is conveniently synthesised by reaction of ttpy with Ru(dmso)(4)Cl-2 to give [Ru(ttpy)(dmso)Cl-2], which reacts in turn with KCN in aqueous ethanol to afford [Ru(ttpy)(CN)(3)] which was isolated and crystallographically characterised as both its (PPN)(+) and K+ salts. The K+ salt contains clusters containing three complex anions and three K+ cations connected by end-on and side-on cyanide ligation to the K+ ions. The solution speciation behaviour of [Ru(ttpy)(CN)(3)] was investigated with both Zn2+ and K+ salts in MeCN, a solvent sufficiently non-competitive to allow the added metal cations to associate with the complex anion via the externally-directed cyanide lone pairs. UV-Vis spectroscopic titration of (PPN)[Ru(ttpy)(CN)(3)] with Zn(ClO4)(2) showed a blue shift of 2900 cm (1) in the (MLCT)-M-1 absorption manifold due to the ` metallochromism' effect; a series of distinct binding events could be discerned corresponding to formation of 4:1, 1:1 and then 1:3 anion: cation adducts, all with high formation constants, as the titration proceeded. In contrast titration of (PPN)[Ru(ttpy)(CN)(3)] with the more weakly Lewis-acidic KPF6 resulted in a much smaller blue-shift of the 1MLCT absorptions, and the titration data corresponded to formation of 1:1 and then 2: 1 cation: anion adducts with weaker stepwise association constants of the order of 10(4) and then 10(3) M (1). Although association of [Ru(ttpy)(CN)(3)] resulted in a blue-shift of the (MLCT)-M-1 absorptions, the luminescence was steadily quenched, as raising the (MLCT)-M-3 level makes radiationless decay via a lowlying (MC)-M-3 state possible. (C) 2010 Elsevier B. V. All rights reserved

Human Immunodeficiency Virus Type 1 Infection of Cells and Tissues from the Upper and Lower Human Female Reproductive Tract

Viable tissue sections and isolated cell cultures from the human fallopian tube, uterus, cervix, and vaginal mucosa were examined for susceptibility to infection with human immunodeficiency virus type 1 (HIV-1). We examined infectivity by using the monocytotropic strain HIV-1JR-FLand several primary isolates of HIV-1 obtained from infected neonates. HIV-1 infection was measured by p24 production in short-term culture and by immunofluorescence detection of HIV-1 Nef and p24 proteins by laser scanning confocal microscopy. Three-color immunofluorescence was used to phenotype HIV-infected cells within tissue sections from each site. Our findings indicate that epithelial, stromal, and dendritic cells and cells with CD14+, CD4+, CD14-, CD4-, and CD4+, CD14- phenotypes from the female reproductive tract are infectable with HIV-1. Of importance is the finding that tissues from the upper reproductive tract are susceptible to infection with HIV-1. Moreover, tissue samples from women in all stages of the menstrual cycle, including postmenopausal women (inactive), could be infected with HIV-1. Female reproductive tract cells required a minimum of 60 min of exposure to HIV-1 in order for infection to occur, in contrast to peripheral blood lymphocytes, which became infected after being exposed to HIV-1 for only 1 min. These findings demonstrate that HIV-1 can infect cells and tissues from different sites within the female reproductive tract and suggest that multiple cell types, including epithelial cells, may be targets for the initial infection by HIV-1

Mid-Infrared Spectrophotometric Observations of Fragments B and C of Comet 73P/Schwassmann-Wachmann 3

We present mid-infrared spectra and images from the GEMINI-N (+Michelle) observations of fragments SW3-[B] and SW3-[C] of the ecliptic (Jupiter Family) comet 73P/Schwassmann-Wachmann 3 pre-perihelion. We observed fragment B soon after an outburst event (between 2006 April 16 - 26 UT) and detected crystalline silicates. The mineralogy of both fragments was dominated by amorphous carbon and amorphous pyroxene. The grain size distribution (assuming a Hanner modified power-law) for fragment SW3-[B] has a peak grain radius of a_p ~ 0.5 micron, and for fragment SW3-[C], a_p ~ 0.3 micron; both values larger than the peak grain radius of the size distribution for the dust ejected from ecliptic comet 9P/Tempel 1 during the Deep Impact event (a_p = 0.2 micron. The silicate-to-carbon ratio and the silicate crystalline mass fraction for the submicron to micron-size portion of the grain size distribution on the nucleus of fragment SW3-[B] was 1.341 +0.250 -0.253 and 0.335 +0.089 -0.112, respectively, while on the nucleus of fragment SW3-[C] was 0.671 +0.076 -0.076 and 0.257 +0.039 -0.043, respectively. The similarity in mineralogy and grain properties between the two fragments implies that 73P/Schwassmann-Wachmann 3 is homogeneous in composition. The slight differences in grain size distribution and silicate-to-carbon ratio between the two fragments likely arises because SW3-[B] was actively fragmenting throughout its passage while the activity in SW3-[C] was primarily driven by jets. The lack of diverse mineralogy in the fragments SW3-[B] and SW3-[C] of 73P/Schwassmann-Wachmann 3 along with the relatively larger peak in the coma grain size distribution suggests the parent body of this comet may have formed in a region of the solar nebula with different environmental properties than the natal sites where comet C/1995 O1 (Hale-Bopp) and 9P/Tempel 1 nuclei aggregated.Comment: 31 pages, 5 figure, accepted for publication in A