Baby Steps

A creative non-fiction piece about childbirth and walking, situating the self and the new child, and climate anxiety and fear for the future

College Departure: Exploring Student Aid Effects on Multiple Mobility Patterns from Four-Year Institutions

College departure involves multiple mobility patterns that include lateral transfer (from a four-year to another four-year institution), reverse transfer (from a four-year to a two-year institution), and stop out (taking time out of higher education altogether). This study addresses how financial aid influences the likelihood of such mobility patterns for minority and low-income students. Utilizing data from the Education Longitudinal Survey of 2002, this study found that the effects of financial aid on multiple mobility patterns are similar across students of different income groups. By contrast, non-white students benefit significantly from financial aid, particularly from low-burden aid options (e.g., tuition waivers and grants) in lowering the probability of lateral transfer. No financial aid has a significant effect on changing the likelihood that students reverse transfer or stop out

A Hierarchical Analysis of How Institutional, Faculty, and Student Characteristics Relate to Intercultural Maturity

The purpose of this study is to investigate the relationship between institutional characteristics of colleges and universities and Intercultural Maturity. More specifically, the study looked at two relationships: (1) the institution's emphasis on diversity and faculty emphasis on Intercultural Maturity in the classroom, and (2) the institution's emphasis on diversity and student gains in Intercultural Maturity. This national study included 4,274 senior college students, 1,371 general education faculty members, and 80 four-year higher education institutions. Findings that focused on faculty emphasis on Intercultural Maturity indicated that the strongest predictors were those that represented how faculty spent their time in class: the extent to which faculty emphasized diversity in their course content and the inclusion of a service learning project were significant positive predictors of faculty emphasis on Intercultural Maturity. The institution's emphasis on diversity varied in predicting faculty emphasis on Intercultural Maturity: emphasizing student contact with diverse others was a strong significant positive predictor, inclusion of diversity in the undergraduate curriculum was a negative significant predictor, and inclusion of diversity in the mission statement was not a significant predictor. Female faculty, faculty of color, faculty in a soft discipline, or those who were not on the tenure track were more likely to emphasize Intercultural Maturity than their respective peers who were male, white, in a hard discipline, or tenured /on the tenure track. When looking at variables that predicted student gains in Intercultural Maturity, student experience variables were the strongest predictors. Those experience variables included participating in a learning community, incorporating diverse perspectives in class, participating in class group work, and practicing reflective learning. Institutional promotion of student contact with diverse others was a strong significant predict of student gains in Intercultural Maturity but emphasizing diversity in the mission statement and the undergraduate curriculum were not significant predictors of the outcome measure. Faculty emphasis on diversity and reflective learning in the classroom was also not a significant predictor of student gains in Intercultural Maturity. Students who were female, non-white, or traditional aged made greater gains in Intercultural Maturity than their respective peers who were male, white, or non-traditional aged

Physician decision making in selection of second-line treatments in immune thrombocytopenia in children.

Immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder which presents with isolated thrombocytopenia and risk of hemorrhage. While most children with ITP promptly recover with or without drug therapy, ITP is persistent or chronic in others. When needed, how to select second-line therapies is not clear. ICON1, conducted within the Pediatric ITP Consortium of North America (ICON), is a prospective, observational, longitudinal cohort study of 120 children from 21 centers starting second-line treatments for ITP which examined treatment decisions. Treating physicians reported reasons for selecting therapies, ranking the top three. In a propensity weighted model, the most important factors were patient/parental preference (53%) and treatment-related factors: side effect profile (58%), long-term toxicity (54%), ease of administration (46%), possibility of remission (45%), and perceived efficacy (30%). Physician, health system, and clinical factors rarely influenced decision-making. Patient/parent preferences were selected as reasons more often in chronic ITP (85.7%) than in newly diagnosed (0%) or persistent ITP (14.3%, P = .003). Splenectomy and rituximab were chosen for the possibility of inducing long-term remission (P < .001). Oral agents, such as eltrombopag and immunosuppressants, were chosen for ease of administration and expected adherence (P < .001). Physicians chose rituximab in patients with lower expected adherence (P = .017). Treatment choice showed some physician and treatment center bias. This study illustrates the complexity and many factors involved in decision-making in selecting second-line ITP treatments, given the absence of comparative trials. It highlights shared decision-making and the need for well-conducted, comparative effectiveness studies to allow for informed discussion between patients and clinicians

Ringed sideroblasts in βâ thalassemia

Symptomatic βâ thalassemia is one of the globally most common inherited disorders. The initial clinical presentation is variable. Although common hematological analyses are typically sufficient to diagnose the disease, sometimes the diagnosis can be more challenging. We describe a series of patients with βâ thalassemia whose diagnosis was delayed, required bone marrow examination in one affected member of each family, and revealed ringed sideroblasts, highlighting the association of this morphological finding with these disorders. Thus, in the absence of characteristic congenital sideroblastic mutations or causes of acquired sideroblastic anemia, the presence of ringed sideroblasts should raise the suspicion of βâ thalassemia.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136352/1/pbc26324.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136352/2/pbc26324_am.pd

Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

Abstract Background Reduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality. Methods We conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model. Results From 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 - 83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias). Conclusions Reduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium

The Effects of Mental Health First Aid Preparation on Nursing Student Self-Efficacy in their Response to Mental Health Issues

Background: Past studies show a high prevalence of nursing students experience depressive symptoms at varying levels of severity. Teaching nursing students early in their studies how to recognize these symptoms in themselves, their peers, or clients, and how to take appropriate action, may promote better outcomes. Studies in Australia and England have found that Mental Health First Aid (MHFA) increases nursing students’ self-confidence when supporting those experiencing mental health crises. Limited Canadian studies regarding MHFA training exist. Purpose: To examine the effect of MHFA training on the self-efficacy of nursing students to deliver mental health first aid in a clinical setting and among peers. Methods: Participants for this study included 22 volunteer first- or second-year students from a three-year accelerated Canadian Baccalaureate nursing program. Each volunteer answered three demographic questions and ranked their confidence level on a 100-point scale to perform five situation-specific MHFA actions for each of two scenarios (peer and clinical). Questionnaires were completed by participants before and after attending a two-day, 14-hour training course on MHFA. Results: Paired t-tests performed on each questionnaire item revealed significant increases in confidence levels to perform situation-specific mental health first aid actions for each scenario from pre- to post-training. Cronbach’s alpha results show acceptable internal reliability for the five-item questionnaires (pre- and post-test for each scenario). Conclusion: Mental Health First Aid training appears to improve the self-efficacy of nursing students to deliver MHFA actions to clients and peers experiencing mental health crises. Résumé Contexte : Des études antérieures ont révélé qu’un nombre élevé d’étudiantes et étudiants en sciences infirmières éprouvent des symptômes de dépression avec différents niveaux de sévérité. Enseigner dès le début de leurs études à reconnaître ces symptômes chez eux-mêmes, leurs pairs et leurs patients, et comment agir dans ces situations, pourrait favoriser de meilleurs résultats. Des études menées en Australie et en Angleterre auprès d’étudiantes et étudiants en sciences infirmières ont montré qu’une formation en premiers soins en santé mentale (PSSM) renforce leur confiance en eux lorsqu’ils sont confrontés à une personne aux prises avec un problème de santé mentale. Les études canadiennes sur la formation en PSSM sont limitées. But : Le but de cette étude était d’évaluer l’impact d’une formation en PSSM sur le sentiment d’auto-efficacité d’étudiantes et étudiants en sciences infirmières dans la prestation de premiers soins en santé mentale en milieu clinique et auprès de leurs pairs. Méthodes : L’échantillon de cette étude était composé de 22 étudiantes et étudiants bénévoles, inscrits en première ou deuxième année du baccalauréat accéléré de trois ans en sciences infirmières au Canada. Tous les participants ont répondu à trois questions démographiques et ont évalué leur niveau de confiance sur une échelle de 100 points, pour effectuer cinq actions de PSSM spécifiques à une situation pour chacun des deux scénarios (entre pairs et clinique). Les questionnaires ont été remplis avant et après la participation à une formation de deux jours (14 heures) en PSSM. Résultats : Des tests t appariés réalisés pour chaque élément du questionnaire ont révélé une augmentation significative des niveaux de confiance de démontrer des actions spécifiques de premiers soins en santé mentale pour chacun des scénarios, entre le test pré- et post-formation. Les résultats de l’indice alpha de Cronbach révèlent une fiabilité interne acceptable pour les questionnaires à cinq éléments (pré- et post-test, pour chaque scénario). Conclusion : Il semble que la formation en PSSM ait un impact positif sur le sentiment d’auto-efficacité des étudiantes et étudiants en sciences infirmières, les rendant plus aptes à intervenir efficacement auprès des patients et des pairs qui vivent une crise de santé mentale

Changes in Gene Expression and Cellular Architecture in an Ovarian Cancer Progression Model

BACKGROUND: Ovarian cancer is the fifth leading cause of cancer deaths among women. Early stage disease often remains undetected due the lack of symptoms and reliable biomarkers. The identification of early genetic changes could provide insights into novel signaling pathways that may be exploited for early detection and treatment. METHODOLOGY/PRINCIPAL FINDINGS: Mouse ovarian surface epithelial (MOSE) cells were used to identify stage-dependent changes in gene expression levels and signal transduction pathways by mouse whole genome microarray analyses and gene ontology. These cells have undergone spontaneous transformation in cell culture and transitioned from non-tumorigenic to intermediate and aggressive, malignant phenotypes. Significantly changed genes were overrepresented in a number of pathways, most notably the cytoskeleton functional category. Concurrent with gene expression changes, the cytoskeletal architecture became progressively disorganized, resulting in aberrant expression or subcellular distribution of key cytoskeletal regulatory proteins (focal adhesion kinase, α-actinin, and vinculin). The cytoskeletal disorganization was accompanied by altered patterns of serine and tyrosine phosphorylation as well as changed expression and subcellular localization of integral signaling intermediates APC and PKCβII. CONCLUSIONS/SIGNIFICANCE: Our studies have identified genes that are aberrantly expressed during MOSE cell neoplastic progression. We show that early stage dysregulation of actin microfilaments is followed by progressive disorganization of microtubules and intermediate filaments at later stages. These stage-specific, step-wise changes provide further insights into the time and spatial sequence of events that lead to the fully transformed state since these changes are also observed in aggressive human ovarian cancer cell lines independent of their histological type. Moreover, our studies support a link between aberrant cytoskeleton organization and regulation of important downstream signaling events that may be involved in cancer progression. Thus, our MOSE-derived cell model represents a unique model for in depth mechanistic studies of ovarian cancer progression

Second-line treatments in children with immune thrombocytopenia: Effect on platelet count and patient-centered outcomes

Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder with isolated thrombocytopenia and hemorrhagic risk. While many children with ITP can be safely observed, treatments are often needed for various reasons, including to decrease bleeding or improve health related quality of life (HRQoL). There are a number of available second-line treatments, including rituximab, thrombopoietin-receptor agonists, oral immunosuppressive agents, and splenectomy, but data comparing treatment outcomes are lacking. ICON1 is a prospective, multi-center, observational study of 120 children starting second-line treatments for ITP designed to compare treatment outcomes including platelet count, bleeding, and HRQoL utilizing the Kids ITP Tool (KIT). While all treatments resulted in increased platelet counts, romiplostim had the most pronounced effect at 6 months (p=0.04). Only patients on romiplostim and rituximab had a significant reduction in both skin-related (84% to 48%, p=0.01 and 81% to 43%, p=0.004) and non-skin-related bleeding symptoms (58% to 14%, p=0.0001 and 54% to 17%, p=0.0006) after 1 month of treatment. HRQoL significantly improved on all treatments. However, only patients treated with eltrombopag had a median improvement in KIT scores at 1 month that met the minimal important difference (MID). Bleeding, platelet count, and HRQoL improved in each treatment group, but the extent and timing of the effect varied among treatments. These results are hypothesis generating and help to improve our understanding of the effect of each treatment on specific patient outcomes. Combined with future randomized trials, these findings will help clinicians select the optimal second-line treatment for an individual child with ITP

A communal catalogue reveals Earth’s multiscale microbial diversity

Our growing awareness of the microbial world’s importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earth’s microbial diversity