Evaluation of a web-based portal to improve resident education by neonatology fellows

Background: Integration of web-based educational tools into medical training has been shown to increase accessibility of resources and optimize teaching. We developed a web-based educational portal (WBEP) to support teaching of pediatric residents about newborn medicine by neonatology fellows. Objectives: 1) To compare residents’ attitudes about their fellow-led education in the NICU pre- and post-WBEP; including assessment of factors that impact their education and usefulness of teaching tools. 2) To compare fellow utilization of various teaching modalities pre- and post-WBEP. Design/methods We queried residents about their attitudes regarding fellow-led education efforts and various teaching modalities in the NICU and logistics potentially impacting effectiveness. Based on these data, we introduced the WBEP – a repository of teaching tools (e.g., mock code cases, board review questions, journal articles, case-based discussion scenarios) for use by fellows to supplement didactic sessions in a faculty-based curriculum. We surveyed residents about the effectiveness of fellow teaching pre- and post-WBEP implementation and the type of fellow-led teaching modalities that were used. Results: After analysis of survey responses, we identified that residents cited fellow level of interest as the most important factor impacting their education. Post-implementation, residents described greater utilization of various teaching modalities by fellows, including an increase in use of mock codes (14% to 76%, p<0.0001) and journal articles (33% to 59%, p=0.02). Conclusions: A web-based resource that supplements traditional curricula led to greater utilization of various teaching modalities by fellows and may encourage fellow involvement in resident teaching

Convergence Of Proliferative And Survival Signals On The pRB/E2F Pathway In Haematopoietic Cells

Chronic myeloid leukemia (CML) is a malignant stem cell disease characterised by an expansion of myeloid progenitor cells. These cells express a BCR/ABL fusion protein with constitutively activated tyrosine kinase activity, which causes a deregulation of apoptosis and cell cycle progression. In the pro-B BaF3 cell line, BCR/ABL has been shown to abrogate the EL-3 dependence to proliferate, but the signalling pathways activated by BCR/ABL and IL-3 to promote proliferation and survival are not yet well defined. In this study, BaF3 cells and a BaF3 cell line stably over-expressing BCR/ABL, BaF3-p210, were used to identify the downstream targets of BCR/ABL and IL-3. Both BCR/ABL and IL-3 were shown to induce the expression of cyclin D2 and inhibit the expression of the cell cycle inhibitor, p27 kipl. This regulation was shown to be directly due to BCR/ABL, in haematopoietic cells, by two different approaches. First, using a BaF3 cell line (TonB210.1) where the BCR/ABL expression is inducible by doxycycline and second, by inhibiting the kinase activity of BCR/ABL with the Abl tyrosine kinase inhibitor STI571. In order to establish the functional significance of cyclin D2 and p27 Kipl expression in response to IL-3 and BCR/ABL expression, the effects of ectopic expression of cyclin D2 and p27 Kipl on cell proliferation and survival were studied. The results demonstrate that both cyclin D2 and p27 Kipl have a role in BaF3 cell proliferation and survival, as ectopic expression of cyclin D2 is sufficient to abolish the cell cycle arrest and apoptosis induced by IL-3 withdrawal or BCR/ABL inactivation, while over-expression of p27 Kipl can cause cell cycle arrest and apoptosis in BaF3 cells. Next, the signal pathways triggered by BCR/ABL and IL-3 to regulate cell proliferation and apoptosis via cyclin D2 and p27 Kipl were investigated. The PI 3-Kinase inhibitor LY294002 blocks the ability of BCR/ABL or IL-3 to induce cyclin D2 up-regulation and p27 Kipl down-regulation and inhibits BCR/ABL-induced entry in S phase. Ectopic expression of cyclin D2 was found to overcome the cell cycle arrest induced by inhibition of PI 3-Kinase by LY294002. The results indicate that BCR/ABL and EL-3 target cyclin D2 and p27 Kipl to mediate cell cycle arrest and apoptosis through a pathway involving the phosphatidylinositol-3 kinase (PI 3-K)

A study of thirty-five cases presenting marital problems to the Providence Family Welfare Society

Thesis (M.S.)--Boston University, 1948. This item was digitized by the Internet Archive

NIDCAP improves brain function and structure in preterm infants with severe intrauterine growth restriction

Objective: The effect of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) was examined on the neurobehavioral, electrophysiological and neurostructural development of preterm infants with severe intrauterine growth restriction (IUGR). Study Design: A total of 30 infants, 27–33 weeks gestation, were randomized to control (C; N=17) or NIDCAP/experimental (E; N=13) care. Baseline health and demographics were assessed at intake; electroencephalography (EEG) and magnetic resonance imaging (MRI) at 35 and 42 weeks postmenstrual age; and health, growth and neurobehavior at 42 weeks and 9 months corrected age (9 months). Results: C and E infants were comparable in health and demographics at baseline. At follow-up, E infants were healthier, showed significantly improved brain development and better neurobehavior. Neurobehavior, EEG and MRI discriminated between C and E infants. Neurobehavior at 42 weeks correlated with EEG and MRI at 42 weeks and neurobehavior at 9 months. Conclusion: NIDCAP significantly improved IUGR preterm infants' neurobehavior, electrophysiology and brain structure. Longer-term outcome assessment and larger samples are recommended

Diagnosis of Cystic Fibrosis in Screened Populations

Objective Cystic fibrosis (CF) can be difficult to diagnose, even when newborn screening (NBS) tests yield positive results. This challenge is exacerbated by the multitude of NBS protocols, misunderstandings about screening vs diagnostic tests, and the lack of guidelines for presumptive diagnoses. There is also confusion regarding the designation of age at diagnosis. Study design To improve diagnosis and achieve standardization in definitions worldwide, the CF Foundation convened a committee of 32 experts with a mission to develop clear and actionable consensus guidelines on diagnosis of CF with an emphasis on screened populations, especially the newborn population. A comprehensive literature review was performed with emphasis on relevant articles published during the past decade. Results After reviewing the common screening protocols and outcome scenarios, 14 of 27 consensus statements were drafted that apply to screened populations. These were approved by 80% or more of the participants. Conclusions It is recommended that all diagnoses be established by demonstrating dysfunction of the CF transmembrane conductance regulator (CFTR) channel, initially with a sweat chloride test and, when needed, potentially with newer methods assessing membrane transport directly, such as intestinal current measurements. Even in babies with 2 CF-causing mutations detected via NBS, diagnosis must be confirmed by demonstrating CFTR dysfunction. The committee also recommends that the latest classifications identified in the Clinical and Functional Translation of CFTR project [http://www.cftr2.org/index.php] should be used to aid with CF diagnosis. Finally, to avoid delays in treatment, we provide guidelines for presumptive diagnoses and recommend how to determine the age of diagnosis

Innate immune activation in neonatal tracheal aspirates suggests endotoxin-driven inflammation

Background:: Tracheal aspirates (TAs) from critically ill neonates accumulate bacterial endotoxin and demonstrate mobilization of endotoxin-binding proteins, but the potential bioactivity of endotoxin in TAs is unknown. We characterized innate immune activation in TAs of mechanically ventilated neonates. Methods: Innate immune activation in TAs of mechanically ventilated neonates was characterized using a targeted 84-gene quantitative real-time (qRT) PCR array. Protein expression of cytokines was confirmed by multiplex assay. Expression and localization of the endotoxin-inducible antimicrobial protein Calgranulin C (S100A12) was assessed by flow cytometry. Endotoxin levels were measured in TA supernatants using the Limulus amoebocyte lysate assay. Results:: Analyses by qRT-PCR demonstrated expression of pattern recognition receptors, Toll-like receptor-nuclear factor κB and inflammasome pathways, cytokines/chemokines and their receptors, and anti-infective proteins in TA cells. Endotoxin positivity increased with postnatal age. As compared with endotoxin-negative TAs, endotoxin-positive TAs demonstrated significantly greater tumor necrosis factor (TNF), interleukin (IL)-6, IL-10, and serpin peptidase inhibitor, clade E, member 1 (SERPINE1) mRNA, and IL-10, TNF, and IL-1β protein. Expression of S100A12 protein was localized to TA neutrophils. Conclusion:: Correlation of endotoxin with TA inflammatory responses suggests endotoxin bioactivity and the possibility that endotoxin antagonists could mitigate pulmonary inflammation and its sequelae in this vulnerable population

Understanding Factors Associated with Clinician Confidence to Identify and Treat PTSD and Complex PTSD

ABSTRACT This dissertation explores mental health clinicians’ experiences and self-identified confidence to identify and treat post-traumatic stress disorder (PTSD) and Complex PTSD. PTSD is a highly prevalent mental health condition that impacts an estimated 24.4 million individuals in the United States (PTSD United, 2019). Complex PTSD has just emerged for the first time with official diagnostic criteria in the publication of the ICD-11 in 2019 for use beginning in January 2022 (WHO, 2019). There is very little existing research that considers the experience or confidence of clinicians who work with clients who have PTSD and Complex PTSD, which is troubling given the prevalence rates of these disorders. Nor does research exist that speaks to what it will mean for clinicians to incorporate the new taxonomy for Complex PTSD or the ways in which Complex PTSD differs in identification or treatment approach in comparison to PTSD. Through the analysis of three principal factors, primary clinical focus on trauma, years of experience, and highest level of training, a foundational understanding of the ways these factors influence clinician confidence is presented in this Volume I report of the Meier’s Therapists’ Experiences Survey (M-TES). This exploratory survey research utilizes descriptive statistics, crosstab calculations, and several post hoc tests to begin to unpack the aggregated responses of 217 outpatient mental health clinicians who participated in the first distribution of the M-TES. This study provides an introductory look at factors associated with clinician confidence to identify PTSD and Complex PTSD and differentiate their treatment approach between the two. Recommendations are suggested for follow-up studies that would enhance knowledge specific to improving clinician confidence in identifying and treating PTSD and Complex PTSD. This research identifies needed areas of support for clinicians to identify PTSD and Complex PTSD and differentiate their treatment approach between the two, which would ultimately enhance and improve the treatment outcomes for individuals seeking mental health care for trauma conditions

Potential Impact of Expanded Carrier Screening on the Incidence of Duchenne Muscular Dystrophy in Neonates

Background: Duchenne Muscular Dystrophy (DMD), the most common form of muscular dystrophy is associated with a 25 year life expectancy and occurs in 1 in 5,000 male births. At Brigham and Women’s Hospital over 18,000 infants have undergone newborn screening (NBS) for DMD without a positive result. We identified a case where a DMD carrier mother (detected through pre-pregnancy expanded carrier screening (ECS), underwent assisted reproductive technology that led to implantation of an embryo confirmed to be DMD negative. To test the hypothesis that ECS that included DMD might decrease the incidence of DMD through reproductive planning, we sought to determine the extent of ECS in our birth cohort. Methods: We performed a retrospective maternal chart review of DMD screened infants born in the first seven days of each month from January 2022 – May 2024. and documented ECS screening (with or without DMD), at pre-conception or post-conception [n= 2,614] Results: Of the screened participants 49.7% received ECS with DMD and 93.9% of the sample received some form of genetic screening. There was an increase in ECS with DMD from 2022 (46.6%) to 2024 (56.2%). Conclusion: Uptake of ECS may vary widely by geographic location, local practice norms and parental uptake but is prevalent in our cohort. Increasing ECS inclusive of DMD, along with intervention through ART, could explain why our DMD NBS has not identified an affected newborn

Brightview Senior Living Intergenerational Connections

We are working with Brightview Senior Living to create a connection between the Brightview Residents and the Merrimack College Students. To achieve this, we are implementing a weekly activity open to all students to attend that brings them closer with the senior population at Brightview.https://scholarworks.merrimack.edu/rcac_2025_posters/1018/thumbnail.jp

Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis

Background: Respiratory tract infection with Pseudomonas aeruginosa occurs inmost people with cystic fibrosis. Once chronic infection is established, Pseudomonas aeruginosa is virtually impossible to eradicate and is associated with increased mortality and morbidity. Early infection may be easier to eradicate. This is an update of a Cochrane review first published in 2003, and previously updated in 2006 and 2009. Objectives: To determine whether antibiotic treatment of early Pseudomonas aeruginosa infection in children and adults with cystic fibrosis eradicates the organism, delays the onset of chronic infection, and results in clinical improvement. To evaluate whether there is evidence that a particular antibiotic strategy is superior to or more cost-effective than other strategies and to compare the adverse effects of different antibiotic strategies (including respiratory infection with other micro-organisms). Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Most recent search: 08 September 2014. Selection criteria: We included randomised controlled trials of people with cystic fibrosis, in whom Pseudomonas aeruginosa had recently been isolated from respiratory secretions. We compared combinations of inhaled, oral or intravenous antibiotics with placebo, usual treatment or other combinations of inhaled, oral or intravenous antibiotics. We excluded non-randomised trials, cross-over trials, and those utilising historical controls. Data collection and analysis: Both authors independently selected trials, assessed risk of bias and extracted data. Main results: The search identified 49 trials; seven trials (744 participants) with a duration between 28 days and 27 months were eligible for inclusion. Three of the trials are over 10 years old and their results may be less applicable today given the changes in standard treatment. Some of the trials had low numbers of participants and most had relatively short follow-up periods; however, there was generally a low risk of bias from missing data. In most trials it was difficult to blind participants and clinicians to treatment given the interventions and comparators used. Two trials were supported by the manufacturers of the antibiotic used. Evidence from two trials (38 participants) at the two-month time-point showed treatment of early Pseudomonas aeruginosa infection with inhaled tobramycin results in microbiological eradication of the organism from respiratory secretions more often than placebo, odds ratio 0.15 (95% confidence interval 0.03 to 0.65) and data from one of these trials, with longer follow up, suggested that this effect may persist for up to 12 months. One randomised controlled trial (26 participants) compared oral ciprofloxacin and nebulised colistin versus usual treatment. Results after two years suggested treatment of early infection results in microbiological eradication of Pseudomonas aeruginosa more often than no anti-pseudomonal treatment, odds ratio 0.12 (95% confidence interval 0.02 to 0.79). One trial comparing 28 days to 56 days treatment with nebulised tobramycin solution for inhalation in 88 participants showed that both treatments were effective and well-tolerated, with no notable additional improvement with longer over shorter duration of therapy. However, this trial was not powered to detect non- inferiority or equivalence. A trial of oral ciprofloxacin with inhaled colistin versus nebulised tobramycin solution for inhalation alone (223 participants) failed to show a difference between the two strategies, although it was underpowered to show this. A further trial of inhaled colistin with oral ciprofloxacin versus nebulised tobramycin solution for inhalation with oral ciprofloxacin also showed no superiority of the former, with increased isolation of Stenotrophomonas maltophilia in both groups. A recent, large trial in 306 children aged between one and 12 years compared cycled nebulised tobramycin solution for inhalation to culture-based therapy and also ciprofloxacin to placebo. The primary analysis showed no difference in time to pulmonary exacerbation or proportion of Pseudomonas aeruginosa positive cultures. An analysis performed in this review (not adjusted for age) showed fewer participants in the cycled therapy group with one or more isolates of Pseudomonas aeruginosa, odds ratio 0.51 (95% CI 0.31 to 0.28). Authors’ conclusions: We found that nebulised antibiotics, alone or in combination with oral antibiotics, were better than no treatment for early infection with Pseudomonas aeruginosa. Eradication may be sustained for up to two years. There is insufficient evidence to determine whether antibiotic strategies for the eradication of early Pseudomonas aeruginosa decrease mortality or morbidity, improve quality of life, or are associated with adverse effects compared to placebo or standard treatment. Four trials of two active treatments have failed to show differences in rates of eradication of Pseudomonas aeruginosa. There have been no published randomised controlled trials that investigate the efficacy of intravenous antibiotics to eradicate Pseudomonas aeruginosa in cystic fibrosis. Overall, there is still insufficient evidence from this review to state which antibiotic strategy should be used for the eradication of early Pseudomonas aeruginosa infection in cystic fibrosis