How Should We Measure Effectiveness of Medical-Legal Partnerships?

Medical-legal partnerships (MLPs) try to mitigate health inequity by uniting legal and health professionals to respond to legal determinants of patients’ health. While there is a long tradition of “patients-to-policy” work in MLPs, the current empirical evidence base has evaluated MLP effectiveness by assessing benefits to individual patients, clinicians, and hospital and legal systems. This article calls for future research to measure how community power, which includes shifting power to impacted communities to develop and lead equity-focused agendas, is built as both a process and an outcome of MLPs

Leveraging Academic-Medical Legal Partnerships to Advance Health Justice

Unmet legal needs contribute to housing, income, and food insecurity, along with other conditions that harm health and drive health inequity. Addressing health injustice requires new tools for the next generations of lawyers, doctors, and other healthcare professionals. An interprofessional group of co-authors argue that law and medical schools and other university partners should develop and cultivate Academic Medical-Legal Partnerships (A-MLPs), which are uniquely positioned to leverage service, education, and research resources, to advance health justice

The RNA-binding protein, ZFP36L2, influences ovulation and oocyte maturation

ZFP36L2 protein destabilizes AU-rich element-containing transcripts and has been implicated in female fertility. In the C57BL/6NTac mouse, a mutation in Zfp36l2 that results in the decreased expression of a form of ZFP36L2 in which the 29 N-terminal amino acid residues have been deleted, ΔN-ZFP36L2, leads to fertilized eggs that arrest at the two-cell stage. Interestingly, homozygous ΔN-Zfp36l2 females in the C57BL/6NTac strain release 40% fewer eggs than the WT littermates (Ramos et al., 2004), suggesting an additional defect in ovulation and/or oocyte maturation. Curiously, the same ΔN-Zfp36l2 mutation into the SV129 strain resulted in anovulation, prompting us to investigate a potential problem in ovulation and oocyte maturation. Remarkably, only 20% of ΔN-Zfp36l2 oocytes in the 129S6/SvEvTac strain matured ex vivo, suggesting a defect on the oocyte meiotic maturation process. Treatment of ΔN-Zfp36l2 oocytes with a PKA inhibitor partially rescued the meiotic arrested oocytes. Furthermore, cAMP levels were increased in ΔN-Zfp36l2 oocytes, linking the cAMP/PKA pathway and ΔN-Zfp36l2 with meiotic arrest. Since ovulation and oocyte maturation are both triggered by LHR signaling, the downstream pathway was investigated. Adenylyl cyclase activity was increased in ΔN-Zfp36l2 ovaries only upon LH stimulation. Moreover, we discovered that ZFP36L2 interacts with the 3′UTR of LHR mRNA and that decreased expression levels of Zfp36l2 correlates with higher levels of LHR mRNA in synchronized ovaries. Furthermore, overexpression of ZFP36L2 decreases the endogenous expression of LHR mRNA in a cell line. Therefore, we propose that lack of the physiological down regulation of LHR mRNA levels by ZFP36L2 in the ovaries is associated with anovulation and oocyte meiotic arrest.Fil: Ball, Christopher B.. University of North Carolina; Estados UnidosFil: Rodriguez, Karina F.. National Institutes of Health; Estados UnidosFil: Stumpo, Deborah J.. National Institutes of Health; Estados UnidosFil: Ribeiro Neto, Fernando. National Institutes of Health; Estados UnidosFil: Korach, Kenneth S.. National Institutes of Health; Estados UnidosFil: Blackshear, Perry J.. University of Duke; Estados Unidos. National Institutes of Health; Estados UnidosFil: Birnbaumer, Lutz. National Institutes of Health; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ramos, Silvia B. V.. University of North Carolina; Estados Unido

An Interprofessional Approach to Teaching Advocacy Skills: Lessons from an Academic Medical-Legal Partnership

Medical students and educators recognize that preparing the next generation of health leaders to address seemingly intractable problems like health disparities should include advocacy training. Opportunities to acquire the knowledge and skills needed to effectively advocate at the policy level to promote systems-, community-, and population-level solutions are a critical component of such training. But formal advocacy training programs that develop and measure such skills are scarce. Even less common are interprofessional advocacy training programs that include legal and policy experts to help medical students learn such skills. This 2016–2017 pilot study started with a legislative advocacy training program for preclinical medical students that was designed to prepare them to meet with Capitol Hill representatives about a health justice issue. The pilot assessed the impact of adding an interprofessional education (IPE) dimension to the program, which in this case involved engaging law faculty and students to help the medical students understand and navigate the federal legislative process and prepare for their meetings. Results from the pilot suggest that adding law and policy experts to advocacy-focused training programs can improve medical students’ advocacy knowledge and skills and increase their professional identity as advocates

Legal Needs and Health Outcomes for People with Cancer in Medical-Legal Partnership Programs: A Systematic Review

Medical-legal partnerships (MLPs) integrate lawyers into the medical team to address patients’ unmet legal needs that create barriers to good health and well-being (i.e., “health-harming legal needs”) and improve health outcomes. Given the growing popularity of MLP as an innovative healthcare model, this review has two objectives: to identify peer-reviewed literature measuring (1) cancer patients’ legal needs, and (2) outcomes for cancer patients after receiving MLP legal services. A systematic literature search was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for the period 2006- 2022. Four articles met the inclusion criteria for objective one: three articles, including one that also met the inclusion criteria for objective one, met the inclusion criteria for objective two, for a total of six articles. Literature confirms that when screened, cancer patients regularly struggle with health-harming legal needs. Further published research is needed to better identify and understand the unmet legal needs of cancer patients and the impact of MLPs on cancer patients’ outcomes

Comparing the effectiveness of game literacy education and game coding education in improving problematic internet gaming

ObjectiveProblematic internet gaming by adolescents has been thought to be associated with low self-esteem, depression, anxiety, and attention problems. We hypothesized that both game literacy and coding education would effectively improve problematic internet use. However, game coding education would be more effective in enhancing self-esteem and social anxiety in adolescents than game literacy education.MethodsA total of 733 adolescent volunteers were included and randomly assigned to either the game coding education or game literacy education programs. Both programs consisted of eight sessions, each lasting 45 minutes, over four weeks. The coding education sessions included game planning and development lessons and allowed students to create the game’s characters, stages, and tutorials directly using Scratch, a free coding program. Game literacy education sessions included lessons on enjoying gaming with a healthy rationale and etiquette. Data on demographics, gaming patterns, and psychological status, including positive/negative perceptions of online games, depression, social anxiety, and self-esteem, were collected.ResultsBoth game coding and game literacy education significantly improved YIAS scores compared to baseline, and there was no significant difference in the YIAS scores between the two groups after the interventions. In the hierarchical logistic regression analysis of all participants, higher YIAS scores, stronger negative perceptions of gaming, and lower attention problem scores at baseline predicted lower levels of internet gaming addiction after interventions. In the hierarchical logistic regression analysis among individuals with game coding education, higher YIAS scores, stronger negative perceptions of gaming, lower attention problem scores, and higher self-esteem scores at baseline predicted lower levels of internet gaming addiction after intervention. In addition, game coding education greatly improved negative perceptions of games, self-esteem, and social anxiety compared to game literacy education.ConclusionBoth game literacy and game coding education effectively mitigate internet game addiction. However, game coding education effectively mitigated problematic internet gaming by improving negative perceptions of games, self-esteem, and social anxiety in adolescents. We found that the application of knowledge by students in creating their own games was more effective than simply developing a conceptual understanding of the games

The Academic Medical-Legal Partnership: Training the Next Generation of Health & Legal Professionals to Work Together to Advance Health Justice

As the national medical-legal partnership (MLP) movement grows, the need for doctors, nurses, social workers, other health professionals, and lawyers who have the knowledge, skills, and experience to collaborate effectively in this holistic healthcare approach is increasing. Given the unique role that institutions of higher education play in training students as they develop their professional identities, members of the Georgetown University Health Justice Alliance sought to build on prior efforts to define the MLP model by focusing on MLPs that exist in academic settings as a specific type of MLP. This report is based on the results of an environmental scan of MLPs that had evidence of engagement with a medical or law school and reflects the core elements of those MLPs as embodied by their objectives, activities, and unique features. The scan started with prior research conducted by the National Center for Medical-Legal Partnership, which categorized MLPs based on their targeted patient populations and identified eight core elements of infrastructure shared across MLPs. The Health Justice Alliance research team then collected data on the impact of interprofessional MLP learning on core undergraduate and graduate medical education knowledge, attitudes, and skill competencies sets for students. Other reports and articles describing specific MLP programs that create interprofessional education opportunities for law and medical students to learn and practice together also provided foundational background

Designing and Developing a Medical-Legal Partnership to Address Cancer Patients\u27 Health-Harming Legal Needs

The Georgetown University\u27s Cancer Legal Assistance and Well-being Project launched in 2020 as a medical-legal partnership that works with health care providers at a Washington, D.C. safety-net hospital to treat the health-harming legal needs of historically and intentionally marginalized patients with cancer

High-Resolution Sequencing and Modeling Identifies Distinct Dynamic RNA Regulatory Strategies

Cells control dynamic transitions in transcript levels by regulating transcription, processing, and/or degradation through an integrated regulatory strategy. Here, we combine RNA metabolic labeling, rRNA-depleted RNA-seq, and DRiLL, a novel computational framework, to quantify the level; editing sites; and transcription, processing, and degradation rates of each transcript at a splice junction resolution during the LPS response of mouse dendritic cells. Four key regulatory strategies, dominated by RNA transcription changes, generate most temporal gene expression patterns. Noncanonical strategies that also employ dynamic posttranscriptional regulation control only a minority of genes, but provide unique signal processing features. We validate Tristetraprolin (TTP) as a major regulator of RNA degradation in one noncanonical strategy. Applying DRiLL to the regulation of noncoding RNAs and to zebrafish embryogenesis demonstrates its broad utility. Our study provides a new quantitative approach to discover transcriptional and posttranscriptional events that control dynamic changes in transcript levels using RNA sequencing data.National Human Genome Research Institute (U.S.) (Centers for Excellence in Genomics Science 1P50HG006193-01)Howard Hughes Medical InstituteNational Institutes of Health (U.S.) (Pioneer Award)Massachusetts Institute of Technology. William Asbjornsen Albert Memorial FellowshipXerox Fellowship Progra

Genomic analysis of male puberty timing highlights shared genetic basis with hair colour and lifespan.

The timing of puberty is highly variable and is associated with long-term health outcomes. To date, understanding of the genetic control of puberty timing is based largely on studies in women. Here, we report a multi-trait genome-wide association study for male puberty timing with an effective sample size of 205,354 men. We find moderately strong genomic correlation in puberty timing between sexes (rg = 0.68) and identify 76 independent signals for male puberty timing. Implicated mechanisms include an unexpected link between puberty timing and natural hair colour, possibly reflecting common effects of pituitary hormones on puberty and pigmentation. Earlier male puberty timing is genetically correlated with several adverse health outcomes and Mendelian randomization analyses show a genetic association between male puberty timing and shorter lifespan. These findings highlight the relationships between puberty timing and health outcomes, and demonstrate the value of genetic studies of puberty timing in both sexes