Peeking Inside the Black Box: One Institution\u27s Experience Developing Policy for Unrepresented Patients

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The prism model: advancing a theory of practice for arts and humanities in medical education

Introduction: The arts and humanities have transformative potential for medical education. Realizing this potential requires an understanding of what arts and humanities teaching is and what it aims to do. A 2016 review of exclusively quantitative studies mapped three discursive positions (art as intrinsic to, additive to or curative for medicine) and three epistemic functions (art for mastering skills, perspective taking, and personal growth and activism). A more inclusive sample might offer new insights into the position and function of arts and humanities teaching in medical education. Methods: Informed by this 2016 framework, we conducted discursive and conceptual analyses of 769 citations from a database created in a recent scoping review. We also analyzed the 15 stakeholder interviews from this review for recurring themes. These three analyses were iteratively compared and combined to produce a model representing the complex relationship among discursive functions and learning domains. Results: The literature largely positioned arts and humanities as additive to medicine and focused on the functions of mastering skills and perspective taking. Stakeholders emphasized the intrinsic value of arts and humanities and advocated their utility for social critique and change. We offer a refined theory of practice—the Prism Model of four functions (mastering skills, perspective taking, personal insight and social advocacy)—to support more strategic use of arts and humanities in medical education across all learning domains. Discussion: The Prism Model encourages greater pedagogical flexibility and critical reflection in arts and humanities teaching, offering a foundation for achieving its transformative potential

How are the arts and humanities used in medical education? Results of a scoping review

Purpose Although focused reviews have characterized subsets of the literature on the arts and humanities in medical education, a large-scale overview of the field is needed to inform efforts to strengthen these approaches in medicine. Method The authors conducted a scoping review in 2019 to identify how the arts and humanities are used to educate physicians and interprofessional learners across the medical education continuum in Canada and the United States. A search strategy involving 7 databases identified 21,985 citations. Five reviewers independently screened the titles and abstracts. Full-text screening followed (n = 4,649). Of these, 769 records met the inclusion criteria. The authors performed descriptive and statistical analyses and conducted semistructured interviews with 15 stakeholders. Results The literature is dominated by conceptual works (n = 294) that critically engaged with arts and humanities approaches or generally called for their use in medical education, followed by program descriptions (n = 255). The literary arts (n = 197) were most common. Less than a third of records explicitly engaged theory as a strong component (n = 230). Of descriptive and empirical records (n = 424), more than half concerned undergraduate medical education (n = 245). There were gaps in the literature on interprofessional education, program evaluation, and learner assessment. Programming was most often taught by medical faculty who published their initiatives (n = 236). Absent were voices of contributing artists, docents, and other arts and humanities practitioners from outside medicine. Stakeholders confirmed that these findings resonated with their experiences. Conclusions This literature is characterized by brief, episodic installments, privileging a biomedical orientation and largely lacking a theoretical frame to weave the installments into a larger story that accumulates over time and across subfields. These findings should inform efforts to promote, integrate, and study uses of the arts and humanities in medical education

Knowledge, Attitudes, Beliefs and Behaviors Regarding Fruits and Vegetables among Cost-Offset Community-Supported Agriculture (CSA) Applicants, Purchasers, and a Comparison Sample

Data were collected in August, amid the summer CSA season, when shares include many of the summer FV preferred by low-income caregivers and their children [33], which may have contributed to the magnitude of the differences in children’s FV consumption that we observed. Because resources to support the CO-CSA were limited and offsets were awarded on a first-come first-served basis, and because almost all KABs were equivalent for purchaser and non-purchaser sub-groups, selection bias into the purchaser sub-group is an unlikely explanation for differences observed between CO-CSA purchasers and non-purchasers. [...]the inclusion of some CO-CSA applicants who participated in a longitudinal study regarding CO-CSA may have biased upwards estimates of KAB and self-efficacy with respect to FV consumption in the applicant sample. [...]although selection of adults into the comparison group used similar eligibility criteria, they were not comparable to CO-CSA applicants who were older, more educated, and more often lived in food-secure households. [...]sample sizes were too small to permit exploration of observed associations in a multivariate context that controlled for key sample differences such as age, educational attainment, or self-efficacy for eating and cooking FV. 5

Gray matter injury associated with periventricular leukomalacia in the premature infant

Neuroimaging studies indicate reduced volumes of certain gray matter regions in survivors of prematurity with periventricular leukomalacia (PVL). We hypothesized that subacute and/or chronic gray matter lesions are increased in incidence and severity in PVL cases compared to non-PVL cases at autopsy. Forty-one cases of premature infants were divided based on cerebral white matter histology: PVL (n = 17) with cerebral white matter gliosis and focal periventricular necrosis; diffuse white matter gliosis (DWMG) (n = 17) without necrosis; and

Growing Opportunities for Equitable, Interdisciplinary Undergraduate Food Systems Education: A Review of Food Systems Education at Land-Grant Institutions and Development of Open-Access Materials

Post-secondary coursework related to agriculture and the food supply has been at the core of the United States' land-grant system for more than 150 years. However, as the complexity of food systems has grown, so too have critiques that the education provided in these programs is too narrow to adequately prepare graduates to address pressing food systems issues. In response, some higher education institutions have developed degrees in food systems. To support development of this burgeoning field, we created, tested, and refined four evidence-informed, interdisciplinary, equity-oriented, open-access teaching modules. These modules are based on our experience conducting a multi-site, multi-year transdisciplinary investigation of subsidized, or “cost-offset”, community supported agriculture and a survey asking instructors at land-grant institutions (n = 66) about topic offerings and current unmet needs for instructional materials. Our collaboration illuminated the potential and challenges of food systems research; underscored the value of transdisciplinary research teams; and identified several equity-oriented topics related to the design, implementation, and evaluation of local food initiatives suitable for advancing sustainable foods systems education. Instructors reported that the most helpful teaching aids would be case studies, lesson plans with active learning components, and reference lists with relevant peer-reviewed publications. The final modules seek to shed light on the complexity of food systems projects and build knowledge, vocabularies, and skills across disciplines engaged with food systems. Per instructor-defined needs, each module features a case study, active-learning activities, and references. We anticipate that the adaptable modules will be suitable for a wide range of students and courses

Cooperative and Antagonistic Contributions of Two Heterochromatin Proteins to Transcriptional Regulation of the Drosophila Sex Determination Decision

Eukaryotic nuclei contain regions of differentially staining chromatin (heterochromatin), which remain condensed throughout the cell cycle and are largely transcriptionally silent. RNAi knockdown of the highly conserved heterochromatin protein HP1 in Drosophila was previously shown to preferentially reduce male viability. Here we report a similar phenotype for the telomeric partner of HP1, HOAP, and roles for both proteins in regulating the Drosophila sex determination pathway. Specifically, these proteins regulate the critical decision in this pathway, firing of the establishment promoter of the masterswitch gene, Sex-lethal (Sxl). Female-specific activation of this promoter, SxlPe, is essential to females, as it provides SXL protein to initiate the productive female-specific splicing of later Sxl transcripts, which are transcribed from the maintenance promoter (SxlPm) in both sexes. HOAP mutants show inappropriate SxlPe firing in males and the concomitant inappropriate splicing of SxlPm-derived transcripts, while females show premature firing of SxlPe. HP1 mutants, by contrast, display SxlPm splicing defects in both sexes. Chromatin immunoprecipitation assays show both proteins are associated with SxlPe sequences. In embryos from HP1 mutant mothers and Sxl mutant fathers, female viability and RNA polymerase II recruitment to SxlPe are severely compromised. Our genetic and biochemical assays indicate a repressing activity for HOAP and both activating and repressing roles for HP1 at SxlPe

Increased Number of Cerebellar Granule Cells and Astrocytes in the Internal Granule Layer in Sheep Following Prenatal Intra-amniotic Injection of Lipopolysaccharide

Chorioamnionitis is an important problem in perinatology today, leading to brain injury and neurological handicaps. However, there are almost no data available regarding chorioamnionitis and a specific damage of the cerebellum. Therefore, this study aimed at determining if chorioamnionitis causes cerebellar morphological alterations. Chorioamnionitis was induced in sheep by the intra-amniotic injection of lipopolysaccharide (LPS) at a gestational age (GA) of 110 days. At a GA of 140 days, we assessed the mean total and layer-specific volume and the mean total granule cell (GCs) and Purkinje cell (PC) number in the cerebelli of LPS-exposed and control animals using high-precision design-based stereology. Astrogliosis was assessed in the gray and white matter (WM) using a glial fibrillary acidic protein staining combined with gray value image analysis. The present study showed an unchanged volume of the total cerebellum as well as the molecular layer, outer and inner granular cell layers (OGL and IGL, respectively), and WM. Interestingly, compared with controls, the LPS-exposed brains showed a statistically significant increase (+20.4%) in the mean total number of GCs, whereas the number of PCs did not show any difference between the two groups. In addition, LPS-exposed animals showed signs of astrogliosis specifically affecting the IGL. Intra-amniotic injection of LPS causes morphological changes in the cerebellum of fetal sheep still detectable at full-term birth. In this study, changes were restricted to the inner granule layer. These cerebellar changes might correspond to some of the motor or non-motor deficits seen in neonates from compromised pregnancies