Long-acting reversible contraception use among residents in obstetrics/gynecology training programs

Background: The objective of the study was to estimate the personal usage of long-acting reversible contraception (LARC) among obstetrics and gynecology (Ob/Gyn) residents in the United States and compare usage between programs with and without a Ryan Residency Training Program (Ryan Program), an educational program implemented to enhance resident training in family planning. Materials and methods: We performed a web-based, cross-sectional survey to explore contraceptive use among Ob/Gyn residents between November and December 2014. Thirty-two Ob/Gyn programs were invited to participate, and 24 programs (75%) agreed to participate. We divided respondents into two groups based on whether or not their program had a Ryan Program. We excluded male residents without a current female partner as well as residents who were currently pregnant or trying to conceive. We evaluated predictors of LARC use using bivariate analysis and multivariable Poisson regression. Results: Of the 638 residents surveyed, 384 (60.2%) responded to our survey and 351 were eligible for analysis. Of those analyzed, 49.3% (95% confidence interval [CI]: 44.1%, 54.5%) reported current LARC use: 70.0% of residents in Ryan Programs compared to 26.8% in non-Ryan Programs (RRadj 2.14, 95% CI 1.63-2.80). Residents reporting a religious affiliation were less likely to use LARC than those who described themselves as non-religious (RRadj 0.76, 95% CI 0.64-0.92). Of residents reporting LARC use, 91% were using the levonorgestrel intrauterine device. Conclusion: LARC use in this population of women's health specialists is substantially higher than in the general population (49% vs. 12%). Ob/Gyn residents in programs affiliated with the Ryan Program were more likely to use LARC

Developmental cues and persistent neurogenic potential within an in vitro neural niche

<p>Abstract</p> <p>Background</p> <p>Neurogenesis, the production of neural cell-types from neural stem cells (NSCs), occurs during development as well as within select regions of the adult brain. NSCs in the adult subependymal zone (SEZ) exist in a well-categorized niche microenvironment established by surrounding cells and their molecular products. The components of this niche maintain the NSCs and their definitive properties, including the ability to self-renew and multipotency (neuronal and glial differentiation).</p> <p>Results</p> <p>We describe a model <it>in vitro </it>NSC niche, derived from embryonic stem cells, that produces many of the cells and products of the developing subventricular zone (SVZ) and adult SEZ NSC niche. We demonstrate a possible role for apoptosis and for components of the extracellular matrix in the maintenance of the NSC population within our niche cultures. We characterize expression of genes relevant to NSC self-renewal and the process of neurogenesis and compare these findings to gene expression produced by an established neural-induction protocol employing retinoic acid.</p> <p>Conclusions</p> <p>The <it>in vitro </it>NSC niche shows an identity that is distinct from the neurally induced embryonic cells that were used to derive it. Molecular and cellular components found in our <it>in vitro </it>NSC niche include NSCs, neural progeny, and ECM components and their receptors. Establishment of the <it>in vitro </it>NSC niche occurs in conjunction with apoptosis. Applications of this culture system range from studies of signaling events fundamental to niche formation and maintenance as well as development of unique NSC transplant platforms to treat disease or injury.</p

In vitro neural stem cell niche grown in 3D scaffold [abstract]

Abstract only availableRecent studies show that adult neural tissues can harbor stem cells within unique niches. In the mammalian central nervous system, neural stem cell (NSC) niches are present in the dentate gyrus and the subventricular zone (SVZ). Stem cells in the well-characterized SVZ exist in a microenvironment established by surrounding cells and tissue components including transit-amplifying cells, neuroblasts, ependymal cells, blood vessels and a basal lamina. Within this microenvironment, stem cell proliferation and differentiation are regulated. We have recently described a novel cell-attached NSC culture system, derived from mouse embryonic stem (ES) cells, that displays elements of a NSC niche in the absence of exogenously applied mitogens or complex physical scaffolding. In this study, we report our initial attempts to move this in vitro niche into a 3D scaffold, PuraMatrix. PuraMatrix is a peptide hydrogel developed by BD Biosciences that self-assembles into a complex molecular matrix in culture upon addition of media. This scaffold acts to anchor cultured cells in a tissue-like microenvironment. Here we report the addition of neuralized mouse ES cells into this scaffold in the presence of various basement membrane components. Mouse Laminin-1 alone, three concentrations of entactin/collagen/laminin (ECL), and culture media alone were tested with PuraMatrix to identify the optimal combination for development of the in vitro niche. Microscopic analysis of cell culture morphology revealed that the highest concentration of ECL produced the best substrate for niche growth and survival. The data demonstrate that cellular aggregation occurred in several of the experimental groups, but concentrated ECL led to the best process development and connectivity between adjacent cellular aggregates. 3D culture of a neuralized stem cell population may contribute to better understanding of the process of neurogenesis and NSC niche formation and regulation. In addition, our results may have implications for application of cells stem in cellular transplant therapeutics

A 3-D in vitro neural stem cell niche derived from mouse embryonic stem cells [abstract]

Abstract only availableOur laboratory works with cell therapies for injuries to the central nervous system and neurodegenerative disorders, including the neuronal ceroid lipofuscinoses (NCLs) or Batten's Disease. We are working toward a treatment for this NCL through the development and application of an in vitro stem cell niche. Recent studies show that adult neural tissue can harbor stem cells within unique niches. In the mammalian central nervous system, neural stem cell (NSC) niches have been identified in the dentate gyrus and the subventricular zone (SVZ). Stem cells in the well-characterized SVZ exist in a microenvironment established by surrounding cells and tissue components including transit-amplifying cells, neuroblasts, ependymal cells, blood vessels and a basal lamina. Within this microenvironment, stem cell properties including proliferation and differentiation are maintained. Current NSC culture techniques often include the addition of molecular components found within the in vivo niche, such as mitogenic growth factors. We have described a novel NSC culture system, derived from mouse embryonic stem (ES) cells, that displays elements of a NSC niche in the absence of exogenously applied mitogens. Here, we explored the transfer of this system to a 3-D hydrogel environment and analyzed the retention of the putative neural stem cell within this 3-D environment. Application of this 3-D matrix will be important as it mimics a tissue-like environment. Future plans include transplantation of this culture system for the replacement of cells lost due to neurodegenerative disease and protection of cells that would otherwise be lost due to disease progression.NIH grant to M. Kir

Potential bias and lack of generalizability in electronic health record data: reflections on health equity from the National Institutes of Health Pragmatic Trials Collaboratory

Embedded pragmatic clinical trials (ePCTs) play a vital role in addressing current population health problems, and their use of electronic health record (EHR) systems promises efficiencies that will increase the speed and volume of relevant and generalizable research. However, as the number of ePCTs using EHR-derived data grows, so does the risk that research will become more vulnerable to biases due to differences in data capture and access to care for different subsets of the population, thereby propagating inequities in health and the healthcare system. We identify 3 challenges-incomplete and variable capture of data on social determinants of health, lack of representation of vulnerable populations that do not access or receive treatment, and data loss due to variable use of technology-that exacerbate bias when working with EHR data and offer recommendations and examples of ways to actively mitigate bias