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

Nine years of comparative effectiveness research education and training: initiative supported by the PhRMA Foundation

The term comparative effectiveness research (CER) took center stage with passage of the American Recovery and Reinvestment Act (2009). The companion US$1.1 billion in funding prompted the launch of initiatives to train the scientific workforce capable of conducting and using CER. Passage of the Patient Protection and Affordable Care Act (2010) focused these initiatives on patients, coining the term ‘patient-centered outcomes research’ (PCOR). Educational and training initiatives were soon launched. This report describes the initiative of the Pharmaceutical Research and Manufacturers Association of America (PhRMA) Foundation. Through provision of grant funding to six academic Centers of Excellence, to spearheading and sponsoring three national conferences, the PhRMA Foundation has made significant contributions to creation of the scientific workforce that conducts and uses CER/PCOR

A Chemical Abundance Study of 10 Open Clusters Based on WIYN-Hydra Spectroscopy

We present a detailed chemical abundance study of evolved stars in 10 open clusters based on Hydra multi-object echelle spectra obtained with the WIYN 3.5m telescope. From an analysis of both equivalent widths and spectrum synthesis, abundances have been determined for the elements Fe, Na, O, Mg, Si, Ca, Ti, Ni, Zr, and for two of the 10 clusters, Al and Cr. To our knowledge, this is the first detailed abundance analysis for clusters NGC 1245, NGC 2194, NGC 2355 and NGC 2425. These 10 clusters were selected for analysis because they span a Galactocentric distance range Rgc~9-13 kpc, the approximate location of the transition between the inner and outer disk. Combined with cluster samples from our previous work and those of other studies in the literature, we explore abundance trends as a function of cluster Rgc, age, and [Fe/H]. The [Fe/H] distribution appears to decrease with increasing Rgc to a distance of ~12 kpc, and then flattens to a roughly constant value in the outer disk. Cluster average element [X/Fe] ratios appear to be independent of Rgc, although the picture for [O/Fe] is more more complicated by a clear trend of [O/Fe] with [Fe/H] and sample incompleteness. Other than oxygen, no other element [X/Fe] exhibits a clear trend with [Fe/H]; likewise, there does not appear to be any strong correlation between abundance and cluster age. We divided clusters into different age bins to explore temporal variations in the radial element distributions. The radial metallicity gradient appears to have flattened slightly as a function of time, as found by other studies. There is also indication that the transition from the inner disk to the outer disk occurs at different Galactocentric radii for different age bins. (Abridged.)Comment: 35 pages, 12 figures, 18 tables; published in The Astronomical Journal (http://stacks.iop.org/1538-3881/142/59

IQ Trajectory, Cognitive Reserve, and Clinical Outcome Following a First Episode of Psychosis: A 3-Year Longitudinal Study

Comparison of current and estimated premorbid IQ in schizophrenia suggests that there are subgroups with low IQ, deteriorated IQ (DIQ), or preserved IQ and that this is established by psychosis onset. There are no controlled studies examining the trajectory of these IQ subgroups longitudinally or their relationship with clinical and social outcomes. Of 129 individuals with first-episode schizophrenia or schizoaffective disorder, 25% showed stable low IQ, 31% showed stable IQ in the average/high range, and 44% demonstrated intellectual deterioration by 10 points or more. Patients in the low and deteriorated groups were equally impaired on tests of memory and executive function compared with the preserved average/high-IQ group and controls and showed more negative and disorganization symptoms than the preserved average/high-IQ group. Sixty patients and 27 controls were assessed again 1 and 3 years later. There was no evidence that those with IQ deterioration at baseline continued on a declining cognitive trajectory or that those with preserved average/high IQ experienced subsequent IQ decline. The low IQ group showed no change in IQ, whereas both the DIQ and the preserved IQ groups improved. However, the rate of improvement of these 2 subgroups was no greater than that of the healthy controls, suggesting that this reflected practice effects. Both the low and the deteriorated groups had longer index admissions, more core negative symptoms, and worse occupational outcomes at 3 years. These data suggest that following psychosis onset, IQ is stable and that it is IQ at psychosis onset rather than premorbid IQ predicts a more severe illness

Visuospatial working memory in children and adolescents with 22q11.2 deletion syndrome; an fMRI study

22q11.2 deletion syndrome (22q11DS) is a genetic disorder associated with a microdeletion of chromosome 22q11. In addition to high rates of neuropsychiatric disorders such as schizophrenia and attention deficit hyperactivity disorder, children with 22q11DS have a specific neuropsychological profile with particular deficits in visuospatial and working memory. However, the neurobiological substrate underlying these deficits is poorly understood. We investigated brain function during a visuospatial working memory (SWM) task in eight children with 22q11DS and 13 healthy controls, using fMRI. Both groups showed task-related activation in dorsolateral prefrontal cortex (DLPFC) and bilateral parietal association cortices. Controls activated parietal and occipital regions significantly more than those with 22q11DS but there was no significant between-group difference in DLPFC. In addition, while controls had a significant age-related increase in the activation of posterior brain regions and an age-related decrease in anterior regions, the 22q11DS children showed the opposite pattern. Genetically determined differences in the development of specific brain systems may underpin the cognitive deficits in 22q11DS, and may contribute to the later development of neuropsychiatric disorders

Reproducibility in the absence of selective reporting: An illustration from large‐scale brain asymmetry research

The problem of poor reproducibility of scientific findings has received much attention over recent years, in a variety of fields including psychology and neuroscience. The problem has been partly attributed to publication bias and unwanted practices such as p‐hacking. Low statistical power in individual studies is also understood to be an important factor. In a recent multisite collaborative study, we mapped brain anatomical left–right asymmetries for regional measures of surface area and cortical thickness, in 99 MRI datasets from around the world, for a total of over 17,000 participants. In the present study, we revisited these hemispheric effects from the perspective of reproducibility. Within each dataset, we considered that an effect had been reproduced when it matched the meta‐analytic effect from the 98 other datasets, in terms of effect direction and significance threshold. In this sense, the results within each dataset were viewed as coming from separate studies in an “ideal publishing environment,” that is, free from selective reporting and p hacking. We found an average reproducibility rate of 63.2% (SD = 22.9%, min = 22.2%, max = 97.0%). As expected, reproducibility was higher for larger effects and in larger datasets. Reproducibility was not obviously related to the age of participants, scanner field strength, FreeSurfer software version, cortical regional measurement reliability, or regional size. These findings constitute an empirical illustration of reproducibility in the absence of publication bias or p hacking, when assessing realistic biological effects in heterogeneous neuroscience data, and given typically‐used sample sizes

Young lives in Ireland: a school-based study of mental health and suicide prevention.

Globally, mental disorders are the largest cause of disability among those aged 10-24 years (1), with approximately half of all mental disorders emerging during adolescence, broadly the period between the ages of 12 and 18 (2-5). Suicide is one of the leading causes of death among young people (6) and in Ireland peak rates of hospital-treated self-harm are among 20-24 year old males and 15-19 year old females (7). Connecting for Life, Ireland’s National Strategy to Reduce Suicide 2015-2020, has identified young people aged 15-24 as a priority group at whom to target approaches to reduce suicidal behaviour and improve mental health (Goal 3, page 29) (8). Youth suicide prevention programmes are often based in a school setting. However, high-quality evidence has been limited, in both an Irish and international setting, to identify the true impact of suicide prevention interventions (9). In particular, no randomised controlled trials of school-based prevention programmes examining changes in suicidal behaviour had been conducted anywhere in Europe prior to the Saving and Empowering Young Lives in Europe (SEYLE) study. In this report we present the research findings of the SEYLE study, a mental health-promoting programme for adolescents in European schools (10). The study participants, 11,110 adolescents aged between 14 and 17 years old, were recruited from randomly selected mainstream second-level schools in ten European countries. The study was a randomised controlled trial (RCT) that aimed to identify an effective method of promoting adolescent mental health and decreasing suicidal thoughts and behaviours. A second aim was to gather information on the lifestyles and mental health of adolescents in order to identify risk and protective factors associated with suicidal behaviour. In this report we present both overall findings of the multi-centre trial and detailed findings on the mental health and lifestyles of Irish youth using data from the Irish study centre. In addition, this report details a range of risk and protective factors associated with mental ill-health and suicidal behaviour in Irish adolescents. The SEYLE trial identified one school-based intervention, Youth Aware of Mental Health (YAM), that was associated with a significantly lower number of subsequent suicide attempts and suicidal ideation compared to the control intervention (10). YAM is a brief, universal mental health awareness programme that was delivered in the classroom over a four-week period and includes role-play sessions, interactive lectures and workshops. The programme aimed to improve the mental health literacy and coping skills of young people, to raise awareness of risk and protective factors associated with suicide, and to enhance young people’s knowledge about mental health issues such as depression and anxiety