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Anna Banana and the chocolate explosion
When Anna Banana and her stuffed animal friends set out to make a chocolate cake, they make a big mess, instead.
Book
Assessment of Perceptions of Professionalism Among Faculty, Trainees, Staff, and Students in a Large University-Based Health System
With a renewed focus on medical professionalism, an opportunity exists to better define its standards and application to meet the needs of an increasingly diverse workforce given the important association between interprofessional behavior and patient care.
To examine the context of how professionalism is operationalized and perceived in diverse health care work and learning environments.
A qualitative mixed-methods analysis of survey data collected from February to April 2015, was conducted followed by analysis of narrative data collected in June 2017. The setting was 2 health systems and 4 health professional and graduate schools. Participants were faculty, trainees, staff, and students (3506 survey respondents and 52 narratives) affiliated with the University of Pennsylvania and the University of Pennsylvania Health System. Data analysis was conducted in 2018 and 2019.
Independent variables included the following respondent characteristics: gender identity, sexual orientation, race/ethnicity, position, generational age group, length of employment at institution, disability status, belief system or religion, and primary site of work or study.
Survey questions were used to assess participants' perception and experiences of professionalism in the workplace as measured by a 5-point Likert-type scale.
For the survey, there were 3506 respondents from a pool of 18 550 potential respondents (18.9% response rate). Of 3506 survey respondents, 2082 of 3231 (64.4%) were women, 331 of 3164 (10.5%) identified as gender or sexual minority groups, and 360 of 3178 (11.3%) were non-Hispanic Black individuals. In adjusted analyses, women compared with men (adjusted odds ratio [aOR], 1.8; 95% CI, 1.4-2.3) and Asian individuals (aOR, 2.0; 95% CI, 1.7-2.3) and Hispanic individuals (aOR, 2.0; 95% CI, 1.4-2.7) compared with non-Hispanic White individuals were more likely to value institutional professionalism. In addition, gender identity and sexual minority groups compared with heterosexual respondents (aOR, 1.5; 95% CI, 1.2-1.8) and non-Hispanic Black individuals compared with non-Hispanic White individuals (aOR, 1.3; 95% CI, 1.2-1.4) were statistically significantly more likely to consider changing jobs because of unprofessional behavior at work. The qualitative analysis of narratives revealed that marginalized populations (including but not limited to women, gender and sexual minority groups, racial/ethnic minority groups, those who identify as having a disability, and religious minority groups) reported (1) greater infringements on their professional boundaries, as well as increased scrutiny over their professional actions, and (2) a tension between inclusion vs assimilation.
The findings of this study highlight the need for health care organizations to revisit how they define and operationalize professionalism to improve inclusivity.
Journal Article
The Influence of Gender and Underrepresented Minority Status on Medical Student Ranking of Residency Programs
Physician diversity is linked to improved quality of care of diverse patient populations. The transition from medical school to residency is an opportunity to improve and increase workforce diversity in all specialties. However, there is limited published literature on the factors contributing to the ranking of residency programs on women and underrepresented minorities (URMs).
To characterize factors medical students used to rank residency programs and describe any differences based on race/ethnicity or gender.
A mixed-methods study consisting of a web-based survey and semi-structured interviews with National Resident Matching Program (NRMP) participating graduates over a two-year period. The survey assessed demographics and a 6-point Likert scale rating of various factors used to rank residency programs. Unpaired student t-tests were used to compare means. A subset of students was interviewed and a modified grounded theory approach identified decision-making themes as well as the role of gender and URM status.
Out of a total of 316 invitations sent, 148 completed the survey (46.8% response rate), of which 21% of respondents self-identified as URMs. The majority of respondents graduated in 2014 (53%), and were male (51%). Participants ranked program atmosphere, reputation, location, and proximity to family the highest. URM students ranked patient population (p < 0.01), revisit opportunities (p = 0.04), gender diversity (p < 0.01), and ethnic diversity (p < 0.01) significantly higher than non-URM students. Female students ranked patient population (p < 0.01) and gender diversity (p < 0.01) significantly higher than males. Qualitative findings revealed differences in perceptions by URMs and non-URMs of patient population, revisit opportunities, gender diversity, and ethnic diversity.
While all students prioritized pragmatic factors, women and URM students assess and weigh additional factors related to culture, inclusion, and diversity more than others. By tailoring recruitment strategies to meet the expectations of women and URMs, residency programs can better meet goals in becoming more diverse and inclusive.
Journal Article
Employee Health and Wellness Outcomes Associated With Perceived Discrimination in Academic Medicine
Organizational culture and workplace interactions may enhance or adversely impact the wellness of all members of learning and work environments, yet a nuanced understanding of how such experiences within health care organizations impact the health and wellness of their membership is lacking.
To identify and characterize the reported health and wellness outcomes associated with perceived discrimination among academic medicine faculty, staff, and students.
This qualitative study analyzed anonymously submitted written narratives from 2016 that described experiences related to inclusion in the workplace or lack thereof. Narratives that described health outcomes associated with work- or school-based discrimination were purposively sampled. Participants were faculty, staff, and students at health-related schools or hospitals affiliated with the University of Pennsylvania. Data analysis was performed from March 2019 to January 2020.
Self-reported experiences, both witnessed and personal, of discrimination in the workplace.
A total of 315 narratives were collected, and 115 narratives from 115 participants were analyzed. Most respondents identified as female (70 respondents [60.9%]), non-Hispanic White (68 respondents [59.1%]), and heterosexual (89 respondents [77.4%]) and had worked at the institution for at least 1 year (99 respondents [86.0%]). The outcomes associated with adverse workplace experiences were broad and ranged in nature from emotional to mental and physical. Most reported outcomes were emotional (101 respondents [87.8%]), and more than 1 in 10 narratives (14 respondents [12.2%]) described a mental or physical health outcome. Many of the participants felt devaluated, overexerted, and hopeless, resulting in clinically relevant manifestations, such as increased stress and anxiety levels and even elevated blood pressure.
This qualitative study identified a continuum of negative outcomes on employee health and well-being associated with perceived discrimination and chronic exclusion in the workplace. These findings suggest the need for organizations to promote inclusion as a component of workplace wellness interventions.
Journal Article
Validity of impedance-based predictions of total body water as measured by 2 H dilution in African HIV/AIDS outpatients
Measurements of body composition are crucial in identifying HIV-infected patients at risk of malnutrition. No information is available on the validity of indirect body composition methods in African HIV-infected outpatients. Our first aim was to test the validity of fifteen published equations, developed in whites, African-Americans and/or Africans who were or not HIV-infected, for predicting total body water (TBW) from bioelectrical impedance analysis (BIA) in HIV-infected patients. The second aim was to develop specific predictive equations. Thirty-four HIV-infected patients without antiretroviral treatment and oedema at the beginning of the study (age 39 ( sd 7) years, BMI 18·7 ( sd 3·7) kg/m 2 , TBW 30·4 ( sd 7·2) kg) were measured at inclusion then 3 and 6 months later. In the resulting eighty-eight measurements, we compared TBW values predicted from BIA to those measured by 2 H dilution. Range of bias values was 0·1–4·3 kg, and errors showed acceptable values (2·2–3·4 kg) for fourteen equations and a high value (10·4) for one equation. Two equations developed in non-HIV-infected subjects showed non-significant bias and could be used in African HIV-infected patients. In the other cases, poor agreement indicated a lack of validity. Specific equations developed from our sample showed a higher precision of TBW prediction when using resistance at 1000 kHz (1·7 kg) than at 50 kHz (2·3 kg), this latter precision being similar to that of the valid published equations (2·3 and 2·8 kg). The valid published or developed predictive equations should be cross-validated in large independent samples of African HIV-infected patients.
Journal Article
Validity of impedance-based predictions of total body water as measured by 2H dilution in African HIV/AIDS outpatients
Measurements of body composition are crucial in identifying HIV-infected patients at risk of malnutrition. No information is available on the validity of indirect body composition methods in African HIV-infected outpatients. Our first aim was to test the validity of fifteen published equations, developed in whites, African-Americans and/or Africans who were or not HIV-infected, for predicting total body water (TBW) from bioelectrical impedance analysis (BIA) in HIV-infected patients. The second aim was to develop specific predictive equations. Thirty-four HIV-infected patients without antiretroviral treatment and oedema at the beginning of the study (age 39 (sd 7) years, BMI 18·7 (sd 3·7) kg/m2, TBW 30·4 (sd 7·2) kg) were measured at inclusion then 3 and 6 months later. In the resulting eighty-eight measurements, we compared TBW values predicted from BIA to those measured by 2H dilution. Range of bias values was 0·1–4·3 kg, and errors showed acceptable values (2·2–3·4 kg) for fourteen equations and a high value (10·4) for one equation. Two equations developed in non-HIV-infected subjects showed non-significant bias and could be used in African HIV-infected patients. In the other cases, poor agreement indicated a lack of validity. Specific equations developed from our sample showed a higher precision of TBW prediction when using resistance at 1000 kHz (1·7 kg) than at 50 kHz (2·3 kg), this latter precision being similar to that of the valid published equations (2·3 and 2·8 kg). The valid published or developed predictive equations should be cross-validated in large independent samples of African HIV-infected patients.
Journal Article
Karyopherin alpha expression in porcine tissue
The cell must modify expression of certain genes in order to respond appropriately to environmental and internal stimuli. In order for signaling molecules to exert their regulatory effects, they must first gain access to the nucleus, where transcription takes place. Transport occurs through the nuclear pore complexes embedded in the nuclear membrane. One of the best characterized nuclear transport systems is the classical nuclear transport complex, which consists primarily of two karyopherin proteins, alpha and beta, in addition to the cargo protein. While karyopherin beta manages nuclear entry via the nuclear pore, karyopherin alpha (KPNA) links the cargo and karyopherin beta. In mammals, there are seven known subtypes of KPNA. The subtypes are expressed at different levels in different tissues and vary in abundance throughout early development. While very similar in structure, evidence suggests that each subtype may bind a specific set of unique cargoes. KPNA plays essential roles in embryonic cleavage development, neural differentiation, and reproductive competence. To identify the unique functions of specific KPNA paralogs, I used two different methods of RNA interference to target specific paralogs within porcine fetal fibroblasts and germinal-vesicle stage oocytes. While neither microinjection of siRNA or induction of an miRNA-mimicking shRNA after lentiviral transfection affected the abundance of the targeted transcripts, further refinement of the lentiviral vector may provide a versatile platform for studying the effects of KPNA depletion. I also performed analysis of a data set of putative KPNA1- or KPNA7-interacting proteins identified within porcine ovarian tissue. Five out of twelve possible candidates identified on the basis of their size or the strength of their nuclear localization signal were repeatedly amplified from porcine cDNA; however two candidates were successfully cloned into the pENTR/SD/D-TOPO vector in an inverted orientation. In order to validate candidates, their ability to localize to the nucleus and interaction with KPNA1 or KPNA7 must be confirmed. Further characterization of the unique functions of each KPNA subtype and the transport patterns of their specific cargoes contributes to understanding the critical role of these transport proteins in precisely regulating gene expression during major differentiation events, including embryonic development and establishment of reproductive competence.
Dissertation
Structural evolution at the oxidative and reductive limits in the first electrochemical cycle of Li1.2Ni0.13Mn0.54Co0.13O2
High-energy-density lithium-rich materials are of significant interest for advanced lithium-ion batteries, provided that several roadblocks, such as voltage fade and poor energy efficiency are removed. However, this remains challenging as their functioning mechanisms during first cycle are not fully understood. Here we enlarge the cycling potential window for Li
1.2
Ni
0.13
Mn
0.54
Co
0.13
O
2
electrode, identifying novel structural evolution mechanism involving a structurally-densified single-phase A’ formed under harsh oxidizing conditions throughout the crystallites and not only at the surface, in contrast to previous beliefs. We also recover a majority of first-cycle capacity loss by applying a constant-voltage step on discharge. Using highly reducing conditions we obtain additional capacity via a new low-potential P” phase, which is involved into triggering oxygen redox on charge. Altogether, these results provide deeper insights into the structural-composition evolution of Li
1.2
Ni
0.13
Mn
0.54
Co
0.13
O
2
and will help to find measures to cure voltage fade and improve energy efficiency in this class of material.
Practical application of high-energy-density lithium-rich materials remains a challenge due to issues including voltage fade and poor energy efficiency. Here the authors report a novel densified phase together with a trick to recover capacity in these materials that could help in curing their practical limitations.
Journal Article
Circulating ACE2-expressing extracellular vesicles block broad strains of SARS-CoV-2
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the pandemic of the coronavirus induced disease 2019 (COVID-19) with evolving variants of concern. It remains urgent to identify novel approaches against broad strains of SARS-CoV-2, which infect host cells via the entry receptor angiotensin-converting enzyme 2 (ACE2). Herein, we report an increase in circulating extracellular vesicles (EVs) that express ACE2 (evACE2) in plasma of COVID-19 patients, which levels are associated with severe pathogenesis. Importantly, evACE2 isolated from human plasma or cells neutralizes SARS-CoV-2 infection by competing with cellular ACE2. Compared to vesicle-free recombinant human ACE2 (rhACE2), evACE2 shows a 135-fold higher potency in blocking the binding of the viral spike protein RBD, and a 60- to 80-fold higher efficacy in preventing infections by both pseudotyped and authentic SARS-CoV-2. Consistently, evACE2 protects the hACE2 transgenic mice from SARS-CoV-2-induced lung injury and mortality. Furthermore, evACE2 inhibits the infection of SARS-CoV-2 variants (α, β, and δ) with equal or higher potency than for the wildtype strain, supporting a broad-spectrum antiviral mechanism of evACE2 for therapeutic development to block the infection of existing and future coronaviruses that use the ACE2 receptor.
El-Shennawy et al. report that ACE2
+
circulating extracellular vesicles (evACE2) are associated with COVID-19 severity and that evACE2 inhibits the infection of SARS-CoV-2 variants of concern at a higher efficacy than soluble ACE2.
Journal Article