دیدگاه کارورزان، دستیاران و اعضای هیأت علمی بخش زنان در خصوص عوامل مؤثر بر شکل‌گیری اخلاق حرفه‌ای در بالین

مقدمه: آموزش اخلاق حرفه­ای بخش مهمی از برنامه­های فراگیران پزشکی است و حرفه ای‌گری (پروفیشنالیسم) از شایستگی­های محوری دوره پزشکی محسوب می­شود. شناسایی عوامل مؤثر بر فراگیری حرفه ای‌گری در بخش زنان و زایمان که از چالش­های اخلاقی خاص خود برخوردار است، می­تواند به کارآمدی برنامه­های آموزشی کمک کند. مطالعه حاضر با هدف تبیین دیدگاه و تجربیات اساتید و فراگیران پزشکی در بخش زنان و زایمان در خصوص عوامل مؤثر بر شکل‌گیری اخلاق حرفه­ای در بالین انجام شد. روش‌کار: در این مطالعه کیفی (1392)، 10 نفر از اساتید زنان و زایمان و 30 نفر از دستیاران تخصصی و کارورزان بخش زنان و زایمان مرکز آموزشی درمانی شهید صیاد شیرازی مشارکت نمودند. برای جمع‌آوری داده‌ها از روش مصاحبه­های انفرادی نیمه‌ساختار تا رسیدن به اشباع داده­ها استفاده شد. مصاحبه­ها خط به خط، دست‌نویس و مطابق رویکرد "تحلیل محتوای مرسوم" کدگذاری و طبقه‌بندی شدند. یافته‌ها: از تحلیل داده­ها چهار مضمون اصلی"ماهیت انسانی کار، شخصیت و منش فردی، داشتن الگو و مدل و عوامل آموزشی اجتماعی" استخراج شد که تبیین کننده عوامل مؤثر بر شکل‌گیری اخلاق حرفه­ای در بخش زنان و زایمان از دیدگاه اساتید و دانشجویان و دستیاران پزشکی بود. نتیجه‌گیری: الگو بودن اساتید و برنامه­های آموزشی بالینی در بخش زنان و زایمان، از مهم‌ترین عوامل مؤثر بر شکل‌گیری اخلاق حرفه­ای است، لذا به نظر می­رسد با مداخلات آموزشی مناسب روی این دو مؤلفه مهم بتوان به ارتقاء آموزش اخلاق حرفه­ای در بالین کمک کرد. کلیدواژه ها آموزش اخلاق؛ اخلاق حرفه‌ای؛ برنامه­های دستیاری؛ حرفه‌ ای گری؛ زنان و زایمان؛ کارورز پزشکی عنوان مقاله [English

A Feasible and Efficacious Mobile-Phone Based Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Randomized Controlled Trial

BackgroundFilipino Americans have a high prevalence of obesity, type 2 diabetes (T2D), and cardiovascular disease compared with other Asian American subgroups and non-Hispanic whites. Mobile health (mHealth) weight loss interventions can reduce chronic disease risks, but these are untested in Filipino Americans with T2D.ObjectiveThe objective of this study was to assess feasibility and potential efficacy of a pilot, randomized controlled trial (RCT) of a culturally adapted mHealth weight loss lifestyle intervention (Pilipino Americans Go4Health [PilAm Go4Health]) for overweight Filipino Americans with T2D.MethodsThis was a 2-arm pilot RCT of the 3-month PilAm Go4Health intervention (phase 1) with an active waitlist control and 3-month follow-up (phase 2). The waitlist control received the PilAm Go4Health in phase 2, whereas the intervention group transitioned to the 3-month follow-up. PilAm Go4Health incorporated a Fitbit accelerometer, mobile app with diary for health behavior tracking (steps, food/calories, and weight), and social media (Facebook) for virtual social support, including 7 in-person monthly meetings. Filipino American adults ≥18 years with T2D were recruited from Northern California. Feasibility was measured by rates of recruitment, engagement, and retention. Multilevel regression analyses assessed within and between group differences for the secondary outcome of percent weight change and other outcomes of weight (kg), body mass index (BMI), waist circumference, fasting plasma glucose, HbA1c, and steps.ResultsA total of 45 Filipino American adults were enrolled and randomized. Mean age was 58 (SD 10) years, 62% (28/45) were women, and mean BMI was 30.1 (SD 4.6). Participant retention and study completion were 100%, with both the intervention and waitlist group achieving near-perfect attendance at all 7 intervention office visits. Groups receiving the PilAm Go4Health in phase 1 (intervention group) and phase 2 (waitlist group) had significantly greater weight loss, -2.6% (-3.9 to -1.4) and -3.3% (-1.8 to -4.8), respectively, compared with the nonintervention group, resulting in a moderate to small effect sizes (d=0.53 and 0.37, respectively). In phase 1, 18% (4/22) of the intervention group achieved a 5% weight loss, whereas 82% (18/22) maintained or lost 2% to 5% of their weight and continued to maintain this weight loss in the 3-month follow-up. Other health outcomes, including waist circumference, BMI, and step counts, improved when each arm received the PilAm Go4Health, but the fasting glucose and HbA1c outcomes were mixed.ConclusionsThe PilAm Go4Health was feasible and demonstrated potential efficacy in reducing diabetes risks in overweight Filipino Americans with T2D. This study supports the use of mHealth and other promising intervention strategies to reduce obesity and diabetes risks in Filipino Americans. Further testing in a full-scale RCT is warranted. These findings may support intervention translation to reduce diabetes risks in other at-risk diverse populations.Trial registrationClinicaltrials.gov NCT02290184; https://clinicaltrials.gov/ct2/show/NCT02290184 (Archived by WebCite at http://www.webcitation.org/6vDfrvIPp)

Local equilibrium properties of ultraslow diffusion in the Sinai model

We perform numerical studies of a thermally driven, overdamped particle in a random quenched force field, known as the Sinai model. We compare the unbounded motion on an infinite 1-dimensional domain to the motion in bounded domains with reflecting boundaries and show that the unbounded motion is at every time close to the equilibrium state of a finite system of growing size. This is due to time scale separation: inside wells of the random potential, there is relatively fast equilibration, while the motion across major potential barriers is ultraslow. Quantities studied by us are the time dependent mean squared displacement, the time dependent mean energy of an ensemble of particles, and the time dependent entropy of the probability distribution. Using a very fast numerical algorithm, we can explore times up top 10(17) steps and thereby also study finite-time crossover phenomena

Correction: A Feasible and Efficacious Mobile-Phone Based Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/diabetes.8156.]

The evolution of food security: where are we now, where should we go next?

Food security is one of the most challenging topics globally; however, the concept of food security has taken on additional dimensions that are general and are less detailed. This study aims to identify the intellectual structure of food security research and the changes in this structure. This paper analyzed 3169 documents from the Web of Science database through a bibliometric review. A review of the published documents shows an increasing trend over the past 46 years. In accordance with co-occurrence analysis, 125 keywords were grouped into five clusters: food security and sustainable development; food security and socioeconomic factors; food security policy and governance; coping strategies for poverty, inequality, and hunger; and modern food security management. This study identifies four streams within food security research: sustainability and environmental, socioeconomic, cultural, and political factors. The paper concludes that even though food security might investigate many significant areas, other new dimensions should still be considered. Further gaps in the literature emerge that present avenues for future research directions. Reviewing indicators and techniques of food security assessment and identifying high-risk groups should be a priority

The flipflop orphan genes are required for limb bud eversion in the Tribolium embryo

Abstract Background Unlike Drosophila but similar to other arthropod and vertebrate embryos, the flour beetle Tribolium castaneum develops everted limb buds during embryogenesis. However, the molecular processes directing the evagination of epithelia are only poorly understood. Results Here we show that the newly discovered genes Tc-flipflop1 and Tc-flipflop2 are involved in regulating the directional budding of appendages. RNAi-knockdown of Tc-flipflop results in a variety of phenotypic traits. Most prominently, embryonic limb buds frequently grow inwards rather than out, leading to the development of inverted appendages inside the larval body. Moreover, affected embryos display dorsal closure defects. The Tc-flipflop genes are evolutionarily non-conserved, and their molecular function is not evident. We further found that Tc-RhoGEF2, a highly-conserved gene known to be involved in actomyosin-dependent cell movement and cell shape changes, shows a Tc-flipflop-like RNAi-phenotype. Conclusions The similarity of the inverted appendage phenotype in both the flipflop- and the RhoGEF2 RNAi gene knockdown led us to conclude that the Tc-flipflop orphan genes act in a Rho-dependent pathway that is essential for the early morphogenesis of polarised epithelial movements. Our work describes one of the few examples of an orphan gene playing a crucial role in an important developmental process

DRhoGEF2 Regulates Cellular Tension and Cell Pulsations in the Amnioserosa during Drosophila Dorsal Closure

Coordination of apical constriction in epithelial sheets is a fundamental process during embryogenesis. Here, we show that DRhoGEF2 is a key regulator of apical pulsation and constriction of amnioserosal cells during Drosophila dorsal closure. Amnioserosal cells mutant for DRhoGEF2 exhibit a consistent decrease in amnioserosa pulsations whereas overexpression of DRhoGEF2 in this tissue leads to an increase in the contraction time of pulsations. We probed the physical properties of the amnioserosa to show that the average tension in DRhoGEF2 mutant cells is lower than wild-type and that overexpression of DRhoGEF2 results in a tissue that is more solid-like than wild-type. We also observe that in the DRhoGEF2 overexpressing cells there is a dramatic increase of apical actomyosin coalescence that can contribute to the generation of more contractile forces, leading to amnioserosal cells with smaller apical surface than wild-type. Conversely, in DRhoGEF2 mutants, the apical actomyosin coalescence is impaired. These results identify DRhoGEF2 as an upstream regulator of the actomyosin contractile machinery that drives amnioserosa cells pulsations and apical constriction

E6-mediated activation of JNK drives EGFR signalling to promote proliferation and viral oncoprotein expression in cervical cancer

Human papillomaviruses (HPV) are a major cause of malignancy worldwide, contributing to ~5% of all human cancers including almost all cases of cervical cancer and a growing number of ano-genital and oral cancers. HPV-induced malignancy is primarily driven by the viral oncogenes, E6 and E7, which manipulate host cellular pathways to increase cell proliferation and enhance cell survival, ultimately predisposing infected cells to malignant transformation. Consequently, a more detailed understanding of viral-host interactions in HPV-associated disease offers the potential to identify novel therapeutic targets. Here, we identify that the c-Jun N-terminal kinase (JNK) signalling pathway is activated in cervical disease and in cervical cancer. The HPV E6 oncogene induces JNK1/2 phosphorylation in a manner that requires the E6 PDZ binding motif. We show that blockade of JNK1/2 signalling using small molecule inhibitors, or knockdown of the canonical JNK substrate c-Jun, reduces cell proliferation and induces apoptosis in cervical cancer cells. We further demonstrate that this phenotype is at least partially driven by JNK-dependent activation of EGFR signalling via increased expression of EGFR and the EGFR ligands EGF and HB-EGF. JNK/c-Jun signalling promoted the invasive potential of cervical cancer cells and was required for the expression of the epithelial to mesenchymal transition (EMT)-associated transcription factor Slug and the mesenchymal marker Vimentin. Furthermore, JNK/c-Jun signalling is required for the constitutive expression of HPV E6 and E7, which are essential for cervical cancer cell growth and survival. Together, these data demonstrate a positive feedback loop between the EGFR signalling pathway and HPV E6/E7 expression, identifying a regulatory mechanism in which HPV drives EGFR signalling to promote proliferation, survival and EMT. Thus, our study has identified a novel therapeutic target that may be beneficial for the treatment of cervical cancer