Evaluation of a Simulation-Based Training Program on Childhood Trauma with Occupational Therapy Students

An educational and simulation-based training model, the Professional ACEs-Informed Training for Health Professionals designed for allied health students was evaluated using a pre-and-post design. The training model emphasizes trauma-informed care and uses social simulation to educate and train students with skills to address adverse childhood experiences. This study evaluated occupational therapy students’ (N=70) levels of self-efficacy and knowledge of trauma-informed care at both pre- and post-training. Analysis of variance results indicated a statistically significant improvement in students’ levels of general self-efficacy and knowledge from pre- to post-assessment (p \u3c .01). These results are suggestive of the usefulness of brief didactics combined with simulation to educate occupational therapy students on adverse childhood experiences and trauma-informed care

Noncanonical NF-κB Signaling Upregulation in Inflammatory Bowel Disease Patients is Associated With Loss of Response to Anti-TNF Agents

Objectives: Targeting tumor necrosis factor (TNF) with biologic agents, such as infliximab and adalimumab, is a widely used and effective therapeutic strategy in inflammatory bowel disease (IBD). Unfortunately, a significant number of patients fail to respond or lose response over time to these agents. Previous studies have defined multiple complex roles for canonical NF-κB signaling in the pathogenesis of IBD. However, preliminary evidence suggests that the lesser defined noncanonical NF-κB signaling pathway also contributes to disease pathogenesis and response to anti-TNF agents. The objective of this study was to evaluate this hypothesis in Crohn’s disease (CD) and ulcerative colitis (UC) patients.Design: A total of 27 subjects with IBD (19 with CD and 8 with UC) and 15 control subjects were tested. Clinical criteria, patient history, and endoscopic disease activity were factors used to categorize patients and define therapeutic response. Biopsy specimens were collected during colonoscopy and expression was determined for 88 target genes known to be associated with noncanonical NF-κB signaling and IBD.Results: Noncanonical NF-κB signaling was significantly upregulated in IBD patients and was associated with increased gastrointestinal inflammation, epithelial cell death, lymphocyte migration, and Nod-like receptor signaling. Furthermore, noncanonical NF-κB signaling was further upregulated in patients unresponsive to anti-TNF agents and was suppressed in responsive patients. MAP3K14, NFKB2, CCL19, CXCL12, and CXCL13 were significantly dysregulated, as were genes that encode pathway regulators, such as CYLD, NLRP12, and BIRC2/3.Conclusion: Our study identifies a previously uncharacterized role for the understudied noncanonical NF-κB signaling pathway in the pathogenesis of IBD and anti-TNF therapy responsiveness. The genes and pathways identified may ultimately prove useful in IBD management and could potentially be used as biomarkers of drug response

Queer Affirmative Practice for Medical and Social Work Students: An Introductory Module

BACKGROUND: Research suggests members of the sexual and gender minority (SGM) community fail to seek out medical care despite a higher prevalence of negative health outcomes, ranging from implicit bias to structural violence. In response, the OU-TU School of Community Medicine, the Anne and Henry Zarrow School of Social Work, and the Simulation Center at OU-Tulsa partnered with faculty from the OSU College of Osteopathic Medicine to design and implement a three-part education and training module promoting queer-affirmative practice among medical school and social work students. METHODS: This introductory module begins with a lecture-based overview of human sexuality that emphasizes caring for the specific healthcare and social needs of SGM populations. The initial lecture is followed by a high-fidelity simulation with standardized patient actors (SPs) to implement the practices discussed. To better provide an authentic simulation experience, special attention is taken to recruit SPs who identify as members of the LGBTQIA+ community. The simulation cases begin with a patient presenting a complaint of anxiety related to SGM status, requiring students to work collaboratively to adequately address those needs. Skills emphasized throughout the simulation include interprofessional communication, queer-affirmative practice, expressing empathy and building rapport with patients. Finally, all students engage in a debriefing process—first as pairs with their respective SPs, then as a collective group with all SPs and training facilitators. All participants (N = 24) completed a standardized pre-post educational assessment, evaluating the development of clinical skills related to SGM populations, the importance of this material to their profession, their comfort working with SGM populations, their confidence in working with SGM populations, and the importance of affirmative practice to their profession. RESULTS: A repeated measures ANOVA analyzed changes over time, both within groups (i.e., all students) and between groups (i.e., medical/social work students). Results indicated statistically significant improvements within groups on all measures (p .2). Additionally, results indicated no statistically significant difference between groups (p > .05). In sum, the results validate the affirmative-practice module as an effective teaching method for students, regardless of discipline. CONCLUSION: The results of this study illustrate the capabilities of interdisciplinary education in the form of didactics and high-fidelity simulation to educate students on how to address the complex issues faced by SGM populations.N

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Noncanonical NF-κB signaling is elevated in inflammatory bowel disease patients and may be associated with therapeutic response

Abstract The canonical NF-κB signaling pathway is well characterized in the context of inflammatory bowel disease (IBD). However, noncanonical NF-κB signaling has not been evaluated. This pathway is key for the production of specific chemokines with diverse immunological effects in the gut. To evaluate this pathway, biopsy specimens from control patients and patients with IBD (CD and UC) were collected and pathways associated with inflammation were assessed via custom RT-PCR arrays. These expression data were compared to lesion status, IBD subtype (CD or UC), and treatment. Our analysis revealed significant up-regulation of several key genes associated with noncanonical NF-κB signaling in lesion tissue from IBD patients compared to controls and non-lesion areas. Interestingly, CD patients displayed increased noncanonical signaling compared to both control and UC patients in over 20 genes directly involved in the noncanonical pathway. Treatment with the anti-TNF biologic infliximab resulted in down-regulation of these and other noncanonical NF-κB signaling molecules in CD patients. Subsequent bioinformatics analysis of CD patients revealed that elevation of chemokines associated with noncanonical NF-κB signaling are indicators of infliximab responsiveness, with patients refractory to infliximab showing significantly elevated levels of gene expression. Together, these data indicate that noncanonical NF-κB signaling is elevated in IBD patients and may have links to therapeutic response.</jats:p

Beyond the inflammasome: regulatory NOD-like receptor modulation of the host immune response following virus exposure

Široko je prihvaćeni koncept da žučovod povećava promjer nakon kolecistektomije. Međutim, postoje prijeporni rezultati u dostupnoj literaturi o ovoj temi. Saznanje može li se kod kolecistektomiranih pacijenata očekivati širi promjer žučnih vodova od opće populacije bilo bi korisno da se izbjegnu nepotrebna i potencijalno invazivna istraživanja žučnih vodova. Cilj rada je prikazati radiološke tehnike u analizi žučnog mjehura i žučnih vodova i prikazati radiološke tehnike u analizi promjena promjera žučnih vodova nakon kolecistektomije. Istražiti relevantnu literaturu i znanstvene baze podataka s prikazom radova na temu dosadašnjih istraživanja promjena promjera žučnih vodova nakon kolecistektomije. Radiološke tehnike u analizi promjena promjera žučnih vodova nakon kolecistektomije su ultrazvuk, endoskopska retrogradna kolangiopankreatografija, endoskopski ultrazvuk, kompjuterizirana tomografija, magnetska rezonancija s magnetskorezonantnom kolangiopankreatografijom. Većina studija na temu promjena promjera žučnih vodova nakon kolecistektomije je ultrazvučna, što je i razumljivo zbog široke dostupnosti i neinvazivnosti pretrage. Veliki broj ultrazvučnih studija su potvrdile ali i opovrgnule tezu o postkolecistektomičnoj dilataciji žučovoda. Prijeporni rezultati mogu se tumačiti i niskom osjetljivošću ultrazvuka u odnosu na druge radiološke tehnike kao što su EUS, MRCP i ERCP. U studijama CT-om koji također ima nisku osjetljivost također su vidljivi prijeporni rezultati. Najmanji broj studija izveden je tehnikama koje imaju veliku osjetljivost, ERCP-om zbog invazivnosti pretrage te EUS-om i MRCP-om zbog manje dostupnosti i cijene pretrage., Rezultati tih studija govore u prilog postkolecistektomične dilatacije. Potrebna su daljnja istraživanja s viskom metodološkom kvalitetom za potvrdu postkolecistektomične dilatacije žučovoda.It is widely accepted that the common bile duct diameter increases after cholecystectomy. However, there are controversial results in available literature on this subject. Knowledge whether cholecystectomy patients are expected to have a wider diameter of bile ducts than the general population would be beneficial to prevent unnecessary and potentially invasive research of the bile ducts. The aim of the research is to present radiological techniques in the analysis of the gallbladder and bile duct and the analysis of bile duct diameter changes after cholecystectomy. Relevant literature and scientific databases on the topic and current research is presented. Radiological techniques in the analysis of the common bile duct diameter after cholecystectomy are: ultrasound, endoscopic retrograde cholangiopankreatography, endoscopic ultrasound, computerized tomography, magnetic resonance imaging with magnetic resonance cholangiopankreatography. Most of the studies of the common bile duct diameter changes after cholecystectomy are performed with ultrasound, due to the wide availability, reproducibily and non-invasiveness of the examination. A large number of ultrasound studies have confirmed but also rejected the thesis on postcholecistectomic dilation of the common bile duct. Controversial results can be interpreted with low sensitivity of ultrasound examination compared to other radiological techniques such as EUS, MRCP and ERCP. Controversial results are also reported for the CT studies. The smallest number of studies have been conducted with high sensitivity techniques. ERCP is a highly invasive examination and EUS and MRCP are not as available due to the high cost. Further research with high methodological quality is required to confirm the postcholecystectomic dilation of the bile ducts

NF-κB-inducing kinase (NIK): A novel modulator of eosinophilic esophagitis (EoE) in mouse models and human patients

Abstract Eosinophilic esophagitis (EoE) is an allergic disease of the esophagus driven by T cell and eosinophil responses to dietary allergens resulting in chronic mucosal inflammation and fibrosis. NF-κB inducing kinase (NIK) is a key signaling molecule of the noncanonical NF-κB pathway, an alternative signaling cascade producing chemokines involved in lymphoid stroma development and leukocyte trafficking. Nik−/− mice have been shown to develop a spontaneous hypereosinophilic syndrome in major organs; however, the gastrointestinal mucosa of these mice have not been evaluated. Here we show that Nik−/− mice develop significant eosinophilic esophagitis that mimics human EoE, including intraepithelial eosinophil accumulation, degranulation, mucosal thickening, fibrosis, and basal cell hyperplasia. Additionally, these mice display mucosal hyperplasia in the cranial glandular stomach surrounding the gastroesophageal junction. Interestingly, the remainder of the gastrointestinal tract including the caudal stomach, small intestine, and colon are unaffected, also similar to human EoE. Esophageal tissue from Nik−/− mice contains elevations in Th2 cytokines as well as TSLP, a gene implicated in human EoE. Retrospective metadata analysis of biopsies from human EoE patients shows many significant changes in gene expression throughout the noncanonical NF-κB pathway that are consistent with our murine model. Given that current models of this disease involve artificial sensitization or infectious agents, we conclude that Nik−/− mice may a useful spontaneous model of eosinophilic disease of the esophageal mucosa with improved physiologic relevance. These findings also highlight a novel role for noncanonical NF-κB signaling in EoE.</jats:p

Map3K14 signaling attenuates the development of colorectal cancer through activation of the non-canonical NF-κB signaling cascade

Abstract Dysregulation of NF-κB signaling is a common feature in Colorectal Cancer (CRC). While the canonical signaling pathway is well characterized, the non-canonical NF-κB signaling cascade is understudied. Thus, we evaluated the hypothesis that non-canonical NF-κB signaling significantly modulates CRC pathogenesis. To evaluate this hypothesis, we initially conducted a meta-analysis of human gene expression data. Using this approach, we found that non-canonical NF-κB signaling is significantly down-regulated in CRC patients and the extent of pathway attenuation is correlated with disease severity. These findings were confirmed in patient biopsy specimens, where we found significantly reduced expression of ligands, receptors, regulators, and chemokines associated with non-canonical NF-κB signaling. Notably, we observed significantly reduced CCL19, CCL21, CXCL12, and CXCL13 expression in CRC patients compared to healthy controls. To gain mechanistic insight, we utilized genetically modified mice lacking the kinase Map3K14 (NIK), which is essential for non-canonical NF-κB signaling. Nik−/− mice exhibited ablation of non-canonical NF-κB signaling and significantly increased epithelial cell proliferation in the GI tract compared to wild type mice in both in vivo and in vitro studies. Together, our data defines a protective role for non-canonical NF-κB signaling in the gut during CRC and identifies a highly protective role for Map3K14 in attenuating epithelial cell proliferation.</jats:p