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Jacob V, Reynolds JA, Chattopadhyay SK, Hopkins DP, Brown DR, Devlin HM, Barrett A, Berrigan D, Crespo CJ, Heath GW, Brownson RC, Cuellar AE, Clymer JM, Chriqui JF. Parks, Trails, and Greenways for Physical Activity: A Community Guide Systematic Economic Review. Am J Prev Med 2024; 66:1089-1099. [PMID: 38331114 PMCID: PMC11102847 DOI: 10.1016/j.amepre.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION This systematic economic review examined the cost-benefit and cost-effectiveness of park, trail, and greenway infrastructure interventions to increase physical activity or infrastructure use. METHODS The search period covered the date of inception of publications databases through February 2022. Inclusion was limited to studies that reported cost-benefit or cost-effectiveness outcomes and were based in the U.S. and other high-income countries. Analyses were conducted from March 2022 through December 2022. All monetary values reported are in 2021 U.S. dollars. RESULTS The search yielded 1 study based in the U.S. and 7 based in other high-income countries, with 1 reporting cost-effectiveness and 7 reporting cost-benefit outcomes. The cost-effectiveness study based in the United Kingdom reported $23,254 per disability-adjusted life year averted. The median benefit-to-cost ratio was 3.1 (interquartile interval=2.9-3.9) on the basis of 7 studies. DISCUSSION The evidence shows that economic benefits exceed the intervention cost of park, trail, and greenway infrastructure. Given large differences in the size of infrastructure, intervention costs and economic benefits varied substantially across studies. There was insufficient number of studies to determine the cost-effectiveness of these interventions.
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Affiliation(s)
- Verughese Jacob
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jeffrey A Reynolds
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sajal K Chattopadhyay
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David P Hopkins
- Community Guide Program, Office of Scientific Evidence and Recommendations, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David R Brown
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather M Devlin
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Austin Barrett
- National Recreation and Park Association, Ashburn, Virginia
| | - David Berrigan
- Behavior Research Program, National Cancer Institute, Bethesda, Maryland
| | - Carlos J Crespo
- College of Applied Health Sciences, University of Illinois, Chicago, Illinois
| | - Gregory W Heath
- Department of Health and Human Performance, The University of Tennessee at Chattanooga, Chattanooga, Tennessee
| | - Ross C Brownson
- Brown School, Washington University in St. Louis, Saint Louis, Missouri; Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - John M Clymer
- National Forum for Heart Disease & Stroke Prevention, Washington, District of Columbia
| | - Jamie F Chriqui
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois
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Tamargo JA, Martin HR, Diaz-Martinez J, Delgado-Enciso I, Johnson A, Bastida Rodriguez JA, Trepka MJ, Brown DR, Garba NA, Roldan EO, Hernandez Suarez Y, Marty AM, Bursac Z, Campa A, Baum MK. Drug use and COVID-19 testing, vaccination, and infection among underserved, minority communities in Miami, Florida. PLoS One 2024; 19:e0297327. [PMID: 38687734 PMCID: PMC11060546 DOI: 10.1371/journal.pone.0297327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/24/2023] [Indexed: 05/02/2024] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted people who use drugs (PWUD). This study explored relationships between drug use, COVID-19 testing, vaccination, and infection. This cross-sectional study was conducted in Miami, Florida between March 2021 and October 2022 as part of the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative and the Miami Adult Studies on HIV (MASH) cohort. Users of cannabis, cocaine/crack, heroin/fentanyl, methamphetamines, hallucinogens, and/or prescription drug misuse in the previous 12 months were considered PWUD. Sociodemographic data, COVID-19 testing history, and vaccination-related beliefs were self-reported. Vaccinations were confirmed with medical records and positivity was determined with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Statistical analyses included chi-square tests and logistic regression. Of 1,780 participants, median age was 57 years, 50.7% were male, 50.2% Non-Hispanic Black, and 66.0% reported an annual income less than $15,000. Nearly 28.0% used drugs. PWUD were less likely than non-users to self-report ever testing positive for SARS-CoV-2 (14.7% vs. 21.0%, p = 0.006). However, 2.6% of participants tested positive for SARS-CoV-2, with no significant differences between PWUD and non-users (3.7% vs. 2.2%, p = 0.076). PWUD were more likely than non-users to experience difficulties accessing testing (10.2% vs. 7.1%, p = 0.033), vaccine hesitancy (58.9% vs. 43.4%, p = 0.002) and had lower odds of receiving any dose of a COVID-19 vaccine compared to non-users (aOR, 0.63; 95% CI, 0.49-0.81; p<0.001). PWUD presented with greater difficulties accessing COVID-19 testing, greater vaccine hesitancy, and lower odds of vaccination. Testing and immunization plans that are tailored to the needs of PWUD and consider access, trust-building campaigns, and education may be needed.
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Affiliation(s)
- Javier A. Tamargo
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Haley R. Martin
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Janet Diaz-Martinez
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Ivan Delgado-Enciso
- Faculty of Medicine, University of Colima, Las Víboras, Colima, Mexico
- Cancerology State Institute, Colima State Health Services, La Esperanza, Colima, Mexico
| | - Angelique Johnson
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Jose A. Bastida Rodriguez
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Mary Jo Trepka
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - David R. Brown
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Nana A. Garba
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Eneida O. Roldan
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Yolangel Hernandez Suarez
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Aileen M. Marty
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Zoran Bursac
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Adriana Campa
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
| | - Marianna K. Baum
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, United States of America
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Martin HR, Hu N, Liu Q, Bastida Rodriguez JA, Gieseken S, Johnson A, Enrione E, Trepka MJ, Brown DR, Marty AM, Sales Martinez S, Campa A, Roldan EO, Hernandez Suarez Y, Barbieri M, Palacios C, Bursac Z, Baum MK. Disability and COVID-19: Challenges, testing, vaccination, and postponement and avoidance of medical care among minoritized communities. Disabil Health J 2024; 17:101571. [PMID: 38071138 PMCID: PMC10999341 DOI: 10.1016/j.dhjo.2023.101571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND People with disabilities face heightened vulnerability to COVID-19. OBJECTIVE This study investigated (1) the relationships between disability and COVID-19-related challenges, testing, vaccination, and infection and (2) predictors of loss of healthcare coverage and postponement and avoidance of medical care during the pandemic. METHODS This cross-sectional study was conducted in Miami, Florida, between March 2021 and February 2022 as part of the NIH Rapid Acceleration of Diagnostics-Underserved Populations initiative. Disability was defined using a standard measure that assesses six universal functions. Participants reported sociodemographic data, COVID-19 testing, infection history, challenges, and healthcare history. Vaccinations were confirmed with medical records and COVID-19 positivity was assessed using real-time reverse transcription-polymerase chain reaction. Statistical analyses included multivariable logistic regression. RESULTS Among 1,689 participants with a median age of 57.0, 50.6% were male, and 48.9% were non-Hispanic Black. Disability was associated with greater odds of all assessed COVID-19 challenges: healthcare (aOR:1.60; 95% CI:1.23-2.07), housing (aOR:2.15; 95% CI:1.62-2.87), insufficient food (aOR:1.97; 95% CI:1.54-2.52), water scarcity (aOR:2.33; 95% CI:1.60-3.37), medications (aOR:2.04; 95% CI:1.51-2.77), and transportation (aOR:2.56; 95% CI:1.95-3.36). Those reporting employment disability were less likely to have received COVID-19 testing (81.1% vs. 85.3%, p = 0.026) or to have history of COVID-19 positivity (aOR:0.63; 95% CI:0.44-0.92). Disability predicted avoidance (aOR:2.76; 95% CI:1.95-3.91) and postponement (aOR: 2.24; 95% CI:1.72-2.91) of medical care. CONCLUSIONS Disability is associated with higher odds of COVID-19 challenges and postponement and avoidance of medical care. Those reporting employment disability had a lower likelihood of COVID-19 testing. Public health responses to healthcare crises should prioritize the special challenges of people living with disabilities.
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Affiliation(s)
- Haley R Martin
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Nan Hu
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Biostatistics, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Qingyun Liu
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Jose A Bastida Rodriguez
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Stephanie Gieseken
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Angelique Johnson
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Evelyn Enrione
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Mary Jo Trepka
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Epidemiology, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - David R Brown
- Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th Street, AHC2, Miami, FL, 33199, United States.
| | - Aileen M Marty
- Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th Street, AHC2, Miami, FL, 33199, United States.
| | - Sabrina Sales Martinez
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Adriana Campa
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Eneida O Roldan
- Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th Street, AHC2, Miami, FL, 33199, United States.
| | - Yolangel Hernandez Suarez
- Florida International University, Herbert Wertheim College of Medicine, 11200 SW 8th Street, AHC2, Miami, FL, 33199, United States.
| | - Manuel Barbieri
- Florida International University, College of Arts, Sciences & Education, Department of Biological Sciences, 11200 SW 8th Street, OE 167, Miami, FL, 33199, United States.
| | - Cristina Palacios
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Zoran Bursac
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Biostatistics, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
| | - Marianna K Baum
- Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, 11200 SW 8th Street, AHC5, Miami, FL, 33199, United States.
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Hyde ET, Brown DR, Webber BJ, Piercy KL, Omura JD, Rose K, Whitfield GP. Meeting the Aerobic and Muscle-Strengthening Physical Activity Guidelines Among Older US Adults, National Health Interview Survey 1998-2018. J Appl Gerontol 2024:7334648241232930. [PMID: 38375621 DOI: 10.1177/07334648241232930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
The Physical Activity Guidelines for Americans, second edition, recommends older adults participate in ≥150 minutes per week of moderate-intensity equivalent aerobic activity and ≥2 days per week of muscle-strengthening activity. We estimated prevalence and trends of meeting the guidelines among US adults aged ≥65 years from 1998 to 2018. Using the 1998-2018 National Health Interview Survey, we estimated the prevalence of meeting aerobic, muscle-strengthening, and combined physical activity guidelines stratified by age group, sex, race and ethnicity, and education level. Within age groups, we calculated prevalence differences by sociodemographic categories. Prevalence of meeting each guideline increased for all age groups and most sociodemographic subgroups. The increased magnitude of meeting the combined guideline from 1998-2000 to 2016-2018 differed across levels of educational attainment for most age groups. Despite increasing over time, the prevalence among older adults of meeting physical activity guidelines remains low (range for combined guideline: 7.2%-17.2%).
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Affiliation(s)
- Eric T Hyde
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California-San Diego, San Diego, CA, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - David R Brown
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bryant J Webber
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katrina L Piercy
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD, USA
| | - John D Omura
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ken Rose
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Geoffrey P Whitfield
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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5
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Fallon EA, Brown DR, Callahan LF, Foster AL, Kim JS, Lo GH, Piercy KL. Stepping Up Counseling and Referral to Effective Physical Activity Interventions for Adults With Osteoarthritis. J Rheumatol 2024; 51:209-212. [PMID: 37967909 DOI: 10.3899/jrheum.2023-0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Affiliation(s)
- Elizabeth A Fallon
- Centers for Disease Control and Prevention, Division of Population Health, Atlanta, Georgia;
| | - David R Brown
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia
| | - Leigh F Callahan
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Osteoarthritis Action Alliance, University of North Carolina, Chapel Hill, North Carolina
| | - Anika L Foster
- Centers for Disease Control and Prevention, Division of Population Health, Atlanta, Georgia
| | | | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Veterans Affairs Health Services Research and Development, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Katrina L Piercy
- U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Washington, DC, USA
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Martin HR, Brown DR, Fluney E, Trepka MJ, Marty AM, Roldan EO, Liu Q, Barbieri MA, Baum MK. Community-Engaged Research: COVID-19 Testing, Infection, and Vaccination among Underserved Minority Communities in Miami, Florida. Vaccines (Basel) 2024; 12:117. [PMID: 38400101 PMCID: PMC10892380 DOI: 10.3390/vaccines12020117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Community collaboration is a cornerstone of modern public health efforts. This work aimed to use community-engaged research to explore COVID-19 vaccination, testing, and infection in a minoritized community. This study was conducted in Miami, Florida, from March 2021 to February 2022 in community partner sites and the Miami Adult Studies on HIV (MASH) cohort. Sociodemographic characteristics, vaccination and testing beliefs, and COVID-19 challenges were self-reported. COVID-19 vaccinations were verified with medical records, testing history was self-reported, and severe acute respiratory syndrome coronavirus 2 positivity was determined via real-time reverse transcription-polymerase chain reaction (rt-PCR). Of 1689 participants, the median age was 57, 51% were male, 49% were non-Hispanic Black, 66% reported an income < USD 15,000/year, and 75.9% received at least one dose of a COVID-19 vaccine. Belief that COVID-19 vaccination is effective was associated with lower odds of COVID-19 positivity and was the strongest predictor of vaccination. Challenges accessing health care, housing, food, and transportation were associated with lower odds of vaccination. Employment, health insurance, higher education, and greater perceived test accuracy were associated with greater odds of COVID-19 testing. Social determinants of health and the belief that vaccines are effective and tests are accurate predicted behaviors and thus should be considered during public health crises in vulnerable communities.
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Affiliation(s)
- Haley R. Martin
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5, Miami, FL 33199, USA; (H.R.M.); (Q.L.)
| | - David R. Brown
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC2, Miami, FL 33199, USA; (D.R.B.); (A.M.M.); (E.O.R.)
| | - Eileen Fluney
- Paradise Christian School, 6184 W 21st Court, Hialeah, FL 33016, USA;
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5, Miami, FL 33199, USA;
| | - Aileen M. Marty
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC2, Miami, FL 33199, USA; (D.R.B.); (A.M.M.); (E.O.R.)
| | - Eneida O. Roldan
- Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC2, Miami, FL 33199, USA; (D.R.B.); (A.M.M.); (E.O.R.)
| | - Qingyun Liu
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5, Miami, FL 33199, USA; (H.R.M.); (Q.L.)
| | - Manuel A. Barbieri
- Department of Biological Sciences, College of Arts, Sciences & Education, Florida International University, 11200 SW 8th Street, OE 167, Miami, FL 33199, USA;
| | - Marianna K. Baum
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, AHC5, Miami, FL 33199, USA; (H.R.M.); (Q.L.)
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Encandela JA, Shaull L, Jayas A, Amiel JM, Brown DR, Obeso VT, Ryan MS, Andriole DA. Entrustable professional activities as a training and assessment framework in undergraduate medical education: A case study of a multi-institutional pilot. Med Educ Online 2023; 28:2175405. [PMID: 36794397 PMCID: PMC9937016 DOI: 10.1080/10872981.2023.2175405] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/16/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
In 2014, the Association of American Medical Colleges (AAMC) published 13 Core Entrustable Professional Activities (EPAs) that graduating students should be able to perform with indirect supervision when entering residency. A ten-school multi-year pilot was commissioned to test feasibility of implementing training and assessment of the AAMC's 13 Core EPAs. In 2020-21, a case study was employed to describe pilot schools' implementation experiences. Teams from nine of ten schools were interviewed to identify means and contexts of implementing EPAs and lessons learned. Audiotapes were transcribed then coded by investigators using conventional content analysis and a constant comparative method. Coded passages were organized in a database and analyzed for themes. Consensus among school teams regarding facilitators of EPA implementation included team commitment to piloting EPAs; agreement that: proximal EPA adoption with curriculum reform facilitates EPA implementation; EPAs 'naturally fit' in clerkships and provided opportunity for schools to reflect on and adjust curricula and assessments; and inter-school collaboration bolstered individual school progress. Schools did not make high-stakes decisions about student progress (e.g., promotion, graduation), yet EPA assessment results complemented other forms of assessment in providing students with robust formative feedback about their progress. Teams had varied perceptions of school capability to implement an EPA framework, influenced by various levels of dean involvement, willingness, and capability of schools to invest in data systems and provide other resources, strategic deployment of EPAs and assessments, and faculty buy-in. These factors affected varied pace of implementation. Teams agreed on the worthiness of piloting the Core EPAs, but substantial work is still needed to fully employ an EPA framework at the scale of entire classes of students with enough assessments per EPA and with required data validity/reliability. Recommendations stemming from findings may help inform further implementation efforts across other schools adopting or considering an EPA framework.
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Affiliation(s)
- John A. Encandela
- Associate Proessor of Psychiatry and Executive Director of the Teaching & Learning Center at the Yale School of Medicine, New Haven, Connecticut
| | - Lynn Shaull
- Senior Research Specialist at the Association of American Medical Colleges, Washington, DC, USA
| | - Amy Jayas
- Research Analyst at the Association of American Medical Colleges, Washington, DC, USA
| | - Jonathan M. Amiel
- Professor of Psychiatry and Senior Associate Dean at Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - David R. Brown
- Professor and Chief of Family and Community Medicine at Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Vivian T. Obeso
- Associate Professor of Medicine and Associate Dean for Curriculum and Medical Education at Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Michael S. Ryan
- , Professor of Pediatrics and Associate Dean for Assessment, Evaluation, Research, Scholarly Innovation in Medical Education at the University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Dorothy A. Andriole
- Senior Director of Medical Research at the Association of American Medical Colleges, Washington, DC, USA
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Clarke RD, Garba NA, Barbieri MA, Acuna L, Baum M, Rodriguez MS, Frias H, Saldarriaga P, Stefano T, Mathee K, Narasimhan G, R Brown D. Detection of SARS-CoV-2 in high-efficiency particulate air (HEPA) filters of low-cost air purifiers in community-based organizations. Environ Monit Assess 2023; 195:1320. [PMID: 37837468 PMCID: PMC10576720 DOI: 10.1007/s10661-023-11950-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
This study aims to investigate the presence of SARS-CoV-2 in public spaces and assess the utility of inexpensive air purifiers equipped with high-efficiency particulate air (HEPA) filters for viral detection. Samples were collected from six community-based organizations in underserved minority neighborhoods in Northwest Miami, Florida, from February to May 2022. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to detect SARS-CoV-2 in air purifier filters and surface swabs. Among 32 filters tested, three yielded positive results, while no positive surface swabs were found. Notably, positive samples were obtained exclusively from child daycare centers. These findings highlight the potential for airborne transmission of SARS-CoV-2 in indoor air, particularly in child daycare centers. Moreover, the study demonstrates the effectiveness of readily available HEPA filters in detecting the virus. Improving indoor ventilation and implementing air filtration systems are crucial in reducing COVID-19 transmission where people gather. Air filtration systems incorporating HEPA filters offer a valuable approach to virus detection and reducing transmission risks. Future research should explore the applicability of this technology for early identification and mitigation of viral outbreaks.
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Affiliation(s)
- Rachel D Clarke
- Department of Humanities Health, and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Nana Aisha Garba
- Department of Humanities Health, and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Manuel A Barbieri
- Department of Biological Sciences, Florida International University, Miami, FL, USA
| | - Leonardo Acuna
- Biochemistry PhD Program, Florida International University, Miami, FL, USA
| | - Marianna Baum
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Maribel Saad Rodriguez
- Department of Environmental Health Sciences, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Hansel Frias
- Department of Humanities Health, and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Paulina Saldarriaga
- Department of Humanities Health, and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Troy Stefano
- Department of Humanities Health, and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Kalai Mathee
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Biomolecular Sciences Institute, Florida International University, Miami, FL, USA
| | - Giri Narasimhan
- Biomolecular Sciences Institute, Florida International University, Miami, FL, USA
- Bioinformatics Research Group (BioRG), Knight Foundation School of Computing and Information Sciences, Miami, FL, USA
| | - David R Brown
- Department of Humanities Health, and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
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Brown DR, Burney CP, Nevil GK, Gray PJ, Eid MA, Sorensen MJ. Extreme Elevation of Baseline Intraoperative Parathyroid Hormone Measurements: Should Usual Protocols Apply? J Surg Res 2023; 283:1073-1077. [PMID: 36914998 DOI: 10.1016/j.jss.2022.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Intraoperative parathyroid hormone (IOPTH) monitoring is routinely used to facilitate minimally invasive parathyroidectomy. Many IOPTH protocols exist for predicting biochemical cure. Some patients are found to have extremely high baseline IOPTH levels (defined in this study as >500 pg/mL), which may affect the likelihood of satisfying certain final IOPTH criteria. We aimed to discover whether clinically significant differences exist in patients with extremely high baseline IOPTH and which IOPTH protocols are most appropriately applied to these patients. MATERIALS AND METHODS This is a retrospective review of 237 patients who underwent parathyroidectomy with IOPTH monitoring for primary hyperparathyroidism (pHPT) from 2016 to 2020. Baseline IOPTH levels, drawn prior to manipulation of parathyroid glands, were grouped into categories labeled "elevated" (>65-500 pg/mL) and "extremely elevated" (>500 pg/mL). Final IOPTH levels were analyzed to determine whether there was a >50% decrease from baseline and whether a normal IOPTH value was achieved. 6-wk postoperative calcium levels were also examined. RESULTS Of the patients in this cohort, 76% were in the elevated group and 24% in the extremely elevated group. Male sex and higher preoperative PTH levels were correlated with higher baseline IOPTH levels. Patients with extremely elevated baseline IOPTH were less likely to have IOPTH fall into normal range at the conclusion of the case (P = 0.019), and final IOPTH levels were higher (P < 0.001), but the IOPTH was equally likely to decrease >50% from baseline. There was no difference in the mean postoperative calcium levels between the two groups at 6-wk or at longer term follow-up (mean 525 d). CONCLUSIONS Detection of baseline IOPTH levels >500 pg/mL during parathyroidectomy performed for pHPT is not uncommon. IOPTH in patients with extremely elevated baseline levels were less likely to fall into normal range, but follow-up calcium levels were equal, suggesting that applying more stringent IOPTH criteria for predicting biochemical cure may not be appropriate for this population.
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Affiliation(s)
- David R Brown
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | | | - Grace K Nevil
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Phillip J Gray
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Mark A Eid
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Meredith J Sorensen
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
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Lavinghouze SR, Kettel Khan L, Auld ME, Sammons Hackett D, Brittain DR, Brown DR, Greaney E, Harris DM, Maynard LM, Onufrak S, Robillard AG, Schwartz R, Siddique S, Youngner CG, Wright LS, O’Toole TP. From Practice to Publication: The Promise of Writing Workshops. Health Promot Pract 2022; 23:21S-33S. [DOI: 10.1177/15248399221117477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Practitioners in health departments, university extension programs, and nonprofit organizations working in public health face varied challenges to publishing in the peer-reviewed literature. These practitioners may lack time, support, skills, and efficacy needed for manuscript submission, which keeps them from sharing their wisdom and experience-based evidence. This exclusion can contribute to literature gaps, a failure of evidence-based practice to inform future research, reduced ability to educate partners, and delays in advancing public health practice. Our article describes the writing workshops offered to Division of Nutrition, Physical Activity, and Obesity (DNPAO), Centers for Disease Control and Prevention (CDC) funded programs in 2021. This project consisted of three 60-minute introductory writing webinars open to all recipients, followed by a Writing for Publications workshop, an 8- to 9-week virtual learning/writing intensive for selected writing team applicants. The Society for Public Health Education staff, consultants, and CDC/DNPAO staff developed, refined, and presented the curriculum. The workshop for public health practitioner writing teams was offered to two cohorts and included extensive coaching and focused on potential submission to a Health Promotion Practice supplement, “Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field” (see Supplemental Material), which was supported by CDC/DNPAO. We describe the webinars, the workshop design, modifications, evaluation methods and results.
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Affiliation(s)
| | | | - M. Elaine Auld
- Society for Public Health Education, Washington, DC, USA
| | | | | | - David R. Brown
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eryn Greaney
- Society for Public Health Education, Washington, DC, USA
| | - Diane M. Harris
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Stephen Onufrak
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Sana Siddique
- Society for Public Health Education, Washington, DC, USA
| | - Cole G. Youngner
- Contractor to Centers for Disease Control and Prevention through McKing Consulting Corporation, Atlanta, GA, USA
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Sacca L, Garba NA, Clarke RD, Maroun V, Brown DR. Using Community-Based Implementation Frameworks and Strategies to Address Food Insecurity During the COVID-19 Pandemic: A Scoping Review. Journal of Hunger & Environmental Nutrition 2022. [DOI: 10.1080/19320248.2022.2136024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lea Sacca
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida, United States
| | - Nana Aisha Garba
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida, United States
| | - Rachel D. Clarke
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida, United States
| | - Veronica Maroun
- Department of Nutritional Sciences, Lebanese American University, Byblos, Lebanon
| | - David R. Brown
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida, United States
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Brown DR, Berrigan D, Do V, Hill MA, Reed JA. Evaluation Of Practice-based Programs To Increase Use Of Trails Among Youth From Under-resourced Communities. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000877948.15820.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brown DR, Moeller JJ, Grbic D, Andriole DA, Cutrer WB, Obeso VT, Hormann MD, Amiel JM. Comparing Entrustment Decision-Making Outcomes of the Core Entrustable Professional Activities Pilot, 2019-2020. JAMA Netw Open 2022; 5:e2233342. [PMID: 36156144 PMCID: PMC9513644 DOI: 10.1001/jamanetworkopen.2022.33342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Gaps in readiness for indirect supervision have been identified for essential responsibilities encountered early in residency, presenting risks to patient safety. Core Entrustable Professional Activities (EPAs) for entering residency have been proposed as a framework to address these gaps and strengthen the transition from medical school to residency. OBJECTIVE To assess progress in developing an entrustment process in the Core EPAs framework. DESIGN, SETTING, AND PARTICIPANTS In this quality improvement study in the Core EPAs for Entering Residency Pilot, trained faculty made theoretical entrustment determinations and recorded the number of workplace-based assessments (WBAs) available for each determination in 2019 and 2020. Four participating schools attempted entrustment decision-making for all graduating students or a randomly selected subset of students. Deidentified, individual-level data were merged into a multischool database. INTERVENTIONS Schools implemented EPA-related curriculum, WBAs, and faculty development; developed systems to compile and display data; and convened groups to make theoretical summative entrustment determinations. MAIN OUTCOMES AND MEASURES On an EPA-specific basis, the percentage of students for whom an entrustment determination could be made, the percentage of students ready for indirect supervision, and the volume of WBAs available were recorded. RESULTS Four participating schools made 4525 EPA-specific readiness determinations (2296 determinations in 2019 and 2229 determinations in 2020) for 732 graduating students (349 students in 2019 and 383 students in 2020). Across all EPAs, the proportion of determinations of "ready for indirect supervision" increased from 2019 to 2020 (997 determinations [43.4%] vs 1340 determinations [60.1%]; 16.7 percentage point increase; 95% CI, 13.8-19.6 percentage points; P < .001), as did the proportion of determinations for which there were 4 or more WBAs (456 of 2295 determinations with WBA data [19.9%] vs 938 [42.1%]; 22.2 percentage point increase; 95% CI, 19.6-24.8 percentage points; P < .001). The proportion of EPA-specific data sets considered for which an entrustment determination could be made increased from 1731 determinations (75.4%) in 2019 to 2010 determinations (90.2%) in 2020 (14.8 percentage point increase; 95% CI, 12.6-16.9 percentage points; P < .001). On an EPA-specific basis, there were 5 EPAs (EPA 4 [orders], EPA 8 [handovers], EPA 10 [urgent care], EPA 11 [informed consent], and EPA 13 [patient safety]) for which few students were deemed ready for indirect supervision and for which there were few WBAs available per student in either year. For example, for EPA 13, 0 of 125 students were deemed ready in 2019 and 0 of 127 students were deemed ready in 2020, while 0 determinations in either year included 4 or more WBAs. CONCLUSIONS AND RELEVANCE These findings suggest that there was progress in WBA data collected, the extent to which entrustment determinations could be made, and proportions of entrustment determinations reported as ready for indirect supervision. However, important gaps remained, particularly for a subset of Core EPAs.
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Affiliation(s)
- David R. Brown
- Division of Family and Community Medicine, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami
| | - Jeremy J. Moeller
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Douglas Grbic
- Medical Education Research, Association of American Medical Colleges, Washington, District of Columbia
| | - Dorothy A. Andriole
- Medical Education Research, Association of American Medical Colleges, Washington, District of Columbia
| | - William B. Cutrer
- Department of Pediatrics, Division of Critical Care Medicine at Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Vivian T. Obeso
- Division of Internal Medicine, Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami
| | - Mark D. Hormann
- Division of Community and General Pediatrics, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas
| | - Jonathan M. Amiel
- Dean’s Office, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Vigue R, Hernandez WE, Ramirez AL, Castro G, Barengo NC, Brown DR, Ruiz-Pelaez J. Factors Associated With Control of Diabetes and Hypertension Among Patients Seen as Part of a Longitudinal Medical School Service-Learning Program From 2018-2019: An Exploratory Analysis. Cureus 2022; 14:e28225. [PMID: 36158330 PMCID: PMC9487391 DOI: 10.7759/cureus.28225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction The Florida International University (FIU) Green Family Neighborhood Health Education Learning Program (NeighborhoodHELP) in Miami-Dade County serves communities impacted by adverse social determinants of health. This study identified sociodemographic factors affecting control of diabetes and hypertension among NeighborhoodHELP patients. Methods This non-concurrent cohort study evaluated NeighborhoodHELP patients who received care at mobile health centers (MHCs) utilizing de-identified data extracted from the MHCs' clinical quality metrics data set for the 2018-2019 fiscal year. A total of 143 eligible adults with diabetes and 222 adults with hypertension were identified. Condition control was defined as blood pressure ≤ 130 mmHg (systolic) and ≤ 80 mmHg (diastolic) or hemoglobin A1c (HbA1c) ≤ 7% (diabetes). Association with age, gender, ethnicity, marital status, language, service area, income per-capita, and medical student assignment was explored using logistic regression. Results The model showed decreased diabetes control likelihood among Haitian-Creole speakers (OR: 0.13; 95% CI: 0.02-0.75). Odds of diabetes control were greater in two discrete areas serviced by the program, one known as Hippocrates (OR: 4.9; 95% CI: 1.23-19.37) and the other Semmelweis (OR: 3.71; 95% CI: 1.07-12.83). Income greater than $10,000 increased hypertension control likelihood (OR: 2.22; 95% CI: 1.03-4.8). Conclusions Among NeighborhoodHELP patients, geographic region and language impact diabetes control, while income affects hypertension control. Further research is warranted to identify the role of other factors.
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Garber AM, Ownby AR, Trimble G, Aiyer MK, Brown DR, Grbic D. Evaluating the Association of a Core EPA-Oriented Patient Handover Curriculum on Medical Students' Self-reported Frequency of Observation and Skill Acquisition. Med Sci Educ 2022; 32:855-864. [PMID: 36035537 PMCID: PMC9411269 DOI: 10.1007/s40670-022-01578-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION "Giving or receiving a patient handover to transition patient care responsibility" is one of the thirteen Core Entrustable Professional Activities (Core EPAs) for Entering Residency. However, implementing a patient handover curriculum in undergraduate medical education (UME) remains challenging. Educational leaders in the multi-institutional Core EPA8 pilot workgroup developed a longitudinal patient handover UME curriculum that was implemented at two pilot institutions. MATERIALS AND METHODS We utilized multi-school graduation questionnaire data to assess the association of our patient handover curriculum on self-reported frequency of observation/feedback and skill acquisition by comparing data from the shared curriculum schools to data from other Core EPA pilot schools (three schools with school-specific curriculum; five without a dedicated handover curriculum). Questionnaire data from 1,278 graduating medical students of the class of 2020 from all ten Core EPA pilot schools were analyzed. RESULTS Graduates from the two medical schools that implemented the shared patient handover curriculum reported significantly greater frequency of handover observation/feedback compared to graduates at the other schools (school-specific curriculum (p < .05) and those without a handover curriculum (p < .05)). Graduates from the two shared approach schools also more strongly agreed that they possessed the skill to perform handovers compared to graduates from the other eight pilot schools that did not implement this curriculum. CONCLUSION The findings of this study suggest that the implementation of a multi-institutional Core EPA-based curricular model for teaching and assessing patient handovers was successful and could be implemented at other UME institutions.
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Affiliation(s)
- Adam M. Garber
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, PO Box 980102, Richmond, VA 23298-0102 USA
| | - Allison R. Ownby
- Office of Educational Programs, McGovern Medical School at UTHealth, Houston, TX USA
| | - Gregory Trimble
- Department of Internal Medicine, University of Virginia School of Medicine INOVA Campus, Fairfax, VA USA
| | - Meenakshy K. Aiyer
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL USA
| | - David R. Brown
- Division of Family and Community Medicine, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, FL USA
| | - Douglas Grbic
- Association of American Medical Colleges, Washington, DC USA
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Greenwood EK, Angelova DM, Büchner HMI, Brown DR. The AICD fragment of APP initiates a FoxO3a mediated response via FANCD2. Mol Cell Neurosci 2022; 122:103760. [PMID: 35901928 DOI: 10.1016/j.mcn.2022.103760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Abstract
The amyloid precursor protein (APP) is a cell surface protein of uncertain function that is notable for being the parent protein of beta-amyloid. Research around this protein has focussed heavily on the link to Alzheimer's disease and neurodegeneration. However, there is increasing evidence that APP may be linked to neuronal loss through mechanisms independent of beta-amyloid. FoxO3a is a transcription factor associated with neuronal longevity and apoptosis. In neurons, FoxO3a is associated with cell death through pathways that include BIM, a BCL-2 family member. In this study we have shown that APP overexpression increased the cellular levels and activity of FoxO3a. This increased expression and activity is not a result of decreased phosphorylation but is more likely a result of increased nuclear stability due to increased levels of FANCD2, a binding partner of FoxO3a. The changes caused by APP overexpression were shown to be due to the AICD fragment of APP possibly directly inducing transcription increase in FANCD2. These findings strengthen the link between APP metabolism and FoxO3a neuronal activity. This link may be crucial in better understanding the cellular role of APP and its link to neurodegeneration and aging.
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Affiliation(s)
| | | | | | - David R Brown
- Department of Life Sciences, University of Bath, Bath BA2 7AY, UK.
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Garba NA, Sacca L, Clarke RD, Bhoite P, Buschman J, Oller V, Napolitano N, Hyppolite S, Lacroix S, Archibald A, Hamilton O, Ash T, Brown DR. Addressing Food Insecurity during the COVID-19 Pandemic: Intervention Outcomes and Lessons Learned from a Collaborative Food Delivery Response in South Florida’s Underserved Households. IJERPH 2022; 19:ijerph19138130. [PMID: 35805790 PMCID: PMC9265639 DOI: 10.3390/ijerph19138130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
Abstract
Background: The COVID-19 pandemic highlighted underlying disparities in health, healthcare access, and other social factors that have been documented for racial/ethnic minorities. The social-distancing mandate exacerbated the impact of social determinants of health, such as unemployment and food insecurity, particularly among underserved minority populations. We highlight intervention outcomes and lessons learned from the Florida International University (FIU) Herbert Wertheim College of Medicine (HWCOM) NeighborhoodHELP’s response to pandemic-related food insecurity among Miami Dade County’s underserved population. Methods: Following the stay-at-home mandate, a weekly needs assessment of program households was conducted by the NeighborhoodHELP team, during which food insecurity emerged as a pandemic-related urgent need, rising from three percent of program Households in March 2020 to 36.9 percent six months later. Consequently, the program staff collaborated with another FIU department, community partners, and a benefactor to develop a food donation and delivery project. Results: Fifteen hundred and forty-three culturally appropriate food boxes were delivered to 289 participating households, comprising 898 household members, over a 14-month period. Conclusion: This project underscores the importance of leveraging community assets to address their needs during a crisis and the significance of sustained community engagement for researchers and service providers who work in underserved communities.
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Affiliation(s)
- Nana Aisha Garba
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 32413, USA; (L.S.); (R.D.C.); (P.B.); (V.O.); (N.N.); (S.H.); (S.L.); (D.R.B.)
- Correspondence:
| | - Lea Sacca
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 32413, USA; (L.S.); (R.D.C.); (P.B.); (V.O.); (N.N.); (S.H.); (S.L.); (D.R.B.)
| | - Rachel D. Clarke
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 32413, USA; (L.S.); (R.D.C.); (P.B.); (V.O.); (N.N.); (S.H.); (S.L.); (D.R.B.)
| | - Prasad Bhoite
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 32413, USA; (L.S.); (R.D.C.); (P.B.); (V.O.); (N.N.); (S.H.); (S.L.); (D.R.B.)
| | - John Buschman
- Chaplin School of Hospitality and Tourism Management, Florida International University, Miami, FL 33181, USA;
| | - Virama Oller
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 32413, USA; (L.S.); (R.D.C.); (P.B.); (V.O.); (N.N.); (S.H.); (S.L.); (D.R.B.)
| | - Nancy Napolitano
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 32413, USA; (L.S.); (R.D.C.); (P.B.); (V.O.); (N.N.); (S.H.); (S.L.); (D.R.B.)
| | - Samuel Hyppolite
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 32413, USA; (L.S.); (R.D.C.); (P.B.); (V.O.); (N.N.); (S.H.); (S.L.); (D.R.B.)
| | - Sophia Lacroix
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 32413, USA; (L.S.); (R.D.C.); (P.B.); (V.O.); (N.N.); (S.H.); (S.L.); (D.R.B.)
| | - Al Archibald
- Grace United Community Church, Miami, FL 32413, USA;
| | - Ocean Hamilton
- Redland Ahead Inc., Farmer to Families Program, Homestead, FL 32413, USA;
| | - Tobi Ash
- Joshua’s Heart Food Pantry, North Miami Beach, FL 32413, USA;
| | - David R. Brown
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 32413, USA; (L.S.); (R.D.C.); (P.B.); (V.O.); (N.N.); (S.H.); (S.L.); (D.R.B.)
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Del Giudice F, Huang J, Li S, Sorensen S, Enemchukwu E, Maggi M, Salciccia S, Ferro M, Crocetto F, Pandolfo SD, Autorino R, Krajewski W, Crivellaro S, Cacciamani GE, Bologna E, Asero V, Scornajenghi C, Moschini M, D'Andrea D, Brown DR, Chung BI. Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00558-x. [PMID: 35729329 DOI: 10.1038/s41391-022-00558-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To identify trends, costs, and predictors in the use of different surgical procedures for post-radical prostatectomy incontinence (PPI). MATERIALS AND METHODS We identified 21,589 men who were diagnosed with localized prostate cancer (PCa) and treated with radical prostatectomy (RP) from 2003 to 2017. The primary outcome was the incontinence procedure performances. Optum's de-identified Clinformatics® Data Mart Database was queried to define the cohort of interest. The average costs of the different incontinence procedures were obtained and compared. Also, demographic, and clinical predictors of incontinence surgery were evaluated by multivariable regression analysis. RESULTS Of the 21,589 men with localized PCa treated with RP, 740 (3.43%) underwent at least one incontinence procedure during a median of 5 years of follow-up. In total, there were 844 unique incontinence procedures. Male slings were the most common procedure (47.5%), had an intermediate cost compared to the other treatment options, and was the first-choice treatment for the majority of patients (50%). The use of an artificial urinary sphincter (AUS) was the second most common (35.3%), but also was the most expensive treatment and was first-choice-treatment for 32.3% of patients. On multivariable analysis, metabolic syndrome related disorders, adjuvant/salvage radiation therapy as well as a history of neurological comorbidities were independently associated with an increased likelihood of incontinence surgery. CONCLUSIONS The receipt of male slings increased and then subsequently decreased, while AUS utilization was stable, and the use of urethral bulking agents was uncommon. From a cost standpoint, AUS was the most expensive option. Finally, patient's comorbidity history and RP related factors were found to influence the choice for primary or subsequent PPI interventions.
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Affiliation(s)
- Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy. .,Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Jianlin Huang
- Department of Urology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Shufeng Li
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Simon Sorensen
- Department of Urology, Aarhus University, Aarhus, Denmark
| | - Ekene Enemchukwu
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Martina Maggi
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Stefano Salciccia
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy.,Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - Riccardo Autorino
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Simone Crivellaro
- University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | | | - Eugenio Bologna
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Vincenzo Asero
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Carlo Scornajenghi
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Marco Moschini
- Department of Urology, San Raffaele Hospital, IRCCS Milan, Milan, Italy
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Benjamin I Chung
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
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Brown DR, Moeller JJ, Grbic D, Biskobing DM, Crowe R, Cutrer WB, Green ML, Obeso VT, Wagner DP, Warren JB, Yingling SL, Andriole DA. Entrustment Decision Making in the Core Entrustable Professional Activities: Results of a Multi-Institutional Study. Acad Med 2022; 97:536-543. [PMID: 34261864 DOI: 10.1097/acm.0000000000004242] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE In 2014, the Association of American Medical Colleges defined 13 Core Entrustable Professional Activities (EPAs) that all graduating students should be ready to do with indirect supervision upon entering residency and commissioned a 10-school, 5-year pilot to test implementing the Core EPAs framework. In 2019, pilot schools convened trained entrustment groups (TEGs) to review assessment data and render theoretical summative entrustment decisions for class of 2019 graduates. Results were examined to determine the extent to which entrustment decisions could be made and the nature of these decisions. METHOD For each EPA considered (4-13 per student), TEGs recorded an entrustment determination (ready, progressing but not yet ready, evidence against student progressing, could not make a decision); confidence in that determination (none, low, moderate, high); and the number of workplace-based assessments (WBAs) considered (0->15) per determination. These individual student-level data were de-identified and merged into a multischool database; chi-square analysis tested the significance of associations between variables. RESULTS The 2,415 EPA-specific determinations (for 349 students by 4 participating schools) resulted in a decision of ready (n = 997/2,415; 41.3%), progressing but not yet ready (n = 558/2,415; 23.1%), or evidence against student progression (n = 175/2,415; 7.2%). No decision could be made for the remaining 28.4% (685/2,415), generally for lack of data. Entrustment determinations' distribution varied across EPAs (chi-square P < .001) and, for 10/13 EPAs, WBA availability was associated with making (vs not making) entrustment decisions (each chi-square P < .05). CONCLUSIONS TEGs were able to make many decisions about readiness for indirect supervision; yet less than half of determinations resulted in a decision of readiness to perform this EPA with indirect supervision. More work is needed at the 10 schools to enable authentic summative entrustment in the Core EPAs framework.
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Affiliation(s)
- David R Brown
- D.R. Brown is professor, chief, Division of Family and Community Medicine, and interim chair, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0002-5361-6664
| | - Jeremy J Moeller
- J.J. Moeller is associate professor and residency program director, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-6135-5572
| | - Douglas Grbic
- D. Grbic is lead research analyst, Medical Education Research, Association of American Medical Colleges, Washington, DC
| | - Diane M Biskobing
- D.M. Biskobing is professor of medicine and associate dean of medical education, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Ruth Crowe
- R. Crowe is director of integrated clinical skills, director of practice of medicine, Office of Medical Education, and associate professor of medicine, New York University Grossman School of Medicine, New York, New York
| | - William B Cutrer
- W.B. Cutrer is associate dean for undergraduate medical education and associate professor of pediatrics (critical care medicine), Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0003-1538-9779
| | - Michael L Green
- M.L. Green is professor of medicine and director of student assessment, Teaching and Learning Center, Yale University School of Medicine, New Haven, Connecticut
| | - Vivian T Obeso
- V.T. Obeso is associate dean for curriculum and medical education and associate professor, Division of Internal Medicine, Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Dianne P Wagner
- D.P. Wagner is associate dean for undergraduate medical education and professor of medicine, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Jamie B Warren
- J.B. Warren is associate professor, Division of Neonatology, and clinical vice chair, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon; ORCID: https://orcid.org/0000-0003-4422-1502
| | - Sandra L Yingling
- S.L. Yingling is associate dean for educational planning and quality improvement, University of Illinois College of Medicine (Chicago, Peoria, Rockford, and Urbana), Chicago, Illinois
| | - Dorothy A Andriole
- D.A. Andriole is senior director, Medical Education Research, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0001-8902-1227
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Bekins NM, Brown DR. Abundance of Songbirds in Eastern Hemlock Stands Following Chemical Treatments for Hemlock Woolly Adelgid. Northeast Nat (Steuben) 2022. [DOI: 10.1656/045.029.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Natalie M. Bekins
- Department of Biological Sciences, Eastern Kentucky University, Richmond, KY 40403
| | - David R. Brown
- Department of Biological Sciences, Eastern Kentucky University, Richmond, KY 40403
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21
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Brown DR, Moeller JJ, Grbic D, Andriole DA, Cutrer WB, Obeso VT, Hormann MD, Amiel JM. The First 2 Years of Entrustment Decisions in the Core Entrustable Professional Activities (Core EPAs) Pilot. Acad Med 2021; 96:S201-S202. [PMID: 34705702 DOI: 10.1097/acm.0000000000004275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- David R Brown
- Author affiliations: D.R. Brown, V.T. Obeso, Florida International University Herbert Wertheim College of Medicine
| | | | - Douglas Grbic
- D. Grbic, D.A. Andriole, Association of American Medical Colleges
| | | | | | - Vivian T Obeso
- Author affiliations: D.R. Brown, V.T. Obeso, Florida International University Herbert Wertheim College of Medicine
| | | | - Jonathan M Amiel
- J.M. Amiel, Columbia University College of Physicians and Surgeons
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22
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Garba NA, Anderson F, Schneider GW, Bisschops J, Bhoite P, Lage OO, Sackstein R, Brown DR. Caring for Vulnerable Communities in Miami Dade County during the COVID-19 Pandemic. J Health Care Poor Underserved 2021; 32:598-606. [PMID: 34120960 DOI: 10.1353/hpu.2021.0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In response to the COVID-19 pandemic, the Herbert Wertheim College of Medicine's Neighborhood Health Education Learning Program (NeighborhoodHELP) initiated a longitudinal assessment and mitigation of social and health care challenges for a population of approximately 850 underserved households. Here, we describe the needs assessment, ensuing interventions, and lessons learned during this pandemic.
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23
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Amiel JM, Andriole DA, Biskobing DM, Brown DR, Cutrer WB, Emery MT, Mejicano GC, Ryan MS, Swails JL, Wagner DP. Revisiting the Core Entrustable Professional Activities for Entering Residency. Acad Med 2021; 96:S14-S21. [PMID: 34183597 DOI: 10.1097/acm.0000000000004088] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Core EPAs for Entering Residency Pilot project aimed to test the feasibility of implementing 13 entrustable professional activities (EPAs) at 10 U.S. medical schools and to gauge whether the use of the Core EPAs could improve graduates' performance early in residency. In this manuscript, the authors (members of the pilot institutions and Association of American Medical Colleges staff supporting the project evaluation) describe the schools' capacity to collect multimodal evidence about their students' performance in each of the Core EPAs and the ability of faculty committees to use those data to make decisions regarding learners' readiness for entrustment. In reviewing data for each of the Core EPAs, the authors reflected on how each activity performed as an EPA informed by how well it could be assessed and entrusted. For EPAs that did not perform well, the authors examined whether there are underlying practical and/or theoretical issues limiting its utility as a measure of student performance in medical school.
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Affiliation(s)
- Jonathan M Amiel
- J.M. Amiel is associate professor of psychiatry, senior associate dean for curricular affairs, and interim co-vice dean for education, Columbia University Vagelos College of Physicians & Surgeons, New York, New York; ORCID: https://orcid.org/0000-0003-4027-6397
| | - Dorothy A Andriole
- D.A. Andriole is senior director, Medical Education Research, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0001-8902-1227
| | - Diane M Biskobing
- D.M. Biskobing is professor of medicine and associate dean for pre-clinical medical education, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - David R Brown
- D.R. Brown is associate professor, chief, Family and Community Medicine, and interim chair, Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: https://orcid.org/0000-0002-5361-6664
| | - William B Cutrer
- W.B. Cutrer is associate dean for undergraduate medical education and associate professor of pediatrics, Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0003-1538-9779
| | - Matthew T Emery
- M.T. Emery is associate professor of emergency medicine and medical director for simulation, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - George C Mejicano
- G.C. Mejicano is professor of medicine and senior associate dean for Education, Oregon Health & Science University School of Medicine, Portland, Oregon; ORCID: https://orcid.org/0000-0002-6087-3730
| | - Michael S Ryan
- M.S. Ryan is associate professor of pediatrics and assistant dean for clinical medical education, Virginia Commonwealth University School of Medicine, Richmond, Virginia; ORCID: https://orcid.org/0000-0003-3266-9289
| | - Jennifer L Swails
- J.L. Swails is associate professor of internal medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas; ORCID: https://orcid.org/0000-0002-6102-831X
| | - Dianne P Wagner
- D.P. Wagner is professor of medicine, associate dean for undergraduate medical education, and interim senior associate dean for academic affairs, Michigan State University College of Human Medicine, East Lansing, Michigan
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24
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Brown DR. Narrow Phrasing Is Not Always Best: In Defense of Core EPAs 7, 9, and 13. Acad Med 2021; 96:614. [PMID: 33885404 DOI: 10.1097/acm.0000000000003992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- David R Brown
- Associate professor and chief, Division of Family and Community Medicine, and interim chair, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ; Twitter: @drdrbrown; ORCID: https://orcid.org/0000-0002-5361-6664
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25
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Saha J, Kim JH, Amaya CN, Witcher C, Khammanivong A, Korpela DM, Brown DR, Taylor J, Bryan BA, Dickerson EB. Propranolol Sensitizes Vascular Sarcoma Cells to Doxorubicin by Altering Lysosomal Drug Sequestration and Drug Efflux. Front Oncol 2021; 10:614288. [PMID: 33598432 PMCID: PMC7882688 DOI: 10.3389/fonc.2020.614288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023] Open
Abstract
Angiosarcoma is a rare cancer of blood vessel-forming cells with a high patient mortality and few treatment options. Although chemotherapy often produces initial clinical responses, outcomes remain poor, largely due to the development of drug resistance. We previously identified a subset of doxorubicin-resistant cells in human angiosarcoma and canine hemangiosarcoma cell lines that exhibit high lysosomal accumulation of doxorubicin. Hydrophobic, weak base chemotherapeutics, like doxorubicin, are known to sequester within lysosomes, promoting resistance by limiting drug accessibility to cellular targets. Drug synergy between the beta adrenergic receptor (β-AR) antagonist, propranolol, and multiple chemotherapeutics has been documented in vitro, and clinical data have corroborated the increased therapeutic potential of propranolol with chemotherapy in angiosarcoma patients. Because propranolol is also a weak base and accumulates in lysosomes, we sought to determine whether propranolol enhanced doxorubicin cytotoxicity via antagonism of β-ARs or by preventing the lysosomal accumulation of doxorubicin. β-AR-like immunoreactivities were confirmed in primary tumor tissues and cell lines; receptor function was verified by monitoring downstream signaling pathways of β-ARs in response to receptor agonists and antagonists. Mechanistically, propranolol increased cytoplasmic doxorubicin concentrations in sarcoma cells by decreasing the lysosomal accumulation and cellular efflux of this chemotherapeutic agent. Equivalent concentrations of the receptor-active S-(-) and -inactive R-(+) enantiomers of propranolol produced similar effects, supporting a β-AR-independent mechanism. Long-term exposure of hemangiosarcoma cells to propranolol expanded both lysosomal size and number, yet cells remained sensitive to doxorubicin in the presence of propranolol. In contrast, removal of propranolol increased cellular resistance to doxorubicin, underscoring lysosomal doxorubicin sequestration as a key mechanism of resistance. Our results support the repurposing of the R-(+) enantiomer of propranolol with weak base chemotherapeutics to increase cytotoxicity and reduce the development of drug-resistant cell populations without the cardiovascular and other side effects associated with antagonism of β-ARs.
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Affiliation(s)
- Jhuma Saha
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
| | - Jong Hyuk Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States.,Animal Cancer Care and Research Program, College of Veterinary Medicine University of Minnesota, St. Paul, MN, United States.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Clarissa N Amaya
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, United States.,Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Caleb Witcher
- Department of Biology, Stephen F. Austin State University, Nacogdoches, TX, United States
| | - Ali Khammanivong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
| | - Derek M Korpela
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
| | - David R Brown
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
| | - Josephine Taylor
- Department of Biology, Stephen F. Austin State University, Nacogdoches, TX, United States
| | - Brad A Bryan
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, United States.,Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Erin B Dickerson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States.,Animal Cancer Care and Research Program, College of Veterinary Medicine University of Minnesota, St. Paul, MN, United States.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
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26
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Jacob V, Chattopadhyay SK, Reynolds JA, Hopkins DP, Morgan JA, Brown DR, Kochtitzky CS, Cuellar AE, Kumanyika SK. Economics of Interventions to Increase Active Travel to School: A Community Guide Systematic Review. Am J Prev Med 2021; 60:e27-e40. [PMID: 33341185 PMCID: PMC7770808 DOI: 10.1016/j.amepre.2020.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 10/22/2022]
Abstract
CONTEXT The number of children who bicycle or walk to school has steadily declined in the U.S. and other high-income countries. In response, several countries responded in recent years by funding infrastructure and noninfrastructure programs that improve the safety, convenience, and attractiveness of active travel to school. The objective of this study is to synthesize the economic evidence for the cost and benefit of these programs. EVIDENCE ACQUISITION Literature from the inception of databases to July 2018 were searched, yielding 9 economic evaluation studies. All analyses were done in September 2018-May 2019. EVIDENCE SYNTHESIS All the studies reported cost, 6 studies reported cost benefit, and 2 studies reported cost effectiveness. The cost-effectiveness estimates were excluded on the basis of quality assessment. Cost of interventions ranged widely, with higher cost reported for the infrastructure-heavy projects from the U.S. ($91,000-$179,000 per school) and United Kingdom ($227,000-$665,000 per project). Estimates of benefits differed in the inclusion of improved safety for bicyclists and pedestrians, improved health from increased physical activity, and reduced environmental impacts due to less automobile use. The evaluations in the U.S. focused primarily on safety. The overall median benefit‒cost ratio was 4.4:1.0 (IQR=2.2:1-6.0:1, 6 studies). The 2-year benefit-cost ratios for U.S. projects in California and New York City were 1.46:1 and 1.79:1, respectively. CONCLUSIONS The evidence indicates that interventions that improve infrastructure and enhance the safety and ease of active travel to schools generate societal economic benefits that exceed the societal cost.
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Affiliation(s)
- Verughese Jacob
- Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sajal K Chattopadhyay
- Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey A Reynolds
- Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David P Hopkins
- Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer A Morgan
- Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David R Brown
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher S Kochtitzky
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Shiriki K Kumanyika
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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27
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Omura JD, Brown DR, McGuire LC, Taylor CA, Fulton JE, Carlson SA. Cross-sectional association between physical activity level and subjective cognitive decline among US adults aged ≥45 years, 2015. Prev Med 2020; 141:106279. [PMID: 33035548 PMCID: PMC10941305 DOI: 10.1016/j.ypmed.2020.106279] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/17/2022]
Abstract
Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss within the previous 12 months and can be one of the earliest symptoms of Alzheimer's disease. Regular physical activity can contribute to the primary, secondary, and tertiary prevention of cognitive decline. At the national level, prevalence estimates of SCD by physical activity level in the United States are currently unknown. The purpose of this study is to examine the prevalence of SCD and resulting functional limitations by physical activity level among US adults aged ≥45 years. Data from 33 states and the District of Columbia participating in the 2015 Behavioral Risk Factor Surveillance System (N = 128,925) were analyzed. We estimated the prevalence of SCD (a positive response to a question about worsening or more frequent confusion or memory loss within the previous 12 months) and resulting functional limitations overall and by self-reported physical activity level based on current guidelines (i.e., active, insufficiently active, and inactive). Odds ratios were estimated using logistic regression models adjusting for respondent characteristics. Overall, 11.3% of US adults aged ≥45 years reported SCD. Prevalence of SCD increased as physical activity level decreased (active: 8.8%; insufficiently active: 11.4%; inactive: 15.7%). Among those with SCD, the prevalence of functional limitations also increased as physical activity level decreased (active: 40.5%; insufficiently active: 50.0%; inactive: 57.4%). These differences largely remained after adjusting for respondent characteristics. Findings highlight the potential public health impact nationally of efforts to promote physical activity for cognitive health.
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Affiliation(s)
- John D Omura
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
| | - David R Brown
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
| | - Lisa C McGuire
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S106-7, Atlanta, GA 30341, USA.
| | - Christopher A Taylor
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S106-7, Atlanta, GA 30341, USA.
| | - Janet E Fulton
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-5, Atlanta, GA 30341, USA.
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-5, Atlanta, GA 30341, USA; Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S106-7, Atlanta, GA 30341, USA.
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Stumbar S, Lage O, Whisenant EB, Brown DR. Developing the Community Engaged Physician: Medical Students Reflect on a Household Visit Curriculum. Cureus 2020; 12:e11593. [PMID: 33364115 PMCID: PMC7752743 DOI: 10.7759/cureus.11593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: To educate students about social determinants of health, our medical school assigns interprofessional student teams to work longitudinally with underserved households to identify and address their health and social needs. To cultivate reflective practice--an essential component to training competent professionals through service-learning programs--students are asked to recognize their emotional responses to patient encounters. This project used reflective essays to identify the emotional responses of medical students to the start of their household visit experience and to assess their observations in relation to social determinants of health. Methods: Thematic analysis was used to examine patterns in reflective essays provided by 99 medical students. Two independent reviewers read the essays and created initial codes, which were developed into a common codebook by consensus. Codes were categorized into themes, including observations of the social determinants and emotional reactions to household visits. Results: Through the provision of household-centered care, medical students recognize the roles that social determinants play in the health of patients, households, and communities. Furthermore, they are able to identify household and community level interventions to address these identified needs. A variety of emotional responses to household visits were identified, ranging from frustration and sadness to empathy and humility. Conclusions: Medical students undergo an emotional evolution even at the start of their household visit experience; highlighting that early patient care responsibilities play an important role in their development from pre-professional students to doctors-in-training. Additionally, student observations of the social determinants suggest that household visits can provide an opportunity for the application of knowledge about identifying and addressing these barriers to care.
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29
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Omura JD, Carlson SA, Brown DR, Hopkins DP, Kraus WE, Staffileno BA, Thomas RJ, Lobelo F, Fulton JE. Built Environment Approaches to Increase Physical Activity: A Science Advisory From the American Heart Association. Circulation 2020; 142:e160-e166. [PMID: 32787451 PMCID: PMC10959241 DOI: 10.1161/cir.0000000000000884] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Engaging in regular physical activity is one of the most important things people can do to improve their cardiovascular health; however, population levels of physical activity remain low in the United States. Effective population-based approaches implemented in communities can help increase physical activity among all Americans. Evidence suggests that built environment interventions offer one such approach. These interventions aim to create or modify community environmental characteristics to make physical activity easier or more accessible for all people in the places where they live. In 2016, the Community Preventive Services Task Force released a recommendation for built environment approaches to increase physical activity. This recommendation is based on a systematic review of 90 studies (search period, 1980-June 2014) conducted using methods outlined by the Guide to Community Preventive Services. The Community Preventive Services Task Force found sufficient evidence of effectiveness to recommend combined built environment strategies. Specifically, these strategies combine interventions to improve pedestrian or bicycle transportation systems with interventions to improve land use and environmental design. Components of transportation systems can include street pattern design and connectivity, pedestrian infrastructure, bicycle infrastructure, and public transit infrastructure and access. Components of land use and environmental design can include mixed land use, increased residential density, proximity to community or neighborhood destinations, and parks and recreational facility access. Implementing this Community Preventive Services Task Force recommendation in communities across the United States can help promote healthy and active living, increase physical activity, and ultimately improve cardiovascular health.
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30
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Blinn HN, Utz RM, Greiner LH, Brown DR. Exposure assessment of adults living near unconventional oil and natural gas development and reported health symptoms in southwest Pennsylvania, USA. PLoS One 2020; 15:e0237325. [PMID: 32810134 PMCID: PMC7446921 DOI: 10.1371/journal.pone.0237325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/25/2020] [Indexed: 01/27/2023] Open
Abstract
Recent research has shown relationships between health outcomes and residence proximity to unconventional oil and natural gas development (UOGD). The challenge of connecting health outcomes to environmental stressors requires ongoing research with new methodological approaches. We investigated UOGD density and well emissions and their association with symptom reporting by residents of southwest Pennsylvania. A retrospective analysis was conducted on 104 unique, de-identified health assessments completed from 2012-2017 by residents living in proximity to UOGD. A novel approach to comparing estimates of exposure was taken. Generalized linear modeling was used to ascertain the relationship between symptom counts and estimated UOGD exposure, while Threshold Indicator Taxa Analysis (TITAN) was used to identify associations between individual symptoms and estimated UOGD exposure. We used three estimates of exposure: cumulative well density (CWD), inverse distance weighting (IDW) of wells, and annual emission concentrations (AEC) from wells within 5 km of respondents' homes. Taking well emissions reported to the Pennsylvania Department of Environmental Protection, an air dispersion and screening model was used to estimate an emissions concentration at residences. When controlling for age, sex, and smoker status, each exposure estimate predicted total number of reported symptoms (CWD, p<0.001; IDW, p<0.001; AEC, p<0.05). Akaike information criterion values revealed that CWD was the better predictor of adverse health symptoms in our sample. Two groups of symptoms (i.e., eyes, ears, nose, throat; neurological and muscular) constituted 50% of reported symptoms across exposures, suggesting these groupings of symptoms may be more likely reported by respondents when UOGD intensity increases. Our results do not confirm that UOGD was the direct cause of the reported symptoms but raise concern about the growing number of wells around residential areas. Our approach presents a novel method of quantifying exposures and relating them to reported health symptoms.
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Affiliation(s)
- Hannah N. Blinn
- Falk School of Sustainability, Chatham University, Gibsonia, Pennsylvania, United States of America
- Southwest Pennsylvania Environmental Health Project, McMurray, Pennsylvania, United States of America
| | - Ryan M. Utz
- Falk School of Sustainability, Chatham University, Gibsonia, Pennsylvania, United States of America
| | - Lydia H. Greiner
- Southwest Pennsylvania Environmental Health Project, McMurray, Pennsylvania, United States of America
| | - David R. Brown
- Southwest Pennsylvania Environmental Health Project, McMurray, Pennsylvania, United States of America
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Korpela DM, Saha J, Khammanivong A, Phung SK, Brown DR, Dickerson EB. Abstract 1845: Propranolol reduces hemangiosarcoma cell viability by disrupting lipid homeostatic pathways. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-1845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Angiosarcoma is a highly aggressive cancer of blood vessel-forming cells with few effective treatment options and high patient mortality. Recent studies have shown that the beta-adrenergic antagonist propranolol, a drug historically used for the treatment of cardiac disease, promotes regression of angiosarcomas when combined with standard chemotherapies and increases the overall survival of angiosarcoma patients. Because angiosarcomas are rare, undertaking studies to understand the susceptibility of these tumors to propranolol remains a challenge. In contrast, hemangiosarcoma is a common cancer in dogs that closely models the genetic landscape and the pathogenesis of human angiosarcoma, making it a powerful tool for investigating the susceptibility of angiosarcomas to propranolol. Treatment of an angiosarcoma and hemangiosarcoma cell line panel with propranolol or its receptor active S-(-), and inactive R-(+) enantiomers similarly reduced cell viability in all lines in a concentration dependent manner, suggesting the effects of propranolol are independent of adrenergic receptor activity. Lipin-1, an enzyme responsible for the conversion of phosphatidic acid (PA) to diacylglycerol (DAG), is a known target of propranolol. Inhibition of lipin-1 by propranolol rapidly increases the levels PA, which plays a key role in phospholipid synthesis, intracellular vesicle transport, and signaling pathways involved in regulation of metabolism. Hence, we tested the hypothesis that propranolol induces its detrimental effects in angiosarcomas by disrupting lipid metabolic pathways and vesicular transport. We found that propranolol induced synthesis of cholesterol and fatty acid pathways within 30 minutes via the activation of SREBP-1. Propranolol also blocked endocytosis of extracellular cholesterol, suggesting the rapid induction of lipid synthesis was used by cells to maintain lipid homeostasis. The rapid induction of lipid synthesis activated an ER stress response, contributing to a loss of cell viability. Propranolol also blocked autophagy, proteasomal degradation pathways, and vesicular transport of cholesterol, limiting access to essential metabolites and further exacerbating ER stress. Because mTORC1 is a key regulator of SREBP-1 and mTORC1 is stabilized by PA, we evaluate the effects of propranolol on mTORC1 activity. While propranolol rapidly increased PA levels, it modestly increased the phosphorylation of 4E-BP1, a downstream target of mTORC1, and results were not consistent across all cell lines. Instead, propranolol rapidly induced the phosphorylation and inhibition of GSK-3beta, a known inhibitor of SREBP-1, providing a mechanism for the activation of lipid synthesis pathways by propranolol. Our data suggest propranolol induces sarcoma cell death by disrupting lipid homeostatic pathways and inducing ER stress. Importantly, our findings identify a mechanistic pathway that can be targeted in combination with propranolol to further improve patient responses.
Citation Format: Derek M. Korpela, Jhuma Saha, Ali Khammanivong, Shee Kwan Phung, David R. Brown, Erin B. Dickerson. Propranolol reduces hemangiosarcoma cell viability by disrupting lipid homeostatic pathways [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1845.
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Moeller JJ, Warren JB, Crowe RM, Wagner DP, Cutrer WB, Hyderi AA, Lupi CS, Obeso VT, Yingling S, Andriole DA, Brown DR. Developing an Entrustment Process: Insights from the AAMC CoreEPA Pilot. Med Sci Educ 2020; 30:395-401. [PMID: 34457683 PMCID: PMC8368864 DOI: 10.1007/s40670-020-00918-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
One of the main goals of the CoreEPA pilot has been to determine the feasibility of developing a process to make summative entrustment decisions regarding entrustable professional activities (EPAs). Five years into the pilot, we report results of a research study we conducted to explore approaches to the entrustment process undertaken by our ten participating schools. We sought to identify the choices that participating schools made regarding the entrustment process and why these decisions were made. We are sharing these results, highlighting ongoing challenges that were identified with the intent of helping other medical schools that are moving toward EPA-based assessment. We conducted semi-structured interviews with representatives of all 10 medical schools in the CoreEPA pilot to understand their choices in designing the entrustment process. Additional information was obtained through follow-up communication to ensure completeness and accuracy of the findings. Several common themes are described. Our results indicate that, while approaches to the entrustment process vary considerably, all schools demonstrated consistent adherence to the guiding principles of the pilot. Several common barriers to the entrustment process emerged, and there was a consensus that more experience is needed with the process before consequential entrustment decisions can be made. The CoreEPA pilot schools continue to address challenges identified in implementing entrustment processes and making entrustment decisions for our students graduating in the Class of 2020.
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Affiliation(s)
| | - Jamie B. Warren
- Oregon Health & Science University School of Medicine, Portland, OR USA
| | - Ruth M. Crowe
- New York University School of Medicine, New York, NY USA
| | - Dianne P. Wagner
- Michigan State University College of Human Medicine, East Lansing, MI USA
| | | | - Abbas A. Hyderi
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA
| | - Carla S. Lupi
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA
| | - Vivian T. Obeso
- Florida International University Herbert Wertheim College of Medicine, Miami, FL USA
| | - Sandra Yingling
- University of Illinois College of Medicine (Chicago, Peoria, Rockford and Urbana), Chicago, IL USA
| | | | - David R. Brown
- Florida International University Herbert Wertheim College of Medicine, Miami, FL USA
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Stumbar SE, Brown DR, Lupi CS. Developing and Implementing Curricular Objectives for Sexual Health in Undergraduate Medical Education: A Practical Approach. Acad Med 2020; 95:77-82. [PMID: 31348064 DOI: 10.1097/acm.0000000000002891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PROBLEM In 2014, medical students at the Florida International University Herbert Wertheim College of Medicine (FIU HWCOM) first drew attention to perceived gaps in the sexual health curriculum. The authors used Kern and colleagues' model for curriculum development to review and update the existing curriculum. APPROACH To develop longitudinal sexual health curricular objectives for undergraduate medical education (UME), the authors reviewed existing specialty- and organization-specific objectives. Then, an iterative process guided by clear criteria was used to develop feasible objectives, which were refined through stakeholder feedback. As these objectives were being finalized in 2017, UME sexual health competencies were first published; the authors mapped their objectives to these, as possible. The medical school's course activities and assessments were mapped to the authors' sexual health objectives to identify curricular gaps and unplanned redundancies. OUTCOMES This process resulted in 12 sexual health curricular objectives that are adaptable by other institutions. In mapping the FIU HWCOM curriculum to these objectives, specific gaps and assessment weaknesses emerged. With stakeholder support obtained through a strong curricular management structure, the work of modifying content to address gaps has begun. NEXT STEPS New assessments specific to these sexual health objectives are needed, especially within the clinical curriculum. Assessment of these objectives may be strengthened through the development of new sexual-health-related entrustable professional activities (EPAs) nested within the broader Core EPAs for Entering Residency being piloted. When data on learning outcomes are available, the process of targeting curricular improvement will begin.
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Affiliation(s)
- Sarah E Stumbar
- S.E. Stumbar is assistant dean for clinical education and assistant professor of humanities, health, and society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida. D.R. Brown is vice chair, chief of family and community medicine, and associate professor of humanities, health, and society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida. C.S. Lupi is associate dean for assessment and evaluation and professor of clinical science, Kaiser Permanente School of Medicine, Pasadena, California
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Angelova DM, Brown DR. Microglia and the aging brain: are senescent microglia the key to neurodegeneration? J Neurochem 2019; 151:676-688. [PMID: 31478208 DOI: 10.1111/jnc.14860] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 12/15/2022]
Abstract
The single largest risk factor for etiology of neurodegenerative diseases like Alzheimer's disease is increased age. Therefore, understanding the changes that occur as a result of aging is central to any possible prevention or cure for such conditions. Microglia, the resident brain glial population most associated with both protection of neurons in health and their destruction is disease, could be a significant player in age related changes. Microglia can adopt an aberrant phenotype sometimes referred to either as dystrophic or senescent. While aged microglia have been frequently identified in neurodegenerative diseases such as Alzheimer's disease, there is no conclusive evidence that proves a causal role. This has been hampered by a lack of models of aged microglia. We have recently generated a model of senescent microglia based on the observation that all dystrophic microglia show iron overload. Iron-overloading cultured microglia causes them to take on a senescent phenotype and can cause changes in models of neurodegeneration similar to those observed in patients. This review considers how this model could be used to determine the role of senescent microglia in neurodegenerative diseases.
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Affiliation(s)
- Dafina M Angelova
- Department of Biology and Biochemistry, University of Bath, Bath, UK
| | - David R Brown
- Department of Biology and Biochemistry, University of Bath, Bath, UK
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Brown DR, Greiner LH, Weinberger BI, Walleigh L, Glaser D. Assessing exposure to unconventional natural gas development: using an air pollution dispersal screening model to predict new-onset respiratory symptoms. J Environ Sci Health A Tox Hazard Subst Environ Eng 2019; 54:1357-1363. [PMID: 31452436 DOI: 10.1080/10934529.2019.1657763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
Various exposure estimates have been used to assess health impact of unconventional natural gas development (UNGD). The purpose of this study was to (1) use an air pollution dispersal screening model and wind direction to characterize the air emissions from UNGD facilities at each residence and (2) assess association of this exposure estimate with respiratory symptoms. Respiratory symptoms were abstracted from health records of a convenience sample of 104 adults from one county in southwestern PA who had completed a standard clinical interview with a nurse practitioner. Using publicly available air emission data, we applied a "box" air pollution dispersion screening model to estimate the median ambient air level of CO, NOx, PM 2.5, VOCs, and formaldehyde at the residence during the year health symptoms were reported. Sources and median emissions were categorized as north, south, east, or west of the residence to account for the effect of wind direction on dispersion. Binary logistic regression was performed for each respiratory symptom. Number of sources had varying magnitudes of association with some symptoms (i.e., cough, shortness of breath, and "any respiratory symptom") and no association with others (i.e., sore throat, sinus problems, wheezing). Air emissions were not associated with any symptom.
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Affiliation(s)
- David R Brown
- Southwest Pennsylvania Environmental Health Project, McMurray, PA, USA
| | - Lydia H Greiner
- Southwest Pennsylvania Environmental Health Project, McMurray, PA, USA
- San Diego State University, San Diego, CA, USA
| | - Beth I Weinberger
- Southwest Pennsylvania Environmental Health Project, McMurray, PA, USA
| | - Leslie Walleigh
- Southwest Pennsylvania Environmental Health Project, McMurray, PA, USA
| | - Dale Glaser
- San Diego State University, San Diego, CA, USA
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Engle B, Brogan-Hartlieb K, Obeso VT, Pedoussaut M, Hospital MM, Lupi CS, Esposito KC, Brown DR. From the Classroom to Entrustment - The Development of Motivational Interviewing Skills as an Entrustable Professional Activity. MedEdPublish (2016) 2019; 8:153. [PMID: 38440162 PMCID: PMC10911765 DOI: 10.15694/mep.2019.000153.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Introduction The move towards value-based care and population health has highlighted the prominent role of social and behavioral factors in determining health outcomes. Patient-centered behavioral guidance to improve patient self-management is recognized as an evidence-based intervention for a variety of chronic conditions but has yet to be adopted as a core competency or core entrustable professional activity (EPA). Motivational Interviewing (MI) is an evidence-based behavioral intervention involving an integrated set of competencies, featuring reflective listening, affirmation, evocation, and collaborative planning. An MI encounter is an observable, discrete task that can be framed as an EPA. Successful implementation of EPAs in the workplace requires institutional engagement, a thoughtful curricular approach, faculty development, and feasible, valid workplace-based assessment (WBA). Methods We implemented competency-based MI training and assessed competency outcomes for students and faculty. After joining the Association of American Medical Colleges Core EPA Pilot, we applied an iterative group process to develop an EPA and workplace-based assessment based on established MI competencies. Results Drawing upon nine years of developing MI curriculum, we present competency data for a student training study and a faculty coaching study, describe how we transitioned training from the classroom to the clinical setting employing an EPA framework, and present a one-page schematic and related WBA for an EPA based on MI. Conclusion We propose that MI is a core EPA for future physicians practicing value-based care, and offer a roadmap for curriculum implementation.
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Affiliation(s)
- Brett Engle
- Florida International University Herbert Wertheim College of Medicine
| | | | - Vivian T. Obeso
- Florida International University Herbert Wertheim College of Medicine
| | - Maryse Pedoussaut
- Florida International University Herbert Wertheim College of Medicine
| | | | | | - Karin C. Esposito
- Florida International University Herbert Wertheim College of Medicine
| | - David R. Brown
- Florida International University Herbert Wertheim College of Medicine
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May M, Brown DR. International Committee on Systematics of Prokaryotes Subcommittee on the taxonomy of Mollicutes: Minutes of the closed meeting, 8 July 2018, Portsmouth, New Hampshire, USA. Int J Syst Evol Microbiol 2019; 69:2169-2171. [PMID: 30856090 DOI: 10.1099/ijsem.0.003342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This report documents the International Committee on Systematics of Prokaryotes Subcommittee on the taxonomy of Mollicutes by recording the minutes of the meeting, held 8 July 2018, Portsmouth, New Hampshire, USA.
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Affiliation(s)
- M May
- 1University of New England, USA
| | - D R Brown
- 2University of Florida College of Veterinary Medicine, USA
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Abstract
The single greatest risk factor for neurodegenerative diseases is aging. Aging of cells such as microglia in the nervous system has an impact not only on the ability of those cells to function but also on cells they interact with. We have developed a model microglia system that recapitulates the dystrophic/senescent phenotype, and we have combined this with the study of β-amyloid processing. The model is based on the observation that aged microglia have increased iron content. By overloading a human microglial cell line with iron, we were able to change the secretory profile of the microglia. When combining these senescent microglia with SH-SY5Y cells, we noted an increase in extracellular β-amyloid. The increased levels of β-amyloid were due to a decrease in the release of insulin-degrading enzyme by the model senescent microglia. Further analysis revealed that the senescent microglia showed both decreased autophagy and increased ER stress. These studies demonstrate the potential impact of an aging microglial population in terms of β-amyloid produced by neurons, which could play a causal role in diseases like Alzheimer's disease. Our results also further develop the potential utility of an in vitro model of senescent microglia for the study of brain aging and neurodegenerative disease.
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Affiliation(s)
- Dafina M. Angelova
- Department of Biology and Biochemistry, University of Bath, Bath BA2 7AY, U.K
| | - David R. Brown
- Department of Biology and Biochemistry, University of Bath, Bath BA2 7AY, U.K
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Whitfield GP, Carlson SA, Ussery EN, Watson KB, Brown DR, Berrigan D, Fulton JE. Racial and ethnic differences in perceived safety barriers to walking, United States National Health Interview Survey - 2015. Prev Med 2018; 114:57-63. [PMID: 29894716 PMCID: PMC10886426 DOI: 10.1016/j.ypmed.2018.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 11/30/2022]
Abstract
Barriers to safe walking may prevent people from being physically active, and previous reports have identified differences in barriers to safe walking across racial and ethnic groups. The purpose of this research was to determine the role demographic characteristics play on racial/ethnic differences in perceived barriers to safe walking and determine if racial/ethnic differences vary by urban/rural residence and Census region. Participants in the 2015 National Health Interview Survey Cancer Control Supplement (n = 31,433 adults ≥18 years) reported perceived barriers to safe walking (traffic, crime, and animals) and demographic characteristics. Urban/rural residence and Census region were based on home addresses. We calculated adjusted prevalence of barriers by race/ethnicity using logistic regression; geographic differences in barriers across racial/ethnic groups were examined via interaction terms. After adjustment for demographic characteristics, non-Hispanic blacks (blacks) and Hispanics reported crime and animals as barriers more frequently than non-Hispanic whites (whites) (crime: blacks, 22.2%; Hispanics, 16.7%; whites, 9.0%; animals: blacks, 18.0%; Hispanics, 12.4%; whites, 8.5%). Racial/ethnic differences in perceived crime as a barrier were more pronounced in the Northeast and Midwest than in the South and West. Urban-dwelling blacks (all regions) and Hispanics (Midwest and South) reported animals as barriers more frequently than whites. Racial/ethnic differences in perceived barriers to safe walking remained after adjusting for demographic characteristics and varied by geographic location. Addressing perceived crime and animals as barriers to walking could help reduce racial/ethnic differences in physical activity, and several barriers may need to be assessed to account for geographic variation.
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Affiliation(s)
- Geoffrey P Whitfield
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway MS F-77, Atlanta, GA 30341, United States of America.
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway MS F-77, Atlanta, GA 30341, United States of America
| | - Emily N Ussery
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway MS F-77, Atlanta, GA 30341, United States of America
| | - Kathleen B Watson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway MS F-77, Atlanta, GA 30341, United States of America
| | - David R Brown
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway MS F-77, Atlanta, GA 30341, United States of America
| | - David Berrigan
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive MSC 7344 Room 3E522, Bethesda, MD 20892-7344, United States of America
| | - Janet E Fulton
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway MS F-77, Atlanta, GA 30341, United States of America
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Abstract
Emerging evidence indicates that proximity to unconventional oil and gas development (UOGD) is associated with health outcomes. There is intense debate about "How close is too close?" for maintaining public health and safety. The goal of this Delphi study was to elicit expert consensus on appropriate setback distances for UOGD from human activity. Three rounds were used to identify and seek consensus on recommended setback distances. The 18 panelists were health care providers, public health practitioners, environmental advocates, and researchers/scientists. Consensus was defined as agreement of ≥70% of panelists. Content analysis of responses to Round 1 questions revealed four categories: recommend setback distances; do not recommend setback distances; recommend additional setback distances for vulnerable populations; do not recommend additional setback distances for vulnerable populations. In Round 2, panelists indicated their level of agreement with the statements in each category using a five-point Likert scale. Based on emerging consensus, statements within each category were collapsed into seven statements for Round 3: recommend set back distances of <¼ mile; ¼-½ mile; 1-1 ¼ mile; and ≥ 2 mile; not feasible to recommend setback distances; recommend additional setbacks for vulnerable groups; not feasible to recommend additional setbacks for vulnerable groups. The panel reached consensus that setbacks of < ¼ mile should not be recommended and additional setbacks for vulnerable populations should be recommended. The panel did not reach consensus on recommendations for setbacks between ¼ and 2 miles. The results suggest that if setbacks are used the distances should be greater than ¼ of a mile from human activity, and that additional setbacks should be used for settings where vulnerable groups are found, including schools, daycare centers, and hospitals. The lack of consensus on setback distances between 1/4 and 2 miles reflects the limited health and exposure studies and need to better define exposures and track health.
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Affiliation(s)
- Celia Lewis
- Southwest Pennsylvania Environmental Health Project, New Haven, Connecticut, United States of America
| | - Lydia H. Greiner
- Southwest Pennsylvania Environmental Health Project, McMurray, Pennsylvania, United States of America
| | - David R. Brown
- Southwest Pennsylvania Environmental Health Project, New Haven, Connecticut, United States of America
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Peterson EL, Carlson SA, Schmid TL, Brown DR, Galuska DA. Supporting Active Living Through Community Plans: The Association of Planning Documents With Design Standards and Features. Am J Health Promot 2018; 33:191-198. [PMID: 29860864 DOI: 10.1177/0890117118779011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to examine the association between the presence of supportive community planning documents in US municipalities with design standards and requirements supportive of active living. DESIGN Cross-sectional study using data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living. SETTING Nationally representative sample of US municipalities. PARTICIPANTS Respondents are 2005 local officials. MEASURES Assessed: (1) The presence of design standards and feature requirements and (2) the association between planning documents and design standards and feature requirements supportive of active living in policies for development. ANALYSIS Using logistic regression, significant trends were identified in the presence of design standards and feature requirements by plan and number of supportive objectives present. RESULTS Prevalence of design standards ranged from 19% (developer dedicated right-of-way for bicycle infrastructure development) to 50% (traffic-calming features in areas with high pedestrian and bicycle volume). Features required in policies for development ranged from 14% (short/medium pedestrian-scale block sizes) to 44% (minimum sidewalk widths of 5 feet) of municipalities. As the number of objectives in municipal plans increased, there was a significant and positive trend ( P < .05) in the prevalence of each design standard and requirement. CONCLUSIONS Municipal planning documents containing objectives supportive of physical activity are associated with design standards and feature requirements supportive of activity-friendly communities.
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Affiliation(s)
- Erin L Peterson
- 1 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan A Carlson
- 1 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas L Schmid
- 1 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David R Brown
- 1 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deborah A Galuska
- 1 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Greer PJ, Brown DR, Brewster LG. In Reply to Kim. Acad Med 2018; 93:817-818. [PMID: 29846226 DOI: 10.1097/acm.0000000000002224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Pedro J Greer
- Professor and chair, Department of Humanities, Health, and Society, and associate dean, Community Engagement, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0001-6682-8204. Associate professor and chief, Division of Family and Community Medicine, and vice chair, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ; ORCID: http://orcid.org/0000-0002-5361-6664. Associate professor and chief, Division of Policy and Community Development, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0001-8067-3667
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Abstract
In September 2015, Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities (Call to Action) was released. This descriptive study reports the proportion of adults who responded to the 2016 Summer ConsumerStyles survey (N = 4,114) who identified walking as the activity the US Surgeon General recently promoted in the Call to Action to help Americans be more physically active. Less than half of adults (44%) correctly identified walking. Adults who were aged 18 to 24 years (35%), were male (43%), were non-Hispanic white (42%), or were physically inactive (36%) were less likely to identify walking than their counterparts. This study highlights an opportunity to raise awareness and promote the Call to Action, especially among certain populations.
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Affiliation(s)
- Gayathri Suresh Kumar
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341.
| | - Kathleen B Watson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David R Brown
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Carlson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Affiliation(s)
- Rebecca E Hasson
- Schools of Kinesiology and Public Health University of Michigan Ann Arbor, MI Physical Activity and Health Branch Division of Nutrition, Physical Activity and Obesity Centers for Disease Control and Prevention Atlanta, GA City College of New York New York, NY Department of Clinical Medicine College of Medicine University of Central Florida Orlando, FL Kinetics Consulting Bethesda, MD Gramercy Research Group Winston-Salem, NC Department of Exercise and Wellness School of Nutrition and Health Promotion Arizona State University Tempe, AZ Indiana University Center for Aging Research Regenstrief Institute, Inc. Indianapolis, IN
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Brown DR, Ballard R, Reedy J, Berrigan D, Samuels A. The National Collaborative on Childhood Obesity Research’s Measures Registry and User Guides. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536038.42599.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lyte M, Villageliú DN, Crooker BA, Brown DR. Symposium review: Microbial endocrinology-Why the integration of microbes, epithelial cells, and neurochemical signals in the digestive tract matters to ruminant health. J Dairy Sci 2018; 101:5619-5628. [PMID: 29550113 DOI: 10.3168/jds.2017-13589] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/07/2018] [Indexed: 12/14/2022]
Abstract
The union of microbiology and neurobiology, which has been termed microbial endocrinology, is defined as the study of the ability of microorganisms to produce and respond to neurochemicals that originate either within the microorganisms themselves or within the host they inhabit. It serves as the basis for an evolutionarily derived method of communication between a host and its microbiota. Mechanisms elucidated by microbial endocrinology give new insight into the ways the microbiota can affect host stress, metabolic efficiency, resistance to disease, and other factors that may prove relevant to the dairy industry.
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Affiliation(s)
- Mark Lyte
- Department of Veterinary Microbiology and Preventive Medicine, Iowa State University, Ames 50011.
| | - Daniel N Villageliú
- Department of Veterinary Microbiology and Preventive Medicine, Iowa State University, Ames 50011
| | - Brian A Crooker
- Department of Animal Science, University of Minnesota, St. Paul 55108
| | - David R Brown
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul 55108
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Vidovic S, Medihala P, Dynes JJ, Daida P, Vujanovic V, Hitchcock AP, Shetty D, Zhang H, Brown DR, Lawrence JR, Korber DR. Importance of the RpoE Regulon in Maintaining the Lipid Bilayer during Antimicrobial Treatment with the Polycationic Agent, Chlorhexidine. Proteomics 2018; 18. [PMID: 29280319 DOI: 10.1002/pmic.201700285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/23/2017] [Indexed: 12/28/2022]
Abstract
The emergence of multidrug resistance in bacteria has reached alarming levels. To solve this growing problem, discovery of novel cellular targets or pathways important for antimicrobial resistance is urgently needed. In this study, we explored how the alternative sigma factor, RpoE, protects Escherichia coli O157 against the toxic effects of the polycationic antimicrobial agent, chlorhexidine (CHX). Susceptibility of this organism to CHX was found to directly correlate to the growth rate, with the faster replicating wild-type being more susceptible to CHX than its more slowly replicating ΔrpoE O157 mutant. Once the wild-type and rpoE mutant strains had undergone growth arrest (entered the stationary growth phase), their resistance to CHX became entirely dependent on the functionality of RpoE. The RpoE regulon plays a critical role in maintaining the integrity of the asymmetric lipid bilayer of E. coli, thereby preventing the intracellular accumulation of CHX. Finally, using a single-cell, high-resolution, synchrotron-based approach, we discovered a subpopulation of the rpoE mutant strain with no detectable intracellular CHX, a predominant characteristic of the wild-type CHX-resistant population. This finding reveals a role of phenotypic heterogeneity in antimicrobial resistance.
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Affiliation(s)
- Sinisa Vidovic
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, USA
| | - Prabhakara Medihala
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - James J Dynes
- Canadian Light Source, Inc., University of Saskatchewan, Saskatoon, Canada
| | - Prasad Daida
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Vladimir Vujanovic
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Adam P Hitchcock
- Brockhouse Institute for Materials Research, McMaster University, Hamilton, Canada
| | - Deeksha Shetty
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Haixia Zhang
- Department of Plant Sciences, University of Saskatchewan, Saskatoon, Canada
| | - David R Brown
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, USA
| | | | - Darren R Korber
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
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Abstract
α-Synuclein (α-syn) is associated with a range of diseases, including Parkinson disease. In disease, α-syn is known to aggregate and has the potential to be neurotoxic. The association between copper and α-syn results in the formation of stellate toxic oligomers that are highly toxic to cultured neurons. We further investigated the mechanism of toxicity of α-syn oligomers. Cells that overexpress α-syn showed increased susceptibility to the toxicity of the oligomers, while those that overexpressed β-syn showed increased resistance to the toxic oligomers. Elevated α-syn expression caused an increase in expression of the transcription factor Forkhead box O3a (FoxO3a). Inhibition of FoxO3a activity by the overexpression of DNA binding domain of FoxO3a resulted in significant protection from α-syn oligomer toxicity. Increased FoxO3a expression in cells was shown to be caused by increased ferrireductase activity and Fe(II) levels. These results suggest that α-syn increases FoxO3a expression as a result of its intrinsic ferrireductase activity. The results also suggest that FoxO3a plays a pivotal role in the toxicity of both Fe(II) and toxic α-syn species to neuronal cells.-Angelova, D. M., Jones, H. B. L., Brown, D. R. Levels of α- and β-synuclein regulate cellular susceptibility to toxicity from α-synuclein oligomers.
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Affiliation(s)
- Dafina M Angelova
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Hannah B L Jones
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - David R Brown
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
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Brown DR, Carlson SA, Kumar GS, Fulton JE. Research highlights from the Status report for step it up! The surgeon general's call to action to promote walking and walkable communities. J Sport Health Sci 2018; 7:5-6. [PMID: 30356461 PMCID: PMC6180529 DOI: 10.1016/j.jshs.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 09/23/2017] [Indexed: 05/13/2023]
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Greer PJ, Brown DR, Brewster LG, Lage OG, Esposito KF, Whisenant EB, Anderson FW, Castellanos NK, Stefano TA, Rock JA. Socially Accountable Medical Education: An Innovative Approach at Florida International University Herbert Wertheim College of Medicine. Acad Med 2018; 93:60-65. [PMID: 28658020 PMCID: PMC5753826 DOI: 10.1097/acm.0000000000001811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PROBLEM Despite medical advances, health disparities persist, resulting in medicine's renewed emphasis on the social determinants of health and calls for reform in medical education. APPROACH The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Herbert Wertheim College of Medicine provides a platform for the school's community-focused mission. NeighborhoodHELP emphasizes social accountability and interprofessional education while providing evidence-based, patient- and household-centered care. NeighborhoodHELP is a required, longitudinal service-learning outreach program in which each medical student is assigned a household in a medically underserved community. Students, teamed with learners from other professional schools, provide social and clinical services to their household for three years. Here the authors describe the program's engagement approach, logistics, and educational goals and structure. OUTCOMES During the first six years of NeighborhoodHELP (September 2010-August 2016), 1,470 interprofessional students conducted 7,452 visits to 848 households with, collectively, 2,252 members. From August 2012, when mobile health centers were added to the program, through August 2016, students saw a total of 1,021 household members through 7,207 mobile health center visits. Throughout this time, households received a variety of free health and social services (e.g., legal aid, tutoring). Compared with peers from other schools, graduating medical students reported more experience with clinical interprofessional education and health disparities. Surveyed residency program directors rated graduates highly for their cultural sensitivity, teamwork, and accountability. NEXT STEPS Faculty and administrators are focusing on social accountability curriculum integration, systems for assessing and tracking relevant educational and household outcomes, and policy analysis.
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Affiliation(s)
- Pedro J. Greer
- P.J. Greer Jr is professor and chair, Department of Humanities, Health, and Society, and associate dean, Community Engagement, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0001-6682-8204
| | - David R. Brown
- D.R. Brown is associate professor and chief, Division of Family and Community Medicine, and vice chair, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0002-5361-6664
| | - Luther G. Brewster
- L.G. Brewster is associate professor and chief, Division of Policy and Community Development, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0001-8067-3667
| | - Onelia G. Lage
- O.G. Lage is associate professor and vice chair, Education and Faculty Development, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0002-2121-4687
| | - Karin F. Esposito
- K.F. Esposito is professor, Department of Psychiatry and Behavioral Sciences, and associate dean, Curriculum and Medical Education, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0002-3988-235X
| | - Ebony B. Whisenant
- E.B. Whisenant is assistant professor, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0002-1100-1565
| | - Frederick W. Anderson
- F.W. Anderson is assistant professor and medical director, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0003-4750-5236
| | - Natalie K. Castellanos
- N.K. Castellanos is assistant professor, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0002-4393-4191
| | - Troy A. Stefano
- T.A. Stefano is consultant, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID: http://orcid.org/0000-0002-6972-5873
| | - John A. Rock
- J.A. Rock is professor, Department of Obstetrics and Gynecology, dean, Herbert Wertheim College of Medicine, and senior vice president, Health Affairs, Florida International University, Miami, Florida; ORCID: http://orcid.org/0000-0002-9970-8417
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