Publications by authors named "Kathryn Smith"

254 Publications

Use of Situational Judgment Tests to Teach Empathy, Assertiveness, Communication, and Ethics.

Am J Pharm Educ 2021 Nov 16:8761. Epub 2021 Nov 16.

University of Oklahoma, College of Pharmacy, Oklahoma City, Oklahoma.

The objectives of this study were to (1) develop SJT scenarios for use in teaching empathy, assertiveness, and interprofessional communication in second-year pharmacy (P2) students, and ethics in third-year (P3) pharmacy students, (2) determine if SJTs developed were effective at measuring student's communication skills and ethical judgment, (3) compare the performance of individual P3 students to the performance of teams of P3 students on the ethics SJT and (4) evaluate student feedback about SJTs as a teaching tool. Pharmacy faculty developed five SJT scenarios related to communications and five SJT scenarios related to ethics and piloted the scenarios with P2 and P3 students, respectively. P2 students completed SJTs individually while P3 students completed theirs individually and as a team. Scenarios and responses were discussed with faculty after completion of the SJT. Students completed a questionnaire to provide feedback on the SJT. The communications SJT was completed by 59 P2 students with a mean score of 67.5% and reliability of α=0.594. The ethics SJT was completed by 57 P3 students with a mean score of 80.1% and reliability of α=0.789. The ethics SJT was also completed by 10 teams of P3 students resulting in a mean score of 93.2%. Students indicated the SJT content was realistic and the tests provided the opportunity to reflect on how to approach challenging situations. SJTs were useful for teaching empathy, assertiveness, interprofessional communication, and ethics in pharmacy students. Future research should focus on predictive validity of SJTs for these content areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5688/ajpe8761DOI Listing
November 2021

Pain Management Considerations in Patients with Opioid Use Disorder Requiring Critical Care.

J Clin Pharmacol 2021 Nov 14. Epub 2021 Nov 14.

Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA.

The opioid epidemic has resulted in increased opioid-related critical care admissions, presenting challenges in acute pain management. Limited guidance exists in the management of critically ill patients with opioid use disorder (OUD). This narrative review provides the intensive care unit (ICU) clinician with guidance and treatment options, including non-opioid analgesia, for patients receiving medications for opioid use disorder (MOUD) and for patients actively misusing opioids. Verification and continuation of the patient's outpatient MOUD regimen, specifically buprenorphine and methadone formulations, assessment of pain and opioid withdrawal, and treatment of acute pain with non-opioid analgesia, nonpharmacologic strategies, and short-acting opioids as needed, are all essential to adequate management of acute pain in patients with OUD. A multidisciplinary approach to treatment and discharge planning in patients with OUD may be beneficial to engage patients with OUD early in their hospital stay to prevent withdrawal, stabilize their OUD, and to reduce the risk of unplanned discharge and other associated morbidity. This article is protected by copyright. All rights reserved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jcph.1999DOI Listing
November 2021

Affective response to binge eating as a predictor of binge eating disorder treatment outcome.

Clin Psychol Sci 2021 Jul 13;9(4):752-760. Epub 2021 Apr 13.

Department of Biobehavioral Research, Sanford Health, Fargo, ND.

This report examined baseline affective response to binge eating as a predictor of binge-eating disorder (BED) treatment outcome. Baseline affective response was defined as: (1) each individual's average net change (i.e., area under the curve [AUC]) of positive affect (PA) or negative affect (NA) before and after binge-eating episodes and (2) post-binge eating slope of PA or NA across seven-days of ecological momentary assessment (EMA). Adults with BED completed Integrative Cognitive-Affective Therapy (ICAT-BED) or cognitive behavioral therapy guided self-help (CBTgsh). Individuals with greater net increases in PA (AUC) following binge eating at baseline exhibited better treatment response in ICAT-BED at end-of-treatment and follow-up. NA affective response was only significant at end-of-treatment; individuals with less rapid post-binge improvements in NA (slope) did better in ICAT-BED, while individuals with lower net improvements in NA (AUC) did better in CBTgsh. Affective response to binge eating may be a marker of BED treatment response.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2167702620985198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579466PMC
July 2021

Master-planned communities in the United States as novel contexts for individual and population-level research.

Prev Med 2021 Nov 3;154:106864. Epub 2021 Nov 3.

Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches Research Building, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA; Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA. Electronic address:

It has long been known that social and physical environments can shape individual and population health, for better or worse. Master-planned communities (MPCs) in the US are custom-designed residential neighborhoods with defined boundaries planned and developed under a single, private owner or entity from their inception. Across the US, these vary greatly in scale ranging from 100 to over 50,000 homes, but broadly all provide residents with housing, infrastructure, landscaping, and purpose-built facilities to support socialization. Current research in the urban planning literature suggests that MPCs can influence the health of their residents. However, few studies have examined the use of MPCs as settings to conduct individual or population health research. In this paper, we examine the potential of MPCs as context for observational or intervention studies aimed at understanding individual and population-level health and well-being. We first summarize links between built and social environment and individual and population health research. Next, we describe the history of planned communities in the US. Then, we review specific features of MPCs related to governance, development, design, and social structure. We end by exploring how those specific features may lead to potential opportunities and challenges when using MPCs in health research. Through this discussion, we highlight MPCs as overlooked settings that may offer potential for collaborative, innovative, and socially engaged health research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ypmed.2021.106864DOI Listing
November 2021

Momentary affective response to bouts of moderate-to-vigorous physical activity predicts changes in physical activity and sedentary behavior during behavioral weight loss.

Psychol Sport Exerc 2021 Nov 11;57. Epub 2021 Sep 11.

Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI, USA.

Background: Affective responses are posited to be key predictors of the uptake and maintenance of health behaviors. However, few studies have examined how individuals' affective response to physical activity, as well as the degree to which their affect response changes, may predict changes in physical activity and sedentary time during behavioral weight loss treatment.

Purpose: The current study examined how baseline momentary affective response (i.e., stress and anxiety) to moderate-to-vigorous physical activity (MVPA) and the degree of pre--post intervention change in this response predicted change in daily sedentary, light, and MVPA time during a three-month internet-based weight loss program.

Methods: Women with overweight/obesity (final =37) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after the intervention.

Results: Women who had more reinforcing responses to MVPA (i.e., greater reductions in anxiety and stress response following MVPA bouts) at baseline had greater increases in overall MVPA at the end of the intervention. Those who had greater anxiety reductions after MVPA bouts at baseline also evidenced less sedentary time at the end of the intervention. Changes in affective responses across the intervention were not related to changes in physical activity levels.

Conclusions: Findings suggest initial levels of affective reinforcement from MVPA bouts predict future change in MVPA and sedentary time during behavioral weight loss. Future work is needed to examine the utility of more precisely targeting affective responses to physical activity to optimize intervention approaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychsport.2021.102056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562688PMC
November 2021

Computational Screening of Physical Solvents for CO Pre-combustion Capture.

J Phys Chem B 2021 Nov 4. Epub 2021 Nov 4.

National Energy Technology Laboratory, 626 Cochrans Mill Road, P.O. Box 10940, Pittsburgh, Pennsylvania 15236-0940, United States.

A computational scheme was used to screen physical solvents for CO pre-combustion capture by integrating the commercial NIST database, an in-house computational database, chem-informatics, and molecular modeling. A commercially available screened hydrophobic solvent, diethyl sebacate, was identified from the screening with favorable physical properties and promising absorption performance. The promising performance to use diethyl sebacate in CO pre-combustion capture has also been confirmed from experiments. Water loading in diethyl sebacate is very low, and therefore, water is kept with H in the gas stream. The favorable CO interaction with diethyl sebacate and the intermediate solvent free volume fraction leads to both high CO solubility and high CO/H solubility selectivity in diethyl sebacate. An in-house NETL computational database was built to characterize CO, H, N, and HO interactions with 202 different chemical functional groups. It was found that 13% of the functional groups belong to the strong interaction category with the CO interaction energy between -15 and -21 kJ/mol; 62% of the functional groups interact intermediately with CO (-8 to -15 kJ/mol). The remaining 25% of functional groups interact weakly with CO (below -8 kJ/mol). In addition, calculations show that CO interactions with the functional groups are stronger than N and H interactions but are weaker than HO interactions. The CO and HO interactions with the same functional groups exhibit a very strong linear positive correlation coefficient of 0.92. The relationship between CO and H gas solubilities and solvent fractional free volume (FFV) has been systematically studied for seven solvents at 298.2 K. A skewed bell-shaped relation was obtained between CO solubility and solvent FFV. When an organic compound has a density approximately 10% lower than its density at 298.2 K and 1 bar, it exhibits the highest CO loading at that specific solvent density and FFV. Note that the solvent densities were varied using simulations, which are difficult to be obtained from the experiment. In contrast, H solubility results exhibit an almost perfect positive linear correlation with the solvent FFV. The theoretical maximum and minimum physical CO solubilities in any organic compound at 298.2 K were estimated to be 11 and 0.4 mol/MPa L, respectively. An examination of 182 experimental CO physical solubility data and 29 simulated CO physical solubilities shows that all the CO physical solubility data are within the maximum and minimum with only a few exceptions. Finally, simulations suggest that in order to develop physical solvents with both high CO solubility and high CO/H solubility selectivity, the solvents should contain functional groups which are available to interact strongly with CO while minimizing FFV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/acs.jpcb.1c07268DOI Listing
November 2021

External food cue responsiveness and emotional eating in adolescents: A multimethod study.

Appetite 2021 Oct 30:105789. Epub 2021 Oct 30.

Research Center for Health Equity, Cedars-Sinai Medical Center, 700 N. San Vicente Blvd., West Hollywood, CA, 90069, USA.

Eating in response to external food cues (i.e., external eating) and internal emotional experiences (i.e., emotional eating) are associated with obesity. While external and emotional eating co-occur, little is known about how external food cue responsiveness may interact with internal emotional cues to influence eating episodes in adolescents. The current study examined how trait-level external food cue responsiveness modulates momentary associations between affective states and eating in adolescents. Participants were drawn from a prior study of siblings (N = 78; ages 13-17) who completed an ecological momentary assessment protocol to assess eating episodes and affective states. External food cue responsiveness was determined by comparing energy consumption following presentation of an appetizing food (pizza) on one day and a control activity (reading) on another day. Generalized linear mixed models examined positive and negative affective states, cue responsiveness, and their interactions as predictors of the likelihood of eating. The relationship between affective states and likelihood of eating was stronger among adolescents with higher versus lower external food cue responsiveness. Among adolescents with higher cue responsiveness, endorsing negative affect was associated with a lower likelihood of eating, whereas endorsing positive affect was associated with a higher likelihood of eating (within-person effects). Findings suggest that high sensitivity to external food cues and greater proclivity for emotional eating may be likely to coincide such that any cue, internal or external, is likely to disrupt sensitivity to internal hunger and satiety signals. Future studies are needed to elucidate how sensitivities to internal and external cues may interact to influence obesity risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.appet.2021.105789DOI Listing
October 2021

Socioeconomic impacts of marine heatwaves: Global issues and opportunities.

Science 2021 10 22;374(6566):eabj3593. Epub 2021 Oct 22.

Marine Biological Association of the United Kingdom, The Laboratory, Citadel Hill, Plymouth, PL1 2PB, UK.

[Figure: see text].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/science.abj3593DOI Listing
October 2021

Characterization of Differentially Expressed miRNAs by CXCL12/SDF-1 in Human Bone Marrow Stromal Cells.

Biomol Concepts 2021 Oct 13;12(1):132-143. Epub 2021 Oct 13.

Department of Orthopedics, Augusta University, Augusta, GA.

Stromal cell-derived factor 1 (SDF-1) is known to influence bone marrow stromal cell (BMSC) migration, osteogenic differentiation, and fracture healing. We hypothesize that SDF-1 mediates some of its effects on BMSCs through epigenetic regulation, specifically via microRNAs (miRNAs). MiRNAs are small non-coding RNAs that target specific mRNA and prevent their translation. We performed global miRNA analysis and determined several miRNAs were differentially expressed in response to SDF-1 treatment. Gene Expression Omnibus (GEO) dataset analysis showed that these miRNAs play an important role in osteogenic differentiation and fracture healing. KEGG and GO analysis indicated that SDF-1 dependent miRNAs changes affect multiple cellular pathways, including fatty acid biosynthesis, thyroid hormone signaling, and mucin-type O-glycan biosynthesis pathways. Furthermore, bioinformatics analysis showed several miRNAs target genes related to stem cell migration and differentiation. This study's findings indicated that SDF-1 induces some of its effects on BMSCs function through miRNA regulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/bmc-2021-0015DOI Listing
October 2021

Dynamic associations between anxiety, stress, physical activity, and eating regulation over the course of a behavioral weight loss intervention.

Appetite 2021 Sep 21;168:105706. Epub 2021 Sep 21.

Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI, USA.

Negative emotional experiences are associated with dysregulated eating behaviors that impede weight management. While weight loss interventions promote physical activity and self-regulation of eating, no studies have examined how physical activity may directly influence eating by attenuating associations between negative emotions and eating.

Objective: The current study examined how momentary negative emotions (stress and anxiety), moderate-to-vigorous intensity physical activity (MVPA), and their interactions predict eating dysregulation (i.e., intensity of eating temptations, inability to resist eating tempting foods, overeating), as well as how these associations change during a weight loss intervention.

Methods: Women with overweight/obesity (N = 55) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after a three-month internet-based weight loss program.

Results: Three-way interactions emerged predicting overeating and eating tempting foods. When women experienced higher than usual levels of momentary anxiety or stress at end-of-treatment, they were less likely to subsequently overeat or eat tempting foods when they had recently engaged in more MVPA (relative to their usual level). No significant associations were found for ratings of temptation intensity.

Conclusions: Findings suggest MVPA may exert direct effects on eating regulation. Specifically, MVPA appears to increasingly buffer the effect of negative emotional states on dysregulated eating behavior over the course of a weight loss intervention. Future work is needed to develop ways of communicating to patients how activity can have both indirect and direct effects on body weight, and examine whether such knowledge improves outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.appet.2021.105706DOI Listing
September 2021

Expressed emotion and long-term outcome among adolescents with anorexia nervosa.

Int J Eat Disord 2021 11 22;54(11):2019-2024. Epub 2021 Sep 22.

Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.

Objective: The purpose of the current study is to examine expressed emotion (EE) and long-term treatment outcome among adolescents participating in a randomized controlled trial (RCT) for treatment of anorexia nervosa (AN). It was hypothesized that patients with high EE parents at baseline would show more severe symptoms at end-of-treatment, 12-month follow-up, and 4-year follow-up than patients from low EE families.

Method: Secondary data analysis was conducted of original RCT data from a two-site eating disorder treatment trial conducted in the United States. Participants were 121 adolescents with AN who completed measures of EE, eating disorder psychopathology, depression, and self-esteem.

Results: Generalized estimating equations showed that participants who were in the Low EE group achieved a more accelerated drop in depression scores in the context of treatment (first 12 months) than participants in the High EE group. No other significant Group × Time interactions were found.

Discussion: Findings suggest that high parental EE at baseline does not indicate that adolescent patients with AN will fare poorly 4 years later.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/eat.23613DOI Listing
November 2021

Examining prospective mediational relationships between momentary rumination, negative affect, and binge eating using ecological momentary assessment.

J Affect Disord Rep 2021 Jul 28;5. Epub 2021 Mar 28.

Sanford Center for Bio-Behavioral Research, Sanford Health, Faro, North Dakota, United States.

Background: Rumination is linked to negative affect (NA), and there is accumulating support for an association between rumination and eating disorder (ED) behaviors. However, no research has examined the dynamic interrelationships between negative affect, rumination, and binge eating in naturalistic settings.

Methods: The present study used ecological momentary assessment (EMA) to assess the hypotheses that momentary rumination would mediate relationships between NA and binge eating, and momentary NA would mediate relationships between rumination and binge eating. Given that rumination may be focused on weight, shape, and food in ED samples, models were examined separately for general and ED-specific rumination. Forty women completed a 10-day EMA protocol that included measures of NA, general and ED-specific rumination, and binge eating.

Results: Multilevel mediation models indicated significant within-subjects indirect effects, such that momentary general rumination mediated the association between NA and binge eating, and NA also mediated the association between general but not ED-specific rumination and binge eating. Between-subjects effects indicated women with higher overall NA reported greater ED-specific rumination, which was associated with greater binge eating.

Limitations: The study was limited by a modest sample size, and the design precludes causal inferences.

Conclusions: Results highlight the momentary interplay between rumination and NA as a mechanism underlying binge eating, as well as the specificity of ruminative thought content in relationship to binge eating. Future work is needed to address the construct of rumination in the context of eating disorder interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jadr.2021.100138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8388245PMC
July 2021

Photoreactive hydrogel stiffness influences volumetric muscle loss repair.

Tissue Eng Part A 2021 Aug 19. Epub 2021 Aug 19.

University of Virginia, 2358, Chemical Engineering, Biomedical Engineering, Charlottesville, Virginia, United States;

Volumetric muscle loss (VML) injuries are characterized by permanent loss of muscle mass, structure, and function. Hydrogel biomaterials provide an attractive platform for skeletal muscle tissue engineering due to the ability to easily modulate their biophysical and biochemical properties to match a range of tissue characteristics. In this work we successfully developed a mechanically tunable hyaluronic acid (HA) hydrogel system to investigate the influence of hydrogel stiffness on VML repair. HA was functionalized with photoreactive norbornene groups to create hydrogel networks that rapidly crosslink via thiol-ene click chemistry with tailored mechanics. Mechanical properties were controlled by modulating the amount of matrix metalloproteinase (MMP)-degradable peptide crosslinker to produce hydrogels with increasing elastic moduli of 1.1 ± 0.002, 3.0 ± 0.002, and 10.6 ± 0.006 kPa mimicking a relevant range of developing and mature muscle stiffnesses. Functional muscle recovery was assessed following implantation of the HA hydrogels by photopolymerization into rat latissimus dorsi (LD) VML defects at 12 and 24 weeks post-injury. After 12 weeks, muscles treated with medium stiffness (3.0 kPa) hydrogels produced maximum isometric forces most similar to contralateral healthy LD muscles. This trend persisted at 24 weeks post-injury, suggestive of sustained functional recovery. Histological analysis revealed a significantly larger zone of regeneration with more muscle fibers following implantation of medium stiffness hydrogels in VML-injured muscles compared to other experimental groups. Lower (low and medium) stiffness hydrogels also appeared to attenuate the chronic inflammatory response characteristic of VML injuries, displaying similar levels of macrophage infiltration and polarization to healthy muscle. Together these findings illustrate the importance of hydrogel mechanical properties in supporting functional repair of VML injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/ten.TEA.2021.0137DOI Listing
August 2021

Using the acquired preparedness model to explore the role of eating expectancies and impulsivity in binge eating.

Eat Disord 2021 Aug 12:1-10. Epub 2021 Aug 12.

Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, California, US.

The acquired preparedness (AP) model of eating disorder (ED) risk suggests transaction between impulsive traits and eating expectancies, though there remains a lack of research investigating distinct facets of impulsivity within this framework. This study examined how different facets of impulsivity moderate associations between eating expectancies and binge-eating severity in daily life. Women with binge-eating symptoms ( = 40) completed surveys followed by 10 days of ecological momentary assessment (EMA). Generalized estimating equations examined the independent and interactive effects of impulsivity facets and eating expectancies on EMA-measured binge-eating severity. Significant interactions were found between eating expectancies and emotional and behavioral impulsivity, but not a cognitive facet. Results suggest that among women high in emotional impulsivity, those with greater eating expectancies report higher binge-eating severity. Conversely, among those with lower behavioral impulsivity, those with lower eating expectancies report lower binge-eating severity. Future prospective work is needed with non-clinical samples.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10640266.2021.1924924DOI Listing
August 2021

Multi-state modeling of thought-shape fusion using ecological momentary assessment.

Body Image 2021 Aug 3;39:139-145. Epub 2021 Aug 3.

Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States.

Body dissatisfaction (BD) and preoccupation with thoughts of food (PTF) are intertwined and are components of thought-shape fusion. Thought-shape fusion describes the process by which PTF lead to beliefs about weight and shape. To study thought-shape fusion in daily life and explore various transitions between BD and PTF, 30 women with binge eating completed ecological momentary assessment for 14 days. BD and PTF were assessed using continuous rating scales at each prompt. Multi-state modeling, which analyzes micro-temporal transitions between discrete states, was used to examine transitions among four states created with BD and PTF ratings. The four states included low BD/low PTF, low BD/high PTF, high BD/low PTF, and high BD/high PTF. Affect and disordered eating were examined as covariates of state transitions. Results showed high BD states were self-perpetrating, such that when in high BD states, transition to low BD states were less likely. Regarding covariates, positive affect buffered against maladaptive transitions whereas negative affect and disordered eating increased risk. Findings highlighted high BD states as influential, and negative affect and disordered eating as risk factors and positive affect as preventive. This study enhances theory of thought-shape fusion and implicates transitions from BD to PTF as possible underlying transitions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bodyim.2021.07.002DOI Listing
August 2021

Our Priorities Are Not Evolving, but Our Strategies Are.

Am J Pharm Educ 2021 Jul 22:8732. Epub 2021 Jul 22.

Pacific University, School of Pharmacy, Hillsboro, Oregon.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5688/ajpe8732DOI Listing
July 2021

Assessing professionalism in health profession degree programs: A scoping review.

Curr Pharm Teach Learn 2021 08 23;13(8):1078-1098. Epub 2021 Jun 23.

Department of Environmental and Global Health, University of Florida College of Public Health and Health Professions, P.O.Box 100175, Gainesville, FL 32610-0175, United States. Electronic address:

Background: To identify and classify methods for assessing professionalism across health profession degree programs and identify gaps in the literature regarding types of assessments.

Methods: The authors conducted a scoping review of articles published from database inception through 24 January 2020. Included articles described an assessment approach for professionalism in health profession degree programs available in full-text in the English language. Articles were classified based on profession, timing of assessment, feedback type, assessment type, professionalism dimension, and Barr's modified Kirkpatrick hierarchy.

Results: Authors classified 277 articles meeting inclusion criteria. Most articles were from medical education (62.5%) conducted during didactic (62.1%) or experiential/clinical curriculum (49.8%). Few articles (15.5%) described longitudinal assessment. Feedback type was formative (32.2%) or summative (35%), with only 8.3% using both. Assessment types frequently reported included self-administered rating scales (30%), reflections (18.8%), observed clinical encounters (17.3%), and knowledge-based tests (13.4%). Ethical practice principles (65%) and effective interactions with patients (48.4%) were the most frequently assessed dimensions of professionalism. Authors observed balanced distribution among Barr's modified Kirkpatrick model at levels of reaction (38.3%), modification of perceptions and attitudes (33.6%), acquisition of knowledge and skills (39%), and behavioral change (36.1%).

Implications: The classification scheme identified in current literature on professionalism assessment does not align with International Ottawa Conference Working Group on the Assessment of Professionalism recommendations. Gaps identified were limited description of professionalism assessment during admissions, infrequent longitudinal assessment, limited use of methods for both formative and summative assessment, and limited reports of assessments applicable to interprofessional education settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cptl.2021.06.006DOI Listing
August 2021

Improved pyrrolysine biosynthesis through phage assisted non-continuous directed evolution of the complete pathway.

Nat Commun 2021 06 24;12(1):3914. Epub 2021 Jun 24.

Department of Biosciences, Rice University, Houston, TX, USA.

Pyrrolysine (Pyl, O) exists in nature as the 22 proteinogenic amino acid. Despite being a fundamental building block of proteins, studies of Pyl have been hindered by the difficulty and inefficiency of both its chemical and biological syntheses. Here, we improve Pyl biosynthesis via rational engineering and directed evolution of the entire biosynthetic pathway. To accommodate toxicity of Pyl biosynthetic genes in Escherichia coli, we also develop Alternating Phage Assisted Non-Continuous Evolution (Alt-PANCE) that alternates mutagenic and selective phage growths. The evolved pathway provides 32-fold improved yield of Pyl-containing reporter protein compared to the rationally engineered ancestor. Evolved PylB mutants are present at up to 4.5-fold elevated levels inside cells, and show up to 2.2-fold increased protease resistance. This study demonstrates that Alt-PANCE provides a general approach for evolving proteins exhibiting toxic side effects, and further provides an improved pathway capable of producing substantially greater quantities of Pyl-proteins in E. coli.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41467-021-24183-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225853PMC
June 2021

Psychiatric Comorbidity Associated with Eating Disorders in 9- to 10-year-old Children.

Can J Psychiatry 2021 Jun 18:7067437211026485. Epub 2021 Jun 18.

Department of Psychiatry and Behavioral Sciences, 5116University of Southern California, Los Angeles, CA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/07067437211026485DOI Listing
June 2021

A Tryptophan-Deficient Diet Induces Gut Microbiota Dysbiosis and Increases Systemic Inflammation in Aged Mice.

Int J Mol Sci 2021 May 8;22(9). Epub 2021 May 8.

Department of Medicine, Augusta University, Augusta, GA 30912, USA.

The gut microflora is a vital component of the gastrointestinal (GI) system that regulates local and systemic immunity, inflammatory response, the digestive system, and overall health. Older people commonly suffer from inadequate nutrition or poor diets, which could potentially alter the gut microbiota. The essential amino acid (AA) tryptophan (TRP) is a vital diet component that plays a critical role in physiological stress responses, neuropsychiatric health, oxidative systems, inflammatory responses, and GI health. The present study investigates the relationship between varied TRP diets, the gut microbiome, and inflammatory responses in an aged mouse model. We fed aged mice either a TRP-deficient (0.1%), TRP-recommended (0.2%), or high-TRP (1.25%) diet for eight weeks and observed changes in the gut bacterial environment and the inflammatory responses via cytokine analysis (IL-1a, IL-6, IL-17A, and IL-27). The mice on the TRP-deficient diets showed changes in their bacterial abundance of Coriobacteriia class, genus, Lachnospiraceae family, species, sp genus, and genus. Further, these mice showed significant increases in IL-6, IL-17A, and IL-1a and decreased IL-27 levels. These data suggest a direct association between dietary TRP content, the gut microbiota microenvironment, and inflammatory responses in aged mice models.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijms22095005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125914PMC
May 2021

Using network analysis to compare diagnosis-specific and age-specific symptom networks in eating disorders.

Int J Eat Disord 2021 08 5;54(8):1463-1476. Epub 2021 May 5.

Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany.

Objective: The network theory of mental disorders conceptualizes eating disorders (EDs) as networks of interacting symptoms. Network analysis studies in EDs mostly have examined transdiagnostic and/or mixed age samples. The aim of our study was to investigate similarities and differences of networks in adolescents and adults with anorexia nervosa (AN) or bulimia nervosa (BN).

Method: Participants were 2,535 patients (n = 991 adults with AN, n = 821 adolescents with AN, n = 473 adults with BN, and n = 250 adolescents with BN) who completed the Eating Disorder Inventory-2. Twenty-seven items were selected. Cross-sectional networks were estimated via Joint Graphical Lasso. Core symptoms were identified using strength centrality. Spearman correlations and network comparison tests (NCTs) were used to compare groups.

Results: Across diagnoses and ages, feeling ineffective, desire to be thinner, worries that feelings will get out of control, guilt after overeating as well as doing things perfectly emerged as most central symptoms. There were moderate to high correlations between symptom profiles (0.62-0.97, mean: 0.78) as well as high correlations between network structures (0.83-0.93, mean: 0.87) and network strengths (0.73-0.95, mean: 0.85). Global strength significantly differed in two of the six NCTs, and 2.5-10% of edges differed between networks.

Discussion: Considerable similarities in network structures and strengths across diagnoses and ages speak in favor of the transdiagnostic approach to EDs. Besides drive for thinness, ineffectiveness, emotion regulation difficulties, and perfectionism might be the most consistent factors in ED networks. These symptoms as well as their symptom connections should be especially focused in treatment regardless of age and diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/eat.23523DOI Listing
August 2021

Methadone bioavailability and dose conversion implications with intravenous and enteral administration: A scoping review.

Am J Health Syst Pharm 2021 07;78(15):1395-1401

Department of Pharmacy, Critical Care, Maine Medical Center, Portland, ME, USA.

Purpose: Despite its availability for more than 70 years, many details concerning methadone remain contentious, such as the dosing equivalents for intravenous and enteral administration. A scoping review was performed to evaluate whether existing literature on methadone bioavailability in human subjects support the current recommendation that an equivalent enteral dose is twice the intravenous dose.

Methods: A librarian-assisted search of the PubMed and EMBASE databases identified all English-language articles with the terms methadone and bioavailability and/or conversion in the title or abstract published from inception though December 2019. A manual search of references was also performed to identify any additional articles. Studies were included in a scoping review if they were published in English and evaluated methadone bioavailability in human subjects.

Results: Among 65 publications initially identified, 6 studies involving a total of 50 patients were included in the review. Bioavailability data for healthy volunteers and patients with opioid use disorder, metastatic cancer, chronic pain from malignant or nonmalignant disease were available for analysis. The pooled mean (95% confidence interval) bioavailability (F) was 85.4% (75.2%-95.6%), with heterogeneity (I2) of 0. In the 4 studies that provided individual patient-level data, F was >50% in 40 of 42 patient measurements (95.2%) and ≥75% in 33 of 42 patient measurements (78.6%).

Conclusion: Available evidence suggests the bioavailability of methadone is generally more than 75%, there is limited evidence for the currently recommended 1:2 ratio (intravenous:enteral), and a more appropriate dosing ratio may be 1:1.3. This scoping review underscores the need for further research to establish an effective and safe ratio when converting between intravenous and enteral dosing formulations of methadone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ajhp/zxab166DOI Listing
July 2021

Re-initiation of CT colonography services during the COVID-19 pandemic: Preliminary evaluation of safety.

Br J Radiol 2021 May 9;94(1121):20201316. Epub 2021 Apr 9.

Gastrointestinal Imaging Group, University Hospitals Leicester NHS Trust, Leicester, United Kingdom.

Objective: The COVID-19 pandemic has led to cancellation and deferral of many cancer investigations, including CT colonography (CTC). In May 2020, BSGAR and SCoR issued guidelines outlining steps for conduct of CTC in the early recovery phase. We evaluated the implementation of these in four English hospital trusts.

Methods: Ethical permission was not required for this multicentre service evaluation. We identified patients undergoing CTC over a 2-month period from May to July 2020 at four Trusts. We recorded demographics, scan indications, colonic findings, and incidental lung base changes compatible with COVID-19. A subset of patients were contacted via telephone to document new symptoms 2 weeks following their scan. Staff were contacted to determine if any acquired COVID-19 during the period.

Results: 224 patients (118 male, 52.7%) were scanned during the period. In 55 patients (24.6%), CTC showed a ≥6 mm polyp. 33 of 224 (14.7%) scans showed incidental lung base changes felt unrelated to COVID-19, and only one patient had changes indeterminate for COVID-19; no classic COVID-19 pulmonary changes were found. Of 169 patients with telephone follow-up, none reported any new symptoms of COVID-19 (cough, fever, anosmia, ageusia) within 14 days of CTC. None of the 86 staff contacted developed COVID-19.

Conclusion: We found no cases of patients or staff acquiring COVID-19 infection following CTC; and no evidence of significant asymptomatic COVID-19 patients attending for CTC appointments based on lung base changes.

Advances In Knowledge: Our findings suggest that current practice is unlikely to contribute significantly to spread of SARS-nCOV2. Cancer and significant polyp detection rates were high, underlining the importance of maintaining service provision.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1259/bjr.20201316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8506191PMC
May 2021

Naturalistic assessment of patterns and predictors of acute headache medication use among women with comorbid migraine and overweight or obesity.

Transl Behav Med 2021 08;11(8):1495-1506

Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, RI, USA.

Given the potential for obesity to complicate migraine treatment outcomes, there is a need to understand patterns and correlates of acute medication use among individuals with this comorbidity. Experience sampling methodology (ESM) was used to characterize patterns of acute medication use among those with migraine and overweight/obesity and to examine individual and momentary factors related to medication use (both migraine-specific and nonspecific medications). Women with migraine and overweight/obesity (N = 170) seeking behavioral migraine treatment completed questionnaires followed by 28 days of daily ESM headache diaries. Participants used medications to treat 71.9% of attacks, 20% of which were treated with migraine-specific medications. Participants were more likely to use medication in the context of longer and more severe attacks that started earlier in the day. Presence of aura and greater work-related pain interference uniquely related to migraine-specific medication use. Questionnaire-assessed factors were not related to medication use, although older age and higher educational attainment related to more frequent use. A substantial proportion of attacks were left untreated, suggesting unmet treatment needs in this population. Results also suggest that ESM-assessed factors are more salient correlates of medication use compared to questionnaires. Additional investigation of barriers to medication use is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/tbm/ibab027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8604266PMC
August 2021

Differences in Affective Dynamics Among Eating Disorder Diagnostic Groups.

Clin Psychol Sci 2020 09 23;8(5):857-871. Epub 2020 Jun 23.

Department of Psychiatry, University of California, San Francisco; San Francisco, CA.

Emotion regulation theories suggest that affect intensity is crucial in the development and maintenance of eating disorders. However, other aspects of emotional experience, such as lability, differentiation, and inertia, are not as well understood. This study is the first to use ecological momentary assessment (EMA) to examine differences in several daily negative affect (NA) indicators among adults diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). Using EMA data from three large studies, a series of linear mixed models showed that participants in the AN and BN groups experienced significantly greater NA intensity and better emotion differentiation than participants in the BED group. Alternatively, the BN group demonstrated significantly greater NA lability than the AN group and greater NA inertia than the BED group. These results suggest that several daily affective experiences differ among eating disorders diagnostic groups and have implications towards distinct conceptualizations and treatments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2167702620917196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983702PMC
September 2020

Examining the roles of emotion dysregulation and impulsivity in the relationship between psychological trauma and substance abuse among women with bulimic-spectrum pathology.

Eat Disord 2021 May-Jun;29(3):276-291. Epub 2021 Mar 16.

Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA.

Individuals with bulimia nervosa report elevated rates of childhood maltreatment, which appears to increase risk for co-occurring substance use problems and negatively impact clinical course. The current study sought to examine the mechanistic pathways by which specific forms of childhood maltreatment may give rise to substance use problems among individuals with bulimic-spectrum pathology. Women with bulimic-spectrum disorders ( = 204) completed measures of childhood trauma, emotion dysregulation, impulsivity, and substance use. Path analysis was used to examine emotion dysregulation and impulsivity as mediators of the relationship between distinct forms of childhood trauma (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and the presence of problematic alcohol/drug use. In the full path model, significant pathways from childhood emotional abuse to emotion dysregulation, childhood emotional neglect to impulsivity, and emotion dysregulation to problematic substance use emerged. Further, emotion dysregulation significantly mediated the relationship between emotional abuse and substance use. Results indicate that emotion dysregulation may be an important mechanism linking a history of childhood emotional maltreatment to later eating and substance use problems, and therefore may be an important treatment target among individuals with co-occurring eating and substance use concerns.Childhood emotional abuse was related to greater emotion dysregulation.Childhood emotional neglect was related to greater impulsivity.Emotion dysregulation was related to greater problematic substance use.Emotional abuse may impact substance use through emotion dysregulation.Creating emotion dysregulation may improve substance and eating disorder symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10640266.2021.1891370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373646PMC
October 2021

Donor-Specific and Auto-Antibodies in Pediatric Liver Transplant: When Are They Important? What Do They Mean?

J Pediatr Gastroenterol Nutr 2021 05;72(5):643-644

Department of Pediatrics, University of California San Francisco.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MPG.0000000000003093DOI Listing
May 2021

Incidence of Urinary Tract Infections in Newborns with Spina Bifida-Is Antibiotic Prophylaxis Necessary?

J Urol 2021 07 8;206(1):126-132. Epub 2021 Mar 8.

Division of Urology, Duke University Medical Center, Durham, North Carolina.

Purpose: Urinary tract infections commonly occur in patients with spina bifida and pose a risk of renal scarring. Routine antibiotic prophylaxis has been utilized in newborns with spina bifida to prevent urinary tract infections. We hypothesized that prophylaxis can safely be withheld in newborns with spina bifida until clinical assessment allows for risk stratification.

Materials And Methods: Newborns with myelomeningocele at 9 institutions were prospectively enrolled in the UMPIRE study and managed by a standardized protocol with a strict definition of urinary tract infection. Patient data were collected regarding details of reported urinary tract infection, baseline renal ultrasound findings, vesicoureteral reflux, use of clean intermittent catheterization and circumcision status in boys. Risk ratios and corresponding 95% confidence intervals were calculated using log-binomial models.

Results: From February 2015 through August 2019 data were available on 299 newborns (50.5% male). During the first 4 months of life, 48 newborns (16.1%) were treated for urinary tract infection with 23 (7.7%) having positive cultures; however, only 12 (4.0%) met the strict definition of urinary tract infection. Infants with grade 3-4 hydronephrosis had an increased risk of urinary tract infection compared to infants with no hydronephrosis (RR=10.1; 95% CI=2.8, 36.3). Infants on clean intermittent catheterization also had an increased risk of urinary tract infection (RR=3.3; 95% CI=1.0, 10.5).

Conclusions: The incidence of a culture positive, symptomatic urinary tract infection among newborns with spina bifida in the first 4 months of life was low. Patients with high grades of hydronephrosis or those on clean intermittent catheterization had a significantly greater incidence of urinary tract infection. Our findings suggest that routine antibiotic prophylaxis may not be necessary for most newborns with spina bifida.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JU.0000000000001690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268042PMC
July 2021

Discrimination and Eating Disorder Psychopathology: A Meta-Analysis.

Behav Ther 2021 03 30;52(2):406-417. Epub 2020 May 30.

University of Southern California, Los Angeles.

Eating disorders occur in diverse populations, and discrimination may be a specific factor that is related to higher eating disorder psychopathology among marginalized individuals. To evaluate the current evidence on this topic, a meta-analysis was used to quantitatively synthesize the literature on discrimination and eating disorder psychopathology across a heterogeneous range of studies. Searches were conducted in peer-reviewed journals and accessible unpublished dissertations of all years through January 2020. Studies were coded by two authors using a tailored coding form, and zero-order bivariate correlations were used as effect size measures. There were 55 cross-sectional studies extracted for inclusion in the meta-analysis. Results showed a small-to-medium association between discrimination and eating disorder psychopathology that was consistent across domains. Effect sizes were typically higher for weight discrimination. For binge eating and general eating disorder pathology, effects were smaller in studies that had larger proportions of women, and for binge eating only, effects were higher in college samples. These findings could suggest that discrimination represents a contributory factor related to eating disorder psychopathology across types of discrimination and eating disorder psychopathology. Implications are discussed for future research on discrimination and psychopathology including possible mechanisms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.beth.2020.05.003DOI Listing
March 2021

Pain, eating behavior, and weight outcomes in adolescent girls.

Int J Eat Disord 2021 05 16;54(5):893-897. Epub 2021 Feb 16.

Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA.

Objective: In adults, pain is prospectively associated with overweight/obesity and concurrently associated with dysregulated eating, with evidence for stronger associations in women than men. This study aimed to evaluate whether similar associations among pain response, BMI, and loss of control (LOC) eating are also evident in adolescent girls.

Method: Girls (n = 202) completed the cold pressor test (CPT) at age 10, and BMI and LOC eating were assessed annually from ages 10-16 years. Generalized linear models were used to test associations between pain tolerance (total immersion time) and threshold (latency to highest pain rating), and changes in BMI and LOC eating.

Results: Lower pain tolerance and threshold at age 10 were associated with increases in LOC eating from age 10 to 16 (tolerance: B < -.01, SE < .01, p = .005; threshold: B = -.03, SE = .01, p = .0118). No significant associations were observed between pain tolerance/threshold and increasing BMI.

Discussion: Pain responsivity in childhood is associated with increases in dysregulated eating from childhood to adolescence. These findings provide support for the early development of an interface between pain and eating behaviors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/eat.23484DOI Listing
May 2021
-->