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The objective of this study was to gain knowledge and ascertain challenges about periviability counseling among obstetricians to inform curricular development. Focus groups were utilized. A series of open-ended questions was posed to each group of obstetricians; responses were audio recorded and transcribed. Transcriptions were analyzed by two coders using thematic analysis. Four focus groups were convened. Prominent themes included: (1) Obstetrician knowledge about neonatal outcomes is limited, (2) Periviability counseling is both time intensive and time-challenged, (3) Patient processing of information relies on the content, delivery and patient readiness, and (4) Obstetrician bias is toward advocating for maternal safety, which may run counter to parental instinct to "do everything." The last theme was specifically focused on the role of cesarean delivery. Curricula focused on improving obstetrician periviability counseling should focus on neonatal outcomes, the role of cesarean delivery, and utilization of shared decision-making. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare maternity leave satisfaction between physicians and nonphysicians. Currently, paid maternal leave is not guaranteed in the United States, resulting in palpable dissatisfaction among parents. Previous studies have shown associations between length of paid leave and career satisfaction and maternal happiness. Materials and Methods: A Qualtrics® electronic survey was distributed to female professionals through email and social media from April 2019 to March 2020. Inclusion criterion was ≥1 child by birth or adoption, or active pregnancy. Continuous and categorical data were analyzed using two-sample t-test and chi-square, respectively. Results: Of 808 respondents, 77% were physicians. Mean age at birth/adoption of first child was higher in physicians versus nonphysicians (32.1 years vs. 29.7 years; p < 0.001). Physicians took shorter maternity leave than nonphysicians (10.9 weeks vs. 12.0 weeks, p = 0.017) with half of that time paid by employers (5.4 weeks vs. 5.9 weeks, p = 0.2). Dissatisfaction was high among physicians (85.1%) and nonphysicians (92.4%) that correlates with maternity leave compensation dissatisfaction (49% vs. 71.3%, p < 0.001). Thirty-four percent of physicians versus 41% of nonphysicians stated that their health was negatively impacted by maternity leave length. Physicians and nonphysicians reported similar incidences of depression, and breastfeeding, delivery, and other postpartum complications. When queried, 38.8% of physicians and 57% of nonphysicians said they would desire >16 weeks of paid maternity leave (p < 0.001). Conclusions: In conclusion, dissatisfaction among professional women on maternity leave duration and compensation is high in the United States. Given health implications for both mother and child, this should invite further discussion and changes. [ABSTRACT FROM AUTHOR]

Contends that early childhood educators need to understand how exposure to computers and constructive computer programs affects the development of children. Specifically examines: (1) research on children's technology experiences; (2) determining best practices; and (3) addressing educators' concerns about computers replacing other developmentally appropriate activities, difficulty levels, social effects, student control, and stifled creativity; and (4) teacher role. (SD)

Histone deacetylase 3 (HDAC3) contributes to the regulation of gene expression, chromatin structure, and genomic stability. Because HDAC3 associates with oncoproteins that drive leukemia and lymphoma, we engineered a conditional [...]

Many doctors how work in a hospital do not discuss medical errors during morbidity and mortality conferences, according to doctors who observed 332 conferences. Surgery conferences were much more likely to discuss medical errors than internal medicine conferences. Morbidity and mortality conferences are often held every day, where groups of doctors discuss a particular case.

Introduction: Barriers to research participation by racial and ethnic minority group members are multi-factorial, stem from historical social injustices and occur at participant, research team, and research process levels. The informed consent procedure is a key component of the research process and represents an opportunity to address these barriers. This manuscript describes the development of the Strengthening Translational Research in Diverse Enrollment (STRIDE) intervention, which aims to improve research participation by individuals from underrepresented groups. Methods: We used a community-engaged approach to develop an integrated, culturally, and literacy-sensitive, multi-component intervention that addresses barriers to research participation during the informed consent process. This approach involved having Community Investigators participate in intervention development activities and using community engagement studios and other methods to get feedback from community members on intervention components. Results: The STRIDE intervention has three components: a simulation-based training program directed toward clinical study research assistants that emphasizes cultural competency and communication skills for assisting in the informed consent process, an electronic consent (eConsent) framework designed to improve health-related research material comprehension and relevance, and a "storytelling" intervention in which prior research participants from diverse backgrounds share their experiences delivered via video vignettes during the consent process. Conclusions: The community engaged development approach resulted in a multi-component intervention that addresses known barriers to research participation and can be integrated into the consent process of research studies. Results of an ongoing study will determine its effectiveness at increasing diversity among research participants. [ABSTRACT FROM AUTHOR]

Introduction: The updated common rule, for human subjects research, requires that consents "begin with a 'concise and focused' presentation of the key information that will most likely help someone make a decision about whether to participate in a study" (Menikoff, Kaneshiro, Pritchard. The New England Journal of Medicine. 2017; 376(7): 613–615.). We utilized a community-engaged technology development approach to inform feature options within the REDCap software platform centered around collection and storage of electronic consent (eConsent) to address issues of transparency, clinical trial efficiency, and regulatory compliance for informed consent (Harris, et al. Journal of Biomedical Informatics 2009; 42(2): 377–381.). eConsent may also improve recruitment and retention in clinical research studies by addressing: (1) barriers for accessing rural populations by facilitating remote consent and (2) cultural and literacy barriers by including optional explanatory material (e.g., defining terms by hovering over them with the cursor) or the choice of displaying different videos/images based on participant's race, ethnicity, or educational level (Phillippi, et al. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2018; 47(4): 529–534.). Methods: We developed and pilot tested our eConsent framework to provide a personalized consent experience whereby users are guided through a consent document that utilizes avatars, contextual glossary information supplements, and videos, to facilitate communication of information. Results: The eConsent framework includes a portfolio of eight features, reviewed by community stakeholders, and tested at two academic medical centers. Conclusions: Early adoption and utilization of this eConsent framework have demonstrated acceptability. Next steps will emphasize testing efficacy of features to improve participant engagement with the consent process. [ABSTRACT FROM AUTHOR]

Objective: To discuss the study design and data analysis for three‐phase interrupted time series (ITS) studies to evaluate the impact of health policy, systems, or environmental interventions. Simulation methods are used to conduct power and sample size calculation for these studies. Methods: We consider the design and analysis of three‐phase ITS studies using a study funded by National Institutes of Health as an exemplar. The design and analysis of both one‐arm and two‐arm three‐phase ITS studies are introduced. Results: A simulation‐based approach, with ready‐to‐use computer programs, was developed to determine the power for two types of three‐phase ITS studies. Simulations were conducted to estimate the power of segmented autoregressive (AR) error models when autocorrelation ranged from −0.9 to 0.9 with various effect sizes. The power increased as the sample size or the effect size increased. The power to detect the same effect sizes varied largely, depending on testing level change, trend changes, or both. Conclusion: This article provides a convenient tool for investigators to generate sample sizes to ensure sufficient statistical power when three‐phase ITS study design is implemented. [ABSTRACT FROM AUTHOR]

Outcomes: 1. Learn about the Massachusetts Medical Schools' Collaborative's toolbox of educational competencies and curriculum mapping in serious illness communication, with examples on using the tools to improve curricula at each school 2. Generate ideas and strategies for developing educational activities at your own institution that promote learners' acquisition of palliative care skills, regardless of their future discipline All clinicians require a sophisticated set of serious illness communication (SIC) skills to ensure high-quality, humanistic care for patients and families from diverse communities as they face life-changing medical decisions at vulnerable times in their lives. However, most clinicians are not trained in SIC and, as former students, learned these concepts "on the fly" or in electives. The Massachusetts Medical Schools' Collaborative was created to change this paradigm and ensure all students receive foundational SIC training. The collaborative includes faculty, administrators, and students from four schools (Boston University School of Medicine, Harvard Medical School, Tufts University School of Medicine, and UMass Chan Medical School) and is convened by the Massachusetts Coalition for Serious Illness Care, a group of over 125 member organizations focused on equity in serious illness care. Our collaborative seeks to develop longitudinal, developmentally based curricula in SIC. We first developed and published five educational SIC competencies. We then created a standardized curriculum mapping process to understand existing educational activities across schools and opportunities to fill gaps defined by the competencies. The collaborative also conducted focus groups with 50 fourth-year medical students; among key themes, students viewed SIC as essential, yet described their exposure as based mostly on "luck" if they were included in family meetings or coached on SIC. Armed with the competencies, curricular mapping, and focus group data, leaders at each school are expanding curricula in SIC and palliative care based on local needs and resources. Presenters will use most of the session to share concrete examples of curriculum design and implementation based on the collaborative's toolbox, which will be available for participants to bring to their own institutions. As a field, we can make this critical investment in the next generation of clinicians and create educational best practices to help build more trustworthy, equitable healthcare systems. [ABSTRACT FROM AUTHOR]

Marine alginates are well established in wound management. Compared with different modern wound dressings, marine alginates cannot prove superior effects on wound healing. Alginates from bacteria have never been studied for medical applications so far, although the microbial polymer raises expectations for improved binding of wound factors because of its unique O-acetylation. Due to its possible positive effects on wound healing, alginates from bacteria might be a superior future medical product for clinical use. To prove the binding capacity of microbial alginates to pathophysiological factors in chronic wounds, we processed microbial alginate fibres, produced from fermentation of the soil bacterium Azotobacter vinelandii ATCC 9046, into needle web dressings and compared them with commercial dressings made of marine alginate. Four dressings were assessed: Marine alginate dressings containing either ionic silver or zinc/manganese/calcium, and microbial alginate dressings with and without nanosilver. All dressings were tested in an in vitro approach for influence on chronic wound parameters such as elastase, matrix metalloproteases-2, tumour necrosis factor-α, interleukin-8, and free radical formation. Despite the alginate origin or addition of antimicrobials, all dressings were able to reduce the concentration of the proinflammatory cytokines TNF-α and IL-8. However, microbial alginate was found to bind considerable larger amounts of elastase and matrix metalloproteases-2 in contrast to the marine alginate dressings. The incorporation of zinc, silver or nanosilver into alginate fibres did not improve their binding capacity for proteases or cytokines. The addition of nanosilver slightly enhanced the antioxidant capacity of microbial alginate dressings, whereas the marine alginate dressing containing zinc/manganese/calcium was unable to inhibit the formation of free radicals. The enhanced binding affinity by microbial alginate of Azotobacter vinelandii to pathophysiological factors may be interesting to support optimal conditions for wound healing. [ABSTRACT FROM AUTHOR]