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Background: History and health humanities instruction offers a framework for professional students to examine the arc and development of their profession as well as develop cultural competencies. Exploring ideas, themes, and health care practices and approaches through historical instruction can show students how culture influences health care and practice, therefore providing a context for further development of cultural competence skills. Case Presentation: This case report describes a collaboration among a dentistry course instructor, a liaison librarian, and curators of a rare book collection. Working together, this team offers an active learning class that examines the historical arc of the dental profession. We aim to have students use primary source materials to examine the experiences, research, and narratives of their profession. Discussion: Using a World Cafe with thematic tables allows students to safely examine rare materials and artifacts and have meaningful conversations about themes that are critical to dentistry’s past, present, and future. Students reported that engaging with artifacts and historical materials provided a different way to understand history and enhanced their learning experience. Engaging students in this work builds critical thinking skills that are essential to evidence-based practice.

Societal Impact Statement Increasing evidence indicates gene flow commonly occurs between closely related species in diverse plant genera and can involve numerous species. Here, we present a simple method to quantify and characterize the potential for gene flow among “sympatric” species (they share some part of their geographic distribution), using oaks as a case study. The resulting sympatry networks provide insight into potential interspecific gene flow, from the perspective of each species and across the entire suite of interfertile species. In a rapidly changing world, interspecific gene flow will play an increasingly important role in the conservation of endangered species, both positive and negative. Summary We provide a simple method, using geographic distribution data, to quantify and characterize sympatry networks among a suite of interfertile species to assess potential routes for introgressive hybridization (IH). Sympatry is a necessary condition for IH and is easily determined from widely available geographic distribution data. Oaks, famous for hybridization, present an excellent case study. We use county‐level data for 94 oak species in the contiguous US states to determine patterns of sympatry of species within the four sections, assumed to be interfertile. The pairwise sympatry relationships can generate species‐centric local networks or a syngameon‐wide network. Two different measures of sympatry are used: proportional and relative. Most oak species are exposed to IH from many species, with red oaks having slightly higher local levels of sympatry (5.7 vs. 3.8 spp per county) than white oaks but lower total numbers of sympatric species (13.7 vs. 14.8). The nature of potential IH generally differs for threatened species, which are often embedded in the much larger distributions of widespread species. Potential IH within oak sections is widespread and disproportionately affects rare species. Given that IH has potentially positive or negative impacts on species cohesion, persistence, and adaptation, the geographic connections among species and the ‘local sympatry effect’ can serve as a springboard for hypothesis generation and genetic investigation of introgression patterns.

Societal Impact Statement Understanding the current state of trees within the United States is imperative for protecting those species, their habitats, and the countless communities they support, as well as the ecosystem services they provide. We present an updated checklist of all tree species native to the contiguous United States, their state distribution, extinction risk, and most common threats. Knowledge of national threat “hotspots” and conservation priorities facilitates efficient conservation efforts and the allocation of resources to safeguard the 11–16% of US tree species that are threatened. These results lay the groundwork for tree and ecosystem conservation efforts in the United States that contribute to achieving critical international conservation goals, including the United Nations Decade for Ecosystem Restoration and the Global Tree Assessment. Summary The Global Tree Assessment aims to complete threat assessments for all the world's ~60,000 tree species, but most species native to the continental United States had either never been assessed or were outdated on the two most widely used threat assessment platforms in the United States, International Union for the Conservation of Nature (IUCN) Red List and NatureServe. There was also no coordinated mechanism for sharing data between these platforms, resulting in missing, duplicated, or outdated information. We (1) created an updated checklist of all tree species native to the contiguous United States based on the standardized Global Tree Assessment tree definition, (2) created over 700 new or updated IUCN Red List assessments and NatureServe Global Ranks, and (3) developed a replicable assessment data sharing process. We present an updated checklist of native US trees that includes 881 species from 269 genera, with Quercus and Crataegus as the most species‐rich tree genera. We present the first country‐wide analysis of tree extinction risk, patterns of geographic and taxonomic diversity, and leading threats. An estimated 11–16% of US tree species are threatened with extinction, with the most common threat being invasive and problematic pests and diseases. We introduce a “crosswalk” process for efficient, large‐scale data sharing between the IUCN Red List and NatureServe, using IUCN Red List Species Information Service (SIS) Connect, which can be applied to other taxonomic groups in North America. The checklist, threat assessments, and crosswalk methodology represent a significant advancement in prioritizing conservation action for at‐risk tree species and restoration of forests in the United States, supporting the global goals of the United Nations Decade for Ecosystem Restoration and the Global Tree Assessment effort.

BackgroundFreely available and asynchronous implementation supports can reduce the resource burden of evidence-based practice training to facilitate uptake. Freely available web-based training videos have proliferated, yet there have been no efforts to quantify their breadth, depth, and content for suicide prevention. ObjectiveThis study presents results from a scoping review of freely available training videos for suicide prevention and describes a methodological framework for reviewing such videos. MethodsA scoping review of freely available training videos (≥2 minutes) for suicide prevention practices was conducted using 4 large video-sharing platforms: YouTube, Vimeo, Bing Video, and Google Video. Identified suicide prevention training videos (N=506) were reviewed and coded. ResultsMost content was targeted toward gatekeepers or other lay providers (n=370) versus clinical providers (n=136). Videos most commonly provided content related to suicidal thoughts or behaviors (n=420). Many videos (n=274, 54.2%) included content designed for certain communities or organizations. Less than half (n=232, 45.8%) of training videos included formal clinical content pertaining to assessment or intervention for suicide prevention. ConclusionsResults suggested an abundance of videos providing broad informational content (eg, “signs and symptoms of someone at risk for suicide”) and a limited portion of videos with instructional content aimed at clinical providers delivering formal evidence-based assessments or interventions for suicide prevention. Development of resources to address identified gaps may be needed. Future work may leverage machine learning techniques to expedite the review process.

Introduction: Reflective writing, an exercise where students respond to a prompt in writing and then read their writing aloud in class, is a core component of Narrative Medicine. Student writings often reveal truths about their own experiences moving through medical education, including the identity transformation they experience. Method: The purpose of this study was to ask fourth-year medical students (N=15) enrolled in Narrative Medicine elective courses at two large U.S. Midwestern medical schools to reflect on their medical school experience. The students were asked to write a letter in response to the following prompt: “if you could tell your 1st day of medical school self anything, what would it be?” Results: Through thematic analysis, the authors identified three major themes in these letters, including student reflections of medical school as a journey, identity transformation and identity management within medical school, and the value of important relationships and the role they play in the medical student experience. Discussion: We conclude the paper with a discussion on what we can learn from these student letters, calling for more attention to the vulnerability of students as they progress through medical school and more research on the kinds of transformation students experience. Medical students can be vulnerable, and the system that has been created for them to develop into empathetic, skilled physicians often contributes to that vulnerability. Therefore, institutions should not only allow students to reflect and give voice to their experience, but also encourage a reimagining of certain aspects of medical education.

Abstract Although the genetic diversity and structure of in situ populations has been investigated in thousands of studies, the genetic composition of ex situ plant populations has rarely been studied. A better understanding of how much genetic diversity is conserved ex situ, how it is distributed among locations (e.g., botanic gardens), and what minimum sample sizes are needed is necessary to improve conservation outcomes. Here we address these issues in a threatened desert oak species, Quercus havardii Rydb. We assess the genetic, geographic, and ecological representation of 290 plants from eight ex situ locations, relative to 667 wild individuals from 35 in situ locations. We also leverage a recent dataset of >3000 samples from 11 other threatened plants to directly compare the degree of genetic conservation for species that differ in geographic range size. We found that a majority of Q. havardii genetic diversity is conserved; one of its geographic regions is significantly better conserved than the other; genetic diversity conservation of this widespread species is lower than documented for the 11 rarer taxa; genetic diversity within each garden is strongly correlated to the number of plants and number of source populations; and measures of geographic and ecological conservation (i.e., percent area and percent of ecoregions represented) were typically lower than the direct assessment of genetic diversity (i.e., percent alleles). This information will inform future seed sampling expeditions to ensure that the intraspecific diversity of threatened plants can be effectively conserved.

Abstract Background Closing mucosal defects to reach mucosal healing is an important goal of therapy in inflammatory bowel disease (IBD). Among other cells, monocyte‐derived macrophages are centrally involved in such intestinal wound healing. We had previously demonstrated that the anti‐α4β7 integrin antibody vedolizumab blocks the recruitment of non‐classical monocytes as biased progenitors of wound healing macrophages to the gut and delays wound healing. However, although important for the interpretation of disappointing results in recent phase III trials in IBD, the effects of the anti‐β7 antibody etrolizumab on wound healing are unclear so far. Methods We analyzed the expression of etrolizumab targets on human and mouse monocyte subsets by flow cytometry and assessed their function in adhesion and homing assays. We explored wound‐associated monocyte recruitment dynamics with multiphoton microscopy and compared the effects of etrolizumab and vedolizumab surrogate (‐s) antibodies on experimental wound healing and wound‐associated macrophage abundance. Finally, we investigated wound healing macrophage signatures in the large intestinal transcriptome of patients with Crohn's disease treated with etrolizumab. Results Human and mouse non‐classical monocytes expressed more αEβ7 integrin than classical monocytes and were a target of etrolizumab‐s, which blocked non‐classical monocyte adhesion to MAdCAM‐1 and E‐Cadherin as well as gut homing in vivo. Intestinal wound healing was delayed on treatment with etrolizumab‐s along with a reduction of peri‐lesional wound healing macrophages. Wound healing macrophage signatures in the colon of patients with Crohn's disease were substantially down‐regulated on treatment with etrolizumab, but not with placebo. Conclusions Combined blockade of αEβ7 and α4β7 with etrolizumab seems to exceed the effect of anti‐α4β7 treatment on intestinal wound healing, which might help to inform further investigations to understand the recent observations in the etrolizumab phase III trial program.

Abstract The translation of research findings into clinical practice is challenging, especially fields like in pediatric rheumatology, where the evidence base is limited, there are few clinical trials, and the conditions are rare and heterogeneous. Implementation science methodologies have been shown to reduce the research- to- practice gap in other clinical settings may have similar utility in pediatric rheumatology. This paper describes the key discussion points from the inaugural Childhood Arthritis and Rheumatology Research Alliance Implementation Science retreat held in February 2020. The aim of this report is to synthesize those findings into an Implementation Science Roadmap for pediatric rheumatology research. This roadmap is based on three foundational principles: fostering curiosity and ensuring discovery, integration of research and quality improvement, and patient-centeredness. We include six key steps anchored in the principles of implementation science. Applying this roadmap will enable researchers to evaluate the full range of research activities, from the initial clinical design and evidence acquisition to the application of those findings in pediatric rheumatology clinics and direct patient care.

Abstract Background Vedolizumab has become a standard treatment for the inflammatory bowel diseases ulcerative colitis (UC) and Crohn’s disease (CD). However, there is an ongoing debate on the ideal individual treatment algorithms and means to predict treatment response are not routinely established. Aims We aimed to describe our experiences with vedolizumab at a large German tertiary referral center and to identify clinical predictors of success of vedolizumab treatment. Methods We performed a retrospective single-center cohort study employing univariable and multivariable analyses as well as Kaplan–Meier analyses of persistence on treatment. Results 36% and 35% of the patients with UC and CD, respectively, reached clinical remission after 17 weeks. Patients with lower clinical disease activity were more likely to achieve remission. The median persistence on treatment was 33 months for UC and 29 months for CD. Conclusion Our study confirms that vedolizumab is an efficient option for the treatment of UC and CD. Clinical parameters of disease activity may help to predict the success of treatment.

Abstract Background While the number of therapeutic options for treating inflammatory bowel diseases (IBD) is increasing, evidence for rational treatment decisions is scarce in many cases. In particular, appropriate biomarkers to predict the response to the anti-α4β7 integrin antibody vedolizumab are currently lacking. Methods We performed a cohort study with 21 patients suffering from ulcerative colitis (UC), in which first-time treatment with vedolizumab was initiated. CD4+ T cells were isolated from the peripheral blood and dynamic adhesion to recombinant mucosal vascular addressin cell adhesion molecule (MAdCAM-)1 in vitro as well as the effect of vedolizumab on such adhesion in vitro was determined. The expression of α4β1 integrin on peripheral blood CD4+ T cells was quantified by flow cytometry. Electronic patient records were reviewed to determine clinical response to vedolizumab. Results Dynamic adhesion of peripheral blood CD4+ T cells to MAdCAM-1 and the reduction of adhesion following vedolizumab treatment in vitro were higher and the change in α4β1 expression on CD4+ T cells was different in vedolizumab responders and non-responders. Responders could be identified with high specificity and positive-predictive value. Conclusions Determining dynamic adhesion of CD4+ T cells to MAdCAM-1 and the in vitro response to vedolizumab before treatment initiation or dynamic integrin regulation in the early course of treatment seem to be promising tools to predict the clinical response to vedolizumab therapy. Larger prospective studies are warranted.

Genetic studies must enroll large numbers of participants to obtain adequate statistical power. Data are needed on how researchers can best use limited financial and practical resources to achieve these targets, especially in under-represented populations. This paper provides a retrospective analysis of the recruitment strategies for a large glaucoma genetics study in African Americans. The Primary Open-Angle African American Glaucoma Genetics study enrolled 10,192 African American subjects from the Philadelphia region. Major recruitment approaches included clinic enrollment from University of Pennsylvania (UPenn) sites, clinic enrollment from external sites, sampling of Penn Medicine Biobank (PMBB), and community outreach. We calculated the enrollment yield, cost per subject, and seasonal trends of these approaches. The majority (65%) of subject were enrolled from UPenn sites with an average cost of $133/subject. Over time, monthly case enrollment declined as the pool of eligible subjects was depleted. Expanding to external sites boosted case numbers ($129/subject) and the biobank provided additional controls at low cost ($5/subject), in large part due to the generosity of PMBB providing samples free of cost. Community outreach was costly with low return on enrollment ($978/subject for 220 subjects). Summer months (Jun-Aug) produced the highest recruitment yields (p

Background: The anti-α4β7 integrin antibody vedolizumab is an established therapeutic option for the treatment of inflammatory bowel disease (IBD). It has also been successfully used in patients with chronic antibiotic-refractory pouchitis following proctocolectomey with ileal pouch-anal anastomosis. However, the expression and function of gut-homing markers as well as strategies to predict the response to vedolizumab in pouchitis are understudied so far. Methods: We used flow cytometry and dynamic adhesion assays to study the expression and function of gut-homing integrins on T cells from patients with pouchitis and controls as well as longitudinally during therapy of pouchitis with vedolizumab. Moreover, we describe clinical effects of vedolizumab in a cohort of patients with pouchitis. Results: T cells from patients with pouchitis express a specific profile of gut-homing integrins. Integrin α4β7 on T cells from patients with pouchitis mediates adhesion to mucosal addressin cell adhesion molecule (MAdCAM)-1, which can be blocked by vedolizumab in vitro . Vedolizumab efficiently treats pouchitis in a portion of patients and response correlates with dynamic adhesion profiles to MAdCAM-1. Conclusion: Our data suggest that T cell trafficking seems to be important for the pathogenesis of pouchitis and support the therapeutic use of vedolizumab. Integrin function might serve as a biomarker to predict response to vedolizumab.

Cryopreservation is increasingly important as a conservation tool, particularly for threatened exceptional species. The goal of this study was to investigate the current knowledge of plant cryopreservation through a search of the literature in Web of Science and align that with the 775 species currently identified on the Working List of Exceptional Plants. While there is a good foundation in plant cryopreservation research, particularly with economically important species, there are significant gaps in research on families that contain the largest numbers of currently known exceptional species, including the Dipterocarpaceae, Rhizophoraceae, and Pittosporaceae. Even families well represented in both in the literature and on the List of Exceptional Plants had much less overlap at the level of genus. Tropical trees, a significant portion of exceptional species, were not as well represented in the literature as herbaceous species. Over 70% of all articles dealt with in vitro cryopreservation, with much less emphasis on other methods (seed, embryo, dormant bud, and pollen) that will be more cost-effective for species where they can be applied. While the research on plant cryopreservation to date provides a strong foundation and is being utilized effectively for conserving the diversity of a number of economically important species, this study revealed significant gaps that can help prioritize future research to more effectively conserve the diversity of threatened exceptional species.

Inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and ulcerative colitis (UC) are multifactorial diseases with still unknown aetiology and an increasing prevalence and incidence worldwide. Despite plentiful therapeutic options for IBDs, the lack or loss of response in certain patients demands the development of further treatments to tackle this unmet medical need. In recent years, the success of the anti-α4β7 antibody vedolizumab highlighted the potential of targeting the homing of immune cells, which is now an important pillar of IBD therapy. Due to its complexity, leukocyte trafficking and the involved molecules offer a largely untapped resource for a plethora of potential therapeutic interventions. In this review, we aim to summarise current and future directions of specifically interfering with immune cell trafficking. We will comment on concepts of homing, retention and recirculation and particularly focus on the role of tissue-derived chemokines. Moreover, we will give an overview of the mode of action of drugs currently in use or still in the pipeline, highlighting their mechanisms and potential to reduce disease burden.

BackgroundInfection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a wide range of symptoms including gastrointestinal manifestations, and intestinal epithelial cells are a target of the virus. However, it is unknown how the intestinal immune system contributes to systemic immune responses in coronavirus disease 2019 (COVID-19).MethodsWe characterized peripheral blood lymphocytes from patients with active COVID-19 and convalescent patients as well as healthy controls by flow cytometry.ResultsThe frequency and absolute number of circulating memory T and B cells expressing the gut homing integrin α4β7 integrin was reduced during COVID-19, whether gastrointestinal symptoms were present or not. While total IgA-expressing B cells were increased, gut-imprinted B cells with IgA expression were stable.ConclusionCOVID-19 is associated with a decrease in circulating adaptive immune cells expressing the key gut homing marker α4β7 suggesting that these cells are preferentially recruited to extra-intestinal tissues independently of α4β7 or that the systemic immune response against SARS-CoV-2 is at least numerically dominated by extraintestinal, particularly pulmonary, immune cell priming.

Our objective was to determine which messaging approaches from a marketing campaign were most effective in recruiting African American individuals to a glaucoma screening and research study. We conducted a multimedia marketing campaign in Philadelphia from 01/31/2018 to 06/30/2018. Messaging approaches included radio advertisements and interviews (conducted in partnership with a local radio station with a large African American listener base), print materials, event tables, and online postings. Participants received free glaucoma screenings and the opportunity to enroll in our glaucoma genetics study. These screenings allowed individuals with glaucoma to receive a full examination and treatment plan with a glaucoma specialist, as well as to contribute to future efforts to identify genetic variants underlying this disease. We compared inquiry, enrollment, and cost yield for each messaging approach. Our campaign resulted in 154 unique inquiries, with 98 patients receiving glaucoma screenings (64%) and 60 patients enrolling in our study (39%). Commercials on WURD radio yielded the highest number of inquiries (62%) and enrollments (62%), but at relatively high cost ($814/enrolled patient). The most inexpensive approach that yielded more than five enrollments was postcards ($429/enrolled patient). Our campaign suggests that high-frequency commercials and postcards distributed at targeted healthcare locations are particularly effective and affordable options for connecting with the African American community. Our findings can help to inform recruitment efforts for other understudied diseases in minority populations. Keywords: African Americans, Minority populations, Marketing campaign, Ophthalmology, Glaucoma, Screenings, Blindness

Executive functions (EF) reached full maturity during the transition from adolescence to adulthood. Human studies provide important information about adolescent developmental trajectories; however, little remains known about the neural circuits underlying the acquisition of mature EF. Ethical and technical considerations with human subjects limit opportunities to design experimental studies that allows for an in-depth understanding of developmental changes in neural circuits that regulate cognitive maturation. Preclinical models can offer solutions to this problem. Unfortunately, current rodent models of adolescent development have inherent flaws that limit their translational value. For instance, females are often omitted from studies, preventing the assessment of potential sex-specific developmental trajectories. Furthermore, it remains unclear whether cognitive developmental changes in rodents are similar to those observed in humans. Here, we tested adolescent and adult male and female mice in a neurocognitive battery of assays. Based on this approach, we assessed mice performances within distinct subdomains of EF, and observed similarities with human developmental trajectories. Furthermore, the sex-specific cognitive changes we observed were paralleled by molecular and neural activity changes demonstrating that our approach can be used in future research to assess the contribution of precise neural circuits to adolescent cognitive maturation. Keywords: Executive functions, Adolescence, Prefrontal cortex, Striatum, Mice

Background: Anti-integrin therapy is a new frontline strategy in the treatment of inflammatory bowel diseases (IBD). The anti-β7 integrin antibody etrolizumab is currently being investigated for safety and efficacy in Crohn’s disease (CD) and ulcerative colitis (UC) in several phase III trials. Mechanistically, etrolizumab is known to block β7 integrin ligand binding and reduces intestinal trafficking of β7-expressing cells. Etrolizumab blocks β7 integrin ligand binding and reduces β7-positive lymphocyte migration and retention in the inflamed gut mucosa, but the exact mechanisms by which this inhibition occurs are not fully understood.Methods: Cellular effects of etrolizumab or etrolizumab surrogate antibody (etrolizumab-s) were investigated in cell culture models and analyzed by flow cytometry, fluorescence microscopy, ImageStream®, stimulated emission depletion (STED) microscopy and functional dynamic in vitro adhesion assays. Moreover, effects on α4β7 integrin were compared with the pharmacodynamically similar antibody vedolizumab.Results: As demonstrated by several different approaches, etrolizumab and etrolizumab-s treatment led to internalization of β7 integrin. This resulted in impaired dynamic adhesion to MAdCAM-1. Internalized β7 integrin localized in endosomes and re-expression of β7 was dependent on de novo protein synthesis. In vitro etrolizumab treatment did not lead to cellular activation or cytokine secretion and did not induce cytotoxicity. Internalization of α4β7 integrin was increased with etrolizumab compared with vedolizumab.Discussion: Our data suggest that etrolizumab does not elicit secondary effector functions on the single cell level. Integrin internalization may be an important mechanism of action of etrolizumab, which might explain some but not all immunological effects observed with etrolizumab.

Before Cyclone Amphan took place in 2020, Cyclone Fani (May 2019) is the strongest pre-monsoon cyclone in the Bay of Bengal (BOB) since 1991, killing 90 people in eastern India and Bangladesh while causing US$1.81 billion of damages. Fani developed during a period of high concentration of anthropogenic aerosols in the BOB with abnormally high sea surface temperature (SST), thereby presenting an opportunity to understand the compound effects of atmospheric aerosols and regional climate warming on a tropical cyclone. A quantitative attribution analysis was conducted using the Weather Research and Forecasting model with chemistry (WRF-Chem) run at the convection-permitting (4 km) grid spacing, accompanied by an ensemble of coarser-resolution simulations to quantify the uncertainty. The removal of post-1990 trends in the tropospheric variables and SST from WRF-Chem’s initial conditions (IC) and boundary conditions (BC, including the lateral and lower boundary conditions) resulted in a reduction of cyclone precipitation by about 51% during the 5 d of April 28-May 2. The removal of tropospheric warming shows approximately twice as strong an effect on Fani (39% reduction in precipitation) as that of SST warming (22% reduction). When aerosol’s direct and indirect effects were removed from the simulations, i.e., no aerosol influence on radiation and cloud microphysics, Fani initially strengthened but later weakened, as measured by geopotential height and precipitation amounts. These results suggest that aerosol and its interaction with the atmosphere acted to mitigate the strengthening effect of anthropogenic warming on Fani, but was not strong enough to entirely counteract it. Although the ensemble of coarser simulations appears to overestimate Cyclone Fani in terms of precipitation, the direction of the effects is in agreement with that obtained from the 4 km simulations. Given the increasing anthropogenic aerosols in the BOB, future attribution studies using more sophisticated dynamical aerosol models on BOB tropical cyclones are urged.