Transgender and gender diverse curriculum in medical imaging programs: a case study.

BACKGROUND: Transgender and gender diverse (TGD) individuals face barriers, including harassment and discrimination, when accessing healthcare services. Medical imaging procedures require personal information to be shared, such as date of last menstrual cycle and/or pregnancy status; some imaging exams are also invasive or intimate in nature. Terminology is based on binary sex creating an inherently cis-heteronormative environment. TGD patients fear being outed and often feel a need to function as educators and advocates for their care. Incorporation of inclusive healthcare curriculum related to TGD populations is an effective means of educating new health providers and promotes safer and more inclusive spaces in healthcare settings. Educators face barriers which hinder the creation and implementation of TGD content. The purpose of this study was to examine the impacts educators are faced with when creating and delivering TGD content in their medical imaging curriculum. METHODS: A case study of medical imaging programs at a Canadian post-secondary institute was undertaken. Data was collected via semi-structured interviews with faculty. Relevant institutional documents such as strategic plans, policies/procedures, websites, and competency profiles were accessed. Framework analysis was used to analyze the data. RESULTS: The study found seven themes that influence the development of TGD curriculum as follows: familiarity and comfort with the curriculum and content change process; collaboration with other healthcare programs; teaching expertise; management of course workload and related. duties; connections to the TGD community; knowledge of required TGD content and existing gaps in curriculum; and access to supports. CONCLUSIONS: Understanding educators' perspectives can lead to an increased sense of empowerment for them to create and incorporate TGD curriculum in the future. Many post- secondary institutions are incorporating an inclusive lens to educational plans; this research can be used in future curriculum design projects. The goal is improved medical imaging experiences for the TGD population.

Spirituality in Addiction Recovery: A Narrative Review.

In the area of addiction, Canada has been in a public health crisis since 2016. Addiction takes a toll on an individual's self-worth and identity. In this narrative literature review, the distinct nature of spirituality was addressed. Next, individualized conceptualizations of spirituality were outlined. Subsequently, the importance of fellowship in addiction recovery was detailed. Next, the significance of being of service was presented. Meaningful and authentic spirituality were discussed in the context of recovery identity. Lastly, spirituality as a personal journey is described. A narrative literature review of 70 manuscripts published between 1999 and 2021 was undertaken to determine multiple approaches to treating addiction recovery in the context of spiritual development. An understanding of spirituality can inform counsellors regarding spiritual development in addiction recovery. Implications for counselling include a roadmap to support clients developing an individualized spiritual connection and operating as a functional system.

A qualitative study examining newly diagnosed breast cancer patients' experiences of participating in the Alberta Moving Beyond Breast Cancer (AMBER) prospective cohort study.

BACKGROUND: Decisions to participate in cancer trials are associated with uncertainty, distress, wanting to help find a cure, the hope for benefit, and altruism. There is a gap in the literature regarding research examining participation in prospective cohort studies. The aim of this study was to examine the experiences of newly diagnosed women with breast cancer participating in the AMBER Study to identify potential strategies to support patients' recruitment, retention, and motivation. METHODS: Newly diagnosed breast cancer patients were recruited from the Alberta Moving Beyond Breast Cancer (AMBER) cohort study. Data were collected using semi-structured conversational interviews with 21 participants from February to May 2020. Transcripts were imported into NVivo software for management, organization, and coding. Inductive content analysis was undertaken. RESULTS: Five main concepts associated with recruitment, retention, and motivation to participate were identified. These main concepts included: (1) personal interest in exercise and nutrition; (2) investment in individual results; (3) personal and professional interest in research; (4) burden of assessments; (5) importance of research staff. CONCLUSIONS: Breast cancer survivors participating in this prospective cohort study had numerous reasons for participating and these reasons could be considered in future studies to enhance participant recruitment and retention. Improving recruitment and retention in prospective cancer cohort studies could result in more valid and generalizable study findings that could improve the care of cancer survivors.

Health-care providers' experiences during the COVID-19 pandemic: lessons for leaders.

PURPOSE: The purpose of this qualitative research study is to explore health-care providers' perspectives and experiences with a specific focus on supports reported to be effective during the COVID-19 pandemic. The overarching goal of this study is to inform leaders and leadership regarding provision of supports that could be implemented during times of crisis and in the future beyond the pandemic. DESIGN/METHODOLOGY/APPROACH: Data were collected by semi-structured, conversational interviews with a sample of 33 health-care professionals, including Registered Nurses, Nurse Practitioners, Registered Psychologists, Registered Dieticians and an Occupational Therapist. FINDINGS: Three major themes emerged from the interview data: (1) professional and personal challenges for health-care providers, (2) physical and mental health impacts on health-care providers and (3) providing supports for health-care providers. The third theme was further delineated into three sub-theses: formal resources and supports, informal resources and supports and leadership strategies. ORIGINALITY/VALUE: Health-care leaders are advised to pay attention to the voices of the people they are leading. It is important to know what supports health-care providers need in times of crisis. Situating the needs of health-care providers in the Carter and Bogue Model of Leadership Influence for Health Professional Wellbeing (2022) can assist leaders to deliberately focus on aspects of providers' wellbeing and remain cognizant of the supports needed both during a crisis and when circumstances are unremarkable.

The philosophy of Hans-Georg Gadamer: An exemplar of the complicated relationship between philosophy and nursing practice.

Philosophy has a complicated relationship with nursing practice. Selected concepts from Hans-Georg Gadamer's Truth and Method specifically prejudice, conversation, and language are articulated. An exemplar involving nursing practice at an outpatient clinic for women seeking pre- and postbreast cancer care is offered to explicate these concepts. We considered the fit of Gadamer's philosophy, particularly the concept of conversation, within a public health nursing practice context in home and community settings of the client/family and offered tentative conclusions. To extend the discussion of the relationship between philosophy and nursing practice, we posed questions developed to provide deeper insight into this complicated relationship.

Lessons learned from clinical course design in the pandemic: Pedagogical implications from a qualitative analysis.

AIMS: The purpose of this study was to examine clinical pedagogy based on experiences of changes and adaptations to clinical courses that occurred in nursing education during the pandemic. Beyond learning how to manage nursing education during a pandemic or other crisis, we uncover the lessons to be learned for overall improvement of nursing education. DESIGN: Qualitative descriptive analysis using semi-structured interview data with baccalaureate nursing students. METHODS: Data were collected in the spring of 2021 using semi-structured interview with 15 participants. Transcribed text was analysed using thematic content analysis. The COREQ checklist was used to guide our reporting. RESULTS: Three themes were identified related to course design in clinical courses for nursing students: the role and limitations of simulation, competency evaluations and career implications. Students expressed some concern over not 'finishing hours', loss of in-person clinical experiences and their reduced exposure to different clinical settings. CONCLUSION: To prepare work-ready nurses, educators need to keep in mind the trends, issues and demands of future healthcare systems. Simulation may have been a temporary measure to achieve clinical competence during the pandemic but needs to be of high-quality and cannot meet all the expected learning outcomes of clinical courses. Exposure to different patients, families and communities will ensure that the future nursing workforce has experience, socialization, competence, and desire to work in various clinical settings. Competency evaluation similarly needs to be robust and objective and consider the role and perception of hours completed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. Participants were nursing students.

Clinical learning during the pandemic: Experiences of LPN-BN undergraduate nursing students.

BACKGROUND: When the COVID-19 pandemic was declared in March 2020, nursing programs made rapid decisions regarding clinical placement experiences for students. In many nursing programs, this meant ending clinical placements early, delaying clinical courses, and moving clinical courses to simulation. PURPOSE: The purpose of this study was to explore LPN-BN students' experiences in clinical courses during the COVID-19 pandemic. METHOD: A qualitative descriptive approach was employed in this study. Fifteen semi-structured conversational interviews with nursing students and recent graduates were conducted. Inductive content analysis was used to analyse the data. RESULTS: Four main concepts were identified: (1) logistics of learning; (2) shifts in clinical learning; (3) mental health matters; (4) readiness to practice. CONCLUSION: It is important to understand the experience of nursing students as this is an inordinately stressful and impressionable time for them. Insight into the student experience, will inform educators in the areas of curriculum and competency-based evaluation as well as supports for student mental health and well-being.

Effect of online versus in-person clinical experiences on nursing student's competency development: A cross-sectional, quasi-experimental design.

BACKGROUND: Clinical experience is an important component of nursing education, yet placements in agencies are hard to secure, and evaluation of outcomes challenging. The shift to virtual, online clinical courses during the pandemic created the conditions of a natural experiment. OBJECTIVES: To compare differences in outcomes between an in-person and online design for a family and community health clinical course. DESIGN: Quasi-experimental, 2-group, cross-sectional study. METHODS: Competency evaluations were reviewed from a baccalaureate nursing program in Canada from 19 students who completed an in-person clinical, and 32 students who completed an online clinical. Quantitative analysis compared competencies achieved, interest in community health nursing, and linguistic analysis of unstructured narratives using natural language processing. RESULTS: There are differences in competency evaluations for in-person versus online community clinical courses, and potential implications for future interest in community health. Natural language processing detected differences in content and psychological processes between the two groups. CONCLUSIONS: Nursing programs could apply this methodology to track impact of changes to clinical course design on achievement of competencies. There are important differences in outcomes between online and in-person clinical courses.

Zbtb20 identifies and controls a thymus-derived population of regulatory T cells that play a role in intestinal homeostasis.

The expression of BTB-ZF transcription factors such as ThPOK in CD4+ T cells, Bcl6 in T follicular helper cells, and PLZF in natural killer T cells defines the fundamental nature and characteristics of these cells. Screening for lineage-defining BTB-ZF genes led to the discovery of a subset of T cells that expressed Zbtb20. About half of Zbtb20+ T cells expressed FoxP3, the lineage-defining transcription factor for regulatory T cells (Tregs). Zbtb20+ Tregs were phenotypically and genetically distinct from the larger conventional Treg population. Zbtb20+ Tregs constitutively expressed mRNA for interleukin-10 and produced high levels of the cytokine upon primary activation. Zbtb20+ Tregs were enriched in the intestine and specifically expanded when inflammation was induced by the use of dextran sodium sulfate. Conditional deletion of Zbtb20 in T cells resulted in a loss of intestinal epithelial barrier integrity. Consequently, knockout (KO) mice were acutely sensitive to colitis and often died because of the disease. Adoptive transfer of Zbtb20+ Tregs protected the Zbtb20 conditional KO mice from severe colitis and death, whereas non-Zbtb20 Tregs did not. Zbtb20 was detected in CD24hi double-positive and CD62Llo CD4 single-positive thymocytes, suggesting that expression of the transcription factor and the phenotype of these cells were induced during thymic development. However, Zbtb20 expression was not induced in "conventional" Tregs by activation in vitro or in vivo. Thus, Zbtb20 expression identified and controlled the function of a distinct subset of Tregs that are involved in intestinal homeostasis.

Implementation of transgender and gender diverse curriculum in medical imaging programs: A review of the literature.

INTRODUCTION: Sexual and gender minority patients experience significant inequities when accessing health care. Transgender and non-binary patients are at an even greater risk of experiencing health disparities due to their specialized health care needs. In the discipline of medical imaging, limited cultural competence, social stigma, and cis-heteronormative environments are barriers for these patients. There is an urgent need to improve medical imaging care for transgender and non-binary people; inclusion of sexual and gender minority content in medical imaging curriculum is one strategy to begin to address this need. METHOD: A review of the literature was undertaken to explore implementation of sexual and gender minority content in the curricula of medical imaging programs. RESULTS/DISCUSSION: Three main themes were identified: 1) educators' acknowledgement of the importance and value of adding sexual and gender minority content to healthcare curriculum; 2) educators' lack of a sense of preparedness, experience, and knowledge to adequately teach this content: and 3) lack of resources and institutional support to help develop curriculum. CONCLUSION: Including content in the curriculum related to the needs of transgender and non-binary patients will help ensure entry-to-practice Medical Radiation Technologists are better prepared to provide inclusive care.

Attenuation of TCR-induced transcription by Bach2 controls regulatory T cell differentiation and homeostasis.

Differentiation and homeostasis of Foxp3+ regulatory T (Treg) cells are strictly controlled by T-cell receptor (TCR) signals; however, molecular mechanisms that govern these processes are incompletely understood. Here we show that Bach2 is an important regulator of Treg cell differentiation and homeostasis downstream of TCR signaling. Bach2 prevents premature differentiation of fully suppressive effector Treg (eTreg) cells, limits IL-10 production and is required for the development of peripherally induced Treg (pTreg) cells in the gastrointestinal tract. Bach2 attenuates TCR signaling-induced IRF4-dependent Treg cell differentiation. Deletion of IRF4 promotes inducible Treg cell differentiation and rescues pTreg cell differentiation in the absence of Bach2. In turn, loss of Bach2 normalizes eTreg cell differentiation of IRF4-deficient Treg cells. Mechanistically, Bach2 counteracts the DNA-binding activity of IRF4 and limits chromatin accessibility, thereby attenuating IRF4-dependent transcription. Thus, Bach2 balances TCR signaling induced transcriptional activity of IRF4 to maintain homeostasis of thymically-derived and peripherally-derived Treg cells.

Two of a kind: transmissible Schwann cell cancers in the endangered Tasmanian devil (Sarcophilus harrisii).

Devil facial tumour disease (DFTD) comprises two genetically distinct transmissible cancers (DFT1 and DFT2) endangering the survival of the Tasmanian devil (Sarcophilus harrisii) in the wild. DFT1 first arose from a cell of the Schwann cell lineage; however, the tissue-of-origin of the recently discovered DFT2 cancer is unknown. In this study, we compared the transcriptome and proteome of DFT2 tumours to DFT1 and normal Tasmanian devil tissues to determine the tissue-of-origin of the DFT2 cancer. Our findings demonstrate that DFT2 expresses a range of Schwann cell markers and exhibits expression patterns consistent with a similar origin to the DFT1 cancer. Furthermore, DFT2 cells express genes associated with the repair response to peripheral nerve damage. These findings suggest that devils may be predisposed to transmissible cancers of Schwann cell origin. The combined effect of factors such as frequent nerve damage from biting, Schwann cell plasticity and low genetic diversity may allow these cancers to develop on rare occasions. The emergence of two independent transmissible cancers from the same tissue in the Tasmanian devil presents an unprecedented opportunity to gain insight into cancer development, evolution and immune evasion in mammalian species.

Pou2f2 Regulates the Distribution of Dorsal Interneurons in the Mouse Developing Spinal Cord.

Spinal dorsal interneurons, which are generated during embryonic development, relay and process sensory inputs from the periphery to the central nervous system. Proper integration of these cells into neuronal circuitry depends on their correct positioning within the spinal parenchyma. Molecular cues that control neuronal migration have been extensively characterized but the genetic programs that regulate their production remain poorly investigated. Onecut (OC) transcription factors have been shown to control the migration of the dorsal interneurons (dINs) during spinal cord development. Here, we report that the OC factors moderate the expression of Pou2f2, a transcription factor essential for B-cell differentiation, in spinal dINs. Overexpression or inactivation of Pou2f2 leads to alterations in the differentiation of dI2, dI3 and Phox2a-positive dI5 populations and to defects in the distribution of dI2-dI6 interneurons. Thus, an OC-Pou2f2 genetic cascade regulates adequate diversification and distribution of dINs during embryonic development.

Class-Switch Recombination Occurs Infrequently in Germinal Centers.

Class-switch recombination (CSR) is a DNA recombination process that replaces the immunoglobulin (Ig) constant region for the isotype that can best protect against the pathogen. Dysregulation of CSR can cause self-reactive BCRs and B cell lymphomas; understanding the timing and location of CSR is therefore important. Although CSR commences upon T cell priming, it is generally considered a hallmark of germinal centers (GCs). Here, we have used multiple approaches to show that CSR is triggered prior to differentiation into GC B cells or plasmablasts and is greatly diminished in GCs. Despite finding a small percentage of GC B cells expressing germline transcripts, phylogenetic trees of GC BCRs from secondary lymphoid organs revealed that the vast majority of CSR events occurred prior to the onset of somatic hypermutation. As such, we have demonstrated the existence of IgM-dominated GCs, which are unlikely to occur under the assumption of ongoing switching.

Onecut Factors and Pou2f2 Regulate the Distribution of V2 Interneurons in the Mouse Developing Spinal Cord.

Acquisition of proper neuronal identity and position is critical for the formation of neural circuits. In the embryonic spinal cord, cardinal populations of interneurons diversify into specialized subsets and migrate to defined locations within the spinal parenchyma. However, the factors that control interneuron diversification and migration remain poorly characterized. Here, we show that the Onecut transcription factors are necessary for proper diversification and distribution of the V2 interneurons in the developing spinal cord. Furthermore, we uncover that these proteins restrict and moderate the expression of spinal isoforms of Pou2f2, a transcription factor known to regulate B-cell differentiation. By gain- or loss-of-function experiments, we show that Pou2f2 contribute to regulate the position of V2 populations in the developing spinal cord. Thus, we uncovered a genetic pathway that regulates the diversification and the distribution of V2 interneurons during embryonic development.

The Work of Preparing Canadian Nurses for A Licensure Exam Originating from the USA: A Nurse Educator's Journey into the Institutional Organization of the NCLEX-RN.

The licensing exam for registered nurses in Canada has recently been changed from a Canadian developed, owned and delivered exam to the National Council Licensure Examination for Registered Nurses (NCLEX-RN) which originates from the United States. Rationale for this exam change focused on transitioning to a computer-based exam that has increased writing dates, with increased security, validated psychometrics, increased exam result delivery, and an anticipated decrease in expense to students. Concerns have arisen around the acceptance, implementation and delivery of this exam to Canadian nursing students that reflects the broad Canadian landscape of education and nursing practice. The experience of a Canadian nurse educator in working to facilitate students' transition to this exam is addressed using an institutional ethnographic lens. Finally, we come to conclusions about the importance of countries utilizing licensing exams that reflect their nursing education and practice.

Transcription Factor PU.1 Promotes Conventional Dendritic Cell Identity and Function via Induction of Transcriptional Regulator DC-SCRIPT.

Dendritic cells (DCs) are can be broadly divided into conventional (cDC) and plasmacytoid (pDC) subsets. Despite the importance of this lineage diversity, its genetic basis is not fully understood. We found that conditional ablation of the Ets-family transcription factor PU.1 in DC-restricted progenitors led to increased pDC production at the expense of cDCs. PU.1 controlled many of the cardinal functions of DCs, such as antigen presentation by cDCs and type I interferon production by pDCs. Conditional ablation of PU.1 de-repressed the pDC transcriptional signature in cDCs. The combination of genome-wide mapping of PU.1 binding and gene expression analysis revealed a key role for PU.1 in maintaining cDC identity through the induction of the transcriptional regulator DC-SCRIPT. PU.1 activated DC-SCRIPT expression, which in turn promoted cDC formation, particularly of cDC1s, and repressed pDC development. Thus, cDC identity is regulated by a transcriptional node requiring PU.1 and DC-SCRIPT.

Haemopedia RNA-seq: a database of gene expression during haematopoiesis in mice and humans.

During haematopoiesis, haematopoietic stem cells differentiate into restricted potential progenitors before maturing into the many lineages required for oxygen transport, wound healing and immune response. We have updated Haemopedia, a database of gene-expression profiles from a broad spectrum of haematopoietic cells, to include RNA-seq gene-expression data from both mice and humans. The Haemopedia RNA-seq data set covers a wide range of lineages and progenitors, with 57 mouse blood cell types (flow sorted populations from healthy mice) and 12 human blood cell types. This data set has been made accessible for exploration and analysis, to researchers and clinicians with limited bioinformatics experience, on our online portal Haemosphere: https://www.haemosphere.org. Haemosphere also includes nine other publicly available high-quality data sets relevant to haematopoiesis. We have added the ability to compare gene expression across data sets and species by curating data sets with shared lineage designations or to view expression gene vs gene, with all plots available for download by the user.

Generation of novel Id2 and E2-2, E2A and HEB antibodies reveals novel Id2 binding partners and species-specific expression of E-proteins in NK cells.

NK cells are cytotoxic lymphocytes with a key role in limiting tumour metastases. In mice, the NK cell lineage continually expresses high levels of the Inhibitor of DNA-binding 2 (Id2) protein and loss of Id2 is incongruous with their survival due to aberrant E-protein target gene activity. Using novel Id2 and E-protein antibodies that detect both mouse and human proteins, we have extensively characterised Id2 and E-protein expression in murine and human NK cells. We detected clear expression of E2 A and HEB, and to a lesser extent E2-2 in murine NK cells. In contrast HEB appears to be the major E-protein expressed in human NK cells, with minor E2-2 expression and surprisingly, no E2 A detected in primary NK cells nor human NK cell lines. These novel antibodies are also functional in immunofluorescence and immunoprecipitation. Mass spectrometry analysis of Id2 immuno-precipitated from murine NK cells revealed a number of novel associated proteins including several members of the SWI/SNF-related matrix-associated actin-dependent regulator chromatin (SMARC) and Mediator complex (MED) families. Taken together, these data highlight the utility of novel Id2 and E-protein antibodies and caution against mouse models for understanding Id2/E-protein biology in NK cells given their clearly disparate expression patternbetween species.