Resisting the racialization of medical deservingness: How Latinx nurses produce symbolic resources for Latinx immigrants in clinical encounters.

This paper investigates how Latinx nurses resisted the racialization of medical un-deservingness against co-ethnic immigrants in everyday clinical encounters. Drawing on 26 in-depth interviews and dialoguing with the literature on minority professionals, we find that, as a form of racialized equity work, Latinx nurses produced certain symbolic resources, specifically the interactional signals to counteract Latinx patients' internalization of un-deservingness and other medical staff's open hostility towards these "undeserving illegals." Latinx nurses hybridized neoliberal norms (self-sufficiency and responsibility) and social justice values (including healthcare as a universal right and compassion for members of the community): they emphasized Latinx immigrants' efforts at "becoming" self-sufficient and clinically responsible, debunked the relevance of citizenship to a right to healthcare, and highlighted their communal bonds with co-ethnic patients. Meanwhile, accentuating these communal bonds revealed hefty loads of previously self-censored healthcare needs among Latinx patients, which compelled Latinx nurses to reassert some professional boundaries. Whereas some Latinx nurses were able to engage in "moralized boundary-drawing," others experienced setting professional boundaries as "demoralizing boundary-drawing," which resulted in burnout, disillusionment, or internalized racism. Our findings indicate that the path to de-racializing medical deservingness needs to be multi-tiered. Latinx nurses' racialized equity work of generating symbolic resources for Latinx immigrants is only sustainable if supported by non-Latinx colleagues' cross-ethnic equity work. Furthermore, everyday resistance in clinical encounters is necessarily incomplete unless state-level policy initiatives transform the currency of symbolic capital for medical deservingness.

Factors Impacting Efficacy of AAV-Mediated CRISPR-Based Genome Editing for Treatment of Choroidal Neovascularization.

Frequent injections of anti-vascular endothelial growth factor (anti-VEGF) agents are a clinical burden for patients with neovascular age-related macular degeneration (AMD). Genomic disruption of VEGF-A using adeno-associated viral (AAV) delivery of clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 has the potential to permanently suppress aberrant angiogenesis, but the factors that determine the optimal efficacy are unknown. Here, we investigate two widely used Cas9 endonucleases, SpCas9 and SaCas9, and evaluate the relative contribution of AAV-delivery efficiency and genome-editing rates in vivo to determine the mechanisms that drive successful CRISPR-based suppression of VEGF-A, using a mouse model of laser-induced choroidal neovascularization (CNV). We found that SpCas9 demonstrated higher genome-editing rates, greater VEGF reduction, and more effective CNV suppression than SaCas9, despite similar AAV transduction efficiency between a dual-vector approach for SpCas9 and single-vector system for SaCas9 to deliver the Cas9 orthologs and single guide RNAs (gRNAs). Our results suggest that successful VEGF knockdown using AAV-mediated CRISPR systems may be determined more by the efficiency of genome editing rather than viral transduction and that SpCas9 may be more effective than SaCas9 as a potential therapeutic strategy for CRISPR-based treatment of CNV in neovascular AMD.

Facial surface morphology predicts variation in internal skeletal shape.

INTRODUCTION: The regular collection of 3-dimensional (3D) imaging data is critical to the development and implementation of accurate predictive models of facial skeletal growth. However, repeated exposure to x-ray-based modalities such as cone-beam computed tomography has unknown risks that outweigh many potential benefits, especially in pediatric patients. One solution is to make inferences about the facial skeleton from external 3D surface morphology captured using safe nonionizing imaging modalities alone. However, the degree to which external 3D facial shape is an accurate proxy of skeletal morphology has not been previously quantified. As a first step in validating this approach, we tested the hypothesis that population-level variation in the 3D shape of the face and skeleton significantly covaries. METHODS: We retrospectively analyzed 3D surface and skeletal morphology from a previously collected cross-sectional cone-beam computed tomography database of nonsurgical orthodontics patients and used geometric morphometrics and multivariate statistics to test the hypothesis that shape variation in external face and internal skeleton covaries. RESULTS: External facial morphology is highly predictive of variation in internal skeletal shape ([Rv] = 0.56, P <0.0001; partial least squares [PLS] 1-13 = 98.7% covariance, P <0.001) and asymmetry (Rv = 0.34, P <0.0001; PLS 1-5 = 90.2% covariance, P <0.001), whereas age-related (r(2) = 0.84, P <0.001) and size-related (r(2) = 0.67, P <0.001) shape variation was also highly correlated. CONCLUSIONS: Surface morphology is a reliable source of proxy data for the characterization of skeletal shape variation and thus is particularly valuable in research designs where reducing potential long-term risks associated with radiologic imaging methods is warranted. We propose that longitudinal surface morphology from early childhood through late adolescence can be a valuable source of data that will facilitate the development of personalized craniodental and treatment plans and reduce exposure levels to as low as reasonably achievable.

Accuracy of cone-beam computed tomography in predicting the diameter of unerupted teeth.

INTRODUCTION: An accurate prediction of the mesiodistal diameter (MDD) of the erupting permanent teeth is essential in orthodontic diagnosis and treatment planning during the mixed dentition period. Our objective was to test the accuracy and reproducibility of cone-beam computed tomography (CBCT) in predicting the MDD of unerupted teeth. Our secondary objective was to determine the accuracy and reproducibility of 3 viewing methods by using 2 CBCT software programs, InVivoDental (version 4.0; Anatomage, San Jose, Calif) and CBWorks (version 3.0, CyberMed, Seoul, Korea) in measuring the MDD of teeth in models simulating unerupted teeth. METHODS: CBCT data were collected on the CB MercuRay (Hitachi Medical Corporation, Tokyo, Japan). Models of unerupted teeth (n = 25), created by embedding 25 tooth samples into a polydimethylsiloxane polymer with a similar density to tissues surrounding teeth, were scanned and measured by 2 investigators. Repeated MDD measurements of each sample were made by using 3 CBCT viewing methods: InVivo Section, InVivo Volume Render (both Anatomage), and CBWorks Volume Render (version 3.0, CyberMed). These measurements were then compared with the MDD physically measured by digital calipers before the teeth were embedded and scanned. RESULTS: All 3 of the new methods had mean measurements that were statistically significantly less (P <0.0001) than the physical method, adjusting for investigator and tooth effects. Specifically, InVivo Section measurements were 0.3 mm (95% CI, -0.4 to -0.2) less than the measurements with calipers, InVivo Volume Render measurements were 0.5 mm less (95% CI, -0.6 to -0.4) than those with calipers, and CBWorks Volume Render measurements were 0.4 mm less (95% CI, -0.4 to -0.3) than those with calipers. CONCLUSIONS: Overall, there were high correlation values among the 3 viewing methods, indicating that CBCT can be used to measure the MDD of unerupted teeth. The InVivo Section method had the greatest correlation with the calipers.