Lee University

Academic medical institutions face longstanding challenges in recruiting and retaining historically excluded, midcareer research faculty. Although progress in recruiting has been documented, retention has focused on individuals rather than a system-level approach. The University of California San Francisco (UCSF) Mid-Career Development Program was launched in 2020 to advance and retain historically excluded research faculty (scholars) and their historically excluded mentees via a novel program that provided faculty discretionary funding of $150,000 per person over 2 years, a structured career development curriculum, networking with executive campus leaders, personalized and peer group mentorship, and sponsorship. A formative evaluation in 2024 collected baseline and follow-up data on scholars' and mentees' academic output and leadership attainment. Between 2020 and 2024, 7 midcareer scholars and 35 mentees have benefited from the program. The first 2 cohorts of scholars documented academic rank and step advancements; scholarly outcomes, including 119 articles and $2.3 million new National Institutes of Health (NIH) career awards; and key campus and national leadership roles. These changes reflected not only standard accumulated academic experience but also increased leadership opportunities previously unavailable to participants. Multiplier effects were documented among the scholars' primary mentees, who were awarded $2 million in NIH career awards and published 194 peer-reviewed manuscripts, for an overall program total of 313 articles. This model program showed a return on its initial $1.05 million investment: for every dollar spent, the program generated $3.10 in NIH funding-a 310% return on investment. Program leaders and UCSF executive leadership are working to promote program sustainability. Additionally, collection of comparison data for program outcomes among participants and comparable faculty applicants for the program, who met criteria and were not enrolled due to space limitation, is being planned to enhance the pilot program results and, if successful, scale to other sites.

Sexual violence among adolescents and adults is a significant health and safety issue. Identifying and mitigating risk factors for sexual violence perpetration is central to preventing these acts before they occur. Substantial work has examined the risk for recidivism among known sexual offenders. To complement that work, this literature synthesis focuses on risk indicators among nonadjudicated and first-time adolescent and adult perpetrators. This synthesis is intended to support clinical practice by providing an overview of the magnitude, burden, and developmental course of sexual violence victimization and perpetration. Across rigorous studies, strong support suggests that adversity or abuse during childhood, perpetration during adolescence, fraternity membership, unhealthy peer norms, and peer approval for sexual violence during college-paired with impulsivity and/or a hostile view of women-are associated with a higher likelihood of sexual violence perpetration. Risk for perpetration can be offset by providing social support and parental monitoring and by increasing empathy during adolescence. In addition, variation in perpetration patterns over time exists, suggesting the need for developmentally focused prevention approaches.

Estimating mortality risk in incarcerated adults is important for identifying individuals who may benefit from palliative care and compassionate release referrals. To develop and internally validate a 2-year mortality prediction model in incarcerated adults. Cohort study (February 1, 2018-February 1, 2020). Incarcerated adults aged ≥ 18years residing at a California Department of Corrections and Rehabilitation (CDCR) prison for ≥ 1year. Model predictors included demographics (e.g., age, sex), housing status (general housing vs. higher acuity infirmary bed vs. lower acuity infirmary bed), functional assessment (level of mobility restriction), healthcare utilization (e.g., hospitalizations and intensive care unit admissions in the previous year), and chronic conditions. The primary outcome was natural death at 2years, defined as death due to causes other than suicide, homicide, accidental injury, or drug overdose. Cox proportional hazards regression with LASSO for variable selection was used to develop the model. Model performance was assessed by discrimination (area under the receiver operating characteristic curve (AUC) at 2years) and calibration (plots of predicted and observed mortality). Classification metrics were assessed at clinically relevant thresholds. The final cohort included 89,430 adults (median age 40years (interquartile range = 20), 10.2% ≥ 60years, 30.6% Black, 41.4% Hispanic). At 2years, 506 (0.6%) individuals experienced a natural death. The optimism-corrected AUC at 2years after bootstrap internal validation was 0.926 (95% confidence interval (CI) = 0.915-0.938). The calibration plot at 2years suggested good calibration. At a 2-year mortality risk threshold of 5%, sensitivity, specificity, and positive predictive value were 47.6% (95% CI = 42.3-51.6%), 98.4% (95% CI = 98.2-98.4%), and 16.7% (95% CI = 14.3-18.5%), respectively. The mortality risk estimates from this model can help clinicians identify individuals who may most benefit from advance care planning discussions, palliative care services, and compassionate release referrals.

Introducción: Este estudio analiza las experiencias de docentes de educación básica en la implementación de proyectos comunitarios con perspectiva de género, desarrollados en el marco de un diplomado de formación continua. El objetivo es explorar los efectos de estas iniciativas en el alumnado y la comunidad escolar, los desafíos enfrentados, los factores que condicionaron su ejecución y los elementos necesarios para fortalecer su desarrollo. Metodología: La investigación corresponde a un estudio cualitativo descriptivo con perspectiva feminista. Se realizaron 12 entrevistas semiestructuradas a docentes de preescolar, primaria y secundaria que participaron del diplomado. Resultados: Los proyectos comunitarios promovieron cambios positivos en las actitudes del estudiantado, mayor apertura al diálogo y colaboración entre pares. Además, propiciaron procesos de trabajo colegiado entre docentes y una mayor participación de las familias. Entre los desafíos identificados se encuentran la resistencia de docentes a temas de género, barreras ideológicas en las familias y limitaciones estructurales de la organización escolar. Se destaca la importancia del apoyo institucional y la creación de redes interinstitucionales de acompañamiento. Conclusiones: El aprendizaje basado en proyectos comunitarios se consolida como una metodología útil para articular los saberes docentes con su contexto y fortalecer el vínculo entre escuela-vida-hogar.

Passive acoustic monitoring has emerged as an invaluable technique for surveying fisheries, tracking endangered species, and evaluating acoustic propagation models, along with a host of other applications. Gliders (buoyancy-propelled autonomous underwater vehicles) are an attractive platform for passive acoustic monitoring due to their controllability, mission duration, and generally low-noise profile. Hydrophones can be mounted onto gliders externally with self-contained power or integrated into the vehicles for real-time data capability; however, noise generated at inflections (buoyancy pump actuation and battery motor motion) and during navigation (rudder motion and turbulence) can mask critical biological cues while filling the limited data allotment with false positives. Recent glider surveys conducted with an integrated hydrophone off the Georgia/Florida coast during the calving season for the critically endangered North Atlantic right whales suggests that reducing the amount of 'self-noise' could significantly increase the number of whale detections during monitoring missions while also reducing battery consumption and extending the monitoring period. This work characterizes the spectrum three major sources of self-noise, analysis the effectiveness of various flight and mission based noise mitigation strategies, and proposes a preliminary method for removing self-noise from the real-time audio signal. With a focus on both prevention and filtering, this research demonstrates significant improvements in glider-based passive acoustic monitoring, especially in the context of right whale detection. These techniques have the potential for broader application in scientific, industrial, and military settings to improve both the quality and quantity of the acoustic data collected.

Hypotension during liver transplantation often requires vasopressor therapy. Acute kidney injury is a common complication after liver transplantation. Vasopressin acts as a portal flow modulator, may increase the glomerular filtration rate, and reduce the dose of catecholamines required. We hypothesized that intraoperative vasopressin use could be associated with reduced postoperative acute kidney injury. This single-center retrospective cohort study included 1120 adult liver transplant recipients between June 2012 and November 2022. We assessed the association between intraoperative vasopressin use and postoperative severe acute kidney injury by using a propensity score-adjusted multivariable regression model. The incidence of severe postoperative acute kidney injury was 29.2%. The median age was 60 y, 64.9% of patients were males. Vasopressin was used in 34.0% of the cases. Patients receiving vasopressin had a higher Model for End-Stage Liver Disease-sodium score (24 versus 16, P < 0.001). The median [interquartile range] dose of catecholamine vasopressors was significantly higher in patients who received vasopressin (0.08 [0.05-0.12] versus 0.03 [0.01-0.05] µg·kg-1·min-1 norepinephrine equivalents, P < 0.001). We did not observe an association between the intraoperative use of vasopressin and severe acute kidney injury after liver transplantation (adjusted odds ratio: 1.29; 95% confidence interval: 0.92-1.80). Vasopressin use was not associated with a higher hazard of experiencing graft failure or related outcomes over time (hazard ratio = 1.17, P = 0.44). In patients requiring high doses of intraoperative vasopressors during liver transplantation, vasopressin use was not associated with an increased risk of severe postoperative acute kidney injury or decreased graft survival.

ObjectiveEmergency medical dispatch is intended to ensure that emergency medical services (EMS) allocate appropriate resources for the treatment of patients with status epilepticus (SE). However, it is unclear whether dispatch algorithms accurately identify those patients having a seizure-related medical emergency and how dispatch algorithms influence what prehospital resources are allocated for the encounter.MethodsWe performed a cross-sectional analysis of prehospital encounters for SE using data from the 2019 ESO Data Collaborative. We included patients who were ≥18 years of age, had an EMS diagnostic impression of SE, and did not have a cardiac arrest. We examined the dispatch-determined complaint designated by the emergency medical dispatch (EMD) code, dispatch-determined level of acuity (A, B, C, D), ambulance response, and training level of the responding prehospital professional.ResultsOf the 18,515 patient encounters for SE with an EMD code, 8,279 (44.9%) were women, and the mean age was 40.0 years (SD 19.7). There were 13,829 (75%) encounters that received a dispatch code for seizures/convulsions and 4,686 (25%) with a dispatch code for a non-seizure-related condition. Among encounters for SE identified by dispatch as seizures/convulsions, 6,412 (46.4%) were designated high acuity, 6,626 (63.6%) were designated low acuity, and the majority received emergent ambulance responses (98.1% among those designated high acuity and 81.8% among those designated low acuity) and an Advanced Life Support-trained responder (93.7% among those designated high acuity and 92.7% among those designated low acuity). Median response times were similar for all acuity levels (9.1, 8.8, 9.1, and 8.3 minutes for A-D, respectively).ConclusionApproximately one-fourth of SE cases were categorized as a non-seizure related condition at dispatch, and fewer than half received the highest acuity determinant code. Despite this, dispatch-assigned acuity did not have a strong relationship with the ambulance response or training level of the EMS responder or response time, suggesting that use of dispatch algorithms might be further optimized and highlighting a potential area to improve quality of EMS care.

ABSTRACT In 2021, we piloted a three-part, critical place-based curriculum comprised (1) a digital mapping project, (2) an associated academic course, and (3) an affiliated group of peer-mentors at our university to interrogate racism in Lexington, Virginia. Believing that the best way to study race is to investigate its local topography, we tailored the course to provide students with opportunities to critically reflect upon Lexington, the place that has framed their college years. In detailing this curriculum and its associated pedagogies, we hope that it can serve as a prototype for other faculty who wish to engage students in antiracist work within their local communities.