In November 2022, the second symposium on locally developed and led research in the Eastern Region of the Dominican Republic was held in La Romana. More than 100 researchers, students, and health practitioners participate in a day of presentations, interactive panels, and an interactive workshop on grant writing.

The Symposium was conceived and run by INDEICOL, the Institute’s local NGO partner in the Dominican Republic, and is an important step in achieving our mission of increasing health research capacity in underresourced communities. The research in the Dominican Republic has a particular focus on emerging infectious diseases and One Health.

Institute partner Matthew Dacso, MD, MSc has been appointed Director of the Charles E. Cheever, Jr. Center for Medical Humanities and Ethics and Professor in the Department of Medicine effective May 1, 2024. Dr. Dacso was selected after a national search led by Dr. Francisco Cigarroa. My sincere thanks to the members of the search committee for their hard work on this important recruitment.

Dr. Dacso joins UT Health San Antonio from UTMB at Galveston where he is Chair ad interim of the Department of Global Health & Emerging Diseases in the School of Public & Population Health, a tenured associate professor in the departments of Internal Medicine and Microbiology & Immunology, and the director of the John Sealy School of Medicine Global Health concentration. As a clinician, he provides care in the outpatient primary care clinics as well as the inpatient general internal medicine teaching service.  He is also an active member of the UTMB Biocontainment Care Unit emerging/special pathogens response team.

Dr. Dacso received his B.A. in Music from McGill University in Montreal, Quebec, Canada, and his M.D. from UTMB. During medical school he completed a Masters of Science in international development studies at the University of London School of Oriental and African Studies. Following his residency in general internal medicine at Brown University, he moved to Gaborone, Botswana, where he served as a clinician-educator for the Botswana-UPenn Partnership, an organization dedicated to strengthening capacity for clinical care, education, and research in Botswana. He was subsequently recruited to UTMB, where over the past 12 years he has led UTMB’s global health efforts in both the School of Medicine and the School of Public & Population Health.  During that time, he has formed partnerships with institutions in sub-Saharan Africa, Latin America, and the Caribbean that center on student, resident, and faculty collaborations rooted in the values of relationships, respect, and reciprocity. Through this work, he has sought to develop academic collaborations that improve health and address health inequities both at home and around the world.  In his various roles in educational leadership, he has worked to instill into learners an ethical and humanistic approach to clinical medicine, global and community health, and public health research. Dr. Dacso is a Fellow of the American College Physicians and is an active member of the Consortium of Universities for Global Health and the American Society of Tropical Medicine and Hygiene.  He has published peer-reviewed articles, book chapters, and abstracts in the areas of interprofessional global health education, ethics of global health partnerships, mentorship, and narrative medicine. He has been recognized for humanism in medicine and public health by being named an emeritus Faculty Scholar in the John P. McGovern Academy of Oslerian Medicine and as a member of both Alpha Omega Alpha and the Delta Omega Honor Society for Public Health.

Abstract

Objective

The objective of this study was to determine the psychometric properties of the 3-dimensional latent model of empathy on the Jefferson Scale of Physician Empathy instrument (version S), and to verify the existence of cutoff points capable of differentiating empathy measures classified as: “high,” “medium,” and “low” using data collected from observations of students from 11 dental faculties of 5 Central American and Caribbean countries (n = 3082) between 2015 and 2019.

Methods

This is an exploratory, “a posteriori,” and non-experimental study. Factor structure and factor invariance by country and gender were analyzed. Hierarchical cluster analysis and bifactorial analysis were applied, and the data were normalized by cluster and by percentiles within them.

Results

Confirmatory factor analysis showed that the original model was replicable and fit the data, while multigroup analysis allowed assuming an invariant factor structure by country and by gender. There is reliability in the measurement made by the scale and its dimensions.

Conclusions

The instrument has adequate psychometric properties, and cutoff values obtained allow people with lower or higher levels of empathy and its components to be classified. Therefore, these results solve the problem of comparing the scores and observed levels of empathy between dental schools within and between countries and between genders. Such comparisons were only possible since the original data of each study were made available for traditional statistical methods.

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Abstract

Our group recently characterized a cell-autonomous mammalian 12-h clock independent from the circadian clock, but its function and mechanism of regulation remain poorly understood. Here, we show that in mouse liver, transcriptional regulation significantly contributes to the establishment of 12-h rhythms of mRNA expression in a manner dependent on Spliced Form of X-box Binding Protein 1 (XBP1s). Mechanistically, the motif stringency of XBP1s promoter binding sites dictates XBP1s’s ability to drive 12-h rhythms of nascent mRNA transcription at dawn and dusk, which are enriched for basal transcription regulation, mRNA processing and export, ribosome biogenesis, translation initiation, and protein processing/sorting in the Endoplasmic Reticulum (ER)-Golgi in a temporal order consistent with the progressive molecular processing sequence described by the central dogma information flow (CEDIF). We further identified GA-binding proteins (GABPs) as putative novel transcriptional regulators driving 12-h rhythms of gene expression with more diverse phases. These 12-h rhythms of gene expression are cell autonomous and evolutionarily conserved in marine animals possessing a circatidal clock. Our results demonstrate an evolutionarily conserved, intricate network of transcriptional control of the mammalian 12-h clock that mediates diverse biological pathways. We speculate that the 12-h clock is coopted to accommodate elevated gene expression and processing in mammals at the two rush hours, with the particular genes processed at each rush hour regulated by the circadian and/or tissue-specific pathways.
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Abstract

Clinical trials using human adipogenic mesenchymal stem cells (hAdMSCs) for the treatment of cardiac diseases have shown improvement in cardiac function and were proven safe. However, hAdMSCs do not convert efficiently into cardiomyocytes (CMs) or vasculature. Thus, reprogramming hAdMSCs into myocyte progenitors may fare better in future investigations. To reprogramme hAdMSCs into electrically conductive cardiac progenitor cells, we pioneered a three-step reprogramming strategy that uses proven MESP1/ETS2 transcription factors, β-adrenergic and hypoxic signalling induced in three-dimensional (3D) cardiospheres. In Stage 1, ETS2 and MESP1 activated NNKX2.5, TBX5, MEF2C, dHAND, and GATA4 during the conversion of hAdMSCs into cardiac progenitor cells. Next, in Stage 2, β2AR activation repositioned cardiac progenitors into de novo immature conductive cardiac cells, along with the appearance of RYR2, CAV2.1, CAV3.1, NAV1.5, SERCA2, and CX45 gene transcripts and displayed action potentials. In Stage 3, electrical conduction that was fostered by 3D cardiospheres formed in a Synthecon®, Inc. rotating bioreactor induced the appearance of hypoxic genes: HIF-1α/β, PCG 1α/β, and NOS2, which coincided with the robust activation of adult contractile genes including MLC2v, TNNT2, and TNNI3, ion channel genes, and the appearance of hyperpolarization-activated and cyclic nucleotide-gated channels (HCN1-4). Conduction velocities doubled to ~200 mm/s after hypoxia and doubled yet again after dissociation of the 3D cell clusters to ~400 mm/s. By comparison, normal conduction velocities within working ventricular myocytes in the whole heart range from 0.5 to 1 m/s. Epinephrine stimulation of stage 3 cardiac cells in patches resulted in an increase in amplitude of the electrical wave, indicative of conductive cardiac cells. Our efficient protocol that converted hAdMSCs into highly conductive cardiac progenitors demonstrated the potential utilization of stage 3 cells for tissue engineering applications for cardiac repair.
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Abstract

There continues to be an increase in the number of learners who participate in international health electives (IHEs). However, not all learners enter IHEs with the same level of knowledge, attitude, and previous experience, which puts undue burden on host supervisors and poses risks to student and patient safety. The Multiple Mini-Interview (MMI) is a technique that has become a popular method for undergraduate and postgraduate-level health science admissions programs. This paper describes the MMI process used by our program to screen first-year medical students applying for pre-clinical IHEs. Two country-specific cases were developed to assess non-cognitive skills. One hundred percent (100%) of the students (n = 48) and interviewers (n = 10) who participated in MMIs completed anonymous surveys on their experience. The majority of students rated the scenarios as realistic (>90%); 96% found the MMI format fair and balanced; 96% of students felt that they were able to clearly articulate their thoughts; 75% of students stated that they had a general understanding of how the MMIs worked; only 33% of students would have preferred a traditional one-to-one interview. Feedback from both interviewers and students was positive toward the MMI experience, and no students were identified as unfit for participation. Ultimately, 43 students participated in pre-clinical IHEs in 2016. In this paper, we will outline our MMI process, detail shortcomings, and discuss our next steps to screen medical students for IHEs.
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A new article by Matthew Dacso, Kara McArthur, and Clifford Dacso on the website of The Scientist explains how economic and social inequality have epigenetic ramifications and how those, in turn, aggrandize health disparities.  As SARS-CoV-2 continues to ravage the world, its disproportionate effect on those of lower socio-economic status is both a reminder of this fact and a call to action.

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An article in the April 21 New England Journal of Medicine, titled “Partnerships, Not Parachutists, for Zika Research,” explains why it is critical for research to be conducted collaboratively. Building and strengthening public health capacities (through local ethics review and collaborative research) will not only make for better research, but are also central to the International Health Regulations, an international agreement of all WHO member countries designed to strengthen health security.

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CGIAR is a World Bank subsidiary for sustainable agriculture. Its website and the article below are worth reading for their hard-won thoughtful approach to global development.

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This is a fascinating article on Dr. Jim Kim’s tenure at the World Bank from Foreign Policy magazine. Essentially, there are two big stories in Kim’s career. One is that healthcare is retail, although health systems can be wholesale. What this means is that organizations like the WHO, the World Bank, the Gates Foundations, and others like them can do big things. They can drain swamps, develop vaccines, and eradicate Guinea worm. But the cause of causes remains income disparity and the alienation from power that comes with it. Mao famously wrote that political power comes from the barrel of a gun. But I do believe that political power comes from economic power and control of the means of production (to use a Marxist inflammatory phrase). Second is that poverty and degradation do not respect great women or men. Dr. Kim genuinely is a great man and the story of his work and legacy is a very important read.

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