The Covid-19 pandemic has greatly disrupted the education of first-generation college students (first-gens)-those whose parents did not complete a college degree. With campuses closed, activities canceled, and support services curtailed, many first-gens have increasingly relied on their parents for mental, emotional, and logistical support. At the same time, their parents face compounding stresses and challenges stemming from the prolonged effects of the Covid pandemic. We examined the role that relational dynamics between first-gens and their parents played in how they weathered the first 2 years of the Covid pandemic together. We draw upon journals submitted by self-identified first-gens and parents of first-gens to the Pandemic Journaling Project between October 2021 and May 2022 as part of a pilot study of first-gen family experiences of Covid-19, along with a series of interviews conducted with three student-parent dyads. We argue that what we term the micropractices of care-the "little things," like a kind word, small gift, or car ride, that were regularly exchanged between parents and students-played a key role in mental wellness and educational persistence. We find that when there is synchrony between practices offered by one dyad member and their reception by the other, mental wellbeing is preserved. When there is asynchrony, mental health is destabilized. These findings reflect the strategies on which first-gen families have creatively relied to maintain shared mental wellness and student success during a time of crisis. We show how everyday mental wellness is forged in the intersubjective space between two people engaged in achieving shared life goals.
Phenomenon: While professionalism is largely understood to be complex and dynamic, it is oftentimes implemented as if it were static and concrete. As a result, policies and practices reflect dominant historical norms of the medical profession, which can cause tension for trainees from marginalized groups. One such group comprises those who identify as first-generation physicians - those whose parents have not earned an associate's degree or higher. This group is highly diverse in terms of gender, race, ethnicity, and socioeconomic status; however, their experiences with institutional professionalism policies and practices has not yet been fully explored. In this study, our aims were to understand the ways in which these participants experience professionalism, and to inform how professionalism can be more inclusively conceptualized. Approach: In November 2022-March 2023, we conducted semi-structured interviews with 11 first-generation medical students, residents, and physicians and analyzed select national and institutional professionalism policies in relation to key themes identified in the interviews. The interviews were designed to elicit participants' experiences with professionalism and where they experienced tension and challenges because of their first-gen identity. Data were analyzed using thematic analysis through a critical perspective, focused on identifying tensions because of systemic and historical factors. Findings: Participants described the ways in which they experienced tension between what was written, enacted, desirable, and possible around the following elements of professionalism: physical appearance; attendance and leaves of absence; and patient care. They described a deep connection to patient care but that this joy is often overshadowed by other elements of professionalism as well as healthcare system barriers. They also shared the ways in which they wish to contribute to changing how their institutions conceptualize professionalism. Insights: Given their unique paths to and through medicine and their marginalized status in medicine, first-generation interviewees provided a necessary lens for viewing the concept of professionalism that has been largely absent in medicine. These findings contribute to our understanding of professionalism conceptually, but also practically. As professionalism evolves, it is important for institutions to translate professionalism's complexity into educational practice as well as to involve diverse voices in refining professionalism definitions and policies.
The transition from high school to college is a taxing time for young adults. New students arriving on campus navigate a myriad of challenges centered around adapting to new living situations, financial needs, academic pressures and social demands. First-year students need to gain new skills and strategies to cope with these new demands in order to make good decisions, ease their transition to independent living and ultimately succeed. In general, first-generation students are less prepared when they enter college in comparison to non-first-generation students. This presents additional challenges for first-generation students to overcome and be successful during their college years. We study first-year students through the lens of mobile phone sensing across their first year at college, including all academic terms and breaks. We collect longitudinal mobile sensing data for N=180 first-year college students, where 27 of the students are first-generation, representing 15% of the study cohort and representative of the number of first-generation students admitted each year at the study institution, Dartmouth College. We discuss risk factors, behavioral patterns and mental health of first-generation and non-first-generation students. We propose a deep learning model that accurately predicts the mental health of first-generation students by taking into account important distinguishing behavioral factors of first-generation students. Our study, which uses the StudentLife app, offers data-informed insights that could be used to identify struggling students and provide new forms of phone-based interventions with the goal of keeping students on track.
Higher education may protect an individual against depressive symptoms, yet, disadvantaged socioeconomic status (SES) during childhood, often measured by lower parental education, may put them at higher risk for depressive symptoms later in life. This study evaluates if midlife depression is similar for first-generation and multi-generation college graduates. For US Health and Retirement Study (HRS) participants ages 55-63 (N = 16,752), we defined a 4-category exposure from parents' (highest of mother or father's) and participant's own years of education, with 16 years indicating college completion: multi-gen (both ≥ 16 years: reference); first-gen (parents <16; own ≥ 16); only parent(s) (parents ≥ 16; own <16); and neither (both <16) college graduates across three birth cohorts. We used linear regressions to evaluate relationships between college completion and depressive symptoms measured by an 8-item Center for Epidemiologic Studies - Depression (CES-D) scale. Models pooled over time evaluated differences by sex, race/ethnicity, and birthplace. First-gen and multi-gen college graduates averaged similar depressive symptoms in midlife (β: 0.01; 95% CI: 0.15, 0.13). Results were similar by sex and race/ethnicity. Consistent with resource substitution theory, college completion may offset the deleterious effects of lower parental education on midlife depressive symptoms for first-generation graduates.
Many factors contribute to students' academic success, and some, including first-generation (FG) college student status and academic preparation, are especially relevant in physiology programs. The purpose of this qualitative study was to examine FG college students' perceptions of academic preparedness and intended success strategies with the goal of informing program-level strategies to support FG students in similar undergraduate physiology-related programs. FG freshmen completed short surveys and reflections at the start and end of the semester. Qualitative responses from written reflections were compiled, and content was analyzed. Students were high achievers in high school; 98% expected As and Bs in college, but only 53% had achieved this by the end of the first semester. At the start of the semester, FG students reported feeling prepared academically but were hoping to improve their academic readiness skills, and academic success plans focused on organizational strategies. At the end of the semester, some thought they were as prepared as they expected, but most found they were not as academically prepared for college as they had expected. Several minor themes were identified as areas to address with future cohorts. This study proposes several potential avenues by which to support FG freshmen's academic success in similar physiology programs, including early identification of at-risk students, setting realistic expectations, educating students early and often about evidence-based strategies, and developing academic recovery strategies as needed.NEW & NOTEWORTHY A qualitative investigation of first-generation (FG) college freshmen's perceptions of academic preparedness and intended success strategies informs the development of potential avenues by which to support FG freshmen in physiology programs.
Academic dishonesty is becoming more common among university students in science, technology, engineering, and mathematics (STEM)-based programs. This is concerning because these students hold positions of responsibility in their professional careers. The purpose of this qualitative study was to examine if a student's academic standing and/or first-generation (First-Gen) status would affect their views of academic integrity and dishonesty within their academic coursework. Freshmen completed reflections at the start and end of their first semester of college. Qualitative responses from their reflections were reviewed and organized into common themes. Students were grouped based on university matriculation criteria [high-school grade-point average (GPA), Standards Admissions Test (SAT), and the American College Test (ACT) scores and parental higher education status]. The primary findings of the study demonstrated that the students responded similarly to their views of academic honesty, but some themes were more prevalent across the groups (First-Gen, Honors, and Pre-Math). This study identified several areas to help STEM students in a physiology-based program gain a better understanding of academic integrity and dishonesty.NEW & NOTEWORTHY A qualitative investigation of the views of academic honesty among freshmen in a physiology-based program.
Third-generation (third-gen) epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have revolutionized the management of advanced EGFR-mutated non-small cell lung cancer (NSCLC). However, a head-to-head comparison of efficacy and safety among third-gen EGFR TKIs is lacking. Seven randomized controlled trials with 3012 patients were included. All third-gen TKIs significantly prolonged progression-free survival (PFS) compared to first-generation (first-gen) TKIs, with no significant differences in PFS or objective response rate among the third-gen TKIs. Furmonertinib ranked highest for PFS (HR, 0.82; 95% credible intervals [CrI], 0.72-0.94). Aumolertinib demonstrated the best intracranial control (HR, 0.74; 95% CrI, 0.63-0.89). Osimertinib (HR, 0.90; 95% CrI, 0.83-0.99) and lazertinib (HR, 0.89; 95% CrI, 0.79-1.00) showed overall survival benefits over first-gen TKIs. Furmonertinib, aumolertinib, and osimertinib had lower rates of severe treatment-related adverse events (TRAEs), while befotertinib exhibited the highest risk of grade ≥3 TRAEs (RR, 3.96; 95% CrI, 2.35-7.17). This study is the first head-to-head comparison of third-gen EGFR-TKIs using a Bayesian network meta-analysis, offering critical insights into efficacy and safety. Our results support personalized selection of third-gen EGFR TKIs for patients with advanced EGFR-mutated NSCLC, particularly for subpopulations with CNS metastases or different mutation subtypes.
Chiral secondary amines in lactams are commonly used as chiral organocatalysts (MacMillan catalysts) in a broad range of transformations. The related thiolactam derivatives are less explored although possessing some significantly differing properties originating from the stereoelectronic characteristics of sulfur. In the present study, we present a streamlined synthesis and application of imidazolidine-4-thiones from naturally abundant L-phenylalanine. Suitable substituents enable asymmetric Diels-Alder reactions with high enantioselectivity and yield. Here, we discovered the formation of a novel bicyclic thiolactam aldehyde motif in absence of the diene. The obtained hetero-bicycle, with four consecutive stereocenters, is formed in high yield and stereoselectivity from imidazolidine-4-thione and two cinnamaldehyde units, whereas the first gen. MacMillan catalyst shows no reactivity. We propose a mechanism of formation which is supported by DFT calculations, revealing a combination of thermodynamic and kinetic factors for the observed selectivity. Our results demonstrate the surprising versatility of imidazolidine-4-thiones, as this compound class can not only engage as a catalyst but can simultaneously participate as a reagent to form complex structures. The hetero-bicyclic skeleton is accessible in a single step and allows for facile structural modifications.
To determine the relationship between adverse childhood experiences (ACEs), social disadvantage, psychological distress, and resilience in graduate health professions students. This study includes cross-sectional analyses from a longitudinal survey of medical, veterinary, and advanced practice provider students at matriculation to the University of California Davis in July 2019. The survey contained an expanded Adverse Childhood Experiences Questionnaire (ACEs-14), a measure of psychological distress (the Medical Student Well-Being Index [MSWBI]), and the Brief Resilience Scale. Responses were linked to demographics, including markers of social disadvantage (female gender, underrepresented in medicine [URM] status, and first-generation college graduate [first-gen] status). The relationships between ACEs, social disadvantage, psychological distress, and resilience were tested using linear or logistic regression. Complete survey responses were provided from 240 of 357 students (67% completion rate). About two-thirds of students (67%, 161/240) reported ≥ 1 ACE, while a quarter (25%, 60/240) reported ≥ 4 ACEs. URM and first-gen students had higher odds of reporting ≥ 4 ACEs (odds ratio [OR] = 1.56; P = .049 and OR = 2.63; P < .001, respectively) than their nondisadvantaged peers based on binary logistic regression analysis. Higher ACEs-14 scores were associated with higher psychological distress scores ( P < .001). The majority of students reported normal or high resilience (normal: 76%, 183/240; high: 10%, 25/240) regardless of ACEs-14 scores. There was not a statistically significant relationship between ACEs-14 scores and resilience scores ( P = .936). Health professions students from some socially disadvantaged backgrounds at this institution reported statistically significantly higher ACEs-14 scores than their nondisadvantaged peers. Childhood adversity was associated with increased psychological distress but not with low resilience. Implications for equity- and trauma-informed health professions education and interventions are discussed.
Sacral neuromodulation (SNM) requires removal for infectious complications in 3-11%. The objective of this study was to examine the effect of preoperative antibiotic choice on all-cause SNM device removal rates. This was a retrospective cohort analysis, using the Health Facts Database, representing more than 750 hospitals. We included female patients undergoing SNM implantation from 2010 to 2018. Univariate and multivariate logistic regression identified factors associated with removal. Thirty-five comorbidities were evaluated. Those with P < 0.2 on univariate analysis were included in the multivariate analysis. We decided a priori to include prophylactic antibiotic choice in the final model. Of 1,433 patients, 170 (11.9%) had device removal. Patients were 63.0 ± 14.9 years old, predominantly Caucasian (90.0%), treated in urban hospitals (94.1%), and married (54.2%). A total of 11.8% were obese, and 18.0% smoked. Those in the removal cohort were more likely from the Northeastern United States; 52.3% received first-gen cephalosporins (CPSN), 7.4% second- or third-generation CPSNs, 9.1% vancomycin, 13.4% aminoglycosides, 4.6% clindamycin, and 13.3% fluoroquinolones. Compared to vancomycin, more removals were associated with first-generation CPSNs (odds ratio [OR] = 3.1, 95% confidence interval [1.4, 6.8]); clindamycin (OR = 3.2, [1.2, 8.4]); second/third-generation CPSNs (OR = 3.1, [1.3, 7.6]); and aminoglycosides (OR = 3.1, [1.3, 7.4]). Additionally, patients treated in the Northeast were more likely to undergo removal (OR = 1.9, [1.0, 3.7]). Vancomycin as a prophylactic antibiotic was associated with fewer device removals compared to most antibiotics in this retrospective cohort analysis. While prospective trials could confirm this benefit, low removal rates may make this impractical.
There are many reasons to consider postdoctoral research after completing a Ph.D. For those interested in academic careers at all levels, a postdoctoral research associate (PDRA) position is often required or at least preferred. Even for those interested in industry, government, or alternative careers, postdoctoral research provides opportunities to expand your knowledge and skill sets beyond your Ph.D. training. It can be a wonderful time to focus on research with minimal distractions and interruptions. However, there has been little discussion about the challenges of the postdoc transition. The postdoc experience can vary widely, but common challenges include transitioning into a new environment, learning new skills, serving in multiple roles as a mentor and mentee, different and sometimes unclear positions in the institution, and competition for limited opportunities. In this Commentary, we draw on our personal experiences and interviews with postdocs of various backgrounds and intersectionalities (gender, race, first-gen, neurodiversity, etc.) to discuss how to successfully navigate various aspects of the postdoc experience. Our perspective comes primarily within mass spectrometry (MS) research, but the interviews include several experiences outside of the MS field to develop discussions applicable to a broad range of PDRA experiences.
Being in the first generation to access Higher Education (First Gen) is a barrier to academic success. First Gens face difficulties transitioning into, completing, and attaining competitive grades in undergraduate studies despite intervention strategies. Triangulating data across studies, we reveal the unique challenges resulting from being First Gen in science and show how these persist at every stage of a career in academia. We propose that invitation practices, i.e. behaviors that encourage, guide, and/or affirm others, need to be intentionally directed towards First Gens throughout their career journey to successfully support their retention and progression in science. As First Gens are overrepresented in other intersectionally marginalised groups, such actions will contribute to building a more inclusive and diverse scientific community.
A growing body of literature is examining the relationships between socio-demographic factors influencing recruitment and retention of students in higher education. The purpose of this study was to explore the characteristics of first generation to college (First-Gen) nursing applicants including socio-demographic variables compared to applicants whose parents received a higher education degree. We also aimed to explore whether acceptance or rejection into the program varied based on an applicant's First-Gen identification. A total of 3469 applications were analyzed over a six-year admission period from 2012 to 2017 across three programs: Accelerated Registered Nursing; Graduate (Master's degree), and PhD. Data analysis included descriptive and inferential statistics (e.g., chi-square, t-tests) aimed at describing the sample of First-Gen applicants as well as comparing First-Gen applicants to those whose parents received at least a university degree. Approximately 30% of applicants identified as First-Gen. First-Gen applicants were significantly more likely to be a student of color, older, a Veteran, immigrant or international student. PhD first-gen applicants were significantly more likely to be rejected than those who whose parents had higher education degrees. This study describes a growing population of nursing student applicant requiring further research and engagement on what supports are most needed. The long-term goal of boosting the diversity of our workforce is to increase recruitment, improve retention, increase graduation rates, and ultimately increase access to and quality of care to the patients we serve.
In higher education, it is a common ask to do more with less while delivering high-quality, holistic service to students. Coaching has been shown to produce significant gains in strengthening self-efficacy, improving GPA, and increasing retention through graduation (Alzen et al., 2021; Capstick et al., 2019; Catchings, 2014; Grover & Furnham, 2016; Losch et al., 2016), therefore making it a logical program to target for growth. To expand the impact of the University of Kentucky's academic coaching program, in 2020, leadership modified the Appreciative Academic Coaching framework (Bradley & Reynolds, 2021) into Integrated Success Coaching with the intent to build a coaching culture across campus. This modification created a two-pronged approach to serving students, faculty, and staff across our campus: (a) training for professionally certified International Coaching Federation (ICF) coaches across six domains, including academic life, career, finances, wellness, leadership, and identity (e.g., First Gen) to directly serve students, and (b) training in foundational coaching skills for faculty, staff, and student leaders to incorporate into their daily practice. The evolution of this coaching model has allowed for holistic support of students and immersive coaching values and practices for faculty, staff, and student leaders that have led to improved retention and better GPA outcomes for students on probation and a culture of coaching care among faculty, staff, and students.
Treatment of acromegaly resistant to first generation somatostatin analogues (first gen-SSA) is often difficult. We aimed to investigate the role of partial response and resistance to first gen-SSA in the choice of second line treatments and their outcomes. A retrospective and multicenter study was conducted on 100 SSA-resistant acromegaly patients and treated with Pasireotide Lar (Pasi-Lar), Peg-V in monotherapy (m-Peg-V) or in combination with first gen-SSA (c-Peg-V). Thirty-three patients (33%) were treated with m-Peg-V, 36 (36%) with c-Peg-V and 31 with Pasi-Lar (31%). According to logistic regression, m-Peg-V was chosen in older patients (p = 0.01) and with not-invasive adenomas (p = 0.009), c-Peg-V therapy in younger patients (p = 0.001), with invasive adenomas (p = 0.02), Pasi-Lar was in invasive adenomas (p = 0.01) and in patients partially responsive to first-gen SSA (p = 0.01). At the last follow-up, 68 patients (68%) reached the acromegaly control: 22 with m-Peg-V (32.4%), 23 with c-Peg-V (33.8%) and 23 with Pasi-Lar (33.8%). Patients non-responsive to c-Peg-V had higher IGF-I levels (median 3.2 x ULN, IQR: 1.6, p < 0.001) and required higher Peg-V dosage (median 30 mg/daily IQR: 10, p = 0.002) as compared to responsive patients (median IGF-I x ULN: 2.1 IQR: 1.4; median Peg-V dosage 20 mg/daily IQR: 10). All patients responsive to Pasi-Lar were partially responsive to first gen-SSAs (p = 0.02). Our data showed that c-Peg-V and Pasi-Lar are chosen for the treatment of invasive tumors. The partial response to first gen-SSA seems to be the main determinant for the choice of Pasi-Lar and positively predicts the treatment outcome.
Of Being a First Generation (First Gen) college graduate is an important intersectionality which impacts the lens through which First Gen students learn to become physicians. In this Perspective, we define the First Gen identity and review some of the salient First Gen literature as it applies to the medical school experience. We discuss the conception, design and execution of First Gen initiatives and program development at our medical school as a call to action and model for other institutions to create communities for their First Gen populations, focusing on inclusion and tailored support. We describe the framework through which we envisioned our programming for First Gen medical students, trainees, staff, and faculty at the David Geffen School of Medicine at UCLA.
Acromegaly is a chronic disease with an increased mortality in case of persistently active disease. The treatment of acromegaly is mainly based on the surgical resection of the GH secreting pituitary tumor and, in cases with persistent disease, on the medical therapy with first generation somatostatin analogues (first gen-SSAs). Data from national registries, meta-analysis and epidemiology studies showed that 24%-65% of acromegaly patients treated with first gen-SSA did not reach the control of disease, requiring second line therapies, as the second gen-SSAs and the GH receptor antagonist. According to the high efficacy of these treatments and their molecular mechanisms of action, the choice of second line therapies should be personalized. In this review, we summarize the evidence on clinical, molecular and morphological aspects that may predict the response to second line therapies, in order to integrate and translate in the clinical practice for a patient-tailored therapeutic approach.
Circulating tumor cells (CTCs) are cancer cells that break away from either a primary tumor or a metastatic site and circulate in the peripheral blood as the cellular origin of metastasis. With their role as a "tumor liquid biopsy", CTCs provide convenient access to all disease sites, including that of the primary tumor and the site of fatal metastases. It is conceivable that detecting and analyzing CTCs will provide insightful information in assessing the disease status without the flaws and limitations encountered in performing conventional tumor biopsies. However, identifying CTCs in patient blood samples is technically challenging due to the extremely low abundance of CTCs among a large number of hematologic cells. To address this unmet need, there have been significant research endeavors, especially in the fields of chemistry, materials science, and bioengineering, devoted to developing CTC detection, isolation, and characterization technologies. Inspired by the nanoscale interactions observed in the tissue microenvironment, our research team at UCLA pioneered a unique concept of "NanoVelcro" cell-affinity substrates, in which CTC capture agent-coated nanostructured substrates were utilized to immobilize CTCs with high efficiency. The working mechanism of NanoVelcro cell-affinity substrates mimics that of Velcro: when the two fabric strips of a Velcro fastener are pressed together, tangling between the hairy surfaces on two strips leads to strong binding. Through continuous evolution, three generations (gens) of NanoVelcro CTC chips have been established to achieve different clinical utilities. The first-gen NanoVelcro chip, composed of a silicon nanowire substrate (SiNS) and an overlaid microfluidic chaotic mixer, was created for CTC enumeration. Side-by-side analytical validation studies using clinical blood samples suggested that the sensitivity of first-gen NanoVelcro chip outperforms that of FDA-approved CellSearch. In conjunction with the use of the laser microdissection (LMD) technique, second-gen NanoVelcro chips (i.e., NanoVelcro-LMD), based on polymer nanosubstrates, were developed for single-CTC isolation. The individually isolated CTCs can be subjected to single-CTC genotyping (e.g., Sanger sequencing and next-generation sequencing, NGS) to verify the CTC's role as tumor liquid biopsy. Created by grafting of thermoresponsive polymer brushes onto SiNS, third-gen NanoVelcro chips (i.e., Thermoresponsive NanoVelcro) have demonstrated the capture and release of CTCs at 37 and 4 °C, respectively. The temperature-dependent conformational changes of polymer brushes can effectively alter the accessibility of the capture agent on SiNS, allowing for rapid CTC purification with desired viability and molecular integrity. This Account summarizes the continuous evolution of NanoVelcro CTC assays from the emergence of the original idea all the way to their applications in cancer research. We envision that NanoVelcro CTC assays will lead the way for powerful and cost-efficient diagnostic platforms for researchers to better understand underlying disease mechanisms and for physicians to monitor real-time disease progression.
Image-to-Video generation (I2V) animates a static image into a temporally coherent video sequence following textual instructions, yet preserving fine-grained object identity under changing viewpoints remains a persistent challenge. Unlike text-to-video models, existing I2V pipelines often suffer from appearance drift and geometric distortion, artifacts we attribute to the sparsity of single-view 2D observations and weak cross-modal alignment. Here we address this problem from both data and model perspectives. First, we curate ConsIDVid, a large-scale object-centric dataset built with a scalable pipeline for high-quality, temporally aligned videos, and establish ConsIDVid-Bench, where we present a novel benchmarking and evaluation framework for multi-view consistency using metrics sensitive to subtle geometric and appearance deviations. We further propose ConsID-Gen, a view-assisted I2V generation framework that augments the first frame with unposed auxiliary views and fuses semantic and structural cues via a dual-stream visual-geometric encoder as well as a text-visual connector, yielding unified conditioning for a Diffusion Transformer backbone. Experiments across ConsIDVid-Bench