Ethan Aminov

Background: The rapid expansion of telehealth has outpaced formal training in virtual interprofessional collaboration across health professions education. Although telehealth and interprofessional education (IPE) competency frameworks exist, limited evidence informs how longitudinal, virtual IPE curricula prepare learners for team-based telehealth practice. Objective: This study evaluated a longitudinal virtual interprofessional telehealth course to examine its impact on learners’ perceived telehealth competencies, understanding of interprofessional roles, and readiness for virtual team-based care. Methods: We conducted a mixed methods evaluation of a 4-week virtual IPE course involving graduate students from medicine, nursing, physical and occupational therapy, and social work. Learners participated in longitudinal standardized patient telehealth encounters, interprofessional debriefing sessions, and asynchronous learning activities. Quantitative outcomes were assessed using a validated postcourse survey. Qualitative data were obtained from open-ended survey responses and analyzed using thematic analysis. Results: Twenty-eight students completed the course and postcourse evaluation. Quantitative findings demonstrated high self-reported confidence in telehealth communication, ethical practice, interprofessional collaboration, and role clarity, with mean scores ranging from 4.4 (0.7) to 4.8 (0.6) on a 5-point Likert scale. Qualitative analysis identified three core themes: (1) development of interprofessional collaboration skills in virtual settings, (2) growth in telehealth-specific clinical and communication competencies, and (3) perceived value of longitudinal standardized patient encounters with iterative feedback. Conclusions: A longitudinal, standardized patient–based virtual IPE curriculum was associated with strong self-reported preparedness for interprofessional telehealth practice among health professions students. These findings support the use of structured, longitudinal virtual IPE models to address evolving educational needs in telehealth training.

BACKGROUND The COVID-19 pandemic increased the demand for expedited, flexible virtual care and necessitated an immediate shift from in-person to online education. Faculty rapidly transitioned core in-person concepts to virtual learning, with minimal guidance and without effective evaluation of content delivery in a virtual environment. OBJECTIVE Despite the increased need for virtual training sessions, a lack of knowledge exists about how to effectively train and assess learners within a cohesive virtual medical team. Although core competencies have been developed for telehealth and interprofessional education, the impacts of early virtual interprofessional education (IPE) have not been well defined. The objective of our study was to explore how early virtual interprofessional education affects collaboration among healthcare students, skills development with remote clinical care, and perception of telehealth. METHODS An interdisciplinary course was implemented consisting of 28 students from nursing, medical, occupational/physical therapy, or social work backgrounds. The course consisted of asynchronous and synchronous activities, meeting twice a week for four weeks. Activities included longitudinal telehealth for standardized patient interactions, group discussion, and patient feedback. After the course, a self-survey was conducted to assess student learning. RESULTS Survey results indicated an increase in interdisciplinary understanding and confidence within telehealth settings. Students from medical, nursing, occupational therapy, physical therapy, and social work backgrounds all had a significant increase in familiarity with other professions’ role in telehealth settings (p <0.05). After the course, students rated highly their knowledge of telehealth etiquette, their ability to perform professional roles over telehealth, and their confidence to successfully collaborate with other healthcare professionals in a virtual setting. CONCLUSIONS Post-course comments highlighted the value of direct feedback from standardized patients and the value of interdisciplinary education. The positive feedback in both the general rating of how they perceive telehealth as well as working in a collaborative environment demonstrates the positive aspects of working together through virtual platforms. The longitudinal component of patient interactions also allowed for greater improvement in quality of care as students grew more comfortable with working together in a team-based environment.

Heart failure (HF) affects over 55 million individuals globally, with prevalence projected to exceed 11 million in the United States by 2050 and is increasingly recognized as a systemic disorder extending beyond hemodynamic dysfunction to encompass profound alterations in neural and gut physiology. Cognitive impairment affects nearly half of HF patients and represents a major determinant of morbidity, self-care capacity, and mortality. Recent advances suggest that the gut microbiome serves as a pivotal intermediary in the heart–brain crosstalk, influencing neurocognitive outcomes through inflammatory, metabolic, and neurohumoral pathways. Dysbiosis in HF disrupts intestinal barrier integrity, facilitating translocation of endotoxins and microbial metabolites such as trimethylamine-N-oxide (TMAO), short-chain fatty acids (SCFAs), and bile acids, which in turn modulate neuroinflammation, cerebral perfusion, and neuronal signaling. The gut–heart–brain axis provides an integrative framework linking HF and cognitive impairment pathophysiology through dysbiosis-driven systemic inflammation and metabolite dysregulation. Gut-derived biomarkers and microbiome-targeted interventions represent promising strategies for detection of early alterations and precision treatment, highlighting the urge for prospective, multi-omics studies to establish causality and therapeutic efficacy. This review synthesizes current evidence connecting gut microbiome dysbiosis and metabolite alterations to both HF and cognitive impairment pathophysiology and proposes translational strategies for integrating microbiome-targeted therapies in HF patients with cognitive dysfunction.

Heart failure (HF) affects over 55 million individuals globally, with prevalence projected to exceed 11 million in the United States by 2050 and is increasingly recognized as a systemic disorder extending beyond hemodynamic dysfunction to encompass profound alterations in neural and gut physiology. Cognitive impairment affects nearly half of HF patients and represents a major determinant of morbidity, self-care capacity, and mortality. Recent advances suggest that the gut microbiome serves as a pivotal intermediary in the heart–brain crosstalk, influencing neurocognitive outcomes through inflammatory, metabolic, and neurohumoral pathways. Dysbiosis in HF disrupts intestinal barrier integrity, facilitating translocation of endotoxins and microbial metabolites such as trimethylamine-N-oxide (TMAO), short-chain fatty acids (SCFAs), and bile acids, which in turn modulate neuroinflammation, cerebral perfusion, and neuronal signaling. The gut-heart-brain axis provides an integrative framework linking HF and cognitive impairment pathophysiology through dysbiosis-driven systemic inflammation and metabolite dysregulation. Gut-derived biomarkers and microbiome-targeted interventions represent promising strategies for detection of early alterations and precision treatment, highlighting the urge for prospective, multi-omics studies to establish causality and therapeutic efficacy. This review synthesizes current evidence connecting gut microbiome dysbiosis and metabolite alterations to both HF and cognitive impairment pathophysiology and proposes translational strategies for integrating microbiome-targeted therapies in HF patients with cognitive dysfunction.

Background: Type II diabetes (T2DM) is one of the most prevalent metabolic disorders, and its multisystemic health consequences are widely known. Due to skeletal muscle's ability to sequester a vast amount of glucose, muscle function and exercise have become a subject of much research into strategies to prevent and treat T2DM. Myokines are bioactive molecules released by muscle during contraction and involved in several biological processes such as metabolism, inflammation and behaviour. Irisin, a recently discovered myokine, has been implicated in a vast array of physiological roles, including the ability to induce fat beiging. Since beige and brown fat both serve important roles in metabolic regulation, irisin's role in the context of T2DM is the subject of ongoing investigations.Methods: We systematically reviewed articles indexed in PubMed, Scopus and Web of Science that were published between 2011 and 2024 and compared circulating irisin levels in patients affected by T2DM and healthy subjects. As part of our systematic review of the literature, we performed meta‐analysis of the data across all included articles, as well as stratified by body mass index (BMI), country of origin and by average irisin concentration in the control group.Results: We discovered great variability across the included studies in the average irisin levels detected, which spanned four orders of magnitude, hence the attempt at reducing variability by stratifying based on average levels in the control group. While the statistical power of our meta‐analysis was decreased by the great variability in reported irisin concentrations, we nonetheless detected a consistent trend of decreased irisin concentration in T2DM patients compared with healthy controls, regardless of BMI, country of origin or average irisin concentration in the control group.Conclusions: With almost 60 articles included, ours is the first extensive systematic review and meta‐analysis of irisin in T2DM, yet a highly statistically significant association between circulating irisin levels and T2DM could not be established due to the great variability of the data across include articles. Nonetheless, we noticed a trend that is independent of BMI, suggesting a direct relationship between T2DM and irisin that is likely not secondary to diabetic sarcopenia. While our work encourages further research into irisin's potential role in T2DM pathogenesis, the reproducibility of irisin detection methods in biological samples should be determined and standardized protocols should be made available to the research and clinical communities.

The role of ribonucleic acid (RNA) in biology continues to grow, but insight into important aspects of RNA behavior is lacking, such as dynamic structural ensembles in different environments, how flexibility is coupled to function, and how function might be modulated by small molecule binding. In the case of proteins, much progress in these areas has been made by complementing experiments with atomistic simulations, but RNA simulation methods and force fields are less mature. It remains challenging to generate stable RNA simulations, even for small systems where well-defined, thermostable structures have been established by experiments. Many different aspects of RNA energetics have been adjusted in force fields, seeking improvements that are transferable across a variety of RNA structural motifs. In this work, the role of weak CHO interactions is explored, which are ubiquitous in RNA structure but have received less attention in RNA force field development. By comparing data extracted from high-resolution RNA crystal structures to energy profiles from quantum mechanics and force field calculations, it is shown that CHO interactions are overly repulsive in the widely used Amber RNA force fields. A simple, targeted adjustment of CHO repulsion that leaves the remainder of the force field unchanged was developed. Then, the standard and modified force fields were tested using molecular dynamics (MD) simulations with explicit water and salt, amassing over 300 mu s of data for multiple RNA systems containing important features such as the presence of loops, base stacking interactions as well as canonical and noncanonical base pairing. In this work and others, standard force fields lead to reproducible unfolding of the NMR-based structures. Including a targeted CHO adjustment in an otherwise identical protocol dramatically improves the outcome, leading to stable simulations for all RNA systems tested.

Ribonucleic acid (RNA) molecules can adopt a variety of secondary and tertiary structures in solution, with stem-loops being one of the more common motifs. Here, we present a systematic analysis of 15 RNA stem-loop sequences simulated with molecular dynamics simulations in an implicit solvent environment. Analysis of RNA cluster ensembles showed that the stem-loop structures can generally adopt the A-form RNA in the stem region. Loop structures are more sensitive, and experimental structures could only be reproduced with modification of CH···O interactions in the force field, combined with an implicit solvent nonpolar correction to better model base stacking interactions. Accurately modeling RNA with current atomistic physics-based models remains challenging, but the RNA systems studied herein may provide a useful benchmark set for testing other RNA modeling methods in the future.

Ribonucleic acid (RNA) molecules can adopt a variety of secondary and tertiary structures in solution, with stem-loops being one of the more common motifs. Here we present a systematic analysis of fifteen RNA stem-loop sequences simulated with molecular dynamics simulations in an implicit solvent environment. Analysis of RNA cluster ensembles showed that the stem-loop structures can generally adopt A-form RNA in the stem region. Loop structures are more sensitive and experimental structures could only be reproduced with modification of CH---O interactions in the force field, combined with an implicit solvent nonpolar correction to better model base stacking interactions. Accurately modeling RNA with current atomistic physics-based models remains challenging but the RNA systems studied herein may provide a useful benchmark set for testing other RNA modeling methods in the future.