Implementation Science and Implementation Science Communications are focused on the implementation of evidence into healthcare practice and policy. This editorial offers reflections on how we handle this as editors. Studies that focus on the simultaneous implementation of implementation objects and  structures to enable their implementation are considered on a case-by-case basis regarding their contribution to implementation science. Studies on implementation objects with limited, mixed, or of out-of-context evidence are considered if the evidence for key components of the object of interest is sufficiently robust. We follow GRADE principles in our assessment of the certainty of research findings for health-related interventions in individuals. Adapted thresholds apply to evidence for population health interventions, organizational changes, health reforms, health policy innovations, and medical devices. The added value of a study to the field of implementation science remains of central interest for our journals.The journals  Implementation Science and Implementation Science Communications focus on the implementation of evidence into practice and policy. The evidence concerns objects of implementation, such as clinical or public health interventions, guidelines, medical technologies , and healthcare delivery models (e.g. structured diabetes care). We have never operationalized the concept of evidence in healthcare in detail, but in the journal editorial that launched Implementation Science, Eccles and Mittman made it clear that it relates to research evidence rather than evidence from practical experience or other sources [The journals  sources . There a sources , systema sources , and, in sources  or “implHowever, some researchers perceive that this threshold is not entirely explicit, difficult to reach, or inappropriate in certain contexts. Our journals will remain focused on the implementation of evidence-based practices, programmes, or policies in healthcare, but we believe that there are several reasons to reflect on what is meant by this. In many cases, a set of practices is implemented, some of which are clearly evidence-based while others are not, or have mixed evidence. For instance, many clinical practice guidelines contain recommendations with a strong evidence base and recommendations with weak or conflicting evidence. Furthermore, using guidelines requires clinical judgement, ideally in partnership with patients . Second,In the remainder of this commentary, we will discuss three specific cases and how we deal with these in our journals. Before we turn to this, we summarize the arguments for a focus on evidence-based practices for implementation.Our rationale for a focus on the implementation of evidence-based practices, programmes, devices, and policies  is linked to the argument for the use of evidence in healthcare generally. Historically, it implies a departure from authority-based practice, which was motivated by examples of outdated practices that continued to be used and new practices of proven value that were only implemented after many years, or not at all . The useImplementation heavily focuses on implementation strategies, whose choice, optimization, and effectiveness require dedicated research. Furthermore, the field examines the context(s) in which an object is implemented, as the application of objects does not happen in a vacuum but involves complex interactions with many contextual factors . Nevertheless, here we focus on the evidence for the objects of implementation, which also influence the uptake of objects into practice. Beginning with the ground-breaking work of Everett Rogers , factorsimplementation science, changes in structures  may be conceptualized as implementation strategies [Some interventions can only be applied and evaluated after specific technological, organizational, legal, or financial structures have been put in place. For instance, health-related software applications depend on technological infrastructure. The establishment of such new structures can be an intervention on its own, which may be evaluated in terms of benefits and harms. These typically facilitate various objects or practices being implemented, not just a particular one. Studies that entirely focus on implementing a technological or other infrastructure remain out of scope for our journals. In the context of rategies , 18. Somrategies . So far,rategies .In many situations, the research evidence related to the implementation object is limited, mixed, or out of context. Examples are the treatment of post-Covid syndrome (limited evidence), case management of chronic disease (mixed evidence), and decision aids for patients . Other examples are diagnostic tests that have been examined for predictive value, but not regarding clinical effectiveness in a targeted population. While we cannot provide pertinent requirements, the following provides some guidance.In all cases, we prefer a consolidated synthesis of studies on interventions (i.e. systematic review) over evidence from single studies. If interventions imply substantial risks, costs, or consequences for health equity, the synthesized research evidence is required to be strong, coherent, and relevant to the context of the application. Ideally, the evidence relates to the primary active ingredients of the package that are implemented. Complex interventions or other multiple component interventions may need further justification or optimization for use in a given context if their effectiveness varies substantially across trials despite the pooled overall evidence. Complex interventions may need further testing if they are adapted after the effectiveness research. Recommendations for practice or policy should be accompanied by reflections on research limitations, heterogeneity, and context. Our expectations regarding the required strength of evidence are discussed in the subsequent section.Thresholds for quality, strength, or certainty of research evidence are a topic of debate and development. In the context of systematic reviews and clinical practice guidelines, the GRADE principles  have beeWe remain interested in the implementation of population health interventions mediated through agencies, technologies, or networks, typically involving healthcare providers but potentially others—such as interventions like community health workers who connect people to health and care resources in the community or child welfare workers who engage families in behavioural health services. We welcome evaluation via randomized designs, natural experiments, rigorous quasi-experimental designs, and other designs. However, we realize that interventions that target populations may not be examined in randomized trials or related designs. We are willing to accept population health interventions as implementation objects, if these were evaluated in studies that provided the highest level of certainty under the given circumstances. We recognize that non-randomized and or “natural” experiments and other designs can provide adequate evidence when randomized designs are not possible, where interventions are demonstrably feasible and acceptable, and where there is little potential for harm . FeatureLarge-scale service delivery reconfiguration to improve healthcare and health outcomes is an area that generally does not lend itself to randomized designs. Nevertheless, we have published on the implementation of such changes or policies in the past and will continue to do so. Similar to population health interventions, we would accept organizational changes and health policies that are examined using evaluation designs that optimize the certainty of findings. For example, a study that seeks to improve the reach of an evidence-based clinical intervention through targeting organizational culture or climate must address the degree to which the change affected the reach and/or outcomes of the clinical intervention. It is also critical that the theory of change be tested and its relation to the appropriate theory, model, or framework also be clearly articulated. That is, the causal pathways between determinants, mechanisms, and outcomes should be considered and tested to the extent possible.Medical devices comprise an emerging field of research and development, covering a broad range of tools varying from wheelchairs and surgical materials to sensors for home care and health apps for patients. If such devices imply substantial risk of harm, or high cost, they should be examined in clinical trials in order to be considered evidence based . We do nImplementation Science and Implementation Science Communications. There is an entire field of study in philosophy and related areas devoted to the nature of evidence, and a similar discussion in areas outside healthcare can certainly be engaged. We have attempted to clarify a complex topic that arises frequently as a problem in reviewing manuscripts submitted to our journals.We fully appreciate that the discussion in this editorial only covers issues pertaining to submissions to the journals


Background: The recent publication of the new classification of periodontal and peri-implant disease has given clear indications on the parameters to be taken into consideration to correctly diagnose the different phases of these diseases. To date, however, there are no equally clear indications on the treatments to be implemented to solve these diseases. The objective of this Consensus Report is to provide guidance for the non-surgical management of peri-implant mucositis and peri-implantitis. For the drafting of the consensus, the most recent scientific literature was analysed. Materials and Methods: A group of 15 expert Italian dental hygienists were selected by the Italian technical-scientific societies  and, starting from the literature review, they formulated indications according to the GRADE method  on the treatment of peri-implant mucositis, peri-implantitis and on management of the various implanting surfaces. Conclusions: in accordance with the international literature, non-surgical therapy alone can resolve peri-implant mucositis, but not peri-implantitis. Several adjunctive therapies have been considered and some appear to be helpful in managing inflammation. A new classification for peri-implant health, peri-implant mucositis and peri-implantitis was developed by the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions in 2017. During the workshop, clear clinical criteria were identified to define peri-implant health, peri-implant diseases, and relevant aspects of implant site conditions and deformities. The aim of the workshop was to reach a consensus for this classification that could be accepted worldwide. As for periodontal health, peri-implant health is characterized by an absence of visual signs of inflammation and bleeding on probing [The use of dental implants for supporting prosthetic rehabilitations has shown highly satisfactory results regarding restoration of the patient’s function and aesthetics, as well as in terms of long-term survival. However, dental implants can lose supportive bone caused by local inflammation during peri-implant diseases .Peri-implant mucositis is defined by bleeding on probing and visual signs of inflammation, there is strong evidence that peri-implant mucositis is caused by plaque, and it can be reversed with measures aimed at eliminating the biofilm . Peri-imThe management and non-surgical treatment of peri-implant disease is an issue that still divides the scientific community. Therefore, the prevention and treatment of peri-implant diseases are important aspects in clinical dentistry, and the available scientific evidence should help define adequate preventive and therapeutic approaches. The limited available literature suggests that mechanical non-surgical therapy could be effective in the treatment of peri-implant mucositis .The primary objective for treatment of both peri-implant mucositis and peri-implantitis is elimination of biofilm from the implant surface, however it can be challenging. Biofilm formation is partially controlled by an interbacterial communication mechanism that is dependent on bacterial population density, called quorum sensing.By doing so, efficient mechanical debridement is difficult but critical in the management of dental implant infections. The prosthetic supra-structure often prevents effective cleaning around the implant neck by the patient, and conventional mechanical therapies adopted from the treatment of periodontal disease have their limitations because getting good access to the relevant area can be difficult .As guidelines have never been published, clinical practice may apply techniques that deviate from current scientific evidence.This consensus aims to highlight the importance and need for scientific evidence in clinical decision-making in the treatment of patients with peri-implant mucositis and peri-implantitis.Its main objective is therefore to support daily clinical practice with evidence-based recommendations for the various interventions used in the different phases of non-surgical therapy, based on the best available evidence and/or expert consensus.During the A.T.A.S.I.O.  National Congress on 5–6 February 2021, the participating dental hygienists were asked to take an instant poll with the aim of surveying their attitudes towards the diagnosis and non-surgical management of peri-implant problems in their daily practice. The analysis of the answers showed that the non-surgical management of mucositis and peri-implantitis is largely in line with the attitude that the current scientific literature proposes, but there are still some grey areas on the choice of certain instruments and techniques in addition to the standard instrumentation. For this reason, it was decided, based on a thorough literature review, to propose a series of clinical recommendations to guide clinicians in the daily management of peri-implant disease therapy.The aim of this consensus is to highlight the importance and need for scientific evidence in clinical decision-making in the treatment of patients with peri-implant mucositis and peri-implantitis.Type of studies. Randomized controlled clinical trials, prospective clinical trials, and Meta-analysis were included.Types of participants. Participants with the peri-implant disease were considered.Type of interventions. Evaluation of the scientific literature about the efficacy of different therapy and techniques applied in patient affected by peri-implant disease.All publications that did not meet the eligibility criteria, all studies published not in English, all studies for which the full text was not available were excluded.A panel of 12 expert dental Hygienists, representative of both the university area and the free profession, was selected by the  (ATASIO) and the two Technical Scientific Associations (ATS) listed by the Ministry of Health, the  (AIDI) and the  (UNID), in order to discuss the clinical results proposed by the current scientific literature .The panellists signed the conflict of interest declaration and then a first plenary meeting was convened on a zoom platform, in which the session chairman explained the objectives, working methodology and criteria for inclusion and exclusion of scientific articles.The bibliography search was carried out by the authors, no manual search was performed and only publications written in English were searched in three databases: MEDLINE/PubMed, EMBASE and Cochrane.We performed the search using the following terms: “peri-implant oral health”, “peri implant-disease”, “peri-implant mucositis”, “peri-implantitis”, “non-surgical peri-implant therapy”, “peri-implant Clinical Practice Guidelines”, “peri-implant disease management”, “manual instrumentation”, “manual instrumentation AND peri-implant disease”, “manual instrumentation AND peri-implant mucositis”, “manual instrumentation AND peri-implantitis”, “manual instrumentation AND non-surgical peri-implant therapy” “glycine”, “glycine AND peri-implant diseases”, “glycine AND peri-implant mucositis”, “glycine AND peri-implantitis”, “glycine AND non-surgical peri-implant therapy”, “erythritol”, “erythritol AND peri-implant diseases”, “erythritol AND peri-implant mucositis”, “erythritol AND peri-implantitis”, “erythritol AND non-surgical peri-implant therapy”, “laser”, “laser AND peri-implant diseases”, “laser AND peri-implant mucositis”, “laser AND peri-implantitis”, “laser AND non-surgical peri-implant therapy”, “photodynamic therapy”, “photodynamic AND peri-implant disease”, “photodynamic AND peri-implant mucositis”, “photodynamic AND peri-implantitis”, “photodynamic AND non-surgical peri-implant therapy”, “chlorhexidine”, “chlorhexidine AND peri-implant diseases”, “chlorhexidine AND peri-implant mucositis”, “chlorhexidine AND peri-implantitis”, “chlorhexidine AND non-surgical peri-implant therapy”, “ozone”, “ozone AND peri-implant diseases”, “ozone AND peri-implant mucositis”, “ozone AND peri-implantitis”, “ozone AND non-surgical peri-implant therapy”.Two reviewers selected eligible studies by examining the list of titles and abstracts and considering the inclusion and exclusion criteria. Full articles from eligible titles and abstracts were obtained and independently reviewed to determine eligibility. Discrepancies between these reviewers regarding the selection and inclusion of any specific paper were discussed until a consensus was reached or a third reviewer determined inclusion or exclusion.A second meeting was organized at which the final document was presented for approval. According to the principles provided by the Guidelines International Network , working group members who declared relevant and potential conflicts of interest abstained from voting on the recommendations in this consensus.The second step saw the reviewers present the data to the panel members, who voted anonymously to confirm or not that they agreed with the current scientific evidence; the vote was done with a dichotomous option: agree/disagree.It was decided to proceed with anonymous voting in order not to influence the voting in any way and to make practitioners free to vote against techniques strongly supported by the literature, this to understand whether the clinical attitude reflects the evidence or not. In the case of a lack of evidence, the experts were asked to state their thoughts.A table containing the strength of the recommendation, the degree of recommendation of the procedure and the anonymous panel vote was compiled.I.evidence based on a meta-analysis of randomised controlled trials.II.evidence based on at least one randomised controlled trial.III.evidence based on at least one non-randomised controlled study.IV.evidence based on at least one non-controlled experimental study.V.evidence based on non-experimental descriptive studies (including comparative studies).VI.evidence based on strong consensus and/or expert clinical experience.The levels of available evidence (evidence) and the strength of recommendations were classified according to the National Plan Guidelines:A.the performance of that particular diagnostic procedure or test is strongly recommended. This indicates a particular recommendation supported by good quality scientific evidenceè, although not necessarily type I or II.B.there is some doubt as to whether that particular procedure or intervention should always be recommended, but it is felt that its performance should be carefully considered.C.there is substantial uncertainty for or against the recommendation to perform the procedure or intervention.D.performing the procedure is not recommended.E.performing the procedure is strongly discouraged.The strength of the recommendations was then classified as follows:Dental and medical professionals, together with all stakeholders related to health care, particularly oral health, including patients.Dental and medical academic/hospital environments, clinics, and practices.People with peri-implant mucositis and periimplantitis.Based on the new classification of periodontal and peri-implant disease, the diagnosis of peri-implant mucositis requires the presence of bleeding and/or suppuration at gentle probing with or without increased probing depth compared to previous examinations, and the absence of bone loss beyond crestal bone level changes resulting from initial bone remodelling.Based on current knowledge and evidence, the expert panel produces the recommendations shown in Based on the new classification of periodontal and peri-implant disease, the diagnosis of peri-implantitis requires the presence of bleeding and/or suppuration at probing, increased probing depth compared to baseline and the presence of bone loss in addition to crestal bone resorption resulting from initial bone remodelling.Based on current knowledge and evidence, the expert panel produces the recommendations shown in The management of surfaces influences the long-term maintenance of dental implants.A correct choice of the headmasters in terms of materials of the hand tools and implants surfaces is fundamental to solve implant-prosthetic problems without creating iatrogenic damage.Based on current knowledge and evidence, the expert panel produces the recommendations shown in In order to better understand the recommendations of the panel of experts, the studies taken into consideration are summarized in Dental implants are a valid support in dental restorations and are part of the oral cavity of a significant proportion of the population.Peri-implant diseases are becoming increasingly prevalent, the prevalence of peri-implant mucositis ranged from 19 to 65% and peri-implantitis ranged from 1 to 47%, according to systematic reviews and meta-analysis conducted in recent years .With the increasing use of dental implants, peri-implant diseases are also becoming more prevalent, therefore the prevention of peri-implant disease is an important aspect to take care of.In recent years, several protocols for the non-surgical management of mucositis and peri-implantitis have been proposed in the literature, the aim of which is the decontamination of implant surfaces by mechanical debridement as a basis for the reduction of bacterial colonisation and the elimination of the risk factor for peri-implant disease, including adherent oral biofilm.Over the years, protocols have been proposed involving the addition of low-abrasiveness powders with air polishing systems, the use of laser and photodynamic therapy, the addition of antiseptics (chlorhexidine) both locally and as an additional home therapy, and even the addition of ozone.The aim of our consensus was to, based on an analysis of the most recent literature, provide indications for the non-surgical treatment of peri-implant pathologies.The effectiveness of the various types of treatment of peri-implantitis in addition to or as an alternative to mechanical debridement is still debated in the literature.Regarding peri-implant mucositis, considering the evidence, we can state that non-surgical therapy alone is sufficient to resolve the inflammation. As far as additional therapies are concerned, there is no evidence that the use of other technologies and systems in the literature alone gives better results than conventional therapy.For the instrumentation of implant sites, the use of dedicated instruments such as titanium curettes and peek inserts for ultrasound is recommended. Steel instruments are not recommended due to their hardness, which can scratch implant surfaces, and Teflon instruments due to the risk of losing some splinters during instrumentation.Regarding the use of additional therapies to NSPT, long-term antimicrobial effects and reduction of inflammation around implant sites have been shown with the use of low-abrasiveness powders (such as erythritol and glycine), photodynamic therapy, antiseptic substances, and the use of ozone therapy.Regarding peri-implantitis, evidence suggests that non-surgical therapy alone is often not sufficient to resolve inflammation. As with the treatment of mucositis, the use of titanium and peek instruments is recommended for the management of peri-implantitis, so as not to alter the surfaces of fixtures and abutments.Current evidence suggests that, in addition to non-surgical therapy, the use of low-abrasiveness powders (such as erythritol and glycine), laser, photodynamic therapy and ozone therapy can be a valuable adjunct to mechanical debridement to control inflammation.It is also essential to know and recognise the different types of implant surfaces to choose the most appropriate instruments and avoid possible iatrogenic damage.The use of abrasive pastes or low abrasive powders such as glycine or erythritol does not appear to alter implant surfaces, as do non-metallic hand instruments or sonic/ultrasonic instruments with dedicated tips.The use of metal instruments, whether manual or sonic, should always be avoided/however, it is not always possible to access all sites due to the size of the instrument or the anatomical surface of the implant that is difficult to decontaminate.Based on the results discussed in this consensus report, we can assume that the additional therapies found in scientific literature and used for peri-implantitis disease, may provide additional clinical benefits in the non-surgical treatment of peri-implant diseases.Analysing the clinical, microbiological and radiographical effects of those therapies, supporting the mechanical debridement for the treatment of peri-implant diseases, some improvements have emerged.Considering the results found in scientific literature, the application alone of these additional therapies is not recommended, however their application in addition to mechanical debridement with non-metallic hand tools or sonic/ultrasonic instruments is helpful.


Evidence is central to all maternal and child health (MCH) decision-making processes, continuously interacting with and influencing our work. There is a growing emphasis in MCH on using evidence-based approaches when addressing public health challenges, but the field lacks a unified understanding of what constitutes evidence. MCH must operate from an expansive understanding of evidence that centers community voice and acknowledges the role of evidence prioritization in achieving equitable population-level outcomes.What we consider valid evidence has immense implications for MCH practice, including whose work is deemed worthy of funding and replication. The authors advocate for shifting the field’s evidence paradigm from being primarily focused on research findings to also recognize the importance of community-rooted evidence. Contextual and experiential evidence, alongside research evidence, should be considered for two purposes: (1) to support the effectiveness of a given practice generally, and (2) to support that the practice will work in specific contexts.Putting this shift into practice requires explicit power shifting – the MCH workforce must cede power to those who have been historically barred from participating in and guiding research. To facilitate this, MCH professionals must build skills in communication, equitable leadership, and change management.The MCH workforce should position communities to set their own priorities and define, develop, and disseminate evidence representative of their priorities. Evidence co-creation is key to establishing and sustaining transformative relationships between community members and Title V programs, shifting power structures to build upon existing community leadership and assets. Evidence is key to maternal and child health (MCH) decision-making and programming. Although what the field considers evidence is evolving to recognize community preferences and insights, MCH programming is prioritized towards research-based evidence that often excludes its intended beneficiaries.We propose a paradigm shift in how we consider evidence to center the values, needs, and expertise of impacted communities and those with lived experience, and posit that shifting power is essential to putting this approach into action. Evidence co-creation is an essential pathway to building and sustaining trust and is key to advance racial and other forms of equity.Imagine yourself in this hypothetical, but hopefully resonant scenario: After identifying priorities through your jurisdiction’s five-year Needs Assessment, you’ve been assigned by your supervisor to develop, seek sustainable funding for, and implement a practice aimed at achieving more equitable outcomes within your maternal and child health (MCH) domain of expertise. You scan funding sources and target a federal notice of funding opportunity to increase service delivery capacity within jurisdictions. You also identify a request for proposals from a private foundation whose mission includes addressing health needs in your geographic region. Responding to these opportunities requires your team to include “evidence-based” approaches in your proposal. But what does “evidence-based” mean? What comes to mind when you see the word “evidence” and where does your understanding of this term come from?A final, more encompassing question: How does what we consider “evidence” influence the practices we design, implement, or fund?MCH commonly uses phrases like “evidence-based” to label effective practices, but there is no clear definition in the field as to what constitutes “evidence”  – the “conscientious, explicit, judicious, and reasonable use of modern, best evidence in making decisions about the care of individual patients”  is a separate discipline from medicine, many of its philosophies, principles, and theories are grounded in EBM; this extends to what we consider evidence and how it is valued . This is in stark contrast to the explicit guidance it provides in its Evidence is central to all MCH decision-making processes, continuously interacting with and influencing our work. The percent of Health Resources and Services Administration notices of funding opportunities including the term “evidence-based” has increased from 5.4% to 2008 to 48.8% in 2021 . This increase emphasizes the danger of operating with a narrow view of evidence focused solely on research; entities with the resources to conduct experimental studies and to submit to peer-reviewed journals may be given priority over community-based organizations (CBOs) for funding opportunities as they may be viewed as more credible approaches and better able to generate valuable evidence. This dynamic leads to a cycle of exclusion where community-rooted practices are diminished within or kept out of the evidence canon considered actionable for public health decision making because they do not appear in scholarly literature. Instead, CBOs are often competing for limited pools of community-oriented funding or relegated to supplemental roles  on proposals led by government agencies, universities, or private firms.Breaking this cycle of exclusion requires shifting the MCH field’s evidence paradigm, establishing and consistently reinforcing the importance of contextual and experiential evidence in determining the efficacy of a practice. These types of evidence are not just accessories to research evidence, but integral components of all evidence-based decision making and critical types of evidence in their own right.When determining the scope of a challenge and making decisions about how to address them, contextual and experiential evidence, alongside research evidence, should be utilized for two distinct purposes: (1) to support the effectiveness of a given practice generally, and (2) to support that the practice will work in specific contexts. Community-defined evidence (CDE), a “set of practices that communities have used and found to yield positive results as determined by community consensus over time,” is one example of contextual evidence being used to fulfill this first purpose . These practices may or may not have been measured empirically but have reached a level of acceptance within a geographically- or identity-defined community. CDE takes into consideration a population’s worldview as well as historical and social contexts acknowledging that communities are experts about what “works for them” . Examples of prioritizing CDE in decision making could look like allocating funds to a neighborhood resource center to scale up an existing adolescent health initiative that is widely regarded by community members as being instrumental in supporting youth well-being, ensuring that community members are provided with adequate resources and support to identify examples of CDE at the local level, and supporting a local health education organization to design and implement an evaluation of an engagement technique that incorporates art and storytelling into a sexual health curriculum. Capturing the insights, understanding, skills, and expertise of people with lived experience (PWLE) through qualitative methods such as focus groups, surveys, and key informant interviews  can also provide nuanced information about the impact and effectiveness of a practice. Research approaches such as community-based participatory research (CBPR), a “collaborative approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process,” are yet another form of evidence that can support the effectiveness of a practice while amplifying the voices of those impacted by the practice  through methods that center their voices and opinions. Even if a practice has strong research, contextual, and experiential evidence supporting its impact generally, it must also be perceived by intended beneficiaries as being in alignment with their values and life circumstances. Efforts to decolonize research and CBPR are examples of the transformative impact of using methodology to center community voices. Contextual and experiential evidence gathered in partnership with community representatives should be regarded as key components of assessing fit. Of note, uplifting contextual and experiential evidence in no way suggests that research evidence is not of critical importance when making evidence-based decisions. Rather, doing so aims to rebalance the currently accepted evidence equation that unintentionally contributes to inequitable population-level MCH outcomes.As is often raised in the context of racial equity work, truly shifting power  encourages jurisdictions to “collaborate with community leaders/organizations and families of every background in needs/assets assessments, program planning, service delivery and valuation/monitoring/quality improvement activities.” This statement rightfully calls out the importance of seeking and embedding contextual and experiential evidence across processes – not just in assessing needs – necessitating a foundational set of skills that the Maternal and Child Health Leadership Competencies: Version 4.0  touches on in areas such as ethics, cultural competency, family-professional partnerships, and working with communities and systems.So how do we build the necessary pressure to shift the evidence paradigm and fully recognize the value of contextual and experiential evidence? As individuals, shifting power requires the cultivation of sustained momentum and enthusiasm, as well as training  to develop strategic and reflective skills in three inextricably linked domains:Communication: Forging a holistic view of evidence demands active listening and establishing multiple channels of open and transparent communication with impacted community members. This influences the degree to which we as MCH professionals can capably and authentically present community assets, resources, and priorities.Equitable leadership: We must build awareness of programs and policies (past and present) that may enable or hinder community partnerships. A justice orientation is essential across the lifecycle of evidence assessment, creation, implementation, and dissemination. It also necessitates the establishment of opportunities for community members to access training and mentorship that builds on their existing expertise and augments their capacity to critically assess and produce evidence.Change management: We acknowledge that MCH professionals may need to adhere to traditionally accepted frameworks for research practice due to funding requirements, leadership expectations, politics, and time and resource constraints. Working around these constraints requires a commitment to shifting power through change management approaches, including targeted communication with funders and other influential partners about the benefits of valuing contextual and experiential evidence and promoting narratives that affirm community capacity.The stark, persistent racial and other identity- and circumstance-based disparities in health outcomes across domains mean we must work urgently to break cycles of community exclusion in evidence generation; this begins with intentionally emphasizing the importance of contextual and experiential evidence when making decisions about which practices we implement and replicate. There will be necessary stumbling and tensions between funders, researchers, and PWLE as we rebalance and change longstanding norms. This tension presents exciting opportunities for MCH to better resemble the anti-oppressive field we collectively envision, and to model this for the rest of public health. Together, Title V can help the MCH field shift the evidence paradigm by:Developing and investing in partnerships with community-rooted organizations that includes holistic evaluation of their practices;Thinking critically about what evidence currently guides our work to identify gaps in the types of evidence we are not adequately considering, and identifying with whom we need to connect to gather that information;Talking with existing and potential funders about raising the profile of contextual and experiential evidence within their mission statements, funding proposals, and scoring rubrics; and.Creating and sharing outcome measures that rely primarily on contextual and experiential evidence, which can contribute to broader community accountability efforts.The MCH workforce, inclusive of all levels of leadership, can and should position the communities we’re responsible for serving to set their own priorities and define, develop, and disseminate evidence that is representative of their priorities. Failing to do so will increase the distance between the intention and impact of MCH practices, result in community expertise being ignored, and allow disparate MCH outcomes to persist. Uplifting evidence that centers the voices of communities and PWLE can contribute to power and infrastructure building, as well as the cultivation of mutually beneficial relationships between community members and Title V programs. Evidence co-creation is an essential pathway to building and sustaining trust, and its role in strengthening MCH efforts to advance racial and other forms of equity cannot be overstated.


Dirofilaria.Dirofilaria immitis is cosmopolitan as regards its distribution in animals, being responsible for human pulmonary dirofilariasis in the New World. However, human infections by Dirofilaria immitis are exceptional in Europe, and the previously reported Italian cases of pulmonary dirofilariasis were due to Dirofilaria repens. We performed a systematic literature review of the Italian cases of human dirofilariasis due to Dirofilariaimmitis according to the PRISMA guidelines. We also report the first autochthonous case of human pulmonary dirofilariasis due to Dirofilariaimmitis, confirmed by polymerase chain reaction analysis. The patient was a 60-year-old man who lived in the Po river valley and had never traveled abroad; on histological examination, the 2-cm nodule found in his right upper lung was an infarct due to a parasitic thrombotic lesion. Only one other autochthonous  case due to Dirofilariaimmitis (molecularly confirmed) was previously found in the same geographic area. Climatic changes, the increasing movements of animal reservoirs and vectors, and new competent carriers have expanded the geographic distribution of the Dirofilaria species, increasing the risk of human infections. Our report demonstrates that at least some pulmonary Italian cases of human dirofilariasis are due to Dirofilaria immitis, as in the New World.Dirofilariasis is a zoonosis caused by nematodes of the genus  Dirofilaria (Filarioidea: Onchocercidae) [Dirofilaria repens (D. repens) and Dirofilaria immitis (D. immitis) are common mosquito (Culicidae)-transmitted parasites found in Canidae and felines, and the most frequently involved species in human dirofilariasis [Aedes Albopictus) have expanded their geographic distribution, increasing the risk of human infections [D. repens is smaller, has an undulated external cuticle, and seems to be present only in the Old World. Conversely, D. immitis is larger with a smooth cuticle, and is cosmopolitan as regards its distribution in animals, while human infections in Europe are exceptional [D. immitis, confirmed by polymerase chain reaction (PCR) analysis. We have also performed a systematic literature review of the Italian cases of human dirofilariasis due to D. immitis.Dirofilariasis is a zoonosis caused by nematodes of the genus ercidae) ,30,31,32lariasis ,12,13,14fections ,18,19,20eptional ,18,19,20The PCR analysis was performed on a 10% buffered formalin-fixed, paraffin-embedded tissue sample , as previously described . Brieflyhttps://www.ncbi.nlm.nih.gov/genbank/; accessed on 10 October 2022). The primers included:D. immitis: 5′-ACGTATCTGAGCTGGCTCAC-3′  and 5′-ATGATCATTCCGCTTACGCC-3′  , specific to a 378 base-pair fragment of the cuticular surface antigen gene of D. immitis.D. repens: DIR 3  and DIR 4  , specific to a 246 base-pair fragment of IpS insert 11 of D. repens.The sequence of the tested PCR primer sets was retrieved by the GenBank database  . The primers were synthesized by Roche Diagnostics, S.p.A., Monza, Italy; they have been commonly and successfully used in various previously reported studies to specifically identify these Dirofilaria species [D. repens and D. immitis cases) were also tested by PCR analysis for both the Dirofilaria species. Further information about the PCR analysis  are described in We searched and aligned the GenBank sequences to a query sequence that included  species ,22,23. Nhttp://www.prisma-statement.org/; accessed on 10 October 2022) in order to identify cases of human infection by D. immitis in Italy  guidelines opulation: human patients affected by infections due to (I)ntervention: any;(C)omparison: none;(O)utcomes: patients’ clinical outcomes ; detection rate of PCR analysis and histopathological exam.We answered the following PICO questions:https://pubmed.ncbi.nlm.nih.gov, accessed on 10 October 2022), Scopus  and Web of Science  databases. No limitations or additional filters were set. The bibliographic research ended on 10 October 2022. We applied the following:D. immitis in Italy.Eligibility/inclusion criteria: case series/reports of human dirofilariasis due to D. immitis; cases that did not occur in Italy; animal studies.Exclusion criteria: infections not due to We searched for (dirofilaria OR dirofilariasis OR dirofilariasi OR dirofilariosis OR “D. immitis” OR “D.immitis”) AND immitis AND  in the PubMed . A pulmonary tumor was suspected, and a right upper lobectomy was performed.On gross examination, the nodule was white-yellow, showed increased consistency, and measured 2 cm × 1.5 cm × 1 cm.Histologic examination  revealedD. immitis. The PCR analysis confirmed our histological diagnosis, detecting the amplification of a 378 base-pair product specific to D. immitis DNA, while the PCR test for D. repens was negative; in all the performed tests, the positive and negative tissue controls resulted as expected. The patient recovered well after surgery, but we lost him at follow-up.The infarcted pulmonary architecture was still partially recognizable, revealing a parasitic thrombotic lesion in a pulmonary vessel (probably an artery). The few, well-preserved nematode sections were more visible after a few recuts and Masson’s Trichrome staining. Size and morphology, including the typical smooth profile of the external cuticle, qualified the nematode as a D. immitis  extracted from the right eye  of a 51-year-old Caucasian man, living in the city of Carpi (near Modena). The nematode caused foreign body sensation and conjunctival swelling. Other subcutaneous or pulmonary localizations, as well as microfilaremia, were excluded. The patient completely recovered. PCR analysis of the frozen worm parts (−80 °C) confirmed the diagnosis. Another conjunctival infection by D. immitis (an imported case in a Tunisian boy) did not undergo PCR analysis [D. immitis were previously reported in Italy.Only 1 case  was cleaanalysis . No convD. repens, which typically migrates through the tissues, resulting in subcutaneous, ocular/peri-ocular/conjunctival or deep soft tissue/visceral nodules [Most of the worldwide-reported human cases of dirofilariasis have been due to  nodules ,30,31,32D. immitis, which relatively prevails in human patients living in the New World and Japan. Conversely and exceptionally, this species caused human infections in Europe, but an extrapulmonary D. repens-like presentation is uncommon [Globally, human pulmonary dirofilariasis has rarely been described, typically due to uncommon ,19,20,21uncommon ,16,17,18D. repens and D. immitis is not universal, and important caveats are also linked to the epidemiologic distribution of the two species; subcutaneous cases due to D. immitis and pulmonary localizations of D. repens have rarely been described [However, the rule of the different behavior of escribed ,18,19,20Dirofilaria species has increased in endemic regions, as well as in areas where only sporadic cases had been previously reported; moreover, new animal and human cases have been described in formerly spared areas. In the endemic Po river valley, the prevalence of D. repens and D. immitis infections in Canidae reaches about 30% and >50%, respectively, while that of D. immitis in felines accounts for 7–27% [In Italy, over the course of several decades, the prevalence of or 7–27% ,12,13,15D. repens seem to prevail even in European/Italian areas in which D. immitis is highly endemic in mosquitos and animal reservoirs. Indeed, the rare previously reported Italian cases of pulmonary dirofilariasis were due to D. repens, while our case represents the first one caused by D. immitis; moreover, considering the cases that occur in other sites of the body, this is only the second autochthonous Italian report of molecularly confirmed human dirofilariasis due to D. immitis [Human infections due to  immitis ,16,17,18Pulmonary, subcutaneous, or soft tissue nodules of dirofilariasis are usually incidentally found; after a clear histopathological diagnosis is established with or without the aid of molecular tests, most patients present no particular clinical complications at follow-up ,30,31,32Dirofilaria species, as well as their patterns of infection in human and animal hosts, could be affected by relevant diagnostic biases, concerning the clinical–pathological under-recognition of these parasitic lesions and the difficulties in correctly classifying the Dirofilaria species [Our current knowledge about the prevalence rates and geographic distribution of the various  species ,18,19,20At least in some cases, worm sections are not easily detectable or classifiable upon histological examination, owing to their advanced necrotic stage or their unfavorable orientation for a proper evaluation of the external cuticle. Further recuts or Masson’s Trichrome staining may allow for an easier detection of the parasitic sections and a more contrasted evaluation of the different internal organs of these nematodes ,18,19,20Dirofilaria species might be difficult for general pathologists, who are usually not particularly confident with the histomorphological features of these parasites. Some authors [D. immitis in the Old World, finding that at least some worms were incorrectly classified in the original reports, or information was too scant to properly identify the parasite species. Moreover, other patients with a diagnosis of infection by D. immitis were travelers/globetrotters, or lived outside Italy; therefore, it was impossible to establish if they had contracted the infection in Italy or abroad [The identification of the correct  authors  have crir abroad .D. immitis by serological results without testing the serology of D. repens or lacking a histopathological confirmation of the parasitic nodule [In addition, some cases were attributed to c nodule ,18. Recec nodule .Dirofilaria species. Our report demonstrates that at least some pulmonary autochthonous Italian cases of human dirofilariasis can be due to D. immitis, as in the New World.Molecular typization by PCR has been recently introduced and it is currently available only in selected laboratories; moreover, molecular analysis was not performed in older cases reported in the literature ,3,5. PCR


N-1-naphthylphthalamic acid (NPA). Our results could clearly determine the zonation patterns and regional difference characteristics of BAs on mouse liver, ileum, and colon tissue sections, and the relative content of BAs based on NPA could also be ascertained. In conclusion, our method promoted the accessibility of spatial localization and quantitative study of BAs on gastrointestinal tissue sections and demonstrated that MALDI-MSI was a valuable tool to investigate and locate several BA molecules in different tissue types leading to a better understanding of the role of BAs behind the gastrointestinal diseases.Changes in overall bile acid (BA) levels and specific BA metabolites are involved in metabolic diseases, gastrointestinal, and liver cancer. BAs have become established as important signaling molecules that enable fine-tuned inter-tissue communication within the enterohepatic circulation. The liver, BAs site of production, displayed physiological and functional zonal differences in the periportal zone versus the centrilobular zone. In addition, BA metabolism shows regional differences in the intestinal tract. However, there is no available method to detect the spatial distribution and molecular profiling of BAs within the enterohepatic circulation. Herein, we demonstrated the application in mass spectrometry imaging (MSI) with a high spatial resolution (3 μm) plus mass accuracy matrix-assisted laser desorption ionization (MALDI) to imaging BAs and  Schematic illustrations showing the mass spectrometry imaging based identification and spatial visualization of dysregulated bile acid metabolism in high-fat diet-fed mice. The liver and gut share an intimate relationship whose communication relies heavily on metabolites, among which bile acids (BAs) play a key role . PreviouBile acids, whose functional role in the global mammalian system is multifaceted, are an important class of metabolites that undergo extensive enterohepatic recycling and gut microbial modification . To undeThus, in our study, the iMScope was adapted to investigate the spatial distribution and molecular profiling of BAs in the liver and intestine slices of a mouse under high-fat diet (HFD) to indicate the effects of metabolism of BAs on the health and diseases of the body.N-1-naphthylphthalamic acid (NPA), was purchased from Chem Service . Ultra-pure grade (18 MU) water was prepared by a Milli-Q system . Other reagents include formic acid ; Trifluoroacetic Acid ; Methanol ; Ethanol ; Ethanol ; Acetonitrile ; Xylene ; Eosin ; Neutral gum , and indium tin oxide (ITO)-coated glass slides .Mass spectrometry grade chemicals and reagents were used in the present study. Matrix moieties inclusive of 9-aminoacridine , 2, 5-dihydroxybenzoic acid , α-cyano-4-hydroxycinnamic acid  were obtained from Sigma-Aldrich . The internal standard (IS), Eleven BAs were selected for analysis: deoxycholic acid (DCA), chenodeoxycholic acid (CDCA), ursodeoxycholic acid (UDCA), taurodeoxycholic acid (TDCA), taurochenodeoxycholic acid (TCDCA), tauroursodeoxycholic acid (TUDCA), lithocholic acid (LCA), taurolithocholic acid (TLCA), taurocholic acid (TCA), tauromuricholic acid (TMCA), and glycocholic acid (GCA).All animal procedures were approved by the Institutional Animal Care and Use Committee (IACUC) at the China Medical University. Six to eight weeks old male C57BL/6 mice were purchased from Beijing Huafukang Biotechnology Co., Ltd. The mice were fed with normal circadian circulation for 12 h and had enough food and water. Mice were fed an HFD  or a control diet  for 4 weeks. There were 6–10 mice in both the CD group and the HFD group. After 4 weeks of feeding, animals were sacrificed for analysis.–1 of NPA) was installed in a sample holder, which was then embedded in a vacuum deposition system . A matrix holder was filled with approximately 300 mg of matrix powder (9AA) and the sample holder and matrix bracket were positioned with 8 cm distance. The matrix power was then heated to the boiling point of the matrix crystals (220°C for 9AA) and the vapor covered the specimen surface for 8 min. The vacuum pressure of the chamber was maintained at 10–4 Pa in the process of sublimation. (2) Airbrushing: Matrix solution (10 mg ml–1 of 9AA) was prepared by dissolving matrix power in acetonitrile and distilled water  at a ratio of 1:1. The matrix solution (1 ml) was added to the capacity of an artist’s airbrush . The distance between the tip of the airbrush and the tissue surface was about 8 cm. For the first 3 cycles, the matrix was airbrushed for 2 s at 60 s intervals and, in the following 20 cycles, the matrix was continuously sprayed for 1.0 s at 30 s intervals. The glass slide was then placed in a vacuum dryer to vaporize the solvent for 5 min. After that, the glass slide was vacuum-dried, and then the BA distribution was observed with iMScope.After euthanasia, the tissues were quickly removed and all samples should be frozen immediately and stored at −80°C until further analysis. Set the cryomicrotome  to −25°C and cut the samples at a thickness of 10 μm. The slices were pasted on ITO-coated glass slide for analysis by MALDI-MSI. Three to five serial sections (each 10 μm thick) of sampled liver, ileum, and colon tissue were used to evaluate the reproducibility of the iMScope technique. A small droplet of optimal cutting temperature (OCT) compound is applied for mounting the tissue sample on the specimen holder. Because polyvinyl alcohol/polyethylene glycol-based media, such as OCT compound, cause ion suppression during MSI analysis, it is essential to avoid contamination of tissue sections, cryostat tables, or blades by OCT compounds , 20. (1)m/z values were externally calibrated using the DHB matrix. The identification of BAs was confirmed by MALDI-TOF-MS/MS with reference to product ion spectra of authentic BA standards.The parameters of IT-TOF (time-of-flight) MS were set as follows: ion polarity, negative; mass range, 350–550; sample voltage, 3.0 kV; and detector voltage, 1.90 kV. The imaging MS Solution Version 1.12.26 software  was used to control the instrument, and the data acquisition, visualization, and quantification were also performed by the same software. The via a charge-coupled device (CCD) camera  and the imaging area was then defined according to the maximum imaging point under a scan pitch of 40 μm. The illumination in the iMScope was operated under the following parameters: light type, trans-illumination; light intensity, 12%. Foci and observation points were controlled with a joystick and the XYZ stage  on which the electrically conductive glass slide was fixed. The XYZ coordinates, with position-feedback scales, immediately displayed the ROIs to make position reproducibility possible on a sub-micrometer order. The tissue slices were then irradiated by a focused laser beam in synchrony with stage scanning. The laser in the iMScope system was a diode-pumped 355 nm Nd, YAG laser , and operated under the following parameters: frequency, 1,000 Hz; laser intensity, 55.0; and laser diameter, 3 μm. All the experiments in this work were conducted with the minimum irradiation diameter and irradiated the tissue surface with 100 shots  for each pixel.The iMScope TRIO  instrument, a hybrid IT-TOF MS combining an optical microscope and atmospheric pressure MALDI/ionization system, was used to acquire the imaging MS data. One of the most critical processes in MSI is the creation of the region of interest (ROI). The optical microscope embedded in the iMScope permitted us to precisely choose the relevant tissue region prior to performing data acquisition. An ultraviolet laser, tightly focused with a triplet lens, was used to ensure high spatial resolution. Based on the advanced configuration above, a tissue ROI was freely selected Quantitative analysis with MALDI-TOF MS has been demonstrated for compounds of biological interest. For quantification, ISs are necessary to compensate for the poor shot-to-shot reproducibility inherent in the use of MALDI analysis. An ideal IS should be the stable isotope-labeled intact BAs during the qualitative and quantitative analyses of BAs . HoweverAfter MSI, the tissue sections were stained with hematoxylin and eosin (H&E) for examination based on a protocol . In briep < 0.05 as statistically significant. ROI analysis by using Imaging MS Solution software (version 1.30). The p of comparison for ROI analyses was assessed via average peak intensities or signals acquired from MS spectra of areas indicated by ROI. Low values of p (p < 0.05) denote significant differences between average peak intensities or signals of targets within the stipulated ROIs.Data in bar graphs are expressed as mean ± SEM. The Shapiro-Wilcoxon test was used to test the Gaussian distribution of biological parameters. The Student t test was used for comparison between two groups. The Mann-Whitney test was used for variables that were not normally distributed. Correlations were assessed with the Pearson correlation coefficient or as indicated in the graphs. All statistical analysis was performed using SPSS (version 25), considering value of Determination of spatial distribution and quantification of BAs in animal models are challenging due to shortage of suitable methods. Here, we adopted a novel iMScope coupled with MALDI-TOF-MS for simultaneously mapping and semi-quantitating the BAs in tissues of mice. There is no precedent to analyze the spatial distribution and quantitative study of BAs within the enterohepatic circulation. Moreover, our work makes it possible to detect the relative content and spatial distribution of BAs in liver, ileum, and colon tissue sections from short-term HFD feeding mice, which provides a new perspective for the study of gastrointestinal diseases.m/z 290.082, although NPA is chemically different from BAs, there are an adequate signal and no interference peaks in the mass spectrum of NPA. Therefore, it is a feasible method to quantitatively describe the relative exposure level of BAs in tissue sections by the average intensity ratio of each BA to NPA. Two of the major impediments to the application of MALDI to quantitative experiments are signal suppression and signal interference, especially, of less concentrated components . BAs show a high degree of isomerism and similar binding  and the corresponding m/z image. Based on previous quantitative studies of BAs in rat liver, we assumed that all isomers contributed to the ion abundance  or sub-class . DiffereBile acid synthesis occurs in the liver. Before the synthetic BA enters the duodenum, the liver BAs bind to glycine or taurine. The conjugated BA is stored in the gallbladder until it is released to the duodenum after eating . BAs in m/z 498.2895 ± 0.05 (TCDCA/TUDCA/TDCA) and m/z 514.2844 ± 0.05 (TCA/TMCA) at the bile ducts indicated by the green arrows. The bile duct, portal venule, and portal arteriole form the portal trial, in which the bile duct receives bile from bile canaliculi. Our results have shown that MS ion images in the same liver tissue section at high spatial resolution show that there are zonation patterns and regional differences characteristics of BAs in tissues. Thus, the liver, BAs site of production, displayed physiological and functional zonal differences in the periportal zone versus the centrilobular zone. Therefore, our method can not only explore the spatial distribution characteristics and content variety of BAs in the liver but also intuitively see the distribution characteristics of BAs around blood vessels and bile ducts in liver tissue.Here, we clearly showed that 1 month of HFD-feeding resulted in visible multiple BAs zonation patterns and might have disturbed the inherent BAs gradients or functional zonal differences in enterohepatic circulation. Taking the spatial information into account is crucial to investigate the underlying mechanisms of injury induced by site-specific BA alterations. Combined with the transport network of BAs in the liver, we analyzed the distribution of TCDCA/TUDCA/TDCA and TCA/TMCA in mouse liver tissue sections at high spatial resolution. As expected, BAs were not evenly distributed in the liver and showed a certain regional aggregation pattern, which had been clearly shown from the MS ion image . It shouvia the portal vein, and the rest is excreted with feces. Therefore, the terminal ileum is also the main site of BAs accumulation, especially, conjugated BAs. We took a 3-cm long mouse terminal ileum and rolled it up in a “Swiss roll”  and mucosa layer (ROI-2) of the sectioned colon tissues. The p in this context is defined as the statistical analyses of average intensities/signals acquired from areas specified by ROI. A small p (p < 0.05) denotes a low likelihood that average intensity values are equal between ROIs. For colonic tissue sections, the relative abundances of TCA/TMCA, TCDCA/TUDCA/TDCA, GCA, and CDCA/UDCA/DCA in the ROI-1 were significantly different from ROI-2  and 75%, respectively. The red line in the center of the “box” is the median. The notches of the “box” represent the difference of the median. The notches indicate the 95% confidence interval (CI) of the median (the median range of the population estimated from the median of samples with a probability of 95%). If the 95% CI of median (notch length) does not overlap between two groups (ROI-1 and ROI-2), the two groups are considered different in the median with a probability of 95% (p < 0.05). However, overlapping does not always indicate that there is no significant difference between the two groups. In other words, if the notches of ROI-1 and ROI-2 are not at the same height, this means that the intensity of ROI-1 and that of ROI-2 have medians that differ by a significance level of 5%. The “whiskers” extending upward and downward from the “box” indicate the range of 1.5× the length of the box. Intensity values beyond the length of the “whiskers” are displayed with a red+ as outliers with significant deviance from the median. If the median is not in the center of the “box,” this means that the intensity distribution is skewed. When checking the test results, the statistical values of the samples (spectrum peak intensity at measurement points) visualized with box plots can be referred to values of p. To evaluate the relative abundance and distribution of detectable BAs in the sampled colon tissues, we further analyzed the mass spectra data through multiple ROI analyses of detectable BAs . Severalom ROI-2 . The boxm/z 498.289 (TCDCA/TDCA) and m/z 514.284 (TCA/TMCA) showed slight downregulation due to Amitriptyline treatment without comment upon the role of BAs homeostasis in the observed toxicological response. Specifically, the fold change of Bas is based on the average peak intensity of the particular monoisotopic peak within the analyzed region -MS/MS] were adopted –4, 35–38d region . Furtherd region , 25, 41.d region . Therefoperiment . Our metperiment , 45. It In summary, in addition to MS ion images that can identify the spatial distribution of BAs with low spatial resolution, the iMScope can also display high spatial resolution MS ion images of the same tissue section. Using a short-term HFD feeding mice model, we fully verified the feasibility and sensitivity of our current method for analyzing the spatial distribution and content of BAs in tissues. Our study further demonstrates even greater potency for a more clear understanding of the mechanism and treatment of gastrointestinal diseases by given spatial distribution and content information of BAs within the enterohepatic circulation.Our method can not only detect the relative content of BAs in tissues, but also intuitively display and compare the changes and spatial distribution of BAs content or intensity in different parts of the same tissue. This method has wide application value. Taking the spatial information of BAs into account is crucial to investigate the underlying mechanisms of tissues injury induced by site-specific metabolic alterations, one important future direction of analysis of BAs is fully deciphering the complete molecular signatures of BAs in different biological samples and link them to the pathology of the corresponding diseases. Our method has laid a solid foundation for this development direction.The original contributions presented in the study are included in the article/The animal study was reviewed and approved by China Medical University.H-XL and Z-YW conceived of the study and participated in its design and coordination. QZ and Z-HW carried out the experimental work and were responsible for analyzing the data. Z-HW, S-SZ, JY, LC, and X-YW were responsible for animal experiments. All authors have given approval to the final version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


To promote their personal and professional growth, medical educators need practical, actionable feedback on their scholarship, as well as guidance for documenting their scholarship in educator portfolios. We offer a framework and resources to provide formative and summative feedback to faculty, administrators, and/or learners delivering an oral presentation at a face-to-face or virtual health professions education meeting.In 2014, the leadership of the Central Group on Educational Affairs (CGEA) meeting planning committee developed and piloted a process to provide individuals with formative and summative feedback on their oral CGEA research presentations at face-to-face meetings and create a transparent process for determining the Best Presentation Award. The feedback process was implemented for 7 years until revised in 2021 for the CGEA's first virtual meeting. Past and present meeting organizers conducted four focus groups in 2021 with presenters and peer reviewers via Zoom. Transcripts were analyzed for major themes using conventional content analysis.To date, 102 presentation assessments have been conducted, including formative and summative assessments. Sixty-two volunteer assessors have participated, 19 (31%) of whom served for more than 2 years. Focus groups identified best practices and suggestions to improve the feedback process.This resource offers a feasible, systematic process to provide individuals with formative feedback on presentations at professional conferences, promote a community of practice for personal and professional development, and create a transparent process for determining a Best Presentation Award. Participants valued providing and receiving feedback and recommended implementation at other professional meetings. To disseminate their work, education scholars must apply rigorous inquiry, use theoretical and conceptual frameworks to develop and communicate their work, assess meaningful learning outcomes,4 and provide inclusive language.5 Understanding how to plan, carry out, and disseminate the results of scholarship in HPE requires access to many opportunities to learn and practice scholarly activities.Scholarship in health professions education (HPE) has developed substantially in recent decades.9 academies of educators,10 educational scholars programs, and other faculty development opportunities.14 Some academic health centers have facilitated regular meetings of education scholars to discuss works in progress15 or cross-campus research collaborations for education scholarship.16Academic health centers and professional organizations have developed various approaches to promote scholarship in HPE and build the capacity of learners and faculty to participate, including creating education units,17 Through collegial interactions with peers, these events provide a developmental opportunity to build scholars’ capacity for high-quality scholarship and presentation skills while facilitating their professional identity development as members of a community of practice.18 A community of practice is a relational network in which members observe, learn, and participate in a practice, first at the periphery of the group and then with increasing engagement. In this resource, community comprises education scholars, and their practice is the work of doing and presenting education scholarship.20 Supporting members’ development promotes self-efficacy, engages members as learners and peers, and furthers the experience of the community. A community of practice in HPE scholarship provides opportunities for experienced scholars to give back to the community and for junior scholars to mature in their ability to do and share scholarly work. Within a community of practice, formative and summative feedback provides a time-tested approach to teaching and learning and for promoting the engagement of members with varying levels of experience.Academic health centers and professional organizations also promote education scholarship by hosting scholarly dissemination events, such as meetings or conferences, where education scholars present and discuss their work.The target audience for this assessment resource includes meeting planners who want to build a systematic process to offer feedback on presentations delivered at in-person or virtual scholarly dissemination events. Our resource provides a structure to support faculty scholarly development via professional meetings or conferences that include presentations about education scholarship, within a community of medical educators who learn and promote education scholarship. Furthermore, this resource includes practical tools for those who convene such events.MedEdPORTAL for planning and convening a symposium of education research and scholarship,17 we are not aware of a publication in MedEdPORTAL or elsewhere that features tools for providing feedback on oral presentations as an approach to learning about scholarly dissemination and building a community of practice. Our resource provides a practical, feasible way to develop skills for high-quality scholarship in the context of a meeting and the presentations that occur. We also do not know of other work that has followed up with recipients and providers of feedback on education scholarship presentations about how this process contributes to their professional growth and experience of community. With this assessment resource, we aim to address that gap.While there are tools in This assessment resource offered a framework for providing feedback to faculty, administrators, and/or learners delivering an oral presentation at a face-to-face or virtual HPE meeting. Our intent, as past and present regional chairs of the Medical Education, Scholarship, Research and Evaluation (MESRE) section of the Central Group on Educational Affairs (CGEA), was to offer presenters—particularly those with less experience at medical education conferences—specific guidance on how to prepare and deliver an effective oral presentation and provide them with formative feedback that they could use to improve their research and their presentation skills. Additionally, we sought a fair and defensible summative assessment approach in which to select a presenter to receive an award for the best oral presentation.In 2014, the CGEA's steering committee decided to provide presenters with summative and formative feedback after they had attended the CGEA regional conference. The CGEA MESRE chair (Beth Bierer), based on experience with programmatic assessment, designed separate forms to provide presenters with summative and formative feedback given the different purpose of each type of feedback. The summative assessment form focused on having assessors use numeric rating scales to rate the content and delivery of oral presentations to determine recipients for the Best Presentation Award at the CGEA conference. The formative assessment form asked assessors to provide individualized, narrative feedback to each presenter, with the goal of offering encouragement and advice in order to advance scholarship. Both assessment forms were based on input from the CGEA steering committee, as a literature review did not provide guidance. The two feedback forms were piloted at the face-to-face 2014 CGEA conference. During subsequent years, MESRE section chairs continued to provide presenters with summative and formative feedback given the initial success of this feedback process.Informed by our experience as past and present regional MESRE chairs, we met on several occasions in the fall of 2020 to adapt the existing assessment forms and feedback protocol in anticipation of the 2021 CGEA spring conference going virtual in response to the COVID-19 pandemic. The summative assessment form was revised to reflect unique aspects of delivering a presentation at a virtual meeting . The formative assessment form and feedback protocol  remained the same. The regional MESRE chair (Heeyoung Han) piloted the updated feedback process at the 2021 CGEA virtual conference, and the current MESRE chair (Janice Hanson) repeated the updated protocol at the 2022 CGEA virtual conference.•○Generate a list of the complete names and email addresses of presenters selected to give an oral presentation.○Send an email to each presenter offering guidance on how to prepare an effective oral presentation . Include○Recruit assessors with expertise in medical education who plan to attend the event. Provide a task description and expectations for each role (formative and summative). After identifying assessors, ask them to specify their preference for providing formative or summative feedback.○Develop a schedule where two summative assessors and one formative assessor are assigned to provide feedback for four to five presentations. Pay attention to potential conflicts of interest  and scheduling . If feasible, distribute the schedule to assessors in advance, and ask them to specify the set of presentations on which they would prefer to provide feedback.○Distribute a final schedule, links to electronic assessment forms, assessors’ specific presentation assignments, and conference abstracts for assigned presentation assignments to assessors .○If feasible, recruit session moderators who can introduce speakers and solicit questions/monitor the chat if the meeting is virtual. The meeting organizer could also ask the summative assessor to serve as a session moderator.○Send a reminder to assessors and moderators before the event.Before the event:•○If a face-to-face meeting, have meeting organizers verify that moderators and assessors arrive at the correct locations. If a virtual meeting, have someone qualified to serve as an assessor or moderator on standby in case an assessor or moderator experiences technical problems and cannot access the assigned session.○Have the feedback organizer—in our case, it was the MESRE chair—monitor for timely submission of assessments.During the event:•○Approximately 2–3 days after the event, compile and aggregate the summative assessment forms, and determine the recipient of the Best Presentation Award. For our conference, the meeting organizer averaged the ratings of the two summative assessments for each presenter and ranked the presenters based on their ratings to identify the recipient of the Best Presentation Award. Additionally, compile all formative and summative assessment forms for each presenter, and create PDF files to distribute to individual presenters.○Distribute a personalized email  to each ○Distribute a personalized email  to each After the event:Based on our years of experience with this feedback protocol in face-to-face and virtual contexts, we developed a detailed checklist and timeline for those wishing to replicate our feedback approach  at other18 We thought of the members of a professional organization involving education research and scholarship as a community of scholars who could support learning the abilities for conducting and presenting education work. Therefore, we explored community development and engagement. Consequently, our data collection focused on presenter and assessor involvement and perceptions of the usefulness of providing and receiving feedback. We used separate focus groups for assessors and presenters  in June 2021 to understand participants’ perspectives regarding strengths and recommended improvements. Below, we summarize key points from these focus groups, with representative comments presented in The presenters found the formative and narrative feedback helpful, instructive, thorough, and useful for their presentations as well as for future scholarship. They shared that the formative feedback included actionable advice to improve their research and motivated them to continue their scholarship, such as preparing a journal article submission.Presenters reported that feedback quality differed from what they received at other events, as it came from experts familiar with their topics. This finding was consistent with our recruitment practice, whereby we tried to align the presentations with each assessor's expertise. The finding also aligned with assessors’ self-reported confidence as feedback providers. Assessors said they had baseline knowledge of what average presentations were like at CGEA meetings and were comfortable providing feedback based on their expertise.Assessors also reported benefits, saying that scholarly service could support career development, especially for those on a research track. However, assessors did not always describe direct, practical benefits for their jobs but, rather, symbolic benefits with respect to altruism. For example, some assessors reported working at institutions that prioritized clinical research over educational research, where there was no job-related reward for providing feedback on education scholarship, yet they volunteered because they wanted to help presenters appreciate their own work and to provide actionable guidance for improvement.Participants appreciated our feedback process as a well-designed, rigorous system that facilitated scholarly community building. Meaningful and constructive feedback facilitated assessors’ and presenters’ engagement and participation in the event by showing value in community development. Assessors were inspired to learn about various projects happening at other schools, and due to their feedback assignment, they were engaged in the presentations and discussions.Although we provided both assessors and presenters with requisite information, including assessment criteria, forms, abstracts, and actual presentation slides via emails, some of them, especially newcomers and presenters, did not seem to pay attention to the materials. Some assessors, especially formative assessors, found it helpful to have abstracts in advance, whereas others asked for all materials and information ahead of time even though we had already provided the materials and information.Assessors expressed uncertainty regarding how to focus/balance presentation skill versus content in their assessments. One participant mentioned focusing on both presentation skills and content, but another assessor, who was not a native English speaker, shared that it was hard to judge presentation skills.Assessors shared that multitasking and time management during presentations were challenging, especially for formative assessment. Some assessors felt that formative feedback would be too brief if they did not prepare feedback drafts in advance. Given the time limit during presentations, some assessors suggested having two alternating formative assessors per session to provide a mental break between presentations.In earlier years of our feedback process, one of the two summative assessors also served as the session moderator. In 2021, the virtual format allowed us to separate these roles. Assessors appreciated this change, given the issues with time management.Securing assessors able to provide valuable feedback required a pipeline approach. One of the ideas participants shared was to use this feedback process for assessor development, especially for junior community members who might not have mentors at their institutions. For example, senior and junior community members could be paired as assessors, producing a collaborative review. Alternatively, assessors could invite their trainees. Presenters suggested getting involved in assessing, as seeing a variety of quality among presentations could provide the best way to learn presentation skills and develop a professional identity. Sharing formative reviews among formative assessors could help assessors learn from each other regarding effective presentation skills.Assessors recommended sending thank-you notes and publishing assessors’ names in the CGEA program to recognize their service.Participants suggested revising the behavioral anchors in the summative feedback form as they might not adapt to each presentation/context . For example, virtual presentations were prerecorded with only slides and audio, making it impossible to assess eye contact during the presentation.Participants thought other conferences should adopt this peer feedback process.We set out to create a process for providing formative and summative feedback and selecting presenters for awards at a meeting of medical educators. We met these goals and learned that the process also facilitated the development of a community of practice for education scholars in our professional organization. We developed this assessment resource to engage experienced scholars in providing a forum to share education scholarship in a way that would promote skill development in a community of practice. As illustrated by the number of reoccurring assessors and the constant influx of new assessors in our process, developing a feedback process and a set of assessment resources  has supported the sustainability of the process among successive MESRE chairs and has helped our professional organization mentor the next generation of education scholars.Our assessment resource can be appreciated by institutions and those in charge of professional meetings. The detailed information we provide offers clear guidelines for assessing scholarly presentations and an approach for sustaining a community of scholars. Through the feedback process we created, experienced community members share their wisdom with junior or early career community members. These assessors see the program's value and are willing to help others. This process mobilizes a community of scholarly educators based on their needs, expertise, and commitment to the profession. It also works as a succession-planning process for the next generation. Another value of this assessment resource is to support participants’ professional development. Presenters use actionable feedback from experienced community members to advance their scholarly output, such as publication. Sharing these assessment resources and a detailed description of the feedback process can enable leaders in other organizations to replicate and adapt this approach, thereby facilitating a community of practice in other groups of education scholars.This assessment resource requires careful planning and central oversight for successful implementation. However, we believe the benefits for both presenters and peer reviewers, as summarized in Meeting Organizer Checklist.docxEmail to Presenters (Before Conference).docxSummative Assessment Forms.docFormative Assessment Form.docxEmail to Assessors (Before Conference).docxEmail to Presenters (After Conference).docxEmail to Assessors (After Conference).docxFocus Group Guides.docxAll appendices are peer reviewed as integral parts of the Original Publication.