The Changing Representation of Men and Women in United States Medical Residencies from 2014-2022

Research Question: How have gender trends in US medical residents changed from 2014 to 2022 across all specialties?Background and Significance: Historically, women have been underrepresented in medicine. While there have been studies on gender trends in certain individual specialties, few studies have examined the overall trends in gender among all specialties for US-based medical residents. This study aims to fill this knowledge gap by examining gender trends in US medical residents from 2014 to 2022 across all specialties.Materials and Methods: The data for this study were obtained from the Association of American Medical Colleges (AAMC) Report on Residents annual reports from 2014-2022. The number and proportion of men and women were recorded for each of the 32 primary residency choices. The gender distribution within each residency was then assessed and compared over the nine-year study period.Results: Our analysis showed that more women are in medical residencies in 2022 than in any other year during the study period. Over the past nine years, there has been a 2.37% average annual increase in the proportion of women in all surgical specialties. Furthermore, 62% of medical specialties have experienced an increase in the proportion of women filling residency slots in the past nine years. In 2022, the residency with the highest proportion of women was Obstetrics and Gynecology (86.4%), and the residency with the highest proportion of men was Orthopedic Surgery (81.7%).Conclusion: These findings highlight the need for further research to understand the factors contributing to these trends and how to continue to improve diversity and representation in the physician workforce

The Impact of Alternative to Opioids (ALTO) Protocol on Opioid Reduction in the Community Emergency Department ¿ and the Impact of the COVID?19 Pandemic on the ALTO Protocol for Opioid Reduction in the Emergency Department

Research Question: In patients visiting the Emergency Department (ED), is an Alternative To Opioid (ALTO) protocol for pain management effective in reducing opioid administration in the ED?Background and Significance: The Alternatives to Opioids (ALTO) approach utilizes non?opioid medications for pain management to ultimately diminish opioid utilization in the emergency department (ED).Materials and Methods: This retrospective, single center, cohort study investigates the impact of the ALTO protocol on opioid use, patient satisfaction with pain control, and subsequent ED flow. Patients receiving pain medication in an urban level three trauma center from March to August of 2018 prior to implementation of the ALTO protocol were identified as the pre?protocol control group and patients receiving pain medication between March to August 2019 after implementation of the protocol in the same ED were allocated to the postprotocol group. The primary interest of the study was the effect on opioid use in the ED. The secondary outcomes investigated were door?to?doctor time, the left without being seen (LWOBS) rate, patient satisfaction with pain control, and the average turnaround time.Results: Total opioid administration decreased by 59.6% in the post?protocol group. The LWOBS rate (p=0.003) and the average door?to?doctor time (p<0.001) were significantly decreased in this group as well. No significant difference in patient satisfaction to pain control (p=0.192) or average turnaround time (p=0.209) was identified between the groups.Conclusion: ALTO protocol implementation was associated with a significant reduction in opioid administration without impacting patient satisfaction with pain control or ED flow

Traumatic subclavian artery injury with a pulmonary artery bullet embolism

A patient in his 20s presented to our trauma bay after sustaining multiple gunshot wounds to the left thorax. Upon arrival, the patient was hypotensive with a blood pressure of 95/58¿mm Hg, heart rate of 129 beats/minute, respiratory rate of 29 breaths/minute, and oxygen saturation of 94% on 10¿L non-rebreather. The patient was intubated for airway protection due to mentation and concern for his respiratory status. Focal assessment with sonography in trauma revealed a small anterior pericardial effusion. Initial chest X-ray showed a widened mediastinum and left hemopneumothorax with a bullet overlying the left hilum. Secondary survey and adjuncts created a puzzling picture. On the left side, the patient had three gunshot wounds in the mid-supraclavicular, superior mid-scapular, and posterior midaxillary regions. Additional injuries included a left scapula fracture, left second and third rib fractures, and fractures of the anterior T1 and T2 vertebral bodies. On the right side, the patient had a palpable thrill at the right neck and supraclavicular region and was found to have a mid-shaft clavicle fracture and a large subclavian artery pseudoaneurysm with concern for active extravasation. No injuries were identified in the abdomen or pelvis. After resuscitation and two units of whole blood in the trauma bay, blood pressure improved to 162/85¿mm Hg

The effects of measurement, input, and AAC devices on word knowledge of children who speak using AAC

The purpose of this dissertation is to evaluate the impact of measurement, input, and AAC devices on word knowledge of children who speak using augmentative or alternative communication (AAC). The first study in this dissertation manuscript compares language sample elicitation strategies with children who speak using AAC (CAAC). A generic play-based elicitation strategy yielded the most valid samples when correlated with another valid measure. The second study compares two vocabulary input approaches to determine the approach that yields more words learned for CAAC. Explicit instruction yielded better vocabulary outcomes for all participants. Finally, the third study evaluates CAAC’s taxonomic knowledge in comparison to their age-matched, vocabulary-matched, and IQ-matched peers. Findings suggest that cognition, vocabulary size, and AAC device use influence CAAC’s taxonomic knowledge and that CAAC present with disordered taxonomic knowledge in language-based tasks. All results yield clinically relevant findings that will support CAAC in the early word learning process

Faking it or making it: emotional labor, individual and organizational well-being in student affairs professionals

The study aimed to achieve two main objectives: first, to investigate the presence and nature of emotional labor within student affairs; and second, to explore the correlations between emotional labor and both individual and organizational well-being among student affairs professionals. This research examines the intricate interconnections between emotional labor and a range of psychological, emotional, and occupational challenges. It adopts a comprehensive, multidimensional approach to well-being, encompassing individual facets such as emotional, social, and psychological well-being, as well as burnout dimensions like emotional exhaustion, depersonalization, and personal accomplishment. Additionally, it examines organizational well-being markers including job stress, overall job satisfaction, and turnover intention. The research methodology employed a quantitative approach, using an online survey for data collection and multiple regression for analysis. The findings offer initial insights into emotional labor within student affairs roles, illuminating the relationships between discordant and concordant emotional regulation strategies and various outcomes related to well-being

Health?Related Quality of Life in Youth with Hypercholesterolemia

Research Question: Is the perceived quality of life different in youth <18 years?of?age with familial hypercholesterolemia (FH) compared to healthy peers?Background and Significance: In the U.S. and developed countries, cardiovascular disease (CVD) is the #1 cause of death in adults. Children with FH, a genetic disorder of dysregulated low?density lipoprotein cholesterol (LDL?C) metabolism, have the highest risk of developing premature CVD. Over the past 25 years, there has been an increased awareness of the need to assess and, whenever possible, optimize an individual¿s quality of life. This is particularly compelling in children, who encounter medical conditions during a vulnerable time of cognitive and emotional development. The Pediatric Quality of Life Inventory (PedsQL®) has been shown to reliably measure Health Related Quality of Life (HRQOL) in healthy youth, and in youth with a wide variety of medical conditions, such as obesity, congenital heart and kidney disease. The PedsQL® questionnaire is a comprehensive and multidimensional instrument capable of quantitating physical, emotional and social well?being, as well as school functioning. Completion of the PedsQL® is validated in both written and electronic formats, and several languages, including English and Spanish. While previous research has shown that youth with medical conditions often score significantly lower on the PedsQL® than their healthy peers, no prior studies have evaluated HRQOL in youth with FH.Materials and Methods: The PedsQL® 4.0 Generic Core Scales are multidimensional child self?report and parent proxy?report scales developed as the generic core measure to be integrated with the PedsQL® Disease?Specific Modules. The PedsQL® 4.0 Generic Core Scales consist of 23 items applicable for healthy school and community populations, as well as pediatric populations with acute and chronic health conditions. The scales measure physical, emotional, social, and school functioning. The R.E.A.C.H. (Risk Evaluation to Assess Cardiovascular Health) Clinic was established by Cook Children¿s Medical Center to better understand the cause(s) of premature CVD, including genetic and acquired forms of abnormal blood fats, elevated blood pressure, and weight?related health risks; developing effective means of prevention through health education, early detection of those at risk and timely treatment. The REACH clinic has a robust screening program, which has identified youth with FH. We compared the child self?report questionnaires of this population to published data of healthy peers.Results: Children with hypercholesterolemia demonstrated a significant difference in their perceived HRQOL compared healthy peers; and similar to children with chronic illness. Additionally, the average parent?proxy scores in children with hypercholesterolemia were lower when compared to a healthy population.Conclusion: Because the HRQOL assesses multidimensional well?being, an evaluation of these scores provide a comprehensive assessment of this vulnerable population. Although data are limited, an impaired HRQOL may be a risk factor for comorbid conditions. Furthermore, these data will help identify unmet needs beyond current recommendations for clinical care of youth with FH

Synthesis and characterization of RPy2N2 pyridinophane ligands and transition metal complexes as therapeutics and catalysts

The pyridinophane family of macrocycles has been studied for decades as ligand scaffolds for metals towards a wide variety of applications including biological mimics, catalysts, and therapeutics A newer ligand scaffold to join the library, RPy2N2, introduces a second pyridine ring to the long-standing PyN3 scaffold. This work explores the effect of 4 position modification of the two pyridine rings of RPy2N2 on the characteristics of the ligand and the complexes of Cu(II) and Fe(III) for application as a SOD1 mimic and catalyst respectively. This work found that the modulation of the electronics of the 4-position substitution tuned the electronics of the ligand overall, as evidenced in 1H NMR shifts and protonation constants. This mirrored the trends seen with the 4-position substituted RPyN3 series, but beyond that the exchange of one secondary nitrogen atom for a pyridine ring vastly changed the behavior of the ligand scaffold, more than the electronics of the 4-position did. The pyridine ring is less electron-rich than a secondary amine nitrogen atom, the effects of which can be seen throughout the rest of this work. When metalated with Cu(II), the RPy2N2 series vastly outperformed the previously studied RPyN3 series as functional SOD1 mimics, resulting in the most active copper-based small molecule functional SOD mimic to date. The electron-withdrawing groups improved the activity, but the change in the ligand scaffold allowed for more drastic changes that greatly increased the activity of the [CuII(RPy2N2)]2+ complexes as SOD1 mimics. Similarly, the RPy2N2 ligand scaffold had such a great effect on the catalytic yields of the complex formed in situ between FeIII(OTf)3 and RPy2N2, that no difference could be seen between the different electronic substitutions. The ligand scaffold change increased the catalytic yield to the maximum possible yield for the model reaction in use, an improvement of at least 10% over the RPyN3 series. Additionally, it was seen that the RPy2N2 ligand series is capable of forming two distict species in solution with Fe(III), posited to be the monomeric and µ-oxo dimeric complexes, and that these complexes can interchange with each other with simple pH control. Altogether, this work focused on the functionalization of pyridine rings in RPy2N2 ligands and studying the effect of that functionalization on the activity of the ligands and the metal complexes

Pre-service teachers' systems thinking about the nervous system

In an era of increasingly complex challenges, fostering holistic thinking among educators has never been more evident. This study explored the impact of a holistic approach to teaching the nervous system on pre-service teachers' (PSTs) understanding and reasoning abilities. The research investigated how PSTs’ preconceptions, understanding, and reasoning regarding the nervous system evolve after participating in a holistic unit. The study adopted a mixed-methods approach, employing pre- and post-assessments, interviews, rubrics, lesson activities, and observations to gather data. Sixty-eight PSTs engaged in an eight-week unit on the nervous system. Results indicated significant improvements in PSTs’ understanding of the nervous system and systems thinking and enhancements in their reasoning levels. The study highlighted the effectiveness of explicitly teaching systems thinking characteristics in deeper understanding and more holistic teaching practices. The findings offered valuable insights for enhancing science education pedagogy, emphasizing the importance of incorporating systems thinking approaches in PSTs’ training programs

A Perspective on the Milky Way Bulge Bar as Seen from the Neutron-capture Elements Cerium and Neodymium with APOGEE

This study probes the chemical abundances of the neutron-capture elements cerium and neodymium in the inner Milky Way from an analysis of a sample of similar to 2000 stars in the Galactic bulge bar spatially contained within divided by X-Gal divided by < 5 kpc, divided by Y-Gal divided by < 3.5 kpc, and divided by Z(Gal)divided by < 1 kpc, and spanning metallicities between -2.0 less than or similar to [Fe/H] less than or similar to +0.5. We classify the sample stars into low- or high-[Mg/Fe] populations and find that, in general, values of [Ce/Fe] and [Nd/Fe] increase as the metallicity decreases for the low- and high-[Mg/Fe] populations. Ce abundances show a more complex variation across the metallicity range of our bulge-bar sample when compared to Nd, with the r-process dominating the production of neutron-capture elements in the high-[Mg/Fe] population ([Ce/Nd] < 0.0). We find a spatial chemical dependence of Ce and Nd abundances for our sample of bulge-bar stars, with low- and high-[Mg/Fe] populations displaying a distinct abundance distribution. In the region close to the center of the MW, the low-[Mg/Fe] population is dominated by stars with low [Ce/Fe], [Ce/Mg], [Nd/Mg], [Nd/Fe], and [Ce/Nd] ratios. The low [Ce/Nd] ratio indicates a significant contribution in this central region from r-process yields for the low-[Mg/Fe] population. The chemical pattern of the most metal-poor stars in our sample suggests an early chemical enrichment of the bulge dominated by yields from core-collapse supernovae and r-process astrophysical sites, such as magnetorotational supernovae

THE IMPACT OF EXERGAMING COMPETITIONS ON AFFECTIVE AND PERFORMANCE VARIABLES

This study investigated the impact of competitive exergaming on affective and performance variables. Participants (N=26) participated in two separate rowing conditions consisting of a competitive exergame system and a control rowing system. Utilizing a within-subjects design, participants completed two rowing tasks in the competitive grand prix exergaming condition or control condition. Heart rate, rating of perceived exertion (RPE), attention, and feeling were recorded throughout the task. Perceived activity enjoyment (PACES), session rating of perceived exertion (sRPE), distance rowed, power output (watts), and strokes per minute were measured following the task. Participants within the competitive exergame system had a greater distance rowed, higher sRPE score, greater power output, and higher strokes per minute than the control condition. Both groups had an increase in heart rate, associative attention, RPE, and feeling across time. This research benefits healthcare providers and practitioners who want to prescribe exercise for patients and clients who are struggling to find enjoyment in exercise and increase performance. Additional research is needed to include a more representative population and conduct a longitudinal study to assess the significance of these results