The Impact of the COVID-19 Pandemic on First-Generation Women Test-Takers: Magnifying Adversities, Stress, and Consequences for Bar Exam Performance.

By magnifying gender- and socioeconomic status-based inequalities, the COVID-19 pandemic caused stress and disrupted career progress for professional students. The present work investigated the impact of pandemic-related stress and prevailing barriers on structurally disadvantaged women preparing for a high-stakes professional exam. In Study 1, we found that among US law students preparing for the October 2020 California Bar Exam—the professional exam that enables one to become a practicing attorney in California—first-generation women reported the greatest stress from pandemic-related burdens and underperformed on the exam relative to others overall, and particularly compared to continuing-generation women. This underperformance was explained by pandemic-related stress they contended with most, as well as by structural demands shouldered most by first-generation test-takers regardless of gender. Even when controlling for the structural features of caregiving and working while studying, the psychological burdens experienced most by first-generation women predicted lower exam success. Study 2 investigated the February 2021 California Bar Exam. Consistent with Study 1, first-generation women test-takers reported the most pandemic-related stress, which predicted lower exam performance above and beyond structural barriers to exam success. We offer policy prescriptions to bolster the success of at-risk groups in the legal profession pipeline, a challenge magnified by the pandemic

Reach, Usage, and Effectiveness of a Medicaid Patient Navigator Intervention to Increase Colorectal Cancer Screening, Cape Fear, North Carolina, 2011

IntroductionScreening for colorectal cancer can reduce incidence and death, but screening is underused, especially among vulnerable groups such as Medicaid patients. Effective interventions are needed to increase screening frequency. Our study consisted of a controlled trial of an intervention designed to improve colorectal cancer screening among Medicaid patients in North Carolina.MethodsThe intervention included a mailed screening reminder letter and decision aid followed by telephone support from an offsite, Medicaid-based, patient navigator. The study included 12 clinical practices, 6 as intervention practices and 6 as matched controls. Eligible patients were aged 50 years or older, covered by Medicaid, and identified from Medicaid claims data as not current with colorectal cancer screening recommendations. We reviewed Medicaid claims data at 6 months and conducted multivariate logistic regression to compare participant screening in intervention practices with participants in control practices. We controlled for sociodemographic characteristics.ResultsMost of the sample was black (53.1%) and female (57.2%); the average age was 56.5 years. On the basis of Medicaid claims, 9.2% of intervention participants (n = 22/240) had had a colorectal cancer screening at the 6-month review, compared with 7.5% of control patients (n = 13/174). The adjusted odds ratio when controlling for age, comorbidities, race, sex, and continuous Medicaid eligibility was 1.44 (95% confidence interval, 0.68–3.06). The patient navigator reached 44 participants (27.6%).ConclusionThe intervention had limited reach and little effect after 6 months on the number of participants screened. Higher-intensity interventions, such as use of practice-based navigators, may be needed to reach and improve screening rates in vulnerable populations

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Evaluating Productive Mindset Interventions that Promote Excellence on California’s Bar Exam

As Mindsets in Legal Education (MILE) researchers, we designed, administered, and evaluated the online productive mindset intervention referred to as the California Bar Exam Strategies and Stories Program (the program). In partnership with the State Bar of California (SBC), we streamlined and simplified the enrollment process while improving participation on the July 2018 and July 2019 California bar exams. 1. Proven Effectiveness: Working closely with the SBC, we conducted a preliminary analysis of the program in January 2020. The results suggest that the program increases the likelihood of passing the bar exam, after controlling for LSAT and GPA, by between 6.8 to 9.6 percent, depending on the analysis conducted. 2. Boost for First-Generation and Underrepresented Minority Students: The program particularly helped applicants who were first-gen college students and underrepresented minorities, according to our analyses. 3. Reductions in Psychological Friction: Our analyses suggest that the productive mindset intervention succeeded by reducing psychological friction. Among applicants studying for the exam, it fostered stress-is-enhancing and growth mindsets that helped them succeed in the face of stress, anxiety, and mistakes. In light of these results, we recommend that the SBC offer the California Bar Exam Strategies and Stories Program to future cohorts. Future test takers would likely benefit from the stress-is-enhancing and growth mindsets that the program fosters. Adaptive mindsets may be especially important in the immediate future, as applicants face adversity associated with COVID-19. We anticipate updating the program to address these new sources of psychological friction

The Impact of the COVID-19 Pandemic on First-Generation Women Test-Takers: Magnifying Adversities, Stress, and Consequences for Bar Exam Performance.

By magnifying gender- and socioeconomic status-based inequalities, the COVID-19 pandemic caused stress and disrupted career progress for professional students. The present work investigated the impact of pandemic-related stress and prevailing barriers on structurally disadvantaged women preparing for a high-stakes professional exam. In Study 1, we found that among US law students preparing for the October 2020 California Bar Exam—the professional exam that enables one to become a practicing attorney in California—first-generation women reported the greatest stress from pandemic-related burdens and underperformed on the exam relative to others overall, and particularly compared to continuing-generation women. This underperformance was explained by pandemic-related stress they contended with most, as well as by structural demands shouldered most by first-generation test-takers regardless of gender. Even when controlling for the structural features of caregiving and working while studying, the psychological burdens experienced most by first-generation women predicted lower exam success. Study 2 investigated the February 2021 California Bar Exam. Consistent with Study 1, first-generation women test-takers reported the most pandemic-related stress, which predicted lower exam performance above and beyond structural barriers to exam success. We offer policy prescriptions to bolster the success of at-risk groups in the legal profession pipeline, a challenge magnified by the pandemic

Structure of Ustilago maydis killer toxin KP6 alpha-subunit - A multimeric assembly with a central pore

Ustilago maydis is a fungal pathogen of maize, some strains of which secrete killer toxins. The toxins are encoded by double-stranded RNA viruses in the cell cytoplasm, The U. maydis killer toxin KP6 contains two polypeptide chains, alpha and beta, having 79 and 81 amino acids, respectively, both of which are necessary for its killer activity, The crystal structure of the alpha-subunit of KP6 (KP6 alpha) has been determined at 1.80-Angstrom resolution. KP6 alpha forms a single domain structure that has an overall shape of an ellipsoid with dimensions 40 Angstrom x 26 Angstrom x 21 Angstrom and belongs to the alpha/beta-sandwich family. The tertiary structure consists of a four-stranded antiparallel beta-sheet, a pair of antiparallel alpha-helices, a short strand along one edge of the sheet, and a short N-terminal helix. Although the fold is reminiscent of toxins of similar size, the topology of KP6 alpha is distinctly different in that the alpha/beta-sandwich motif has two right-handed beta alpha beta Split crossovers. Monomers of KP6 alpha assemble through crystallographic symmetries, forming a hexamer with a central pore lined by hydrophobic N-terminal helices, The central pore could play an important role in the mechanism of the killing action of the toxin