Race and Implicit Bias in the JeffMD Case-Based Learning Curriculum

Purpose: Race is related to health disparities, not to genetic predispositions, but race is often presented to medical students as a biological variable. At Sidney Kimmel Medical College, the curriculum has never been reviewed to analyze how race is presented to students. This Scholarly Inquiry project aims to analyze how the case-based learning (CBL) narratives presented to medical students perpetuate or challenge implicit biases in medicine, especially in regard to race. This paper will describe the methods of the project, which can serve as a model for other institutions to review their own curricula. Methods: Thirty-nine CBL cases from the 2018-2019 SKMC curriculum are being coded using the iterative process of directed content analysis. One of the two coders is a white medical student who has seen all of the cases in the classroom setting, and the other is a black doctoral student and adjunct faculty member in the College of Population Health who has never seen the cases before. The cases were imported into the qualitative analysis program NVivo, and each coder conducted line-by-line open-coding of seven different cases. From those cases, the coders developed a code book which includes definitions and examples of each code. Updates were made to the code book as more cases were coded and new topics emerged, and discrepancies were resolved by consensus. Using the final code book, all cases are now in the process of being double-coded (i.e. coded by each coder independently). Results and Conclusions: The coders aim to complete double-coding by the end of January 2020. At that point, the kappa value will be calculated to assess inter-coder reliability and codes will be organized into themes to write a results section. Already, we have noted the value of having at least one “case-naïve” coder and coders of different racial backgrounds, as many nuances of the cases were overlooked by the non-minority coder

CBL Facilitation: A Survey of Facilitators and Students with a Particular Interests in Team Building and Facilitation Improvement

Purpose: As the CBL cases have become more refined, there is a desire to continually improve the way cases are being facilitated, understand the methods that are working well, learn if there are practices that are detrimental to learning, and better understand how students are transitioning to teams. This project gathered information from both the from the Class of 2023 during their first year in the SKMC program and their CBL facilitators in order to improve the CBL facilitation. With the information gathered, there were two aims. First, to generate suggestions which were discussed at the CBL facilitators’ back to school meeting. Second, to work towards improvements in the first CBL transition during Wellness Week. Methods: The data was collected in the form of an IRB exempt survey via GoogleForms. The survey links were emailed to the Phase 1, Year 1 CBL students and their Phase 1, Year 1 CBL facilitators twice (5/11/2020 and 5/19/2020). Responses were collected, complied, and sent to Dr. Truong and Dr. Ankam prior to the faculty and curricular development meetings for the 2020-2021 academic year. The target learners were SKMC students with particular emphasis on Year 1 students. Results and Conclusions: When asked to rate CBL experience overall, responses from both students and facilitators were positive. Students expressed a desire for there to be changes made to the Wellness Week programming and results were mixed when asked if a structured teambuilding activity would be a good addition to CBL. Both Dr. Truong and Dr. Ankam expressed that the feedback collected from the surveying was useful and implemented in their planning for the 2020-2021 academic year. Future surveying could seek to collect data on whether students and their CBL facilitators feel that there has been improvement made in the delivery of CBL and Wellness Week

Understanding and Improving Patient Arrival Rates at an Urban Ambulatory Medicine Resident Clinic

AIMS: To improve the arrival rate of patients at the Jefferson Hospital Ambulatory Practice (JHAP) by 10% over a 10-month period from July-April 2016 using a combination of additional reminder calls and targeted summaries from physicians.https://jdc.jefferson.edu/patientsafetyposters/1011/thumbnail.jp

An effective hyper-parameter can increase the prediction accuracy in a single-step genetic evaluation

The H-matrix best linear unbiased prediction (HBLUP) method has been widely used in livestock breeding programs. It can integrate all information, including pedigree, genotypes, and phenotypes on both genotyped and non-genotyped individuals into one single evaluation that can provide reliable predictions of breeding values. The existing HBLUP method requires hyper-parameters that should be adequately optimised as otherwise the genomic prediction accuracy may decrease. In this study, we assess the performance of HBLUP using various hyper-parameters such as blending, tuning, and scale factor in simulated and real data on Hanwoo cattle. In both simulated and cattle data, we show that blending is not necessary, indicating that the prediction accuracy decreases when using a blending hyper-parameter <1. The tuning process (adjusting genomic relationships accounting for base allele frequencies) improves prediction accuracy in the simulated data, confirming previous studies, although the improvement is not statistically significant in the Hanwoo cattle data. We also demonstrate that a scale factor, α, which determines the relationship between allele frequency and per-allele effect size, can improve the HBLUP accuracy in both simulated and real data. Our findings suggest that an optimal scale factor should be considered to increase prediction accuracy, in addition to blending and tuning processes, when using HBLUP

Reducing Treble with Performance Focused Music Programs in Medical School: A Student Driven Needs Assessment to Clarify Participation Barriers Amongst Undergraduate Medical Students

Integration of the arts into medical education has numerous benefits, including reducing burnout and producing empathetic physicians. Investment in arts-related activities has expanded considerably. However, funding remains a common limitation for further integration of arts into medical education. Clarifying student preferences and barriers to music programs can optimize such limited resources to best suit medical student needs.https://digitalcommons.unmc.edu/emet_posters/1033/thumbnail.jp

Kratom-induced transaminitis with subsequent precipitated opioid withdrawal following naltrexone

Kratom is an herbal supplement that has gained popularity for recreational use within the United States. Kratom exerts opioid-like effects and, although not US FDA approved, is commonly used for self-treatment of pain, withdrawal management from opioids, and euphoria. Drug-related hepatic injury has been associated with kratom use. All of this raises concern for patient safety and monitoring. The potential for additive liver toxicity must be considered when kratom is used concurrently with hepatotoxic, over-the-counter, herbal, and prescription medications. This case report describes a case of kratom-induced liver inflammation complicated by opioid withdrawal that was precipitated by initiation of IM naltrexone. To our knowledge, there are no published case reports related to opioid withdrawal following naltrexone administration in patients using kratom (without other opioids). The purpose of this case report is to demonstrate potential complications that may arise with kratom use and considerations that should be taken prior to initiation of naltrexone in kratom users

Prevalence and correlates of zinc deficiency in pregnant Vietnamese women in Ho Chi Minh City

Background: Although Vietnam is a region with a plant-based diet that has a high zinc deficiency, epidemiological data showing how this affects pregnant women are limited. This study explores the prevalence of zinc deficiency and possible correlates in pregnant Vietnamese women in Ho Chi Minh City. Methods: This was a crosssectional study conducted at a general hospital in Ho Chi Minh City, Vietnam. All pregnant women who came to their first antenatal care visit from November 2011 to June 2012 were recruited. Those taking a vitamin and/or mineral supplement were excluded. Serum zinc concentrations, determined by a standard colorimetric method, of 10.7 mol/L-17.5 mol/L (70.0 g/dL-114 g/dL) were classified as normal and under 10.7 mol/L (70.0 g/dL) as zinc deficient. Results: In total, 254 pregnant women were invited and 107 (42%) participated. The mean age of participants was 29 years, and mean gestational age was 10 weeks. Median zinc concentration in serum was 13.6 mol/L, and the prevalence of zinc deficiency was 29% (95% CI=21%-39%). The daily intake of a milk product supplement was the only significant correlate of zinc deficiency of the items investigated (adjusted OR=0.40, p=0.049). Discussion: This is the first study reporting that more than 25% of pregnant Vietnamese women in Ho Chi Minh City are zinc deficient. Further academic and clinical input is needed to confirm the scale of this neglected issue and to investigate the potential of milk product supplementation in this population

Understanding the impact of antibiotic therapies on the respiratory tract resistome: A novel pooled-template metagenomic sequencing strategy

Determining the effects of antimicrobial therapies on airway microbiology at a population-level is essential. Such analysis allows, for example, surveillance of antibiotic-induced changes in pathogen prevalence, the emergence and spread of antibiotic resistance, and the transmission of multi-resistant organisms. However, current analytical strategies for understanding these processes are limited. Culture- and PCR-based assays for specific microbes require the a priori selection of targets, while antibiotic sensitivity testing typically provides no insight into either the molecular basis of resistance, or the carriage of resistance determinants by the wider commensal microbiota. Shotgun metagenomic sequencing provides an alternative approach that allows the microbial composition of clinical samples to be described in detail, including the prevalence of resistance genes and virulence traits. While highly informative, the application of metagenomics to large patient cohorts can be prohibitively expensive. Using sputum samples from a randomised placebo-controlled trial of erythromycin in adults with bronchiectasis, we describe a novel, cost-effective strategy for screening patient cohorts for changes in resistance gene prevalence. By combining metagenomic screening of pooled DNA extracts with validatory quantitative PCR-based analysis of candidate markers in individual samples, we identify population-level changes in the relative abundance of specific macrolide resistance genes. This approach has the potential to provide an important adjunct to current analytical strategies, particularly within the context of antimicrobial clinical trials

The Amino-Terminus of Nitric Oxide Sensitive Guanylyl Cyclase α1 Does Not Affect Dimerization but Influences Subcellular Localization

BACKGROUND: Nitric oxide sensitive guanylyl cyclase (NOsGC) is a heterodimeric enzyme formed by an α- and a β₁-subunit. A splice variant (C-α₁) of the α₁-subunit, lacking at least the first 236 amino acids has been described by Sharina et al. 2008 and has been shown to be expressed in differentiating human embryonic cells. Wagner et al. 2005 have shown that the amino acids 61-128 of the α₁-subunit are mandatory for quantitative heterodimerization implying that the C-α₁-splice variant should lose its capacity to dimerize quantitatively. METHODOLOGY/PRINCIPAL FINDINGS: In the current study we demonstrate preserved quantitative dimerization of the C-α₁-splice by co-purification with the β₁-subunit. In addition we used fluorescence resonance energy transfer (FRET) based on fluorescence lifetime imaging (FLIM) using fusion proteins of the β₁-subunit and the α₁-subunit or the C-α₁ variant with ECFP or EYFP. Analysis of the respective combinations in HEK-293 cells showed that the fluorescence lifetime was significantly shorter (≈0.3 ns) for α₁/β₁ and C-α₁/β₁ than the negative control. In addition we show that lack of the amino-terminus in the α₁ splice variant directs it to a more oxidized subcellular compartment. CONCLUSIONS/SIGNIFICANCE: We conclude that the amino-terminus of the α₁-subunit is dispensable for dimerization in-vivo and ex-vivo, but influences the subcellular trafficking