Mindfulness Training and Practice in Physician Assistant Education

Purpose: The purpose of this study was to integrate mindfulness, as a compassionate pedagogy, into a physician assistant (PA) program and assess its effects on student depression, anxiety, and stress at the conclusion of the first semester. Method: Fifty-five of 60 first-semester students provided consent. Mindfulness instruction and practice began with a six-hour intensive workshop spread over two days during the first week of the semester. This was followed by seven, brief, 10 to15 minute mindfulness practices integrated across one course. Students completed a demographic questionnaire at the beginning of the project and the DASS 21 survey which measures a range of symptoms common to depression, anxiety, and stress at weeks 1 and 16 of the semester. After the course concluded, 10 students were randomly selected from those who had identified as interested in participating in a focus group to discuss their experiences and offer suggestions for improvement. Results: DASS 21 subscale scores revealed no change in depression, anxiety, nor stress. In contrast, the focus group results revealed that student anxiety and stress levels diminished through learning about mindfulness and practicing mindful meditations. Conclusions: The incorporation of mindfulness training was generally well received by first-semester PA students. Students in the focus group reported decreased levels of anxiety and stress, while the DASS 21 revealed no change. The authors suggest that the experience could be strengthened by modifying the workshop material and extending the mindfulness practice across the didactic and clinical years to allow students more opportunities to develop their personal mindfulness practice and integrate it throughout their career

Effect of Child Overweight/Obesity Didactic Session on Resident Confidence and Detection

Objective . To evaluate the impact of an obesity didactic session for pediatric physicians on confidence in counseling and identified overweight/obesity and follow-up recommendations. Methods . Pediatric residents underwent training and completed pre/post online surveys evaluating confidence in obesity prevention and identification. A booster training occurred 1 year later. Pre-/post-training scores were compared using χ 2 or Fisher’s exact tests. Electronic medical records data for patients ≥3 years with BMI-for-age percentile ≥85 during 3 months prior/following the training/booster compared frequency of overweight/obesity identification and follow-up recommendations (≤3 months recommended vs longer) using logistic regression adjusting for age and overweight/obese status. Results . Post trainings, improvements in confidence to define/screen for obesity were observed, with a decline between trainings. Overweight/obese identification and follow-up time recommendations improved post-training (identification: 14.2% to 27.4%, adjusted odds ratio [aOR] = 3.16, 95% confidence interval [CI] = 1.54-6.51; follow-up: 48.9% to 58.9%, aOR = 1.63, 95% CI = 1.01-2.64), aOR = 1.77, 95% CI = 1.10-2.85, and identification remained stable/above pre-training rates both pre-/post-booster (25.8%, aOR = 3.14, 95% CI = 1.53-6.45; and 22.1%, aOR = 2.57, 95% CI = 1.25-5.30, respectively). Recommended follow-up time rates continued to rise when measured pre-booster (60.6%, aOR = 1.77, 95% CI = 1.10-2.85), then declined (46.0%, aOR = 0.95, 95% CI = 0.60-1.52). Conclusion . This didactic session improved resident confidence in defining/screening, identification of overweight/obesity and follow-up recommendations; however, rates of identification remained low. The successes of this intervention support similar didactic sessions in residency programs and identifies opportunities for improved resident/attending education

SNP-SNP Interactions Discovered by Logic Regression Explain Crohn's Disease Genetics

<div><p>In genome-wide association studies (GWAS), the association between each single nucleotide polymorphism (SNP) and a phenotype is assessed statistically. To further explore genetic associations in GWAS, we considered two specific forms of biologically plausible SNP-SNP interactions, ‘SNP intersection’ and ‘SNP union,’ and analyzed the Crohn's Disease (CD) GWAS data of the Wellcome Trust Case Control Consortium for these interactions using a limited form of logic regression. We found strong evidence of CD-association for 195 genes, identifying novel susceptibility genes (e.g., <em>ISX</em>, <em>SLCO6A1</em>, <em>TMEM183A</em>) as well as confirming many previously identified susceptibility genes in CD GWAS (e.g., <em>IL23R</em>, <em>NOD2</em>, <em>CYLD</em>, <em>NKX2-3</em>, <em>IL12RB2</em>, <em>ATG16L1</em>). Notably, 37 of the 59 chromosomal locations indicated for CD-association by a meta-analysis of CD GWAS, involving over 22,000 cases and 29,000 controls, were represented in the 195 genes, as well as some chromosomal locations previously indicated only in linkage studies, but not in GWAS. We repeated the analysis with two smaller GWASs from the Database of Genotype and Phenotype (dbGaP): in spite of differences of populations and study power across the three datasets, we observed some consistencies across the three datasets. Notable examples included <em>TMEM183A</em> and <em>SLCO6A1</em> which exhibited strong evidence consistently in our WTCCC and both of the dbGaP SNP-SNP interaction analyses. Examining these specific forms of SNP interactions could identify additional genetic associations from GWAS. R codes, data examples, and a ReadMe file are available for download from our website: <a href="http://www.ualberta.ca/~yyasui/homepage.html">http://www.ualberta.ca/~yyasui/homepage.html</a>.</p> </div

Logic structures, frequencies, and associated Crohn's Disease odds ratios of the <i>ISX</i> gene (p-value<3.8×10⁻⁶).

<p>Logic structures, frequencies, and associated Crohn's Disease odds ratios of the <i>ISX</i> gene (p-value<3.8×10⁻⁶).</p

Forty genes with the strongest evidence for association with Crohn's Disease risk, with chromosomal locations, numbers of SNPs, approximate p-values, and Bayes factors.

**<p>indicates genes in the chromosomal locations where the WTCCC single-SNP analysis showed <b>strong</b> evidence.</p>*<p>indicates genes in the chromosomal locations where the WTCCC single-SNP analysis showed <b>moderate</b> evidence.</p>+<p>indicates chromosomal locations are those with three or more genes in the 195 genes (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0043035#pone.0043035.s001" target="_blank">Table S1</a>) showing strong evidence in our WTCCC logic-regression-based analysis, but without strong or moderate evidence in the single-SNP analysis of WTCCC.</p