Mercer University

Background Individuals with obesity often experience weight bias in healthcare, which may negatively impact health outcomes. Weight bias (WB) can be reduced by provider participation in weight bias interventions. This mixed‐methods study investigated the sustainability of reduced WB in those who received a weight bias intervention. Method Registered nurses (RNs) who completed a weight bias intervention during their nursing education and those who did not were recruited to complete an online survey. WB scores and approaches towards caring for patients with obesity were compared. Results Eighty‐four RNs (50 intervention; 34 control) participated. Reduced WB was sustained over 4 and 6 years compared to pre‐intervention scores (p < 0.001). No significant WB differences were found between the groups (p = 0.501). Thematic analysis identified three overarching themes: physical care differences, recognition of obesity's causality and controllability, and equal treatment of all patients. Conclusions Weight bias intervention effects were sustained, but non‐intervention nurses had comparable WB scores, indicating multifaceted influences on WB in clinical practice. In order for nurses to provide unbiased care for individuals with obesity, it is important to develop and implement both high‐impact educational interventions that support reduced weight bias and organizational and structural supports in the practice environment.

Introduction The transition of the United States Medical Licensing Examination (USMLE®) Step 1 to pass/fail has increased the perceived importance of Step 2 Clinical Knowledge (CK) scores, making effective exam preparation increasingly important. Our study characterizes Step 2 CK resource usage patterns and analyzes their relationship with scores. Methods Data from an anonymous, retrospective survey of fourth-year medical students from the Mercer University School of Medicine (MUSM) and the University of Alabama at Birmingham Marnix E. Heersink School of Medicine (HSOM) were analyzed to assess their study resource utilization patterns and self-reported Step 2 CK scores. Results A total of 275 students reported average usage of 4.4 resources, including 1.6 question banks (Qbanks), 1.2 video, 0.6 podcast, 0.5 flashcard, and 0.6 print resources. All but one used Qbanks; all used digital resources, while 42.1% also used print resources. The mean Step 2 CK score of 247.3 (SD = 12.8) mirrored national averages. Total resources used did not impact scores significantly. Using 3 + Qbanks was significantly associated with lower scores. Video usage corresponded to lower scores. Students using no print resources scored significantly higher. Podcast and flashcard usage had no significant associations. The most popular resources were UWorld (97.7%), Anki (50.3%), Divine Intervention (50.3%), and AMBOSS (49.7%). Conclusion Medical students accessed diverse resources for Step 2 CK preparation but focused on commercial question banks most frequently and print materials minimally. Students should avoid resource overload and emphasize active learning with 1–2 Qbanks and use other materials judiciously, building upon past course work to enhance Step 2 CK scores. Ongoing monitoring of study resource usage can guide a school’s academic coaching, curricular decisions, and resource acquisition.

Type 1 diabetes (T1D) is an autoimmune disease with two presymptomatic stages (stages 1 and 2) that precede its clinical onset (stage 3). The presymptomatic stages of T1D are characterized by circulating autoantibodies that can be reliably detected by autoantibody screening panels. Identifying people in the presymptomatic stages of T1D can allow for monitoring and prevention of diabetic ketoacidosis. A disease-modifying therapy that has been shown to delay onset of stage 3 T1D is now also available for individuals with stage 2 disease, highlighting the importance of early detection. This intervention may delay the onset of stage 3 T1D. Updated guidance and protocols are needed to integrate autoantibody screening into standard practice. This report provides guidance for endocrinology providers on establishing clinical autoantibody screening programs within their practices, institutions, healthcare networks, and/or communities. Key steps include nominating a champion for the program, building a team to implement screening, and motivating other providers to participate. Implementation of screening requires standardizing several steps in the screening process, including communicating with individuals at risk, integrating screening into existing workflows, and streamlining logistics such as ordering and coding for autoantibody panels. Providers must have a plan to interpret and communicate results and to ensure that individuals may be appropriately followed in the future. Here, common barriers to screening are addressed, and practical solutions to facilitate the adoption and success of screening initiatives are offered.

Background Nursing students often have negative perceptions of caring for older adults and show less interest in working with this population. It is essential to prepare nurses to meet the unique needs of this population. Purpose To assess the implementation and utility of a health humanities-based activity for nursing students to reflect on their perceptions of older adults. Methods Using a mixed-methods, retrospective pre-posttest design, students (N = 50) observed photographs of older adults living in the community. A consensual qualitative approach analyzed students’ written reflections and investigators’ field notes. An investigator-developed experience survey was analyzed using nonparametric paired t -tests. Results Four themes emerged from the qualitative analysis: relatedness, assumptions about aging, appreciation of aging, and professional formation. Significant improvements were noted on all experience survey items. Conclusion The findings support using a health-humanities teaching strategy to foster nursing students’ positive perceptions toward older adults.

BACKGROUND Single-stage flap reconstruction of surgical defects of the anterior mid and lower ear can prove challenging due to a relative paucity of local and adjacent tissues. While staged flap options for such defects are well described, similar single-stage options are lacking. OBJECTIVE The authors describe surgical techniques for the design and execution of single-stage local flaps to repair soft tissue defects on the concha cavum, incisura, antitragus, antihelix, and lobule after skin cancer extirpation. MATERIALS AND METHODS A retrospective review was conducted on single-stage transposition flaps used to repair soft tissue defects of the lower half of the anterior auricle following Mohs surgery. This study included cases performed by two surgeons (D.K. and S.K.) at a single institution from 2018 to 2024. RESULTS Twenty-four cases utilizing single-stage transposition flaps for reconstruction of the mid to lower anterior auricular surface were performed. Intraoperative steps, modifications, and postoperative outcomes are discussed. No major complications were observed. CONCLUSION Single-stage transposition flaps are useful options for repairing defects of the mid to lower anterior ear, which are not amenable to primary closure, second intent healing, grafting, or in patients who are not candidates for multistage repairs. This technique offers reliable cosmetic outcomes without flap necrosis or other complications.

Social policy is a powerful intervention that has the potential to reduce or widen inequities in population health. While studies estimating the causal effect of social policies on health are valuable to policy stakeholders, these studies frequently report unstratified estimates for the total population, even though differential enforcement by sub-unit populations and geographies is common. The analytical decision to report unstratified estimates assumes a single version of the social policy is implemented uniformly across populations; in the presence of biased implementation these analyses can generate misleading results that impede meaningful policy evaluation. In this commentary, we highlight the importance of considering differential policy effects among subpopulations as a function of poorly defined policy exposure (i.e., lack of causal consistency) rather than effect measure modification or mediation. Framing the issue as one of poorly defined policy exposure allows for critical disentangling of the explicit and implicit purposes of a policy.

Efforts to improve patient engagement in pain management are often hindered by inconsistent definitions and measurements. To address this gap, we developed and pilot-tested the 15-item Patient Engagement in Pain Management survey. A systematic review of 77 survey instruments identified 6 key constructs of patient engagement, and semi-structured interviews with 36 patients and 3 providers from the Johns Hopkins Personalized Pain Program informed its development. The initial 33-item survey was refined to 15 items, and usability and test-retest reliability were evaluated with 60 Personalized Pain Program patients. The median completion time was 3.5 minutes, with minimal missing data (<0.5%). Most respondents (96–100%) found the questions relevant, with higher average scores for patient-provider communication (3.6–4.5 on a 5-point scale) and lower scores for adherence challenges. Although the Patient Engagement in Pain Management survey demonstrated good usability and applicability, further studies are needed to enhance its test-retest reliability and psychometric validation.

CONTEXT Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in 2019, causing the COVID-19 pandemic. While most infected people experienced mild illness, others progressed to severe disease, characterized by hyperinflammation and respiratory distress. There is still much to learn about the innate immune response to this virus. Interferon regulatory factor 3 (IRF3) is a transcription factor that is activated when pattern recognition receptors detect viruses. Upon activation, IRF3 induces the expression of interferon beta (IFN-β) and interferon-stimulated genes, which protect the host from viral infection. However, coronaviruses antagonize this pathway, delaying type 1 IFN production. It is, therefore, unclear how IRF3 influences COVID-19 disease. Our prior reports showed that IRF3 promotes harmful inflammation during bacterial sepsis in mice. HYPOTHESIS We hypothesized that IRF3 cannot effectively control the SARS-CoV-2 viral load and instead promotes harmful inflammation during severe COVID-19. METHODS AND MODELS We used mice transgenic for the human angiotensin converting-enzyme 2 transgene, driven by the keratin 18 promoter (K18-ACE2 mice) that were IRF3 deficient or IRF3 sufficient to test how IRF3 influences COVID-19 disease. RESULTS Upon infection with SARS-CoV-2, K18-ACE2 mice showed a dose-dependent disease, characterized by mortality, lethargy, weight loss, and lung pathology, reminiscent of clinical COVID-19. However, K18-ACE2 mice lacking IRF3 were protected from severe disease with reduced mortality (84.6% vs. 100%) and disease score. We found that IRF3 promoted IFN-β production in the lungs and reprogrammed the cytokine profile, while viral load in the lungs was similar in the presence or absence of IRF3. INTERPRETATIONS AND CONCLUSIONS These data indicated that IRF3 played a detrimental role in murine COVID-19 associated with changes in IFN-β and inflammatory cytokines.

We examined an outdoor, experiential learning approach within a science methods course for nontraditional adult learners who are often career changers or individuals transitioning into teaching later in life. Through immersive, nature-based experiences, the course connected adult learners to science via direct engagement with the natural world. We include reflections from two nontraditional learners who participated in a 6-week nature journaling process, showcasing how they embraced inquiry-based experiences in natural settings. These reflections reveal a supportive learning environment that values diverse learning styles and life experiences and encourages exploration. Insights from these experiences can guide science teacher educators in developing curricula, instructional strategies, and support systems to address the specific needs of nontraditional learners, enriching science education preparation.

Background Standard setting plays a critical role in determining student outcomes by defining the level of biomedical knowledge required to be considered competent. This is especially important for accurately classifying medical students as ready (or not) to progress through the pre-clinical curriculum. In multiple-choice medical knowledge exams, the Yes-No Angoff method may be used for setting passing scores. This method relies on faculty experts’ judgments about whether students with borderline but adequate competence would answer each question correctly. Using a construct validity framework with the construct of academic success defined as the ability of a student to progress without obstacles, we examined the predictive validity of the passing standards set by this method. Methods We analyzed academic success for four pre-clinical semesters across three student cohorts. First, we identified passing standards for pre-clinical courses using the Yes-No Angoff method. Then, we applied binary logistic regression and receiver-operator characteristic (ROC) analyses with area under the curve (AUC) to evaluate passing standards. For binary outcomes, we defined academic success in terms of unimpeded progress through the curriculum and students’ first-attempt passage of the United States Medical Licensing Examination (USMLE) Step 1. Model predictors for ROC analyses included Yes-No Angoff passing standards, Medical College Admissions test scores, and grade point averages for math and science courses. Results ROC analyses showed a low but acceptable area under the curve for a single semester in one cohort and excellent or outstanding AUCs for the remaining 11 semesters. Rates of overall classification accuracy for the Yes-No Angoff passing scores ranged between 89% and 96% for predicting academic success for all pre-clinical semesters across all cohorts. Conclusions The Yes-No Angoff method yielded passing standards that aided in accurately predicting academic success, providing predictive validity evidence for our school’s passing standards in a pre-clinical medical curriculum.

With origins in the conscripted labor system of nineteenth century European colonies, the South Asian diaspora began in the early twentieth. Migrants faced racial hostility, their foreignness identifiable by skin color, physiognomy, languages unintelligible to Anglophone ears, and customs and religions that confirmed them as heathens in a Christian country. More threatening was their capacity for hard work at substandard wages. Driven out of the Pacific Northwest by mob violence, Sikhs from Punjab brought the intensive farming practices of their native Indus Valley to the agricultural districts of California. Prohibited by statute from owning land, they formed farming collectives to pool their modest plots and capital into larger acreages that were competitive with the industrial farms of the Central and Imperial Valleys. Prejudice and economic competition drove laws and policies that prohibited Asian naturalization (Barred Zone Act, 1917). In 1924, the Johnson-Reed Act set quotas that barred migration from India. Unable to establish second generations, by the 1940s Sikh agricultural settlements were threatened with extinction. Anti-Asian policies unwound in the last half of the twentieth century. Prohibitions against Asian immigration were lifted in 1965. Preferred were those trained in science, technology, and medicine. In 1990 the H-1B visa system added workers in the nascent fields of information technology and computer science, fields where the Indian educational system was robust. After a half-century of immigration policies that favored the highly schooled in science and technology, South Asian communities were created that were intellectually, financially, and socially accomplished, transforming American society.

Background: Family caregivers’ perspectives for advance care planning (ACP) are critically important to reflect the end-of-life wishes of people with dementia. Culture can influence ACP practice and people’s perspectives toward it. Little is known about family caregivers’ perspectives toward ACP in Asian countries, especially in Korea. Purpose: The purpose of this study was to explore beliefs and attitudes toward ACP among family caregivers of people with dementia. Methodology: Using a Q methodology, 28 statements (Q sample) were constructed through an extensive literature review to capture the beliefs and attitudes toward ACP in family caregivers. The P sample (25 family caregivers) completed each grid with a statement in Q sorting table. Data analysis was done using the PQ Method program (Ver. 2.35). Results: Three types emerged from 24 caregivers through a Varimax rotation and explained 53% of the total variance. One caregiver fell into a non-significant for any of the three types. Type 1 ( ACP benefit- and patient-caregiver wish-driven caregivers ) hold positive attitudes toward pre-care planning and the benefits but lack of respect for the preferences of people with dementia. Type 2 ( Well-dying- and dignity-pursued advocators ) recognized ACP as a dignity-preserving approach but had concerns about pre-care planning and felt the burden for management of people with dementia. Type 3 ( Patient autonomy supportive surrogates) perceived the importance of respecting the preferences of people with dementia and the roles of family caregivers in ACP care. Conclusions: Differences in the perspectives toward ACP of family caregivers have emerged. It is crucial to develop tailored interventions for each type to optimize ACP care for people with dementia and implement them as early as possible after onset to reduce patient suffering and caregiver burden, enhance dignified death, and improve quality of life.

This study examines preservice teachers’ (PSTs) practices of noticing and responding to students’ scientific thinking within the context of their science methods courses (pedagogy focused). The PSTs, in their senior year and later in their student-teaching internship year at a Midwestern university teacher preparation program, participated in two sequential science methods courses. Over the course of these two semesters, they completed two key course assignments: Sensemaking tasks (senior year) and Student learning analysis (internship year). Their written responses to these assignments were evaluated using Kang and Anderson’s (Sci Educ 99(5):863–895, 2015) framework, which is designed to study teachers’ practices of noticing and responding. The findings reveal that PSTs primarily focused on their own actions as teachers, their students’ behavior, and the canonical nature of their students’ responses. However, their attention to students’ science ideas was limited, often leading to narrow interpretations when these ideas were noticed. The nature of the methods course assignment prompts may have influenced PSTs to prioritize certain aspects of students’ learning over others. These findings suggest important implications for supporting and enhancing PSTs’ practices of noticing and responding through targeted coursework and the design of methods courses.

To examine the relationship between residential racial and economic segregation and main causes of death at the county level in the USA. Residential racial and economic segregation quintiles were determined using the Index of Concentration at the Extremes (ICE). Linear mixed-effects model was applied to calculate adjusted mortality rate ratios (aRR). The ICE for race + income outperformed the ICE for race and the ICE for income. Among 3142 counties, the average age-adjusted all-cause mortality rates were 980.25, 919.82, 844.37, 781.82, and 703.01 per 100,000 across ICE for race + income quintiles, from the most deprived to the most privileged, respectively (p for trend: < 0.001). The corresponding aRRs for all-cause mortality were 1.32, 1.23, 1.17, 1.10, and 1 (p for trend: < 0.001). Furthermore, both mortality rates and aRRs for all 11 main causes of death showed a significant decrease from the most deprived to the most privileged counties (p for trend: < 0.001). There is a strong association between residential racial and economic segregation and age-adjusted all-cause mortality as well as the 11 main causes of death in US counties, with a clear decreasing trend observed across ICE for race + income quintiles. These findings underscore the urgent need for policy interventions to reduce residential segregation, including equitable urban planning, investment in underserved communities, and improved access to healthcare and education in disadvantaged areas. Addressing these structural inequities could be an effective strategy for reducing mortality disparities and advancing health equity.

Gene model for the ortholog of Phosphoinositide-dependent kinase 1 ( Pdk1 ) in the May 2011 (Agencourt dgri_caf1/DgriCAF1) Genome Assembly (GenBank Accession: GCA_000005155.1 ) of Drosophila grimshawi . This ortholog was characterized as part of a developing dataset to study the evolution of the Insulin/insulin-like growth factor signaling pathway (IIS) across the genus Drosophila using the Genomics Education Partnership gene annotation protocol for Course-based Undergraduate Research Experiences.