University of Arkansas – Fort Smith

Background and Aim Women are underrepresented in gastroenterology (GI), and few studies have evaluated gender differences in the authorship of GI clinical practice guidelines. This study aimed to assess gender disparities in the authorship of GI guidelines and their cited articles over time. Methods We reviewed luminal GI guidelines from three major GI societies to compare authorship of current guidelines (defined as published from 2019 to 2022) to their retired guidelines (defined as the previous guideline replaced by the current guideline). Several characteristics of the author and article including gender, faculty rank, study type, and strength of recommendation supported by the cited article were collected to evaluate factors associated with female authorship. Results We reviewed 13 current guidelines, 12 retired guidelines, and 4328 cited articles. There was no significant change in female authorship of guidelines from 2010 to 2022. Proportions of female first ( p ‐value < 0.0001) and senior ( p ‐value < 0.0001) authors of cited articles increased over time. Women were less often first authors of cited randomized control trials, systematic reviews, and meta‐analyses than observational studies (35% vs. 65%, p < 0.0001). Cited articles that supported a “strong” guideline recommendation were less often first‐authored (19% vs. 81%, p = 0.003) and senior‐authored (10% vs. 90%, p = 0.006) by women. Conclusions Female authorship increased over time, but a gender disparity remains. Female authors less commonly authored higher level of evidence studies. Further studies are needed to assess if the proportional increase in female authorship is due to a small subset of prolific authors or representative of the number of women practicing in gastroenterology.

Background The United States Medical Licensure Examination (USMLE) represents a critical step for medical licensure in the United States, requiring extensive preparation that can lead to significant mental health challenges among aspirants. This study aims to explore the prevalence and contributing factors of depression, anxiety, and stress among USMLE aspirants. Methods This cross-sectional survey investigates the prevalence and contributing factors of depression, anxiety, and stress among USMLE aspirants. We deployed a detailed online and paper-based questionnaire targeting a diverse pool of 321 medical students and graduates globally. The survey incorporated validated scales such as the Perceived Stress Scale, Generalized Anxiety Disorder 7-item scale, and Patient Health Questionnaire-9 to evaluate mental health statuses. Data analysis was conducted using SPSS, focusing on demographic correlations and mental health outcomes. Results A total of 321 participant’s data were collected, out of whom 51.1% (n = 164) were male and 48.9% (n = 157) were female. 91.3% (n = 293) were International Medical Graduates (IMG), while 8.7% (n = 28) were American Medical Graduates (AMG), educational status results show undergraduates 38.6% (n = 124) and graduates 61.4% (n = 197). Participants were interviewed through a validated questionnaire, and 75.1% (n = 241) had depression, 71.96 (n = 231) had anxiety, (n = 16) had low stress, (n = 231) had moderate, and (n = 66) had severe perceived stress. Conclusion Our study reveals a high prevalence of depression, anxiety, and stress among USMLE aspirants, with significant variations across demographic subgroups and chosen medical specialities.

784 Background: Portal vein thrombosis (PVT) includes portal vein blockage with a blood clot. Recently, there has been an increase in the incidence of PVT with solid malignancy. Portal vein thrombosis (PVT) is a potentially high-risk complication associated with pancreatic cancer. A hypercoagulable state is frequently observed in pancreatic cancer, with the incidence of thromboembolic events reported to range between 17% and 57%. We wanted to analyze the prevalence of PVT in patients with pancreatic cancer and its impact on hospital outcomes. Methods: We performed a retrospective analysis using the National Inpatient Sample Database (NIS) from 2018 to 2020. Patients with the primary diagnosis of pancreatic cancer and age >18 were diagnosed using ICD-10 codes. They were then stratified based on the presence of portal vein thrombosis. The Chi-square test was used to analyze categorical variables, and the T-test was used to analyze continuous variables. The confounders were adjusted using multivariate regression analysis. We observed the outcomes on mortality, length of stay, and total hospital charges. Results: A total of 336894 patients were diagnosed with a primary diagnosis of pancreatic cancer. Of them, 0.04% (n=13475 patients) were diagnosed with metastatic portal vein thrombosis. The mean age of the patients was 64 years (p <0.001). Out of them, 47% of patients were female. In comparison, the remaining 53% were male (p-value: 0.5). Almost 71% f the patients were White, 13% were African American and 0.09% were Hispanics (p-value <0.001). The presence of PVT was found to be associated with increased mortality in pancreatic patients (aOR 1.6, p-value <0.001) as compared to those without PVT. It was also associated with an increase in mean length of stay (LOS)(7.1 vs 6 days, p-value 0.009) and total hospital charges ($86,000 vs$73794, p-value <0.001). It was also observed that the presence of PVT was associated with increased odds of secondary outcomes, including venous thromboembolism (p-value <0.001), stroke (p-value 0.5), and acute kidney injury (p-value <0.001). Conclusions: The presence of portal vein thrombosis (PVT) in pancreatic cancer patients is associated with significantly worse hospital outcomes. These findings emphasize the importance of early detection and aggressive management of PVT in this patient population. Comparison of hospital outcomes between pancreatic cancer patients with and without portal vein thrombosis. Hospital Outcomes Pancreatic cancer patients with PVT Pancreatic cancer patients without PVT Adjusted Odds Ratio (aOR) 95% CI P-value Mortality 9.4% (n=1310) 7.2% (n=23300) 1.3 0.3-1.5 <0.001 LOS (Days) 7.1 6.0 1.6 1.1-2.3 0.009 Venous thromboembolism (VTE) 11% (n=1645) 4.2% (n=13734) 2.9 2.5-3.3 <0.001 Stroke 0.03% (n=5) 0.02 (n=79) 1.8 0.2-14 0.5 Acute Kidney Injury 21% (n=2970) 20% (n=68499) 1.2 1.09-1.3 <0.001

Organic electrochemical transistors (OECTs) represent a promising platform for biosensing applications in aqueous environments, including the sensitive detection of neurotransmitter molecules, such as serotonin (SE). Conventional methods for SE detection, such as HPLC and ELISA, are time-consuming and expensive. Electrochemical sensors, while sensitive and cost-effective, often struggle with real-time detection and selectivity issues due to interference from similar biomolecules, such as dopamine (DA), ascorbic acid (AA), and uric acid (UA). These interferents are particularly challenging for the OECT detection because they are easier to oxidize than SE on the gate electrode. Molecularly imprinted polymer (MIP) has gained increasing interest in electrochemical analysis, providing a cost-effective method for the selective detection of various analytes by creating matching cavities in the polymer film. Herein, a glassy carbon/multiwall carbon nanotube (GCE/MWCNT) gate electrode was modified by a PSS–doped overoxidized molecularly imprinted polymer (DOMIP) layer in an OECT sensor. Characterizations by cyclic voltammograms (CV), electrochemical impedance spectroscopy (EIS), scanning electron microscopy (SEM), Raman spectroscopy, and wide-angle X-ray scattering (WAXS) demonstrate an improved conductivity of the gate electrode due to DOMIP modification. The resulting GCE/MWCNT/DOMIP sensor demonstrated a low detection limit of 0.31 μM for SE in real-time measurements, comparable to that of the GCE/MWCNT sensor. However, the GCE/MWCNT sensor showed little selectivity toward SE. In addition to the SE-templated cavities, the DOMIP gate electrode modification leveraged the electrostatic interactions between the negatively charged PSS– dopant and the positively charged SE molecules to achieve a higher sensitivity toward SE compared to other negatively charged or neutral interferents in the concentration range of 0.31 μM - 3.1 μM. These findings suggest that combined with the GCE/MWCNT gate electrode, the doping strategy used in DOMIP-modified OECT sensors could provide a low-cost way for the selective and real-time monitoring of SE in complex biological samples without the usage of noble-metal electrode or expensive antibodies, which is potentially suitable for a large-scale medical diagnosis.

Introduction The evolution of healthcare continues to display an incongruence between delivery and outcomes. Current healthcare paradigms for patient empowerment warrants analysis. A lacking operational application for and agree upon assessment of patient empowerment contributes to healthcare’s incongruence. Interchangeable psychosocial concepts and specific patient contextual factors associated with health-related behavioral change have escaped an applicable definition of empowerment. The aim of this theoretical perspective review is to support a comprehensive and contextual understanding of patient empowerment that frames a definition for future consensus research. Methods and mechanisms A theoretical perspective review of patient empowerment including interchangeable concepts and patient contextual factors such as personal suffering and resilience; self-determined meaning and purpose; and autonomy, competence, and self-efficacy are critically analyzed. This analysis builds on adjacent concepts including therapeutic alliance, communication, motivation, and trust. The inclusion of specific patient contextual factors that relate to behavioral change elevate the need to reinforce coping and self-management skills as mechanism for patient empowerment. Practice gaps for those experiencing chronic disease, pain, and mental health disorders in rehabilitation setting are specific populations who benefit from healthcare providers unifying the variables associated with patient empowerment. Results and discussion The review of associated concepts synthesized an actionable definition of patient empowerment that serves as a foundation for future research. Behavior related changes occur through the evolution in one’s identity, perceptions, and abilities. Interventions that inspire autonomy, competence, and relatedness with a renewed sense of purpose establish resilience and self-efficacy. The totality of this inspired self-determined plan of care establishes the mechanisms required for behavioral change and sustainable transformation. The cumulative experience becomes patient empowerment.

Social pedagogy can be understood conceptually as an interdisciplinary approach that considers the underlying social contexts in learning and development. Despite social pedagogy’s global traction, it remains relatively unknown in the United States. This article highlights the potential for social pedagogy to develop uniquely in North America, emphasising the importance of equipping students with both academic content and social awareness. The article examines existing literature through a pragmatic lens, bridging US educational practices that are not categorically termed social pedagogy with international social pedagogy research. It provides an overview of social pedagogy, focusing on how its critical branch promotes democracy through active participation. The article also explores the foundations of the US education system in progressive education. Jane Addams’s writing and works lay the footing for this understanding, particularly in how social pedagogy plays a role in supporting the educational and social needs of the immigrant population. Eleven dimensions of social pedagogy within the US education system are identified. These dimensions include critical reflection, student empowerment, cross-generational opportunities, cooperative learning, integrated schools and classes, generative themes, healthy relationships, dialogue, a student-centred focus, problem-posing and the exploration of cultural narratives. Further research is needed to advance the understanding and application of social pedagogy in the United States, particularly for immigrant students.

This study explored the facilitators and barriers of community bike share use in a mid-sized city with high incidence of poverty and racial diversity using a community-based participatory action research (CBPAR) photovoice framework with the Stanford Our Voice (OV) Discovery Tool digital application. Community members participated in one of three community citizen science walks with follow up focus groups facilitated by osteopathic medical student researcher to address “What makes it easy or hard to ride a bike using the bike share?” Twenty-seven diverse community members partnered with four osteopathic medical students exploring vulnerable individuals’ lived experiences, beliefs/understanding of the Social Determinants of Health (SDoH) and access to the bike share program. A total of 322 photos and narrative comments from citizen science walk audits developed deductive themes and follow up focus groups informed inductive themes. Themes addressed challenges to access, maintenance, safety in bike transit, comfort, and environment that create barriers to use and increase inequities for lower income and historically underrepresented communities. The use of OV provided photograph, narrative, and geocoded photo location. This novel approach served as an effective tool for community action with city decision makers. The narrative research identified the impact of the barriers, and the photographs and geocoding provided clear descriptions for locations to prioritize change by adding street signs for access and safety, fixing road safety issues or bike maintenance concerns. It actively engaged the community with the city to drive discussions and plans for change in repair systems and infrastructure that also addressed equity and acknowledged the SDoH supporting residents in lower income or historically underrepresented communities. Citizen science engaged community voices, supporting change in city policies and transportation initiatives to support the sustainability of the bike share program.

The purpose of this intrinsic case study was to examine the perceived benefits and challenges of implementing informal learning practices through popular music education for preservice music teachers. Specifically, we sought to understand why and how preservice music educators would perceive benefits and challenges from their experiences in a modern band. We conducted a study with five preservice music teachers in a modern band outside of the curriculum in a music teacher education program. We collected the data for 9 weeks, gathering multiple interviews, participants’ written responses, artifacts, and researchers’ field notes. Three overarching themes emerged from the data analysis: (a) a self-navigating process of aural-based learning, (b) autonomy with freedom, and (c) reflective educators. Our findings indicated that the ultimate goal of informal learning practices in music teacher education may not be limited to mastering musical skills but should include improving problem solving and classroom decision making.

OBJECTIVE: To evaluate if stroboscopic vision significantly affected dynamic balance performance on the YBT-LQ in athletes aged 12-18 years. DESIGN: Single group pre-test post-test quasi experimental study METHODS: Two hundred seventy-two participants aged 12-18 years, who participated in a school- or club-sponsored sport, performed the Y-Balance Test Lower Quarter (YBT-LQ) without and with stroboscopic vision. Reach distances were recorded for each participant with and without stroboscopic vision. Main effects were analyzed to interpret the effect of stroboscopic vision on YBT-LQ performance, and secondary effects were analyzed to interpret the effect on individual reach directions and composite scores. RESULTS: There were significant main effects between YBT-LQ scores with and without stroboscopic vision ( p = <.001). Post hoc analyses identified a significant decrease in performance when participants performed the YBT-LQ with stroboscopic vision compared to the YBT-LQ under standard conditions in each reach direction, for left and right lower extremities. There was a significant decrease in composite scores when controlling for leg length of the participants. CONCLUSION: Performance of the YBT-LQ decreases when youth athletes’ vision is perturbed with stroboscopic vision.

Disease may be both a cause and consequence of stress, and physiological responses to infectious disease may involve stress coping mechanisms that have important fitness consequences. For example, glucocorticoid and glycemic responses may affect host fitness by altering resource allocation and use in hosts, and these responses may be affected by competing stressors. To better understand the factors that affect host responses to infection, we challenged the immune system of field acclimatized pygmy rattlesnakes, Sistrurus miliarius, with a sterile antigen, lipopolysaccharide (LPS), and measured the glucocorticoid and glycemic response in healthy non-reproductive snakes, snakes afflicted with an emerging mycosis (ophidiomycosis), and pregnant snakes. We hypothesized that LPS challenge would result in a glucocorticoid and glycemic response typical of the vertebrate acute phase response (APR), and therefore predicted that LPS challenge would result in an acute increase in plasma corticosterone (CORT) and a decline in plasma glucose in all individuals. Additionally, we hypothesized that the APR would be attenuated in individuals simultaneously coping with additional challenges to homeostasis (i.e., disease or reproduction). As predicted, immune challenge elicited an acute increase in plasma CORT and a decrease in plasma glucose. Snakes coping with ophidiomycosis and pregnant snakes were able to mount a robust glucocorticoid and hypoglycemic response to LPS challenge, which was contrary to our hypothesis. Our findings clarify directions of causality linking infection, glucocorticoids, and glucose, and emphasize the importance of future research examining the fitness consequences of interactions between stress and disease in wildlife threatened by emerging pathogens.

Importance Office-based phototherapy is cost-effective for psoriasis but difficult to access. Home-based phototherapy is patient preferred but has limited clinical data, particularly in patients with darker skin. Objective To compare the effectiveness of home- vs office-based narrowband UV-B phototherapy for psoriasis. Design, Setting, and Participants The Light Treatment Effectiveness study was an investigator-initiated, pragmatic, open-label, parallel-group, multicenter, noninferiority randomized clinical trial embedded in routine care at 42 academic and private clinical dermatology practices in the US. Enrollment occurred from March 1, 2019, to December 4, 2023, with follow-up through June 2024. Participants were 12 years and older with plaque or guttate psoriasis who were candidates for home- and office-based phototherapy. Interventions Participants were randomized to receive a home narrowband UV-B machine with guided mode dosimetry or routine care with office-based narrowband UV-B for 12 weeks, followed by an additional 12-week observation period. Main Outcomes and Measures The coprimary effectiveness outcomes were Physician Global Assessment (PGA) dichotomized as clear/almost clear skin (score of ≤1) at the end of the intervention period and Dermatology Life Quality Index (DLQI) score of 5 or lower (no to small effect on quality of life) at week 12. Results Of 783 patients enrolled (mean [SD] age, 48.0 [15.5] years; 376 [48.0%] female), 393 received home-based phototherapy and 390 received office-based phototherapy, with 350 (44.7%) having skin phototype (SPT) I/II, 350 (44.7%) having SPT III/IV, and 83 (10.6%) having SPT V/VI. A total of 93 patients (11.9%) were receiving systemic treatment. At baseline, mean (SD) PGA was 2.7 (0.8) and DLQI was 12.2 (7.2). At week 12, 129 patients (32.8%) receiving home-based phototherapy and 100 patients (25.6%) receiving office-based phototherapy achieved clear/almost clear skin, and 206 (52.4%) and 131 (33.6%) achieved DLQI of 5 or lower, respectively. Home-based phototherapy was noninferior to office-based phototherapy for PGA and DLQI in the overall population and across all SPTs. Home-based phototherapy, compared to office-based phototherapy, was associated with better treatment adherence (202 patients [51.4%] vs 62 patients [15.9%]; P < .001), lower burden of indirect costs to patients, and more episodes of persistent erythema (466 of 7957 treatments [5.9%] vs 46 of 3934 treatments [1.2%]; P < .001). Both treatments were well tolerated with no discontinuations due to adverse events. Conclusions and Relevance In this randomized clinical trial, home-based phototherapy was as effective as office-based phototherapy for plaque or guttate psoriasis in everyday clinical practice and had less burden to patients. Trial Registration ClinicalTrials.gov Identifier: NCT03726489

One of the most popular topics in sustainable chemistry has been the creation of new eco-friendly solvents. Deep eutectic solvents (DES) have established themselves as accessible and affordable substitutes for...

Hypomagnesemia can occasionally present with severe neurological deficiencies, and it is usually attributed to an underlying renal and/or gastrointestinal pathology. Rarely, patients may present with neurological symptoms in the absence of an obvious cause. Our case highlights the importance of considering hypomagnesemia as a primary cause of those presenting with severe neurological deficits in an intensive care unit setting, as well as the significance of conducting a thorough social and medical history on these patients to elucidate their underlying causes. We discuss the case of a 48-year-old Caucasian male who acutely presented with seizures, tremors, visual hallucinations, diplopia, personality changes, and ataxia with recurring severely low magnesium (0.4 mg/dL) at times in the absence of renal, gastrointestinal, hormonal, infectious, or autoimmune pathology.