PROBLEM:: There is increased focus on supporting medical students’ transitions to internships to improve basic knowledge, efficiency and quality of care. Providing pre-residency education may help improve knowledge, clinical skills, and confidence. INTERVENTION:: A 2-day preparatory course for OB/Gyn-matched MS4s reviewed topics in the OB/Gyn ACGME Milestone 1 curriculum. The course used lectures, videos, and “hands-on” skills workshops. CONTEXT:: OB/Gyn-matched MS4s were invited to attend. Students took the APGO Prep for Res knowledge test (scored as percent correct) and completed a survey assessing confidence in Milestone 1 topics (Likert scale, 1=strongly disagree, 5=strongly agree) before and after the course. Students were sent a follow-up survey two months into internship assessing how the course impacted skills and inviting feedback. OUTCOME/LESSONS LEARNED:: Nine students attended. All 9 completed the pre-test, 7 the post-test, and 8 completed both surveys. The average test score before the course was 73%, and after 79% (p=0.24). No student had lower knowledge score after the course. Average confidence skills were 3.03 before and 4.47 after (p<0.05). Confidence improved most for these skills: applying fetal scalp electrode, repairing a perineal laceration, c-section steps. The least improvement noted for knot tying/suturing, and managing common outpatient gynecologic problems. Post-course confidence was highest for interpreting FHR, managing postpartum hemorrhage and repairing perineal lacerations, and lowest for biopsy skills and labor management. Interns reported the course to be “very helpful” to their transition. Suggestions for the future include: induction of labor, pre-eclampsia, hysteroscopy, contraceptive implant certification, and including students entering family medicine.

This paper investigates the impact of social media movements on shareholders' wealth. The #WhoMadeMyClothes Twitter campaign is an annual social media movement that emerged after the collapse of the Rana Plaza, a building in Bangladesh that housed five garment factories, in April 2013. The global campaign serves as a remembrance day for the factory victims and gives social media users an outlet to address ethical concerns towards apparel retail companies that were buyers of the Rana Plaza factories. My research investigates how this Twitter campaign, in specially April 2015, impacted the stock returns of the companies involved in the Rana Plaza collapse. My analysis is based on 180 publicly traded, global apparel and retail firms. I find an overall negative stock market reaction towards the US firms, regardless of their relationship to the factories, when aggregating over the all active campaign days. However, when pooling firms from all represented countries, I find that only firms involved in the collapse experienced significant negative returns. These firms are also more likely to experience negative returns after the campaign day, compared to the other firms that were not involved in the collapse. On a global perspective, shareholders may have punished firms that had significant ties to the collapse during and after the campaign day. Isolating US firms, a spillover effect might explain the negative returns for apparel and retail firms in general, regardless of their relation to the collapse

Objectives/hypothesis

Unilateral ML is a commonly performed surgery for dysphonia secondary to glottic insufficiency. The safety of this procedure performed in the outpatient setting has not been extensively examined. The purpose of the study was to assess the safety of outpatient unilateral ML in adults and determine the incidence and timing of postoperative complications across two tertiary-care academic medical centers.

Study design

Retrospective chart review, METHODS: A review of patients undergoing unilateral ML at two tertiary-care academic centers from 2011 to 2017 was performed. Patients undergoing bilateral medialization laryngoplasty, revision surgery, or those undergoing additional laryngeal framework procedures including arytenoid adduction were excluded. Patient demographics, operative details, and perioperative and postoperative complications were recorded. Comparisons were made between those individuals who underwent inpatient versus outpatient ML.

Results

One hundred three total procedures met inclusion criteria. Fifty-seven were performed as outpatient procedures, and 46 individuals were observed for at least 23 hours following surgery. Silastic or Gore-Tex implants were used in all but two surgeries. There were no postoperative complications in either setting, including hematoma, dyspnea, wound infections or seromas.

Conclusions

The incidence of adverse events during and immediately following unilateral ML is very low. Patients can be discharged safely the day of surgery without geographic restrictions.

Level of evidence

4 Laryngoscope, 129:1647-1649, 2019.

Research has shown mixed results regarding the association between women's postpartum depression and mother-infant interactions, suggesting that a woman's unique experience and context may moderate how depression shapes these interactions. We examined the extent to which a woman's comorbid anxiety, her exposure to adversity, and infant characteristics moderate the relationship between depressive symptoms of women and interactions with their infants at 6 (n = 647) and 12 months (n = 346) postpartum. The methods included standardized coding of mother-infant interactions and structural regression modeling. The results at 6 months of infant age indicated that infant male sex and infant negative affectivity were risk factors for mothers' depression being associated with less optimal interactions. At 12 months of infant age, two moderators appeared to buffer the influence of depression: a woman's history of trauma and infant preterm birth (≤37 weeks gestation). The results reinforce the salience of infant characteristics in the relationship between maternal depression and mother-infant interactions. The findings also suggest that experiences of trauma may offer opportunities for psychological growth that foster constructive management of depression's potential effect on mother-infant interactions. Further research is needed to clarify the underlying processes and mechanisms that explain the influence of these moderators. The ultimate goals are to reduce the risk of suboptimal interactions and reinforce healthy dyadic relations.

A February 3, 2023 train derailment and subsequent burn released hazardous chemicals into East Palestine, Ohio. One potential exposure was polychlorinated dibenzo-p-dioxins, dibenzofurans, and coplanar polychlorinated biphenyls (cPCBs), collectively referred to as dioxins. Many studies have linked dioxins to numerous health effects. A pilot study was conducted July 17-18, 2023 to assess residents serum dioxin levels. Eighteen persons who were White, nonsmokers with a mean age of 55, and 56% female, provided serum for analysis. Measurement of 20 dioxins, furans, and cPCBs congeners was conducted using gas chromatography, isotope dilution, and high-resolution mass spectrometry. A toxic equivalency (TEQ) value for each participant was calculated by multiplying the reported concentration of each congener by its toxic equivalency factor and summing the results. TEQs were compared to 2011-2012 National Health and Nutrition Examination Survey (NHANES) data by race/ethnicity, sex, and age group. All participants had serum TEQ values either below or within the range of NHANES values. Mean TEQ values were lower in younger age groups; we observed no sex-specific differences. These pilot data demonstrate that although dioxins may have formed during the derailment, exposures to participants did not increase their TEQ values compared with 2011-2012 NHANES.

Background

In previous clinical trials, antiangiogenic therapies such as bevacizumab did not show efficacy in patients with newly diagnosed glioblastoma (GBM). This may be a result of the heterogeneity of GBM, which has a variety of imaging-based phenotypes and gene expression patterns. In this study, we sought to identify a phenotypic subtype of GBM patients who have distinct tumor-image features and molecular activities and who may benefit from antiangiogenic therapies.

Methods

Quantitative image features characterizing subregions of tumors and the whole tumor were extracted from preoperative and pretherapy perfusion magnetic resonance (MR) images of 117 GBM patients in 2 independent cohorts. Unsupervised consensus clustering was performed to identify robust clusters of GBM in each cohort. Cox survival and gene set enrichment analyses were conducted to characterize the clinical significance and molecular pathway activities of the clusters. The differential treatment efficacy of antiangiogenic therapy between the clusters was evaluated.

Results

A subgroup of patients with elevated perfusion features was identified and was significantly associated with poor patient survival after accounting for other clinical covariates (P values <.01; hazard ratios > 3) consistently found in both cohorts. Angiogenesis and hypoxia pathways were enriched in this subgroup of patients, suggesting the potential efficacy of antiangiogenic therapy. Patients of the angiogenic subgroups pooled from both cohorts, who had chemotherapy information available, had significantly longer survival when treated with antiangiogenic therapy (log-rank P=.022).

Conclusions

Our findings suggest that an angiogenic subtype of GBM patients may benefit from antiangiogenic therapy with improved overall survival.

Genomic and transcriptomic analysis has furthered our understanding of many tumors. Yet, thyroid cancer management is largely guided by staging and histology, with few molecular prognostic and treatment biomarkers. Here, we utilize a large cohort of 251 patients with 312 samples from two tertiary medical centers and perform DNA/RNA sequencing, spatial transcriptomics, and multiplex immunofluorescence to identify biomarkers of aggressive thyroid malignancy. We identify high-risk mutations and discover a unique molecular signature of aggressive disease, the Molecular Aggression and Prediction (MAP) score, which provides improved prognostication over high-risk mutations alone. The MAP score is enriched for genes involved in epithelial de-differentiation, cellular division, and the tumor microenvironment. The MAP score also identifies aggressive tumors with lymphocyte-rich stroma that may benefit from immunotherapy. Future clinical profiling of the stromal microenvironment of thyroid cancer could improve prognostication, inform immunotherapy, and support development of novel therapeutics for thyroid cancer and other stroma-rich tumors.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.