Supplementary Questions Research Articles

Opportunities for More Tailored Approaches to Genotoxicity Testing and Carcinogenicity Strategy for Oligonucleotide Therapeutics: Outcome of an Industry Survey.

The Oligonucleotide Nonclinical Working Group (WG) of the European Federation of Pharmaceutical Industries and Associations conducted an industry survey to understand current practices and regulatory expectations for genotoxicity and carcinogenicity assessment of oligonucleotide therapeutics (ONTs), along with historical genotoxicity testing results. The survey, involving 29 pharmaceutical and biotechnology companies, revealed a consistent absence of genotoxicity across a diverse range of oligonucleotide classes and chemistries, consistent with previous observations. Despite the lack of genotoxicity, companies continue to follow standard testing guidelines, with only limited divergence. The survey data support the view that well-established ONT modifications can be considered "precedented," in terms of negligible genotoxic risk. As such, further testing of new ONT candidates containing only precedented modifications is unwarranted, when defined criteria are met. Further, we propose a pathway for novel ONT chemical modifications to achieve precedented status. The survey results also indicate that alternative strategies for carcinogenicity assessment (e.g., single-species testing) can be accepted by regulatory agencies under certain circumstances. Overall, the survey findings underscore the need for a more tailored approach to the nonclinical safety assessment of ONTs, and the WG proposes development of supplementary questions for International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use S2(R1) guidance to reflect this broad industry experience.

Impact of endometriosis on the quality of sexual life of women of reproductive age in Poland

Aim. The aim of this study is to demonstrate the impact of endometriosis on the quality of sexual life of women in Poland, through a comparative analysis of a population of healthy women and those struggling with the condition. Methods. The study was conducted using the validated FSFI questionnaire and the author’s supplementary questions. Information about the survey was made available on social networks and groups for women with endometriosis, as well as to healthy women constituting a control group. The CAWI technique was used in the study. The survey consisted of questions divided into mod- ules: metric data, having endometriosis and previous treatment, sexuality before and after possible treatment, and for healthy women - current assessment of the quality of sexual life. Results. Endometriosis negatively affects the quality of sexual life of women of reproductive age in Poland. Decreased quality of sexual life occurring in women with endometriosis indicates the presence of clinically significant sexual dysfunctions. Dyspareunia (a type of sexual dysfunction that manifests itself as pain during intercourse (Lew-Starowicz, Lew-Starowicz, & Skrzypulec-Plinta, 2020)) is signifi- cantly more common in women with endometriosis than in healthy women in Poland. 69 percentage points more women indicate the presence of dyspareunia when suffering from endometriosis compared to healthy women. Treatment reduces pain symptoms in women suffering from endometriosis. 24 per- centage points more women show no symptoms of dyspareunia after treatment, compared to women before treatment. The presence of endometriosis does not significantly affect women’s sense of sexual at- tractiveness. Women with endometriosis, despite the presence of pain, engage in sexual activity as often as healthy women. Treatment of endometriosis, both pharmacological and surgical, increases the quality of sexual life of women of reproductive age in Poland.

Prevalence of Painful Temporomandibular Disorder Symptoms Among Professional and Student Musicians: An Online Survey.

Within the fields of medicine and music, increasing attention is given to evidence indicating music performance being an occupational risk factor for temporo-mandibular disorders (TMD). Assessment of self-reported painful TMD symptoms among student and professional musicians. Using Survey Monkey software, the German version of the 'TMD-Pain-Screener' was distributed electronically to professional and student musicians in Europe. Supplementary questions addressed age, gender, daily playtime, instrument type and type of professional practice. Results are presented as median [interquartile range]. The TMD-pain-screener was completed by 492 participants. Among them, 96 (19.5%) reported painful TMD (Pain_pos) and 396 did not experience pain (80.5%, Pain_neg). Pain_pos participants were significantly younger (Pain_pos: 34 years [26; 46], Pain_neg: 44 years [30; 56], p = 0.0003), had less work experience (Pain_pos: 15.5 years [6; 25], Pain_neg: 20 years [10; 32], p = 0.009), had fewer performances/year (Pain_pos: 20/year [10; 45], Pain_neg: 30/year [12; 53.5], p = 0.03) and were predominantly female (OR = 3.22 [1.87, 5.74], p < 0.0001). Comparisons among music performance types revealed no statistical significance in the overall test (p = 0.13), although 'keyboard' (OR = 2.99 [0.58, 30.12]), 'upper string' (OR = 2.31 [0.43, 23.63]) and 'singer' (OR = 2.14 [0.44, 20.75]) stood out compared to the reference group 'lower string' (OR 1.00). Organ players formed the largest group and showed a comparatively low prevalence of Pain_pos (16%), compared to other keyboard instruments (Pain_pos 30.2%). Prevalence of TMD pain was highest among young inexperienced female musicians. Playing keyboard instruments (other than organ) or upper strings instruments were frequently associated with painful TMD screening. An improved understanding of causes, implementation of preventive measures, professional guidance and a biopsychosocial health care perspective may decrease this occupational risk while maintaining the health benefits of music.

Levels and outcomes of 12-step participation among sexual and gender minority subgroups

IntroductionSexual minority (e.g., bisexual, gay, lesbian, queer) and gender minority (e.g., transgender, non-binary, gender expansive) individuals (SGMI) experience higher rates of alcohol and other substance use disorders than their heterosexual and cisgender (i.e., non-transgender) counterparts. 12-Step programs are currently the most common source of support for alcohol and other substance use-related problems in the United States. Little is known about rates and levels of participation and outcomes of SGMI in 12-Step programs. Examining SGMI with a lifetime alcohol or other substance use disorder, this study aims to: 1) describe lifetime attendance rates (any vs. none) and levels of participation (number of program activities) in 12-Step groups among SGMI overall and compare rates of attendance and levels of participation across sexual and gender minority identities and 2) determine how lifetime level of participation in 12-Step programs relates to past-year alcohol and other substance use outcomes. MethodsWe used data collected through The PRIDE Study, a national, large-scale, longitudinal health study of adult SGMI, administering supplemental questions to assess alcohol and other substance use disorders and 12-step participation. Zero-Inflated Negative Binomial models (N = 1353) run with sexual and gender identities as predictors of lifetime 12-step attendance (yes/no) and level of 12-Step participation determine if greater levels of 12-Step participation were associated with lower levels of past-year Alcohol and Substance Use Disorder (AUD & SUD) symptoms. The study ran models for those with lifetime AUD (n = 1074) and SUD (n = 659) separately. ResultsParticipants who engaged in greater levels of 12-Step participation had lower levels of past-year AUD and SUD symptoms. Gay and queer respondents with AUD were more likely and lesbian respondents with SUD were less likely than other participants to have ever participated in 12-Step programs. All other associations between sexual/gender identities and 12-Step participation disappeared when age was added to the model. ConclusionsThis study provides preliminary evidence that 12-Step participation may be an effective resource for reducing AUD and SUD symptoms among SGMI. Younger SGMI and SGMI holding sexual/gender identities other than gay and queer may require additional support to initiate participation in 12-Step programs.

A Study of Patient Concerns in the Modern Therapeutic Era of Inflammatory Bowel Disease.

Patient concerns and preferences are important in the management of inflammatory bowel disease (IBD: Crohn's disease [CD], ulcerative colitis). In the absence of contemporary data, we aimed to determine patient concerns and preferences and establish if there are demographic or disease-related differences. We surveyed patients with IBD at Massachusetts General Hospital between July and September 2023. The Rating Form of Inflammatory Bowel Disease Patient Concerns (RFIPC) and a set of supplemental questions rated on a visual analog scale (0-100mm) were administered to patients and compared by age, disease type, sex, and surgery status. Additionally, a survey administered to treating providers gathered insight into the difference between patient and provider perceptions of concerns. A total of 350 patients and 30 providers completed the survey. The mean age was 47 years; 50% were female, 49% had CD, and 80% were on advanced IBD therapy. Effects of medication (median = 54), energy level (median = 53), and having an ostomy bag (median = 52) were rated highest by patients. Older patients rated most disease complication and treatment-related concerns similar to younger adults; those aged 35-59 years had the greatest level of concern for most questions. Sex, disease activity, and prior surgical history also impacted patients' concerns. Providers perceived patients' worries as higher than those rated by patients themselves. A shared decision-making model targeting the achievement of disease remission and addressing concerns rated highly by patients is important to meet the goal of care for patients with IBD.

Assessing self-reported prolonged grief disorder with "clinical checks": A proof of principle study.

Psychological assessment is commonly conducted using either self-report measures or clinical interviews; the former are quick and easy to administer, and the latter are more time-consuming and require training. Self-report measures have been criticized for producing higher estimates of symptom and disorder presence relative to clinical interviews, with the assumption being that self-report measures are prone to Type 1 error. Here, we introduce the use of "clinical checks" within an existing self-report measure. These are brief supplementary questions intended to clarify and confirm initial responses, similar to what occurs in a clinical interview. Clinical checks were developed for the items of the International Grief Questionnaire (IGQ), a self-report measure of ICD-11 prolonged grief disorder (PGD). Data were collected as part of a community survey of mental health in Ukraine. Individual symptom endorsements for the IGQ significantly decreased with the use of clinical checks, and the percentage of the sample that met the ICD-11 diagnostic requirements for PGD fell from 13.6% to 10.2%, representing a 24.8% reduction in cases. The value and potential broader application of clinical checks are discussed.

Development of a Simple Patient-reported Outcome Measurement for Terminally Ill Cancer Patients Receiving Home-based Palliative Care.

To develop a patient-reported outcome measurement for terminally ill cancer patients (PROMs-TCP) receiving home-based palliative care, which is valid, reliable and easy to use by patients or caregivers to indicate urgent needs for assistance from the care team. Three-step approach consisting of literature review, focus groups and questionnaire testing. 169 terminally ill cancer patients who received palliative care at Cancer hospital, tertiary-care hospital and university school of medicine in Thailand. The PROMs-TCP comprised five key questions with a total score of 10 and one supplemental question. PROMs-TCP was tested for content validity, internal consistency and inter-rater reliability, criterion validity, discriminant validity and sensitivity to change. The palliative care outcome scale (POS) was used as an indicator. PROMs-TCP consists of five questions. The item-level content validity index (CVI) ranged from 0.8 to 1, and the scale-level CVI was 0.97. PROMs-TCP correlated well with POS scores, with correlations ranging from -0.7 to -0.8. Internal consistency was good (Cronbach's α = 0.85), while inter-rater agreements between patients and caregivers and between patients and nurses were moderate to good (Cohen's weighted k = 0.69-0.87). The tool could reasonably discriminate terrible days from good days for the patients. It was also responsive to change scores, with effect size scores of 0.36. PROMs-TCP could be used for daily health status assessment of home-based patients with terminally ill cancer, supporting the provision of palliative care in primary care settings.

BT37 Can patients with psoriasis and eczema support their self-management by being involved in care decision making?

Abstract Eczema and psoriasis are often associated with psychological and metabolic comorbidities. They usually require long-term medical care. Currently, no intervention is available to regularly assess such patients’ needs and comorbidities and support their involvement in decision making and self-management. The objective of this study was to explore the acceptability and potential of a self-developed questionnaire (study tool) in addressing the needs, comorbidities and feedback of patients with psoriasis and eczema, to support their involvement in decision making and self-management of their chronic conditions. A mixed-methods study was conducted that included a postal survey on adult male and female patients with psoriasis and eczema. The study tool contained the Dermatology Life Quality Index and seven supplementary open-ended questions to capture patients’ views, feedback, comorbidities, coping status and needs. The survey was followed by semistructured face-to-face interviews with a sample of the patients who had participated in the survey. The final study involved sharing the research findings along with a prototype of the proposed online version of the study tool with a group of healthcare professionals. Of the 114 patients who participated in the postal survey, 108 (94.7%) expressed physical, metabolic and psychological comorbidities. Stress was identified as the dominant disease-triggering factor in 72 (63.2%) participants. Thirty-three (28.9%) participants reported that they could not cope with their chronic illness. Eighteen (15.8%) had anxiety, and 12 (10.5%) had depression and suicidal thoughts. Twenty-nine (25.4%) participants addressed their needs for support at home, and 16 (14.0%) of them asked for support at work. In the interviews, all the participants (22, 100%) welcomed the use of the study tool on a regular basis to support their needs and feedback. Nineteen (86%) of them preferred using an online version of the tool (portal system) as a convenient way of remote and interactive communication with the healthcare provider, particularly during the worsening of their skin condition. In the final study, the healthcare experts agreed that the proposed online version of the study tool (portal) would be a convenient platform for such patients to address their unmet needs, comorbidities and feedback. It can be designed to provide access to supportive services including links to patient information on skin diseases, local mental health services, patient forums and other relevant support groups and charities. In conclusion, the study tool has the potential to regularly engage and assess patients’ unmet needs, comorbidities and feedback. All the interviewees welcomed regular use of the study tool. The use of an online version of the tool can have the potential to fill important gaps in patient self-management and in health service improvement.

Correlation between hepatitis B virus infection and adverse pregnancy outcomes-a systematic review and meta-analysis

Objective: To systematically evaluate the effect of hepatitis B virus (HBV) infection on the risk of adverse pregnancy outcomes. Methods: We searched PubMed, Embase, Web of Science, and Cochrane databases. Two researchers independently screened the literature, extracted data, and evaluated the quality. Meta-analysis and cumulative meta-analysis were performed using R4.4.1 software. Fixed/random effects models were used to analyze heterogeneous and non-heterogeneous results. Heterogeneous modifiers were identified by subgroup analysis. Funnel plots and Peters' test were used to analyze potential publication bias. Results: A total of 48 studies involving 92 836 HBsAg-positive pregnant women and 7 123 292 HBsAg-negative pregnant women were included. In terms of adverse pregnancy outcomes, HBV infection was significantly correlated with the occurrence of gestational diabetes mellitus [odds ratio (OR)=1.34, 95% confidence interval (CI): 1.17-1.53] and intrahepatic cholestasis (OR=2.48, 95%CI: 1.88-3.29), with statistically significant differences. In terms of adverse neonatal outcomes, HBV infection was significantly correlated with the occurrence of neonatal asphyxia (OR=1.49, 95%CI: 1.20-1.86) and preterm birth (OR=1.22, 95%CI: 1.12-1.33), with statistically significant differences. In addition, the cumulative meta-analysis demonstrated that the risk of gestational diabetes mellitus and preterm birth both tended to be stable in pregnant women with HBV infection following 2009 and 2010, respectively. The supplementary questions answered for repeated studies had limited significance. Conclusion: Intrahepatic cholestasis, gestational diabetes mellitus, neonatal asphyxia, and preterm birth occurrence risk can be raised with HBV infection in pregnant women.

Reliability of a short diet and vitamin supplement questionnaire for retrospective collection of maternal nutrient intake

BackgroundGestational nutrition can protect against adverse neurodevelopmental outcomes. ObjectivesWe developed a short tool for collecting maternal nutritional intake during pregnancy to facilitate research in this area and compared its retrospective use to prospectively-collected food frequency questionnaires (FFQ). MethodsMaternal nutritional intake was retrospectively assessed using three versions (full interview, full self-administered online, and shortened interview) of the Early Life Exposure Assessment Tool (ELEAT) among participants of the MARBLES pregnancy cohort study of younger siblings of autistic children. Retrospective responses were compared with responses to supplement questions and the validated 2005 Block FFQ prospectively collected in MARBLES during pregnancies 2–7 years prior. ELEAT nutrient values were calculated using reported food intake frequencies and nutrient values from the USDA nutrient database. Correlations between retrospectively- and prospectively-reported intake were evaluated using Kappa coefficients, Youden's J, and Spearman Rank Correlation Coefficients (rs). ResultsMARBLES FFQ dietary intakes were compared among 54 women who completed the ELEAT full form including 12 online, and among 23 who completed the ELEAT short form. Correlations across most foods were fair to moderate. Most ELEAT quantified nutrient values were moderately correlated (rs = 0.3–0.6) with those on the Block FFQ. Supplement questions in both MARBLES and the ELEAT were completed by 114 women. Kappas were moderate for whether or not supplements were taken, but modest for timing. Correlations varied by version and child diagnosis or concerns, and were higher when mothers completed the ELEAT when their child was 4 years old or younger. ConclusionsWith recall up to several years, ELEAT dietary and supplement module responses were modestly to moderately reliable and produced nutrient values moderately correlated with prospectively-collected measures. The ELEAT dietary and vitamin supplements modules can be used to rank participants in terms of intake of several nutrients relevant for neurodevelopment.

Vision-related quality of life, photoaversion, and optical rehabilitation in achromatopsia.

We report on photoaversion and patient-reported quality of life in Danish patients with achromatopsia and evaluate the best optical rehabilitation. Our results contribute to the evaluation of outcome measures in therapy trials and aid in providing the best optical rehabilitation for patients with this and clinically similar conditions. This study aimed to investigate the vision-related quality of life, the impact of photoaversion on daily living, and the best optical rehabilitation in a cohort of achromatopsia patients, including testing the hypothesis that red light-attenuating filters are generally preferred. Patients with genetically verified achromatopsia were recruited. Investigations included the 25-item Visual Function Questionnaire and supplementary questions regarding photoaversion and visual aids. Patients were evaluated by a low vision optometrist and given the choice between different light-attenuating filters. First, two specially designed red and gray filters both transmitting 6% light, and then a pre-defined broader selection of filters. Best-corrected visual acuity and contrast sensitivity were measured without filters and with the two trial filters. Twenty-seven patients participated. Median 25-item Visual Function Questionnaire composite score was 73, with the lowest median score in the subscale near vision (58) and the highest in ocular pain (100). The majority of patients (88%) reported that light caused them discomfort, and 92% used aid(s) to reduce light. Ninety-six percent (26 of 27) preferred the gray filter to the red indoors; 74% (20 of 27) preferred the gray filter. Contrast sensitivity was significantly better with the gray filter compared with no filter (p=0.003) and the red filter (p=0.002). Our cohort has a relatively high vision-related quality of life compared with other inherited retinal diseases, but photoaversion has a large impact on visual function. Despite what could be expected from a theoretical point of view, red filters are not generally preferred.

Residing among the Departed: Exploring the Lived Experience of Individuals Living Within the Proximity of Cemeteries

This qualitative study is conducted to explore and understand the lived experiences of individuals living within the proximity of cemeteries in depth and to identify the individuals’ challenges and coping strategies to navigate the ongoing challenges associated with their proximity to cemeteries. The study adopted a phenomenological research design. The researchers employed snowballing techniques to carefully select a diverse group of fifteen participants for the study. The interview questions were unstructured and validated by respected experts in the field. The researchers have included supplementary probing questions to ensure the depth and richness of the data, which will only be used if necessary. All collected data was securely stored to safeguard confidentiality and privacy. The information was organized systematically, using transcribing, coding into themes by thematically analyzing, and categories that emerged from the interviews. This allowed for easier analysis and interpretation of the data. Living within the proximity of cemeteries uncovers a complex interplay of emotions, perspectives, and unique narratives that challenge conventional notions of individuals’ life and death. This study sheds light on the diverse ways individuals navigates their existence within this unconventional living environment, offering valuable insights into the individuals’ capacity to find meaning and connection even in the proximity of the departed. This research offers a comprehensive exploration of the lived experiences of individuals residing within cemeteries, contributing valuable insights to both academic discourse and practical applications in various fields.

Factors that influence the scope of practice of the chiropractic profession in Australia: a thematic analysis.

Scope of practice has been defined as the activities that an individual health care practitioner is allowed to undertake within a specific profession. The chiropractic profession in Australia does not currently have a documented scope of practice. Informed discussions around scope of practice are hampered by a paucity of literature in this area. Acknowledging this void in the literature, we chose to investigate the factors that influence scope of practice of the chiropractic profession. A knowledge of the factors will facilitate discussion on the topic and help the profession to work towards establishing a scope of practice.Aim The aim of this study was to identify the factors that influence scope of practice of chiropractic in Australia from the perspective of 4 stakeholder groups within the profession.Methods This study employed semi-structured, online-interviews. Open-ended questions, guided by a flexible interview protocol, and augmented by supplemental questions, probes and comments, were used to gather data on the research question. Data were analysed using reflexive thematic analysis.Results Six factors that influenced scope of practice of chiropractic were identified in this study: education, evidence (research-derived and practice-based), political influence, community expectations, entrepreneurial business models, and geographical location.Conclusion Knowledge of the factors that influence scope of practice of chiropractic in Australia is important for establishing a scope of practice for the profession. This knowledge is also of value to a range of stakeholders including patients, health care providers (within and outside the profession), professional associations, and policymakers.

Numbers of prenatal cell-free DNA screens performed: Results of a 2022 CAP exercise.

Determine current analytical methods and number of cell-free (cf) DNA prenatal screening tests performed for common trisomies. The College of American Pathologists 2022-B Noninvasive Prenatal Testing exercise was distributed in December 2022 to 93 participants in 22 countries. Supplemental questions included the number of tests performed in a recent month and the proportion of samples originating outside the United States (US). Eighty-three participants from three continents returned results; 74 (89%) were suitable for the analyses. Nine manufacturer/platform combinations were identified, most commonly Illumina/Nextseq (55%). The most common methodology was whole genome sequencing (76%). Annualized cfDNA tests were 2.80 million, with Asian, European and North American participants representing 10.6%, 6.5% and 82.9% of tests, respectively. When restricted to US in-country tests, the annualized rate was 2.18 million, with four of 20 participants testing 79.2%. Among 73 respondents, 63 (86%) were for-profit, eight (11%) were non-profit academic or government supported and the remaining two included hospital-based and private non-profit. Eighteen (25%) supported relevant academic training. In 2011, screening for common trisomies was based on serum/ultrasound markers with an estimated 2.96 million US pregnancies screened in 131 laboratories. In 2022, cfDNA-based screening was offered by 20 laboratories testing 2.18 million US pregnancies.

Returning to Work Following Hematopoietic Cell Transplantation: The Survivor's Perspective

While curing a patient's underlying disease is the primary goal of physicians performing hematopoietic cell transplantation (HCT), the ultimate objective is to provide patients with optimal post-HCT quality of life. For many survivors, this includes returning to work (RTW). We conducted a survey of 1- to 5-yr post-HCT survivors at our center to evaluate their perspective on facilitators and barriers to RTW as well as to gauge interest in potentially useful RTW support interventions. Survivors aged 18 to 65 yrs (n = 994) were sent an annual survey that included 36 supplementary questions about post-HCT RTW. Survey questions were selected from published national cancer survivor surveys and then modified specifically for HCT survivors. Three hundred forty-four (35%) survivors with a mean age of 53 yrs completed the survey, of whom 272 (79%) had worked prior to their diagnosis. Of those 272 patients, 145 (53%) were working currently and another 22 (8%) had attempted to go back to work following HCT but were not presently working. We found that having had an allogeneic versus autologous HCT (P = .006) was associated with a decreased likelihood of currently working, whereas frequent employer communication (>once a month) (P = .070) and having a more supportive employer (P = .036) were associated with a greater chance of currently working. Of survivors currently working, 45% reported that they had made one or more changes to their work schedule (e.g., flexible schedule or part-time work) or environment (e.g., work from home) upon RTW. Ninety-five percent of responders reported that they could have benefited from RTW support provided by the transplant center, but only 13% indicated that they had received it. Education on RTW challenges, information on disability benefits, and access to physical therapy were among the most requested support interventions. To improve post-HCT quality of life for survivors open to assistance, providers should address work status and goals, recognize barriers to successful return, and offer RTW support including working directly with employers. Allogeneic HCT survivors are particularly vulnerable to failing attempts to RTW and should be the target of retention interventions. A previously published manuscript on RTW guidance for providers of stem cell transplant patients endorsed by the American Society of Transplant and Cellular Therapy is available in Open Access and can be used as a tool to counsel and support these patients.

Medical Students' Knowledge, Attitudes Toward, and Identification of Adverse Childhood Experiences and Trauma-Informed Care.

Adverse childhood experiences (ACEs) are traumatic experiences that occur prior to age 18 years and can have a long-term impact on adult physical and mental health. Knowledge of ACEs, including the link between ACEs and health, and trauma-informed care (TIC), is essential for medical professionals to ensure respectful and compassionate care for those with a history of childhood adversity. This study examined medical students' knowledge, attitudes toward, and identification of ACEs and TIC to inform curricular efforts. Using a cross-sectional design, students were recruited from 2 medical schools, one allopathic (medical degree) and one osteopathic (doctor of osteopathic medicine degree) to complete an electronic needs assessment survey. The survey included a patient vignette to assess students' ability to identify ACEs as contributing factors to patient health. The students were blind to the full purpose of the study to obtain an objective measurement of their ability to identify ACEs as contributors to patient health. Additional questions targeting knowledge and attitudes of ACEs and TIC were devised from previously published surveys with supplemental study-designed questions. Two hundred forty students completed the survey. Results demonstrated variable ability to identify ACEs; strong general knowledge of ACEs, with less developed practical knowledge; and overall positive attitudes toward ACEs and TIC. No differences were found between the medical degree and doctor of osteopathic medicine degree, or year in program. Medical students would benefit from curricular efforts that help to increase knowledge of the link between ACEs and health, increase practical application of ACEs and TIC, and improve their ability to identify ACEs in clinical scenarios.

Understanding and overcoming students’ difficulties in interpreting graphs: insights from a racing car problem

The study investigates university students’ difficulties in interpreting graphs through the analysis of their responses to the modified PISA racing car problem. The impact of adding a distractor that is appealing to students and supplementary questions to enhance students’ graph understanding is explored. Eye-tracking technology was used to capture participants’ visual attention during the task. The findings highlight the challenges of treating graphs as pictures and the benefits of incorporating additional questions to improve students’ comprehension. The study emphasizes the need for instructional strategies that address intuitive reasoning and promote reflective thinking in graph interpretation.

Determining the connectivity of tribal communities to wastewater treatment facilities for use in environmental contamination and exposure assessments by wastewater-based surveillance.

Limited information is available on the connectivity of Tribal communities to wastewater treatment facilities (WWTFs). This is important for understanding current sanitation infrastructure which drives public health and community construction, knowledge of potential routes of exposure through lack of infrastructure and/or discharging facilities, and opportunities to assess community health through wastewater-based surveillance (WBS). The objective of this work was to assess current wastewater infrastructure for 574 Federally Recognized Indian Tribes (FRITs) in the United States (US) to determine the number and location of facilities on or adjacent to Tribal reservations and Off-Reservation Trust Lands, with the goal of determining the feasibility of employing wastewater-based surveillance within these communities and to identify areas with inadequate sanitation infrastructure. Here, we identified available National Pollutant Discharge Elimination System (NPDES) wastewater discharge permits in the Environmental Protection Agency's Environmental Compliance History Online database to assess proximity to and within spatial boundaries of Tribal lands. These data were coupled to race data and tribal spatial boundary information from the US Census Bureau. 94 FRITs have registered NPDES permits within Tribal boundaries including a total of 522 facilities. 210 of these are American Indian (AI)-serving (>50% AI) with the ability to reach 135,000 AI-people through the wastewater network to provide community health assessments via WBS. Of the remaining facilities, 153 predominantly serve non-Tribal populations raising concerns about infrastructure placement and indigenous sovereignty. 523 FRITs were identified as without permitted discharging WWTFs, which may suggest inadequate or alternative infrastructure. Here, multiple data sources including permit information from the Environmental Protection Agency's National Pollution Discharge Elimination System and US Census Bureau data were used to determine the number of wastewater treatment facilities on or adjacent to Tribal lands and how many community members were connected to those municipal systems. This information was used to assess which Tribal communities may be a viable option for wastewater public health surveillance techniques and were used to answer supplemental questions related to basic sanitation and environmental justice concerns.

Opioid Overdose Recognition: A Survey of Perceived Preparedness and Desire for Curricular Integration Among Current US Medical Students.

Opioid overdose deaths remain a major health issue in the United States (US). As future physicians, medical students must receive comprehensive training to recognize and manage opioid overdoses. This study aimed to highlight training gaps at the medical student level and understand students' attitudes toward patients with opioid use disorder (OUD). We assessed baseline knowledge of and attitudes toward the management of opioid overdoses and naloxone administration among medical students in the US. Two validated survey tools (Opioid Overdose Knowledge Scale and Opioid Overdose Attitude Scale) were administered to medical students training at accredited institutions along with supplemental questions measuring knowledge and attitudes towards opioid overdose management, naloxone administration, and prior training. The final sample had N = 73 participants from US medical schools with a mean age of 25.3 (range of 22-37): 72.6% of respondents were female. Although most respondents reported personal/professional experience with OUD before medical school, they expressed interest in additional training. Knowledge surrounding opioid overdoses increased insignificantly over the 4 years of medical school. However, there was a significant increase in both perceived competence in overdose recognition/management and in concerns about intervening from the first to fourth year of medical school. Female respondents had significantly lower perceived competence and readiness to intervene sub-scores than male counterparts; however, there was no significant difference in overall attitude and knowledge scores when stratified by sex. Incorporating opioid overdose prevention training (OOPT) into early medical education was favorable among respondents, who expressed an overwhelming interest in learning and supporting patients with OUD. Given the ongoing opioid crisis, medical students are ideally placed to identify and manage opioid overdoses. Medical students are ready to receive this training, thus strengthening the argument for OOPT integration into early medical student curricula.

Child Neurology and Neurodevelopmental Disabilities Program Directors’ Opinions on Preference Signaling in the 2023-2024 NRMP Match: A Survey

Changes in residency recruitment have significantly altered how programs and applicants evaluate each other including virtual interviews, discontinuation of the United States Medical Licensing Exam Step 2 Clinical Skills exam, and transition of United States Medical Licensing Exam Step 1 to pass-fail scoring. To improve program-applicant fit, the Electronic Residency Application Service introduced supplemental application features including geographic preference, program signaling, and the opportunity to highlight impactful and meaningful experiences. We sought to evaluate child neurology (CN) and neurodevelopmental disabilities (NDD) program director's (PD) opinions regarding these changes. A 10-question anonymous survey was sent to CN (n=75) and NDD (n=8) PDs. The questions centered on PDs' opinions regarding components of the supplemental application, having a standard application review period and in-person recruitment activities. Answer choices to the questions were all close-ended. Respondents could select questions to complete. Thirty-eight CN residency PDs (49%) and 4 NDD residency PDs (50%) responded to the survey. Among CN PDs, there was strong support for use of the supplemental application questions and for the use of 3 program signals per applicant. Most PDs supported a standardized application review period prior to programs sending interview offers; however, there was no consensus on the appropriate length of time. Nearly half agreed with virtual-only interviews, and 62% agreed with the option of in-person second-look visits. CN PDs generally support many of the recent or proposed changes to residency recruitment. The impact of these changes on recruitment will be a topic of future investigation.