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The University at Albany School of Public Health has offered a bachelor of science in public health (BSPH) degree for the past seven years. The final requirement of the BSPH degree is a capstone evidence-based public health class designed to cumulate the degree program. This capstone course is framed by identifying a public health problem and creating a literature review based on this problem. The issues are selected through collaboration between the students and instructors. Developmental and analytical tools necessary to complete the literature review are provided throughout the semester. By the end of the course students achieved the necessary competencies and skills to identify a public health problem, analyze information from peer-reviewed literature and synthesize the relationship between a health issue and its correlated outcome. Successes were measured through achievement of core BSPH competencies, quality of final paper and presentation, and qualitative data gleaned from end of semester self-reported student surveys.

To assess lay beliefs about self and brain, we probed people’s opinions about the central self, in relation to morality, willful control, and brain relevance. In study 1, 172 participants compared the central self to the peripheral self. The central self, construed at this abstract level, was seen as more brain-based than the peripheral self, less changeable through willful control, and yet more indicative of moral character. In study 2, 210 participants described 18 specific personality traits on 6 dimensions: centrality to self, moral relevance, willful control, brain dependence, temporal stability, and desirability. Consistent with Study 1, centrality to the self, construed at this more concrete level, was positively correlated to brain dependence. Centrality to the self was also correlated to desirability and temporal stability, but not to morality or willful control. We discuss differences and similarities between abstract (Study 1) and concrete (Study 2) levels of construal of the central self, and conclude that in contemporary American society people readily embrace the brain as the underlying substrate of who they truly are.

Genetic polymorphism can be maintained over time by negative frequency-dependent (FD) selection induced by Rock-paper-scissors (RPS) social systems. RPS games produce cyclic dynamics, and have been suggested to exist in lizards, insects, isopods, plants, and bacteria. Sexual selection is predicted to accentuate the survival of the future progeny during negative FD survival selection. More specifically, females are predicted to select mates that produce progeny genotypes that exhibit highest survival during survival selection imposed by adult males. However, no empirical evidence demonstrates the existence of FD sexual selection with respect to fitness payoffs of genetic polymorphisms. Here we tested this prediction using the common lizard Zootoca vivipara, a species with three male color morphs (orange, white, yellow) that exhibit morph frequency cycles. In a first step we tested the congruence of the morph frequency change with the predicted change in three independent populations, differing in male color morph frequency and state of the FD morph cycle. Thereafter we ran standardized sexual selection assays in which we excluded alternative mechanisms that potentially induce negative FD selection, and we quantified inter-sexual behavior. The patterns of sexual selection and the observed behavior were in line with context-dependent female mate choice and male behavior played a minor role. Moreover, the strength of the sexual selection was within the magnitude of selection required to produce the observed 3-4-year and 6-8 year morph frequency cycles at low and high altitudes, respectively. In summary, the study provides the first experimental evidence that underpins the crucial assumption of the RPS games suggested to exist in lizards, insects, isopods, and plants; namely, that sexual selection produces negative-FD selection. This indicates that sexual selection, in our study exert by females, might be a crucial driver of the maintenance of genetic polymorphisms.

Human cytomegalovirus (HCMV), a clinically important β-herpesvirus, is a master of evasion and modulation of the host immune system, including inhibition of a number of dendritic cell (DC) functions. DCs play a central role in co-ordination of the immune response against pathogens and any disturbance of DC functions can result in a cascade effect on a range of immune cells. Recently, the HCMV gene UL111A, which encodes viral homologs of human interleukin 10, has been identified as a strong suppressor of a number of DC functions. In this mini review, we focus on HCMV encoded viral IL-10 mediated inhibitory effects on DCs and implications for the development of an effective HCMV vaccine.

We discuss recent progress in the development of cognitive ontologies and summarize three challenges in the coordinated development and application of these resources. Challenge 1 is to adopt a standardized definition for cognitive processes. We describe three possibilities and recommend one that is consistent with the standard view in cognitive and biomedical sciences. Challenge 2 is harmonization. Gaps and conflicts in representation must be resolved so that these resources can be combined for mark-up and interpretation of multi-modal data. Finally, Challenge 3 is to test the utility of these resources for large-scale annotation of data, search and query, and knowledge discovery and integration. As term definitions are tested and revised, harmonization should enable coordinated updates across ontologies. However, the true test of these definitions will be in their community-wide adoption which will test whether they support valid inferences about psychological and neuroscientific data.

To assist cattle producers transition from microsatellite (MS) to single nucleotide polymorphism (SNP) genotyping for parental verification we previously devised an effective and inexpensive method to impute MS alleles from SNP haplotypes. While the reported method was verified with only a limited data set (N=479) from Brown Swiss, Guernsey, Holstein, and Jersey cattle, some of the MS-SNP haplotype associations were concordant across these phylogenetically diverse breeds. This implied that some haplotypes predate modern breed formation and remain in strong linkage disequilibrium. To expand the utility of MS allele imputation across breeds, MS and SNP data from more than 8,000 animals representing 39 breeds (Bos taurus and B. indicus) were used to predict 9,410 SNP haplotypes, incorporating an average of 73 SNPs per haplotype, for which alleles for 12 MS markers could be accurately be imputed. Approximately 25% of the MS-SNP haplotypes were present in multiple breeds (N=2 to 36 breeds). These shared haplotypes allowed for MS imputation in breeds that were not represented in the reference population with only a small increase in Mendelian inheritance inconsistancies. Our reported reference haplotypes can be used for any cattle breed and the reported methods can be applied to any species to aid the transition from MS to SNP genetic markers. While ~91% of the animals with imputed alleles for 12 MS markers had

Impaired decision-making in aging can directly impact factors (financial security, quality of healthcare) that are critical to maintaining quality of life and independence at advanced ages. Naturalistic rodent models mimic human aging in other cognitive domains, and afford the opportunity to parse the effects of age on discrete aspects of decision-making in a manner relatively uncontaminated by experiential factors. Young adult (5-7 mo.) and aged (23-25 mo.) male F344 rats were trained on a probability discounting task in which they made discrete-trial choices between a small certain reward (1 food pellet) and a large but uncertain reward (2 food pellets with varying probabilities of delivery ranging from 100% to 0%). Young rats chose the large reward when it was associated with a high probability of delivery and shifted to the smaller but certain reward as probability of the large reward decreased. As a group, aged rats performed comparably to young, but there was significantly greater variance among aged rats. One subgroup of aged rats showed strong preference for the small certain reward. This preference was maintained under conditions in which large reward delivery was certain, suggesting decreased sensitivity to reward magnitude. In contrast, another subgroup of aged rats showed strong preference for the large reward at low probabilities of delivery. Interestingly, this subgroup also showed elevated preference for probabilistic rewards when reward magnitudes were equalized. Previous findings using this same aged study population described strongly attenuated discounting of delayed rewards with age, together suggesting that a subgroup of aged rats may have deficits associated with accounting for costs (i.e., delay, probability). These deficits in cost-accounting were dissociable from the age-related differences in sensitivity to reward magnitude, suggesting that aging influences multiple, distinct neural mechanisms that can impact cost-benefit decision making.

Study Objectives: Maternal depressive symptoms (MDS) affect most women during the first year postpartum. Mothers provide most of the nighttime care for infants, so studying the relationship between MDS and infant sleep location (ISL) is highly relevant to understanding maternal mental health over the first year of life and beyond. Infant sleep is studied by anthropologists, health care providers, and psychologists, with very little communication across disciplines. This review aimed to determine whether there is a predictive relationship between MDS and ISL., Methods: This systematic review searched 6 databases with terms related to maternal mood and ISL. Final analysis included 14 published studies, analyzed with narrative synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies directly compared ISL and MDS., Results: Five studies showed no relationship between ISL and MDS, and 1 study found bedsharing reduced MDS. Five studies found cosleeping was related to higher MDS although directionality is mixed or missing, and 3 studies found an association at some ages or for some populations only. Examining studies according to type of infant sleep assessment, study design, age of infant, or breastfeeding status failed to detect consistent patterns., Conclusions: A variety of study designs, types and definitions of variable measures, sample recruitment, and study outcomes prevent detection of a consistent relationship between MDS and ISL. We explore reasons for the elusive nature of a relationship and make recommendations for future research in MDS and ISL, including crossdisciplinary collaborations., Citation: Barry ES, D'Souza L. Maternal depressive symptoms and mother-infant cosleeping (including room sharing and bedsharing): a systematic review. J Clin Sleep Med . 2024;20(9):1517-1533., (© 2024 American Academy of Sleep Medicine.)

Leadership development is a challenge for all health care systems. Military Medicine has unique challenges with increased frequency of physician turnover and more junior leaders taking on positions of leadership earlier in their careers. Military medical corps officers are also challenged with leading in clinical, academic, and operational settings. Effective leadership within the Military Healthcare System requires an intentional and ongoing leadership development process across the careers of military medical corps officers. This article describes the leadership lifecycle of military medical corps officers, highlighting existing leadership development opportunities and providing an example of a leadership lifecycle from junior staff to senior executive for other organizations. The article concludes with specific recommendations that will allow military medicine to continue to strengthen the leadership skills of its officers to meet ever growing challenges., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Physicians must be leaders more than ever with innumerable challenges. Despite this need, there is a paucity of consistent leadership development (LD) from medical student to staff physician. Military medicine has additional challenges-working within a large health care organization, constant turnover, working in a variety of contexts-that make the need for LD even more pressing. The purpose of this paper is to describe the LD life cycle for military undergraduate and graduate medical education (UME and GME), providing examples for other organizations while identifying steps to meet the future needs in military medicine. The Health Professions Scholarship Program produces over 75% of graduates for military medicine each year. Yet, since learners are dispersed throughout civilian medical schools any LD results in a heterogeneous experience. Uniformed Services University has a 4-year LD program required for all students as well as other opportunities for leadership professional growth. Military GME programs are unique, requiring a military unique curriculum to prepare graduates for their initial assignments. Military unique curriculum vary, but include clinical topics relevant to military medicine as well as leadership. There is no Military Healthcare System-wide leadership curriculum used by everyone at this time. Based on these UME and GME approaches to LD, there have been multiple lessons learned formed on the authors experience and published literature: learners do not typically see themselves as leaders; learners want applicable curriculum with less lecturing and more application and discussion; programs are often siloed from one another and sharing curriculum content does not typically occur; no one-size-fits-all model. On the basis of the lessons learned and the current state of UME and GME leadership education, there are 5 recommendations to enhance UME and GME leadership programs: (1) develop a Health Professions Scholarship Program Leadership Curriculum; (2) develop a MHS GME Leadership Curriculum; (3) integrate UME and GME Leadership Curricula; (4) develop faculty to teach leadership; and (5) conduct research on UME and GME in military and share lessons learned. We suggest a roadmap for strengthening LD within military medicine and civilian institutions., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Purpose: Effective interprofessional health care team (IHT) members collaborate to reduce medical errors, use resources effectively, and improve patient outcomes, making interprofessional collaboration imperative. Because physicians are often designated as the positional leaders of IHTs, understanding their perspectives on collaboration within IHTs could help to mitigate the disconnects between what is suggested in theory and what is happening in practice. This study aimed to explore leader-follower dynamics within medical teams that are commonly working in clinical care contexts., Method: Using a constructivist approach, the authors conducted 12 individual, semistructured interviews from November 2022 to September 2023 with attending physicians who have led IHTs in perioperative (i.e., preoperative clinic, operating room, postoperative and recovery unit) or emergency department settings. The transcripts were analyzed from December 2022 to December 2023 using inductive thematic analysis., Results: Three themes explained the physician perceptions of IHT leadership-followership dynamics: (1) physicians are comfortable sharing leadership intraprofessionally, (2) the clinical culture and environment constrain interprofessional followership and shared leadership, and (3) hierarchical models hold true even while active followers are appreciated, when appropriate., Conclusions: The data in this study suggest that, in perioperative and emergency department settings, shared leadership largely may not occur interprofessionally but occurs intraprofessionally. Participants suggested that the clinical culture and environment (i.e., legal concerns, hierarchical assumption, patient care ownership responsibilities) constrained interprofessional followership and shared leadership. On the basis of the study's findings and how they align with previous research, future research into interprofessional collaboration and followership roles should focus on what factors enable and constrain active followership and shared leadership. Such collaboration can only be achieved when active followership and shared leadership are allowed and promoted. These findings and others suggest that not all contexts are enabling such types of interprofessional collaboration due to legal concerns, hierarchical traditions, and patient ownership considerations., (Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Objective: A state-of-the-art (SotA) literature review-a type of narrative review- was conducted to answer: What historical developments led to current conceptualisations of followership in interprofessional healthcare teams (IHTs)?, Design: Working from a constructivist orientation, SotA literature reviews generate a chronological overview of how knowledge evolved and presents this summary in three parts: (1) this is where we are now, (2) this is how we got here and (3) this is where we should go next. Using the SotA six-stage methodology, a total of 48 articles focused on followership in IHTs were used in this study., Results: Articles about followership within IHTs first appeared in 1993. Until 2011, followership was framed as leader-centric; leaders used their position to influence followers to uphold their dictums. This perspective was challenged when scholars outside of healthcare emphasised the importance of team members for achieving goals, rejecting a myopic focus on physicians as leaders. Today, followership is an important focus of IHT research but two contradictory views are present: (1) followers are described as active team members in IHTs where shared leadership models prevail and (2) conceptually and practically, old ways of thinking about followership (ie, followers are passive team members) still occur. This incongruity has generated a variable set of qualities associated with good followership., Conclusions: Leadership and followership are closely linked concepts. For leaders and followers in today's IHTs to flourish, the focus must be on followers being active members of the team instead of passive members. Since theories are increasingly encouraging distributed leadership, shared leadership and/or situational leadership, then we must understand the followership work that all team members need to harness. We need to be cognizant of team dynamics that work within different contexts and use leadership and followership conceptualisations that are congruent with those contexts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The COVID-19 pandemic presented unprecedented challenges for leaders in healthcare requiring decision-making and crisis response that can often be tricky without the right level of trust. Trust is fostered and facilitated with emotional intelligence (EI); thus, a critical examination of medical leaders' reflections was essential to understand how leaders perceived their leadership responses during the initial response to COVID-19. This exploratory study used an EI lens to investigate leaders' perceptions of their decision-making during COVID-19., Methods: A purposeful sample of seven leaders in medicine who experienced leading during COVID were invited to participate in semi-structured interviews., Results: Four themes around leadership response during the uncertain times of the COVID-19 were identified. The themes included communication, interprofessional collaboration including decision-making and strategic planning, internal and external awareness, and finally, trust and psychological safety., Conclusions: Incorporating EI competencies into crisis leadership education for healthcare professionals could enhance medical leaders' preparedness to adapt, collaborate and communicate effectively in a crisis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Assessing learner performance is a primary focus within simulation-based education in order to prepare students with the knowledge and skills they will need going forward in their careers. In order to properly conduct these assessments of learner performance, faculty must be adequately trained on the scenario, expectations, assessment measures, and debriefing. During Operation Bushmaster, a five-day "deployment" for learners, faculty assess students as they rotate through different leadership roles. The faculty development includes online and in-person training that provides them with an understanding of the scenario; what learners know; the framework used at USU to guide curriculum, development, and assessment; how to assess learners; and how to provide feedback to learners. Research has examined the value of receiving assessment and feedback from a student perspective, but the impact of being the assessor and giving feedback has not been researched from the faculty point of view. The purpose of this study, therefore, was to examine the impact of assessing students in simulation scenarios on faculty's own development as an educator and leader., Materials and Methods: Through a phenomenological qualitative study, we explored participants' lived experiences as faculty at Operation Bushmaster. Eighteen faculty from a variety of medical specialties and military ranks volunteered to participate. Participants were interviewed in-person using a semi-structured interview. Analyses included individually reading through each transcript; then individually coding and taking notes of terms and phrases used by participants; codes were compiled and organized into categories, which became the themes of our study., Results: The interviews demonstrated the following themes in which providers who serve as faculty of Operation Bushmaster believe they gain from the experience: (1) The experience helps to reground their own thinking; (2) acting as faculty during simulation-based education helps them remain up-to-date on necessary skills; and (3) working with students helps faculty continually develop as an educator and a leader., Conclusions: This work describes how even when faculty are brought in for learner assessment, they are taking away lessons and experiences that aid in their own development as an educator as well as a leader. Acting as an assessing faculty for students may allow faculty to reground their own thinking, remain up-to-date on necessary skills, and continually develop their skills as an educator and leader. These findings suggest that some faculty involved in simulation events may also gain knowledge, skills, and experiences that can help with their own development even when the focus is on learners., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Abstract: Sport psychology is the scientific study and application of psychological principles to enhance performance and well-being in sport, exercise, and physical activity. It has numerous applications to sports medicine, as psychological factors are associated with sport injury risk, recovery, successful return to play, and overall health. This article addresses how sport psychology is important to sports medicine and what applied sport psychologists do. We discuss several psychological principles and practices relevant to individual performance and well-being, including goal setting, communication, arousal and performance, imagery/mental rehearsal, attention management, managing psychological distress, and behavioral health. We also discuss principles and practices of sport psychology relevant to team performance, including stages of team development, goal setting, communication, arousal and performance, and behavioral health. Sport psychology and applied sport psychology practitioners can be valued assets to sports medicine teams in supporting individual and team performance and injury recovery., (Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Introduction: The physician's role in the healthcare delivery system extends beyond patient care to include numerous critical leadership roles in healthcare. In addition to treating patients, physicians manage multidisciplinary teams and influence policies to optimise public health. Yet, leadership education is not currently emphasised as part of undergraduate medical education. The purpose of this pilot study was to survey US allopathic medical schools about their current leadership curricula for medical students, including aspects that promote or inhibit effective curricular implementation., Methods: A survey was developed and administered to representatives at US allopathic medical schools regarding the presence and nature of leadership curricula for medical students currently in place, as well as barriers to effective implementation., Results: A total of 41 of 144 medical schools (28%) responded to the survey. Of the schools that responded, 25 schools reported the presence of a leadership curriculum. Primary competencies and goals were similar among these institutions, but the structure of the curriculum and how it is being implemented varied. The study did not identify consistent methods of assessing student leadership competencies. Themes of improved communication and integration within the curriculum emerged as actions promoting successful implementation. Financial restraints and buy-in among stakeholder groups (eg, faculty, staff and students) were mentioned most frequently as barriers to the effective implementation of leadership curricula., Conclusions: Although leadership education within undergraduate medical education is emphasised by a variety of groups, including the Association of American Medical Colleges, medical schools do not appear to universally address this topic. The Liaison Committee on Medical Education, the primary accrediting body for medical schools, does not currently require leadership education as a core topic for accreditation. To provide effective education on leadership to medical students, administrative bodies could improve their support for this topic by considering the factors identified that both hinder and promote implementation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Leadership development is a cornerstone aspect of military medical education. Operation Bushmaster, a medical field practicum (MFP) conducted by the USU, tests fourth-year medical students' clinical skills and leadership acumen in an operational environment. No studies have examined students' perceptions of their own leadership development during this MFP. Therefore, this study explored leadership development from the students' perspectives., Materials and Methods: Using a qualitative phenomenological design, we analyzed the reflection papers of 166 military medical students who participated in Operation Bushmaster during the fall of 2021. Our research team coded and categorized the data. Once defined, these categories served as the themes in this study., Results: Three central themes were expressed: (1) the importance of direct and decisive communication, (2) unit cohesion and interpersonal relationships enhance the team's ability to adapt, and (3) followership quality determines leadership outcomes. The students' leadership ability was maximized by established relationships within their unit and well-practiced communication, and a decreased propensity for followership negatively affected leadership. Overall, Operation Bushmaster increased students' appreciation of the importance of leadership development and overall enhanced their leadership outlook as a future military medical officer., Conclusions: This study provided an introspective vantage from military medical students pertaining to their own leadership development, as participants described how the challenging environment of a military MFP challenged them to hone and develop their leadership skills. As a result, the participants gained a greater appreciation of continued leadership development and realization of their future roles and responsibilities within the military health care system., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Team building is a real-world necessity in military and civilian health care settings. Interprofessional education (IPE) is therefore an essential component of health care education. At the Uniformed Services University, there are continued, deliberate attempts for IPE to occur to successfully prepare students to work together and adapt to ever-changing contexts. Although past quantitative research has analyzed interprofessional collaboration among military medical students, this study explores the interprofessional experiences of family nurse practitioner (FNP) students during a military medical field practicum., Materials and Methods: This study was reviewed by the Uniformed Services University Human Research Protections Program Office (Protocol DBS.2021.257). We used the qualitative transcendental phenomenological approach to design our study. We analyzed the reflection papers of 20 family nurse practitioner students who participated in Operation Bushmaster in order to explore their interprofessional experiences. Our research team coded and categorized the data, developing textural and structural descriptions of these categories, which served as the results of our study., Results: We present the study's three key findings that students expressed and include perspectives from their viewpoints to illustrate each theme. The three themes related to IPE are (1) quality of integration determines perception of experience, (2) challenges inspire continued growth, and (3) increased self-awareness of one's own strengths., Conclusions: It is important for educators and leaders to find ways to allow for positive team integration and cohesion so that students do not feel overwhelmed by their perceived lack of knowledge or experience. Educators can use that perception to motivate a growth mindset so that they can continually seek out ways to improve and grow. Additionally, educators can prepare students with adequate knowledge to ensure that each team member meets mission success. Finally, to continually develop, students need to have awareness of their own strengths as well as areas for growth to enhance their own performance as well as that of the military interprofessional health care teams., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Physical and psychological well-being play a critical role in the academic and professional development of medical students and can alter the trajectory of a student's quality of personal and professional life. Military medical students, given their dual role as officer and student, experience unique stressors and issues that may play a role in their future intentions to continue military service, as well as practice medicine. As such, this study explores well-being across the 4 years of medical school at Uniformed Services University (USU) and how well-being relates to a student's likelihood to continue serving in the military and practicing medicine., Methods: In September 2019, 678 USU medical students were invited to complete a survey consisting of three sections-the Medical Student Well-being Index (MSWBI), a single-item burnout measure, and six questions regarding their likelihood of staying in the military and medical practice. Survey responses were analyzed using descriptive statistics, analysis of variance (ANOVA), and contingency table analysis. Additionally, thematic analysis was conducted on open-ended responses included as part of the likelihood questions., Results: Our MSWBI and burnout scores suggest that the overall state of well-being among medical students at USU is comparable to other studies of the medical student population. ANOVA revealed class differences among the four cohorts, highlighted by improved well-being scores as students transitioned from clerkships to their fourth-year curriculum. Fewer clinical students (MS3s and MS4s), compared to pre-clerkship students, indicated a desire to stay in the military. In contrast, a higher percentage of clinical students seemed to "reconsider" their medical career choice compared to their pre-clerkship student counterparts. "Medicine-oriented" likelihood questions were associated with four unique MSWBI items, whereas "military-oriented" likelihood questions were associated with one unique MSWBI item., Conclusion: The present study found that the overall state of well-being in USU medical students is satisfactory, but opportunities for improvement exist. Medical student well-being seemed to have a stronger association with medicine-oriented likelihood items than with military-oriented likelihood items. To obtain and refine best practices for strengthening engagement and commitment, future research should examine if and how military and medical contexts converge and diverge throughout training. This may enhance the medical school and training experience and, ultimately, reinforce, or strengthen, the desire and commitment to practice and serve in military medicine., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

The Long Term Career Outcome Study is a central program of research in the Center for Health Professions Education at the Uniformed Services University. The overarching goal of Long Term Career Outcome Study is to perform evidence-based evaluations before, during, and after medical school, and as such, it represents a form of educational epidemiology. In this essay, we highlighted the findings of the investigations published in this special issue. These investigations span from "before" medical school matriculation to "during" medical school and "after" learners go on to graduate training and practice. Furthermore, we discuss how this scholarship might shed light on improving the educational practices at the Uniformed Services University and potentially elsewhere. We hope that this work demonstrates how research can enhance medical education processes and connect research, policy, and practice., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Developing physicians as leaders has gained attention across the United States. Undergraduate medical education (UME) and graduate medical education (GME) leader development programs have increased. During postgraduate years (PGY), graduates bring their leadership education to the bedside; however, associations between leader performance in medical school and GME is largely unknown. It is important to find experiences that can assess leader performance that may be useful to predict future performance. The purpose of this study was to determine if (1) there is a correlation between leader performance during the fourth year of medical school versus leader performance in PGY1 and 3, and (2) leader performance during the fourth year of medical school is associated with military leadership performance in PGY1 and 3s while taking previous academic performance markers into account., Methods: This study examined overall leader performance of learners (classes of 2016-2018) during the fourth year of medical school and their graduate leader performance post-medical school. Leader performance was assessed by faculty during a medical field practicum (UME leader performance) and graduate leader performance was assessed by program directors at the end of PGY1 (N = 297; 58.3%) and 3 (N = 142; 28.1%). Pearson correlation analysis examined relationships among UME leader performance and between the PGY leader performance items. In addition, stepwise multiple linear regression analyses were conducted to examine the relationship between leader performance at the end of medical school with military leadership performance in PGY1 and 3, while taking into account the academic performance markers., Results: Pearson correlation analyses revealed that the UME leader performance was correlated with 3 of 10 variables at PGY1, and was correlated at PGY3 with 10 out of 10 variables. Results of the stepwise multiple linear regression analysis indicated that leader performance during the fourth year of medical school explained an additional 3.5% of the variance of PGY1 leader performance after controlling for the previous academic performance markers (MCAT total score, USMLE Step 1 score and Step 2 CK score). In contrast, leader performance during the fourth year of medical school alone accounted for an additional 10.9% of the variance of PGY3 leader performance above and beyond the set of academic performance markers. Overall, UME leader performance has more predictive power in PGY leader performance than the MCAT or USMLE Step exams., Conclusions: The findings of this study indicate that a positive relationship exists between leader performance at the end of medical school and leader performance in PGY1 and 3 years of residency. These correlations were stronger in PGY3 compared to PGY1. During PGY1, learners may be more focused on being a physician and an effective team member compared to PGY3 where they have a deeper understanding of their roles and responsibilities and can take on more leadership roles. Additionally, this study also found that MCAT and USMLE Step exams performance was not predictive of PGY1 or PGY3 leader performance. These findings provide evidence of the power of continued leader development in UME and beyond., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Purpose/objectives: Veterans Affairs (VA) case managers assist and advocate for veterans navigating VA and civilian health care systems. However, government reports indicate repeated dissatisfaction with veteran care coordination. Several case management publications suggest that VA case managers lead, as well as manage, but do not indicate exactly what this means. Few published articles address leadership, specifically, among VA case managers.The VA All Employee Survey (AES) is an annual survey of VA employees, including case managers, to gather information about their attitudes toward workplace characteristics, relationships, and leadership. The present study utilized a conceptual Leader-Follower Framework (LF2) to assess questions on the annual VA AES to determine which leadership elements are addressed, which leadership elements are not addressed, and whether there are any leadership elements that do not fit within the LF2., Primary Practice Setting: Case managers work in a variety of clinical settings including more than1,400 facilities throughout the United States. VA case managers advocate for safe, effective, and equitable patient care according to their scope of practice., Findings/conclusions: All eight leadership elements from the LF2-Character, Competence, Context, Communication, Personal, Interpersonal, Team, and Organizational-were represented among the AES questions, and no leadership elements outside of the framework were identified. However, the leadership elements were unevenly represented within the AES questions, with communication and personal elements occurring frequently whereas context and team were underrepresented., Implications for Case Management Practice: These results indicate the LF2 can be used to evaluate the responses of VA employees, including those providing case management, and to address questions of interest related to leadership and may be considered in the development of future case management surveys., Competing Interests: The authors have no conflicts of interests. No sources of funding were disclosed by any authors. The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose/objectives: Case management in Veterans Affairs (VA) depends on leadership skills such as effective communication, excellent resource management, self-governance, patient advocacy, and a distinctly professional attitude. VA registered nurses (RNs) and social workers (SWs) also provide case management services, a role and service, which is pivotal to veteran satisfaction and effective health care coordination.The leader-follower framework (LF2) was used to assess and compare the responses of RNs, SWs, and case managers (CMs) on the annual VA All Employee Survey (AES) to provide insight regarding VA case management performance, which has influenced veteran satisfaction., Primary Practice Setting: VA CMs work in a variety of clinical settings, which, in recent years, includes the use of telehealth modalities because of COVID-19. VA CMs remain flexible working in environments where and when veterans require their services while promoting safe, effective, and equitable health care services., Findings/conclusions: RNs and SWs indicated greater agreement and satisfaction scores in 2019 compared with 2018 on questions related to the leadership element of character and questions regarding mutual respect between VA senior leaders and the respondents. In contrast, RNs and SWs indicated less agreement and satisfaction scores on questions related to the leadership elements of competence, context, communication, personal, interpersonal, team, organizational, and greater burnout in 2019 than in 2018. RN response scores in 2018 and 2019 were greater and burnout scores were less than SWs. Additionally, the one-way analysis of variance indicated no difference for RNs and SWs who were performing the duties of a CM., Implications for Case Management Practice: The responses of RNs indicated greater satisfaction and less burnout than SWs and were consistent whether RNs and SWs were in case management roles or not. These are important findings and concerning trends warranting further discussion and research., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Change leadership is essential for individuals, teams, and organizations. It focuses on leadership to initiate, support, and adapt to modifications, alterations, and new situations. Many perspectives, models, theories, and steps have been offered to optimize change. Some approaches emphasize organizational change, whereas others focus on responses of individuals to change. With regard to leading change in health care, it is important to enhance well-being among health-care professionals and patients and to improve organizational and system best practices. To achieve optimal health-care changes, this article draws from several business-focused approaches to change leadership, psychological models, and the authors' Leader-Follower Framework (LF2)., (Published by Elsevier Inc.)

Introduction: Researchers and practitioners rely on literature reviews to synthesize large bodies of knowledge. Many types of literature reviews have been developed, each targeting a specific purpose. However, these syntheses are hampered if the review type's paradigmatic roots, methods, and markers of rigor are only vaguely understood. One literature review type whose methodology has yet to be elucidated is the state-of-the-art (SotA) review. If medical educators are to harness SotA reviews to generate knowledge syntheses, we must understand and articulate the paradigmatic roots of, and methods for, conducting SotA reviews., Methods: We reviewed 940 articles published between 2014-2021 labeled as SotA reviews. We (a) identified all SotA methods-related resources, (b) examined the foundational principles and techniques underpinning the reviews, and (c) combined our findings to inductively analyze and articulate the philosophical foundations, process steps, and markers of rigor., Results: In the 940 articles reviewed, nearly all manuscripts (98%) lacked citations for how to conduct a SotA review. The term "state of the art" was used in 4 different ways. Analysis revealed that SotA articles are grounded in relativism and subjectivism., Discussion: This article provides a 6-step approach for conducting SotA reviews. SotA reviews offer an interpretive synthesis that describes: This is where we are now. This is how we got here. This is where we could be going. This chronologically rooted narrative synthesis provides a methodology for reviewing large bodies of literature to explore why and how our current knowledge has developed and to offer new research directions., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Human infants spend most of their time sleeping, but over the first few years of life their sleep becomes regulated to coincide more closely with adult sleep (Galland et al., 2012; Paavonen et al., 2020). Evidence shows that co-sleeping played a role in the evolution of infant sleep regulation, as it is part of an ancient behavioral complex representing the biopsychosocial microenvironment in which human infants co-evolved with their mothers through millions of years of human history (Ball, 2003; McKenna 1986, 1990). This paper is a conceptual, interdisciplinary, integration of the literature on mother-infant co-sleeping and other mother-infant co-regulatory processes from an evolutionary (biological) perspective, using complexity science. Viewing the mother-infant dyad as a "complex adaptive system" (CAS) shows how the CAS fits assumptions of regulatory processes and reveals the role of the CAS in the ontogeny of mother-infant co-regulation of physiological (thermoregulation, breathing, circadian rhythm coordination, nighttime synchrony, and heart rate variability) and socioemotional (attachment and cortisol activity) development., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Bedsharing is controversial for nighttime caregiving in the U.S. today, as in most of the West. However, from the standpoint of evolutionary pediatrics, anthropology, and cultural psychology, bedsharing is not controversial at all, representing the context for human infant evolution and conferring a host of physiological benefits to the infant as well as the mother. In an effort to understand the rise in Western bedsharing in recent decades (and following Ball, 2002; McKenna & Volpe, 2007), Salm Ward (2015) systematically reviewed the literature on mother-infant bedsharing and identified ten reasons why mothers choose to bedshare: (1) breastfeeding, (2) comforting for mother or infant, (3) better/more sleep for infant or parent, (4) monitoring, (5) bonding/ attachment, (6) environmental reasons, (7) crying, (8) cultural or familial traditions, (9) disagree with danger, and (10) maternal instinct. The current paper offers the "review behind the review," highlighting the scientific evidence behind the reasons mothers give for their decision to bedshare, focusing on how mothers' decisions about infant sleep location influence infant behavior and development., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: The U.S. Military has long been aware of the vital role effective leaders play in high-functioning teams. Recently, attention has also been paid to the role of followers in team success. However, despite these investigations, the leader-follower dynamic in military interprofessional health care teams (MIHTs) has yet to be studied. Although interprofessional health care teams have become a topic of increasing importance in the civilian literature, investigations of MIHTs have yet to inform that body of work. To address this gap, our research team set out to study MIHTs, specifically focusing on the ways in which team leaders and followers collaborate in MIHTs. We asked what qualities of leadership and followership support MIHT collaboration?, Materials and Methods: This study was conducted using semi-structured interviews within a grounded theory methodology. Participants were purposefully sampled, representing military health care professionals who had experience working within or leading one or many MIHTs. Thirty interviews were conducted with participants representing a broad range of military health care providers and health care specialties (i.e., 11 different health professions), ranks (i.e., officers and enlisted military members), and branches of the U.S. Military (i.e., Army, Navy, and Air Force). Data were collected and analyzed in iterative cycles until thematic saturation was achieved. The subsets of data for leadership and followership were further analyzed separately, and the overlap and alignment across these two datasets were analyzed., Results: The insights and themes developed for leadership and followership had significant overlap. Therefore, we present the study's key findings following the two central themes that participants expressed, and we include the perspectives from both leader and follower viewpoints to illustrate each premise. These themes are as follows: (1) a unique collaborative dynamic emerges when team members commit to a shared mission and a shared sense of responsibility to achieve that mission; and (2) embracing and encouraging both leader and follower roles can benefit MIHT collaboration., Conclusions: This study focused on ways in which team leaders and followers on MIHTs collaborate. Findings focused on qualities of leadership and followership that support MIHT's collaboration and found that MIHTs have a commitment to a shared mission and a shared sense of responsibility to achieve that mission. From this foundational position of collective responsibility to achieve a common goal, MIHTs develop ways of collaborating that enable leaders and followers to excel to include (1) understanding your role and the roles of others; (2) mutual respect; (3) flexibility; and (4) emotional safety. The study data suggest that MIHT members work along a continuum of leadership and followership, which may shift at any moment. Military interprofessional health care teams members are advised to be adaptive to these shared roles and contextual changes. We recommend that all members of MIHTs acquire leadership and followership training to enhance team performance., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This article was migrated. The article was marked as recommended. Modern healthcare involves teams composed of educators, learners, healthcare providers, patients, patients' significant others and families, healthcare administrators, and information sources. Principles of social psychology are relevant to interactions among team members when learning and performing professional duties; communicating to build trust, commitment, and teamwork; and collaborating among members of the healthcare team. This paper briefly discusses several classic principles of social psychology and how they apply to healthcare teams and medical education. Understanding and applying these principles will help healthcare providers optimize performance and interactions with colleagues, learners, and patients. It is important to incorporate study and practice of these principles into medical education and professional development., (Copyright: © 2021 Grunberg NE et al.)

Traumatic brain injury (TBI) is known to increase the susceptibility to various age-related neurodegenerative disorders such as Alzheimer's disease (AD) and Parkinson's disease (PD). Although the role of damaged mitochondrial electron transport chain (ETC) in the progression of AD and PD has been identified, its relationship with altered expression of neurodegenerative proteins has not been examined before. This study aimed to investigate 1) how TBI could affect mitochondrial ETC and neurodegeneration in rat brain regions related to behavioral alteration, and 2) if administration of the key mitochondrial substrate pyruvate can improve the outcome of mild TBI (mTBI). In a rat lateral fluid percussion injury model of mTBI, sodium pyruvate in sterile distilled water (1 g/kg body weight) was administered orally daily for 7 days. The protein expression of mitochondrial ETC enzymes, and neurodegeneration proteins in the hippocampus and cerebral cortex and was assessed on Day 7. The hippocampal and cortical expressions of ETC complex I, III, IV, V were significantly and variably impaired following mTBI. Pyruvate treatment altered ETC complex expression, reduced the nitrosyl stress and the MBP expression in the injured brain area, but increased the expression of the glial fibrillary acidic protein (GFAP) and Tau proteins. Pyruvate after mTBI augmented the Rotarod performance but decreased the horizontal and vertical open field locomotion activities and worsened neurobehavioural severity score, indicating a debilitating therapeutic effect on the acute phase of mTBI. These results suggest bidirectional neuroprotective and neurodegenerative modulating effects of pyruvate on TBI-induced alteration in mitochondrial activity and motor behavior. Pyruvate could potentially stimulate the proliferation of astrogliosis, and lactate acidosis, and caution should be exercised when used as a therapy in the acute phase of mTBI. More effective interventions targeted at multiple mechanisms are needed for the prevention and treatment of TBI-induced long-term neurodegeneration., Competing Interests: Conflicts of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (copyright: © 2021 Ariyannur et al.)

Infants evolved in the context of close contact (including co-sleeping). Evolutionary context is rarely considered in psychological infant sleep research, and Western sleep researchers make assumptions about what optimal "normal" infant sleep is and how to achieve early, deep, infant sleep consolidation and avoid infant sleep problems. However, an evolutionary and anthropological view of infant sleep as species-typical recognizes that human evolution likely prepared the infant brain for optimal development within its evolutionary context - co-sleeping. Thus, "normal" infant sleep, sleep consolidation, and sleep problems should all be understood within the framework of co-sleeping infants, not the historically new-phenomenon of solitary-sleeping infants. Much work needs to be done in order to understand "normal" infant sleep as species-typical and how adaptive infants are to environments that stray from their evolutionary norm.

The human need for sleep is universal and unquestioned; however, humans vary in their sleep needs according to age, individual differences, as well as cultural and social norms and practices. Therefore, what is "normal" in infant sleep and the development of sleep architecture in humans is highly dependent on biological and sociocultural variables as well as socially constructed assumptions about what infant sleep "should" look like. This paper uses a multidisciplinary approach to review papers from fields including pediatrics, anthropology, psychology, medicine, and sociology to understand "normal" infant sleep. Because human culture and behavioral practice changes much more quickly than evolved human biology, and because human evolutionary history occurred in the context of breastfeeding and cosleeping, new work in the field of infant sleep architecture development would benefit from a multidisciplinary approach. To come to a consensus about what is "normal" infant sleep, researchers must agree on underlying basic assumptions of infant sleep from which to ask question and interpret findings.

Healthcare providers must acquire extensive knowledge and skills to help promote physical health, behavioral health, and wellness; prevent and treat illnesses and injuries; encourage and guide rehabilitation; counsel and assist with decisions relevant to health, life, and death. In addition, 21st Century healthcare providers must develop leadership knowledge and skills to optimize their interactions and effectiveness with healthcare teams, patients, and patients' significant others. Emotional intelligence is recognized as an essential component of leader education and development. It is important to optimally educate and develop healthcare providers with regard to components of emotional intelligence: self-awareness, self-regulation, social-awareness, and social regulation. Self-awareness focuses on understanding one's own behaviors, cognitions, motivations, and emotions. Self-regulation emphasizes self-control and adaptability to various situations and settings. Social awareness includes understanding others' behaviors, cognitions, motivations, and emotions. Social regulation draws upon the other components of emotional intelligence in order to optimize collaboration and cooperation and attainment of mutual goals with other people. The present paper presents four principles of Social Psychology that are relevant to developing emotionally intelligent healthcare leaders: Field Theory, Informal Social Communication, Social Comparison, and Cognitive Dissonance. Although these principles are well-established and have received extensive attention, analysis, and discussion in the academic social psychology literature, they are rarely mentioned in the emotional intelligence or leadership literatures. Therefore, each of these principles is briefly described in the present paper followed by an explanation of how each principle relates to the development of emotional intelligence in general and to emotionally intelligent healthcare leaders in particular., (Copyright © 2020 Grunberg, McManigle and Barry.)

Introduction: Any implicit and explicit biases that exist may alter our interpretation of people and events. Within the context of assessment, it is important to determine if biases exist and to decrease any existing biases, especially when rating student performance to provide meaningful, fair, and useful input. The purpose of this study was to determine if the experience and gender of faculty members contribute to their ratings of students in a military medical field practicum. This information is important for fair ratings of students. Three research questions were addressed: Were there differences between new versus experienced faculty raters? Were there differences in assessments provided by female and male faculty members? Did gender of faculty raters impact ratings of female and male students?., Materials and Methods: This study examined trained faculty evaluators' ratings of three cohorts of medical students during 2015-2017 during a medical field practicum. Female (n = 80) and male (n = 161) faculty and female (n = 158) and male (n = 311) students were included. Within this dataset, there were 469 students and 241 faculty resulting in 5,599 ratings for each of six outcome variables that relate to overall leader performance, leader competence, and leader communication. Descriptive statistics were computed for all variables for the first four observations of each student. Descriptive analyses were performed for evaluator experience status and gender differences by each of the six variables. A multivariate analyses of variance was performed to examine whether there were differences between gender of faculty and gender of students., Results: Descriptive analyses of the experience status of faculty revealed no significant differences between means on any of the rating elements. Descriptive analyses of faculty gender revealed no significant differences between female and male faculty ratings of the students. The overall MANOVA analyses found no statistically significant difference between female and male students on the combined dependent variables of leader performance for any of the four observations., Conclusions: The study revealed that there were no differences in ratings of student leader performance based on faculty experience. In addition, there were no differences in ratings of student leader performance based on faculty gender., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To describe the clinical presentation and early clinical course of a sample of deployed U.S. military service members following concussion, underscoring the impact of pre-existing migraine and other co-occurring conditions. It is important to obtain a comprehensive clinical history to identify evidence of underlying migraine and other health conditions which may contribute to an individual's presenting symptoms influencing early management and outcomes following concussion. Early outcome measures assessed include headache treatment response and fitness for return to duty., Background: Acute concussion is reported to result in an array of somatic, cognitive, and behavioral symptoms. It is well established that these symptoms are not specific for concussion and may result from exacerbation of pre-existing or underlying medical conditions and factors. Although most symptoms attributable to concussion resolve within days to weeks, there is evidence that persistent symptoms beyond that specific recovery time may be attributable to factors other than concussion. Military populations are at risk for a number of recognized co-morbid and co-occurring conditions, as well as special situational and psychosocial factors which may influence symptoms and clinical course following concussion. In addition, combat-related concussion frequently occurs in the setting of a blast or military vehicle accidents thus causing concurrent injuries where musculoskeletal injuries may contribute to the clinical presentation. The resultant acute stress reaction, secondary to the traumatic experience associated with concussion, may also cause or aggravate underlying psychological co-morbidities that may influence presenting symptoms. Prior studies identified co-morbidities associated with chronic post-concussive syndrome, which we find are also present during the early phase following deployment-related concussion, thereby influencing presentation and impacting recovery. This retrospective chart review was intended to demonstrate the presence and potential impact of co-morbid and co-occurring conditions contributing to symptoms following concussion, especially migraine due to its high prevalence among post-traumatic headaches., Methods: Retrospective chart review was performed by the treating neurologist of 40 service members following concussion in the deployed environment. Clinical symptoms and co-morbid and co-occurring conditions including evidence of pre-existing migraine identified during comprehensive neurologic evaluations were collected. Both pre-deployment/pre-traumatic and post-traumatic headache features supporting migraine and early instituted headache management and treatment response are described. Rates of return to duty in this sample were also tabulated., Results: Headaches were the most frequently reported acute symptom following concussion in this deployed service member population (38/40 patients [98%]), followed by insomnia, tinnitus, impaired concentration, nausea, dizziness, anxiety, impaired balance, depression, and hearing loss. Co-occurring acute injuries, acute stress reaction, and recent onset medication overuse were the most frequent co-occurring conditions identified by the treating neurologist as potentially contributing to the service member's presentation. Chronic co-morbidities identified included chronic headache, anxiety/depression, insomnia, and post-traumatic stress disorder. Service members with 3 or more identified co-morbidities or co-occurring conditions were more likely to require evacuation from theater. Pre-deployment headaches were reported by 25/40 [63%] service members, with 5/40 [12.5%] reporting known prior personal history of migraine. Of those reporting pre-deployment headaches, 21/25 [84%] described migraine features and/or triggers, though most [(15/25) 60%] reported as infrequent. Daily post-traumatic headaches were frequent (26/38 [68%]) and associated with typical migraine features and/or triggers. Of those treated with triptans (16/40 patient [42%]), most (12/16 patient [75%]) showed positive treatment response., Conclusions: Concussion in the deployed settings does not occur in isolation, with co-morbid and co-occurring conditions being common. Presence of multiple co-morbidities appears to influence clinical course and overall recovery. Post-traumatic headaches are often phenotypically fully consistent with migraine, and appear related to pre-existing migraine if supported by detailed pre-deployment headache history suggesting same. Careful and comprehensive history taking and evaluation is invaluable in identifying associated conditions including migraine, potentially helping clinicians with more accurate symptom attribution, diagnoses, and improved clinical management following acute concussion., (© 2020 American Headache Society.)

Introduction: Many medical schools in the United States are introducing leader and leadership curricula. However, there is a large gap regarding how to assess leader performance during undergraduate medical education. With the guidance of a conceptual framework, leadership assessment measures can be developed, learners can make expected improvements in performance over time, and assessment measures can be used in relevant, applied, medical teaching settings. Uniformed Services University (USU) medical students are educated to become healthcare leaders who can perform effectively in various settings. Medical students are assessed on multiple occasions for elements of leader performance during "Operation Bushmaster" - the capstone military medical field practicum event for fourth year medical students - by experienced faculty. A conceptual framework guides the assessment approach for leader performance during Bushmaster. The USU Leader and Leadership Education and Development program developed an assessment tool to measure student leader performance used in a military medical field practicum. The present paper examines whether: (1) leader performance can be measured at Bushmaster; (2) leader performance changed during Bushmaster; (3) leader performance elements are related to each other; and (4) overall leader performance is related to other medical academic performance., Materials and Methods: Trained faculty assessed students' leader performance. Data from three cohorts of USU medical students (N = 509) were collected. All data were collected, compiled, deidentified, and analyzed with approval from the USU Institutional Review Board (Protocol number: KM83XV). Descriptive statistics, repeated measures t-tests, trend analyses, and correlation analyses were performed., Results: Data were available from 483/509 [95%] students. Results revealed that: (1) average leader performance was satisfactory; (2) overall leader performance and performance on each of the major elements of leader performance significantly improved over the course of Bushmaster; (3) major elements of leader performance were significantly correlated with each other and with overall leader performance; (4) leader performance was not correlated with students' performance on the MCAT total score or USMLE Step exam scores., Conclusion: With the guidance of a conceptual framework, the assessment tool was used to assess leader performance in a relevant, applied, medical teaching setting. The findings of this study indicate that leader performance can be measured. Additionally, leader performance appears to be a separate skillset from medical academic performance and both types of performance can be taught and developed. This was a retrospective correlation study and was conducted during a military medical field practicum at a single institution. Gathering additional validity evidence of the assessment tool is needed. With additional validity evidence, the assessment tool could be applied to other medical exercises in different settings and help with the assessment of leader performance beyond medical school., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Co-sleeping is a complex familial phenomenon that has yet to be well understood by Western scientists. This paper provides an interdisciplinary review of research from anthropology, nursing, pediatrics, sociology, social work, public health, family studies, and psychology to focus on the role of physical touch in the context of co-sleeping, and how close physical contact in this context affects infants and their caregivers. Including an anthropological, evolutionary view of co-sleeping with other perspectives highlights it as an experience-expectant proximal context for infant growth and development. From this view, the importance of physical contact and touch in the nighttime caretaking microenvironment of co-sleeping becomes a central question, rather than an artifactual byproduct of "unhealthy" sleep arrangements. Rather than trying to eliminate co-sleeping, public health messages for parents would likely benefit from a more culturally-sensitive approach that focuses on advising how to co-sleep safely for families choosing it. For families trying to retain physical closeness between parent(s) and infants in the context of modern (especially Western) infant care practices that have reduced this physical contact, co-sleeping can be an important developmental context for encouraging and engaging in sensitive and responsive caregiving and providing a context for maternal-infant physiological synchrony and regulation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The literature has consistently emphasized a relationship between chronic stress and depression as well as the involvement of brain-derived neurotrophic factor (BDNF). It is also well known that there are gender disparities with regard to depression. However, there has been a lack of biobehavioral experimental investigations of these relationships with regard to the role of BDNF in sex differences in response to stress. It was hypothesized that stress (chronic unpredictable mild stress [CUMS], shock stress [SS]) would result in greater deleterious alterations in behavior (open field activity [OFA]) and biological (serum BDNF, body weight [BW]) indices of depression for female rats as compared to male rats. Subjects consisted of 79 Sprague-Dawley rats with 11-16 rats per each condition. CUMS consisted of 14 d of stress whereby on each stress day, rats were exposed to 20-min periods of predator stress and unpredictable environmental stress. SS consisted of a 2-h per day session of immobilization and tail-shocks repeated for three consecutive days. Serum BDNF was collected via trunk blood and quantitated using commercial enzyme-linked immunosorbent assay (ELISA). There were pronounced sex differences with regard to stress-induced behavioral and biological alterations. Both stressors decreased vertical activity (VA) (i.e. increased depressive-related behavior) and SS decreased serum BDNF in female rats, but not in male rats. Findings indicate a potential relationship between depressive-like behaviors and BDNF after exposure to stress. The clear sex differences in stress responding emphasize the need for more stress research that involves male and female subjects. Lay summary Stress decreased vertical activity (VA) in female but not male rats while shock stress (SS) decreased serum BDNF in female but not male rats. VA was positively correlated with serum BDNF for female rats. These findings suggest sex differences in response to stress.

The Gateway Hypothesis is based on epidemiological data and states there is a progression of drug use from use of a softer drug (e.g., nicotine) to use of a harder drug (e.g., morphine). It has been suggested that this sequence is causal and is relevant to drug prevention policies and programs. The present experiment used an animal model to investigate whether the Gateway Hypothesis involves a causal progression. Subjects were 16 female and 16 male Sprague-Dawley rats with ages comparable to late adolescence/emerging adulthood in humans. Subjects received nicotine (6 mg/kg/day) or saline for 21 days SC via osmotic minipump and subsequently were allowed to self-administer IV morphine (0.5 mg/kg/injection, 3 h/day) for 10 days. Results did not confirm the Gateway Hypothesis. In fact, rats pre-exposed to nicotine self-administered significantly less morphine than did rats pre-exposed to saline. These findings may be relevant to future drug use prevention policies and programs., (Published by Elsevier Inc.)

This article was migrated. The article was marked as recommended. Problem : Leadership has been identified as an essential component for success in medicine. Many medical schools have initiated Leader and Leadership Education and Development (LEAD) programs to develop physician leaders. Currently, there is no consensus whether teaching leadership is important, who to teach, what topics to teach, and where leadership fits into the curriculum during medical school. Approach : To address these issues, the Uniformed Services University of the Health Sciences (USU) LEAD team convened an inaugural Medical Student LEAD Summit and Working Group Meeting on April 4, 2017. Participants came from public and private U.S. medical schools engaged in LEAD programs, military service academies, the Veterans Administration, and the Association of American Medical Colleges. The purpose of this meeting was to share opinions, experiences, and current practices regarding medical student LEAD. Outcomes : Participants overwhelmingly agreed that: (1) providing LEAD is an essential component of undergraduate medical education; (2) there currently is no single best LEAD program for all medical schools; (3) a clear purpose, goal, philosophy, and conceptual framework consistent with the mission and vision of each institution is needed; (4) assessment of students, programs, faculty must be incorporated; and (5) research and scholarship are essential for LEAD programs. Next Steps : Based on the positive feedback and interest from participants, the USU LEAD team will host a second Summit in April 2018 to follow up with the inaugural participants and to include representatives from additional institutions who are currently conducting or interested in starting their own medical school LEAD programs., (Copyright: © 2018 Grunberg NE et al.)

Motor and sensory deficits are common following traumatic brain injury (TBI). Although rodent models provide valuable insight into the biological and functional outcomes of TBI, the success of translational research is critically dependent upon proper selection of sensitive, reliable, and reproducible assessments. Published literature includes various observational scales designed to evaluate post-injury functionality; however, the heterogeneity in TBI location, severity, and symptomology can complicate behavioral assessments. The importance of choosing behavioral outcomes that can be reliably and objectively quantified in an efficient manner is becoming increasingly important. The Revised Neurobehavioral Severity Scale (NSS-R) is a continuous series of specific, sensitive, and standardized observational tests that evaluate balance, motor coordination, and sensorimotor reflexes in rodents. The tasks follow a specific order designed to minimize interference: balance, landing, tail raise, dragging, righting reflex, ear reflex, eye reflex, sound reflex, tail pinch, and hindpaw pinch. The NSS-R has proven to be a reliable method differentiating brain-injured rodents from non-brain-injured rodents across many brain injury models., (Copyright © 2016 John Wiley & Sons, Inc.)

Wars in Iraq and Afghanistan have highlighted the problems of diagnosis and treatment of mild traumatic brain injury (mTBI). MTBI is a heterogeneous injury that may lead to the development of neurological and behavioral disorders. In the absence of specific diagnostic markers, mTBI is often unnoticed or misdiagnosed. In this study, mice were induced with increasing levels of mTBI and microRNA (miRNA) changes in the serum were determined. MTBI was induced by varying weight and fall height of the impactor rod resulting in four different severity grades of the mTBI. Injuries were characterized as mild by assessing with the neurobehavioral severity scale-revised (NSS-R) at day 1 post injury. Open field locomotion and acoustic startle response showed behavioral and sensory motor deficits in 3 of the 4 injury groups at day 1 post injury. All of the animals recovered after day 1 with no significant neurobehavioral alteration by day 30 post injury. Serum microRNA (miRNA) profiles clearly differentiated injured from uninjured animals. Overall, the number of miRNAs that were significantly modulated in injured animals over the sham controls increased with the severity of the injury. Thirteen miRNAs were found to identify mTBI regardless of its severity within the mild spectrum of injury. Bioinformatics analyses revealed that the more severe brain injuries were associated with a greater number of miRNAs involved in brain related functions. The evaluation of serum miRNA may help to identify the severity of brain injury and the risk of developing adverse effects after TBI.

A significant proportion of the military personnel returning from Iraq and Afghanistan conflicts have suffered from both mild traumatic brain injury (mTBI) and post-traumatic stress disorder. The mechanisms are unknown. We used a rat model of repeated stress and mTBI to examine brain activity and behavioral function. Adult male Sprague-Dawley rats were divided into four groups: Naïve; 3 days repeated tail-shock stress; lateral fluid percussion mTBI; and repeated stress followed by mTBI (S-mTBI). Open field activity, sensorimotor responses, and acoustic startle responses (ASRs) were measured at various time points after mTBI. The protein expression of mitochondrial electron transport chain (ETC) complex subunits (CI-V) and pyruvate dehydrogenase (PDHE1α1) were determined in four brain regions at day 7-post mTBI. Compared to Naïves, repeated stress decreased horizontal activity; repeated stress and mTBI both decreased vertical activity; and the mTBI and S-mTBI groups were impaired in sensorimotor and ASRs. Repeated stress significantly increased CI, CII, and CIII protein levels in the prefrontal cortex (PFC), but decreased PDHE1α1 protein in the PFC and cerebellum, and decreased CIV protein in the hippocampus. The mTBI treatment decreased CV protein levels in the ipsilateral hippocampus. The S-mTBI treatment resulted in increased CII, CIII, CIV, and CV protein levels in the PFC, increased CI level in the cerebellum, and increased CIII and CV levels in the cerebral cortex, but decreased CI, CII, CIV, and PDHE1α1 protein levels in the hippocampus. Thus, repeated stress or mTBI alone differentially altered ETC expression in heterogeneous brain regions. Repeated stress followed by mTBI had synergistic effects on brain ETC expression, and resulted in more severe behavioral deficits. These results suggest that repeated stress could have contributed to the high incidence of long-term neurologic and neuropsychiatric morbidity in military personnel with or without mTBI.

N-acetylaspartate (NAA) is recognized as a noninvasive diagnostic neuronal marker for a host of neuropsychiatric disorders using magnetic resonance spectroscopy (MRS). Numerous correlative clinical studies have found significant decreases in NAA levels in specific neuronal systems in an array of neuropsychiatric and substance-abuse disorders. We have recently identified the methamphetamine-induced neuronal protein known as "shati" as the NAA biosynthetic enzyme (aspartate N-acetyltransferase [Asp-NAT]; gene Nat8l). We have generated an Nat8l transgenic knockout mouse line to study the functions of NAA in the nervous system. We were unable to breed homozygous Nat8l knockout mice successfully for study and so used the heterozygous mice (Nat8l(+/-) ) for initial characterization. MRS analysis of the Nat8l(+/-) mice indicated significant reductions in NAA in cortex (-38%) and hypothalamus (-29%) compared with wild-type controls, which was confirmed using HPLC (-29% in forebrain). The level of the neuromodulator N-acetylaspartylglutamate (NAAG), which is synthesized from NAA, was decreased by 12% in forebrain as shown by HPLC. Behavioral analyses of the heterozygous animals indicated normal behavior in most respects but reduced vertical activity in open-field tests compared with age- and sex-matched wild-type mice of the same strain. Nat8l(+/-) mice also showed atypical locomotor responses to methamphetamine administration, suggesting that NAA is involved in modulating the hyperactivity effect of methamphetamine. These observations add to accumulating evidence suggesting that NAA has specific regulatory functional roles in mesolimbic and prefrontal neuronal pathways either directly or indirectly through impact on NAAG synthesis, (Copyright © 2013 Wiley Periodicals, Inc.)