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Objectives: This study aims to determine the cost-effectiveness of screening and treating otolaryngology-head and neck surgery residents for depression., Methods: A Markov model was built using TreeAgePro, version 2019 (TreeAge Software Inc.; Williamstown, MA) to assess the cost-effectiveness of five potential treatment algorithms: 1) treat all residents with psychotherapy, 2) screen and treat depressed residents with psychotherapy, 3) screen and treat depressed residents with pharmacotherapy, 4) screen and treat depressed residents with combination psychotherapy/pharmacotherapy, and 5) no intervention. A Monte Carlo probabilistic sensitivity analysis (PSA), consisting of 1 thousand simulations over a cumulative 5-year period, was performed to evaluate both base case values and a range of values for model variables., Results: Screening residents for depression and treating with combination psychotherapy/pharmacotherapy was cost-effective and the optimal strategy at a willingness-to-pay threshold of $50 thousand per quality-adjusted life year (QALY). This option demonstrated an incremental cost-effectiveness ratio of $27,578 per QALY for base case values. PSA confirmed these results and demonstrated that screening residents for depression and treating with either combination pharmacotherapy/psychotherapy, pharmacotherapy alone, or psychotherapy alone were cost-effective options in 94.9% of simulations., Conclusion: Depression and burnout remain crucial issues among resident physicians. This study demonstrates that actively screening residents for depression is cost-effective. Based on these results, residency programs may consider trialing standardized depression screening protocols., Level of Evidence: I and II. Laryngoscope, 131:502-508, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Women remain underrepresented in many science, technology, engineering, and mathematics (STEM) fields. Women in Science and Engineering (WISE) support groups were developed in 2001 as an intervention to foster community in graduate and postgraduate women in STEM at a large academic research institution. Since the WISE program's inception, over 1,500 women have participated. From 2011 to 2018, anonymous, voluntary surveys were distributed at the end of every academic year to WISE group members. Surveys consisted of quantitative and qualitative data regarding participants' perceptions of and experiences in the WISE groups. From 2011 to 2018, 76.4% of survey respondents (n = 416) reported that WISE groups were an excellent experience overall. Thematic analysis of the qualitative data demonstrated four major benefits of WISE group participation: creation of community, having a safe space, emotional support, and peer mentorship. Suggestions for improvement included increasing access to groups. The WISE group program was a well-liked intervention that may support graduate and postgraduate women in STEM. Study limitations, as well as implications for future research, practice, and advocacy are noted.

Objective: Rates of medical student depression and suicide are higher than aged-matched peers. Although medical schools have implemented wellness interventions, no program has reported on interventions targeting social support. As one potential intervention, reflection groups for medical students led by psychiatry residents were designed and implemented. It was hypothesized that groups would encourage connectedness among peers, teach coping and emotional self-awareness skills, increase empathy, and decrease loneliness., Methods: Voluntary, biweekly support groups were implemented between 2017 and 2018 at Stanford University School of Medicine for first- and second-year medical students. Participants were surveyed at baseline and 6 months. Surveys included qualitative assessments of groups and validated surveys to assess empathy, wellness, and loneliness. Separate surveys assessed attrition. Analyses included statistical analyses (descriptive statistics) and thematic analysis., Results: In both cohorts, a total number of 30 students participated in groups, and 18 completed post-surveys. Students reported groups improved well-being (55.6% strongly agreed, 27.8% agreed), enhanced self-awareness (44.4% strongly agreed, 38.9% agreed) and ability to empathize (50.0% strongly agreed, 27.8% agreed), and promoted connection (61.1% strongly agreed, 33.3% agreed). Initial attrition was high, with 84% of students not continuing due to feeling too overwhelmed by classes., Conclusions: Thematic analysis demonstrated groups may benefit students in improving impostor syndrome and connection with others (decreased loneliness), allowing exposure and tolerance to diverse perspectives, increasing insight into the importance of self-care and emotional self-awareness, allowing practice for collaborative skills, and increasing thoughtful approaches to patient care. There is preliminary evidence reflection groups may be a feasible, effective intervention to improve loneliness and social belonging in medical school.

Background: In light of recent progress toward pharmacologic interventions to treat adolescent cannabis use disorder, it is important to consider which adolescent characteristics may be associated with a favorable response to treatment. This study presents secondary analyses from a parent randomized controlled trial of N-acetylcysteine (NAC) in adolescents with cannabis use disorder. We hypothesized that high pretreatment impulsivity and medication non-adherence would be associated with reduced abstinence rates., Methods: Participants were treatment-seeking adolescents (N=115) who met criteria for cannabis use disorder and were assessed for pretreatment impulsivity. They received 1200 mg NAC or placebo orally twice daily for 8 weeks. An intent-to-treat analysis using a repeated-measures logistic regression model was used to relate pretreatment impulsivity (Barratt Impulsiveness Scale) and treatment group to abstinence rates, measured by urine cannabinoid tests. To explore mechanisms by which NAC may reduce cannabis use, relationships between impulsivity, adherence, and abstinence were assessed in a second statistical model using data from participants with recorded adherence and urine cannabinoid test results (n=54)., Results: In the intent-to-treat analysis, low pretreatment impulsivity, NAC treatment, and negative baseline urine cannabinoid test results independently increased the odds of having negative urine cannabinoid tests during treatment (OR=2.1, 2.3, and 5.3 respectively). In the sample of participants with adherence data (n=54), adherence tripled the odds of abstinence. Notably, the effect of adherence on abstinence was only observed in the NAC treatment group. Lastly, although the highly impulsive participants had reduced rates of abstinence, highly impulsive individuals adherent to NAC treatment had increased abstinence rates compared to non-adherent individuals., Conclusion: Low impulsivity, NAC treatment, medication adherence, and baseline negative cannabinoid testing were associated with increased rates of abstinence in adolescents seeking treatment for cannabis use disorder. Efforts to optimize pharmacotherapy adherence may be particularly crucial for highly impulsive individuals. Understanding and addressing factors, such as impulsivity and adherence, which may affect outcomes, may aid in the successful evaluation and development of potentially promising pharmacotherapies., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To evaluate the clinical safety of antenatal and postnatal N-acetylcysteine (NAC) as a neuroprotective agent in maternal chorioamnionitis in a randomized, controlled, double-blinded trial., Study Design: Twenty-two mothers >24 weeks gestation presenting within 4 hours of diagnosis of clinical chorioamnionitis were randomized with their 24 infants to NAC or saline treatment. Antenatal NAC (100 mg/kg/dose) or saline was given intravenously every 6 hours until delivery. Postnatally, NAC (12.5-25 mg/kg/dose, n = 12) or saline (n = 12) was given every 12 hours for 5 doses. Doppler studies of fetal umbilical and fetal and infant cerebral blood flow, cranial ultrasounds, echocardiograms, cerebral oxygenation, electroencephalograms, and serum cytokines were evaluated before and after treatment, and 12, 24, and 48 hours after birth. Magnetic resonance spectroscopy and diffusion imaging were performed at term age equivalent. Development was followed for cerebral palsy or autism to 4 years of age., Results: Cardiovascular measures, cerebral blood flow velocity and vascular resistance, and cerebral oxygenation did not differ between treatment groups. Cerebrovascular coupling was disrupted in infants with chorioamnionitis treated with saline but preserved in infants treated with NAC, suggesting improved vascular regulation in the presence of neuroinflammation. Infants treated with NAC had higher serum anti-inflammatory interleukin-1 receptor antagonist and lower proinflammatory vascular endothelial growth factor over time vs controls. No adverse events related to NAC administration were noted., Conclusions: In this cohort of newborns exposed to chorioamnionitis, antenatal and postnatal NAC was safe, preserved cerebrovascular regulation, and increased an anti-inflammatory neuroprotective protein., Trial Registration: ClinicalTrials.gov: NCT00724594., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Evaluate brain metabolites, which reflect neuroinflammation, and relate to neurodevelopmental outcomes in healthy term neonates exposed to chorioamnionitis., Study Design: Thirty-one healthy term neonates with documented fetal inflammatory response after maternal chorioamnionitis underwent magnetic resonance spectroscopy (MRS), with voxels placed in basal ganglia (BG) and frontal white matter. Bayley III examinations were performed at 12 months of age., Result: Infants with below average outcomes did not show the same increase in NAA/Cho ratios postnatally as the group with normal outcomes. Decreased NAA/Cho and increased Lac/Cr in BG correlated with lower motor and cognitive composite scores, respectively, controlling for postnatal age. In males, increased lactate/NAA in BG were associated with lower motor scores. Funisitis severity was associated with decreased NAA/Cho and increased mI/NAA in males., Conclusion: In healthy term newborns with chorioamnionitis, MRS ratios shortly after birth may provide evidence of occult neuroinflammation, which may be associated with worse performance on 1-year neurodevelopmental tests.

Background: Although new interventions treating neonatal brain injury show great promise, our current ability to predict clinical functional outcomes is poor. Quantitative biomarkers of long-term neurodevelopmental outcome are critically needed to gauge treatment efficacy. Kinematic measures derived from commonly used developmental tasks may serve as early objective markers of future motor outcomes., Aim: To develop reliable kinematic markers of head control at 12week corrected gestational age (CGA) from two motor tasks: head lifting in prone and pull-to-sit., Study Design and Subjects: Prospective observational study of 22 preterm infants born between 24 and 34weeks of gestation., Outcome Measures: Bayley Scales of Infant Development III (Bayley) motor scores., Results: Intrarater and interrater reliability of prone head lift angles and pull-to-sit head angles were excellent. Prone head lift angles at 12week CGA correlated with white matter NAA/Cho, concurrent Test of Infant Motor Performance (TIMP) scores, and 12-month Bayley motor scores. Head angles during pull-to-sit at 12-week CGA correlated with TIMP scores., Conclusions: Poor ability to lift the head in prone and an inability to align the head with the trunk during the pull-to-sit task were associated with poorer future motor outcome scores. Kinematic measurements of head control in early infancy may serve as reliable objective quantitative markers of future motor impairment and neurodevelopmental outcome., (Published by Elsevier Ireland Ltd.)