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Background and Objectives: While there is increased attention to underrepresented in medicine (URiM) faculty and students, little is known about what they value in faculty development experiences. Methods: We performed a URiM-focused, 3-day family medicine faculty development program and then collected program evaluation forms. The program evaluations had open-ended questions and a reflection on the activity. We used inductive open coding using NVivo software. We analyzed open-ended responses and reflections, and identified themes. Results: Seven participants provided reflections on the workshop and responses to the evaluation forms. Analysis revealed four major themes in the learners’ responses and reflections: (1) personalizing learning, (2) impacting career trajectories, (3) clarifying the writing process, and (4) creating a safe place, with frequencies of 28.2%, 26.7%, 23.6%, and 20.9%, respectively. Conclusions: Although this faculty development experience was designed to teach writing skills to URiM junior faculty, their collective responses indicate that they found value beyond the skills taught and appreciated the approach taken in this activity.

Background Numerous studies have demonstrated that the increasingly diverse US population benefits from access to diverse healthcare providers from similarly diverse backgrounds. Physician assistant (PA) education programs have striven to increase the diversity of the profession, which is predominantly non-Hispanic white, by focusing on admitting historically underrepresented students. However, strategies such as holistic admissions are predicated on the existence of diverse applicant pools. While studies have examined correlates of matriculation into a medical education program, this study looks earlier in the pipeline and investigates whether applicant – not matriculant – pool diversity varies among PA programs with different characteristics. Methods Data were drawn from the 2017-2018 Central Application Service for PAs admissions cycle. Applications to programs with pre-professional tracks and applicants missing race/ethnicity data were excluded, resulting in data from 26,600 individuals who applied to 189 PA programs. We summarized the racial and ethnic diversity of each program’s applicant pools using: (1)the proportion of underrepresented minority (URM) students, (2)the proportion of students with backgrounds underrepresented in medicine (URiM), and (3)Simpson’s diversity index of a 7-category race/ethnicity combination. We used multiple regressions to model each diversity metric as a function of program characteristics including class size, accreditation status, type of institution, and other important features. Results Regardless of the diversity metric examined, we found that applicant diversity was higher among provisionally accredited programs and those receiving more applications. We also identified trends suggesting that programs in more metropolitan areas were able to attract more diverse applicants. Programs that did not require the GRE were also able to attract more diverse applicants when considering the URM and SDI metrics, though results for URiM were not statistically significant. Conclusions Our findings provide insights into modifiable (e.g., GRE requirement) and non-modifiable (e.g., provisionally accredited) program characteristics that are associated with a diverse applicant pool.

This article analyses the main factors that determined the employment situation of mothers and women in Spain in 2014 and 2018, distinguishing between full-time employment, part-time employment, un...

Faculty from groups that are underrepresented in medicine encounter unique challenges to advancement within academic medicine. The authors describe a fellowship created for junior underrepresented in medicine academic faculty in Family Medicine focused on promoting writing skills and scholarship. Supplemental digital content is available in the text., Objectives The diversity of the US physician workforce lags significantly behind the population, and the disparities in academic medicine are even greater, with underrepresented in medicine (URM) physicians accounting for only 6.8% of all US medical school faculty. We describe a “for URM by URM” pilot approach to faculty development for junior URM Family Medicine physicians that targets unique challenges faced by URM faculty. Methods A year-long fellowship was created for junior URM academic clinician faculty with funding through the Society of Teachers of Family Medicine Project Fund. Seven junior faculty applied and were accepted to participate in the fellowship, which included conference calls and an in-person workshop covering topics related to writing and career advancement. Results The workshop included a mix of prepared programming on how to move from idea to project to manuscript, as well as time for spontaneous mentorship and manuscript collaboration. Key themes that emerged included how to address the high cost of the minority tax, the need for individual passion as a pathway to success, and how to overcome imposter syndrome as a hindrance to writing. Conclusions The “for URM by URM” approach for faculty development to promote writing skills and scholarship for junior URM Family Medicine physicians can address challenges faced by URM faculty. By using a framework that includes the mentors’ lived experiences and creates a psychological safe space, we can address concerns often overlooked in traditional skills-based faculty development programs.

Rejection of manuscripts by academic journals can be devastating for the early-career family medicine faculty members. Taking experience from teaching early-career underrepresented in medicine faculty members writing and scholarship skills, we identify and explain five lessons to be learned from rejected manuscripts. The five lessons are: (1) rejections teach journal scope, (2) rejections teach process, (3) rejection should lead to resubmission, (4) rejections reflect writing effort, and (5) rejections happen to papers, not authors. Early-career family medicine faculty can use these lessons for reassurance and to adapt behaviors to remain in the scholarship arena.

On September 20, 2017, Hurricane Maria made landfall in Puerto Rico as a Category 4 hurricane with sustained winds of 155 miles per hour and torrential rains that ravaged the United States territory. In the midst of the crisis, several hundred thousand Maria survivors boarded humanitarian flights and cruise ships, seeking refuge on the United States mainland. More than three years later, tens of thousands of post-Maria migrants remain on the mainland as long-term emigres. In this article, we lay the theoretical/conceptual groundwork for researchers and practitioners interested in understanding the experiences of post-Maria migrants. Specifically, we aim to assist readers in thinking deeply about: [1] why many Puerto Ricans relocated, [2] the experiences of post-Maria migrants en movimiento, and [3] how such experiences shape their lives, behavior, and well-being. In understanding the experiences of post-Maria migrants, several theories/constructs emerge as especially salient. These include "push and pull" models, cultural stress theory and its transnational variants, the concept of crisis migration, and models of cumulative risk. We provide a succinct overview of each of these theories/constructs and describe the broad perspectives that serve as a foundational or orienting paradigm for our work (i.e., the life course perspective, the strengths perspective, and an ecodevelopmental framework). Finally, we provide illustrations of how these theories/concepts apply to emerging data from the Adelante Boricua study, an ongoing research project with post-Maria migrant youth and their parents, supported by funding from the National Institute on Minority Health and Health Disparities.

Background and Objectives: Among the oldest in the nation, the University of Utah Physician Assistant Program (UPAP) serves the state of Utah and surrounding areas and is a division of the Department of Family and Preventive Medicine. Recognizing the need to produce health care providers from diverse racial and ethnic backgrounds, UPAP instituted structural changes to improve student compositional diversity. This paper is a presentation and evaluation of the changes made to determine their relationship with compositional diversity, ultimate practice setting, and national rankings. Methods: UPAP changed diversity messaging, curriculum, efforts in admissions, recruitment, and retention to improve the representation of Black, Latinx, American Indian/Alaska Native, and Native Hawaiian/Other Pacific Islander students, as well as those from educationally and economically disadvantaged backgrounds. Results: UPAP tripled the number of underrepresented minority matriculated students over the course of five admitted classes, while simultaneously increasing the proportion of students from educationally or economically disadvantaged backgrounds. UPAP maintains both high boards pass rate and top national rankings, (number two ranking in public physician assistant program and number four overall program in the United States). Conclusions: The UPAP experience demonstrates that intentional diversity efforts are associated with improvement in racial/ethnic diversity and national rankings. Other medical school graduate programs, specifically the medical doctor (MD), public health, and basic science programs can use this model to improve their compositional diversity.

The control of Parkinson's disease (PD) is challenged by the motor and non-motor fluctuations as well as dyskinesias associated with levodopa long-term therapy. As such, pharmacological alternatives to reduce the reliance on this drug are needed. Melanostatin (MIF-1), a positive allosteric modulator (PAM) of D2 receptors (D2R), is being explored as a novel pharmacological approach focused on D2R potentiation. In this work, 3-furoic acid (3-Fu) was successfully employed as an l-proline (Pro) surrogate, affording two potent MIF-1 analogues, methyl 3-furoyl-l-leucylglycinate (4a) and 3-furoyl-l-leucylglycinamide (6a). In this series, the C-terminal carboxamide moiety was found crucial to enhancing the potency and toxicological profile, yet it is not considered a requisite for the PAM activity. Conformational analysis excludes 4a from adopting the claimed type II β-turn. The discovery and validation of 6a as a lead compound open a new avenue for the development of a novel class of anti-Parkinson therapeutics targeting the D2R.

Problem American Indian/Alaska Native (AI/AN) populations are facing multiple health crises, including limited access to care, high rates of chronic disease, and early mortality that is far worse than other underrepresented minorities in the U.S. According to the Association of American Indian Physicians, AI/AN people represent 2.0% of the U.S. population but only 0.2% of medical students and 0.1% of full-time faculty at MD-granting institutions. Increasing the number of AI/AN clinicians and scientists is one strategy to improve health outcomes in the AI/AN population and address these crises. Approach In 2010, the University of Utah partnered with research, cultural, and professional mentors to create a 10-week summer Native American Research Internship (NARI) program for AI/AN college students across the U.S. who are interested in pursuing biomedical careers. NARI attracts and supports AI/AN students by offering mentored summer research internships in an innovative, culturally-aware framework that adapts to observed challenges to optimize educational experiences and support biomedical career aspirations. Outcomes During the first decade of the NARI program, 128 students from 22 U.S. states, representing 46 tribal nations and 57 colleges and universities, have participated. Of those 128 students, 113 (88%) have completed a bachelor's degree and the remaining 15 (12%) are currently working towards a bachelor's degree. No NARI student has dropped out of college. Twenty-six (20%) NARI alumni have matriculated to medical school and 30 (23%) to graduate school. Eight (6%) participants have completed medical school and 3 (2%) participants are pursuing a PhD in science. An additional 36 (28%) have gained employment in biomedical research fields. Next steps The NARI program has increased the participation of AI/AN students in medicine and the biomedical sciences. The innovative, culturally-aware, and adaptive framework is a model for other programs for AI/AN students and students in other underrepresented communities.

Background and Objectives: The University of Utah (UU) serves an increasingly diverse state and houses the only public medical school, dental school, and college of pharmacy in the state. Utah’s diversity in the health professions lags behind the diversity of its general population, and the nation. Methods: The Health Sciences Learning, Engagement, Achievement, and Progress (HS-LEAP) Program is a 4-year undergraduate pipeline program intended to increase racial and ethnic diversity in the health professions, specifically focused on students underrepresented in medicine (URM). Each student self-identified and submitted demographics at the time of enrollment. We followed students to successful engagement in their profession of choice; we compared graduation and postgraduation outcomes to non-HS-LEAP students at UU from 2005-2016. Results: Almost 80% of HS-LEAP students are from communities underrepresented in medicine: 41% Latinx, 28% Asian, 7% Black, 2% American Indian/Alaskan Native, and 1% Pacific Islander. HS-LEAP students had lower ACT scores upon undergraduate enrollment, higher grade point averages in their first semester of college, higher fall-to-fall first-year retention rates, and higher 6-year graduation rates when compared to non-HS-LEAP UU students. Students who completed HS-LEAP attended graduate school at twice the rate of students who participated in HS-LEAP, the majority in the health professions. Conclusions: The HS-LEAP program is associated with increased URM success in undergraduate programs and elevated participation in graduate programs in medicine, dentistry, pharmacy, physician assistant, nursing, and public health. Similar programs, with continuous assessment and evaluation, could be adopted in other locations to improve the representation of these groups in health professions.

Neurodegenerative diseases, such as Alzheimer's and Parkinson's diseases, are a class of heterogeneous pathologies of the central nervous system (CNS) affecting millions of people worldwide. CNS-related pathologies represent a global health burden in developed and developing countries with no curative treatments currently available. Thus, the development of novel multitarget neuroprotective drugs is a health priority. In this work, a bioinspired methodology in solution-phase for the assembly and regioselective conjugation of Glypromate® neuropeptide with active pharmaceutical ingredients (APIs) is described. The main purpose is to design new hybrid molecules which may offer increased systemic resistance of Glypromate® towards proteases and/or allow the controlled release of both APIs and the neuroprotective peptide within CNS. For the synthesis of such peptide-hybrid compounds (R)-1-aminoindane, amantadine, and memantine were selected as APIs for conjugation with Glypromate®. Furthermore, capping strategies are explored to prepare Glypromate® conjugates with more favorable pharmacodynamic profiles by masking polar exposed groups. Overall, this synthetic approach led to the development of a small library of 12 conjugates with improved drug-like properties in comparison with Glypromate®, paving the way for the discovery of novel CNS multitarget drugs. Additionally, by exploring the bis-functionalization of glutamate, the formation of chiral glutarimides is disclosed for the first time employing TBTU as the coupling reagent. This unusual reactivity of TBTU with glutamate offers a new synthetic approach for the preparation of chiral glutarimide alkaloids.

This work describes an improved and greener methodology of solution-phase synthesis for the preparation of Glypromate® (glycyl-L-prolyl-L-glutamic acid, GPE), a potent neuropeptide for applications in neurodegenerative conditions such as Huntington's, Parkinson's and Alzheimer's diseases. This protocol comprises the assembly of the perbenzylated form of Glypromate® [Cbz-Gly-Pro-Glu(OBn)-OBn (5)] from L-proline. Following a tandem sequential peptide coupling strategy, two chemoselective peptide bonds are formed without the need for purifying the intermediates ensuing a one-pot fashion synthesis. EcoScale score and E-factor were selected as the green metrics to assess the environmental impact of the preparation of tripeptide 5 using this protocol. After optimization and application of greener conditions, intermediate 5 was obtained with 95% global yield and 99% purity (NMR, HRMS, and rp-HPLC), with excellent final EcoScale score of 75 out of 100 and global E-factor of 1.8. Glypromate® is achieved by removing N- and C-protecting groups by hydrogenolysis using Pd/C as the catalyst in 98% yield, avoiding chromatographic techniques. Moreover, the protocol ensures stereochemical integrity (determined by VT-NMR and rp-HPLC) and was also successfully applied for the preparation of structurally-related Glypromate® analogues with higher degree of molecular complexity compatible with functionalized amino acids with different side chains. For the first time a one-pot protocol for the assembly of tripeptides with the removal of protecting groups in the same reaction vessel is reported.

Introduction: The Department of Family and Preventive Medicine is home for the University of Utah’s Family Medicine Residency program. Although Utah’s diversity is steadily increasing, the race/ethnic diversity of the program’s family medicine residency does not reflect the state’s general population. Methods: From 2017 to 2021, the residency instituted several adjustments to recruitment processes, including modification of an existing screening system to better highlight resiliency in overcoming challenging life experiences; promotion of commitment to diversity during interview days; incorporation of increased participation from diverse faculty and residents on interview days; and addition of outreach from the Office of Health, Equity, Diversity, and Inclusion. Underrepresented in medicine (URiM) applicants were the first to be offered interviews in an identical screening score cohort, and were ranked highest in rank lists in cohorts with identical final rank scores. Results: Over the past five match cycles, Latinx residents have increased from zero to six, and underrepresented Asian residents from zero to two. In the 2021 match cycle, five of 10 incoming residents (50%) are URiM. Overall, URiM residents are now 30%, and residents of color 36%, of a total of 30 residents across all 3 training years. We found that eight URiM interviews were needed for every one URiM match. Conclusion: Intentional resident recruitment initiatives can transform racial/ethnic diversity in a family medicine residency program in a short amount of time.

Neurodegenerative disorders of the central nervous system are a class of heterogeneous pathologies affecting millions of people worldwide and represent a global health burden in developed and developing countries. Without restorative treatments currently available, research on neuroprotective drugs is considered a health priority. In this study, new analogues of the glycyl-l-prolyl-l-glutamic acid (Glypromate) neuropeptide were designed, synthesized, and biologically evaluated using (1R,3S,4S)-2-azanorbornane-3-carboxylic acid as a hybrid construct of l-proline and l-pipecolic acid. Neuroprotection assays carried out in human neuroblastoma SH-SY5Y cells using 6-hydroxydopamine as a stress inducer showed great percentage of recovery (29.7-40.0%) at 100 μM. Among this series, [(1R,3S,4S)-2-glycyl-2-azanorbornane-3-carbonyl]-l-aspartic acid (2a) stands out with a remarkable percentage of recovery (40.0%, at 100 μM) and safe toxicological profile in SH-SY5Y and human adipose mesenchymal stem cells.

The COVID-19 pandemic highlighted the importance of centering health equity in future health system and primary care reforms. Strengthening primary care will be needed to correct the longstanding history of mistreatment of First Nations/Indigenous and racialized people, exclusion of health care workers of color, and health care access and outcome inequities further magnified by the COVID-19 pandemic. The National Academies of Sciences, Engineering, and Medicine (NASEM) released a report on Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, that provided a framework for defining high-quality primary care and proposed 5 recommendations for implementing that definition. Using the report’s framework, we identified health equity challenges and opportunities with examples from primary care systems in the United States and Canada. We are poised to reinvigorate primary care because the recent pandemic and the attention to continued racialized police violence sparked renewed conversations and collaborations around equity, diversity, inclusion, and health equity that have been long overdue. The time to transition those conversations to actionable items to improve the health of patients, families, and communities is now. Appeared as Annals “Online First” article.

Teams have been important in primary care for almost 15 years,[1][1] and the recent National Academies of Sciences, Engineering, and Medicine (NASEM) report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care , calls for the formation of diverse interprofessional teams

Given the well-documented inequities in health care outcomes by race, ethnicity, and gender, many health career pipeline programs have focused on supporting the development of a diverse and inclusive workforce. The State of Utah, is vast, but sparsely populated outside the Salt Lake City metropolitan area. More than 96% of our nearly 85,000 square miles is designated rural (

This work describes the synthesis and pharmacological evaluation of picolinoyl-based peptidomimetics of melanocyte stimulating hormone release inhibiting factor 1 (MIF-1) as dopamine modulating agents. Eight novel peptidomimetics were tested for their ability to enhance the maximal effect of tritiated N-propylapomorphine ([3H]-NPA) at dopamine D2 receptors (D2R). Methyl picolinoyl-l-valyl-l-alaninate (compound 6b) produced a statistically significant increase in the maximal [3H]-NPA response at 0.01 nM (11.9 ± 3.7%), which is close to the effect of MIF-1 in this assay at same concentration (18.3 ± 9.1%). Functional assays measuring cAMP mobilization in the presence of dopamine corroborate the activity of peptidomimetic 6b as a positive allosteric modulator (PAM) of D2R. In this assay, 6b produced a typical bell-shaped dose-response curve similar to that of the parent neuropeptide (18.3 ± 7.1% for 6b vs 15.4 ± 5.5% for MIF-1, both at 0.1 nM). Dose-response curves for dopamine in the presence of 6b show EC50 (0.33 ± 0.21 μM for 6b vs 0.17 ± 0.07 μM for MIF-1) and Emax (86.0 ± 5.4% for 6b vs 93.6 ± 4.4% for MIF-1) comparable to those of MIF-1, both at 0.01 nM. Furthermore, peptidomimetic 6b was tested for agonist activity at the human D2R and the results show that it displays no intrinsic agonism effect, endorsing its activity as a PAM of D2R. Cytotoxic and neurotoxic assays were performed for peptidomimetic 6b using HEK 293T cells and cortex neurons from 19 day old Wistar-Kyoto rat embryos, respectively, suggesting this analogue displays no toxicity effect in these assays up to 100 μM. Conformational energy minimization for 6b shows that this peptidomimetic cannot adopt the postulated type-II β-turn bioactive conformation, endorsing the possibility of an extended bioactive conformation as claimed by other researchers as a second bioactive conformation of MIF-1. Overall, the pharmacological and toxicological profile of peptidomimetic 6b together with its favorable druglike properties and structural simplicity makes it a potential lead compound for further development and optimization.

Se tuvo como finalidad evaluar el contenido de polifenoles totales y la actividad antioxidante de los extractos rizoide, estípite y fronda del alga Eisenia cokeri M.A. Howe, mediante métodos de referencia espectrofotométricos. El resultado de polifenoles de las algas se determinó por el método de Folin-Ciocalteau a partir del estándar de referencia Ácido gálico y la actividad antioxidante es referida a los radicales libres fue determinado por los métodos de 1,1-difenil-2-picrilhidrazil (DPPH) y el ácido 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) ABTS.* . La conclusión fue que el contenido de polifenoles totales es de 3,11346 mg para el estípite; 0,4625 mg para la fronda y 2,31665 mg para el rizoide de ácido gálico/1 gramo de muestra. Para la actividad antioxidante los extractos mostraron actividad antioxidante en los métodos de DPPH para el rizoide (IC50= 659,74 μg/mL): para la fronda (IC50= 280,00 μg/mL) y para el estípite (IC50= 248,50 μg/ mL) y por el método de ABTS.+ los extractos mostraron para el rizoide (IC50= 20,3 μg/mL): para la fronda (IC50= 39,2 μg/ mL) y para el estípite (IC50= 24,7 μg/mL). Estos resultados se correlacionan con los de la actividad antioxidante mostrada por las muestras estudiadas.

Herein we present a new synthesis methodology for the transprotection of the 1-phenylethyl protected tertiary amines to tert-butyloxycarbonyl (Boc) derivatives under exocyclic N–C hydrogenolysis catalyzed by Pd/C. We provide mechanistic insights into the N-dealkylation of hindered tertiary amines under the unrecognized role of tert-butyloxycarbonyl anhydride (Boc2O) as an additive to effectively promote the exocyclic N–C hydrogenolysis of tertiary amines by disclosing the role of Boc2O, which was not fully understood and studied until now. NMR and in silico experiments suggest the formation of a transient charged carbamate as the plausible intermediate. This selective transprotection enabled the development of a robust stereoselective methodology for the preparation of both enantiomers of 2-azanorbornane-3-exo-carboxylates by highly asymmetric aza-Diels–Alder reactions using (−)-8-phenylmenthol (8PM) and (+)-8-phenylneomenthol (8PnM) as chiral auxiliaries.

This work describes the synthesis and pharmacological evaluation of 2-furoyl-based Melanostatin (MIF-1) peptidomimetics as dopamine D2 modulating agents. Eight novel peptidomimetics were tested for their ability to enhance the maximal effect of tritiated N-propylapomorphine ([3H]-NPA) at D2 receptors (D2R). In this series, 2-furoyl-l-leucylglycinamide (6a) produced a statistically significant increase in the maximal [3H]-NPA response at 10 pM (11 ± 1%), comparable to the effect of MIF-1 (18 ± 9%) at the same concentration. This result supports previous evidence that the replacement of proline residue by heteroaromatic scaffolds are tolerated at the allosteric binding site of MIF-1. Biological assays performed for peptidomimetic 6a using cortex neurons from 19-day-old Wistar-Kyoto rat embryos suggest that 6a displays no neurotoxicity up to 100 μM. Overall, the pharmacological and toxicological profile and the structural simplicity of 6a makes this peptidomimetic a potential lead compound for further development and optimization, paving the way for the development of novel modulating agents of D2R suitable for the treatment of CNS-related diseases. Additionally, the pharmacological and biological data herein reported, along with >20â000 outcomes of preclinical assays, was used to seek a general model to predict the allosteric modulatory potential of molecular candidates for a myriad of target receptors, organisms, cell lines, and biological activity parameters based on perturbation theory (PT) ideas and machine learning (ML) techniques, abbreviated as ALLOPTML. By doing so, ALLOPTML shows high specificity Sp = 89.2/89.4%, sensitivity Sn = 71.3/72.2%, and accuracy Ac = 86.1%/86.4% in training/validation series, respectively. To the best of our knowledge, ALLOPTML is the first general-purpose chemoinformatic tool using a PTML-based model for the multioutput and multicondition prediction of allosteric compounds, which is expected to save both time and resources during the early drug discovery of allosteric modulators., This research was funded by Fundação para a Ciência e Tecnologia (FCT, Portugal), through grants UIDB/50006/2020 (to LAQV-REQUIMTE Research Unit) and for project grants PTDC/BIA-MIB/29059/2017 and PEst-OE/QUI/UI0674/2013. This work was also supported by the Collaborative Project of Genomic Data Integration (CICLOGEN)., The support of Ikerbasque, Basque Foundation for Science and the research grants from Ministry of Economy and Competitiveness, MINECO, Spain (FEDER CTQ2016–74881-P), and Basque government (IT1045–16) are also acknowledged. The financial support (ED431G 2019/02) from the Xunta de Galicia (Centro singular de investigación de Galicia accreditation 2019–2022) and the European Union (European Regional Development Fund—ERDF) is gratefully acknowledged. I.E.S.-D. thanks FCT for the doctoral grant SFRH/BD/93632/2013. X.G.-M. thanks Xunta de Galicia for financial support (GPC2014/003).