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The lack of diversity in surgical career pathways impacts the cultural competence of the learning and working environment, the variety of leadership styles found within surgical leadership, and the ability of an organization to achieve equity in the workplace due to ongoing mistrust and untouched bias. Leading mitigating factors include developing pathways for greater numbers of diverse people at the high school and college level and implicit bias training. Though educators have had some success with these factors in the initial stages of diversifying early pathways, these factors are not yet correlated to entry into a surgical career. Future solutions to the lack of diversity in surgery will be predicated on surgeons collectively valuing justice, equity, diversity, and inclusion. [ABSTRACT FROM AUTHOR]

Virtual worlds (VWs) present a viable, low-cost delivery mechanism for telehealth services. Although preliminary reports support the effectiveness of VWs in terms of health metrics, few studies have examined the perceived benefits and learning potential for military service members and veterans. Trust is integral to any interaction and may be even more important, and problematic to establish, during virtual interactions than in-person (IP) communications. The purpose of this study was to compare active duty and veteran U.S. Military service members' (n = 92) self-reported trust, class satisfaction, and didactic learning after completing either an 8-week training course in mindfulness-based stress reduction (MBSR) delivered IP or an 8-week mindfulness meditation class based on MBSR via the VW of Second Life. Results showed that learning performance was not significantly different between the IP and VW groups (p > 0.05). Although overall trust was high for both groups, participants in the IP group reported greater trust and class satisfaction compared with the VW group (p < 0.05). Trust, satisfaction, and learning were significantly correlated with one another, and trust in the instructor significantly predicted trust-in-classmates, trust-in-self, and class satisfaction for both groups (p < 0.05). In this study, IP group training was superior to VW training in terms of self-reported greater trust in the instructor, classmates, and self, and higher satisfaction with the training. Trust in the instructor is particularly important for group training, whether IP or in a VW. This study reiterates the arduous task of establishing trust in a VW setting and suggests that creating trust between the instructor and participants is high priority as a leading objective for VW communications. Suggestions for building trust are tight collaboration and clear communication, along with supporting and advocating for one another. [ABSTRACT FROM AUTHOR]

This Viewpoint discusses the US Supreme Court's June 2023 ruling on affirmative action and its repercussions for Black physicians and health equity for racial and ethnic minority groups. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injury (TBI) is considered a signature injury from the fighting in Iraq and Afghanistan. Since the year 2000, over 370,000 U.S. active duty service members have been diagnosed with TBI. Although prior research has shown that even mild forms of TBI are associated with impaired cognitive performance, it is not clear which facets of cognition (computation, memory, reasoning, etc.) are impacted by injury.Method: In the present study, we compared active duty military volunteers (n = 88) with and without TBI on six measures of cognition using the Automated Neuropsychological Assessment Metric software.Results: Healthy volunteers exhibited significantly faster response times on the matching-to-sample, mathematical processing, and second round of simple reaction time tasks and had higher throughput scores on the mathematical processing and the second round of the simple reaction time tasks (P < 0.05).Conclusion: In this population, cognitive impairments associated with TBI influenced performance requiring working memory and basic neural processing (speed/efficiency). [ABSTRACT FROM AUTHOR]

Unhealthy sleep can interfere with U.S. military service members affective and cognitive functioning, and increase accident and injury risks. This study examined the relationship between U.S. active duty and veterans' (n = 233) self-reported sleep (Pittsburgh Sleep Quality Index), anxiety (Zung Self-Rating Anxiety Scale), and cognitive performance (Automated Neuropsychological Assessment Metric). Statistical analyses included Pearson product moment correlations and multivariate analysis of variance, with Tukey- b post-hoc tests, with a p < 0.05 significance level. Higher education, abstinence from sleep aids, longer time in active duty service, and being on active duty were correlated with better sleep and lower anxiety. Greater sleep disturbance, poor sleep quality, and sleepiness-related daytime dysfunction were associated with greater anxiety and slower response times, and lower response accuracy. Statistically controlling for anxiety diminished the magnitude and significance of the correlations between sleep and cognitive performance, suggesting that reducing anxiety will improve sleep and diminish cognitive performance effects. These findings suggest the need for addressing both sleep and anxiety for those with diagnosed sleep disorders, as well as using a procedural systems approach to decrease anxiety during missions that demand outstanding cognitive performance. [ABSTRACT FROM AUTHOR]

Unhealthy sleep can interfere with U.S. military service members affective and cognitive functioning, and increase accident and injury risks. This study examined the relationship between U.S. active duty and veterans' (n = 233) self-reported sleep (Pittsburgh Sleep Quality Index), anxiety (Zung Self-Rating Anxiety Scale), and cognitive performance (Automated Neuropsychological Assessment Metric). Statistical analyses included Pearson product moment correlations and multivariate analysis of variance, with Tukey-b post-hoc tests, with a p < 0.05 significance level. Higher education, abstinence from sleep aids, longer time in active duty service, and being on active duty were correlated with better sleep and lower anxiety. Greater sleep disturbance, poor sleep quality, and sleepiness-related daytime dysfunction were associated with greater anxiety and slower response times, and lower response accuracy. Statistically controlling for anxiety diminished the magnitude and significance of the correlations between sleep and cognitive performance, suggesting that reducing anxiety will improve sleep and diminish cognitive performance effects. These findings suggest the need for addressing both sleep and anxiety for those with diagnosed sleep disorders, as well as using a procedural systems approach to decrease anxiety during missions that demand outstanding cognitive performance. [ABSTRACT FROM AUTHOR]

Mindfulness meditation training has been shown to reduce stress and improve short-term memory for military personnel. However, no studies have investigated the effects of in-person and virtual world (VW) mindfulness training on Post-Traumatic Stress Disorder (PTSD) or Attention Deficit Hyperactivity Disorder (ADHD) symptoms. In this study, U.S. military active duty service members and veterans were pseudo-randomized into two mindfulness training groups: in-person (IP) and online via a VW, and a wait-list control group. Volunteers answered a demographic questionnaire, and completed the PTSD Checklist-Military Version (PCL-M) and ADHD Current Symptoms Scale before and after training. The results showed practical and clinically relevant reductions in PTSD symptoms, particular for the IP group, but did not show statistical relevance with hypothesis testing. Results also showed post-training reductions in ADHD symptoms for both IP and VW groups, but no change for the control group. To investigate the effects of initial ADHD symptoms, IP and VW groups were combined into a single Mindfulness Training group. Those with high-initial ADHD symptoms attending training showed improvements, but the control group did not. These results expand research on the mindfulness training, and suggest that IP mindfulness training, rather than VW training, may be of greater benefit for those with PTSD symptoms, while either delivery system appears adequate for reducing attentional symptoms. [ABSTRACT FROM AUTHOR]

This Viewpoint reviews the many factors contributing to underrepresentation of Black physicians in US medical training pipelines and the health care workforce, and urges actions to dismantle structural barriers to Black medical school enrollment and achieve racial parity in the profession. [ABSTRACT FROM AUTHOR]

One method to discover possible reasons why individuals fail academic training is to ask them. However, self-report information can be difficult to trust, especially if students are perceived as having something to lose if they are honest. The purpose of this study was to identify potential reasons students fail (or do well) in their training as reported by 4 groups: those who failed the program (F) (n=28) and a peer (F-P) (n=28); and those who passed with a grade of B or above (P) (n=101) and one of their peers (P-P) (n=32). Statistical analysis included chi-square (χ2) test statistics and t tests with a P<.05. Only findings considered “external” to students are included here, including class structure and schedule, instructors and teaching, support systems, and sleep. Few differences were found between peer reports and self reports by students who passed or students who failed their program. On the positive side, both P and F students indicated they could get individual attention even with large classes, having good support systems, and bonding well with their unit. On the negative side, P and F students reported difficulty staying focused during long class hours, and F students felt teaching methods made it difficult to succeed and struggled with the fast pace of the course (P<.05). More than half of all students reported sleeping between 5 and 6 hours per night, but those who failed more often reported sleeping only 3 to 4 hours per night (P<.05). These findings highlight areas of organizational strength, as well as areas of difficulty for students, which will permit administrators to set goals and perhaps tailor their programs to reduce attrition. [ABSTRACT FROM AUTHOR]

Menopause is a naturally occurring “equal opportunity” event that every woman who lives beyond the age of approximately 52 years will experience. During the next 20 years, approximately 3.5 million African American women, 2 million Latinas, and 1 million Asian American women will enter the menopause. How a woman approaches the menopausal transition depends on a number of factors, from educational level to socioeconomic status; health-related factors, including stress; and marital status. Increasingly, the roles of race and ethnicity, as they relate to menopausal symptoms, are being explored. Understanding similarities and differences among women of color in perceptions, attitudes, and expectations surrounding the menopause can help provide culturally appropriate care and promote lifestyles that may decrease symptoms and increase quality of life. For example, minority women are usually the gatekeepers for healthcare for themselves and their families and have a highly developed social support network, often including extended family, a church community, and involvement in sororal or social organizations. In the future, research on menopausal symptoms among women of different racial/ethnic groups should focus on exploring in greater detail the effect of dietary factors and body mass index, additional evaluation of pituitary sensitivity, and use of complementary and alternative medicines in symptom management, with a better understanding of the risks and benefits of such therapies. [Copyright &y& Elsevier]

The aims of this research were to determine whether performance on the Clock Drawing Test (CDT) could accurately distinguish between older patients with depression and elder patients with depression and previously undocumented executive dysfunction and to determine if there was a correlation between CDT and depression severity. The authors studied 52 patients consecutively admitted to a geriatric psychiatry inpatient unit of a university hospital who met DSM-IV criteria for major depression or depression not otherwise specified but had no concurrent diagnosis of dementia. All the subjects completed the Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (DRS), and the CDT, as well as the Geriatric Depression Scale (GDS). The patients were divided into 2 subgroups based on the DRS score: <129 (cognitive impairment) versus ≥129. Results indicated that the depressed patients with a score of DRS <129 had significantly lower CDT scores than did patients with DRS ≥129 and normal comparison subjects (P < .01). The results support the hypothesis that CDT score is lower in elderly depressed patients with executive dysfunction versus nondepressed seniors as well as depressed patients without executive dysfunction. [ABSTRACT FROM AUTHOR]

Presents a study which examined team work in the bar lifting strength of army personnel. Importance of knowing the relationship between individual and team lifting capacity; Methodology used to conduct the study; Results of the study.

While marksmanship is a critical skill for military personnel, some service members experience difficulty in attaining and maintaining marksmanship qualifications. Temporal training may improve marksmanship performance, since rhythm and timing are critical for coordinated movement. In this study, we examined the effect of neurocognitive temporal training (NTT) on military personnel's marksmanship performance. We randomly assigned 41 active duty U.S. Army service members with prior marksmanship training into an NTT group that received 12 NTT training sessions (N = 18) and a Control group (N = 23) that received no NTT training. We measured marksmanship at baseline (pretest) and following either NTT (posttest) or, for the Control group, a comparable time period. We quantified marksmanship during 2 tasks of firing 5 self-paced shots at stationary 175 m and 300 m targets (Task 1) and firing at 50 moving and stationary targets of varying distances (Task 2). We recorded three measures of accuracy and three measures of precision (including Total Path Length, a unique measure quantifying shot-to-shot variability) for the first task, and we recorded one accuracy measure for the second task. To determine group differences for pretest versus posttest, we used multivariate analysis of variances for Task 1 and a mixed-model analysis of variance for Task 2. Results revealed significantly reduced variability and improved precision when firing at the 175 m target for the NTT group compared with the Control group (p <.05), but there were no significant group differences on other measures. While these results suggest the utility of neurocognitive timing and rhythm training for marksmanship precision, additional research is needed and should include varied training regimens, comparisons of expert versus novice shooters, additional outcome measures, and a larger participant sample. [ABSTRACT FROM AUTHOR]

Menopause is a naturally occurring “equal opportunity” event that every woman who lives beyond the age of approximately 52 years will experience. During the next 20 years, approximately 3.5 million African American women, 2 million Latinas, and 1 million Asian American women will enter the menopause. How a woman approaches the menopausal transition depends on a number of factors, from educational level to socioeconomic status; health-related factors, including stress; and marital status. Increasingly, the roles of race and ethnicity, as they relate to menopausal symptoms, are being explored. Understanding similarities and differences among women of color in perceptions, attitudes, and expectations surrounding the menopause can help provide culturally appropriate care and promote lifestyles that may decrease symptoms and increase quality of life. For example, minority women are usually the gatekeepers for healthcare for themselves and their families and have a highly developed social support network, often including extended family, a church community, and involvement in sororal or social organizations. In the future, research on menopausal symptoms among women of different racial/ethnic groups should focus on exploring in greater detail the effect of dietary factors and body mass index; additional evaluation of pituitary sensitivity; and use of complementary and alternative medicines in symptom management, with a better understanding of the risks and benefits of such therapies. [Copyright &y& Elsevier]

The article focuses on the recent Supreme Court ruling in favor of ending the consideration of race in university admissions, which has implications for medical school admissions and diversity. The authors emphasize the importance of diversity in medicine and suggest potential strategies to support diversity while complying with the Court's decision and they also highlight the potential consequences of this decision on healthcare and medical workforce diversity.

Background: Plants are used in traditional healing practices of many cultures worldwide. Momordica balsamina is a plant commonly used by traditional African healers as a part of a treatment for HIV/AIDS. It is typically given as a tea to patients with HIV/AIDS. Water-soluble extracts of this plant were found to contain anti-HIV activity. Methods: We employed cell-based infectivity assays, surface plasmon resonance, and a molecular-cell model of the gp120-CD4 interaction to study the mechanism of action of the MoMo30-plant protein. Using Edman degradation results of the 15 N-terminal amino acids, we determined the gene sequence of the MoMo30-plant protein from an RNAseq library from total RNA extracted from Momordica balsamina. Results: Here, we identify the active ingredient of water extracts of the leaves of Momordica balsamina as a 30 kDa protein we call MoMo30-plant. We have identified the gene for MoMo30 and found it is homologous to a group of plant lectins known as Hevamine A-like proteins. MoMo30-plant is distinct from other proteins previously reported agents from the Momordica species, such as ribosome-inactivating proteins such as MAP30 and Balsamin. MoMo30-plant binds to gp120 through its glycan groups and functions as a lectin or carbohydrate-binding agent (CBA). It inhibits HIV-1 at nanomolar levels and has minimal cellular toxicity at inhibitory levels. Conclusions: CBAs like MoMo30 can bind to glycans on the surface of the enveloped glycoprotein of HIV (gp120) and block entry. Exposure to CBAs has two effects on the virus. First, it blocks infection of susceptible cells. Secondly, MoMo30 drives the selection of viruses with altered glycosylation patterns, potentially altering their immunogenicity. Such an agent could represent a change in the treatment strategy for HIV/AIDS that allows a rapid reduction in viral loads while selecting for an underglycosylated virus, potentially facilitating the host immune response. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: This 7-year, prospective, matched-cohort, clinical study evaluated the effects of intramuscular depot medroxyprogesterone acetate (DMPA) (150 mg/mL) on bone mineral density (BMD) in women aged 25–35 years. Methods: Bone mineral density changes in new DMPA-IM users (n=248) were compared with those in women using nonhormonal contraception (n=360) for up to 240 weeks of treatment and 96 weeks of posttreatment follow-up (in subjects receiving ≥1 dose). Results: At week 240 of treatment, mean percentage changes from baseline in DMPA-IM vs. nonhormonal subjects were: −5.16% (n=21) vs. +0.19% (n=65), total hip (p<.001); −5.38% (n=33) vs. +0.43% (n=105), lumbar spine (p<.001). At week 96 posttreatment, these values were: −0.20% (n=25) vs. +0.84% (n=43), total hip (p=.047); −1.19% (n=41) vs. +0.47% (n=66), lumbar spine (p=.017). Conclusions: These results show BMD declines during DMPA-IM use; following discontinuation, significant increases in BMD occur through 96 weeks posttreatment. [Copyright &y& Elsevier]