Infertility impacts 1 in 4 female physicians which is twice a s high in comparison to the women in the general population. As the proportion of women in the medical workforce
continues to rise, it becomes crucial to address reproductive health issues for female physicians. This study aims to a s s e s s medical students' knowledge of fertility, risk factors for infertility, and available treatment options.

Assessing Medical Students' Understanding of Fertility and Infertility: Implications for Physician Well-being and Reproductive Health

Background/Objective: Suicide is a public health crisis for children
and adolescents. Suicidal ideation and suicidal behavior are
important predictors of suicide risk. Peripheral biological correlates of
suicidal ideation and behavior can guide precision care of suicidality.
To assess the current literature landscape of the field, we conducted
a systematic review of peripheral biological correlates for suicidal
ideation and suicidal behavior of children and adolescents.

Method: We searched through 4 databases (PubMed, the Cochrane
Library, Embase, and PsychInfo) from the earliest date to April 2023.
We used MeSH terms with keyword synonyms related to children
and adolescents, suicidality, and peripheral biological correlates. We
excluded reviews, editorials, protocol papers, abstracts, conference
proceedings, abstracts, and non-English studies. We employed two
independent reviewers for the title/abstract screening and full-text
screening. We followed PRISMA guidelines for reporting systematic
review and used JBI risk of bias tool for the screened studies.

Results: A total of 27980 articles were screened by reviewers, and
133 full texts were extracted. The peripheral biological markers are
grouped into physiologic stress response, serotonin system,
neuromodulators, immune system/inflammation, lipid/metabolism,
HP Axis, genetics, and other.

Conclusion: This systematic review provides a valuable synthesis of
the current literature on peripheral biological correlates for suicidality
in children and adolescents. The review identifies potential
peripheral correlates that can serve as valued biomarkers for
suicidality, and areas of needed studies. The review also notes the
feasibility of meta-analysis of specific peripheral biological markers
on this topic. 


Peripheral biological correlates of suicidal ideation and suicidal behavior in children and adolescents: a systematic review

Background: National data demonstrates that on average, people are treated differently by doctors based on their gender. Unfortunately, this impacts the quality of care patients receive thereby altering health outcomes. This variation ranges from how seriously a patient’s pain is perceived to whether “unusual” signs of a myocardial infarction are noted. Even though the origin of this problem is often subconscious rather than malicious, it is our duty as future healthcare providers to ameliorate implicit gender biases in order to provide patient centered, equitable care. 

Methods: Two medical students under the guidance of two faculty members piloted a mandatory implicit gender bias curricular thread designed for preclinical years. The thread is composed of eight 15-minute sessions spanning the course of two years. The objective is to note if a sensitive topic such as implicit bias is better addressed in shorter, repetitive bursts by peers versus a hypothetical formal alternative led by faculty; and if a peer-led structure designed to remove power differentials and concerns over grades leads to more impactful education and growth. Session content ranges from real case studies within the medical school to bystander training aimed at preparing students to be allies during their clinical rotations. After each session, a survey is distributed to garner feedback and gauge the impact of the curriculum.

Results: Post-presentation survey data demonstrated that 86.1% of students (n=453) preferred to hear these presentations from peers alone, 1.8% preferred an option presented by both peers and faculty members, 6.8% had no preference, and 5.3% preferred an option taught by faculty members alone. Another survey question asked students to rank the statement “I gained something valuable from this presentation” on a scale of one to ten with one signifying “strongly disagree” and ten signifying “strongly agree.” For the first presentation, the average rank for the session was 6.9, the median was 7 and the mode was 10. For the second presentation, the average rank for the session was 8.4, the median was 9, and the mode was 10. 

Conclusion: Findings suggest that peer-to-peer teaching may be an effective model to ameliorate implicit bias in healthcare by leveraging the unique perspective that students develop throughout their pre-clinical and clinical experiences. This innovative approach can be further extended and tested throughout medical training for a wider reach.


Implicit Gender Bias: Development of a Peer-led Curriculum for Pre-clinical Years

Background
Medical school involves a rigorous curriculum to train future physicians, yet many programs do not emphasize issues specific to the care of marginalized populations. Little research has examined medical student confidence in serving such populations prior to entering clinical rotations. A student-run elective was created to provide enhanced didactic and hands-on diversity training to interested first and second-year medical students. Students engaged with lectures on health disparities faced by marginalized communities and then applied learning clinically in standardized patient encounters.
Methods
A pre- and post-test Likert-style survey was administered to assess perceived clinical confidence, competence, and skill working with populations covered in the elective - lesbian, gay, and bisexual; transgender; of color; with mental disabilities; with physical disabilities; English as Second Language (ESL); female; with sexually related issues; with history of trauma/abuse. XX students completed the survey at both time points. Results were de-identified for data analysis.
Results
Prior to the course, the average self-reported confidence working with marginalized communities was 2.91 (1 – “completely unconfident” to 5 – “completely confident”) with a mode of 2 (unconfident). Lowest confidence was reported with transgender patients and patients with mental disabilities. Competence and skill were similarly surveyed with averages of 2.74 and 2.52, respectively, with modes of 3 (neutral).
Following the course, average self-reported confidence had increased to 4.02 with a mode of 4 (somewhat confident). Post-course confidence increased in working with transgender patients by 88%, with patients with mental disabilities by 62%, with ESL patients by 60%, and with traumatized/abused patients by 48%. Self-reported competence and skill levels increased to averages of 3.54 and 3.46, respectively.
Conclusion
This elective sought to enhance medical students confidence, competence, and skill in working with marginalized patient populations. Preliminary results suggest that awareness of and exposure to issues specific to these populations demonstrated improvement in all three domains.

Diversity and inclusion in clinical practice enhancement course: an educational intervention to increase medical student clinical confidence working with underserved communities

Background: Anxiety disorders have complex etiologies. However, several key risk factors have been identified, such sex, stress exposure and more recently neuroinflammation. In response to stress, the Hypothalamus-Pituitary-Adrenal (HPA) axis and the Locus coeruleus (LC)-Norepinephrine (NE) system are triggered. While beneficial in the short-term, chronic, and persistent stress exposure results in HPA axis and LC-NE system dysregulation and neuroinflammatory changes, often leading to anxiety-like phenotypes in animal models. Despite the current findings, the role of sex and the link between chronic stress exposure, neuroinflammation, and LC dysregulation in the development of anxiety disorders has not been elucidated.

Methods: This study demonstrates the sex-dependent neuroinflammatory and neuronal changes in the rodent LC using elevated plus maze (EPM), ex-vivo electrophysiology, and immunohistochemistry (IHC). To model chronic stress, male and female adolescent (8-week-old) Sprague Dawley rats were restrained and exposed to predator odorant for two hours per day for ten days over two consecutive weeks.

Results: Two-way ANOVA analysis of EPM reveals a main effect of stress in open arm time (F1,12=5.127, p=0.0429), suggesting increased anxiety-like behaviors in response to chronic stress. Likewise, a main effect of stress was also noted in LC spontaneous firing frequency (F1,73=6.394, p=0.0136) along with other measures of LC neuronal physiology such as Action potential (AP) threshold, afterhyperpolarization, and activation gap. IHC staining for IBA-1, a microglial marker, and Major histocompatibility II (MHC-II), an activation marker within the LC, reveals a reveal a significant increase in microglia (p=0.0001) and activated microglia (p=0.0351) in stressed males relative to control males. In contrast, an opposite trend was noted in females. Furthermore, correlation analysis between percent weight change, a measure of stress induction, and IBA-1 cell counts within the LC demonstrates a significant negative correlation in males (p=0.0113) and no correlations in females suggesting increased male LC neuroinflammation in response to chronic stress.

Conclusion: Our results indicate that chronic stress exposure induces sex-dependent LC neuroinflammation, which may lead to alterations in LC neuronal physiology and influence rodent anxiety-like behaviors. 


Chronic stress induces sex-dependent neuroinflammation and neuronal physiology alterations in the rodent Locus coeruleus

Background
Type 2 diabetes mellitus (T2DM) is a global epidemic affecting approximately 9.3% of the world population and has an all-cause mortality rate of 8.5%. An increasing number of patients with chronic conditions access online resources for educational purposes, with recent statistics suggesting that up to 80% of adults in the United States have obtained medical information through online search engines. This study aims to assess the accuracy of the information offered by artificial intelligence (AI) chatbots to T2DM questions using ChatGPT.

Methods:
An initial set of questions about T2DM and its complications were obtained from an online platform such as American Diabetes Association. Subsequently, these questions underwent a thorough evaluation by physicians well-versed in diabetes management before being presented to ChatGPT. Each question was introduced to ChatGPT three times, and the responses were recorded. Two study staff reviewed the three sets of responses and summarized the majority response that was repeated at least twice. Data were reviewed by two board-certified internal medicine physicians with a minimum of 11 years of experience. Responses were categorized into appropriate; provide accurate information that meets the standard of care, inappropriate; contain erroneous information but meets the minimal standard of care, and unreliable; the response provides inconsistent content that does not meet the standard of care.


Results:
Of the original 110 questions, 70 were included in the final dataset. Out of the 70 summarized responses generated by ChatGPT, 89.3% were categorized as appropriate, indicating that the AI model provided accurate information meeting the standard of care for Type 2 diabetes management and its associated complications. On the other hand, 10% of the responses were deemed inappropriate, containing errors but still meeting the minimal standard of care in addressing the questions. The remaining 0.7% of ChatGPT's responses were classified as unreliable, displaying inconsistent content that did not meet the standard of care in terms of accuracy and reliability


Conclusion
ChatGPT offers a promising source of information for educating patients with T2DM. The study demonstrates high accuracy in providing appropriate responses that align with the standard of care, positioning it as a useful tool in enhancing patient education and diabetes management.


Artificial Intelligence Shifting the Paradigm of Diabetes Care

Background and Objective: The complexities of the human psyche are tough to capture by a Cartesian system. Unfortunately, the medical enterprise takes pride in simplifying the human experience and disease into neatly organized diagnoses. While psychiatry as a field is much better than others in using the phenomenological approach to illness, this art has been slowly replaced with the rigid diagnostic criteria enshrined in the Diagnostic and Statistical Manual (DSM), now in its 5th edition. The phenomenological approach to diagnosis has been criticized for being overly subjective, lacking in theoretical framework, and relying on the metaphysical (spiritual or theological) aspects of the human self. 
However, experienced psychiatrists use their personal and clinical experiences to intuitively understand their patients’ mental-emotional struggles to arrive at the diagnoses without rigidly following the DSM. The objective is to fill the knowledge gap between the theory and the practice of the phenomenological approach to psychiatric diagnosis by the practice of empathic listening (EL). Additionally, we provide empirical and EEG (electroencephalographic) evidence for the theoretical framework and metaphysical aspects of EL. 
Methods and Results: Five detailed interviews were conducted using EL. Analytical autoethnography, a qualitative research method using Grounded Theory, was used to develop narratives. Verbal and non-verbal statements, the subjective thoughts and feelings of the interviewer, and the objective events in these narratives were open-coded to generate qualitative data, which are inductively analyzed to arrive at the Mindfulness-to-Transcendence (MT) framework of the EL process. Additionally, the neurofeedback/EEG recordings from the Brain-Computer-Interface (BCI) devices worn by the psychiatrist/provider and care recipients during their interviews revealed synchronized emergence of alpha/theta/gamma predominant waves which are reported as markers of mindfulness and Transcendence.
Discussion and Conclusion: The Transcendental state of mind is a metaphysical state that transpires during EL assessment. In such a state the psychiatrist’s assessment reaches beyond subjectivity, and their empathic understanding is free from self-identification and caregiver-burnout. Such a transcendental state empowers patients’ self-empathy, a first step in healing. 
This small pilot study serves as a proof of concept that EL assessment aides the phenomenological approach to psychiatric diagnosis. Without subjectivity, the diagnostic assessments may be more accurate than the currently prevalent Cartesian system. Additionally, EL care can prevent compassion burnout among clinical providers. In conclusion, the BCI-neurofeedback-informed EL assessment can be adapted to reinstate the phenomenological approach to psychiatric diagnostic assessment and care using DSM. Medical trainees may gain skills in EL assessments with BCI-evidence-based EL training in their curricula.


Brain-Computer-Interface Devices Informed Empathic Assessment in Psychiatry: Evidence from a Case Series Study

**Scoring is only possible in the semifinals hall**

**Abstract:**



The Neurological Examination: Overcoming Language Barriers to Increase Access to Patient-Directed Neurologic Care


Background: Estimated Glomerular Filtration Rate (eGFR) is the standard method for determining kidney function and chronic kidney disease (CKD) stage classification. In the Spina Bifida (SB) population, eGFR estimates from a creatinine-based equation may not accurately represent kidney function due to the lower muscle mass in this population. We hypothesized that estimating equations utilizing Cystatin-C (CysC) would yield different CKD classifications than Creatinine (Cr) – based equations for the adult SB population. 

Methods: We conducted a retrospective chart review of all patients seen in an adult urology clinic with a diagnosis of spina bifida from 2004-2021 that were managed in our urology clinic with creatinine and cystatin C values available. All patients were > 18 years old. A cross-sectional study of patients with a CysC and concurrent Cr measurement was performed; the most recent lab values were utilized if multiple existed. Three adult eGFR equations were utilized. Patients were staged based on CKD classification (GFR > 90, GFR 60-90, GFR <60). A Chi-square test was conducted to determine the difference in CKD classification based on each equation.

Results: A total of 105 SB patients (63% female) were included in cross-sectional analysis. The mean age was 33 ± 6.5 years. Medical comorbidities including diabetes (12.4%), hypertension (28.6%), obesity (34.2%) were noted. Table 1 shows the difference in eGFR and CKD classifications between equations. On Chi-square analysis, CKD classifications were significantly different by the type of equation used (p = 0.007). Pair-wise comparison showed that significance was driven by the difference between cystatin C and creatinine equations (p = 0.002) and the cystatin C and combined equations (p = 0.05). 

Conclusion: In an adult SB population, CysC-based equations result in lower eGFRs and different CKD classifications. Determining an appropriate eGFR measurement is essential to assessing and managing renal function in these medically complex patients.

Variability in Cystatin C and Creatinine-Based equations for Chronic Kidney Disease Staging in Adult Spina Bifida Patients

Background
Patients who present with cervical dystonia may also present with cervical myelopathy. This presentation can be problematic because patients with cervical myelopathy need fusion surgery such as an anterior discectomy and fusion (ACDF) to stabilize the spine and prevent damage to the spinal cord. The involuntary tremor caused by cervical dystonia can result in problems with boney fusion in the post-operative period. Deep Brain Stimulation (DBS) provides a potential solution to this problem when more conservative treatments like medication, halo vests, and botulinum toxin fail to reduce tremor.
Case Presentation
A 46-year-old female presented to our center with a chief complaint of neck pain. The patient also presented with bilateral upper extremity radiculopathy, paresthesia, and a myelopathic gait. She had a 15-year history of cervical dystonia and had tried various medications and botulinum toxin injections without resolution of symptoms. In addition to this the patient had cervical myelopathy caused by disc herniation at the C5-C6 and C6-C7 level. Although the patient was a candidate for ACDF, she was advised to have her dystonic tremor treated before ACDF to prevent pseudoarthrosis and hardware failure because of the tremor. The patient underwent bilateral DBS in the Globus pallidus interna (GPi) utilizing an Abbott InfinityTM DBS system. After placement of the DBS-GPi leads, batteries were placed, and the system was turned on which was able to provide significant relief of the patient’s tremor. The patient was followed up at 3 months and had a >75% reduction in her tremors. After the significant reduction in tremor, the patient underwent C5-C6 and C6-C7 ACDF at 6 months post DBS-GPi. The patient reported that the paresthesia had improved significantly, and the weakness had gradually improved at 3 months post ACDF. There was no radiographic evidence of hardware loosening or malalignment.
Discussion
The presentation of both Cervical Dystonia and Cervical Myopathy concurrently is a challenging couple of pathologies to manage. Bilateral DBS-GPi prior to ACDF is a viable strategy for managing these pathologies surgically. 


DBS before ACDF for a patient with Cervical Dystonia and Cervical Myelopathy

Background: Testicular infarction is a rare complication of epididymitis. We present a case of testicular infarction to highlight this complication and the role of ultrasound in aiding diagnosis to guide management.

Case Presentation: 26-year-old male, with recent admission for left epididymitis secondary to Multiple Drug Resistant Enterobacter, presented to the emergency department with a two-day history of progressively worsening left scrotal pain and swelling. Physical examination revealed left scrotal erythema and tenderness. Scrotal ultrasound demonstrated asymmetric enlargement and heterogeneous appearance of the left testicle consistent with left scrotal edema. The left testicle showed peripheral hypervascularity without intrinsic flow on color and spectral Doppler interrogation compatible with testicular infarction. In contrast, the right testicle was homogenous and with normal arterial and venous spectral Doppler flow. Management included intravenous antibiotic and urology consultation with subsequent partial orchiectomy. Patient’s hospital course was complicated by wound dehiscence and residual necrotic tissue requiring scrotal debridement and washout. After transition to oral antibiotics, he was discharged with outpatient follow-up with urology.

Discussion: Ultrasound with color flow Doppler is the primary method to diagnose testicular infarction secondary to epididymitis. Characteristics of testicular infarction include asymmetrically decreased or absent intrinsic testicular blood flow with or without increased peripheral flow. Although understanding of the pathophysiology of testicular infarction is evolving, arterial and venous insufficiency are suspected. Risk of global testicular infarction is low due to the testes receiving blood supply from the testicular, the deferential and cremasteric arteries. Persistent clinical symptoms and worsening imaging findings can warrant surgical intervention. In addition to spectral and color doppler, there is expanding utilization of contrast- enhanced sonography (CEUS) to increase sensitivity for testicular infarction. Testicular infarction is a rare but important diagnosis to consider in the setting of epididymitis that has management implications to prevent morbidity.

Treatment Failure of Epididymitis leads to Testicular Infarction

Background: Since the FDA has mandated a boxed warning on all psychostimulants due to risks for misuse and death, coupled with nationwide shortages, clinicians have utilized non-stimulants, such as alpha-2-agonists for hyperactivity/impulsivity and the norepinephrine reuptake inhibitor atomoxetine for inattention, as safer alternatives. However, these agents lack comparable efficacy with delayed onset compared to psychostimulants. Insurers require generic atomoxetine prior to covering Viloxazine ER (VER), a novel 5-HT2B antagonist, 5-HT2C partial agonist, and 5-HT7 antagonist. We wanted to know whether patients taking atomoxetine would experience improvement in ADHD symptoms after switching to VER.
Methods: 50 patients (35 children) received mean doses of atomoxetine 60 mg (25-100 mg once daily) followed by VER 300 mg (100-600 mg once daily) after 5-day atomoxetine washout. Both atomoxetine and VER were flexibly titrated according to FDA guidelines. The pediatric ADHD-Rating Scale-5 (ADHD-RS-5) and the Adult Investigator Symptom Rating Scale (AISRS) were completed prior to starting atomoxetine; 4 weeks after treatment with atomoxetine or upon earlier response or discontinuation due to side effects, whichever occurred first; same protocol after treatment with VER. We conducted a retrospective chart review of these 50 patients. Statistical analysis was performed using a within-subject, 2-tailed t-test with significance level of p < 0.05.
Results: From baseline total ADHD-RS-5 mean score (40.3+10.3), improvements were greater on VER (13.9+10.2) than atomoxetine (33.1+12.1) (t = -10.12, p < 0.00001), in Inattention (t = -8.57, p < 0.00001) and in Hyperactivity/Impulsivity (t = -9.87, p < 0.00001). From baseline total AISRS mean score (37.3+11.8), improvements were greater on VER (11.9+9.4) than atomoxetine (28.8+14.9) (t = -4.18, p = 0.0009), in Inattention (t = -3.50, p < 0.004) and in Hyperactivity/Impulsivity (t = -3.90, p < 0.002). 86% of patients on VER reported positive response by 2 weeks versus 14% on atomoxetine. 36% discontinued atomoxetine for side effects, including GI upset (6 patients), irritability (6), fatigue (5), insomnia (1) versus 4% who discontinued VER due to fatigue. 96% preferred VER over atomoxetine with 85% (22/26) able to taper psychostimulants following stabilization on VER. 
Conclusion: Pediatric and adult ADHD patients, who have experienced less than optimal response to atomoxetine, demonstrate rapid improvement in inattention and in hyperactivity/impulsivity with greater tolerability on viloxazine extended-release, which deserves consideration as a new first-line ADHD treatment option

Underline digital video library

Assessing Medical Students' Understanding of Fertility and Infertility: Implications for Physician Well-being and Reproductive Health

Peripheral biological correlates of suicidal ideation and suicidal behavior in children and adolescents: a systematic review

Implicit Gender Bias: Development of a Peer-led Curriculum for Pre-clinical Years

Diversity and inclusion in clinical practice enhancement course: an educational intervention to increase medical student clinical confidence working with underserved communities

Chronic stress induces sex-dependent neuroinflammation and neuronal physiology alterations in the rodent Locus coeruleus

Artificial Intelligence Shifting the Paradigm of Diabetes Care

Brain-Computer-Interface Devices Informed Empathic Assessment in Psychiatry: Evidence from a Case Series Study

The Neurological Examination: Overcoming Language Barriers to Increase Access to Patient-Directed Neurologic Care

Variability in Cystatin C and Creatinine-Based equations for Chronic Kidney Disease Staging in Adult Spina Bifida Patients

DBS before ACDF for a patient with Cervical Dystonia and Cervical Myelopathy

Treatment Failure of Epididymitis leads to Testicular Infarction

Viloxazine Extended-Release As A Paradigm Shift In The Treatment Of ADHD

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