Ethical Implications of Mentor Influence on Career Choices in Dermatology.

Mentorship is a critical aspect of personal and professional development throughout anyone's life. Unlike many other fields, a medical career is a long multistep process that can begin in high school and continue throughout a physician's career. When considering competitive specialties such as dermatology, mentors are increasingly crucial in helping students successfully match to programs of their choice, but the variability and extent of mentorship can raise ethical concerns. We discuss the evolution of mentorship in dermatology and the potential ethical issues involved. We propose possible solutions to the ethical conflict between mentor and mentee.

Drastic hourly changes in hand hygiene workload and performance rates: A multicenter time series analysis.

BACKGROUND: High hand hygiene (HH) workload is a commonly cited barrier to optimal HH performance. The objective of this study was to assess trends of HH workload as defined by HH opportunities (HHO) and performance rates over different timescales using automated HH monitoring system data. METHODS: This multiyear retrospective observational study was conducted in 58 inpatient units located in 10 North American hospitals. HHO and HH rates were analyzed by time series mixed effects general additive model. RESULTS: Median HH rates peaked at 50.0 between 6 and 7 AM with a trough of 38.2 at 5 PM. HHO over hours in a day were the highest at 184 per hospital unit per hour at 10 AM with a trough of 49.0 between 2 and 3 AM. Median rates for day and night shifts were 40.8 and 45.5, respectively (P = .078). Weekend day shift had the lowest median rate (39.4) compared with any other 12-hour shift (P < .1018). The median rates and HHO varied little across days in a week and months. CONCLUSIONS: HH workload and performance rates were negatively correlated and changed drastically over hours in a day. Hospitals should consider HH workload in the development and timely delivery of improvement interventions.

Ethics of Dynamic and Differential Pricing for Cosmetic Procedures.

Patient demand for procedures has increased in the evolving landscape of cosmetic dermatology. This has been fueled, in part, by social media and the growing normalization of cosmetic enhancements; however, this has led some patients to have potentially unrealistic expectations, placing undue pressure on dermatologists to meet these often unrealizable demands. This pressure is further exacerbated by patients who are seen as difficult, demanding, and time-consuming and who may require extensive counseling. Physicians may adopt dynamic or differential pricing strategies to offset the additional time and effort these patients require. We discuss the ethical concerns surrounding these pricing strategies in the cosmetic sphere, highlight the importance of transparency in pricing, and offer suggestions to promote clarity and fairness in cosmetic dermatology practices.

Congenital Erythropoietic Porphyria: A Case of Hepatic Failure and Angioedema Following Ferrous Sulfate Supplementation.

This report describes an unusual case of a young anemic female who experienced acute hepatic insufficiency and angioedema after ferrous sulfate consumption. Her primary diagnosis of congenital erythropoietic porphyria (CEP) was revealed after a detailed dermatologic examination and laboratory data. The patient was treated with IV methylprednisolone along with red blood cell transfusion, vitamin supplementation, and wound care. Our case report emphasizes the importance of physician awareness of CEP since it is a rare disease that tends to mimic other chronic porphyrias, various drug reactions, and collagenopathies.

Theta-band neural oscillations reflect cognitive control during language processing.

As we interpret language moment by moment, we often encounter conflicting cues in the input that create incompatible representations of sentence meaning, which must be promptly resolved. Although ample evidence suggests that cognitive control aids in the resolution of such conflict, the methods commonly used to assess cognitive control's involvement in language comprehension provide limited information about the time course of its engagement. Here, we show that neural oscillatory activity in the theta-band (∼3-8 Hz), which is associated with cognitive control in nonlinguistic tasks like Stroop and Flanker, provides a real-time index of cognitive control during language processing. We conducted time-frequency analyses of four electroencephalogram data sets, and consistently observed that increased theta-band power was elicited by various kinds of linguistic conflict. Moreover, increases in the degree of conflict within a sentence produced greater increases in theta activity. These effects emerged as early as 300 ms from the onset of the initiating event, indicating rapid cognitive-control recruitment during sentence processing in response to conflicting representations. Crucially, the effect patterns could not be ascribed to processing difficulty that is not due to conflict (e.g., semantic implausibility was neither necessary nor sufficient to elicit theta activity). We suggest that neural oscillations in the theta-band offer a reliable way to test specific hypotheses about cognitive-control engagement during real-time language comprehension. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Ethics of Residency Candidates Using Application Consulting Services.

While the prevalence is still being determined, more medical students are utilizing application consulting companies when applying to competitive residencies such as dermatology. We outline the structure of these companies, the scope of services provided, and the costs associated. We also discuss the ethical implications for the use in the residency application process of such firms and the impact of these practices on the candidate selection process. Finally, we offer possible solutions and measures that mitigate the impact of the use of consulting firms in residency applications. Application consulting services are meant to assist clients in maximizing their chances for a successful application cycle. Many companies cater to both prospective residency and pre-medical candidates, including "Med School Insiders," "BeMo Academic Consulting," and "Elite Medical Prep." The scope of application consulting services is vast. Clients can request services such as personalized school selection, application advising, document preparation review [e.g., curriculum vitae (CV), personal statements, and essays), electronic residency application service (ERAS)], and interview coaching. Another service offered is residency match advising, which details specific requirements programs desire. Prospective clients would gain a significant advantage, mainly when used at the outset of medical school training when planning a trajectory for competitive specialties. We review the ethical issues associated with using these consulting services.

Children with hemoglobin C or S trait have low serologic responses to a subset of malaria variant surface antigens.

Children with hemoglobin AC or AS have decreased susceptibility to clinical malaria. Parasite variant surface antigen (VSA) presentation on the surface of infected erythrocytes is altered in erythrocytes with hemoglobin C (Hb AC) or sickle trait (Hb AS) mutations in vitro. The protective role of incomplete or altered VSA presentation against clinical malaria in individuals with Hb AC or AS is unclear. Using a high-throughput protein microarray, we sought to use serological responses to VSAs as a measure of host exposure to VSAs among Malian children with Hb AC, Hb AS, or wildtype hemoglobin (Hb AA). In uncomplicated malaria, when compared to Hb AA children, Hb AC children had significantly lower serological responses to extracellular Plasmodium falciparum erythrocyte membrane protein-1 (PfEMP1) domains but did not differ in responses to intracellular PfEMP1 domains and other VSAs, including members of the repetitive interspersed family (RIFIN) and subtelomeric variable open reading frame (STEVOR) family. Healthy children with Hb AC and Hb AS genotypes recognized fewer extracellular PfEMP1s compared to children with Hb AA, especially CD36-binding PfEMP1s. These reduced serologic responses may reflect reduced VSA presentation or lower parasite exposure in children with Hb AC or AS and provide insights into mechanisms of protection.

Limericks for Myocardial Recovery and Regeneration.

Limericks are an easy, casual, and entertaining way to have fun with the English language. Creating them can be an engaging pastime to assist in memorizing important anatomic relationships necessary for being an interventional cardiologist or simply an intellectual exercise that provides respite after a hectic day in the cardiac catheterization laboratory, surgical suite, outpatient clinic, or intensive care unit. Interest in this form of poetry often dates back to when we, as children, were taught the simplistic rhyming pattern of a traditional limerick or learned one during adolescence. As we age, our limericks often became more humorous, personal, and bawdy. That evolution is the beauty of this poetic form. For this edition of Poet's Pen, we invited Dr. Marshall S. Flam, a noted dabbler in the limerick world, to pen "Limericks for Myocardial Recovery and Regeneration" to accompany the theme of this issue.

Do help-seeking adolescents report more psychotic-like experiences than young adults on the 16-item version of the prodromal questionnaire (PQ-16)?

AIM: To compare psychotic-like experiences (PLEs) in adolescents and young adults referred to the Mental Health Services (MHSs). METHODS: Participants scored the 16-item Prodromal Questionnaire (PQ-16) as part of the intake procedure. Data on the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification and demographic data were collected. RESULTS: The PQ-16 was completed by 13 783 respondents (mean age 24.63 years, SD = 6.09; 62.6% female). Overall, the scores on the PQ-16 were not higher for adolescents (11-17 years; m = 4.84, SD = 3.62) than for young adults (18-35 years; m = 5.47, SD = 3.85). On PQ-16 item level, adolescents reported seeing and hearing things more than adults did. Across all age groups, males scored lower on the PQ-16 than females. Specifically, adolescent males scored lower than other participants. For adolescents and young adults alike, PQ-16 scores were higher for participants with borderline personality disorder, PTSD, and mood disorder than for those with other DSM classifications. CONCLUSIONS: Although help-seeking adolescents did not score higher on the PQ-16 than help-seeking young adults, more of them reported perceptual anomalies. Irrespective of age, participants with borderline personality disorder, PTSD and mood disorder scored higher on the PQ-16 than those with other DSM classifications.

Ethics of residency programs and fellowships that electively withdraw from the National Resident Matching Program.

The National Resident Matching Program, known as "The Match" facilitates the placement of medical graduates into residency and fellowship programs in the United States. Programs may opt out of The Match for various reasons. The selective and intermittent withdrawal of programs from The Match raises ethical concerns surrounding fairness, transparency, beneficence, autonomy, and justice for applicants. We discuss these issues, present the history behind The Match, and offer suggestions to promote fairness.

SRPK3 Is Essential for Cognitive and Ocular Development in Humans and Zebrafish, Explaining X-Linked Intellectual Disability.

OBJECTIVE: Intellectual disability is often the outcome of neurodevelopmental disorders and is characterized by significant impairments in intellectual and adaptive functioning. X-linked intellectual disability (XLID) is a subset of these disorders caused by genetic defects on the X chromosome, affecting about 2 out of 1,000 males. In syndromic form, it leads to a broad range of cognitive, behavioral, ocular, and physical disabilities. METHODS: Employing exome or genome sequencing, here we identified 4 missense variants (c.475C > G; p.H159D, c.1373C > A; p.T458N, and c.1585G > A; p.E529K, c.953C > T; p.S318L) and a putative truncating variant (c.1413_1414del; p.Y471*) in the SRPK3 gene in 9 XLID patients from 5 unrelated families. To validate SRPK3 as a novel XLID gene, we established a knockout (KO) model of the SRPK3 orthologue in zebrafish. RESULTS: The 8 patients ascertained postnatally shared common clinical features including intellectual disability, agenesis of the corpus callosum, abnormal eye movement, and ataxia. A ninth case, ascertained prenatally, had a complex structural brain phenotype. Together, these data indicate a pathological role of SRPK3 in neurodevelopmental disorders. In post-fertilization day 5 larvae (free swimming stage), KO zebrafish exhibited severe deficits in eye movement and swim bladder inflation, mimicking uncontrolled ocular movement and physical clumsiness observed in human patients. In adult KO zebrafish, cerebellar agenesis and behavioral abnormalities were observed, recapitulating human phenotypes of cerebellar atrophy and intellectual disability. INTERPRETATION: Overall, these results suggest a crucial role of SRPK3 in the pathogenesis of syndromic X-linked intellectual disability and provide new insights into brain development, cognitive and ocular dysfunction in both humans and zebrafish. ANN NEUROL 2024.

Screened out: Ethically managing sunscreen misinformation by social media influencers.

Rampant social media use allows individuals and organizations to broadcast their views to scoping audiences with minimal requirements for vetting or validating shared information. We discuss the impact of disinformation transmitted via social media and use the recent example of false information broadcast concerning sunscreens recently reported in the Wall Street Journal. We also highlight the ethical consequences of social media influencers who disseminate unchecked information and the need for health care professionals to be involved to enhance accountability, goodwill, and truthfulness.