Background:Despite increasing mental health diagnoses among physician trainees, fewer than one-third seek help due to stigma and fears of professional consequences. While national organizations have successfully advocated for licensing application reforms, trainees continue to cite licensure as a primary barrier, suggesting that additional deterrents may persist within application structure and content. Objective:To identify and quantify potential barriers to seeking mental health care within initial medical licensing applications beyond current recommendations regarding impairment-based questions and supportive language. Methods:This exploratory qualitative study analyzed initial allopathic medical license applications from all 50 US states and Washington, DC at 2 time points: in 2021 and between 2024 and 2025. Using inductive content analysis, authors identified emergent themes representing potential barriers and applied a coding scheme to quantify changes over time. Results:Five potential barriers were identified: application inaccessibility, unclear health question wording, scrutiny of training gaps, stigmatizing question grouping (mental health questions co-located with illegal/immoral activities), and uncertain privacy protections. From 2021 to 2025, improvements occurred in 4 domains: unclear language (11 to 6 states), training gap scrutiny (35 to 29 states), stigmatizing grouping (27 to 20 states), and privacy concerns (38 to 28 states). However, application accessibility worsened substantially (29 to 18 publicly accessible applications). Conclusions:Five distinct potential barriers persist in state medical licensing applications. Longitudinal analysis from 2021 to 2025 showed improvements in 4 domains, though application accessibility worsened substantially.
Thyroid cancer (TC) is the most common endocrine malignancy and has been increasing in incidence in the United States over the last few decades. Incidence and mortality rates are largely owed to papillary TC (PTC), as they constitute approximately 80% of TC cases. PTC is usually contained within the thyroid gland and has an excellent prognosis, with a 5-year survival rate of more than 90% following surgery. Many survivors still need ongoing surveillance, continued treatment, and lifelong thyroid hormone supplementation, while also undergoing the consequences of current therapeutics including hormone fluctuations, surgical complications, and radioactive iodine side effects. Therefore, novel treatments, including herbal medicine, have been suggested. General Nutraceutical Technology, LLC. has a library of over 300 compounds and we screened twenty from different herbs including Glycyrrhiza glabra and Phellodendri chinensis, to name a few. Literature has supported their immunomodulatory effects and therefore we determined their dose-dependent effects at 40 ug/mL, 20ug/mL, 10ug/mL, 5ug/mL, and 2.5ug/mL on PTC cells, K1 and TPC1. Cell viability was assessed with an XTT assay over three days. Those with the lowest IC50 were further screened for synergy through the calculation of an interaction index. Initial screening demonstrated dose-dependent reductions in cell viability over three days in several of the single-blind coded compounds, plateauing at 48 hours. Compounds C35L, C7Q, and C3I were among the lowest IC50 for K1 cells at 4.4ug/mL, 9.5ug/mL, and 23 ug/mL respectively. These compounds also had the most pronounced effects on TPC1 cells with determined IC50 of 8ug/mL, 9.8ug/mL, and 23 ug/mL, respectively. Synergistic interactions were evaluated and concluded that in K1 a combination of all three compounds reduced the IC50 to 4.565ug/mL after 72 hours of treatment (II=0.57). This data warrants further investigation, including the mechanism of cell viability reduction upon treatment using Trypan Blue Exclusion, Western Blot and Flow Cytometry. Apoptosis can be assessed through the protein expression of apoptosis markers by Western Blot and Annexin V/Propidium Iodide staining by Flow Cytometry. Flow Cytometry can also determine effects on the cell cycle. Natural compounds have demonstrated long-lasting effectiveness that is safe and able to regulate multiple targets at once with advantages to Western medicine being more readily available, more convenient, and affordable. Therefore, these novel natural compounds, especially in combination, may provide safe and inexpensive relief to PTC survivors. Michelle Carnazza, Nan Yang, Robert Werner, Raj K. Tiwari, Jan Geliebter, Xiu-Min Li. The effect of novel natural compounds on papillary thyroid cancer cell viability [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 615.
The National Academies of Sciences, Engineering, and Medicine recommends per- and polyfluoroalkyl substance (PFAS) blood testing for patients with risk of elevated exposure, and the Agency for Toxic Substances and Disease Registry (ATSDR) suggests PFAS blood testing based on exposure. Barriers to PFAS blood testing include cost, access to labs, and evolving laboratory methods. We quantify water and serum PFAS levels among a highly-exposed cohort in an area with groundwater contaminated by historical agricultural biosolid application. We compare the gold standard PFAS serum test with a commercial test and results from a one-compartment toxicokinetic model. Participants were adults (n = 30) whose household (n = 19) water had levels of the sum of six PFAS > 500 ng/L. Serum PFAS were measured using liquid chromatography-tandem mass spectrometry. Demographic and water consumption data were collected via telephone. Serum PFAS results from the commercial test were accessed via medical record. Statistical analysis included descriptive statistics and bivariate plots of serum levels. Perfluorohexanoic acid, perfluoroheptanoic acid (PFHpA), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorobutanesulfonic acid, perfluorohexanesulfonic acid (PFHxS), and perfluorooctanesulfonic acid (PFOS) were detected in 19 wells, and PFHpA, PFOA, PFNA, perfluorodecanoic acid, perfluoroundecanoic acid, PFHxS, and PFOS were detected in at least 19 participants' serum. In well water, PFOA and PFOS levels had geometric means (GMs) of 1749 ng/L (geometric standard deviation [GSD] 2.4) and 887 ng/L (GSD 19.7), respectively. In serum, PFOA and PFOS had GMs of 116.2 µg/L (GSD 13.5) and 58.3 µg/L (GSD 13.8), respectively. Our results are comparable with and had a wider mix of PFAS than other high-exposure cohorts. There was good agreement between the commercial and gold standard tests for PFOA, PFNA, and PFHxS, and mixed agreement between the gold standard test and modeled predictions, suggesting water-based toxicokinetic models of serum PFAS may be inadequate for assessing exposure in this population.
Objective To measure the ultra-acute effects of sport-related concussion in children using new normative reference values for the Child SCAT5. Design Observational cross-sectional study. Certified athletic trainers administered the Child SCAT5 on the sideline immediately after a concussion. Setting Middle school sports within a large public-school division in Virginia, USA participating in the George Mason University's Advancing Healthcare Initiatives for Underserved Students (ACHIEVES) Project. Participants Fifty-three children with an ultra-acute concussion (ages 11–13, 41% girls) compared to a normative sample of 984 middle school children. Outcome Measures The Child SCAT5 is comprised of the following scores: Symptoms, Symptom Severity, Standardized Assessment of Concussion-Child Version (SAC-C), and Modified Balance Error Scoring System (mBESS). Main Results Children's ultra-acute post-injury Child SCAT5 scores were significantly worse than the normative reference values, with small effect sizes (p<.01, effect sizes [r]=-.14 to -.09). Most children had one or more post-injury scores reflecting mild or greater impairment using the normative reference values (45/53; 84.9%). Moreover, the majority of children had at least one score reflecting moderate or greater impairment (n=36/53; 67.9%). Conclusions Acutely concussed children, as a group, had Child SCAT5 scores that were only modestly different from normative reference values. Considering each child individually, most (~85%) fell outside of the 'Broadly Normal' interpretation of Child SCAT5 normative classifications, suggesting these normative classifications have value for identifying symptoms and deficits in acutely concussed children.
