This experiment was designed to elucidate the role of testosterone in the decline of sexual behavior in aging males. Old (25 months) and middle-aged (10 months) male rats were given six tests (30-min long) of sexual behavior. The old males then were divided into two groups: intact and castrated with testosterone treatment. The middle-aged males were divided into three groups: intact, castrated with testosterone present all the time, and castrated with testosterone present only when tested. The old males were given another set of six tests 1 week after the operation (when 27.5 months old), and the middle-aged males were given three more sets of six tests 8, 26, and 39 weeks after the operation (when 15, 19, and 22.5 months old, respectively). Blood drawn after each test set was assayed for testosterone. The middle-aged intact males had higher levels of testosterone than the old intact males, and the testosterone-treated castrated males, whether middle-aged or old, had higher levels than the intact males. The presence of higher levels at the time of testing resulted in increased rates of mounting and intromitting in old males and an attenuated decline in the mount rate and percentage of tests with intromissions in middle-aged males. The middle-aged castrated males with continuous testosterone differed from the middle-aged castrated males with periodic testosterone only in the mount-intromission interval; the former group had a longer interval. It was concluded that testosterone, in general, does not prevent or reverse the decline in sexual performance of aging male rats and that the degree and rate of decline do not depend on whether or not testosterone is continuously present.

INTRODUCTION: Social determinants of health (SDoH) such as racism are associated with poor pediatric surgical outcomes. However, the links between modifiable neighborhood-level SDoH and surgical health disparities in children have not been established, hindering public health efforts to ameliorate these inequities. METHODS: This retrospective cohort study used the University of California San Francisco’s National Surgical Quality Improvement Program Pediatric database from 2015 to 2021 and included American Society of Anesthesiologists class 1 and 2 cases. Residential census tracts were geocoded to the 2018 social vulnerability index (SVI), a neighborhood-level indicator comprising 4 themes: (1) socioeconomic status, (2) household composition/disability, (3) minority status/language, and (4) housing/transportation. The primary outcome was any serious postoperative complication, a composite of death, reoperation, and readmission within 30 days after surgery. A multivariable logistic regression model compared the relationship between high SVI (defined as ≥90th percentile) and postoperative outcomes. RESULTS: Among 3,278 cases, 12.1% (378) had a high overall SVI. Adjusting for patient age, sex, race, insurance status, parental language preference, wound class, and the presence of preoperative sepsis, high overall SVI was significantly associated with serious postoperative complications (odds ratio 1.59, 95% CI 1.02 to 2.46). High SVI theme 1 (neighborhood socioeconomic status) also had increased odds of serious postoperative complications (odds ratio 1.73, 95% CI 1.01 to 2.94). CONCLUSION: Neighborhood-level social vulnerability, specifically socioeconomic status, may contribute to increased postoperative complications in healthy children and can serve as targets for public health interventions.

INTRODUCTION:United States medical schools continue to respond to student interest in global health (GH) and the evolution of the field through strengthening related curricula. The COVID-19 pandemic and superimposed racial justice movements exposed chasms in the US healthcare system. We sought to explore the possible relationship between the pandemic, US racial justice movements, and medical student interest in GH to inform future academic offerings that best meet student needs. METHODS:A novel, mixed-methods 30-question Qualtrics survey was disseminated twice (May-August 2021) through email and social media to all current students. Data underwent descriptive and thematic analysis. RESULTS:Twenty students who self-identified as interested in GH responded to the survey. Most (N = 13, 65%) were in preclinical training, and half were women (N = 10, 50%). Five (25%) selected GH definitions with paternalistic undertones, 11 (55%) defined GH as noncontingent on geography, and 12 (60%) said the pandemic and US racial justice movement altered their definitions to include themes of equity and racial justice. Eighteen (90%) became interested in GH before medical school through primarily volunteering (N = 8, 40%). Twelve (60%) students plan to incorporate GH into their careers. CONCLUSIONS:Our survey showed most respondents entered medical school with GH interest. Nearly all endorsed a changed perspective since enrollment, with a paradigm shift toward equity and racial justice. Shifts were potentially accelerated by the global pandemic, which uncovered disparities at home and abroad. These results highlight the importance of faculty and curricula that address global needs and how this might critically impact medical students.

Background Many institutions implemented telehealth initiatives to provide social support for patients during the SARS-CoV-2 (COVID-19) pandemic. Little is known about the impact of these programs on patient support persons and the trainees who facilitated them. Objective To assess perceptions of a resident physician and medical student-driven video visit program. Methods We designed and implemented a trainee-led video visit navigation program across three affiliated urban hospitals to facilitate video visits between patients and their support persons. We used descriptive statistics to understand the patient population served by the program and employed surveys for support persons and trainees to assess attitudes on the program. Results From April to June 2020, a total of 443 video visits were completed. Surveys were conducted for 101 out of 184 (54.9%) support persons and 39 out of 65 (60.0%) of medical trainees. Surveys demonstrated that video visits helped alleviate the stress and anxiety of support persons having a hospitalized loved one they could not visit. For trainees, facilitating these connections helped mitigate stress and provided a mechanism to contribute to the pandemic response. Conclusion Telehealth navigation programs provide high levels of connection for patients and their support persons during the COVID-19 pandemic and potentially beyond. Residents and medical students involved in these initiatives mobilized telehealth modalities to improve experiences with care delivery.

The hidden curriculum of unspoken professional expectations negatively impacts medical student interest in surgery. Medical student mentorship and early surgical exposure have been shown to demystify the hidden curriculum. Although residents and faculty play a vital role, near-peer mentorship may aid in uncovering the hidden curriculum and promoting medical student interest in surgery, especially for those learners who are underrepresented in medicine. We developed and implemented a formalized near-peer mentorship program composed of quarterly small group Surgical Peer Teacher led lessons and one-on-one Surgical Support Team mentorship meetings covering surgical curriculum topics for medical students at an academic medical school. This structured near-peer mentorship model provides a mechanism to demystify surgical culture, increase early access to surgical mentorship, and develop mentorship skills amongst students. This program aims to uncover the surgical hidden curriculum to improve surgical career support and interest among medical students with less exposure and access to physician role models. This longitudinal mentorship model is student-run and can be easily adapted to enhance existing support models at medical schools. Future studies will evaluate utilization, impact on surgical specialty interest, and efficacy in demystifying the surgical hidden curriculum.

The anxiety of starting clinical clerkships is high for third-year medical students (MS3s), who often have questions about topics not formally addressed in standard medical school curricula. The surgical clerkship may be one of the more stress-inducing experiences due to the paucity of contact with surgeons in the preclinical setting. 1 Nnamani O.N. Hernandez S.E. Sosa J.A. et al. The students have spoken: results from a preclinical surgical curriculum pilot. J Am Coll Surg. 2020; 231e202https://doi.org/10.1016/j.jamcollsurg.2020.08.539 Abstract Full Text Full Text PDF Google Scholar Lack of exposure may lead to preconceived notions that often drive student expectations at the start of the surgery clerkship. The literature demonstrates that MS3s express fears about fatigue, long hours, poor performance, and physical and mental hardships. 2 Pettitt B.J. Medical student concerns and fears before their third-year surgical clerkship. Am J Surg. 2005; 189: 492-496https://doi.org/10.1016/j.amjsurg.2004.09.017 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar Additionally, students have reported declining quality-of-life metrics during their surgery clerkship. 3 Goldin S.B. Wahi M.M. Farooq O.S. et al. Student quality-of-life declines during third year surgical clerkship. J Surg Res. 2007; 143: 151-157https://doi.org/10.1016/j.jss.2007.08.021 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar Students are often unfamiliar with the intensity of the surgical workload, the team structure and function, and the general surgical culture. Some students may experience impostor syndrome, and may perceive mistreatment from other members of the surgical team; this is an issue for which many institutions have been in search of effective interventions. 4 Hasty B.N. Miller S.E. Bereknyei Merrell S. Lin D.T. Shipper E.S. Lau J.N. Medical student perceptions of a mistreatment program during the surgery clerkship. Am J Surg. 2018; 215: 761-766https://doi.org/10.1016/j.amjsurg.2018.01.001 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar However, these student experiences are not unique to the surgery clerkship. Overall, student perceptions of their general learning environment worsen during the transition from the safety of the preclinical classrooms to the realities of the patient care settings. 5 Dunham L. Dekhtyar M. Gruener G. et al. Medical student perceptions of the learning environment in medical school change as students transition to clinical training in undergraduate medical school. Teach Learn Med. 2017; 29: 383-391https://doi.org/10.1080/10401334.2017.1297712 Crossref PubMed Scopus (30) Google Scholar