Purpose Papillary thyroid carcinoma detection has increased dramatically in the United States. However, the indolent nature of papillary thyroid microcarcinoma (mPTC) has led the American Thyroid Association (ATA) to advocate for more conservative management. The 2015 ATA recommendations advocated for observation or lobectomy for mPTC. However, the majority of mPTCs continue to be treated with more aggressive surgical management. In this study, we aim to understand the management of mPTC based on facility variables. Materials and methods A retrospective observational study of patients diagnosed with mPTC between 2004 and 2018 was performed using the National Cancer Database incidence data. We collected data on patient sex, age, tumor size, race, ethnicity, geographic location, thyroid surgical volume at the facility, and treatment modality for mPTC were collected. Conservative and non-conservative treatment modalities based on patient and facility characteristics were compared both longitudinally and cross-sectionally between pre- and post-2015 ATA recommendations. Results Total thyroidectomy with or without radioactive iodine ablation (RAI) remains the treatment of choice regardless of patient and facility characteristics. Patients treated at low-volume facilities were actually more likely to be treated conservatively. Conclusions Despite 2015 ATA recommendations advocating for observation or lobectomy for mPTC, patients with mPTC are still more likely to be treated with total thyroidectomy with or without RAI, especially at high-volume facilities.

Abstract Introduction: Developing a healthy sense of professional identity among medical students is an integral aspect of medical education. Despite its importance, addressing professional identity formation (PIF) in medical school has typically been limited to narrative methods. Mask-making represents a complementary visual modality to examine PIF in undergraduate medical education. Methods: 140 students from the Penn State University College of Medicine Class of 2022 participated in a mask-making activity as they transitioned to clinical clerkships. Students expressed their ideal professional self on the outside of the masks and their current sense of self on the inside of the masks. Masks were coded into 31 PIF categories, and data were analyzed using chi-square to identify significant (P < 0.05) differences between self and ideal profiles. Results: Overall, the subdomains Communication skills, Observational Skills, and Relationships had the greatest incongruence between what students perceived as “ideal” and how they saw themselves. Discussion: Mask-making is a modality for self-exploration in the context of identity formation in medical education. Students were able to identify potential areas of growth in their developing professional identities. Our findings suggest arts integration can support holistic student growth and development.

Mask-making is an ancient art form that has been used throughout human history and across many different cultures, particularly during periods of transition. Mask-making is both a process (creating the mask) and a product (the mask itself). Individual masks offer the opportunity to explore elements of identity that individuals are comfortable sharing with the world (the outside of the mask) as well as elements of identity that they prefer not to reveal (the inside of the mask). This chapter explores the use of mask making to examine identity formation in the context of the workspace, with a particular emphasis on medical education.

Survivorship for head and neck cancer patients presents unique challenges related to the anatomic location of their disease. After treatment, patients often have functional impairments requiring additional care and support. In addition, patients may have psychological challenges managing the effect of the disease and treatment. Routine screening is recommended for the identification of psychological conditions. This article reviews the latest research on key psychological conditions associated with head and neck cancer. It discusses risk factors for the development of each condition and provides recommendations for the management of patients who may present with psychological concerns.

PHOTOCLINICA 39-year-old woman presented to the emergency department (ED) via ambulance after a coworker found her unresponsive in her friend's camper.A fingerstick blood sample obtained en route showed a low blood sugar level of 22 mg/ dL (reference, 70-99 mg/dL).After emergency medical technicians administered dextrose, 10% in water, the patient was sluggishly responsive. HistoryUpon presenting to the ED, the patient appeared extremely lethargic and was difficult to arouse.She was unable to report her medical or surgical history. Physical examinationShe was afebrile with a pulse rate of 85 beats/min and blood pressure of 78/53 mm Hg.The rest of the physical examination was unremarkable.

AbstractLonger exclusive breastfeeding duration has been associated with differences in neural development, better satiety responsiveness, and decreased risk for childhood obesity. Given hippocampus sensitivity to diet and potential role in the integration of satiety signals, hippocampus may play a role in these relationships. We conducted a secondary analysis of 149, 7–11‐year‐olds (73 males) who participated in one of five studies that assessed neural responses to food cues. Hippocampal grey matter volume was extracted from structural scans using CAT12, weight status was assessed using age‐ and sex‐adjusted body mass index (%BMIp85), and parents reported exclusive breastfeeding duration and satiety responsiveness (Children's Eating Behaviour Questionnaire). Separate path models for left and right hippocampus tested: (1) the direct effect of exclusive breastfeeding on satiety responsiveness and its indirect effect through hippocampal grey matter volume; (2) the direct effect of hippocampal grey matter volume on %BMIp85 and its indirect effect through satiety responsiveness. %BMIp85 was adjusted for maternal education, yearly income, and premature birth while hippocampal grey matter volume was adjusted for total intercranial volume, age, and study from which data were extracted. Longer exclusive breastfeeding duration was associated with greater bilateral hippocampal grey matter volumes. In addition, better satiety responsiveness and greater left hippocampal grey matter volume were both associated with lower %BMIp85. However, hippocampal grey matter volumes were not associated with satiety responsiveness. Although no relationship was found between breastfeeding and child weight status, these results highlight the potential impact of exclusive breastfeeding duration on the hippocampal structure.

In addition to providing medical students with the knowledge, skills, and attitudes necessary to gather and synthesize information to accurately diagnose and treat disease, medical education must also help students develop a healthy professional identity. The process of professional identity formation (PIF) is less formal and typically not part of the published curriculum. Despite the importance of PIF, it is difficult to analyze and has typically been done so through narrative means. We propose the artistic process of mask making as an alternative, where medical students visually express their perception of an ideal physician (external face of the mask) and their sense of self (internal face of the mask). Mask making allows students to use descriptions and illustrations on the inside and outside of the masks to express their sense of developing professional identity. A cohort of 148 masks from the Class of 2022 at the Penn State University College of Medicine is being analyzed to compile a list of these illustrations and descriptions. This qualitative data is being sorted according to domains modified from the original Transformation in Medical Education (TIME) initiative PIF framework. Specifically, the TIME framework was edited to include the subdomains, abilities and emotional traits, to the personal characteristic’s domain due to the frequency of qualitative data that aligned with these distinct subdomains. This modified framework has been used to create a codebook using the qualitative coding software, NVivo. After using a subsample of masks to achieve sufficient interrater reliability, we will code the sample cohort to define thematic elements consistent across ideal and self images. We plan to use this method to assess PIF longitudinally in this class of medical students. Our findings should inform opportunities for intervention to alleviate some of the obstacles medical students face as they integrate personal and professional identities.