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OBJECTIVE: Much of mental health care is provided by non-psychiatric providers, and unfortunately, bias toward patients with mental health conditions leads to worsened outcomes. The authors endeavored to determine if pre-clinical medical student psychiatry education had an impact on these perceptions. METHODS: All 366 first-year medical students at Indiana University were invited to participate in a survey that consisted of the Mental Illness: Clinician's Attitudes version 2 (MICA-2) and six supplemental questions, pre- and post-course. RESULTS: One hundred seventeen students completed both surveys. The pre- and post-course means were 36.6 and 33.6, a change of - 2.9 (paired t-test p-value < 0.001), indicating a reduction in bias. CONCLUSIONS: These results suggest that pre-clinical education can lead to a measurable decrease in bias in medical students early in training. Unfortunately, individual question results and free responses continue to highlight significant bias in US medical students against mental illness and the field of psychiatry. Health care educators should be aware of these biases and their potential impact on patient outcomes so that these harmful perceptions can be targeted.

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INTRODUCTION: There has been a move to a "flipped classroom" (FC) in medical education. The FC promotes active learning and utilizes independent preparation prior to in-class sessions. Few studies have evaluated the effectiveness of the FC approach in medical education, specifically via virtual learning. The purpose of this study evaluates student and faculty perceptions of the FC approach and relationships between student engagement and performance. METHOD: The first-year medical student psychiatry curriculum was redesigned with an FC approach and subsequently altered by COVID-19 to a virtual learning environment. A mixed-method approach was used to examine both qualitative assessment and quantitative performance data. Students and facilitators were invited to participate in surveys regarding the curriculum changes. Student performance data was collected via quizzes and examinations. Engagement was evaluated by student participation in National Board of Medical Examiners-style multiple-choice questions delivered via Top Hat®. Correlational analyses were used to evaluate associations between engagement and performance. T-tests were used to compare student satisfaction across 2019 and 2020. RESULTS: Performance on in-class questions was positively associated with class rank and performance (p < 0.005). More students were either satisfied or strongly satisfied (91.5%) in 2020 compared to 85.7% in 2019 (two-tailed t-test, p = 0.04). Most students (81.3%) preferred in-class questions to lectures. In 2020, 62.6% of student comments were positive regarding the psychiatry curriculum vs 33.3% in 2019. Over 61.5% of facilitators felt positive towards the changes. CONCLUSION: Our results demonstrate a positive relationship between engagement and class performance. Students and facilitators positively perceived the approach, with students preferring in-class questions compared to lectures. Future research should evaluate overall performance on standardized tests, third-year clerkships, and number of students matching into psychiatry. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01287-x.

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Pseudomonas aeruginosa is a metabolically versatile wide-ranging opportunistic pathogen. In humans P. aeruginosa causes infections of the skin, urinary tract, blood, and the lungs of Cystic Fibrosis patients. In addition, P. aeruginosa's broad environmental distribution, relatedness to biotechnologically useful species, and ability to form biofilms have made it the focus of considerable interest. We used 13C metabolic flux analysis (MFA) and flux balance analysis to understand energy and redox production and consumption and to explore the metabolic phenotypes of one reference strain and five strains isolated from the lungs of cystic fibrosis patients. Our results highlight the importance of the oxidative pentose phosphate and Entner-Doudoroff pathways in P. aeruginosa growth. Among clinical strains we report two divergent metabolic strategies and identify changes between genetically related strains that have emerged during a chronic infection of the same patient. MFA revealed that the magnitude of fluxes through the glyoxylate cycle correlates with growth rates.

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Initially identified to be activated upon virus infection, the double-stranded RNA-dependent protein kinase (PKR) is best known for triggering cell defense responses by phosphorylating eIF-2α, thus suppressing RNA translation. We as well as others showed that the phosphorylation of PKR is down-regulated by insulin. In the present study, we further uncovered a novel function of PKR in regulating the IRS proteins. We found that PKR up-regulates the inhibitory phosphorylation of IRS1 at Ser312, which suppresses the tyrosine phosphorylation of IRS1. This effect of PKR on the phosphorylation of IRS1 is mediated by two other protein kinases, JNK and IKK. In contrast, PKR regulates IRS2, another major IRS family protein in the liver, at the transcriptional rather than the posttranslational level, and this effect is mediated by the transcription factor, FoxO1, which has been previously shown to be regulated by insulin and plays a significant role in glucose homeostasis and energy metabolism. In summary, we found for the first time that initially known as a virus infection response gene, PKR regulates the upstream central transmitters of insulin signaling, IRS1 and IRS2, through different mechanisms.

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