Medicine and Health Sciences Commons^™

Social Cognition Across Bipolar Disorder And Behavioral Variant Frontotemporal Dementia: An Exploratory Study, Izabela Guimarães Barbosa, Flávia Da Mata Chiácchio Leite, Maxime Bertoux, Henrique Cerqueira Guimarães, Luciano Inácio Mariano, Leandro Boson Gambogi, Antônio Lúcio Teixeira, Paulo Caramelli, Leonardo Cruz De Souza

Faculty, Staff and Student Publications

OBJECTIVES: Bipolar disorder type 1 (BD1) and behavioral-variant frontotemporal dementia (bvFTD) share similar behavioral and cognitive symptoms, rendering the differential diagnosis between them a clinical challenge. We investigated the accuracy of social cognition (SC) measures to differentiate bvFTD from BD.

METHODS: We included three groups of participants: early-onset BD1 (in remission, n=20), bvFTD (n=18), and cognitively healthy controls (HC) (n=40), matched for age, schooling, and sex. All participants underwent cognitive assessment, including the Facial Emotion Recognition (FER) and Modified Faux-Pas (mFP) tests, which assess mentalizing.

RESULTS: Compared to HC, BD1 and bvFTD patients underperformed on both SC measures. BD1 and …

Health Professional Well-Being And Preparedness During The Covid-19 Pandemic In Trinidad And Tobago: An Online Survey, Loren De Freitas, Darren Dookeeram, Shastri Motilal

Journal of Wellness

Introduction: Poor well-being impacts mental health and subsequently affects personal lives, leads to absenteeism, poor productivity, and compromised patient safety. Frontline healthcare workers are highly vulnerable to COVID-19 pandemic-related mental health strain. This study assessed the well-being and preparedness of frontline healthcare workers in Trinidad and Tobago during the pandemic.

Methods: An online cross-sectional survey was sent to doctors, nurses, and prehospital providers from public and private healthcare sectors. Data was collected from May to June 2020 utilizing a self- administered online platform. The WHO Five Well-being Index (WHO-5) was used to assess well-being. Raw scores less than 13 indicated …

Developing A Management And Finance Training For Future Public Health Leaders, Kristy T. Hayes, Harry J. Heiman, Peggy A. Honoré

School of Public Health Faculty Publications

Public health leaders are increasingly being asked to address adaptive challenges in the context of finite and often limited resources. Budgets and their associated resources create the financial framework within which public health agencies and organizations must operate. Yet, many public health professionals expected to undertake roles requiring this foundational knowledge and skills are not trained in the fundamentals of public finance and are ill-equipped for managing and monitoring funds. Graduate courses in schools of public health most often are focused on health care management and finance or private sector finance. To meet the needs of future public health leaders, …

A Modified Dbt-Informed Art Therapy Group Curriculum With A Focus On Neurodiversity Acceptance, Megan Moyer

Art Therapy Counseling Final Research Projects

Historically, therapy methods made to support neurodivergent individuals have been focused on reducing “challenge behaviors” and modifying behavior to societal standards. Simultaneously, many behavior modification therapies neglect the emotional well-being of the individual. As neurodiversity grows to be accepted as an aspect of diversity, so too must therapy methods change to promote skill building in line with the cultural values and strengths of neurodivergent individuals and promote social-emotional well-being. This group therapy curriculum poses as one such possibility to this change by utilizing DBT and Art Therapy in a group psychoeducation format.

The Effect Of Microglial Cell Dysfunction On Multi-Modal Pre-Pulse Inhibition, Michelle Besser

Dissertations, 2020-current

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication, restricted behaviors, and executive functioning deficits. Mutations in fractalkine signaling, particularly in CX3CR1, in the brain have been linked to ASD and other neurodevelopmental disorders. This investigation examined wild-type mice and mice with one or two copies of mutated CX3CR1 and their uni-modal (auditory and somatosensory) and multi-modal (combined) pre-pulse inhibitions (PPI). PPI is an unconditioned response – a decrement in the acoustic startle reflex when the mouse detects a non-startling stimulus presented a few hundred ms before the startling sound. In this study, the …

Impact Of Diabetes Mellitus On Vestibular Function: A Scoping Review, Ellen M. Jones

Dissertations, 2020-current

Diabetes mellitus (DM) encompasses a group of metabolic diseases that result in high blood sugar (i.e., hyperglycemia). By 2030, it is anticipated that 578 million adults worldwide will have DM, with this number growing at a faster rate in developed areas of the world.^[27] If left uncontrolled, DM can cause considerable damage to several areas of the body, including the heart, kidneys, nerves, and ears. When focusing exclusively on the ears, there has been markedly less research on the vestibular system when compared to the auditory system, even though DM is a known risk factor for falling. The purpose …

Magnitude Estimates Of Angular Motion: Perception Of Speed And Spatial Orientation Across Visual And Vestibular Modalities, Erin Hernon

Dissertations, 2020-current

Both the vestibular system and optokinetic system generate conjugate eye movements in response to either movement of the head or movement of the visual surround. Both systems help to maintain gaze stability. While the VOR is most sensitive to input frequencies above .2 Hz, the optokinetic system helps maintain gaze stability at lower frequencies. Previous research on perceptual thresholds across the two sensory modalities shows that there are frequency-dependent differences between vestibular and visual perception. The purpose of this study is to extend previous vestibular psychophysics work by 1) comparing magnitude estimates from vestibular stimulation to visual stimulation across multiple …

Age-Related Decline In Neural Synchrony And The Ffr, Haley Szabo

Dissertations, 2020-current

It is a known phenomenon that speech understanding in background noise declines with advancing age. Although there is ample evidence of behavioral measures declining with age, there is less physiologic evidence. This study hypothesizes that the FFR will be degraded with advancing age, consistent with poorer phase locking. This is hypothesized to be present even in people with audiograms within normal limits. A second hypothesis is that middle-aged adults will have degraded neural representation as frequency increases, compared to a younger normal hearing group which will have better high frequency neural representation than the middle-aged group. Subjects were divided into …

Reality Of Counseling In Pediatric Audiology Clinical Practice, Lara Leggio

Dissertations, 2020-current

The overwhelming nature of hearing loss identification often causes families to experience grief and confusion. Children as young as nine months old with severe hearing loss have the option to undergo cochlear implantation (CI) surgery with the hopes of restoring normal hearing. Pediatric audiologists accompany families through the identification of hearing loss and the learning process that coincides with this surgery. Despite knowledge that parents of children with communication disabilities will experience a sense of loss and have moderate to severe cyclic emotional reactions, little is known about how audiologists manage the emotional needs of families, if they feel prepared …

Assessing Word Recognition In Infants With A History Of Chronic Otitis Media, Sarah Wright

Dissertations, 2020-current

Otitis media (OM) is a common ear-related disorder diagnosed in children that can cause a temporary conductive hearing loss. The fluctuating hearing loss may alter auditory processing which may interfere with language development while impacting quality of life for infants and their caregivers (Homøe et al., 2019). In several languages, eleven-month-old infants have shown a preference for familiar words over unfamiliar words using the head-turn preference paradigm. This study examines the effect of chronic OM on the preference for familiar or unfamiliar words in eleven-month-old infants. Fourteen eleven-month-old infants (mean age 344 days) with three or more diagnosed ear infections …

Role Of Emg Monitoring On Cvemp Testing In Preschool Age Children, Brenna Murray

Dissertations, 2020-current

While cervical vestibular evoked myogenic potential (cVEMP) testing has largely been studied and practiced on the adult population, less is known about the best practices for performing cVEMPs on a pediatric population, especially in young children under the age of 5 years. Further, very young children (i.e., 2-3 years) often prefer to sit with their caregiver during the testing, yet there is very little data on how much electromyographic (EMG) activity a child generates if in a seated position as opposed to a supine position. The purpose of this study was to assess the role of EMG on cVEMP recordings …

Characterizing The Effects Of Light On The Early Onset Photoreceptor Function Loss In Mucolipidosis Type Iv, Rebecca Cistulli

Masters Theses, 2020-current

Retinal degenerative diseases (RDD’s) are a diverse group of retinal disorders that cause visual impairment. While RDD prevalence is high, little is known about the molecular mechanisms underlying the pathogenesis within some of these disorders. Here we are trying to elucidate the molecular mechanisms that drive early onset photoreceptor function loss in the RDD, Mucolipidosis type IV (MLIV). MLIV is a lysosomal storage disorder that results from loss of function mutations in the MCOLN1 gene and leads to a disruption of autophagy. The MCOLN1 gene encodes a lysosomal cation channel called Trpml1. Based on previous data from our lab, we …

Five-Year Follow-Up Of Zuma-1 Supports The Curative Potential Of Axicabtagene Ciloleucel In Refractory Large B-Cell Lymphoma, Sattva S Neelapu, Caron A Jacobson, Armin Ghobadi, David B Miklos, Lazaros J Lekakis, Olalekan O Oluwole, Yi Lin, Ira Braunschweig, Brian T Hill, John M Timmerman, Abhinav Deol, Patrick M Reagan, Patrick Stiff, Ian W Flinn, Umar Farooq, Andre H Goy, Peter A Mcsweeney, Javier Munoz, Tanya Siddiqi, Julio C Chavez, Alex F Herrera, Nancy L Bartlett, Adrian A Bot, Rhine R Shen, Jinghui Dong, Kanwarjit Singh, Harry Miao, Jenny J Kim, Yan Zheng, Frederick L Locke

Faculty, Staff and Student Publications

In phase 2 of ZUMA-1, a single-arm, multicenter, registrational trial, axicabtagene ciloleucel (axi-cel) autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy demonstrated durable responses at 2 years in patients with refractory large B-cell lymphoma (LBCL). Here, we assessed outcomes in ZUMA-1 after 5 years of follow-up. Eligible adults received lymphodepleting chemotherapy followed by axi-cel (2 × 106 cells per kg). Investigator-assessed response, survival, safety, and pharmacokinetics were assessed in patients who had received treatment. The objective response rate in these 101 patients was 83% (58% complete response rate); with a median follow-up of 63.1 months, responses were ongoing in 31% …

Factors Affecting Initiation And Retention Of Medication-Assisted Recovery (Mar) Within A Pilot Pharmacist-Involved Practice Model At A Federally Qualified Healthcare Center (Fqhc) During The Covid-19 Pandemic, Tiffany Nguyen, Thomas Craig Cheetham, Souhiela Fawaz, Richard Beuttler, Sharon Xavioer

Pharmacy Faculty Articles and Research

Background: During the COVID-19 pandemic, opioid-related overdose deaths increased. Although Medication-Assisted Treatment or Recovery (MAT or MAR) is available, initiation and retention rates vary. The goal of this study was to evaluate clinical, demographic, and Social Determinant of Health factors affecting MAR initiation, on-time initiation of medications, and successful retention in the program. The secondary goal was to evaluate the impact of a novel interprofessional practice model incorporating pharmacists. Methods: A retrospective analysis was conducted using electronic health record data from a pilot MAR Program initiated within a California Federally Qualified Healthcare Center. Results: From September 2019 to August 2020, …

The Impact Of Sleep Quality Combined With Physical Activity On Autonomic Function (24-Hour Hrv) In College Students, Meghan Peterson

Masters Theses, 2020-current

Long-term poor sleep quality is associated with health outcomes that can lead to autonomic nervous system dysfunction. Both cardiorespiratory fitness and physical activity (PA) are associated with improvements in autonomic function and heart rate variability (HRV). Markers of fitness and sleep were explored to determine the degree of contribution to autonomic dysfunction. A total of 15 subjects, (age = 20.6±0.5; BMI = 23.9±1.0) completed 7 days of physical activity and sleep assessment via accelerometry. Participants then completed a graded exercise test to determine cardiorespiratory fitness (VO_2max), followed by a 24-H HRV measurement. HRV through LF:HF ratio was negatively …

The Effect Of Training Status On Exercise Performance And Oxygen Uptake Responses To Beetroot Juice Supplementation In Cyclists, Haley Mcvannel

Masters Theses, 2020-current

Purpose: To determine if cardiovascular fitness, assessed by peak oxygen consumption (VO_2peak),influences the physiological and performance effects of beetroot juice (BRJ) supplementation and to explore if recent training habits independently influence this response. Methods: Thirteen male and female cyclists completed two graded exercise tests to assess cardiovascular fitness and four, seven-day experimental phases. Five subjects were classified as high fitness (VO_2peak: 65.9 ± 4.5 mL∙kg^-1∙min^-1) and eight as lower fitness (VO_2peak: 44.2 ± 7.0 mL∙kg^-1∙min^-1). Subjects consumed 140 ml of concentrated BRJ or placebo the last …

Effects Of A Commercially Available Acoustic Vibration Device On Nasal Symptoms, Pulmonary Function, And Exercise Performance, Catherine M. Cavallaro

Masters Theses, 2020-current

Purpose: The purpose of this study was to investigate whether the SinuSonic acoustic vibration device influenced nasal symptoms and function, expired nitric oxide (eNO), pulmonary function, and exercise responses and performance in active individuals. Methods: Sixteen recreational exercisers (age 34.5 ± 16.0 y: VO_2max 41.1 ± 6.5 mL/kg/min) completed two exercise trials, each consisting of a 10 min warm up followed by a graded exercise test on a cycle ergometer. In a randomized, counterbalanced design, participants used a SinuSonic device (or sham device) for 5 min, followed by 5 min of rest, before undergoing the graded exercise test. Nasal …

Implementing Cultural Competency Training Among Advanced Practice Providers At An Academic Medical Center: A Quality Improvement Project, Kierah Barnes

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Racial health disparities, inequities, and healthcare bias are long considered concerns for the healthcare community.Cultural competency training (CCT) is one solution that is gaining recognition as an effective intervention to address bias among healthcare providers, resulting in improved patient outcomes and assisting with reducing health disparities among minority populations. This quality improvement project was implemented at an academic medical center and designed for Advanced Practice Providers who completed the training to demonstrate an increase in their cultural competency post-test compared to the pre-test. The increase in CCT will hopefully impact the delivery of culturally conscious/competent healthcare and positive experiences to …

Contributions To Auditory System Conduction Velocity: Insights With Multi-Modal Neuroimaging And Machine Learning In Children With Asd And Xyy Syndrome, Jeffrey I. Berman, Luke Bloy, Lisa Blaskey, Carissa R. Jackel, Judith S. Miller, Judith Ross, J. Christopher Edgar, Thimothy P.L. Roberts

Department of Pediatrics Faculty Papers

Introduction: The M50 electrophysiological auditory evoked response time can be measured at the superior temporal gyrus with magnetoencephalography (MEG) and its latency is related to the conduction velocity of auditory input passing from ear to auditory cortex. In children with autism spectrum disorder (ASD) and certain genetic disorders such as XYY syndrome, the auditory M50 latency has been observed to be elongated (slowed).

Methods: The goal of this study is to use neuroimaging (diffusion MR and GABA MRS) measures to predict auditory conduction velocity in typically developing (TD) children and children with autism ASD and XYY syndrome.

Results: Non-linear TD …

Ramie (Boehmeria Nivea): An Underutilized Plant For A Multipurpose Industrial Application; A Perennial Plant With Protein Identification Using Maldi-Ms, A Biosorbent For Hg (Ii) Removal From Water And As A Bast Fiber Production Via Enzymatic Degumming, Abdul Rashid Issifu

Master's Theses

Identifying plant species that can offer life support to humans and animals without damaging the environment is quite challenging. Ramie, one of the oldest fiber crops was studied due to its nutritional value as fodder and other multipurpose applications in, e.g., medicinal, environmental, and textile industrial fields.

With a brief discussion of background in Chapter I, Chapter II focused on using a proteomic method to investigate unknown proteins in the leaves of ramie and to study their benefits to the biological system. PPiase and RuBisCO with molecular weight 15 and 52 KDa were identified as the proteins after peptide mass …

The Opioid Epidemic: How Genetics Play A Role In Addiction And Treatment, Kirsten Houston

Honors College Theses

The opioid epidemic is an issue within the pharmaceutical industry in the United States of America due to prescription and non-prescription substances being made available to the population. Opioids include chemical substances that affect the body and brain through opioid receptors, including the mu, kappa, and delta receptors. These substances are derived and synthesized from the poppy plant. Multiple causes have been linked to opioid abuse disorder, including but not limited to employment, income, housing, nutrition, mental health disorders, and genetics. By gathering information from previous literature, genetics may be the main cause of narcotic analgesic tolerance and abuse. Specific …

Rational Design Of Highly Potent And Selective Covalent Map2k7 Inhibitors, Dalton R Kim, Meghan J Orr, Ada J Kwong, Kristine K Deibler, Hasan H Munshi, Cory Seth Bridges, Taylor Jie Chen, Xiaoyu Zhang, H Daniel Lacorazza, Karl A Scheidt

Faculty, Staff and Students Publications

The mitogen-activated protein kinase signaling cascade is conserved across eukaryotes, where it plays a critical role in the regulation of activities including proliferation, differentiation, and stress responses. This pathway propagates external stimuli through a series of phosphorylation events, which allows external signals to influence metabolic and transcriptional activities. Within the cascade, MEK, or MAP2K, enzymes occupy a molecular crossroads immediately upstream to significant signal divergence and cross-talk. One such kinase, MAP2K7, also known as MEK7 and MKK7, is a protein of great interest in the molecular pathophysiology underlying pediatric T cell acute lymphoblastic leukemia (T-ALL). Herein, we describe the rational …

3-Phosphoinositide-Dependent Kinase 1 Drives Acquired Resistance To Osimertinib, Ismail M Meraz, Mourad Majidi, Bingliang Fang, Feng Meng, Lihui Gao, Ruping Shao, Renduo Song, Feng Li, Yonathan Lissanu, Huiqin Chen, Min Jin Ha, Qi Wang, Jing Wang, Elizabeth Shpall, Sung Yun Jung, Franziska Haderk, Philippe Gui, Jonathan Wesley Riess, Victor Olivas, Trever G Bivona, Jack A Roth

Faculty, Staff and Students Publications

Osimertinib sensitive and resistant NSCLC NCI-H1975 clones are used to model osimertinib acquired resistance in humanized and non-humanized mice and delineate potential resistance mechanisms. No new EGFR mutations or loss of the EGFR T790M mutation are found in resistant clones. Resistant tumors grown under continuous osimertinib pressure both in humanized and non-humanized mice show aggressive tumor regrowth which is significantly less sensitive to osimertinib as compared with parental tumors. 3-phosphoinositide-dependent kinase 1 (PDK1) is identified as a potential driver of osimertinib acquired resistance, and its selective inhibition by BX795 and CRISPR gene knock out, sensitizes resistant clones. In-vivo inhibition of …

Co-Clinical Imaging Metadata Information (Cimi) For Cancer Research To Promote Open Science, Standardization, And Reproducibility In Preclinical Imaging, Stephen M Moore, James D Quirk, Andrew W Lassiter, Richard Laforest, Gregory D Ayers, Cristian T Badea, Andriy Y Fedorov, Paul E Kinahan, Matthew Holbrook, Peder E Z Larson, Renuka Sriram, Thomas L Chenevert, Dariya Malyarenko, John Kurhanewicz, A Mcgarry Houghton, Brian D Ross, Stephen Pickup, James C Gee, Rong Zhou, Seth T Gammon, Henry Charles Manning, Raheleh Roudi, Heike E Daldrup-Link, Michael T Lewis, Daniel L Rubin, Thomas E Yankeelov, Kooresh I Shoghi

Faculty, Staff and Students Publications

Preclinical imaging is a critical component in translational research with significant complexities in workflow and site differences in deployment. Importantly, the National Cancer Institute's (NCI) precision medicine initiative emphasizes the use of translational co-clinical oncology models to address the biological and molecular bases of cancer prevention and treatment. The use of oncology models, such as patient-derived tumor xenografts (PDX) and genetically engineered mouse models (GEMMs), has ushered in an era of co-clinical trials by which preclinical studies can inform clinical trials and protocols, thus bridging the translational divide in cancer research. Similarly, preclinical imaging fills a translational gap as an …

Management Of Primary Spontaneous Pneumothorax In Children: A Single Institution Protocol Analysis, Shai Stewart Md, James Fraser, Nelimar Cruz-Centeno, Derek Marlor, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Research Days

Background: Primary spontaneous pneumothorax (PSP) affects 3.4 per 100,000 children in the United States. Regardless of the initial management, additional procedures, and prolonged hospital length of stay (LOS) may occur. There is currently no consensus in the pediatric surgical community on the optimal management of these patients, which has resulted in marked variability in management. The Midwest Pediatric Surgery Consortium (MWPSC), of which our site is a participant, suggested a management algorithm to include simple aspiration upon presentation, and if this fails, VATS should be considered.

Objectives/Goal: The purpose of this study was to evaluate the outcomes of instituting a …

Sepsis-Induced Acute Lung Injury (Ali) And The Development Of Bronchopulmonary Dysplasia (Bpd) In Premature Infants., Jacob S. Ward, Hung-Wen Yeh, Megan Tucker, Venkatesh Sampath

Research Days

Background: Bronchopulmonary dysplasia (BPD) is a significant cause of morbidity and mortality in premature infants with several known risk factors. Recent literature described the harmful effect of inflammation on the developing lung. Recently, we showed that late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) causes acute lung injury (ALI) in preterm infants as measured by increases in pulmonary severity scores (PSS). The aim of this study was to investigate the association between LOS-induced ALI and BPD outcomes. We hypothesized that LOS would increase the likelihood of developing BPD, and the associated LOS-induced ALI will add to the ability to predict development …

Institutional Outcomes Of Blunt Liver & Splenic Injury In The Atomac Era, Shai Stewart Md, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) practice management guideline (PMG) was created to standardize management of blunt liver or spleen injury (BLSI) across pediatric trauma centers. Evaluations of institutional outcomes after its adoption remain scarce. We describe our outcomes since PMG adoption at our institution.

Objectives/Goal: The purpose of this study was to assess patient outcomes and resource utilization after implementation of this protocol. We hypothesized there is no difference in length of stay (LOS) or complications regardless of grade of isolated injuries to the liver or spleen. In addition, there is limited guidance on the management of concurrent injuries to …

Predicting Avascular Necrosis After Unstable Slipped Capital Femoral Epiphysis, Jonathan Warren, Alexander Metoxen, Michael Held, Brant Ansley, Berglund Lisa

Research Days

Background: There is no consensus in the literature on the risk of developing avascular necrosis (AVN) after unstable slipped capital femoral epiphysis (SCFE). In recent years, a number of studies have sought to better characterize risk factors for AVN in this population. However, to the best of our knowledge, there is no study that uses predictive modeling to assess the chance of developing AVN based on different patient-centric factors.

Objectives/Goal: Our goal is to assess whether or not previously-published risk factors for AVN in unstable SCFE such as duration of symptoms, reduction type, type of surgery, timing of surgery, and …

Laparoscopic Versus Open Inguinal Hernia Repair: A Single Institution Comparison Of 1200 Patients, Shai Stewart Md, Wendy Jo Svetanoff, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: : Laparoscopy has become the standard of care for many pediatric surgical procedures; however, there is no consensus regarding the optimal approach for inguinal hernia repair (IHR). We report our experience over an 8-year period with open and laparoscopic inguinal hernia repair (LIHR).

Objectives/Goal: We aim to describe our experience within a free-standing tertiary care pediatric institution and compare outcomes between open and laparoscopic repair of pediatric inguinal hernias.

Methods/Design: A retrospective review of patients under 18 years who underwent IHR between June 2010 and June 2017 was performed. The open technique utilizes high ligation of the internal ring, …

“There’S A Difference In Practice When You Have To Make The Decision”: Autonomy In Pediatric Emergency Medicine Fellowship, Katherine Dunne, Vivek Dubey, Sarkan Toy, Camryn Martinez, Kelsey Gavin, Christopher S. Kennedy

Research Days

Background: The Accreditation Council for Graduate Medical Education allows individual training programs to define appropriate supervision and autonomy commensurate with the trainees’ knowledge, clinical competence, and patient complexity and acuity. In pediatric emergency medicine (PEM), supervision is not standardized and subject to supervisor discretion, creating variability in trainee autonomy.

Objectives/Goal: To explore the concept of autonomy from the perspectives of PEM fellows and faculty.

Methods/Design: We conducted a qualitative study consisting of semi-structured interviews of PEM fellows and faculty from a large, single-center pediatric emergency medicine fellowship program. A trained interviewer conducted the interviews over an electronic interview platform. Audio …