University of Minnesota Rochester

Mental health challenges are a significant concern among students and trainees in medical fields worldwide, including Japan, where high psychological distress is prevalent. This pilot study examined the feasibility and impact of a 6-day creative arts program designed for Japanese medical and international graduate students. A total of 14 students provided informed consent to participate in the study. Employing a convergent mixed-methods design, quantitative and qualitative data were collected and analyzed independently. Students completed the Comprehensive Inventory of Thriving (CIT) before and after the program to assess changes in psychological well-being. Pre-post differences were examined using paired t-tests. Qualitative data collection included post-program surveys, semi-structured interviews, and six-month follow-up interviews. We conducted thematic analysis to identify key patterns in student experiences. We then examined whether changes in CIT scores correlated with the frequency of qualitative codes to identify potential points of convergence between the two datasets. Thirteen students completed all major components of the study, with an average attendance of 5.2 out of 6 sessions. CIT scores significantly increased from before (M = 198.0, SD = 29.9) to after completing the program (M = 217.3, SD = 20.2), t(12) = -4.89, p = .0004, indicating a significant increase in thriving. Thematic analysis yielded three core themes: (1) Discovery through the underexplored parts of self and surroundings, (2) Rapid community bonding through inspiration, and (3) Creativity as a disruption to stress. Six-month follow-up interviews revealed additional themes related to enduring impact from the intervention: Applying creative insights into everyday life and mindsets. Through the convergent mixed-methods analysis, one pairing reached statistical significance: the change over time in the CIT subscore ‘Meaning’ was strongly correlated with the qualitative code “Out of the ordinary” (r = + 0.868), suggesting that increases in participants’ sense of meaning were strongly associated with the frequency of experiences that felt “Out of the ordinary” during the creativity program. The findings suggest that a creative arts program for medical students is both feasible and effective in promoting well-being, enhancing stress management skills, and deepening self-awareness. The program shows promise for integration into medical education to support students’ holistic development and mental health.

Abstract Background: The incidence of central nervous system (CNS) metastases varies with BC subtype, but there is limited data about clinical and molecular predictors of CNS vs non-CNS recurrence risk after neoadjuvant chemotherapy (NACT). Here we present patterns of distant recurrence among patients (pts) in the I-SPY2 trial. Methods: This analysis included 2023 pts with molecularly high-risk stage II and III BC who enrolled in the I-SPY2 trial from 2010-2022 with event-free survival (EFS) data (as of 6/22/25). We analyzed type of recurrence (local vs distant) and site(s) of initial distant recurrence (CNS-only, both CNS- and non-CNS, or non-CNS only). We used a competing risk (Fine-Gray) model to estimate cumulative incidence of site-specific relapse at five years and assessed associations with clinical/molecular subtype, clinical staging (cT, cN), and response to NACT by Residual Cancer Burden (RCB) class. Results: Among 2023 evaluable pts, at a median follow up of 4.7 yrs there were 361 EFS events, most of which were distant recurrences (n=259, 72%). Of the pts with distant recurrences, most had initial non-CNS events (180/259, 69%), 36 pts had initial simultaneous CNS- and non-CNS events (36/259, 14%), and 43 pts had initial CNS-only events (43/259, 17%). Table 1 summarizes the cumulative incidence of initial CNS- and/or non-CNS recurrences at 5 years by clinical/molecular features. Rates of CNS-only recurrence were low and similar across clinical and response predictive subtypes (p=0.47 and =0.19 respectively). Risk of distant recurrence increased in pts with larger tumors and node positive disease at both CNS- and non-CNS sites (see Table 1). Rates of initial non-CNS recurrence increased with the amount of residual disease at surgery, with lowest rates in pts with RCB-0 and highest rates in pts with RCB-III (p<0.01). In contrast, the rate of CNS-only recurrence was low but remained similar across the four RCB classes (p=0.67). Because of this, 39% (18/46) of pts with RCB-0/I disease had initial CNS-only recurrence, whereas only 12% (24/204) of pts with RCB-II/III disease had initial CNS-only recurrence. Most CNS recurrences, isolated or not (64/79, 81%), occurred within the first three years after surgery. Conclusions: In pts with molecularly high-risk stage II and III BC who underwent NACT, the incidence of initial CNS-only metastases was low, but the rate was consistent across the four RCB classes, supporting that the CNS is a sanctuary site. Initial CNS-only recurrence accounted for 39% of EFS events for pts with RCB-0/I vs 12% for pts with RCB-II/III. CNS recurrence risk was similar across high-risk BC subtypes, but higher in pts with larger tumors and node positive disease. These results support future research to identify biomarkers that predict CNS recurrence risk and to incorporate CNS-penetrant therapies into early-stage treatment for CNS high-risk pts. Citation Format: L. Huppert, C. Yau, D. Idossa, A. Kahn, F. M. Howard, E. Shagisultanova, A. Zimmer, E. Stringor-Reasor, J. Perlmutter, D. Yee, R. Nanda, N. Hylton, W. F. Symmans, R. Shatsky, C. Isaacs, L. Van't Veer, H. S. Rugo, P. R. Pohlmann, A. DeMichele, L. Pusztai, L. Esserman. Site(s) of Distant Recurrence after Neoadjuvant Therapy for Patients With High-Risk Early-Stage Breast Cancer (BC): Analysis of Data from the I-SPY2 Trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PD13-01.

Abstract Background Candidemia can occur as a consequence of gastrointestinal (GI) injury. The mortality of candidemia is high, ranging 30-60%, even with treatment with antifungal agents. In this retrospective matched case-control study, we aimed to elucidate the medical and surgical risk factors of developing candidemia in patients who received emergency surgery for GI ischemia and/or perforation, and compare clinical outcomes in these patients with or without candidemia. Methods All patients ≥ 18 years of age who had emergency GI surgery at Mayo Clinic Rochester, MN, for the indication of GI ischemia and/or perforation between 01/01/2018 to 07/31/2024 were included. Cases were defined as patients who developed candidemia during index admission and had no alternative sources of candidemia. Controls and cases were matched 4:1 on age (± 5 years), Charlson Comorbidity Index (± 3), and year of surgery (± 2 years). The relationships between risk factors of interest and case/control were assessed using conditional logistic regression. Results Among medical risk factors, any shock requiring vasopressor (OR = 3.44, 95% CI 1.00, 11.97) or respiratory failure (OR = 8.20, 95% CI 1.04, 64.53) during hospitalization were associated with increased risk of candidemia. Among surgical risk factors, perforation in the upper GI tract was strongly associated with development of candidemia (OR = 16.99, 95% CI 2.11, 136.95) and perforation in the lower GI tract were less likely to lead to candidemia (OR = 0.06, 95% CI 0.01, 0.44). The patients who had diffuse intraabdominal contamination were more likely to develop candidemia compared to those who had no contamination or contained contamination (OR = 3.87, 95% CI 1.33, 11.25). The patients with candidemia showed signal towards higher in-hospital and 30-day mortality, and had significantly longer stay in the hospital. Conclusion Candidemia was more frequently identified in patients with shock, respiratory failure, upper GI perforation, and intra-abdominal contamination, and contributed to significant morbidity and mortality. Further analysis will include building a multivariate logistic regression model to implement prospective trial for early initiation of antifungal therapy for high-risk population. Disclosures All Authors: No reported disclosures

BackgroundAccording to consensus guidelines, area under the concentration–time curve (AUC) is recommended for vancomycin dosing rather than trough-based monitoring, but transition to AUC-based dosing requires substantial staff education and resource allocation. We sought to evaluate the level of congruency between vancomycin total daily doses (TDD) determined using a trough concentration goal of 10-15 mcg/mL compared with an online Bayesian calculator targeting an AUC of 400-600 mg·h/L.Patient DemographicsInitial Dose ResultsMethodsWe performed a retrospective, multicenter cohort study of vancomycin therapeutic drug monitoring (TDM) in non–critically ill adults hospitalized from March 1, 2017-December 31, 2021. Patients were included if they received intravenous vancomycin for ≥72 hours with a documented trough target of 10 to 15 mg/L, had ≥1 serum vancomycin trough concentration assessed at steady state, and received ≥2 doses of vancomycin after serum assessment with or without dose adjustment. Using an online vancomycin calculator with Bayesian modeling, the study team input patients’ trough-based dosing data to retrospectively estimate the initial vancomycin AUC exposure achieved and the initial and post-trough TDD recommended for an AUC target of 400 to 600 mg⸱h/L. The initial and post-trough vancomycin total daily dose (TDD) derived by the online calculator were compared with the actual doses used for each patient when a trough concentration of 10 to 15 mg/L was targeted.Comparison of Trough-Based and AUC-Based Dosing of VancomycinAUC indicates area under the concentration–time curve; TDD, total daily dose. Dashed line indicates where the 2 methods are equal; shading indicates where the 2 methods are within 20% of each otherResultsIn total, 89 patients were included in the study. The actual vancomycin TDD with trough monitoring (target, 10-15 mg/L) was within 20% of the recommended AUC-based TDD for 62 patients (70%) with initial dosing and for 74 (83%) after the initial trough concentration. Nephrotoxicity was rarely observed (2%) and the median duration of vancomycin was 4 days.ConclusionGiven the frequency of dosing similarity between 400-600 mg·h/L AUC and 10-15 mg/L trough-based dosing, vancomycin trough-based monitoring to a goal of 10-15 mg/L is an option warranting further exploration.DisclosuresAll Authors: No reported disclosures

Recent decades have seen a rise of anti-science rhetoric, fueled by scientific scandals and failures of peer review, and the rise of trainable generative AI spreading misinformation. We argue, moreover, that the continued erosion of scientific authority also arises from inherent features in science and academia, including a reliance on publication as a method for gaining professional credibility and success. Addressing this multifaceted challenge necessitates a concerted effort across several key areas: strengthening scientific messaging, combating misinformation, rebuilding trust in scientific authority, and fundamentally rethinking academic professional norms. Taking these steps will require widespread effort, but if we want to rebuild trust with the public, we must make significant and structural changes to the production and dissemination of science.

Comparing the intraocular pressure lowering (IOP-L) of microdrops (MD) dispensed with the Nanodropper with conventional drops (CD) in patients on IOP-L monotherapy. Outpatient clinic. Prospective, crossover, examiner-masked, active-controlled, randomized trial conducted at a single center. We enrolled adults with stable primary glaucoma or ocular hypertension on monotherapy with either latanoprost 0.005% or timolol maleate 0.5%. Participants self-administered either CD or MD for 12 weeks, then crossed over to the alternate treatment for an additional 12 weeks. The primary outcome was IOP at 12 weeks compared with baseline at enrollment. Secondary outcomes included running out of drops (premature bottle exhaustion or PBE), adverse effects (AEs), and subjective evaluations of the device's usability. 29 participants completed the study. MD significantly decreased IOP from baseline by 1.6 mm Hg (95% CI 0.88-2.29), compared with a CD (0.13 mm Hg, 95% CI -0.26 to 0.52). Incidence of PBE decreased from 83% with CD to 17% with MD. AEs were reduced from 83% of participants reporting at least 1 AE with CD vs 62% with MD. Most found MD easy to administer and believed it helped prevent eyedrop waste. MD delivered with the Nanodropper adaptor provided additional IOP-L, significantly reduced PBE, and decreased the occurrence and severity of nonsystemic AEs compared with CD in this cohort of stable primary open-angle glaucoma/ocular hypertension participants. MD use among glaucoma participants may enhance tolerability, and improve adherence and long-term IOP control.

Background: Left atrial (LA) strain, measured by two-dimensional speckle tracking (2D-STE), has not been explored in lymphoma patients before anthracycline treatment as a prognostic marker for predicting future major adverse cardiovascular effects (MACE), heart failure, cardiotoxicity, and all-cause mortality after treatment. Hypothesis: Can an abnormal baseline LA peak reservoir strain (LA RS) measured before anthracycline chemotherapy predict MACE, heart failure, cardiotoxicity, and all-cause mortality in lymphoma patients? Methods: A retrospective cohort study was conducted including 104 patients diagnosed with Hodgkin and non-Hodgkin lymphoma, enrolled and followed from January 1, 2013, to June 30, 2023. LA RS was measured in a dedicated 4 chamber view (TomTec Imaging Systems, Unterschleissheim, Germany), abnormal values defined as less than 35%. Univariate Cox regression analyses were performed to assess whether the LA RS was associated with the development of MACE, cardiotoxicity, heart failure, and all-cause mortality. Multivariable Cox regression models were used to adjust for comorbidities. Associations with outcomes were evaluated using the Kaplan-Meier method and Cox regression. Results: Among 104 patients (mean age of 59 years; [IQR], 49–70), 69 (66.3%) were male and 102 (98.1%) were white. MACE occurred in 19 patients, heart failure in 14 patients, and cardiotoxicity was observed in 4 patients. Additionally, all-cause mortality was found in 19 patients (18.3%). Abnormal LA RS was significantly associated with increased all-cause mortality (HR 3.12, 95% CI 1.02–9.53, p=0.0454) (Figure c), even after adjusting for hypertension, dyslipidemia, smoking status, gender and age (Figure d). No significant associations were found between LA RS and MACE (HR 1.42, 95% CI 0.56-3.62, p=0.4604) (Figure a), heart failure (HR 1.12, 95% CI 0.38-3.24, p=0.8299), or cardiotoxicity (HR 3.23, 95% CI 0.33-31.47, p=0.3128) (Figure b). Conclusions: Abnormal baseline LA strain measured by echocardiography is an independent predictor of all-cause mortality in lymphoma patients. These findings support the use of LA strain assessment into initial risk stratification protocols, providing particular value in identifying patients at increased risk of mortality.