Lon J. Van Winkle

In this article collection, we describe how noncoding epigenetic changes in DNA are transmitted across multiple generations in eukaryotic organisms including plants and animals. And such environmentally induced biochemical alterations of DNA and histones result in profound changes in gene expression. In plants and invertebrate animals, transgenerational epigenetic inheritance has been well documented, and it continues to be substantiated in humans and other vertebrates. These exciting new discoveries have profound consequences for changing as well as maintaining phenotypes expressed by various life forms and, thus, the changes likely contribute to evolution. And in a more practical way, such studies are very important because of the likely transgenerational inheritance of diseases and disorders, such as type 2 diabetes mellitus and obesity.

Purpose: To determine whether prospective medical students’ attitudes toward readings and service-learning for a Medical Humanities course predict their perceived impact of the course on their critical reflection and empathy for their peers.Methods: Following a Medical Humanities course, students completed surveys concerning their attitudes toward team-based service-learning and readings required for the course. And they completed surveys designed to measure their empathy for one another and thoughts and feelings about the course (e.g., “owing to this course, I have changed the way I look at myself” = critical reflection).Results: Students’ positive attitudes toward service-learning and readings for the course correlated positively with each other and with their critical reflection (CR) and empathy for their peers (r = 0.28 to 0.63, p < 0.05 to 0.0001).Conclusion: Positive attitudes toward team-based service-learning predicted students’ perceptions of the Humanities course’s impact on both critical reflection and peer empathy, whereas attitudes toward required readings played a significantly lesser role.

Environmental forces impacting public health include exposure to toxic substances, adverse childhood experiences (ACEs), diet, and exercise. Here, we examine the first two of these forces in some detail since they may be amenable to correction through cultural, medical, and practitioner intervention. At the same time, changing people’s dietary and exercise routines are likely more resistant to these interventions and are referred to only incidentally in this review. That is, societal efforts could prevent exposure to toxicants and ACEs—not necessarily requiring cooperation by the affected individuals—whereas changing diet and exercise practices requires an individual’s discipline. Toxic substances considered in this review include endocrine disruptors, arsenics, 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), the organic solvent, Trichloroethylene (TCE), and the Benzo[a]pyrene (B[a]P) produced from incomplete combustion of tobacco and other organic materials. Exposure to each of these toxic substances may have serious adverse health effects, especially in genetically more susceptible individuals. For example, children of mothers exposed to the endocrine disruptor, Atrazine, have significantly lower birth length, weight, and head circumference. Moreover, male offspring exhibit genital abnormalities, and all of these effects may be transgenerational. However, analyses of interactions among genes, the environment, and epigenetic modifications have already revealed distinctive individual risks of adverse reactions to toxic exposure. So, interventions through precision medicine might improve the health of those exposed individuals. Adults previously exposed to more than one ACE (e.g., child abuse and inter-parental violence) are more likely to develop anxiety, cancer, and diabetes. Detecting ACE exposures in children in the general population is fraught with difficulty. Thus, the risks of ACEs to our health remain even more insidious than exposures to toxicants. Nevertheless, higher provider compassion is associated with significantly better clinical outcomes for patients with these afflictions. For all these reasons, the first major aim of this review is to recount several of the major forces contributing to or impairing public health. Our second major aim is to examine mitigating influences on these forces, including social justice and provider compassion in the setting of precision medicine. Idealistically, these mitigators might eventually lead to the development of more cooperative and compassionate cultures and societies.

Purpose: To determine whether the 12-item state empathy scale could be modified reliably to measure empathy in healthcare professions students and to detect changes in their empathy owing to a single improvisation (improv) session. Methods: Three cohorts of students from two healthcare professions programs (total = 165 students) participated in an improv session. During the session, one of the researchers (BS) tasked the students with several improv activities. Participants’ self-reported state empathy scores were assessed at three time points (pre-improv, post-improv, and end of semester) using revised, in-class paper versions of the State Empathy Scale. Results: The exploratory factor analysis revealed a single factor solution for the revised scale, justifying the creation of an overall state empathy score from the questionnaire. Cronbach’s alpha reliability values averaged 0.87. Students’ mean empathy scores were higher directly after the improv session than directly prior to the session (p < 0.0001; effect size = r = 0.67, 0.55, and 0.79 for cohorts 1, 2, and 3, respectively). Conclusions: These findings show that a single one- or two-hour improv session can foster substantial increases in healthcare professional students’ state empathy for one another. Greater healthcare professional empathy and compassion foster better healthcare team cooperation and patient outcomes, so healthcare professionals and their students should engage in such empathy-enhancing activities at regular intervals throughout their training and careers.

Purpose: Previously we assessed healthcare professional students’ feelings about team-based learning, implicit bias, and service to the community using an in-house paper survey. In this study, we determined whether this survey is a reliable and valid measure of prospective medical students’ attitudes toward required service-learning in an Immunology course. To our knowledge, no published questionnaire has been shown to be dependable and useful for measuring such attitudes using only eight survey items.Methods: Fifty-eight prospective medical students in Colorado (CO) and 15 in Utah (UT) completed the same Immunology course using remote technology. In addition to the usual course content, students were required to write critical reflections on required team service-learning. On the last day of class, they completed the survey of attitudes toward service-learning (SASL).Results: Data analyses found Cronbach’s alpha values of 0.84 and 0.85 for the surveys of UT and CO students, respectively. Factor analysis of CO student data revealed only one Eigenvalue greater than one (3.95) justifying retention of a single factor termed “attitudes toward required service-learning.” In addition, CO students’ attitudes toward community service were highly positive, while UT students’ attitudes were nearer neutral (p < 0.0001).Conclusion: Our factor analysis and good Cronbach’s alpha values support the conclusion that the SASL was a reliable measure of prospective medical students’ attitudes toward required team service-learning for an Immunology course. Moreover, we used the SASL to distinguish these attitudes in CO versus UT students, and, thus, the SASL appears to be a valid measure of this difference. Calculation of similarly good Cronbach’s alpha values – for a predecessor of the SASL among pharmacy, masters, and medical students at another institution – indicates that the SASL may be useful more widely. However, the reliability and validity of the SASL needs to be demonstrated more rigorously for other healthcare students at different universities.

Editorial: Mitigating implicit bias and promoting compassionate behavior in public health/healthcare professionals: implications for treatment outcomes

Editorial: From single stem cells to organoids, organ repair, and public health Volume II

The articles in this Special Issue address a wide variety of topics concerning molecular and clinical advances in understanding early embryo development

MSG alters metabolism, especially in the brain, when administered to experimental animals via gavage or similar means. Such administration is, however, not applicable to humans. More recently, though, MSG was shown to have these effects even when added to the food of mammals. Moreover, the levels of MSG in food needed to cause these metabolic changes are the same as those needed for optimum flavor enhancement. Near physiological concentrations of glutamate also cause mammalian blastocysts to develop with fewer cells, especially in their inner cell masses, when these embryos are cultured with this amino acid. We propose that consumption of MSG in food may overwhelm the otherwise well-regulated glutamate signaling needed for optimal development by pre- and peri-implantation mammalian embryos. In addition to immediate changes in cellular proliferation and differentiation as embryos develop, MSG ingestion during early pregnancy might result in undesirable conditions, including metabolic syndrome, in adults. Since these conditions are often the result of epigenetic changes, they could become transgenerational. In light of these possibilities, we suggest several studies to test the merit of our hypothesis.