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This article explains the importance of a communities of practice (CoP) model for continually aligning medical education and clinical transformation with contemporary health issues. It describes the evolution and advantages of using CoP as a model for transforming medical education and clinical practice and applies the CoP methodology to addressing the changing needs of socially vulnerable populations (LGBTQ [lesbian, gay, bisexual, transgender, and queer/questioning], persons experiencing homelessness, and migrant farm workers). In conclusion, this article describes CoP-led activities, achievements, and value creation in medical education by the National Center for Medical Education Development and Research established at the Meharry Medical College. Key words: communities of practice; primary care; medical education, systematic review; vulnerable populations, LGBTQ https://doi.org/10.1370/afm.2925, INTRODUCTION Given the rapid changes in the demographic, social, and personal health landscapes, the health care sector needs to continually update and reinvent itself to meet the evolving needs of [...]

Transgender and gender-diverse (TGD) patients experience a greater burden of health disparities compared with their heterosexual/cisgender counterparts. Some of the poorer health outcomes observed in these populations are known to be associated with the prevalence of implicit bias, bullying, emotional distress, alcoholism, drug abuse, intimate partner violence, sexually transmitted infections (eg, human immunodeficiency virus and human papilloma virus), and cancer. The TGD populations face unique barriers to receiving both routine and gender-affirming health care (acquiring hormones and gender-affirming surgeries). Additional barriers to implementing affirming care training for TGD patients are lack of expertise among medical education faculty and preceptors both in undergraduate and in graduate medical education programs. Drawing on a systematic review of the literature, we propose a policy brief aimed at raising awareness about gender-affirming care among education planners and policy makers in government and advisory bodies. Key words: gender-affirming care; transgender and gender-diverse patients; primary care; medical education; curricula; health care workforce; vulnerable populations; LGBTQ https://doi.org/10.1370/afm.2926, INTRODUCTION Transgender people have a gender identity that differs from their assigned sex at birth. (1) Because transgender medicine is not adequately covered in medical curricula, few clinicians are comfortable [...]

Background: Literature presents limited information on histological subtypes and their association with other factors influencing the survival of melanoma patients. To explore the risk of death due to melanoma associated with histological subtypes, this retrospective study used the Surveillance, Epidemiology, and End Results program (SEER) data from 1998 to 2019. Methods: A total of 27,532 patients consisting of 15,527 males and 12,005 females. The Hypertabastic Accelerated Failure Time model was used to analyze the impact of histology on the survival of patients with cutaneous or mucosal melanoma. Results: The median survival time (MST) for cutaneous patients was 149 months, whereas those diagnosed with mucosal melanoma was 34 months. Nodular melanoma had a hazard ratio of 3.40 [95% CI: (2.94, 3.94)] compared to lentigo maligna melanoma. Across all histological subtypes, females had a longer MST, when compared to males. The hazard ratio (HR) of distant to localized melanoma was 9.56 [95% CI: (7.58, 12.07)]. Conclusions: Knowledge of patients' histological subtypes and their hazard assessment would enable clinicians and healthcare providers to perform personalized treatment, resulting in a lower risk of complication and higher survivability of melanoma patients. Significant factors were stage of the disease, age, histology, sex, and income. Focus should be placed on high-risk populations with severe and aggressive histological subtypes. Programs that emphasize preventive measures such as awareness, education, and early screening could reduce risk. [ABSTRACT FROM AUTHOR]

Channel confluence is one of the important features of each river system and some hydraulic structures. The features that can dominantly control flow characteristics in a confluence are confluence angle, discharge, width ratios, and Froude number of flow. Several research studies have been conducted however a comprehensive three-dimensional (3-D) numerical study of flow characteristics in a confluence has not yet been reported. In the present study, SSIIM2.0, a 3-D numerical model, is validated and applied to investigate secondary currents, velocity distribution, flow separation, and water surface elevation in different conditions. The results of the present study illustrate that flow structure and water surface variations in a confluence are highly influenced by confluence angle, discharge, and width ratios as well as Froude number because of their effect on flow deflection, separation, and secondary currents. The graphs from the present study can be used to analyze water surface variation, velocity field, and flow separation dimensions in difference conditions for engineering designs. Key words: channel confluence, flow structure, numerical model, secondary currents, three-dimensional model. La confluence des canaux est 1'une des caracteristiques importantes de chaque reseau hydrographique et de certains ouvrages hydrauliques. Les attributs qui peuvent principalement affecter les caracteristiques de l'ecoulement dans une confluence sont l'angle de confluence, les rapports debit et largeur, de meme que le nombre de Froude de l'ecoulement. Plusieurs travaux de recherche ont ete realises, mais une etude numerique tridimensionnelle complete des caracteristiques de l'ecoulement dans une confluence n'a pas encore ete signalee. Dans la presente etude, le modele numerique tridimensionnel SSIIM2.0 est valide et utilise pour examiner des courants secondares, la distribution de la vitesse, la separation de l'ecoulement et l'elevation de la surface de 1'eau sous diverses conditions. Les resultats montrent que les variations dans la structure d'ecoulement et la surface de 1'eau dans une confluence sont tres influencees par l'angle de confluence, les rapports debit et largeur de meme que par le nombre de Froude en raison de leur effet sur la deviation de l'ecoulement, la separation des courants et les courants secondaires. Les graphiques qui en decoulent peuvent etre utilises pour analyser la variation de la surface de 1'eau, le champ de vitesse el les volumes lors de la separation de l'ecoulement sous diverses conditions pour aider a la conception technique. Mots-cles : confluence de canaux, structure d'ecoulement, modele numerique, courants secondaires, modele tridimensionnel., 1. Introduction River channel confluence is a point at which two or more rivers or branches of a river are combined together. This feature can also be observed in some [...]

Abstract Background We explore the benefits of applying a new proportional hazard model to analyze survival of breast cancer patients. As a parametric model, the hypertabastic survival model offers a closer fit to experimental data than Cox regression, and furthermore provides explicit survival and hazard functions which can be used as additional tools in the survival analysis. In addition, one of our main concerns is utilization of multiple gene expression variables. Our analysis treats the important issue of interaction of different gene signatures in the survival analysis. Methods The hypertabastic proportional hazards model was applied in survival analysis of breast cancer patients. This model was compared, using statistical measures of goodness of fit, with models based on the semi-parametric Cox proportional hazards model and the parametric log-logistic and Weibull models. The explicit functions for hazard and survival were then used to analyze the dynamic behavior of hazard and survival functions. Results The hypertabastic model provided the best fit among all the models considered. Use of multiple gene expression variables also provided a considerable improvement in the goodness of fit of the model, as compared to use of only one. By utilizing the explicit survival and hazard functions provided by the model, we were able to determine the magnitude of the maximum rate of increase in hazard, and the maximum rate of decrease in survival, as well as the times when these occurred. We explore the influence of each gene expression variable on these extrema. Furthermore, in the cases of continuous gene expression variables, represented by a measure of correlation, we were able to investigate the dynamics with respect to changes in gene expression. Conclusions We observed that use of three different gene signatures in the model provided a greater combined effect and allowed us to assess the relative importance of each in determination of outcome in this data set. These results point to the potential to combine gene signatures to a greater effect in cases where each gene signature represents some distinct aspect of the cancer biology. Furthermore we conclude that the hypertabastic survival models can be an effective survival analysis tool for breast cancer patients.

Abstract Background An understanding of growth dynamics of tumors is important in understanding progression of cancer and designing appropriate treatment strategies. We perform a comparative study of the hyperbolastic growth models with the Weibull and Gompertz models, which are prevalently used in the field of tumor growth. Methods The hyperbolastic growth models H1, H2, and H3 are applied to growth of solid Ehrlich carcinoma under several different treatments. These are compared with results from Gompertz and Weibull models for the combined treatment. Results The growth dynamics of the solid Ehrlich carcinoma with the combined treatment are studied using models H1, H2, and H3, and the models are highly accurate in representing the growth. The growth dynamics are also compared with the untreated tumor, the tumor treated with only iodoacetate, and the tumor treated with only dimethylsulfoxide, and the combined treatment. Conclusions The hyperbolastic models prove to be effective in representing and analyzing the growth dynamics of the solid Ehrlich carcinoma. These models are more precise than Gompertz and Weibull and show less error for this data set. The precision of H3 allows for its use in a comparative analysis of tumor growth rates between the various treatments.