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Despite an aging confined population, the current state of organ transplantation in carceral systems is largely unknown. This scoping review aimed to assess the literature on organ transplantation in populations experiencing incarceration. The review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for a scoping review. Included references were published between January 2000 and January 2022 in PubMed, Cumulative Index to Nursing and Allied Health Literature via EBSCO, EMBASE.com, PsycInfo via EBSCO, Sociological Abstracts via ProQuest, and Scopus. Two reviewers conducted title and abstract screening, full-text review, and data extraction in order to generate common themes. The initial search yielded 3,225 studies, and 2,129 references underwent screening. Seventy studies underwent full-text review, and 10 met inclusion criteria. These studies revealed heterogeneous perspectives and policies by providers and transplant centers regarding transplant consideration of individuals with incarceration history or current involvement. Two studies on a kidney transplant program for patients experiencing incarceration showed transplant as a sustainable and potentially superior option for people who are incarcerated, as compared with chronic hemodialysis. Literature on transplantation for populations experiencing incarceration is sparse. More research is required to understand the demand for transplants and the ethical implications of the heterogeneous perspectives and policies on practice patterns. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer treatment patterns and quality of care among patients experiencing incarceration are underexplored. This study examined associations between incarceration and breast cancer disease and treatment characteristics. Methods: This retrospective analysis was conducted at a tertiary center in the Southeastern United States that serves as the state's safety‐net hospital and primary referral site for the state's prisons. All patients ≥18 years diagnosed with breast cancer between 4/14/2014–12/30/2020 were included. Incarceration status was determined through electronic health record review. Linear regression was used to estimate the association of incarceration with time to treatment. Unadjusted overall survival (OS) was estimated using the Kaplan–Meier method with log‐rank tests to compare groups. Results: Of the 4329 patients included, 30 (0.7%) were incarcerated at the time of diagnosis or treatment (DI) and 4299 (99.3%) had no incarceration history (NI). Compared to patients who were NI, patients who were DI were younger (p < 0.001), more likely to be unmarried (p < 0.001), and more likely to have family history of breast cancer (p = 0.02). Patients who were DI had an increased time from diagnosis to neoadjuvant chemotherapy (+47.2 days on average, 95% CI 3.9–90.5, p = 0.03) and from diagnosis to surgery (+20 days on average, 95% CI 6.5–33.5, p = 0.02) compared to NI patients. No difference in OS was observed (log‐rank p = 0.70). Conclusions: Patients who are incarcerated experienced significant delays in breast cancer care. While no differences in mortality were appreciated, these findings are concerning, as they indicate poorer care coordination for patients who are incarcerated. Further research is necessary to understand the full scope of these disparities and elucidate factors that contribute to them. [ABSTRACT FROM AUTHOR]

This article, published in the European Journal of Immunology, explores the role of interleukin 21 (IL-21) in the differentiation of plasma cells and the inhibition of IgE expression. The study found that IL-21 promotes the differentiation of IgG1+ plasma cells instead of class switching to IgE by inducing the expression of Blimp1. The researchers demonstrated this through experiments using B cells and mice, showing that IL-21 inhibits the generation of IgE+ cells and promotes the differentiation of IgG1+ plasma cells. These findings suggest that IL-21 plays a role in regulating the production of IgE and may have implications for understanding allergic reactions and asthma. [Extracted from the article]

Simple Summary: Esophageal cancer is a severe disease with a high mortality rate. Recent advancements in treatments have improved outcomes, but survival rates remain low. This study investigates the use of immunotherapy, a treatment that helps the immune system fight cancer, in combination with standard chemoradiation and surgery for patients with locally advanced esophageal cancer. By analyzing data from the National Cancer Database, we found that patients who received adjuvant immunotherapy had better survival rates than those who did not receive immunotherapy or who received neoadjuvant immunotherapy. These findings suggest that adjuvant immunotherapy could be a beneficial addition to existing treatment protocols, and further research is needed to confirm these results and optimize patient outcomes. Background: The current National Comprehensive Cancer Network advises neoadjuvant chemoradiotherapy followed by surgery for locally advanced cases of esophageal cancer. The role of immunotherapy in this context is under heavy investigation. Methods: Patients with esophageal adenocarcinoma were identified in the National Cancer Database (NCDB) from 2004 to 2019. Three groups were generated as follows: (a) no immunotherapy, (b) neoadjuvant immunotherapy, and (c) adjuvant immunotherapy. Overall survival was evaluated using the Kaplan–Meier method and Cox proportional hazard analysis, adjusting for previously described risk factors for mortality. Results: Of the total 14,244 patients diagnosed with esophageal adenocarcinoma who received neoadjuvant chemoradiation, 14,065 patients did not receive immunotherapy, 110 received neoadjuvant immunotherapy, and 69 received adjuvant immunotherapy. When adjusting for established risk factors, adjuvant immunotherapy was associated with significantly improved survival compared to no immunotherapy and neoadjuvant immunotherapy during a median follow-up period of 35.2 months. No difference was noted among patients who received no immunotherapy vs. neoadjuvant immunotherapy in the same model. Conclusions: In this retrospective analysis of the NCDB, receiving adjuvant immunotherapy offered a significant survival advantage compared to no immunotherapy and neoadjuvant immunotherapy in the treatment of esophageal adenocarcinoma. The addition of neoadjuvant immunotherapy to patients treated with neoadjuvant chemoradiation did not improve survival in this cohort. Further studies are warranted to investigate the long-term outcomes of immunotherapy in esophageal cancer. [ABSTRACT FROM AUTHOR]

Objectives: Medical schools have sought to incorporate concepts of race and racism in their curricula to facilitate students' abilities to grapple with healthcare disparities in the United States; however, these efforts frequently fail to address implicit bias or equip students with cultural humility, reflective capacity, and interpersonal skills required to navigate racialized systems in healthcare. The purpose of this study was to develop and evaluate an antiracism narrative medicine (NM) program designed by and for preclinical medical students. Method: Preclinical medical students at a single center were eligible to participate from June-July 2021. Program evaluation included a postprogram qualitative interview and electronic survey. The semistructured interview included questions about program experience, lessons learned, and perspectives on antiracism curricula in medical education. Interviews were qualitatively analyzed using open and axial coding. Survey data were analyzed with descriptive statistics. Results: A total of 30 students registered. All (100%) respondents reported "somewhat true" or "very true" in the postprogram survey when asked about their ability to reflect on their own racial identity, racial identity of others, and influence of their racial identity on their future role as a healthcare worker through the program. Qualitative analysis revealed 3 themes: (1) curricular engagement; (2) racism and antiracism in medicine; and (3) group experience. Subthemes included: meaningful theoretical content; multimodal works and unique perspectives; race, identity, and intersectionality; deeper diversity, equity, and inclusion engagement; reconstructive visions; future oriented work; close reading and writing build confidence in discomfort; community and support system; and authentic space among peer learners. Conclusion: This virtual, peer-facilitated antiracism NM program provided an engaging and challenging experience for participants. Postprogram interviews revealed the program deepened students' understanding of racism, promoted self-reflection and community building, and propagated reconstructive visions for continuing antiracism work. [ABSTRACT FROM AUTHOR]

Background: The experiences of pager use among trainees across medical specialties is underexplored. The aim of this study was to assess experiences of pager burden and communication preferences among trainees in different specialties. Methods: An online survey was developed to assess perceived pager burden (eg, pager volume, mistake pages, sleep, and off-time interruptions) and communication preferences at a tertiary center in the United States. All residents and fellows were eligible to participate. Responses were grouped by specialty: General surgery [GS], Surgical subspecialty [SS], Medicine, Anesthesiology, and Psychiatry. Multivariable linear regression was used to assess factors associated with pager burden. Free text responses were analyzed using open coding methods. Results: Of the total 306 responses, the majority were female (58.8%), 30-39 years (59.2%), and White (70.6%). Specialty breakdown was: Medicine (40.2%), Psychiatry (10.8%), SS (18.0%), GS (5.6%), and Anesthesiology (3.6%). GS respondents reported receiving more mistake pages (P <.001), spending more time redirecting mistake pages (P =.003), and having the highest sleep time disruptions (P <.001). For urgent communications, surgical trainees preferred physical pagers, while nonsurgical trainees preferred smartphone pagers (P =.001). "Receive fewer nonurgent pages" was the most common change respondents desired. Discussion: In this single center study, subjective experiences of pager burden were disproportionately high among GS trainees. Reducing nonurgent and mistake pages are potential targets for improving trainee communication experiences. Hospitals should consider incorporating trainee preferences into paging systems. Additional studies are warranted to increase the sample size, assess generalizability of the findings, and contextualize trainee experiences with objective hospital-level paging data. [ABSTRACT FROM AUTHOR]

Cancer is the leading cause of illness-related death in state prisons in the United States. The experiences of physicians providing oncological care to individuals experiencing incarceration are underexplored. The study aims were to evaluate knowledge, attitudes, and practices of oncologists caring for cancer patients who are incarcerated. An online survey was distributed to a random sample of 150 oncologists from the American Society of Clinical Oncology and the American Society for Radiation Oncology from July 2020 to December 2021. Statistical analyses included two proportion Z-test, Fisher's exact test, Kruskal–Wallis test, and Cramer's V to estimate factors associated with attitudes and barriers to care. Of the 55 respondents (36.7% response rate), 21 were medical oncologists and 34 were radiation oncologists. Academic center oncologists were more likely to report caring for incarcerated patients than community or private practice oncologists (p = .04). Most (53%) incorrectly reported "heart disease" as the leading cause of death, as opposed to "cancer" (15% identified correctly). Oncologists practicing at both academic and community centers were more likely to report care coordination barriers than oncologists at academic or community centers (p < .01). We identified potential barriers in caring for incarcerated cancer patients. Future studies should explore ways to improve care coordination between oncology teams and prisons. [ABSTRACT FROM AUTHOR]

Problem: Diversity, Equity, and Inclusion (DEI) trainings for medical school faculty often lack self-reflective and pedagogically focused components that may promote incorporation of anti-racism and social justice into medical school curricula. Intervention: A four-session Narrative Medicine (NM) anti-racism program was designed for medical school faculty using critical race theory, phenomenology, and NM methods. Each workshop consisted of a lecture on key NM concepts and a small-group breakout session incorporating group discussion, close reading, and reflective writing. Context: This NM anti-racism program was developed and implemented in April 2021 by two medical students for faculty at an institution in the southeastern U.S. The program was supported by the Office of Inclusive Excellence at the institution and held in collaboration with the institution's medical education teaching academy. Program evaluation consisted of pre- and post-program surveys, which queried participants' previous experiences with DEI and medical humanities programs, perceptions of self-identity and privilege, and confidence in teaching concepts of anti-racism. Of the total program participants (n = 32), 19 completed both surveys (54.3%). Survey data were analyzed using bivariate testing methods and qualitative thematic analysis. Impact: Post-program surveys showed 13 (68.4%) participants felt "somewhat more" or "more" comfortable engaging in concepts of race, and 12 (63.2%) participants felt "somewhat more" or "more" comfortable including topics of race into their teaching compared to before the program. Five themes were generated following qualitative analysis: (1) the value of longitudinal narrative reflection in a small-group setting for DEI work; (2) desire to commit more time to DEI, anti-racist, and social justice work while balancing busy teaching and clinical schedules; (3) the value of storytelling in DEI and anti-racism programming; (4) an understanding of deconstructive and reconstructive work of anti-racism in medicine; and (5) an increased ability to educate and enact change through teaching, activism, and institutional cultural and policy changes. Lessons Learned: This novel NM DEI training for medical school faculty was successful in increasing comfort discussing and teaching concepts of race in the medical school classroom, while providing a uniquely reflective space for personal growth. Participation in this longitudinal reflective experience was limited by physician schedules, therefore efforts to make time to participate in similar longitudinal interventions must be undertaken. [ABSTRACT FROM AUTHOR]

Japan passed its Child Abuse Prevention Act on 20 November 2000. In these early years following the passage of this Act, it is especially important to attempt to define what constitutes child abuse. Definitions and practical responses may be coloured by perceptions of service providers, and since professional culture is believed to influence individuals, this study compared the perceptions of (a) social workers, (b) physicians, (c) lawyers, and (d) the general public. Results suggested less disagreement in perceptions than was anticipated. When differences were observed, they were correlated more frequently with age and gender rather than with profession.