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To the Editor: Multiple sclerosis (MS) is a chronic autoinflammatory and demyelinating disease of the central nervous system (CNS). The individual risk of developing MS substantially increases after a primary [...]

Despite the prevalence of elephant poaching and ivory trafficking, domestic and international ivory markets around the world are slowly closing due to increased education and enforcement efforts. This includes California’s ivory market in 2016 after the passage of Assembly Bill 96 (AB 96), which prohibits the purchase, sale, offer for sale, possession, or importation with intent to sell, of ivory from elephant, mammoth, and mastodon along with other non-proboscidean species. To assist with enforcement efforts, the California Department of Fish and Wildlife’s Wildlife Forensic Laboratory (CDFW-WFL) has created and implemented a scientific workflow to taxonomically identify, geographically assign, and age California’s seized ivory. Here we discuss the application of this scientific workflow to a 32-piece ivory chess set, which was purchased in 1969 and donated to and examined by the WFL in 2021. Genetic data revealed 11 unique haplotypes and 19 unique genotypes, suggesting a diverse set of African elephants from numerous locations in Africa were used to assemble the chess set. Stable isotope data corroborated these findings and radiocarbon dating suggested the ivory used to carve these chess pieces grew approximately 6 years prior to the chess set being purchased. Our results indicate that the use of a variety of scientific techniques provides a wide scope of information; furthermore, taxonomically identifying, geographically assigning, and aging the ivory chess set demonstrates to law enforcement officers how our ivory workflow can assist them in coordinating efforts locally, nationally, and internationally to help stop the illegal importation of ivory into California.

MY GRANDFATHER died before I was born, and he remains to me a mostly mysterious figure. As is true of many people born poor who are committed to bettering their [...]

On days when the world to me is desolation; when I cannot sit in my seat, or do any productive labor; when I have a terrible desire to be free, [...]

AbstractThe aim was to study discrimination, with a focus on gender and sexual harassment among medical students at Uppsala University in Sweden. A survey was sent via email to all registered medical students in the spring semester of 2020. Data were compared with two previous studies. Questions about gender and sexual harassment were the same as in the study conducted in 2002 and 2013. In addition, the 2020 survey included a question about other grounds of discrimination. Forty percent, that is, 453 out of 1,130 medical students, participated. The proportion of students reporting gender-based discrimination during the preclinical semesters was similar for females and males. During the clinical semesters, significantly more females than males reported gender discrimination (41% vs. 21.5%, p = 0.005) and sexual harassment (22% vs. 5%, p = 0.001). Physicians were the most commonly reported perpetrator. Reports about not being respected had increased from 2% to 20% between 2013 and 2020 among female clinical students. The prevalence of those who experienced several sexually harassing behaviors increased for the female and male clinical students and the female preclinical students. Receiving an unwelcome touch increased from 1% to 7% for the female clinical students. Discrimination due to ethnicity was reported by 36% of the students born in a country other than Sweden compared to 3% of those born in Sweden. Our findings confirm that experiences of different forms of discrimination exist in this medical school, and females and minorities are particularly affected.

Barrett’s esophagus is a pre-malignant condition that can progress to esophageal cancer. Here, the authors carry out whole genome sequencing of samples from patients who did or did not progress to cancer and find that mutations in many genes occur regardless of progression status, but also find features associated with progressive disease.

Background: During the COVID-19 pandemic, we identified a gap in adequate discharge counseling for COVID-19 patients in the Emergency Department. This was due to high patient volumes and lack of patient education regarding a novel disease. Medical students were also restricted from clinical areas due to safety concerns, compromising their clinical experience. We piloted a novel program in which medical students served as virtual discharge counselors for COVID-19 patients via teleconference. We aimed to demonstrate an impact on patient care by examining the patient bounce back rate as well as assessing medical student education and experience. Methods: This program was piloted in a tertiary care Emergency Department. Medical student volunteers served as virtual discharge counselors. Students were trained in discharge counseling with a standardized protocol and a discharge script. Eligible patients for virtual discharge counseling were 18 years old or greater with a diagnosis of confirmed or suspected COVID-19 and no impediment precluding them from participating in a telemedicine encounter. Counseling was provided via secure teleconference in the patient's preferred language. Counseling included diagnosis, supportive care with medication dosing, quarantine instructions, return precautions, follow up, and time to ask questions. Duration of counseling was recorded and medical students were anonymously surveyed regarding their experience. Results: Over an 18-week period, 45 patients were counseled for a median of 20 min. The 72-hr ED revisit rate was 0%, versus 4.2% in similarly-matched, not counseled COVID-19 patients. 90% of medical students believed this project increased their confidence when speaking with patients while 80% indicated this was their first telemedicine experience. Conclusion: Our pilot discharge program provided patients with an extensive discharge counseling experience that would not otherwise be possible in an urban ED setting and demonstrated benefit to patient care. Medical students received a safe clinical experience that improved their communication skills. [ABSTRACT FROM AUTHOR]

The article focuses on William L. Dawson's influential legacy as both a strict educator and a deeply caring individual. Topics include his demanding yet effective teaching methods at Tuskegee Institute, his pioneering arrangements of spirituals that preserved and elevated African American musical heritage, and his personal dedication to supporting and nurturing his students beyond their musical education.

SINEAD O'CONNOR, THE troubled Irish singer-songwriter, died in July at age fifty-six. No cause of death has been announced, but it is fair to note that at times she both [...]

Abstract Barrett's Esophagus is a neoplastic condition which progresses to esophageal adenocarcinoma in 5% of cases. Key events affecting the outcome likely occur before diagnosis of Barrett's and cannot be directly observed; we use phylogenetic analysis to infer such past events. We performed whole‐genome sequencing on 4–6 samples from 40 cancer outcome and 40 noncancer outcome patients with Barrett's Esophagus, and inferred within‐patient phylogenies of deconvoluted clonal lineages. Spatially proximate lineages clustered in the phylogenies, but temporally proximate ones did not. Lineages with inferred loss‐of‐function mutations in both copies of TP53 and CDKN2A showed enhanced spatial spread, whereas lineages with loss‐of‐function mutations in other frequently mutated loci did not. We propose a two‐phase model with expansions of TP53 and CKDN2A mutant lineages during initial growth of the segment, followed by relative stasis. Subsequent to initial expansion, mutations in these loci as well as ARID1A and SMARCA4 may show a local selective advantage but do not expand far: The spatial structure of the Barrett's segment remains stable during surveillance even in patients who go on to cancer. We conclude that the cancer/noncancer outcome is strongly affected by early steps in formation of the Barrett's segment.

Abstract Background Black men who have sex with men (MSM) are disproportionately affected by HIV compared to almost every other demographic group in the country and have worse outcomes along the care continuum. Diagnosis is a critical juncture. This study aims to explore the impact and meaning of an HIV diagnosis for Black MSM, and how this has changed over time, both for the individual’s experience living with HIV as well as for Black MSM in general. Methods From 2017 to 2018, we conducted in-depth interviews with 16 black MSM living with HIV in New York City diagnosed between 1985 and 2016. Results Inductive analysis of the qualitative data allowed three major themes to emerge: diagnosis trauma, lack of patient -centeredness in the healthcare system, and acceptance of HIV diagnosis over time. Conclusions This small pilot study signals that an HIV diagnosis experience possibly remains traumatic for black MSM even in the era of highly effective ART, and they often perceive a lack of patient-centeredness in the delivery of a new diagnosis. This has persisted over time. In most cases, black MSM in our sample overcame this trauma due to self-motivation, social support and seeking out and fostering trusting relationships with their HIV provider and the healthcare system.

BackgroundLimited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19.ObjectiveTo describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America.MethodMulticenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children

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