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Rather than extend oral anticoagulation therapy for patients at high risk for recurrence of venous thromboembolism, advise them to take an aspirin a day. [ABSTRACT FROM AUTHOR]

Introduction: Emerging tick-borne viruses of medical and veterinary importance are increasingly being reported globally. This resurgence emphasizes the need for sustained surveillance to provide insights into tick-borne viral diversity and associated potential public health risks. We report on a virus tentatively designated Kinna virus (KIV) in the family Phenuiviridae and genus Bandavirus. The virus was isolated from a pool of Amblyomma gemma ticks from Kinna in Isiolo County, Kenya. High throughput sequencing of the virus isolate revealed close relatedness to the Guertu virus. The virus genome is consistent with the described genomes of other members of the genus Bandavirus, with nucleotides lengths of 6403, 3332 and 1752 in the Large (L), Medium (M) and Small (S) segments respectively. Phylogenetic analysis showed that the virus clustered with Guertu virus although it formed a distinct and well supported branch. The RdRp amino acid sequence had a 93.3% identity to that of Guertu virus, an indication that the virus is possibly novel. Neutralizing antibodies were detected in 125 (38.6%, 95% CI 33.3-44.1%) of the human sera from the communities in this region. In vivo experiments showed that the virus was lethal to mice with death occurring 6-9 days post-infection. The virus infected mammalian cells (Vero cells) but had reduced infectivity in the mosquito cell line (C636) tested., Conclusion: Isolation of this novel virus with the potential to cause disease in human and animal populations necessitates the need to evaluate its public health significance and contribution to disease burden in the affected regions. This also points to the need for continuous monitoring of vector and human populations in high-risk ecosystems to update pathogen diversity., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Koka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Artisanal and small-scale gold mining (ASGM) plays a crucial role in global gold production. However, the adoption of poor mining practices or the use of mercury (Hg) in gold recovery processes has generated serious environmental contamination events. The focus of this study is assessing the concentration of Hg in surface waters within the coastal region of Ecuador. The results are used to conduct a human health risk assessment applying deterministic and probabilistic methods, specifically targeting groups vulnerable to exposure in affected mining environments. Between April and June 2022, 54 water samples were collected from rivers and streams adjacent to mining areas to determine Hg levels. In the health risk assessment, exposure routes through water ingestion and dermal contact were considered for both adults and children, following the model structures outlined by the U.S. Environmental Protection Agency. The results indicate elevated Hg concentrations in two of the five provinces studied, El Oro and Esmeraldas, where at least 88% and 75% of the samples, respectively, exceeded the maximum permissible limit (MPL) set by Ecuadorian regulations for the preservation of aquatic life. Furthermore, in El Oro province, 28% of the samples exceeded the MPL established for drinking water quality. The high concentrations of Hg could be related to illegal mining activity that uses Hg for gold recovery. Regarding the human health risk assessment, risk values above the safe exposure limit were estimated. Children were identified as the most vulnerable receptor. Therefore, there is an urgent need to establish effective regulations that guarantee the protection of river users in potentially contaminated areas. Finally, it is important to continue investigating the contamination caused by human practices in the coastal region.

Gold mining activity is a source of supply in many areas of the world, and especially in developing countries, it is practiced illegally and by applying unsafe techniques. Particularly in Ecuador, artisanal and small-scale gold mining (ASGM) is widespread, and it is based on the use of toxic substances, such as mercury (Hg), in gold recovery. Hg is a heavy metal that is water-insoluble, which, once mobilized, poses a threat to both the environment and human health. This study analyzes Hg concentrations in the six provinces of Napo, Sucumbíos, Orellana, Pastaza, Morona Santiago, and Zamora Chinchipe of the Ecuadorian Amazon region to conduct a human health risk assessment. Significant differences in Hg levels were found between provinces, but concentrations were below MPL imposed by Ecuadorian regulations everywhere. Nevertheless, a worrisome picture emerges, especially with regard to the most vulnerable receptors represented by the child population. There are multiple factors of incidence that may affect the possible future development of the phenomenon, and with reference to the social, economic, and environmental context of the region, it can be concluded that it may be appropriate to plan further investigation to arrive at a more comprehensive assessment. The results of this study can be used by decision makers to plan further investigation and to implement monitoring networks, risk mitigation strategies, and groundwater protection measures.

Mining activity drives economic development and has established itself as one of the main industrial spheres globally. However, illegal, and artisanal gold mining, which uses mercury (Hg), is a major source of global pollution. Hg is highly toxic and persistent in the environment, affecting human health and the ecosystem. The objective of this research is to; (a) analyze Hg concentrations in surface waters of nine provinces of the Andean region of Ecuador and compare them with the maximum permissible limits of Ecuadorian regulations, and (b) evaluate the health risk of people exposed to waters with high Hg content through residential and recreational scenarios. In this study, 147 water samples from rivers and streams were analyzed. The results revealed worrying levels of Hg, especially in the provinces of Azuay and Loja where Hg values of up to 0.0913 mg/L and 0.0387 mg/L, respectively, were detected. In addition, it was found that 45% of the samples did not meet the water quality criteria for the preservation of aquatic life, which represents a severe risk to the ecosystem. The probabilistic risk analysis yielded values that exceeded the acceptable exposure limit for adults and children in residential settings in Azuay and Loja, while in the recreational scenario the safe exposure limit was exceeded for both receptors only in the province of Azuay. The elevated presence of Hg in the provinces, mainly in Azuay and Loja, possibly related to illegal gold mining activity, represents a threat to water quality and aquatic life in the Andean region of Ecuador. Children are especially vulnerable, and effective regulation is required to ensure the safety of the population. This study provides valuable information for decision makers regarding the risk associated with Hg exposure in areas of mining activity in the Ecuadorian Andean region. In addition, it can contribute to the development of policies and strategies to control contamination in mining environments and protect human and environmental health in the region., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Illegal gold mining activities have contributed to the release and mobilization of Hg and environmental degradation in many parts of the world. This study aims to determine the concentration of Hg in five provinces of the Amazon Region of Ecuador, in addition to assessing the risk to human health of exposed populations, applying deterministic and probabilistic methods. For this purpose, 147 water samples were collected in rivers and streams crossing and/or located near mining areas. As a result, 100% of the samples analyzed exceeded the maximum permissible limit (MPL) according to the water quality criteria for the preservation of aquatic life of the Ecuadorian regulations, while 7% of the samples exceeded the MPL for drinking water. On the other hand, considering the European Environmental Quality Standard (EQS) for surface water bodies, in our study, 100% of the samples exceed the maximum permissible limit (0.07 µg/L), and with respect to the Canadian water quality guidelines, 35% of the samples exceed the permissible limit (0.001 mg/l) for drinking water, and 100% of the samples exceed the limit for life in water bodies (0.0001 mg/l). The risk assessment revealed that the probability of developing adverse health effects from exposure to Hg is below the recommended limits according to the probabilistic assessment; this is in relation to the criterion of residential and recreational use of water resources. However, it was identified that the child population doubles the acceptable systemic risk level according to the results of the deterministic assessment in the residential scenario. This information can be used by decision-makers to implement strategies to reduce Hg contamination and exposure of the population in Ecuadorian Amazonian rivers., (© 2023. The Author(s).)

The purpose of this pilot evaluation was to assess the impact of a university culinary medicine program on participating medical students and community members, which included individuals managing chronic illness and public middle school students. A total of 59 program participants enrolled in the study. Data were obtained using pre- and post-course surveys and qualitative interviews from September 2021-July 2023. Results show increased confidence in medical students' ability to provide nutrition counseling, with a high significance in their ability to provide counseling regarding chronic conditions. Participants managing chronic conditions demonstrated significant increases in self-reported confidence in their understanding of overall chronic disease management and care and in their kitchen skills, with participants who attended five or more classes having significantly higher means. Qualitative feedback from middle school students highlights their knowledge and willingness to try new foods after engaging with the curriculum. Findings add to the growing literature on culinary medicine and provide insight into the effectiveness of culinary medicine programming to increase knowledge and promote positive changes among future healthcare professionals and community members. However, more extensive research across a longer time span is needed to confirm the potential for sustained change.

Consumption of food grown in contaminated soils may be a significant human exposure pathway to pollutants, including toxic elements. This study aimed to investigate the pollution level of trace elements in farmland soil and crops collected in orchards from Ponce Enriquez, one of the Ecuador's most important gold mining areas. The concentration of arsenic (As), cadmium (Cd), chrome (Cr), copper (Cu), nickel (Ni), lead (Pb), and zinc (Zn) was analyzed in soil and crop samples (celery, chives, corn, herbs, lettuce, turnips, green beans, cassava, and carrots). In addition, a probabilistic human health risk assessment, in terms of hazard quotients (HQ) and cancer risk (CR), was conducted to assess the potential risk related to local crop ingestion. The contents of As, Cr, Cu, and Ni in soils exceeded the Ecuadorian quality guidelines for agricultural soils. The trace elements concentration in local crops was higher than the maximum permissible levels set by the Food and Agriculture Organization of the United Nations (FAO). The HQ and CR of local crop ingestion were several orders higher than the safe exposure threshold, mainly for lettuce, chives, and turnips. Our results revealed that inhabitants of the study area are exposed to developing carcinogenic and non-carcinogenic effects due to long-term food consumption with high trace elements. This study sheds light on the need to assess further the quality of agricultural soils and crops grown in mining areas with signs of contamination to guarantee consumer food safety., (© 2023. The Author(s).)

Elevated heavy metal(loid)s concentrations in water lower its quality posing a threat to consumers. This study aims to assess the human health risk caused by heavy metal(loid)s in tap water in Santa Rosa city, Ecuador, and the ecological risk of stream water and sediments in the Santa Rosa River. Concentrations of As, Cd, Cr, Cu, Ni, Pb, and Zn were evaluated in tap waters, stream waters, and sediment samples during the rainy and dry seasons. The Metal Index (MI), Geo-accumulation Index (I geo ), Potential Ecological Risk Index (PERI), and the levels of carcinogenic (CR) and non-carcinogenic risk (HQ) were determined. The results revealed severe pollution levels, mainly in Los Gringos and El Panteon streams, both tributaries of the Santa Rosa River, the primary water source for Santa Rosa inhabitants. More than 20% of the surface water samples showed severe contamination (MI > 6), and 90% of the tap water samples presented a MI value between 1 and 4, which indicates slight to moderate pollution. Drinking water displayed high levels of As, with 83% of the tap water samples collected from households in the dry season above the recommended concentration set by the World Health Organization and Ecuadorian legislation. The I geo-Cd in the sediment samples was significantly high (I geo  > 3), and the PERI showed very high ecological risk (PERI > 600), with Cd as the main pollutant. HQ and CR were above the safe exposure threshold, suggesting that residents are at risk from tap water consumption, with As being the primary concern., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Emergency departments (ED) provide trauma-informed care to sexual assault (SA) survivors and connect them with comprehensive services. Through surveying SA survivor advocates, we aimed to 1) document updated trends in the quality of care and resources offered to SA survivors and 2) identify potential disparities according to geographic regions in the US, urban vs rural clinic locations, and the availability of sexual assault nurse examiners (SANE)., Methods: We conducted a cross-sectional study between June-August 2021, surveying SA advocates who were dispatched from rape crisis centers to support survivors during ED care. Survey questions addressed two major themes in quality of care: staff preparedness to provide trauma-response care; and available resources. Staff preparedness to provide trauma-informed care was assessed through observations of staff behaviors. We used Wilcoxon rank-sum and Kruskal-Wallis tests to analyze differences in responses according to geographic regions and SANE presence., Results: A total of 315 advocates from 99 crisis centers completed the survey. The survey had a participation rate of 88.7% and a completion rate of 87.9%. Advocates who indicated that a higher proportion of their cases were attended by SANEs were more likely to report higher rates of trauma-informed staff behaviors. For example, the recalled rate of staff asking patients for consent at every step of the exam was significantly associated with SANE presence (P < 0.001). With respect to access to resources, 66.7% of advocates reported that hospitals often or always have evidence collection kits available; 30.6% reported that resources such as transportation and housing are often or always available, and 55.3% reported that SANEs are often or always part of the care team. The SANEs were reported to be more frequently available in the Southwest than in other US regions (P < 0.001) and in urban as opposed to rural areas (P < 0.001)., Conclusion: Our study indicates that support from sexual assault nurse examiners is highly associated with trauma-informed staff behaviors and comprehensive resources. Urban-rural and regional disparities exist regarding access to SANEs, suggesting that elevating nationwide quality and equity in care of survivors of sexual assault requires increased investments in SANE training and coverage.

Potential pollution of mining environmental liabilities' locations can be preliminarily and efficiently assessed by the potential generation of acid mine drainage and indices of contamination. This research evaluates the potential pollution by potentially toxic elements at locations with uranium mining liability evidence, using the net acid generation test and determining the background values to estimate acid mine drainage and indices of contamination. Sixty soil samples were collected, and the mineralogy and potentially toxic elements' total contents were determined by x-ray diffraction and optical spectrometry. The findings suggest that the soils related to a specific lithology might not present potential acid mine drainage generation but potential soil and sediment contamination. Future research is recommended on applying leaching tests to identify which potentially toxic elements are effectively being solubilized. Finally, it can be concluded that the study area's potential contamination is relatively low overall., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors' mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors' future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.

Emergency departments (EDs) providing care and forensic examinations for sexual assault (SA) survivors are often supported by SA patient advocates. This study explored advocates' perspectives regarding problems and potential solutions in SA patient care through a focus group with 12 advocates. Thematic analysis identified two major themes: provider-patient interactions and ED-hospital systems. Challenging aspects of provider-patient interactions included (a) provider attitudes and (b) disempowering behaviors. Within ED-hospital systems, themes included time constraints, efficiencies, and hospital preparation. Advocates surveyed were optimistic about an increased presence of SA nurse examiners and enhanced protocols and provider training to improve survivors' experiences.

Background and Objectives: The first all-virtual residency application cycle took place in 2021. Virtual programming can reduce cost, time, and travel burden; these may be especially beneficial to applicants with fewer resources and those from underrepresented backgrounds (URM). Little is known about how applicants evaluate key ranking factors, especially in a virtual format. This study aimed to assess how applicants evaluated programs in the virtual cycle., Methods: We surveyed 271 fourth-year students at three Chicago medical schools after rank-list submission and prior to receiving match results in March 2021. The survey included questions on online content and importance of different ranking factors as well as open-ended questions on how participants evaluated their most important factors. We analyzed quantitative data using descriptive statistics and χ2 tests. We analyzed qualitative data using thematic content analysis., Results: Applicants cited goodness of fit, geographic location, program reputation, fellowship opportunities, and work/life balance as the top-five most important factors. URM applicants were more likely to prioritize diversity at institution or location (P<.0001). Interactions with residents and faculty and opportunities to observe interprogram dynamics were key to assessing fit but were often limited by the virtual format. Additional emergent themes provided recommendations for future cycles. Program websites and videos were rated as the most important online content types., Conclusions: This study provides information about how applicants evaluated the factors they deemed most important in assessing and ranking programs, which can help residency programs improve their recruitment efforts.

Indices of contamination (IC) are usually employed to assess the hazardousness associated with potentially toxic elements (PTE) from mining wastes (MW). For such, it is necessary to know the total concentrations of the PTE and local, regional, or global background or reference levels which are tolerable or acceptable threshold values for total content in soils. Although scientific literature is vast regarding the application of IC to MW, there is scarce research on the reference levels that must be employed in locations with no established comparison values. This study proposes basic reference levels for the global application of PTE contents in MW, leading to a global index of contamination (IC G ). To this end, it was determined that the PTE to be assessed in MW should be As, Cd, Co, Cr, Cu, Hg, Mo, Ni, Pb, Sb, Se, V, and Zn. From the analysis of background and baseline values for soils, reference values for the PTE compiled from worldwide standards or studies on soil and sediment evaluation, and PTE content in MW, a classification is proposed for IC G that considers MW as very low, low, moderate, high, and very high contamination potential. The findings presented herein can be helpful in the comparison of multiple types of MW, representing the contamination hazard by particle emission due to erosion processes that reach the soils or sediments of the surrounding environment. This evaluation can aid in the decision-making process regarding the reutilization of some types of MW that receive a low classification., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: As the proportion of women in family medicine increases, their well-being and job satisfaction become concerns., Objectives: This study aimed to uncover the working conditions and career satisfaction of women family physicians across multiple countries., Methods: A cross-sectional survey of the WONCA Working Party on Women and Family Medicine listserv members to assess working conditions and career satisfaction, with snowballing recruitment. Aspects of physician job satisfaction were measured using the validated Physician Work-Life Survey and calculated as the sum of the scores of each positive item divided by the total number of questions and multiplied by 10. The association between satisfaction and the continent and the country income level was performed using a one-way ANOVA test (P < 0.05)., Results: A total of 315 participants across 49 countries responded to the survey with 205 complete responses. Women family physicians reported high overall career satisfaction (8.2 ± 2.3) but were less satisfied with some aspects of their career such as pay (5.3 ± 3.4), personal time (3.5 ± 2.6), and administrative tasks (3.2 ± 3.7). Despite the widespread experience of sexism at work, satisfaction with personal career aspects was universal at the continent and income level, while satisfaction with other career aspects relevant to relationships in work environment and resources varied., Conclusion: Women family physicians around the world are overall satisfied with their careers. However, variation in certain working conditions among countries leaves room for improvement, drawing attention to the need for national review of working environments and pay scales., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Gold mining is a significant source of metal(loid)s released into the environment. It is an issue of concern due to the potential adverse health effects associated with exposure to toxic elements. This study aimed to assess the ecological and human health risk caused by heavy metal(loid)s exposure in river sediments in Ponce Enríquez, one of the most important mining sites in Ecuador. Concentrations of As, Cd, Cu, Pb, and Zn were evaluated in 172 sediment samples to determine the Potential ecological risk (R I ) and the carcinogenic (CR) and non-carcinogenic risk (HQ). The human exposure to polluted sediments during recreational activities was computed using Bayesian probabilistic models. Residents were randomly surveyed to adjust the risk models to the specific population data. More than 68% of the sampling stations pose a severe As and Cd ecological risk index ([Formula: see text] > 320). Likewise, residents exposed to river sediments showed a non-acceptable carcinogenic risk by incidental ingestion, being As the primary contributor to overall cancer in both children and adults receptors. Moreover, non-carcinogenic risk through the incidental ingestion of sediments was above the safe limit for children. This is the first study conducted in a mining region in Ecuador that reveals the severe levels of ecological and human health risk to which the population is exposed. These results can be applied as a baseline to develop public health strategies to monitor and reduce the health hazards of the residents of mining communities., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Mining operations are important causes of environmental pollution in developing countries where mining waste management is not adequate. Consequently, heavy metal(loid)s are easily released into the environment, being a potential risk to human health. This study carries out a Bayesian probabilistic human health risk assessment, related to multi-pathway exposure to heavy metal(loid)s in a gold mining area in Southern Ecuador. Concentrations of As, Cd, Cr, Cu, Ni, Pb, and Zn in tap water, surface water, and soil samples, were analyzed to assess the potential adverse human health effects based on the Hazard Index (HI) and Total cancer risk (TCR). Adults and children residents were surveyed to adjust their exposure parameters to the site-specific conditions. Exposure to heavy metal(loid)s resulted in unacceptable risk levels for human health in the two age groups, both carcinogenic (TCR > 1 × 10 -5 ) and non-carcinogenic (HI > 1) through ingestion of tap water and incidental ingestion of surface water. Sensitivity analysis showed that As concentration in waters and exposure frequency were the main contributors to risk outcome. Exposure to soil via accidental ingestion and dermal contact was below the safety limit, not posing a risk to human health. These findings can provide a baseline for the environmental management of the mining area and indicate the need for further research on As pollution in water and its implications on the health of the inhabitants of mining communities., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Burnout in medical students is extensive and a critical issue. It is associated with increased rates of depression, suicide, and poor perception of the educational environment. Enhancing resilience, the ability to adapt well in the face of adversity, is a potential tool to mitigate burnout and improve medical student wellness., Methods: Our resilience curriculum consisted of facilitated workshops to cultivate resilience in medical students during their core clerkship rotations. This curriculum served as an introduction to the concept of resilience and taught skills to cultivate resilience and promote wellness. The sessions allowed for identification of and reflection on stressors in the clinical learning environment, including straining team dynamics, disappointment, and uncertainty. Educational sessions included resilience skill-building exercises for managing expectations, letting go of negative emotions, dealing with setbacks, and finding meaning in daily work. Associated materials included lesson plans for small-group facilitators, learner pre- and postcurriculum surveys, and a social media activity guide., Results: This curriculum was delivered to 144 clerkship students at two academic institutions over the 2017-2018 academic year. Sessions were well received by medical students, with the majority of students stating that the sessions should continue. The majority of attendees found the sessions valuable and learned new ways to approach challenges., Discussion: Students valued connecting with peers and feeling less alone through their participation. A challenge was constructing a setting conducive to comfortable reflection for all learners. Not all students found these sessions necessary. Sessions may have improved resilience levels., (© 2020 Bird et al.)

The largest mercury (Hg) mining district in the world is located in Almadén (Spain), with well-known environmental impacts in the surrounding ecosystem. However, the impact of mercury on the health of the inhabitants of this area has not been documented accordingly. This study aims to carry out a probabilistic human health risk assessment using Bayesian modeling to estimate the non-carcinogenic risk related to Hg through multiple exposure pathways. Samples of vegetables, wild mushrooms, fish, soil, water, and air were analyzed, and adult residents were randomly surveyed to adjust the risk models to the specific population data. On the one hand, the results for the non-carcinogenic risk based on Hazard Quotient (HQ) showed unacceptable risk levels through ingestion of Hg-contaminated vegetables and fish, with HQ values 20 and 3 times higher, respectively, than the safe exposure threshold of 1 for the 97.5th percentile. On the other hand, ingestion of mushrooms, dermal contact with soil, ingestion of water, dermal contact with water and inhalation of air, were below the safety limit for the 97.5th percentile, and did not represent a risk to the health of residents. In addition, the probabilistic approach was compared with the conservative deterministic approach, and similar results were obtained. This is the first study conducted in Almadén, which clearly reveals the high levels of human health risk to which the population is exposed due to the legacy of two millennia of Hg mining., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2020 Elsevier Inc. All rights reserved.)

Women ages 30 to 65 years now have a third cervical cancer screening option.

Emergency department (ED) providers serve as the primary point-of-contact for many survivors of sexual assault but are often ill-prepared to address their unique treatment needs. Sexual assault nurse examiners (SANEs) are therefore an important resource for training other ED providers. The objective of this project was to create a SANE-led educational intervention addressing this training gap. We achieved this objective by (a) conducting a needs assessment of ED providers' self-reported knowledge of, and comfort with, sexual assault patient care at an urban academic adult ED and, (b) using these results to create and implement a SANE-led educational intervention to improve emergency medicine residents' ability to provide sexual assault patient care. From the needs assessment survey, ED providers reported confidence in medical management but not in providing trauma-informed care, conducting forensic examinations, or understanding hospital policies or state laws. Less than half of the respondents felt confident in their ability to avoid retraumatizing sexual assault patients, and only 29% felt comfortable conducting a forensic examination. On the basis of these results, a SANE-led educational intervention was developed for emergency medicine residents, consisting of a didactic lecture, two standardized patient cases, and a forensic pelvic examination simulation. Preintervention and postintervention surveys showed an increase in respondents' self-perceived ability to avoid retraumatizing patients, comfort with conducting forensic examinations, and understanding of laws and policies. These results show the value of an interprofessional collaboration between physicians and SANEs to train ED providers on sexual assault patient care.

Background: Advance care planning (ACP) is a critical component of end-of-life (EoL) care, yet infrequently taught in medical training., Objective: We designed a novel curriculum that affords third-year medical students (MS3s) the opportunity to practice EoL care discussions with a trained older adult in the patient's home., Design: Volunteers were instructed as trained patients (TPs) to evaluate MS3s interviewing and communication skills. The MS3s received a didactic lecture and supplemental material about ACP. Pairs of MS3s conducted ACP interviews with TPs who gave verbal and written feedback to students. Student evaluations included reflective essays and pre/postsurveys in ACP skills., Settings and Participants: A total of 223 US MS3s participated in the curriculum., Results: Qualitative analysis of reflective essays revealed 4 themes: (1) students' personal feelings, attitudes, and observations about conducting ACP interviews; (2) observations about the process of relationship building; (3) learning about and respecting patients' values and choices; and (4) the importance of practicing the ACP skills in medical school. Students' confidence in skills significantly improved in all 7 domains ( P < .001): (1) introduce subject of EoL; (2) define advance directives; (3) assess values, goals, and priorities; (4) discuss prior experience with death; (5) assess expectations about treatment and hospitalization; (6) explain cardiopulmonary resuscitation and outcomes; and (7) deal with own feelings about EoL and providers' limitations., Conclusions: The use of older adults as TPs in an ACP curriculum provides students an opportunity to practice skills and receive feedback in the nonmedical setting, thereby improving comfort and confidence in approaching these conversations for future patients.

Purpose: Clinical responses with programmed death (PD-1) receptor-directed antibodies occur in about 20% of patients with advanced head and neck squamous cell cancer (HNSCCa). Viral neoantigens, such as the E6/E7 proteins of HPV16/18, are attractive targets for therapeutic immunization and offer an immune activation strategy that may be complementary to PD-1 inhibition., Patients and Methods: We report phase Ib/II safety, tolerability, and immunogenicity results of immunotherapy with MEDI0457 (DNA immunotherapy targeting HPV16/18 E6/E7 with IL12 encoding plasmids) delivered by electroporation with CELLECTRA constant current device. Twenty-two patients with locally advanced, p16 + HNSCCa received MEDI0457., Results: MEDI0457 was associated with mild injection site reactions, but no treatment-related grade 3-5 adverse events (AE) were noted. Eighteen of 21 evaluable patients showed elevated antigen-specific T-cell activity by IFNγ ELISpot, and persistent cellular responses surpassing 100 spot-forming units (SFUs)/10 6 peripheral blood mononuclear cells (PBMCs) were noted out to 1 year. Induction of HPV-specific CD8 + T cells was observed. MEDI0457 shifted the CD8 + /FoxP3 + ratio in 4 of 5 post immunotherapy tumor samples and increased the number of perforin + immune infiltrates in all 5 patients. One patient developed metastatic disease and was treated with anti-PD-1 therapy with a rapid and durable complete response. Flow-cytometric analyses revealed induction of HPV16-specific PD-1 + CD8 + T cells that were not found prior to MEDI0547 (0% vs. 1.8%)., Conclusions: These data demonstrate that MEDI0457 can generate durable HPV16/18 antigen-specific peripheral and tumor immune responses. This approach may be used as a complementary strategy to PD-1/PD-L1 inhibition in HPV-associated HNSCCa to improve therapeutic outcomes., (©2018 American Association for Cancer Research.)

Background: Cardiovascular disease (CVD) annually claims more lives and costs more dollars than any other disease globally amid widening health disparities, despite the known significant reductions in this burden by low cost dietary changes. The world's first medical school-based teaching kitchen therefore launched CHOP-Medical Students as the largest known multisite cohort study of hands-on cooking and nutrition education versus traditional curriculum for medical students., Methods: This analysis provides a novel integration of artificial intelligence-based machine learning (ML) with causal inference statistics. 43 ML automated algorithms were tested, with the top performer compared to triply robust propensity score-adjusted multilevel mixed effects regression panel analysis of longitudinal data. Inverse-variance weighted fixed effects meta-analysis pooled the individual estimates for competencies., Results: 3,248 unique medical trainees met study criteria from 20 medical schools nationally from August 1, 2012, to June 26, 2017, generating 4,026 completed validated surveys. ML analysis produced similar results to the causal inference statistics based on root mean squared error and accuracy. Hands-on cooking and nutrition education compared to traditional medical school curriculum significantly improved student competencies (OR 2.14, 95% CI 2.00-2.28, p < 0.001) and MedDiet adherence (OR 1.40, 95% CI 1.07-1.84, p = 0.015), while reducing trainees' soft drink consumption (OR 0.56, 95% CI 0.37-0.85, p = 0.007). Overall improved competencies were demonstrated from the initial study site through the scale-up of the intervention to 10 sites nationally ( p < 0.001)., Discussion: This study provides the first machine learning-augmented causal inference analysis of a multisite cohort showing hands-on cooking and nutrition education for medical trainees improves their competencies counseling patients on nutrition, while improving students' own diets. This study suggests that the public health and medical sectors can unite population health management and precision medicine for a sustainable model of next-generation health systems providing effective, equitable, accessible care beginning with reversing the CVD epidemic.

Evidence shows that daily low-dose aspirin during pregnancy can safely lower the risk of preeclampsia and other adverse outcomes.

Malaria elimination strategies require surveillance of the parasite population for genetic changes that demand a public health response, such as new forms of drug resistance. Here we describe methods for the large-scale analysis of genetic variation in Plasmodium falciparum by deep sequencing of parasite DNA obtained from the blood of patients with malaria, either directly or after short-term culture. Analysis of 86,158 exonic single nucleotide polymorphisms that passed genotyping quality control in 227 samples from Africa, Asia and Oceania provides genome-wide estimates of allele frequency distribution, population structure and linkage disequilibrium. By comparing the genetic diversity of individual infections with that of the local parasite population, we derive a metric of within-host diversity that is related to the level of inbreeding in the population. An open-access web application has been established for the exploration of regional differences in allele frequency and of highly differentiated loci in the P. falciparum genome.