Accelerating Climate Action Through Academic Health Systems: Leadership's Call to Duty.

This Viewpoint makes the case for academic health systems to lead the way on climate change action in the US, including planning to reduce greenhouse gas emissions, educating current and future clinicians, and communicating with their patients and communities.

Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era.

OBJECTIVE: To determine whether Olympic medallists live longer than the general population. DESIGN: Retrospective cohort study, with passive follow-up and conditional survival analysis to account for unidentified loss to follow-up. SETTING AND PARTICIPANTS: 15 174 Olympic athletes from nine country groups (United States, Germany, Nordic countries, Russia, United Kingdom, France, Italy, Canada, and Australia and New Zealand) who won medals in the Olympic Games held in 1896-2010. Medallists were compared with matched cohorts in the general population (by country, age, sex, and year of birth). MAIN OUTCOME MEASURES: Relative conditional survival. RESULTS: More medallists than matched controls in the general population were alive 30 years after winning (relative conditional survival 1.08,95% confidence interval 1.07 to1.10). Medallists lived an average of2.8 years longer than controls. Medallists in eight of the nine country groups had a significant survival advantage compared with controls. Gold, silver, and bronze medallists each enjoyed similar sized survival advantages. Medallists in endurance sports and mixed sports had a larger survival advantage over controls at 30 years (1.13, 1.09 to 1.17; 1.11,1.09 to 1.13) than that of medallists in power sports (1.05,1.01 to 1.08). CONCLUSIONS: Olympic medallists live longer than the general population, irrespective of country, medal, or sport. This study was not designed to explain this effect, but possible explanations include genetic factors, physical activity, healthy lifestyle, and the wealth and status that come with international sporting glory.

HOT WAX.

High-potency marijuana wax smoked via dabbing is a newly encountered phenomenon with relevance to prehospital care providers and emergency physicians.The extract is only recently described in current peer-reviewed literature. The drug may produce paranoia and psychosis and mimic psychiatric problems. The synthetic process for this drug poses a risk for both fire and explosions creating burns and blast injuries. These four cases were encountered in a single ED in Los Angeles in a three-week period, suggesting this could be the tip of an emerging public health problem. All four of these patients were complex cases requiring advanced imaging and ICU care. Emergency personnel need to appreciate this new trend and the implications for pre-hospital care, disposition and ED treatment of these patients.

Promotion and Tenure Policies and Practices at U.S. Medical Schools: Is Tenure Irrelevant or More Relevant Than Ever?

ABSTRACT: Promotion and tenure (P&T) have been common mechanisms to support and nurture faculty at higher education institutions and, therefore, have been of continual interest to medical school faculty and administrators. In the last decade, significant changes in the academic medicine sector have occurred, including new medical schools, mergers and acquisitions of academic hospitals and health systems, and institutional and societal efforts to address systemic racism and inequality. In addition, societal controversies have revived long-dormant concerns about academic freedom for medical school faculty, a bedrock principle of U.S. higher education for more than a century. These developments raise the question of whether tenure at medical schools is increasingly irrelevant for large numbers of full-time faculty or more relevant than ever.Using a 2022 survey of 118 medical schools, a review of P&T policies at 37 other medical schools, and an analysis of Association of American Medical Colleges Faculty Roster data, the authors review the prevalence of tenure systems at U.S. MD-granting medical schools; trends in the use of such systems for full-time basic science and clinical faculty; models of including diversity, equity, and inclusion (DEI) criteria in P&T standards; and alterations to introduce greater flexibility into the P&T process.The authors' analysis shows that, although tenure systems remain well established at U.S. MD-granting medical schools, the percentage of full-time faculty on tenured or tenure-eligible tracks declined over the last 4 decades. Troubling gaps in tenure-eligible appointments persist between men and women faculty and among faculty by race and ethnicity. Medical schools have begun to deploy a variety of tactics in P&T processes focused on DEI to address these systemic inequities. To adapt the traditional tenure system to meet the needs of academic medicine, medical schools have altered their policies, including tenure financial guarantees, probationary period extensions, and post-tenure review.

Reasons for Optimism About Academic Medicine's Actions Against Climate Change.

Since the first mention of climate change in Academic Medicine in 2009, the pace of the climate crisis has accelerated, its impacts on every facet of planetary health have grown more severe, and the urgency for humans to act has become more dire. Medical schools, teaching hospitals and health systems, universities, affiliated organizations, and the millions of people who traverse the halls of these institutions as leaders, physicians, scientists, educators, learners, patients and families, and community members have an obligation to respond. In this commentary, the authors describe 3 reasons they are optimistic that academic medicine will continue to act against climate change. First, the mission of academic medicine, inherently aligned with climate action, propels teaching hospitals and health systems to address climate change to improve the health of patients, families, and communities. Second, younger generations of learners, faculty, and staff who populate the workforce increasingly desire, and often demand, to work at institutions that are aligned with their personal values for climate action. Third, broader forces are pushing academic medicine forward in action against climate change. Economic factors will continue to reduce the cost and increase the return on investment of climate-smart facilities, purchased goods and services, fuel, transportation, food systems, and waste management. The authors are optimistic but not complacent. Current levels of climate action in academic medicine are not nearly enough. Faculty, staff, learners, leaders, patients and families, and community partners can and must apply a "climate lens" to everything they do: weave climate solutions into education, patient care, research, community collaborations, operations, and supply chain and facility management; integrate climate actions into strategic thinking, planning, and doing; address health inequities and climate injustice; and leverage their trusted voices to press for climate action and climate justice in the health sector and in society.