Child-focused climate change and health content in medical schools and pediatric residencies.

Anthropogenic climate change-driven primarily by the combustion of fossil fuels that form greenhouse gases-has numerous consequences that impact health, including extreme weather events of accelerating frequency and intensity (e.g., wildfires, thunderstorms, droughts, and heat waves), mental health sequelae of displacement from these events, and the increase in aeroallergens and other pollutants. Children are especially vulnerable to climate-related exposures given that they are still developing, encounter higher exposures compared to adults, and are at risk of losing many healthy future years of life. In order to better meet the needs of generations of children born into a world affected by climate change, medical trainees must develop their knowledge of the relationships between climate change and children's health-with a focus on applying that information in clinical practice. This review provides an overview of salient climate change and children's health topics that medical school and pediatric residency training curricula should cover. In addition, it highlights the strengths and limitations of existing medical school and residency climate change and pediatric health curricula. IMPACT: Provides insight into the current climate change and pediatric health curricular opportunities for medical trainees in North America at both the medical school and residency levels. Condenses climate change and pediatric health material relevant to trainees to help readers optimize curricula at their institutions.

Systematically Assessing Natural Compounds' Wound Healing Potential with Spheroid and Scratch Assays.

Understanding cellular processes involved in wound healing is very important given that there are diseases, such as diabetes, in which wounds do not heal. To model tissue regeneration, we focus on two cellular processes: cellular proliferation, to replace cells lost to the wound, and cell motility, activated at the wound edges. We address these two processes in separate, drug responsive, in vitro models. The first model is a scaffold-free three-dimensional (3D) spheroid model, in which spheroids grow larger - to a certain extent - with increased time in culture. The second model, the scratch wound assay, is focused on cell motility. In conjunction with collagen staining, it analyzes changes to the coverage of the wound edge and wound bed. Our workflow gives insights into candidate compounds for wound healing as we show using manuka honey (MH) as an example. Spheroids are responsive to oxidative damage by hydrogen peroxide (H2O2) which affects viability but mostly produces disaggregation. Conversely, MH supports spheroid health, shown by size measurements and viability. In two-dimensional scratch wound assays, MH helps close wounds with relative less collagen production and increases the loose cellular coverage adjacent to and within the wound. We use these methods in the undergraduate research laboratory as teaching and standardization tools, and we hope these will be useful in similar settings.

We can use our superpower to help end fossil fuel pollution and rise to the challenge of climate change.

In this commentary, we argue that health professionals can play a pivotal role in accelerating the adoption of public policies that will help communities, nations, and the world end fossil fuel pollution and rise to the challenges of climate change. We briefly describe our previously published research showing that communicating about fossil fuel pollution and the health relevance of climate change has many benefits in building public support for climate action. Most importantly, we make the case that because health professionals, especially medical doctors and other clinicians, are highly trusted, we collectively have a unique opportunity to bring people together across the political continuum to have constructive dialogues about the intertwined problems of fossil fuel pollution and climate change and what to do about them - even in the current hyper-partisan environment.

Ideas and Opportunities for Radiologists--Career and Professional Advising and Medical Education.

This article is about two highly diverse radiologists, who fortuitously came together by working as Career and Professional Advisors in the Student Affairs Department of a U.S. medical school. This job opportunity offered each radiologist, albeit for markedly different reasons, a means to transition from full-time Radiology to the opportune world of medical school education. The focus of this paper will be on Career and Professional Advising, while also highlighting the many opportunities for radiologists in current medical school education.

Thyroid Function and Sleep Patterns: A Systematic Review.

Hypothyroidism, defined as a low metabolic function of the thyroid gland that results in low thyroid hormone levels, and insomnia, a condition with the inability to sleep, are two distinct conditions with little overlap that have been extensively established. Both conditions have been studied independently in terms of epidemiology, pathophysiology, diagnosis, and management. The exact causal relationship between the two conditions has yet to be elucidated, and a direct underlying pathophysiology has not been pinpointed. To gain further insight into the relationship between hypothyroidism and insomnia, we performed a systematic review to explore this relationship using predetermined guidelines. Out of 59 studies assessed, four studies evaluated the mechanisms of these two potentially comorbid conditions. Our findings suggest that hypothyroidism and insomnia may have a bidirectional relationship, with symptomatic overlap that is tied to increased metabolic comorbidities and hormonal dysregulation. These findings warrant further research to verify these early findings and gain further insight into the relationship between these conditions. A better understanding of the pathophysiology of overlap between these two conditions will help improve diagnosis and target treatment more effectively.

Why Medical Students Pursue Radiology: A Current Longitudinal Survey on Motivations and Controversial Issues in Radiology.

RATIONALE AND OBJECTIVES: Radiology is an increasingly competitive specialty. Various current factors influence medical students' decision to pursue a radiology career, including artificial intelligence (AI), remote reading, and COVID-19. This study seeks to determine the decision-making factors of all alumni from our medical school who matched into a radiology residency, and to gather opinions on emerging radiology topics. MATERIALS AND METHODS: A survey querying decision-making factors and opinions on current radiology topics was distributed to all alumni from our medical school (first graduating class in 2011) who previously matched into a diagnostic or interventional radiology residency program (n = 57). Wilcoxon Rank-Sum and Fisher's Exact tests were used to determine statistical significance. RESULTS: Forty-three of fifty-seven responses were received (75% response rate). The most influential factor that sparked respondents' interest in radiology was a radiology elective (25/43, 58%). Students who will finish radiology training in 2023 or later were more likely to be influenced by a mentor (15/23, 65%) than those who finished radiology training before 2023 (5/20, 25%) (p = 0.04). Respondents reported a 1.6/5 concern about AI negatively impacting their future career in radiology. There was 1.7/5 concern about performing radiology procedures on patients during the COVID-19 pandemic. Respondents predicted that remote reading would have a 3.2/5 positive impact on helping them achieve their preferred lifestyle. Job satisfaction among attending radiologists is rated at 4.3/5. CONCLUSION: Radiology electives had the greatest influence in piquing students' interest in radiology, while mentorship is assuming increasing influence. AI is perceived as a relatively minimal threat to negatively impact radiologists' jobs. Respondents had little concern about performing radiology procedures during the COVID-19 pandemic. Remote reading is viewed as having a moderately positive impact on lifestyle. Responding radiologists enjoy notably high job satisfaction.

Comparative Evaluation of Astigmatic Changes Induced by Superior and Temporal Corneal Incisions in Sutureless Phacoemulsification Surgery: A Case Series.

Background In cataract surgery, the effect of corneal incision astigmatism has been widely recognized for many years. The incision's size, shape, and location can all impact the patient's postoperative visual outcomes. Currently, phacoemulsification is considered the most preferred surgical technique for cataract extraction. However, there is still some debate about whether temporal incisions, which are smaller and considered nearly astigmatic neutral, result in more astigmatism than other incisions. As a result, it is important to continue studying the refractive changes induced by corneal incisions made at different sites during phacoemulsification surgery. Aim and objective To compare the incidence, extent, and course of postoperative astigmatic changes associated with superior versus temporal clear corneal incisions for sutureless phacoemulsification cataract surgery. Materials and method In this prospective study, 50 patients of the civil hospital in Gujrat with cataracts who underwent sutureless, small incision (2.8 mm) phacoemulsification surgery were included. The preoperative evaluation comprised visual acuity assessment, refraction, keratometry, fundus examination, and intraocular lens (IOL) power calculation. The superior incision was made in 25 patients, and the temporal incision was made in another 25 patients. Patients were examined preoperatively on day 1, at one week (day 7), after one month (day 30), and after two months (day 60). Result Postoperatively, two months (on day 60) postoperatively, in group A (superior approach), the mean surgically induced astigmatism (SIA) was 0.39±0.34 SD diopters, and in group B (temporal approach), it was 0.5±0.42 SD diopters. A significant statistical difference was not seen between these two groups. Conclusion Surgically induced astigmatism was minimal and comparable with both superior and temporal approaches to clear corneal incisions for phacoemulsification surgery.

How Should We Better Manage Human and Planetary Health in a Next Pandemic?

Health care generates a lot of waste that enters landfills, oceans, and incinerators and adversely affects the health of persons and communities close to waste processing and disposal areas. This article considers the nature and scope of individuals' and organizations' disposal responsibilities and discusses personal protective equipment use and waste during the COVID-19 pandemic.

Characterization and regulation of microplastic pollution for protecting planetary and human health.

Microplastics are plastic particles <5 mm in diameter. Since the 1950s, there has been an exponential increase in the production of plastics. As of 2015, it is estimated that approximately 6300 million metric tons of plastic waste had been generated of which 79% has accumulated in landfills or the natural environment. Further, it is estimated that if current trends continue, roughly 12,000 million metric tons of plastic waste will accumulate by 2050. Plastics and microplastics are now found ubiquitously-in the air, water, and soil. Microplastics are small enough to enter the tissues of plants and animals and have been detected in human lungs, stools, placentas, and blood. Their presence in human tissues and the food chain is a cause for concern. While direct clinical evidence or epidemiological studies on the adverse effects of microplastic on human health are lacking, in vitro cellular and tissue studies and in vivo animal studies suggest potential adverse effects. With the ever-increasing presence of plastic waste in our environment, it is critical to understand their effects on our environment and on human health. The use of plastic additives, many of which have known toxic effects are also of concern. This review provides a brief overview of microplastics and the extent of the microplastic problem. There have been a few inroads in regulating plastics but currently these are insufficient to adequately mitigate plastic pollution. We also review recent advances in microplastic testing methodologies, which should support management and regulation of plastic wastes. Significant efforts to reduce, reuse, and recycle plastics are needed at the individual, community, national, and international levels to meet the challenge. In particular, significant reductions in plastic production must occur to curb the impacts of plastic on human and worldwide health, given the fact that plastic is not truly recyclable.

A Pilot Survey of Career and Professional Advising of Medical Schools in the United States.

This article was migrated. The article was marked as recommended. Purpose: Scant information is available about the makeup of Career and Professional Advising systems, and who the advisors are in U.S. medical schools. We created a survey in 2019 and collated the responses to gain information about Advisors and advising systems. Materials and Methods: An 11 question survey was emailed to 72 U.S. medical schools, querying information about whether they had a Career and Professional Advising system and what is the construct of the system. Kruskal Wallis and Fisher's Exact tests were utilized for analysis. Results: 30/72 responses were received (41.67%). Educational backgrounds of advisors included: 27/30 (90%) by physicians; 7/30 (23.3%) by PhDs; 9/30 (30%) by Masters; 4/30 (13.3%) by others. AAMC Careers in Medicine curriculum was delivered in 23/30 (75.7%). Most advising systems were in Student Affairs (27/30, 90%), although only 20/30 (66.7%) reported to the Dean of Student Affairs. Conclusion: There was no unanimity in any of the responses to the 11 questions about who Career and Professional Advisors are, or how the systems are constructed. The closest to unanimity is that most medical schools have advising systems, that they are in Student Affairs departments, and that most advisors are physicians.

Similar virologic and immunologic efficacy with fosamprenavir boosted with 100 mg or 200 mg of ritonavir in HIV-infected patients: results of the LESS trial.

PURPOSE: ritonavir (RTV) effectively boosts most protease inhibitors but is associated with significant dose-dependent adverse events (AEs). In an effort to better manage toxicities through a reduced dose of RTV, this study compared fosamprenavir (FPV) boosted with RTV 100 mg (FPV/r100) or with RTV 200 mg (FPV/r200) daily. METHODS: this 24-week, open-label study enrolled patients taking a FPV/r 200-containing regimen who had HIV RNA <400 copies/mL and randomized them 1:2 to continue that regimen or simplify to FPV/r100 once daily. Other medications were not altered. The primary endpoint was the percentage of patients without suspected or confirmed virologic failure (HIV RNA ≥ 400 copies/mL) through week 24 by a missing/discontinuation equals failure (M/D=F) analysis. Noninferiority criteria were demonstrated if the lower bound of the 95% confidence interval (CI) for the difference in the primary endpoint rates between groups was greater than -12. RESULTS: the 2 regimens met prespecified noninferiority criteria (FPV/r100, 92%; FPV/r 200, 94%; 95% CI, -9.36 to 5.12). At week 24, the percentage of patients with HIV RNA <50 copies/mL by M/ D=F was 83% in the FPV/r100 group and 85% in the FPV/r 200 group. Drug-related grade 2-4 AEs were uncommon (FPV/r100, 4%; FPV/r 200, 7%). Median changes in lipids were similar in both groups, with the exception of triglycerides (FPV/r100, -21 mg/dL; FPV/r 200, -2 mg/dL). CONCLUSIONS: this 24-week study demonstrated that among previously suppressed patients, once-daily FPV/r100 was similar to FPV/r 200 in virologic and immunologic effects but was associated with greater decreases from baseline in triglyceride levels.

Safety and efficacy of a 36-week induction regimen of abacavir/lamivudine and ritonavir-boosted atazanavir in HIV-infected patients.

PURPOSE: The ARIES study assessed safety and efficacy of an induction regimen with atazanavir/ritonavir (ATV/RTV) + abacavir/lamivudine (ABC/3TC) followed by simplification to ATV + ABC/3TC in antiretroviral-naïve patients. METHODS: This report includes a noncomparative analysis of all patients in the induction phase of the ARIES study through 36 weeks (clinicaltrials.gov: NCT00440947). This open-label study included 515 antiretroviral-naïve,HLA-B*5701-negative patients receiving a regimen of ATV 300 mg, RTV 100 mg, and ABC/3TC 600 mg/300 mg once daily for 36 weeks; eligible patients were then randomized to continue the induction regimen or simplify to ATV 400 mg plus ABC/3TC 600 mg/300 mg once daily. RESULTS: Eighty-six percent (442/515) of patients completed 36 weeks on study; 80% (410/515) achieved HIV RNA <50 copies/mL (84% and 76% of patients with baseline HIV RNA of < and >or=100,000 copies/mL achieved this endpoint). Virologic failure (VF) was uncommon (3%); treatment-emergent major protease inhibitor and nucleoside reverse transcriptase inhibitor mutations were detected in 0/15 and 4/15 patients, respectively. Median CD4+ cell increase was 171 (range, -176 to 718) cells/mm(3). Hyperbilirubinemia (13%), diarrhea (4%), nausea (2%), and rash (2%) were the most frequent drug-related Grade 2-4 adverse events. Few adverse events (3%) led to study discontinuation. CONCLUSIONS: Induction with ATV/RTV + ABC/3TC once daily provides an efficacious and well-tolerated regimen for the initial treatment of HIV.

Early Supported Discharge for Neurorehabilitation Following Acquired Brain Injury.

Introduction: Early Supported Discharge (ESD) is a clinical flow management service offering interdisciplinary rehabilitation, wherein patients are provided supported in-home rehabilitation treatment; in comparison to conventional hospital-based rehabilitation model of service delivery. There has been little research into the functional outcomes for other types of acquired brain injury (ABI). Methods: In this prospective cohort study, ABI patients presenting at a level I trauma center in Calgary, Canada were placed in either an ESD program or conventional inpatient rehabilitation (IPR) program based on their medical history and presentation. A small number of patients completed both programs (ESD+IPR group). ESD therapies were designed to emulate IPR. Participants completed professionally-rated Mayo-Portland Adaptability Index-4 (MPAI), Quality of Life after Brain Injury (QOLIBRI), Generalized Anxiety Questionnaire-7 (GAD7), Montreal Cognitive Assessment (MoCA), and Patient Health Questionnaire-9 (PHQ9) surveys at 1, 3, and 6 months following initial assessment pre-rehabilitation. Caregivers completed the Zarit Burden Interview (ZBI) at the same time points. The Supervision Rating Scale (SRS) and Disability Rating Scale (DRS) were completed at admission to rehabilitation and all follow-ups. Generalized estimate equations models were used to describe the three groups over time, including age as a covariate. Results: Significant effects of time were reported in the MPAI participant sub-score in the ESD and IPR groups ( χ ( 2 ) 2 = 42.429, p < 0.000; χ ( 2 ) 2 = 9.773, p = 0.008), showing significantly higher scores between 1 and 3 month timepoints for both groups. ZBI scores were significantly lower in the ESD group at 1 month compared to 3 and 6 months ( χ ( 2 ) 2 = 31.252, p < 0.001). The proportion of patients with medical complications during rehabilitation was 25.3% in ESD compared to 74.7% patients in IPR. Conclusions: Improvements in functional outcomes were evident in patients participating in ESD and IPR, with more medical complications reported in the IPR group. Caregiver burden lessened over time in the ESD group but not in the IPR group. Both ESD and ESD+IPR groups can be considered viable alternatives to traditional inpatient rehabilitation. A randomized control trial would be required to properly compare rehabilitation streams. Further investigation into affective and lifestyle elements of ABI recovery would also improve our understanding of targeted neurorehabilitation in this population.

COVID-19 Solutions Are Climate Solutions: Lessons From Reusable Gowns.

The COVID-19 pandemic has laid bare the inadequacy of the U.S. healthcare system to deliver timely and resilient care. According to the American Hospital Association, the pandemic has created a $202 billion loss across the healthcare industry, forcing health care systems to lay off workers and making hospitals scramble to minimize supply chain costs. However, as the demand for personal protective equipment (PPE) grows, hospitals have sacrificed sustainable solutions for disposable options that, although convenient, will exacerbate supply strains, financial burden, and waste. We advocate for reusable gowns as a means to lower health care costs, address climate change, and improve resilience while preserving the safety of health care workers. Reusable gowns' polyester material provides comparable capacity to reduce microbial cross-transmission and liquid penetration. In addition, previous hospitals have reported a 50% cost reduction in gown expenditures after adopting reusable gowns; given the current 2000% price increase in isolation gowns during COVID-19, reusable gown use will build both healthcare resilience and security from price fluctuations. Finally, with the United States' medical waste stream worsening, reusable isolation gowns show promising reductions in energy and water use, solid waste, and carbon footprint. The gowns are shown to withstand laundering 75-100 times in contrast to the single-use disposable gown. The circumstances of the pandemic forewarn the need to shift our single-use PPE practices to standardized reusable applications. Ultimately, sustainable forms of protective equipment can help us prepare for future crises that challenge the resilience of the healthcare system.

Human tribbles homologue 2 is expressed in unstable regions of carotid plaques and regulates macrophage IL-10 in vitro.

Mammalian orthologues of the Drosophila tribbles protein (Trb1, Trb2 and Trb3) are a recently described family of signalling molecules that regulate gene expression by modulation of protein kinase signalling pathways. In the present study, a screen for mRNA species specifically regulated in vulnerable regions of human atherosclerotic plaque demonstrated the up-regulation of both Trb1 and Trb2, the latter by more than 8-fold. In vitro experiments in primary human monocyte-derived macrophages showed that Trb2 expression was up-regulated by treatment with oxidized LDL (low-density lipoprotein), and that expression of recombinant Trb2 specifically reduced macrophage levels of IL-10 (interleukin-10) mRNA. Our results thus identify Trb2 as a highly regulated gene in vulnerable atherosclerotic lesions, and demonstrate inhibition of macrophage IL-10 biosynthesis as a potential pro-inflammatory consequence of high Trb2 expression, which may contribute to plaque instability.

Support for provision of early medical abortion by mid-level providers in Bihar and Jharkhand, India.

Medical abortion has the potential to increase the number, cadre and geographic distribution of providers offering safe abortion services in India. This study reports on a sample of family planning providers (263 mid-level providers, 54 obstetrician-gynaecologists and 88 general physicians) from a 2004 survey of health facilities and their staff in Bihar and Jharkhand, India. It identified factors associated with mid-level provider interest in training for early medical abortion provision, and examined whether obstetrician-gynaecologists and general physicians supported non-physicians being trained to provide early medical abortion and what factors influenced their attitudes. Findings demonstrate high levels of mid-level provider interest and reasonable physician support. Among mid-level providers, being male, having a more permissive attitude towards abortion and current provision of abortion using any pharmacological drugs were associated with greater interest in attending training. Mid-level providers based in private health facilities were less likely to show interest. More permissive attitude towards abortion and current medical abortion provision using mifepristone-misoprostol were inversely associated with obstetrician-gynaecologists' support for non-physician provision of medical abortion. General physicians based in private/other health facilities were less supportive than those in public facilities. Study findings strengthen the case for policymakers to expand the pool of cadres that can legally provide safe abortion care in India.

Development and Validation of Stability Indicating High-Performance Thin-Layer Chromatographic (HPTLC) Method for Quantification of Asiaticoside from Centella asiatica L. and its Marketed Formulation.

Background: Ayurvedic medicines help in healing disease with fewer undesirable effects in comparison with an allopathic system of medicine to treat central nervous system (CNS) disorders, as the latter is more expensive. Centella asiatica L. is often used in Ayurvedic formulations for the treatment of CNS disorders. Objective: A stability test using an HPTLC method for the estimation of an important marker asiaticoside (ASI) from C. asiatica powder and marketed formulation was developed. Methods: The marker compound ASI from plant powders and marketed formulations were resolved using toluene-ethyl acetate-methanol-glacial acetic acid (2+7+3+1, v/v/v/v) as the mobile phase and then was derivatized. The plant powder and marketed formulation were also subjected to stability studies. Results: The Rf value of ASI was found in range of 0.43-0.47 for the standard ASI, plant powder, and marketed formulation. It was found that the plant powder and formulation exhibited first-order degradation kinetics. Conclusions: The contents of ASI in the formulation (Churna) and its flow characters reduced at the end of the 6 months during an accelerated stability study. The developed method can be used to quantify ASI in the presence of its degradation products. Highlights: The developed method helps in determining batch to batch variation in the content of ASI in herbal formulations.