Analysis of sunscreens and antibiotics in groundwater during the Covid-19 pandemic in the Riviera Maya, Mexico.

Tourism contributes to groundwater pollution, but quantifying its exact impact is challenging due to the presence of multiple pollution sources. However, the COVID-19 pandemic presented a unique opportunity to conduct a natural experiment and assess the influence of tourism on groundwater pollution. One such tourist destination is the Riviera Maya in Quintana Roo, Mexico (specifically Cancun). Here, water contamination occurs due to the addition of sunscreen and antibiotics during aquatic activities like swimming, as well as from sewage. In this study, water samples were collected during the pandemic and when tourists returned to the region. Samples were taken from sinkholes (cenotes), beaches, and wells then tested using liquid chromatography for antibiotics and active ingredients found in sunscreens. The data revealed that contamination levels from specific sunscreens and antibiotics persisted even when tourists were absent, indicating that local residents significantly contribute to groundwater pollution. However, upon the return of tourists, the diversity of sunscreen and antibiotics found increased, suggesting that tourists bring along various compounds from their home regions. During the initial stages of the pandemic, antibiotic concentrations were highest, primarily due to local residents incorrectly using antibiotics to combat COVID-19. Additionally, the research found that tourist sites had the greatest contribution to groundwater pollution, with sunscreen concentration increasing. Furthermore, installation of a wastewater treatment plant decreased overall groundwater pollution. These findings enhance our understanding of the pollution contributed by tourists in relation to other pollution sources.

Value of Modeling Violent Relationships.

Intimate partner violence (IPV) is a scar on human society. Growing evidence demonstrates that relationships involving IPV and women's decisionmaking about violence represent complex phenomena, best studied as complex adaptive systems. Unfortunately, that complexity limits our ability to fully understand it. This paper presents findings from a series of agent-based models (ABMs) that were created from studies involving multiple time series of couples' daily reports of violence, perceptions and behaviors. To identify potential influencing variables, we modeled the impact that random stress and intentional behavior of the women could have on men's violence and stalking. ABM models of IPV noted the lack of violence at baseline without influence, and found that three variable parameters (Distance-Distance+, HerViolence-HerViolence+, Distance-Distance-) accounted for most patterns of violence development. Random stress and arguments had little effect and the nature of the alcoholviolence relationship remained unclear, however, her violence could increase his violence and stalking. One important difference between ABMs was the importance of the persistence of her concern about the effects of violence on children. Although only modeled in the second ABM, it proved critical to results. When modeling women's decision-making, her abstinence from arguments, alcohol use and violence had no effect on whether to seek help, take legal action or leave; random stress and her daily violence did not affect seeking counseling. However, daily arguments, forgiveness and heavy alcohol use did impact actiontaking, increasing counseling, legal action and leaving generally. The addition of catastrophe equations could alter these outcomes, resulting in more counseling but less legal action. In addition, children are very important when considering decision-making; concern for children affects violence while number of children affects decision-making. In conclusion, ABM can yield important insights into IPV and have clinical implications. It can provide greater understanding of the phenomenon and allow us to test the nature of correlations. (i.e., between alcohol use and violence). ABM can clarify the inherent complexity within violent couples and facilitate sense-making. Finally, it can allow clinicians to test interventions in vitro without risk to vulnerable women.

Outcomes of a Scholarly Activity Curriculum for Family Medicine Residents.

BACKGROUND AND OBJECTIVES: Scholarship is essential to growth and innovation in family medicine. Moreover, the Accreditation Council for Graduate Medical Education Review Committee-Family Medicine requires family medicine residents to complete scholarly activities. However, many residents lack the training and confidence to successfully conduct such activities. In the year 2014, our residency implemented a scholarly activity curriculum to train our residents to plan, complete, and disseminate research and quality improvement projects. We sought to evaluate the impact of one institution's scholarly activity curriculum for family medicine residents on resident scholarly activity productivity. METHODS: We reviewed the scholarly activities conducted by our family medicine residents in the 5 years after initiation of the scholarly activity curriculum and compared them to those conducted in the 5 years prior to initiation of the curriculum. RESULTS: Since 2014, the percentage of residents who coauthored at least one poster increased significantly, from 55.2% in 2009-2014, to 82.5% in 2014-2019 (P<.001). In the academic years 2014 to 2019, residents also coauthored significantly more book chapters compared to the 5 years prior to the curriculum. CONCLUSIONS: Our curriculum has been successful in improving resident scholarly activity productivity as evidenced by a significant increase in the percentage of residents coauthoring posters and the total number of book chapters written by residents.

Violence towards women and their decisions to take action: A complex systems approach.

Intimate partner violence (IPV) is a blight on society. Our traditional understanding suggests that interventions should be straightforward, leading to predictable positive results. However, these assumptions do not reflect the reality of IPV, which continues to frustrate physicians. While IPV research has thoroughly described the developmental risks and impacts of IPV, the violent incident itself remains largely unstudied and poorly understood. Although this lack of research may partially explain physician frustration and the limitations of our interventions, the greater problem may be our reliance upon the wrong paradigm in guiding our understanding. Complexity science says that systems are globally understandable, but not completely knowable. Our hypothesis is that IPV needs to be viewed as a complex adaptive system if we are to understand the phenomenon, identify expectations and appropriately intervene. When viewed through the lens of complexity science, IPV becomes less knowable and predictable, suggesting that interventionists should expect variable response. Research has indeed demonstrated that partner violence is a complex phenomenon with multiple, interdependent factors and a nonlinear trajectory. This nonlinearity/unpredictability can impact outcomes in IPV, often more so than the frequency or severity of the violence. Similarly, women's decision-making concerning the violence is also a nonlinear process dependent upon multiple factors and catastrophic influences. Once recognized, complexity science offers a novel approach to explain IPV's obfuscation and resistance to predictable change. Using the tempered expectations of a systems lens, the violent interdependencies can be clarified, the obscure causes of events can be visualized, and the temporal irregularities can be mapped. Not only can the disruptive tipping points, system feedforward propagations, powerful attractors and discontinuities compromise reasoned intervention, but these same factors, if understood, can be harnessed to foster and magnify circumstances that enable positive change.

He Said, She Said: Comparing Men's and Women's Descriptions of Men's Partner Violence.

More than one in three women and one in four men in the United States report victimization by intimate partner violence. Women and men often disagree about the frequency or severity of violent acts, and researchers have proposed various reasons for discordant reports. Using daily surveys and qualitative interviews, we compared men's and women's reports about men's partner aggression and examined language they used to describe their experiences. Fifteen heterosexual couples in violent relationships completed an 8-week study that involved daily telephone surveys about violent behaviors and household environment; baseline and end-of-study surveys addressing predictors and outcomes of violence; and qualitative end-of-study interviews to provide perspective about their relationships. Most participants were Latinos with low income. Relationship length was 5.5 years, median. In daily surveys, both partners reported similar frequencies of men's physical violence (4% of days), but men reported more physical violence by women than women did (8% vs. 3% of days). The qualitative analysts compared men's and women's accounts of male-to-female violence and observed gender-specific variations in style of reporting. Men used indirect language to describe their violent behavior, implied definitions of abuse, and justified their aggression. These findings have implications for clinical guidelines to screen and intervene with victims and perpetrators of intimate partner violence in primary care and emergency settings. Future research should focus on perpetrators of violence and examine effective ways for health care providers to identify and manage their care.

Primary Care and Food Bank Collaboration to Address Food Insecurity: A Pilot Randomized Trial.

Food insecurity is common in the United States and linked to poor control of conditions influenced by diet. We conducted a pilot randomized trial to test whether a novel partnership between a primary care practice and a municipal food bank would improve control of type 2 diabetes among patients with food insecurity. Participants received food bank produce delivered twice monthly to the practice site, brief teaching from a food bank dietitian, and home-based education from a community health worker. After 6 months, glycosylated hemoglobin decreased (absolute change) by 3.1% in the intervention group vs 1.7% in the control group (P = .012). Scores on Starting the Conversation-Diet, a brief dietary measure, improved in the intervention group by 2.47 on a 14-point scale (P < .001). Body mass indexes (BMIs) were unchanged. In this early-stage study, onsite collaboration between primary care and a regional food bank generated clinically meaningful reductions in HbA1c and improvements in diet.

The Dynamics of Partner Violence and Alcohol Use in Couples: Research Methods.

OBJECTIVE: This research team uses complexity science to gain a deeper understanding of daily dynamics of intimate partner violence (IPV). This report describes research methods for gathering daily information about patterns of partner violence and alcohol use from couples in near-real time, and addresses recruitment and retention, adherence to study protocol, data validity, and participant safety. METHODS: Researchers enrolled 20 heterosexual couples with violent relationships from a primary healthcare center. Every day for 8 weeks, participants telephoned an interactive voice response (IVR) system and responded to 33 survey questions assessing violence, alcohol use, and household environment. They also completed baseline and end-of-study surveys. RESULTS: Of 20 enrolled couples, 15 completed the study, providing 90% adherence to daily reporting. Participants reported verbal aggression on an average of 11-13 days over 8 weeks, and physical abuse on an average of 2-4 days. Alcohol use was modest and infrequent. Women and men differed in their reports of women's physical aggression. No reports of physical violence were correlated with social desirability. CONCLUSIONS: We demonstrated the feasibility of enrolling and engaging both women and men in daily longitudinal research about partner violence and described advantages of IVR in daily longitudinal research.

Communication Skills in Dental Students: New Data Regarding Retention and Generalization of Training Effects.

Previous studies have shown that a communications program using patient instructors (PIs) facilitates data-gathering and interpersonal skills of third-year dental students. The aim of this study was to address the question of whether those skills are retained into the students' fourth year and generalized from the classroom to the clinic. In the formative training phase, three cohorts of D3 students (N=1,038) at one dental school received instruction regarding effective patient-doctor communication; interviewed three PIs and received PI feedback; and participated in a reflective seminar with a behavioral science instructor. In the follow-up competency phase, fourth-year students performed two new patient interviews in the clinic that were observed and evaluated by clinical dental faculty members trained in communications. Mean scores on a standardized communications rating scale and data-gathering assessment were compared over training and follow-up sessions and between cohorts with a linear mixed model. The analysis showed that the third-year students' mean communication and data-gathering scores increased with each additional encounter with a PI (p<0.05) and that communication scores were not only maintained but increased during the fourth-year follow-up competency evaluations (p<0.05). Based on changes in the communications curriculum, prior instruction facilitated the students' clinical communication performance at baseline (p<0.05). This study suggests that the current Clinical Communications program improved students' data-gathering and interpersonal skills. Those skills were maintained and generalized through completion of the D4 students' summative competency performance in a clinical setting.