Anti-racism curricula in undergraduate medical education: A scoping review.

PURPOSE: Medical educators have increasingly focused on the systemic effects of racism on health inequities in the United States (U.S.) and globally. There is a call for educators to teach students how to actively promote an anti-racist culture in healthcare. This scoping review assesses the existing undergraduate medical education (UME) literature of anti-racism curricula, implementation, and assessment. METHODS: The Ovid, Embase, ERIC, Web of Science, and MedEdPORTAL databases were queried on 7 April 2023. Keywords included anti-racism, medical education, and assessment. Inclusion criteria consisted of any UME anti-racism publication. Non-English articles with no UME anti-racism curriculum were excluded. Two independent reviewers screened the abstracts, followed by full-text appraisal. Data was extracted using a predetermined framework based on Kirkpatrick's educational outcomes model, Miller's pyramid for assessing clinical competence, and Sotto-Santiago's theoretical framework for anti-racism curricula. Study characteristics and anti-racism curriculum components (instructional design, assessment, outcomes) were collected and synthesized. RESULTS: In total, 1064 articles were screened. Of these, 20 met the inclusion criteria, with 90% (n = 18) published in the past five years. Learners ranged from first-year to fourth-year medical students. Study designs included pre- and post-test evaluations (n = 10; 50%), post-test evaluations only (n = 7; 35%), and qualitative assessments (n = 3; 15%). Educational interventions included lectures (n = 10, 50%), multimedia (n = 6, 30%), small-group case discussions (n = 15, 75%), large-group discussions (n = 5, 25%), and reflections (n = 5, 25%). Evaluation tools for these curricula included surveys (n = 18; 90%), focus groups (n = 4; 20%), and direct observations (n = 1; 5%). CONCLUSIONS: Our scoping review highlights the growing attention to anti-racism in UME curricula. We identified a gap in published assessments of behavior change in applying knowledge and skills to anti-racist action in UME training. We also provide considerations for developing UME anti-racism curricula. These include explicitly naming and defining anti-racism as well as incorporating longitudinal learning opportunities and assessments.

Novel Bidentate Amine Ligand and the Interplay between Pd(II) and Pt(II) Coordination and Biological Activity.

Pt(II) and Pd(II) coordinating N-donor ligands have been extensively studied as anticancer agents after the success of cisplatin. In this work, a novel bidentate N-donor ligand, the N-[[4-(phenylmethoxy)phenyl]methyl]-2-pyridinemethanamine, was designed to explore the antiparasitic, antiviral and antitumor activity of its Pt(II) and Pd(II) complexes. Chemical and spectroscopic characterization confirm the formation of [MLCl2 ] complexes, where M=Pt(II) and Pd(II). Single crystal X-ray diffraction confirmed a square-planar geometry for the Pd(II) complex. Spectroscopic characterization of the Pt(II) complex suggests a similar structure. 1 H NMR, 195 Pt NMR and HR-ESI-MS(+) analysis of DMSO solution of complexes indicated that both compounds exchange the chloride trans to the pyridine for a solvent molecule with different reaction rates. The ligand and the two complexes were tested for in vitro antitumoral, antileishmanial, and antiviral activity. The Pt(II) complex resulted in a GI50 of 10.5 µM against the NCI/ADR-RES (multidrug-resistant ovarian carcinoma) cell line. The ligand and the Pd(II) complex showed good anti-SARS-CoV-2 activity with around 65 % reduction in viral replication at a concentration of 50 µM.

Old but still good: genetic diversity of ancient pecan genotypes from southern Brazil.

Pecan [Carya illinoinensis (Wangenh.) K. Koch] is a crop fruit native to the USA and Mexico currently cultivated in several countries, including Brazil, Uruguay, Argentina, Chile, Peru, China, South Africa, and Australia. Supported by the increasing consumption and market prices, the interest in the cultivation of this fruit crop is strongly growing around the world. In this study, AFLP and S-SAP markers were employed to characterize the genetic diversity of ancient accessions of pecan from southern Brazil. The evaluated plants were selected and preserved by the farmers and are remnants of the first introduction of seedlings from the U.S.A into southern Brazil aiming at developing research towards establishing commercial orchards. High levels of genetic diversity were estimated, suggesting that these plants have an important genetic background for the establishment of a germplasm collection with a wide genetic basis, for the development of breeding programs for this fruit crop. Cluster analysis of the genetic datasets revealed some correlation between the nuts' morphometric traits and genetic markers. Such correlation should be further exploited. These ancient genotypes must be evaluated for other agronomic traits of interest and included in core collections of pecans.

Monitoring the Air Quality in an HVAC System via an Energy Harvesting Device.

The energy consumption of a heating, ventilation, and air conditioning (HVAC) system represents a large amount of the total for a commercial or civic building. In order to optimize the system performance and to increase the comfort of people living or working in a building, it is necessary to monitor the relevant parameters of the circulating air flux. To this end, an array of sensors (i.e., temperature, humidity, and CO2 percentage sensors) is usually deployed along the aeraulic ducts and/or in various rooms. Generally, these sensors are powered by wires or batteries, but both methods have some drawbacks. In this paper, a possible solution to these drawbacks is proposed. It presents a wireless sensor node powered by an Energy Harvesting (EH) device acted on by the air flux itself. The collected data are transmitted to a central unit via a LoRa radio channel. The EH device can be placed in air ducts or close to air outlets.

Rain Discrimination with Machine Learning Classifiers for Opportunistic Rain Detection System Using Satellite Micro-Wave Links.

In the climate change scenario the world is facing, extreme weather events can lead to increasingly serious disasters. To improve managing the consequent risks, there is a pressing need to have real-time systems that provide accurate monitoring and possibly forecasting which could help to warn people in the affected areas ahead of time and save them from hazards. The oblique earth-space links (OELs) have been used recently as a method for real-time rainfall detection. This technique poses two main issues related to its indirect nature. The first one is the classification of rainy and non-rainy periods. The second one is the determination of the attenuation baseline, which is an essential reference for estimating rainfall intensity along the link. This work focuses mainly on the first issue. Data referring to eighteen rain events were used and have been collected by analyzing a satellite-to-earth link quality and employing a tipping bucket rain gauge (TBRG) properly positioned, used as reference. It reports a comparison among the results obtained by applying four different machine learning (ML) classifiers, namely the support vector machine (SVM), neural network (NN), random forest (RF), and decision tree (DT). Various data arrangements were explored, using a preprocessed version of the TBRG data, and extracting two different sets of characteristics from the microwave link data, containing 6 or 12 different features, respectively. The achieved results demonstrate that the NN classifier has outperformed the other classifiers.

Leading the Charge: Effectiveness of a Workshop to Enhance Faculty Education of Health Inequity.

INTRODUCTION: Medical educators in residency programs have unique opportunities to teach health inequities, social determinants of health (SDOH), and implicit bias. However, faculty are not adequately trained to effectively teach these topics. The aim is to assess the effectiveness of a faculty-level workshop to teach health inequity. METHODS: An interactive workshop was designed by an interprofessional faculty from a major urban teaching hospital, addressing SDOH, implicit bias, an "Enhanced Social History," and the benefits of interprofessional care. Before and after completion, workshop participants completed surveys regarding comfort in teaching these concepts. Survey results were analyzed to assess benefits of the intervention. RESULTS: Sixty-four percent of participants completed preworkshop and postworkshop surveys. Participants reported increased contemplation and improved comfort in teaching SDOH, barriers to medical care, and implicit bias. CONCLUSION: Faculty comfort in teaching health inequity increased after this workshop. This may help bridge the gap between the expectation of clinical faculty to evaluate trainee practice of patient-centered, culturally competent care, and faculty possession of and confidence in health inequity teaching skills in clinical settings. Future research should focus on learner- and patient-based outcomes, including teaching time and impact on delivery of care.

Enhancing Cyber Security of LoRaWAN Gateways under Adversarial Attacks.

The Internet of Things (IoT) has disrupted the IT landscape drastically, and Long Range Wide Area Network (LoRaWAN) is one specification that enables these IoT devices to have access to the Internet. Former security analyses have suggested that the gateways in LoRaWAN in their current state are susceptible to a wide variety of malicious attacks, which can be notoriously difficult to mitigate since gateways are seen as obedient relays by design. These attacks, if not addressed, can cause malfunctions and loss of efficiency in the network traffic. As a solution to this unique problem, this paper presents a novel certificate authentication technique that enhances the cyber security of gateways in the LoRaWAN network. The proposed technique considers a public key infrastructure (PKI) solution that considers a two-tier certificate authority (CA) setup, such as a root-CA and intermediate-CA. This solution is promising, as the simulation results validate that about 66.67% of the packets that are arriving from an illegitimate gateway (GW) are discarded in our implemented secure and reliable solution.

Porting Rulex Software to the Raspberry Pi for Machine Learning Applications on the Edge.

Edge Computing enables to perform measurement and cognitive decisions outside a central server by performing data storage, manipulation, and processing on the Internet of Things (IoT) node. Also, Artificial Intelligence (AI) and Machine Learning applications have become a rudimentary procedure in virtually every industrial or preliminary system. Consequently, the Raspberry Pi is adopted, which is a low-cost computing platform that is profitably applied in the field of IoT. As for the software part, among the plethora of Machine Learning (ML) paradigms reported in the literature, we identified Rulex, as a good ML platform, suitable to be implemented on the Raspberry Pi. In this paper, we present the porting of the Rulex ML platform on the board to perform ML forecasts in an IoT setup. Specifically, we explain the porting Rulex's libraries on Windows 32 Bits, Ubuntu 64 Bits, and Raspbian 32 Bits. Therefore, with the aim of carrying out an in-depth verification of the application possibilities, we propose to perform forecasts on five unrelated datasets from five different applications, having varying sizes in terms of the number of records, skewness, and dimensionality. These include a small Urban Classification dataset, three larger datasets concerning Human Activity detection, a Biomedical dataset related to mental state, and a Vehicle Activity Recognition dataset. The overall accuracies for the forecasts performed are: 84.13%, 99.29% (for SVM), 95.47% (for SVM), and 95.27% (For KNN) respectively. Finally, an image-based gender classification dataset is employed to perform image classification on the Edge. Moreover, a novel image pre-processing Algorithm was developed that converts images into Time-series by relying on statistical contour-based detection techniques. Even though the dataset contains inconsistent and random images, in terms of subjects and settings, Rulex achieves an overall accuracy of 96.47% while competing with the literature which is dominated by forward-facing and mugshot images. Additionally, power consumption for the Raspberry Pi in a Client/Server setup was compared with an HP laptop, where the board takes more time, but consumes less energy for the same ML task.

Advanced Real-Time Monitoring of Rainfall Using Commercial Satellite Broadcasting Service: A Case Study.

Correct regulation of meteoric surface and subsurface flow waters is a fundamental goal for the sustainable development of the territories. A new system, aimed at real-time monitoring of the rainfall and of the cumulated rainfall, is introduced and discussed in the present paper. The system implements a Sensor Network based on the IoT paradigm and can cover safety-critical "hot spots" with a relatively small number of sensors, strategically placed, in areas not covered by traditional weather radars and rain gauges, and lowering the costs of deployment and maintenance with respects to these devices. A real application case, based on the implementation of the pilot plant at the Monte Scarpino landfill (Genoa, Italy), is presented and discussed. The system performances are assessed on the basis of comparisons with data provided by a polarimetric weather radar and by a traditional rain gauge.

Biostimulation of sulfate-reducing bacteria and metallic ions removal from coal mine-impacted water (MIW) using shrimp shell as treatment agent.

This paper comprises several assays aiming to identify the basis for the bioremediation of mine-impacted water (MIW). To do so, the conditions for build anoxic microcosms for treating this effluent were varied, containing MIW, and a source of chitin, to biostimulate sulfate-reducing bacteria (SRB). The chitin sources were: commercial chitin (CHIT) and shrimp shell (SS), which in addition to chitin, contains CaCO3, and proteins in its composition. The CHIT assays were not successful in sulfate-reduction, even when the pH was increased with CaCO3. However, in all SS assays the SRB development was successful (85% sulfate removal for assay 3), including the metal-free (MF-SS) assay (75% for assay 5). High-throughput sequencing analysis revealed the structure of bacterial community in the SS assay: the most abundant genera were Clostridium and Klebsiella, both fermentative and chitinase producers; a few SRB from the genera Desulfovibrio and Desulfosporosinus were also detected. In the MF-SS assay, Desulfovibrio genuswas detected but Comamonas was dominant. It could be deduced that SS is a suitable substrate for SRB development, but CHIT is not. The sulfate-reduction process was provided by the cooperation between fermentative/chitinase-producer bacteria together with SRB, which leads to efficient MIW treatment, removing sulfate and metallic ions.

Minimally Invasive Pyelolithotomy: Comparison of Robot-assisted and Laparoscopic Techniques.

OBJECTIVES: To compare the perioperative and short-term outcomes of robotic pyelolithotomy (RP) and laparoscopic pyelolithotomy (LP) for the treatment of renal stones. MATERIALS AND METHODS: We retrospectively evaluated 39 patients who underwent robotic or laparoscopic pyelolithotomy from January 2015 to December 2018. RESULTS: The preoperative characteristics of the two groups were comparable. The mean operative time was 173 ± 51 and 182 ± 62 min in the RP and LP groups, respectively (p=0.6). Blood loss and length of hospital stay with the robotic approach were lower than those with the laparoscopic approach (210 ± 180 ml vs. 639 ± 412 ml, p<0.001, and 3.8 ± 3 days vs. 7.3 ± 2.8 days, p=0.001). A complete stone-free status was achieved in 17 (85%) patients in the RP group and 8 (42%) in the LP group (p=0.01). Post-operative complications with the two approaches were also similar. CONCLUSIONS: In some selected cases, laparoscopic and robotic pyelolithotomy are alternative procedures for large, multiple and complex kidney stones. The robotic approach was associated with less intraoperative blood loss and fewer days of hospitalization compared to the laparoscopic method, and also gives a better stone-free rate.

Skin and lung toxicity in synchronous bilateral breast cancer treated with volumetric-modulated arc radiotherapy: a mono-institutional experience.

PURPOSE: To evaluate acute and late skin/subcutaneous toxicities and radiation-induced lung fibrosis (RILF) in patients treated with adjuvant radiotherapy (RT) for synchronous bilateral breast cancers (SBBC), after conservative surgery. METHODS/PATIENTS: Twenty-five patients were treated with volumetric-modulated arc therapy (VMAT/RapidArc®) on both breasts, and checked clinically for detecting RT toxicities during and after treatment. A high-resolution computed tomography (HRCT) was performed, for detecting RILF during follow-up. RESULTS: We registered acute Grade-1 skin toxicity in 18 patients (72%), while six patients (24%) experienced Grade-2 toxicity. No breath symptoms were reported during and after RT. Late Grade-1 subcutaneous toxicity and late Grade-2 skin toxicity were registered in four patients (16%) and one patient (4%), respectively, at a mean follow-up of 36 months. Grade-1 RILF was detected in six patients (30%). The median volume of fibrosis area was 6.5 cc (range 1.3-21.5 cc). The partial volumes receiving a specified dose (V20, V30, V40, and V50) in patients who developed lung fibrosis were significantly bigger than who did not (p < 0.01). We showed that the mean volume of the tumour boost of patients who developed fibrosis (77.7 cc) was not significantly different from the other patients (90.8 cc) (p = 0.5). CONCLUSION: The clinical impact of this technique is favourable, and this is the first clinical study showing RILF by HRCT in a setting of SBBC. Further study with larger accrual is mandatory.

Chitin as a substrate for the biostimulation of sulfate-reducing bacteria in the treatment of mine-impacted water (MIW).

This study aims to know the basis of sulfate-reducing bacteria (SRB) and chitin source relationship for the development of a biotreatment system for mine-impacted water (MIW). The MIW consists of river water impacted by coal acid mine drainage (AMD), an extremely acid effluent, rich in sulfate and dissolved metal ions, with a high pollutant potential. Chitin was used as metal ion sorbent and biostimulant of SRB, whose anaerobic dissimilatory metabolism reduces sulfate to sulfide. Microcosms were built in an oxygen-free atmosphere using chitin from two different sources: commercial chitin and shrimp shell waste, which contains calcium carbonate, an acidity removal agent, in addition to chitin. The results indicate that the shrimp shell performs best in removing sulfate (99.75%), iron (99.04%), aluminum (98.47%), and manganese (100%) ions. The iron ion sorption kinetics of the sediments were also studied; pseudo-second order behavior was observed. High-throughput sequencing analysis revealed the present bacterial community and its abundance in the microcosms after 11 and 30 treatment days: SRB were detected but were not the majority. Thus, this research aims to contribute to the sustainable treatment MIW through the employment of an abundant and low-cost biomaterial.

Individual effects of seasonal changes, visitor density, and concurrent bear behavior on stereotypical behaviors in captive polar bears (Ursus maritimus).

Stereotypical behaviors in captive polar bears (Ursus maritimus) can be detrimental to their welfare. These behaviors can be reduced through enrichment programs but are often not completely eliminated, so identifying potential triggers is important. The present study investigated the influences of seasonal changes, visitor density, and concurrent bear activity on stereotypical behaviors exhibited by 3 captive polar bears at the Toronto Zoo. All bears exhibited these behaviors; however, individual differences were found in duration and form. The male exhibited less stereotypical behavior during spring, and the females exhibited less stereotypical behavior during winter. An increase in visitor density was associated with more stereotypical behavior in 1 female but less stereotypical behavior in the other 2 bears. All bears engaged in more stereotypical behaviors when the other bears were inactive, and 1 female engaged in more stereotypical behaviors when the other bears were out of sight. Further, when conspecifics were active, all bears engaged in less stereotypical behaviors. Given the variability among individual bears, future enrichment programs must be tailored to the needs of individuals to maximize efficacy.

Fetal growth restriction in hypothyroidism is associated with changes in proliferative activity, apoptosis and vascularisation of the placenta.

The objective of this study was to evaluate fetal weight, histomorphometric changes and proliferative activity, apoptosis and angiogenesis of the placenta in rats with hypothyroidism. Thirty-six adult female rats were divided into two groups with 18 animals each: control and hypothyroidism. Hypothyroidism was induced by daily administration of propylthiouracil (1 mg/animal). The administration began five days before becoming pregnant and the animals were sacrificed at 14 or 19 days of gestation. The control group received a placebo. The number and weight of fetuses and the rate of fetal death was determined, as well as the morphometric characteristics, the immunohistochemical expression of cell division control protein 47 (CDC)-47 and vascular endothelial growth factor (VEGF) and the number of apoptotic cells in the placental disk. The data were analysed by Mann-Whitney U test. Hypothyroidism reduced the weight of fetuses and of the uterus and placenta (P<0.05), altered the thickness of the placental labyrinth and spongiotrophoblast (P<0.05), increased the population of glycogen cells in the spongiotrophoblast (P<0.05), interfered with the vascular development of the placental labyrinth and decreased VEGF expression (P<0.05), reduced the expression of CDC-47 and cellularity and increased the apoptotic rate in the placental disk (P<0.05). We conclude that hypothyroidism affects fetal weight by altering the proliferative activity, apoptosis and vascularisation of the placenta.

Necrotizing pneumonia caused by Panton-Valentine leukocidin-producing methicillin-susceptible Staphylococcus aureus (MSSA).

Staphylococcus aureus harboured by Panton-Valentine leukocidin (PVL) is emerging as a serious problem worldwide. There has been an increase in the incidence of necrotizing lung infections in otherwise healthy young people with very high mortality rate associated with these strains. This report documents a confirmed case of necrotizing pneumonia due to methicillin-susceptible S. aureus (MSSA) harbouring Panton-Valentine leukocidin genes. An apparently healthy 49-year old man was admitted to our hospital for dyspnea and he quickly developed acute respiratory distress syndrome. MSSA harbouring Panton-Valentine leukocidin genes were cultured from the abscess fluid and from multiple blood specimens. Aggressive antibiotic therapy was started and intensive supportive care led finally to a complete recovery. Rapid identification of Panton-Valentine leukocidin in MSSA samples should be supposed when a young, immunocompetent patient, develops a necrotizing pneumonia. Bactericidal antistaphylococcal antibiotics are recommended for the treatment as soon as possible to avoid the potentially devastating consequences of this kind of S. aureus.

Performance-based versus patient-reported physical function: what are the underlying predictors?

BACKGROUND: Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function. Although conceived as representing similar concepts, differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically. OBJECTIVE: The purpose of this study was to compare the Short Physical Performance Battery (SPPB) with the function component of the Late-Life Function and Disability Instrument (LLFDI) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care. DESIGN: This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults (N=137) with mobility limitations enrolled in a randomized controlled trial of exercise. METHODS: A performance-based measure of function (the SPPB) and a self-report measure of function (the LLFDI) served as functional outcomes. Physiologic factors included measures of leg strength, leg velocity, and exercise tolerance test (ETT) duration, which served as a surrogate measure of aerobic capacity. Psychosocial and health factors included age, sex, height, body mass index, number of chronic conditions, depression, and falls efficacy. RESULTS: Separate multivariable regression models predicting SPPB and LLFDI scores described 33% and 42% of the variance in each outcome (R(2)), respectively. Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures. Leg strength and age were positively associated with SPPB scores, whereas number of chronic conditions, sex, and falls efficacy were associated with the LLFDI scores. LIMITATIONS: This study included older adults with mobility limitations and may not generalize to other populations. CONCLUSIONS: Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person's functioning. The SPPB was associated with age and physiologic factors, whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors.

Mechanical thrombolysis using a solitaire stent.

Mechanical offers several advantages over drug thrombolysis: in particular, the haemorrhagic risk may be not significantly increased while working out the indications got intravenous drug thrombolysis. Available tools were in our hands inefficient, stiff and dangerous. We found a retrievable stent efficient and easy to handle for this purpose. This experience is described.