AAHPM Assessment Workgroup: Hospice and Palliative Medicine Fellowship Assessment Needs and Directions.

Context: Medical education is moving towards competency based medical education (CBME). This provides opportunities and challenges for the field of Hospice and Palliative Medicine (HPM). The American Academy of Hospice and Palliative Medicine (AAHPM) created the Assessment Workgroup to spearhead a shared vision and process to implement high-quality assessment of fellow performance.

Approaches to ensure an equitable and fair admissions process for medical training.

There has been considerable discussion of how best to address racial and ethnic disparities in health outcomes, both globally and specifically in the United States. Increasing diversity among future clinicians and physician-scientists has been identified as a key strategy for addressing and correcting health disparities among underrepresented populations. Increasingly, medical schools, the institutions that train clinicians, have embraced the practice of holistic review for evaluating applicants and virtually all medical schools have reported contributing to a diverse physician workforce as an important aspect of their educational mission.

Oncologic outcomes for invasive squamous cell carcinoma with a clinically resolved biopsy site managed by watchful waiting: A retrospective cohort study.

Background: Treatment of cutaneous squamous cell carcinoma largely involves surgical excision. Few studies have examined oncologic outcomes of tumors managed by watchful waiting when the lesion appears resolved after the biopsy site has healed.

Objective: To describe oncologic outcomes for patients diagnosed with cutaneous squamous cell carcinoma that was determined clinically resolved at follow-up and subsequently managed by watchful waiting.

Identifying therapeutic target for prostate cancer: exploring Diosmetin as a CYP inhibitor.

Prostate cancer is a prevalent and highly heterogeneous malignancy that affects men globally. Despite the availability of various treatment targets, Cytochrome P450 (CYP) enzymes have gained significant attention due to their crucial role in metabolizing both endogenous and exogenous compounds. This study explores Diosmetin as a potential CYP antagonist for treating prostate cancer.

Intersection of Wildfire and Legacy Mining Poses Risks to Water Quality.

Mining and wildfires are both landscape disturbances that pose elevated and substantial hazards to water supplies and ecosystems due to increased erosion and transport of sediment, metals, and debris to downstream waters. The risk to water supplies may be amplified when these disturbances occur in the same watershed. This work describes mechanisms by which the intersection of mining and wildfire may lead to elevated metal concentrations in downstream waters: (1) conveyance of metal-rich ash and soil to surface waters, (2) increased dissolution and transport of dissolved metals due to direct contact of precipitation with mine waste, (3) increased erosion and transport of metal-rich sediment from mining waste, (4) remobilization of previously deposited metal-contaminated floodplain sediment by higher postfire flood flows, and (5) increased metal transport from underground mine workings.

Racial and Ethnic Differences in Outcomes of Neonates Born at Less Than 30 Weeks' Gestation, 2018-2022.

Importance: Previous research has examined outcomes among very preterm newborns by the birthing parent's race and ethnicity, but knowledge about these trends during the COVID-19 pandemic is limited.

Objective: To examine trends in outcomes among Black, Hispanic, and Asian preterm newborns compared with White preterm newborns.

Design, Setting, And Participants: This cohort study (2018-2022) took place at 774 neonatal intensive care units in the Vermont Oxford Network.

Oscillometry reference values for children and adolescents.

Background: Oscillometry devices allow quantification of respiratory function at tidal breathing but device-specific reference equations are scarce: the present study aims to create sex-specific oscillometric reference values for children and adolescents using the Resmon PRO FULL device.

Methods: Healthy participants (n=981) aged 6 to 17 years of the Austrian LEAD general population cohort were included. Subjects had normal weight (body mass index ≤99th percentile) and normal lung volumes (total lung capacity (TLC) ≥ lower limit of normal).

Gut microbiota profiling in injection drug users with and without HIV-1 infection in Puerto Rico.

Introduction: The full extent of interactions between human immunodeficiency virus (HIV) infection, injection drug use, and the human microbiome is unclear. In this study, we examined the microbiomes of HIV-positive and HIV-negative individuals, both drug-injecting and non-injecting, to identify bacterial community changes in response to HIV and drug use. We utilized a well-established cohort of people who inject drugs in Puerto Rico, a region with historically high levels of injection drug use and an HIV incidence rate disproportionately associated with drug use.

Development of a psychometrically valid and reliable measure of primary care providers' willingness to engage with value based payments and innovations in care coordination.

Background: Most approaches to healthcare reform envision an enhanced role for primary care providers, supported by innovative payment methodology and improved resources. However, there are currently no instruments to measure providers' ability and willingness to work with existing tools provided by payers, such as Accountable Care Organizations (ACO). In this study, we develop and psychometrically test a new instrument to measure provider engagement with ACOs.

Comparing Medical Record Abstraction (MRA) error rates in an observational study to pooled rates identified in the data quality literature.

Background: Medical record abstraction (MRA) is a commonly used method for data collection in clinical research, but is prone to error, and the influence of quality control (QC) measures is seldom and inconsistently assessed during the course of a study. We employed a novel, standardized MRA-QC framework as part of an ongoing observational study in an effort to control MRA error rates. In order to assess the effectiveness of our framework, we compared our error rates against traditional MRA studies that had not reported using formalized MRA-QC methods.

Effect of nonsteroidal anti-inflammatory drugs on neonatal calf diarrhea when administered at a disease alert generated by automated milk feeders.

The objective of this randomized clinical trial was to assess whether early intervention with a nonsteroidal anti-inflammatory drug (NSAID) following a disease alert generated by automated milk feeders could reduce diarrhea severity and improve performance in dairy calves. Seventy-one Holstein calves were enrolled on an automated milk feeder (recorded milk intake and drinking speed) at 3 d of age and received up to 15 L/d (150 g/L) of milk replacer until 35 d of age. An alert that was previously validated as diagnostically accurate to identify calves at risk for diarrhea was used using automated milk feeder data (≤60% rolling dividends in milk intake and/or drinking speed over 2 d).

Staphylococci and mammaliicocci: which species are important for udder health on organic dairy farms?

Variation in species distribution and diversity of staphylococci and mammaliicocci (SaM) causing intramammary infections in dairy cattle is associated with different management practices. Disparate selective pressures on organic dairies could potentially result in population differences of these mastitis-causing bacteria. The species-specific effect on quarter somatic cell count of SaM for a population of certified organic dairies has not been described previously.

Abemaciclib Plus Fulvestrant in Advanced Breast Cancer Following Progression on CDK4/6 Inhibition: Results from the Phase III postMONARCH Trial.

Purpose: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) combined with endocrine therapy (ET) are the standard first-line treatment for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC); however, disease progression occurs in almost all patients and additional treatment options are needed. Herein we report outcomes of the postMONARCH trial investigating a switch in ET with/without CDK4/6 inhibition with abemaciclib after disease progression on CDK4/6i.

Methods: This double-blind, randomized Phase III study enrolled patients with disease progression on prior CDK4/6i plus aromatase inhibitor as initial therapy for advanced disease or recurrence on/after adjuvant CDK4/6i+ET.

Characteristics of Climbers with High Altitude Pulmonary Edema on Mount Aconcagua.

Introduction—: Mount Aconcagua (6961 m) in Argentina is the highest peak in the Americas, and more than 3000 climbers attempt to summit annually. High altitude pulmonary edema (HAPE) is a leading cause of mortality and evacuation on Aconcagua.

Objective—: This study sought to describe the characteristics of climbers who developed HAPE on Aconcagua to aid in future prevention efforts.

White matter free water mediates the associations between placental growth factor, white matter hyperintensities, and cognitive status.

Introduction: Placental growth factor (PlGF) may regulate cerebrovascular permeability. We hypothesized that white matter interstitial fluid accumulation, estimated via magnetic resonance imaging (MRI) free water (FW), would explain the associations between elevated PlGF, white matter hyperintensities (WMH), and cognitive impairment.

Methods: MarkVCID consortium participants ≥55 years old with plasma PlGF and brain MRI were included.

Clustering of care activities for promoting development and preventing morbidity in hospitalized preterm infants.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of clustering of care activities for promoting development and preventing morbidity in preterm infants.

Personalized Accelerated Physiologic Dual Rate Pacing for Cardiac Amyloidosis.

A 78-year-old man with cardiac amyloidosis developed sinus bradycardia with symptomatic hypotension. Three months after receiving an advanced biventricular pacemaker system with continuous accelerated rate pacing (daytime: 70 beats/min; nighttime: 90 beats/min), his health status and symptoms were markedly improved.

Efficient simulations of Hartree-Fock equations by an accelerated gradient descent method.

We develop convergence acceleration procedures that enable a gradient descent-type iteration method to efficiently simulate Hartree-Fock equations for many particles interacting both with each other and with an external potential. Our development focuses on three aspects: (i) optimization of a parameter in the preconditioning operator; (ii) adoption of a technique that eliminates the slowest-decaying mode to the case of many equations (describing many particles); and (iii) a novel extension of the above technique that allows one to eliminate multiple modes simultaneously. We illustrate performance of the numerical method for the two-dimensional model of the first layer of helium atoms above a graphene sheet.

Tree drought physiology: critical research questions and strategies for mitigating climate change effects on forests.

Droughts of increasing severity and frequency are a primary cause of forest mortality associated with climate change. Yet, fundamental knowledge gaps regarding the complex physiology of trees limit the development of more effective management strategies to mitigate drought effects on forests. Here, we highlight some of the basic research needed to better understand tree drought physiology and how new technologies and interdisciplinary approaches can be used to address them.