Impact of a Geriatric and Palliative Medicine Clerkship on Knowledge and Attitudes about End-Of-Life Care

Previous interventions of students and residents suggest that those which employ patient encounters increases attitude towards end-of-life care and performance on a palliative care knowledge examination, but those studies did not include geriatric preceptors. From a population of third-year medical students, the researcher surveyed attitudes and tested knowledge before and after a combined geriatric and palliative clerkship to determine the impact on these outcomes and if there were any differences among the preceptor or the clinical site. After the rotation, students’ perceptions of the importance that medical students learn about how to care for dying patients of resident and attending physicians increased from 77.5% to 89.6% (p <0.001) and 87.4% to 92.9% (p = 0.001) respectively. More students agreed that physicians have a responsibility to provide bereavement care (p < 0.001) and that depression is treatable among patients with terminal illness (p = 0.017). More students disagreed that they dread having to tell patients the truth about a terminal prognosis and still maintain hope (p = 0.003), that caring for dying patients is depressing (p < 0.001), and that they feel guilty after a death (p <0.001). Test scores increased from a mean of 59.8% to 70.4% (p < 0.001). There were no differences in attitude or knowledge among the preceptors or clinical sites. This rotation was associated with an increase in attitudes and knowledge regardless of the preceptor or clinical site. Results indicated that palliative educational programs should receive more institutional support to better prepare future physicians.Curriculum and Instruction, Department o

UIT-Saviors at MEDVQA-GI 2023: Improving Multimodal Learning with Image Enhancement for Gastrointestinal Visual Question Answering

In recent years, artificial intelligence has played an important role in medicine and disease diagnosis, with many applications to be mentioned, one of which is Medical Visual Question Answering (MedVQA). By combining computer vision and natural language processing, MedVQA systems can assist experts in extracting relevant information from medical image based on a given question and providing precise diagnostic answers. The ImageCLEFmed-MEDVQA-GI-2023 challenge carried out visual question answering task in the gastrointestinal domain, which includes gastroscopy and colonoscopy images. Our team approached Task 1 of the challenge by proposing a multimodal learning method with image enhancement to improve the VQA performance on gastrointestinal images. The multimodal architecture is set up with BERT encoder and different pre-trained vision models based on convolutional neural network (CNN) and Transformer architecture for features extraction from question and endoscopy image. The result of this study highlights the dominance of Transformer-based vision models over the CNNs and demonstrates the effectiveness of the image enhancement process, with six out of the eight vision models achieving better F1-Score. Our best method, which takes advantages of BERT+BEiT fusion and image enhancement, achieves up to 87.25% accuracy and 91.85% F1-Score on the development test set, while also producing good result on the private test set with accuracy of 82.01%.Comment: ImageCLEF2023 published version: https://ceur-ws.org/Vol-3497/paper-129.pd

Tumor Growth Enhances Cross-Presentation Leading to Limited T Cell Activation without Tolerance

Using a tumor model of spontaneously arising insulinomas expressing a defined tumor-associated antigen, we investigated whether tumor growth promotes cross-presentation and tolerance of tumor-specific T cells. We found that an advanced tumor burden enhanced cross-presentation of tumor-associated antigens to high avidity tumor-specific T cells, inducing T cell proliferation and limited effector function in vivo. However, contrary to other models, tumor-specific T cells were not tolerized despite a high tumor burden. In fact, in tumor-bearing mice, persistence and responsiveness of adoptively transferred tumor-specific T cells were enhanced. Accordingly, a potent T cell–mediated antitumor response could be elicited by intravenous administration of tumor-derived peptide and agonistic anti-CD40 antibody or viral immunization and reimmunization. Thus, in this model, tumor growth promotes activation of high avidity tumor-specific T cells instead of tolerance. Therefore, the host remains responsive to T cell immunotherapy

Prophylactic and Therapeutic Efficacy of Avian Antibodies against Influenza Virus H5N1 and H1N1 in Mice

Background: Pandemic influenza poses a serious threat to global health and the world economy. While vaccines are currently under development, passive immunization could offer an alternative strategy to prevent and treat influenza virus infection. Attempts to develop monoclonal antibodies (mAbs) have been made. However, passive immunization based on mAbs may require a cocktail of mAbs with broader specificity in order to provide full protection since mAbs are generally specific for single epitopes. Chicken immunoglobulins (IgY) found in egg yolk have been used mainly for treatment of infectious diseases of the gastrointestinal tract. Because the recent epidemic of highly pathogenic avian influenza virus (HPAIV) strain H5N1 has resulted in serious economic losses to the poultry industry, many countries including Vietnam have introduced mass vaccination of poultry with H5N1 virus vaccines. We reasoned that IgY from consumable eggs available in supermarkets in Vietnam could provide protection against infections with HPAIV H5N1. Methods and Findings: We found that H5N1-specific IgY that are prepared from eggs available in supermarkets in Vietnam by a rapid and simple water dilution method cross-protect against infections with HPAIV H5N1 and related H5N2 strains in mice. When administered intranasally before or after lethal infection, the IgY prevent the infection or significantly reduce viral replication resulting in complete recovery from the disease, respectively. We further generated H1N1 virus-specific IgY by immunization of hens with inactivated H1N1 A/PR/8/34 as a model virus for the current pandemic H1N1/09 and found that such H1N1-specific IgY protect mice from lethal influenza virus infection. Conclusions: The findings suggest that readily available H5N1-specific IgY offer an enormous source of valuable biological material to combat a potential H5N1 pandemic. In addition, our study provides a proof-of-concept for the approach using virus-specific IgY as affordable, safe, and effective alternative for the control of influenza outbreaks, including the current H1N1 pandemic

Primary Care Physicians’ Experiences With and Adaptations to Time Constraints

Importance The primary care workforce shortage is significant and persistent, with organizational and policy leaders urgently seeking interventions to enhance retention and recruitment. Time constraints are a valuable focus for action; however, designing effective interventions requires deeper understanding of how time constraints shape employees’ experiences and outcomes of work. Objective To examine how time constraints affect primary care physicians’ work experiences and careers. Design, Setting, and Participants Between May 1, 2021, and September 31, 2022, US-based primary care physicians who trained in family or internal medicine were interviewed. Using qualitative analysis of in-depth interviews, this study examined how participants experience and adapt to time constraints during a typical clinic day, taking account of their professional and personal responsibilities. It also incorporates physicians’ reflections on implications for their careers. Main Outcomes and Measures Thematic analysis of in-depth interviews and a measure of well-being (American Medical Association Mini-Z survey). Results Interviews with 25 primary care physicians (14 [56%] female and 11 [44%] male; median [range] age, 43 [34-63] years) practicing in 11 US states were analyzed. Two physicians owned their own practice, whereas the rest worked as employees. The participants represented a wide range of years in practice (range, 1 to ≥21), with 11 participants (44%) in their first 5 years. Physicians described that the structure of their work hours did not match the work that was expected of them. This structural mismatch between time allocation and work expectations created a constant experience of time scarcity. Physicians described having to make tradeoffs between maintaining high-quality patient care and having their work overflow into their personal lives. These experiences led to feelings of guilt, disillusionment, and dissatisfaction. To attempt to sustain long-term careers in primary care, many sought ways to see fewer patients. Conclusions and Relevance These findings suggest that organizational leaders must align schedules with work expectations for primary care physicians to mitigate physicians’ withdrawal from work as a coping mechanism. Specific strategies are needed to achieve this realignment, including incorporating more slack into schedules and establishing realistic work expectations for physicians

Associations of Underlying Health Conditions With Anxiety and Depression Among Outpatients: Modification Effects of Suspected COVID-19 Symptoms, Health-Related and Preventive Behaviors

Objectives: We explored the association of underlying health conditions (UHC) with depression and anxiety, and examined the modification effects of suspected COVID-19 symptoms (S-COVID-19-S), health-related behaviors (HB), and preventive behaviors (PB).Methods: A cross-sectional study was conducted on 8,291 outpatients aged 18–85 years, in 18 hospitals and health centers across Vietnam from 14th February to May 31, 2020. We collected the data regarding participant's characteristics, UHC, HB, PB, depression, and anxiety.Results: People with UHC had higher odds of depression (OR = 2.11; p &lt; 0.001) and anxiety (OR = 2.86; p &lt; 0.001) than those without UHC. The odds of depression and anxiety were significantly higher for those with UHC and S-COVID-19-S (p &lt; 0.001); and were significantly lower for those had UHC and interacted with “unchanged/more” physical activity (p &lt; 0.001), or “unchanged/more” drinking (p &lt; 0.001 for only anxiety), or “unchanged/healthier” eating (p &lt; 0.001), and high PB score (p &lt; 0.001), as compared to those without UHC and without S-COVID-19-S, “never/stopped/less” physical activity, drinking, “less healthy” eating, and low PB score, respectively.Conclusion: S-COVID-19-S worsen psychological health in patients with UHC. Physical activity, drinking, healthier eating, and high PB score were protective factors

Diurnal variability of atmospheric O-2, CO2, and their exchange ratio above a boreal forest in southern Finland

The exchange ratio (ER) between atmospheric O(2 )and CO2 is a useful tracer for better understanding the carbon budget on global and local scales. The variability of ER (in mol O(2 )per mol CO2) between terrestrial ecosystems is not well known, and there is no consensus on how to derive the ER signal of an ecosystem, as there are different approaches available, either based on concentration (ERatmos) or flux measurements (ERforest). In this study we measured atmospheric O-2 and CO2 concentrations at two heights (23 and 125 m) above the boreal forest in Hyytiala, Finland. Such measurements of O-2 are unique and enable us to potentially identify which forest carbon loss and production mechanisms dominate over various hours of the day. We found that the ERatmos signal at 23 m not only represents the diurnal cycle of the forest exchange but also includes other factors, including entrainment of air masses in the atmospheric boundary layer before midday, with different thermodynamic and atmospheric composition characteristics. To derive ERforest, we infer O(2 )fluxes using multiple theoretical and observation-based micro-meteorological formulations to determine the most suitable approach. Our resulting ERforest shows a distinct difference in behaviour between daytime (0.92 +/- 0.17 mol mol(-1)) and nighttime (1.03 +/- 0.05 mol mol(-1)). These insights demonstrate the diurnal variability of different ER signals above a boreal forest, and we also confirmed that the signals of ERatmos and ERforest cannot be used interchangeably. Therefore, we recommend measurements on multiple vertical levels to derive O-2 and CO2 fluxes for the ERforest signal instead of a single level time series of the concentrations for the ERatmos signal. We show that ERforest can be further split into specific signals for respiration (1.03 +/-; 0.05 mol mol-1) and photosynthesis (0.96 +/- 0.12 molmol(-1)). This estimation allows us to separate the net ecosystem exchange (NEE) into gross primary production (GPP) and total ecosystem respiration (TER), giving comparable results to the more commonly used eddy covariance approach. Our study shows the potential of using atmospheric O-2 as an alternative and complementary method to gain new insights into the different CO2 signals that contribute to the forest carbon budget.Peer reviewe