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The Neurohospitalist Core Competencies comprise a set of competency-based learning objectives that encapsulate the knowledge, skills, and attitudes of neurohospitalitists who specialize in the care of hospitalized patients with neurologic conditions. These competencies serve to characterize the rapidly expanding field of neurohospitalist medicine. The 27 chapters are divided into 3 sections entitled: neurological conditions, clinical interventions and interpretation of ancillary studies, and neurohospitalist role in the healthcare system. Each individual learning objective in the chapters describes a specific concept with an action verb to illustrate the behavior that the neurohospitalist exhibits. The individual neurohospitalist may not exhibit mastery in each of the topics included as individual practices vary in scope and practice pattern. A few examples of how the complete set of competencies may be used include in the creation of curricula for neurohospitalist fellowships, to assist in defining the scope of practice of neurohospitalists for administrative leaders of hospitals and departments, and in influencing the direction of further research and quality improvement in the field.

ImportanceWomen account for only 28% of current US medical school deans. Studying the differences between women and men in their preparation to becoming deans might help to explain this discrepancy.ObjectiveTo identify differences in the leadership development experiences between women and men in their ascent to the medical school deanship.Design, setting, and participantsIn this qualitative study, volunteers from the roster of the Association of American Medical Colleges Council of Deans were solicited and interviewed from June 15 to November 9, 2023. Women deans were recruited first, then men who had been appointed to their deanships at a similar time to their women counterparts were recruited. Deans were interviewed on topics related to number of applications for deanships, prior leadership roles, leadership development, personal factors, and career trajectories. Interviews were coded, and themes were extracted through conventional content analysis.Main outcome and measuresCareer and leadership development experiences were elicited using a semistructured interview guide.ResultsWe interviewed 17 women and 17 men deans, representing 25.8% (34 of 132) of the total population of US medical school deans. Most deans (23 [67.6%]) practiced a medicine-based specialty or subspecialty. No statistically significant differences were found between women and men with regard to years to attain deanship (mean [SD], 2.7 [3.4] vs 3.7 [3.7] years), years as a dean (mean [SD], 5.7 [5.2] vs 6.0 [5.0] years), highest salary during career (mean [SD], $525 769 [$199 936] vs $416 923 [$195 848]), or medical school rankings (mean [SD], 315.5 [394.5] vs 480.5 [448.9]). Their reports indicated substantive gender differences in their paths to becoming a dean. Compared with men, women deans reported having to work harder to advance, while receiving less support and opportunities for leadership positions by their own institutions. Subsequently, women sought leadership development from external programs. Women deans also experienced gender bias when working with search firms.Conclusions and relevanceThis qualitative study of US medical school deans found that compared with men, women needed to be more proactive, had to participate in external leadership development programs, and had to confront biases during the search process. For rising women leaders, this lack of support had consequences, such as burnout and attrition, potentially affecting the makeup of future generations of medical school deans. Institutional initiatives centering on leadership development of women is needed to mitigate the gender biases and barriers faced by aspiring women leaders.

INTRODUCTION: This article provides an overview of presentations and discussions from the inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium. METHODS: The symposium brought together esteemed experts from various disciplines to explore models for translating evidence-based interventions into practice. RESULTS: The symposium highlighted the importance of disruptive innovation in healthcare, the need for multi-stakeholder engagement, and the significance of family and community involvement in healthcare interventions. CONCLUSIONS: The article concluded with a call to action for advancing healthcare delivery science to achieve health equity.

During the pandemic, many older adults felt out of place in their home, work, and community spaces with potentially long-term consequences for health and wellbeing. Using national data from the COVID-19 Coping Study, thematic analysis of online long-answer responses (n = 1171; mean age 68 years; 71% female; 93% non-Hispanic White; 86% with at least a 4-year college degree; data collected April-June 2022) identified four themes regarding why particular places are challenging since the pandemic onset: (1) viral exposure fears, (2) frustrating regulations, (3) uncomfortable and hostile social dynamics, and (4) out of place negative emotions. Participants also shared how they continuously address or adapt to place-based challenges through lifestyle adjustments and coping strategies. Novel findings may inform multi-scalar policymaking and interventions to support wellbeing in later life in times of stress and instability.

Whitebark pine (WBP, Pinus albicaulis) is a white pine of subalpine regions in the Western contiguous United States and Canada. WBP has become critically threatened throughout a significant part of its natural range due to mortality from the introduced fungal pathogen white pine blister rust (WPBR, Cronartium ribicola) and additional threats from mountain pine beetle (Dendroctonus ponderosae), wildfire, and maladaptation due to changing climate. Vast acreages of WBP have suffered nearly complete mortality. Genomic technologies can contribute to a faster, more cost-effective approach to the traditional practices of identifying disease-resistant, climate-adapted seed sources for restoration. With deep-coverage Illumina short reads of haploid megagametophyte tissue and Oxford Nanopore long reads of diploid needle tissue, followed by a hybrid, multistep assembly approach, we produced a final assembly containing 27.6 Gb of sequence in 92,740 contigs (N50 537,007 bp) and 34,716 scaffolds (N50 2.0 Gb). Approximately 87.2% (24.0 Gb) of total sequence was placed on the 12 WBP chromosomes. Annotation yielded 25,362 protein-coding genes, and over 77% of the genome was characterized as repeats. WBP has demonstrated the greatest variation in resistance to WPBR among the North American white pines. Candidate genes for quantitative resistance include disease resistance genes known as nucleotide-binding leucine-rich repeat receptors (NLRs). A combination of protein domain alignments and direct genome scanning was employed to fully describe the 3 subclasses of NLRs. Our high-quality reference sequence and annotation provide a marked improvement in NLR identification compared to previous assessments that leveraged de novo-assembled transcriptomes.

We use the Survey of Thermodynamic Processes and First and Second Laws-Long, a research-based survey instrument with 78 items at the level of introductory physics, to investigate introductory and advanced students' difficulties with internal energy, work, and heat transfer. We present analysis of data from 12 different introductory and advanced physics classes at four different higher education public institutions in the U.S. in which the survey was administered in person to more than 1000 students. We find that not only introductory but also advanced physics students have many common difficulties with these introductory thermodynamic concepts after traditional lecture-based instruction in relevant concepts. We utilize a wide variety of problem types and contexts and our sample includes large numbers of introductory algebra-based, calculus-based, and advanced students. Some of our findings are consistent with prior research in this area, but others expand upon them and reveal previously unreported aspects of students' thinking. Findings related to common difficulties of students before and after traditional lecture-based instruction in college physics courses can help instructors of these courses plan instruction and curricula to improve student understanding. These findings can also be valuable for developing effective research-based curricula and pedagogies to address student difficulties and help students develop a functional understanding of these fundamental thermodynamic concepts.

During sentence processing, comprehenders have to maintain a mapping between lexical items and their position in the sentence (syntactic position). We propose a model of morpheme-position binding in working memory, based on models such as 'serial-order-in-a-box' and its SOB-complex-span version. Like those working memory models, our sentence processing version derives a range of attested memory interference effects from the process of item-position binding. We present simulation results capturing similarity-based interference and item-distortion. These two major classes of interference effects have not received a unified account before, and are not fully captured by cue-based retrieval models.

INTRODUCTION: Access to primary care has been a long-standing priority for improving population health. Asian Americans, who often settle in ethnic enclaves, have been found to underutilize health care. Understanding geographic primary care accessibility within Asian American enclaves can help to ensure the long-term health of this fast-growing population. METHODS: U.S. Census data from five states (California, Florida, New Jersey, New York, and Texas) were used to develop and describe census-tract level measures of Asian American enclaves and social and built environment characteristics for years 2000 and 2010. The 2-step floating catchment area method was applied to National Provider Identifier data to develop a tract-level measure of geographic primary care accessibility. Analyses were conducted in 2022-2023, and associations between enclaves (versus nonenclaves) and geographic primary care accessibility were evaluated using multivariable Poisson regression with robust variance estimation, adjusting for potential area-level confounders. RESULTS: Of 24,482 census tracts, 26.1% were classified as Asian American enclaves. Asian American enclaves were more likely to be metropolitan and have less poverty, lower crime, and lower proportions of uninsured individuals than nonenclaves. Asian American enclaves had higher primary care accessibility than nonenclaves (adjusted prevalence ratio=1.23, 95% CI=1.17, 1.29). CONCLUSIONS: Asian American enclaves in five of the most diverse and populous states in the U.S. had fewer markers of disadvantage and greater geographic primary care accessibility. This study contributes to the growing body of research elucidating the constellation of social and built environment features within Asian American enclaves and provides evidence of health-promoting characteristics of these neighborhoods.

BackgroundThere is a need to assess neighborhood-level factors driving COVID-19 disparities across racial and ethnic groups.ObjectiveTo use census tract-level data to investigate neighborhood-level factors contributing to racial and ethnic group-specific COVID-19 case rates in California.DesignQuasi-Poisson generalized linear models were used to identify neighborhood-level factors associated with COVID-19 cases. In separate sequential models for Hispanic, Black, and Asian, we characterized the associations between neighborhood factors on neighborhood COVID-19 cases. Subanalyses were conducted on neighborhoods with majority Hispanic, Black, and Asian residents to identify factors that might be unique to these neighborhoods. Geographically weighted regression using a quasi-Poisson model was conducted to identify regional differences.Main measuresAll COVID-19 cases and tests reported through January 31, 2021, to the California Department of Public Health. Neighborhood-level data from census tracts were obtained from American Community Survey 5-year estimates (2015-2019), United States Census (2010), and United States Department of Housing and Urban Development.Key resultsThe neighborhood factors associated with COVID-19 case rate were racial and ethnic composition, age, limited English proficiency (LEP), income, household size, and population density. LEP had the largest influence on the positive association between proportion of Hispanic residents and COVID-19 cases (- 2.1% change). This was also true for proportion of Asian residents (- 1.8% change), but not for the proportion of Black residents (- 0.1% change). The influence of LEP was strongest in areas of the Bay Area, Los Angeles, and San Diego.ConclusionNeighborhood-level contextual drivers of COVID-19 burden differ across racial and ethnic groups.

Current single-cell RNA-sequencing approaches have limitations that stem from the microfluidic devices or fluid handling steps required for sample processing. We develop a method that does not require specialized microfluidic devices, expertise or hardware. Our approach is based on particle-templated emulsification, which allows single-cell encapsulation and barcoding of cDNA in uniform droplet emulsions with only a vortexer. Particle-templated instant partition sequencing (PIP-seq) accommodates a wide range of emulsification formats, including microwell plates and large-volume conical tubes, enabling thousands of samples or millions of cells to be processed in minutes. We demonstrate that PIP-seq produces high-purity transcriptomes in mouse-human mixing studies, is compatible with multiomics measurements and can accurately characterize cell types in human breast tissue compared to a commercial microfluidic platform. Single-cell transcriptional profiling of mixed phenotype acute leukemia using PIP-seq reveals the emergence of heterogeneity within chemotherapy-resistant cell subsets that were hidden by standard immunophenotyping. PIP-seq is a simple, flexible and scalable next-generation workflow that extends single-cell sequencing to new applications.

Heather L Gill, Jeffrey J Siracuse, In-Kyong Parrack, Zhen S Huang, Andrew J Meltzer Division of Vascular and Endovascular Surgery, Weill Cornell Medical College, New York, NY, USA Abstract: Acute ischemic stroke is a significant source of morbidity and mortality across the globe. Currently, the only US Food and Drug Administration approved medical treatment of acute ischemic stroke is intravascular (IV) alteplase. While IV thrombolysis has been shown to decrease morbidity and mortality from acute ischemic stroke, it is limited in both its efficacy in certain types of stroke, as well as in its generalizability. It has been shown that time to revascularization is one of the most important predictors of outcomes in acute ischemic stroke, and thus clinicians have turned to endovascular options in efforts to improve outcomes from stroke. Direct intra-arterial thrombolysis was one of the first of such efforts to improve efficacy rates and increase the timeline for thrombolytic therapy. More recently, investigators and clinicians have turned to newer endovascular options in attempts to further improve recanalization rates. Many different endovascular techniques have been employed and are growing exponentially in use. Examples include stenting, as well as mechanical thrombectomy with both older-generation devices and newer stent retrieval technology. While the majority of the literature focuses on the effectiveness of different techniques, such as recanalization rates and major overall outcomes such as death and disability, there is very little literature on the complications of the different techniques. The purpose of this article is to review the different forms of endovascular treatment of acute ischemic stroke and their associated complications. Keywords: alteplase, endovascular techniques, revascularization

Jeffrey J Siracuse, Zhen S Huang, Heather L Gill, Inkyong Parrack, Darren B Schneider, Peter H Connolly, Andrew J MeltzerDivision of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USAAbstract: Successful treatment of patients with critical limb ischemia (CLI), hinges on the adequacy of revascularization. However, CLI is associated with a severe burden of systemic atherosclerosis, and patients often suffer from multiple cardiovascular comorbidities. Therefore, CLI patients in general represent a cohort at increased risk for procedural complications and adverse events. Although endovascular therapy represents a minimally invasive alternative to open surgical bypass, the durability of surgical reconstruction is superior, and it remains the “gold standard” approach to revascularization in CLI. Therefore, selection of the optimal treatment modality for individual patients requires careful consideration of the procedural risks and likelihood of adverse events associated with surgery. Individualized decision-making with regard to revascularization strategy requires a comprehensive understanding of the likelihood of adverse outcomes after major surgery. Here we review the risks of surgical bypass in patients with CLI, with particular emphasis on the identification of preoperative variables that predict poor outcome.Keywords: critical limb ischemia, bypass, adverse events

The overall aim of this paper was to provide background knowledge to the Nordic Nutrition Recommendations 2023 Committee for integrating environmental sustainability in a framework for national Food-Based Dietary Guidelines (FBDG) within the Nordics and Baltics. Additionally, this paper aims to give an overview of recent Nordic scientific literature on environmental impact of foods and dietary patterns and of the FBDG of the Nordics. Finally, we suggest methods for developing national sustainable FBDG. Nordic and Baltic studies on sustainability of diets were searched in August 2022 and complemented with additional relevant literature. The studies show that current diets are far from environmentally sustainable, exceeding planetary boundaries for most impact categories; meat and dairy products being the largest contributors to dietary greenhouse gas emissions (GHGEs) and land use. Scenario, modelling, optimisation and intervention studies confirm the potential of shifting towards more plant-based diets to improve overall diet quality in terms of both health and environmental sustainability. Such diets comprised of vegetables, fruits, legumes, potatoes, whole grain and refined cereal products, nuts, seeds and vegetable oils, with animal foods in moderate or limited amounts. The FBDG in the Nordics promotes more plant-based diets than the current average diet but could improve from further integration of environmental sustainability. To form basis for sustainable FBDG dietary modelling at the national level, prioritising health outcomes and nutritional adequacy is essential. Second, integrating environmental sustainability involves estimating the impact of food choices and amounts on GHGE, land and water use, eutrophication and biodiversity loss. Exploring positive and negative implications of fortified foods and supplementation in relation to nutrient intake, health and environmental sustainability may be needed. Implementing dietary transition requires solutions beyond FBDG to ensure affordability, acceptability and ease of adaption.

Abstract Case investigation and contact tracing (CICT) are public health measures that aim to break the chain of pathogen transmission. Changes in viral characteristics of COVID-19 variants have likely affected the effectiveness of CICT programs. We estimated and compared the cases averted in Vermont when the original COVID-19 strain circulated (Nov. 25, 2020–Jan. 19, 2021) with two periods when the Delta strain dominated (Aug. 1–Sept. 25, 2021, and Sept. 26–Nov. 20, 2021). When the original strain circulated, we estimated that CICT prevented 7180 cases (55% reduction in disease burden), compared to 1437 (15% reduction) and 9970 cases (40% reduction) when the Delta strain circulated. Despite the Delta variant being more infectious and having a shorter latency period, CICT remained an effective tool to slow spread of COVID-19; while these viral characteristics did diminish CICT effectiveness, non-viral characteristics had a much greater impact on CICT effectiveness.

Abstract This study introduces StreetTalk, an original qualitative research methodology inspired by social media influencers, to investigate perceptions and experiences of energy insecurity among New York City (NYC) residents. Briefly, energy insecurity is defined as difficulty meeting household energy needs due to affordability, housing quality, outages and coping strategies. This present study employs dynamic short-form interviews with 34 participants from all five NYC boroughs of diverse economic, and racial/ethnic backgrounds. Thematic analysis of video-recorded interviews revealed six major energy insecurity-related categories: (1) conservation and trade-offs, (2) physical inefficiencies, (3) thermal agency, (4) response to the bill, (5) disappointment and distrust in energy-related authorities, and (6) desire for and barriers to clean energy adoption. These themes provide insight into NYC residents’ experiences with energy insecurity and are consistent with prior research. Beyond new scholarly insights, this study introduces StreetTalk, an innovative qualitative research methodology emphasizing rapid data collection and dissemination through social media platforms, including TikTok, Instagram, Facebook, and YouTube (@hotandcold_nyc). Taking advantage of modern technology and modes of communication, the research team was able to effectively break down barriers to academic research consumption as the videos achieved substantial engagement, with almost 200,000 views and impressions within the first year of launching this novel street-based data collection and social media dissemination campaign.

Abstract The COVID-19 pandemic brought forth an urgent need for widespread genomic surveillance for rapid detection and monitoring of emerging SARS-CoV-2 variants. It necessitated design, development, and deployment of a nationwide infrastructure designed for sequestration, consolidation, and characterization of patient samples that disseminates de-identified information to public authorities in tight turnaround times. Here, we describe our development of such an infrastructure, which sequenced 594,832 high coverage SARS-CoV-2 genomes from isolates we collected in the United States (U.S.) from March 13th 2020 to July 3rd 2023. Our sequencing protocol (‘Virseq’) utilizes wet and dry lab procedures to generate mutation-resistant sequencing of the entire SARS-CoV-2 genome, capturing all major lineages. We also characterize 379 clinically relevant SARS-CoV-2 multi-strain co-infections and ensure robust detection of emerging lineages via simulation. The modular infrastructure, sequencing, and analysis capabilities we describe support the U.S. Centers for Disease Control and Prevention national surveillance program and serve as a model for rapid response to emerging pandemics at a national scale.

We use the Survey of Thermodynamic Processes and First and Second Laws-Long (STPFaSL-Long), a research-based survey instrument with 78 items at the level of introductory physics, to investigate introductory and advanced students' difficulties with entropy and the second law of thermodynamics. We present an analysis of data from 12 different introductory and advanced physics classes at four different higher education public institutions in the United States in which the survey was administered in person to more than 1000 students. We find that a widespread unproductive tendency for introductory students to associate the properties of entropy with those of energy leads to many errors based on an idea of "conservation of entropy," in which entropy increases are "always" balanced by equal entropy decreases. For many of the more advanced students (calculus based and upper level), we detect a tendency to expect entropy increases even in processes in which the entropy does not change. We observed a widespread failure to correctly apply the relationship [delta]"S"="Q"[subscript reversible]"/T," either by using it for "irreversible" processes to which it does not apply or by applying it incorrectly or completely neglecting it in reversible processes to which it does apply. We also noted that many introductory students are simply not aware that total entropy must increase in any "spontaneous" heat transfer process. Students at all levels were very frequently found to be confused that while net entropy (system+reservoir) in reversible isothermal processes does not change, the entropy of the working substance itself does indeed increase or decrease depending on whether the process is an expansion or compression. Our findings are broadly consistent with prior research findings in this area, expanding upon them and revealing previously unreported aspects of students' thinking. Moreover, our results reflect several new problem contexts in addition to those reported in prior research, and our sample population includes large numbers of both introductory and advanced students. Our detailed findings related to common student difficulties with entropy and the second law of thermodynamics before and after traditional instruction in college physics courses can potentially help instructors of these courses improve student understanding of these concepts. These findings can also be valuable for developing effective research-based curricula and pedagogies to reduce student difficulties and help students develop a solid grasp of these fundamental thermodynamic concepts.

We evaluated the diagnostic yield using genome-slice panel reanalysis in the clinical setting using an automated phenotype/gene ranking system. We analyzed whole genome sequencing (WGS) data produced from clinically ordered panels built as bioinformatic slices for 16 clinically diverse, undiagnosed cases referred to the Pediatric Mendelian Genomics Research Center, an NHGRI-funded GREGoR Consortium site. Genome-wide reanalysis was performed using Moon™, a machine-learning-based tool for variant prioritization. In five out of 16 cases, we discovered a potentially clinically significant variant. In four of these cases, the variant was found in a gene not included in the original panel due to phenotypic expansion of a disorder or incomplete initial phenotyping of the patient. In the fifth case, the gene containing the variant was included in the original panel, but being a complex structural rearrangement with intronic breakpoints outside the clinically analyzed regions, it was not initially identified. Automated genome-wide reanalysis of clinical WGS data generated during targeted panels testing yielded a 25% increase in diagnostic findings and a possibly clinically relevant finding in one additional case, underscoring the added value of analyses versus those routinely performed in the clinical setting.