bluuebunny/crossref_metadata_2025_split huggingface dataset:
Climate Change Curriculum in a Network of US Family Medicine Residency Programs
Authors: Robohm Jennifer S. , Shih Grace , Stenger Robert 
Published: December 2024

Background Physicians require climate-related training, but not enough is known about actual or desired training at the graduate medical education level.
Objective To quantify the climate curriculum provided within a network of family medicine residency programs in the Northwestern United States, to assess barriers to adoption of climate curricula, and to identify preferred climate-related content, delivery methods, and program actions.
Methods In fall 2021, residents and faculty in a family medicine residency network responded to a 25-item, anonymous, online survey about climate-related training within their programs. Likert scales were used to assess the extent of current and desired climate curricula in respondent programs, and a paired samples t test was used to compare them. Drop-down menus and frequencies were used to identify top barriers to integration of a climate curriculum, and preferred curricular content, delivery methods, and program actions.
Results Responses were received from 19.3% (246 of 1275) of potential respondents. Nearly ninety percent (215 of 240) reported little or no climate content in their programs. Respondents desired significantly more climate-related training (t[237]=18.17; P&lt;.001; Cohen’s d=1.18) but identified several barriers, including insufficient time/competing curricular priorities (80.7%, 192 of 238), concern about the political/controversial nature of the topic (27.3%, 65 of 238), and perceived irrelevance (10.9%, 26 of 238). More respondents selected integration of climate content throughout relevant didactics (62.2%, 145 of 233) than other delivery methods. Over 42% of respondents selected each of the climate-related topics and program actions suggested.
Conclusions Despite a number of barriers, most family medicine faculty and residents desire significantly more climate-related content in their training curricula.
Feasibility and Acceptability of a Virtual Reality Curriculum to Support Firearm Safety Counseling Skills Among Pediatric Residents
Authors: Real Francis J. , Griggs Cornelia , March Michelle , Masiakos Peter T. , Meisman Andrea , Felopulos Gretchen , Sacks Chana A. , Zackoff Matthew W. 
Published: December 2024

Background Firearm-related injury is the leading cause of death among US children and adolescents. Residents across specialties report low preparedness to provide firearm safety counseling. Virtual reality (VR) may offer a modality to support residents’ skills through deliberate practice in a simulated setting.
Objective To describe a novel screen-based VR curriculum on firearm safety counseling and report feasibility and acceptability outcomes, including residents’ perceptions.
Methods Fifteen senior pediatric residents were recruited from 2 large children’s hospitals. The curriculum included 4 simulated scenarios in VR during which residents verbally counseled graphical caregivers who responded in real time, driven by a human facilitator. The curriculum focused on introducing firearm safety, discussing storage devices, and navigating the conversation through motivational interviewing. Following participation, residents completed the Measurement, Effects, Conditions Spatial Presence Questionnaire (MEC-SPQ) to indicate the degree of immersion in the virtual environment. Additional study data were derived from semistructured interviews. We used a constructivist general inductive approach to explore perspectives via coding and pattern identification.
Results Quantitatively 14 of 14 residents completing the survey indicated notable attention allocation and spatial presence in the VR environment. During the 15 interviews, residents identified VR as an acceptable modality for deliberate practice of firearm safety counseling skills in a realistic, scaffolded manner. They indicated the rehearsal of specific verbiage as critical to supporting behavior change. Notably, residents reported that the training helped overcome prior barriers to counseling by providing a framework for efficient counseling.
Conclusions Among pediatric residents, VR proved a feasible and acceptable modality for training on firearm safety counseling.
Reducing Waste at the Bedside: A Resident-Led Project to Decrease Waste and Cost From Diagnostic Paracentesis
Authors: Gottesman Sara , Mensah Barbara , Jagannathan Priyanka , Hyman Charles , Agrawal Deepak 
Published: December 2024

Background Physicians have a responsibility to reduce the environmental harms from health care waste. Residents contribute to waste during bedside procedures.
Objective To calculate waste and estimated cost reduction with the introduction of a novel resident-designed paracentesis kit at a single academic center in Texas in 2023.
Methods We calculated waste through observation of bedside diagnostic paracentesis performed by internal medical residents, tracking which components were discarded without use from the hospital-provided kit. Residents designed a novel kit containing only procedural essentials. We calculated possible waste reduction when using the novel kit, as well as potential cost savings by comparing the average cost of the current hospital kit across multiple medical equipment retailers to the summed cost of the components of the novel kit.
Results Sixteen items were discarded without use from the commercially available kit, out of 29 total items. The estimated cost saving per diagnostic paracentesis was $95.
Conclusions This resident-led development of a diagnostic paracentesis kit was successful in decreasing both waste and cost, while involving residents in improving the environmental impact of their practices.
Implementing a Clinical Decision Support Tool to Reduce Operating Room Anesthetic Fresh Gas Flow: A Resident-Led, Sustainability-Focused Quality Improvement Initiative
Authors: Collins Julia , Karim Marcus , Akcay Bebhinn , Palaniappa Nandini , Wong Jenson 
Published: December 2024

Background Lowering fresh gas flow (FGF) can help decrease the carbon footprint of the operating room as FGF levels act as an indirect measure of anesthetic gas waste.
Objective The aim of this quality improvement project was to reduce clinician FGF during general anesthesia with clinical decision support (CDS) tools within the electronic health record (EHR) at a single institution.
Methods A non-interruptive alert to reduce FGF was coded into the anesthesia intraoperative EHR workspace to alert whenever the 10-minute average FGF exceeded 1 L/min. It was targeted at anesthesia residents, attendings, and certified registered nurse anesthetists at a single US large academic level 1 trauma center. The number of general anesthesia cases with a target FGF of ≤2 L/min and the amount of sevoflurane (L/hr) was tracked on an individual and institutional basis.
Results Following CDS implementation from July 2023 through July 2024, 2677 of 4573 (58.5%) had a mean FGF ≤2 L/min, demonstrating a 116.7% increase from our institution’s baseline of 27.0% (1200 of 4446 cases) from July 2022 to June 2023, corresponding to a sevoflurane usage reduction of 36.7%.
Conclusions Implementing a non-interruptive alert in the EHR altered institution-level behaviors to reduce environmentally harmful anesthetic gas emissions.
Climate Change Curricula in US Graduate Medical Education: A Scoping Review
Authors: Cois Adrian , Kirkpatrick Sara , Herrin Rachelle 
Published: December 2024

Background Climate change threatens humanity’s health and well-being. While climate change topics have been increasingly incorporated into undergraduate medical education, it is unclear to what extent they have been incorporated into graduate medical education (GME) curricula in the United States.
Objective To examine how climate change has been incorporated into GME curricula in the United States.
Methods We conducted a scoping review of published literature from January 2013 through November 2023. PubMed and Scopus were searched, with articles assessed by 3 reviewers in a blinded fashion. Resources were included if they described how climate change is incorporated into GME curricula in the United States, and if they discussed topics such as disaster medicine, mass casualty events, environmental medicine, public health, health policy, wilderness medicine, quality improvement, and sustainability. Articles were analyzed using descriptive numerical analysis and qualitative assessment to identify article characteristics and themes.
Results The inclusion criteria generated 17 articles that examined climate change incorporation into GME curricula and curriculum interventions covering topics used for inclusion. The most common type of article (5 of 17, 29%) employed surveys of program directors on the inclusion of climate-related topics.
Conclusions Published accounts of climate-related topics in US GME program curricula are few. More content is found in topics related to emergency medicine. Curricula frameworks have been proposed for pediatric and internal medicine residency programs, but we know little about their efficacy. Future scholarship should fill these gaps to educate learners to improve health care sustainability and resiliency.
A Novel Longitudinal Training Experience in Obesity Medicine for Internal Medicine Residents
Authors: Neuman Melissa , Kane Jamie , Kline Myriam , Shafer Rebecca , Lambert Douglas C. 
Published: December 2024

Background Treatment of obesity is a public health priority. However, little training in obesity medicine is currently integrated into residency programs. We integrated a 12-month obesity medicine training experience within a New York internal medicine residency program.
Objective We describe the structure, feasibility and acceptability, resident assessments, and patient weight loss outcomes of an optional longitudinal obesity medicine training experience for internal medicine residents.
Methods Between July 2016 and June 2021, 26 second-year residents participated in the 12-month program, which comprised 10 educational/clinical sessions overseen by obesity medicine attendings. Residents completed baseline and post-program 5-point surveys of knowledge, competence, and attitudes. Differences at 12 months were analyzed using paired t tests. Resident patient weight loss was analyzed using the Wilcoxon signed rank test.
Results The training experience was successfully integrated over the study period and remains ongoing at present, demonstrating feasibility and acceptability. Fourteen of 26 (54%) residents completed post-program surveys. Significant improvements in all measures of knowledge and competence were seen. The greatest improvements were in comfort discussing weight loss with patients (+1.1; 95% CI 0.8-1.5; P&lt;.001) and prescribing weight loss medications (+1.4; 95% CI 1.1-1.6; P&lt;.001). The 98 patients seen by residents lost an average of 4.5 kilograms (95% CI 3.0-6.0; P&lt;.001).
Conclusions The training experience was feasible and acceptable, and demonstrated improvements in resident outcomes and patient weight.
From Chrysalis to Taking Flight, the Metamorphosis of the ACGME During Dr Thomas Nasca’s Tenure as CEO
Authors: Holmboe Eric S. 
Published: December 2024

Thomas J. Nasca, MD, MACP, served as the President and Chief Executive Officer (CEO) of the Accreditation Council for Graduate Medical Education (ACGME) for 17 years, with his tenure ending December 2024. During this time he led and supported significant changes in accreditation and medical education. This article will examine the changes during this period through the lens of key themes, including the redesign of the graduate medical education (GME) accreditation model and new and expanded roles that the ACGME assumed during 3 phases between 2007 and 2024: (1) the development years leading to the Next Accreditation System (NAS), (2) implementation of the NAS, and (3) the COVID-19 pandemic.
Launched in 2012, the NAS redesigned accreditation as a balanced combination of assurance- and improvement-focused policies and activities. The NAS served as the foundation for harmonizing GME training through the creation of the single accreditation system. The ACGME also took on new roles within the professional self-regulatory system by tackling difficult issues such as wellness and physician suicide, as well as diversity, equity, and inclusion in medical education. In addition, the ACGME substantially expanded its role as facilitator and educator via the introduction of multiple resources to support GME. However, the medical education landscape remains complex and faces continued uncertainty, especially as it emerges from the effects of the COVID-19 pandemic. The next ACGME President and CEO faces critical issues in GME.
Relationships between blood concentrations of cadmium, lead, mercury, selenium, and manganese and the risk of chronic kidney disease: a cross-sectional study based on NHANES 2011–2018
Authors: Yao Shenghua , Xu Dan 
Published: December 2024

IntroductionCurrently, knowledge on relationships between blood concen-trations of cadmium, lead, mercury, selenium, and manganese and the risk of chronic kidney disease (CKD) is lacking. The aim of the study was to ex-plore the relationships between blood concentrations of heavy metals and the occurrence of CKD.Material and methodsData from the National Health and Nutrition Examination Survey (NHANES) 2011–2018 were used to investigate the relationships between blood concentrations of mercury, lead, cadmium, selenium, and manganese and the occurrence of CKD using a weighted logistic recession analysis. Restrictive cubic spline analysis was applied to assess the dose–response relationship. The sample population was divided into four groups based on the quartiles of heavy metal concentrations (Q1: < 25th percentile, Q2: 25th–50th percentile, Q3: 50th–75th percentile, Q4: ≥ 75th percentile).ResultsA total of 15,450 participants were included. With regard to blood lead concentrations, the odds ratio (OR) for CKD in Q4 relative to Q1 was 1.36 (95% confidence interval [CI]: 1.20–1.61), indicating an increased oc-currence of CKD in Q4. With regard to blood cadmium concentrations, the ORs for CKD in Q2, Q3, and Q4 were 1.06 (95% CI: 0.92–1.22), 1.21 (95% CI: 1.05–1.39), and 1.52 (95% CI: 1.31–1.76), respectively. Non-linear dose–response relationships were identified between blood cadmium and lead concentrations and the occurrence of CKD. Further, blood lead and cadmium concentrations showed statistically significant interaction effects with age, hypertension, and obesity on CKD.ConclusionsHigher cadmium and lead concentrations in blood are asso-ciated with increased occurrence of CKD, especially in older adults, people with hypertension, and people with obesity.
Introduction
Authors: Carter Eric D. 
Published: December 2024

Abstract
This chapter sets the stage for an intellectual and political history of Latin American social medicine. Opening with the Brazilian health reforms of the 1980s, the chapter then lays out the major research questions and themes to be explored in the book; situates the book’s argument within key scholarly fields, especially the history of public health in Latin America and history of international development; and explains the significance of the project, beyond academia.
Roots
Authors: Carter Eric D. 
Published: December 2024

Abstract
This chapter disputes the notion that social medicine diffused from Europe to Latin America as a coherent leftist ideological project. Rather, social medicine emerged in the region as one response to what was termed the “social question,” a coming-to-grips with the social consequences of modernization and urbanization. With the academic social sciences still in their infancy, the pioneers of social medicine used an eclectic analytical toolkit that adapted ideas from the natural sciences about organisms, systems, harmony, growth, and decay and applied them to understand the workings of society. Social medicine was also strongly tied, and at times hard to distinguish from, other streams of scientific-reformist thought, including eugenics (and “race science,” more generally), scientific hygiene, and puericulture, which are discussed in detail in the chapter. Ideological foundations of Latin American social medicine include socialist ideas, Catholic social doctrine, and anarchism, which offered the most radically divergent vision of the role of the state in promoting population health.
Perdition
Authors: Swanson Drew A. 
Published: December 2024

Abstract
The second chapter describes federal governance of North Carolina during the early Reconstruction period, including the importance of the Freedmen’s Bureau in administering interracial interactions. It then turns to profiles of crucial figures in state and county life, including Governor William Woods Holden and senator John Stephens’s background and his rapid rise to political prominence in the late 1860s. Organizations like the Union League sought to secure Republican political power and the rights of freedpeople at the state and local level, while Conservatives aimed to reestablish their political and economic power through the use of violence and intimidation. The chapter culminates in the election of 1868, in which Republicans firmed their control of state governance and Stephens was elected to the Senate.
Urban Specters
Authors: Mayorga Sarah 
Published: December 2024

Abstract
Racial capitalism, invisible but threaded throughout the world, shapes our lives. Focusing on the experiences of white, Black, and Latinx residents of Cincinnati, Sarah Mayorga argues that residents' interpretations of their circumstances, what she calls urban specters, are often partial recognitions of the exploitation and dehumanization produced by racial capitalism. Much scholarly work on racial capitalism has necessarily focused on historical, theoretical, and macro-level accounts. Mayorga takes these vital insights and applies them to two contemporary working-class neighborhoods, centering the lives of working-class and poor people. Using data from interviews with 117 residents, Mayorga maps how racial capitalism creates the everyday harms people know all too well. Chronic underdevelopment, private property, and policing, she shows, have produced these harms. In this enlightening book, Mayorga identifies small windows into abolitionist possibilities that create different types of relations, ones based on care and connection. This is a guide for anyone trying to understand urban inequality, but also more importantly, for how we might create a different world.
Security and Policing
Authors: Mayorga Sarah 
Published: December 2024

Abstract
This chapter presents stories from many Carthage and Riverside residents who witnessed firsthand the failures of policing as the sole source of harm reduction and community justice. Poor and working-class resident narratives illustrate how Cincinnati police are generally unsuccessful at stopping crimes from happening. Security is an urban specter or ideology that obscures and justifies the exploitative and dehumanizing work of the policing relation. Already existing abolitionist possibilities in Cincinnati are also discussed.
Records and Manifestos
Authors: Menconi David 
Published: December 2024

Abstract
Rounder formally began in 1970, joining a folk-label landscape including labels like Takoma, Arhoolie, County and Yazoo. Rounder signed plenty of old-time folk and bluegrass musicians, as well as new acts like Holy Modal Rounders and Spark Gap Wonder Boys. Living communally, the three founders adopted a very frugal lifestyle to support their label, pinching pennies wherever they could. Calling themselves “anti-profit,” Rounder printed a manifesto to that effect on early releases. They also became a distribution to get their records into stores when no one else would carry them.
Quiet Girls
Authors: Menconi David 
Published: December 2024

Abstract
Ken Irwin discovered Rounder’s franchise act Alison Krauss on an unsolicited cassette demo in 1985, launching a career of millions of sales and dozens of Grammy Awards. It was a very gradual build, and she passed up many overtures by major labels. Rounder also bought another label for the first time, Philo Records, which was in bankruptcy in 1984. That brought in another major act, Nanci Griffith.
Openings
Authors: Nelson John William 
Published: December 2024

Abstract
In the seventeenth century, beavers built an immense dam along the wetland landscape of Chicago’s continental divide. The chapter begins with an environmental history of Chicago’s portage geography, showing how the entire area thrived as an ecological borderland—an ecotone—between Lake Michigan and the area’s wetlands, between oak “openings” and tallgrass prairies, and between the two key watersheds of the continental interior: the Great Lakes and Mississippi drainages. The chapter recreates what we know about Chicago’s early Indigenous history before European contact, before going on to document early French exploration into the region. Detailing the turmoil of the Mourning Wars, in which Haudenosaunee (Iroquois) raiders faced off against Illinois, Miamis, and other Indigenous allies of the French, the chapter shows how accessing and controlling the portages as a site of movement became vital to a variety of French and Native peoples during the conflicts as the area transitioned from a prosperous ecotone to a violent borderland in the wake of European contact.
Making the Latino South
Authors: Márquez Cecilia 
Published: December 2024

Abstract
In the 1940s South, it seemed that non-Black Latino people were on the road to whiteness. In fact, in many places throughout the region governed by Jim Crow, they were able to attend white schools, live in white neighborhoods, and marry white southerners. However, by the early 2000s, Latino people in the South were routinely cast as "illegal aliens" and targeted by some of the harshest anti-immigrant legislation in the country. This book helps explain how race evolved so dramatically for this population over the course of the second half of the twentieth century. Cecilia Márquez guides readers through time and place from Washington, DC, to the deep South, tracing how non-Black Latino people moved through the region’s evolving racial landscape. In considering Latino presence in the South’s schools, its workplaces, its tourist destinations, and more, Márquez tells a challenging story of race-making that defies easy narratives of progressive change and promises to reshape the broader American histories of Jim Crow, the civil rights movement, immigration, work, and culture.
Deadly Transitions
Authors: Dizon Mark 
Published: December 2024

Abstract
Located along foothills, the missions of Ituy and Paniqui occupied a crossroad that uplanders and lowlanders traversed as they conducted their various activities. Throughout the eighteenth century, growing contact between uplanders and lowlanders increased the prevalence of disease in this transitional space. On one hand, missions located in foothills were a breeding ground for malaria that most probably earned this area its reputation for being pestilential. The foundation of mission settlements and the concomitant promotion of cattle and horses potentially made the situation worse by multiplying the mosquito population. On the other hand, lowlanders brought with them contagious diseases such as smallpox that decimated the upland population. Greater borderland mobility helped spread epidemic diseases and resulted in more infections and deaths.