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BackgroundTo inform discussions on rates, burden and priority-setting in relation to police violence, we quantified the number and rate of years of life lost (YLLs) due to police violence by race/ethnicity and age in the USA, 2015–2016.MethodsWe used data on the number of deaths due to police violence from ‘The Counted’, a media-based source compiled by The Guardian. YLLs are the difference between an individual’s age at death and their corresponding standard life expectancy at age of death.ResultsThere were 57 375 and 54 754 YLLs due to police violence in 2015 and 2016, respectively. People of colour comprised 38.5% of the population, but 51.5% of YLLs. YLLs were greatest among those aged 25–34 years, and the number of YLLs at younger ages was greater among people of colour than whites.ConclusionsThe number of YLLs due to police violence is substantial. YLLs highlight that police violence disproportionately impacts young people, and the young people affected are disproportionately people of colour. Framing police violence as an important cause of deaths among young adults provides another valuable lens to motivate prevention efforts.

The hydrolysis of β-lactam antibiotics by β-lactamase enzymes is the most prominent antibiotic resistance mechanism for many pathogenic bacteria. Out of this broad class of enzymes, metallo-β-lactamases are of special clinical interest because of their broad substrate specificities. Several in vitro inhibitors for various metallo-β-lactamases have been reported with no clinical efficacy. Previously, we described a 10-nucleotide single stranded DNA aptamer (10-mer) that inhibits Bacillus cereus 5/B/6 metallo-β-lactamase very effectively. Here, we find that the aptamer shows uncompetitive inhibition of Bacillus cereus 5/B/6 metallo-β-lactamase during cefuroxime hydrolysis. To understand the mechanism of inhibition, we report a 2.5 Å resolution X-ray crystal structure and solution-state NMR analysis of the free enzyme. Chemical shift perturbations were observed in the HSQC spectra for several residues upon titrating with increasing concentrations of the 10-mer. In the X-ray crystal structure, these residues are distal to the active site, suggesting an allosteric mechanism for the aptamer inhibition of the enzyme. HADDOCK molecular docking simulations suggest that the 10-mer docks 26 Å from the active site. We then mutated the three lysine residues in the basic binding patch to glutamine and measured the catalytic activity and inhibition by the 10-mer. No significant inhibition of these mutants was observed by the 10-mer as compared to wild type. Interestingly, mutation of Lys50 (Lys78; according to standard MBL numbering system) resulted in reduced enzymatic activity relative to wild type in the absence of inhibitor, further highlighting an allosteric mechanism for inhibition.

Objective Radiation necrosis (RN) can be difficult to radiographically discern from tumor progression after stereotactic radiosurgery (SRS). The objective of this study was to investigate the utility of radiomics and machine learning (ML) to differentiate RN from recurrence in patients with brain metastases treated with SRS. Methods Patients with brain metastases treated with SRS who developed either RN or tumor reccurence were retrospectively identified. Image preprocessing and radiomic feature extraction were performed using ANTsPy and PyRadiomics, yielding 105 features from MRI T1-weighted post-contrast (T1c), T2, and fluid-attenuated inversion recovery (FLAIR) images. Univariate analysis assessed significance of individual features. Multivariable analysis employed various classifiers on features identified as most discriminative through feature selection. ML models were evaluated through cross-validation, selecting the best model based on area under the receiver operating characteristic (ROC) curve (AUC). Specificity, sensitivity, and F1 score were computed. Results Sixty-six lesions from 55 patients were identified. On univariate analysis, 27 features from the T1c sequence were statistically significant, while no features were significant from the T2 or FLAIR sequences. For clinical variables, only immunotherapy use after SRS was significant. Multivariable analysis of features from the T1c sequence yielded an AUC of 76.2% (standard deviation [SD] ± 12.7%), with specificity and sensitivity of 75.5% (± 13.4%) and 62.3% (± 19.6%) in differentiating radionecrosis from recurrence. Conclusions Radiomics with ML may assist the diagnostic ability of distinguishing RN from tumor recurrence after SRS. Further work is needed to validate this in a larger multi-institutional cohort and prospectively evaluate it’s utility in patient care.

The prevalence of burnout and depression are high among surgical trainees. This study examined the impact of program-driven initiatives to improve surgical trainee wellness. A survey was administered to residents and fellows at all surgical training programs across an urban academic health system. The survey measured burnout, depressive symptoms, and perceptions of program-driven wellness initiatives. The response rate was 44% among 369 residents. Of these, 63.2% screened positively for burnout, and 36.7% for depression. Residents who were burned out were more likely to work >80 h per week, have greater clerical duties, and miss educational activities more frequently. Conversely, having opportunities for wellness activities, dedicated faculty and housestaff wellness champions, and assistance with clerical burden were all associated with lower rates of burnout and depression. The presence of wellness support was associated with better outcomes, suggesting the value of initiatives to manage workload and support the well-being of surgical resident physicians. •Burnout and depressive symptoms are prevalent among surgical trainees.•Training program-driven wellness initiatives can support trainee well-being.•Depression may be difficult to predict from individual- and program-level factors. The present study measured the prevalence of burnout and depressive symptoms among surgical residents and fellows across an urban academic health system. Prevalence of burnout and depression were 63.2% and 36.7%, respectively. Greater workload appeared to be correlated with increased burnout and depression, whereas the presence of program-driven wellness initiatives was associated with better wellness outcomes.

Irrigation water contaminated with Salmonella enterica and Listeria monocytogenes may provide a route of contamination of raw or minimally processed fruits and vegetables. While previous work has surveyed specific and singular types of agricultural irrigation water for bacterial pathogens, few studies have simultaneously surveyed different water sources repeatedly over an extended period of time. This study quantified S. enterica and L. monocytogenes levels (MPN/L) at 6 sites, including river waters: tidal freshwater river (MA04, n = 34), non-tidal freshwater river, (MA05, n = 32), one reclaimed water holding pond (MA06, n = 25), two pond water sites (MA10, n = 35; MA11, n = 34), and one produce wash water site (MA12, n = 10) from September 2016-October 2018. Overall, 50% (84/168) and 31% (53/170) of sampling events recovered S. enterica and L. monocytogenes, respectively. Results showed that river waters supported significantly (p < 0.05) greater levels of S. enterica than pond or reclaimed waters. The non-tidal river water sites (MA05) with the lowest water temperature supported significantly greater level of L. monocytogenes compared to all other sites; L. monocytogenes levels were also lower in winter and spring compared to summer seasons. Filtering 10 L of water through a modified Moore swab (MMS) was 43.5 (Odds ratio, p < 0.001) and 25.5 (p < 0.001) times more likely to recover S. enterica than filtering 1 L and 0.1 L, respectively; filtering 10 L was 4.8 (p < 0.05) and 3.9 (p < 0.05) times more likely to recover L. monocytogenes than 1L and 0.1 L, respectively. Work presented here shows that S. enterica and L. monocytogenes levels are higher in river waters compared to pond or reclaimed waters in the Mid-Atlantic region of the U.S., and quantitatively shows that analyzing 10 L water is more likely recover pathogens than smaller samples of environmental waters.

In 2013 the United States spent $2.9 trillion on health care, more than in any previous year. Much of the debate around slowing health care spending growth focuses on the complicated pricing system for services. Our investigation contributes to knowledge of health care spending by assessing the relationship between charges and payments in the inpatient hospital setting. In the US, charges and payments differ because of a complex set of incentives that connect health care providers and funders. Our methodology can also be applied to adjust charge data to reflect actual spending. We extracted cause of health care encounter (cause), primary payer (payer), charge, and payment information for 50,172 inpatient hospital stays from 1996 through 2012. We used linear regression to assess the relationship between charges and payments, stratified by payer, year, and cause. We applied our estimates to a large, nationally representative hospital charge sample to estimate payments. The average amount paid per $1 charged varies significantly across three dimensions: payer, year, and cause. Among the 10 largest causes of health care spending, average payments range from 23 to 55 cents per dollar charged. Over time, the amount paid per dollar charged is decreasing for those with private or public insurance, signifying that inpatient charges are increasing faster than the amount insurers pay. Conversely, the amount paid by out-of-pocket payers per dollar charged is increasing over time for several causes. Applying our estimates to a nationally representative hospital charge sample generates payment estimates which align with the official US estimates of inpatient spending. The amount paid per $1 charged fluctuates significantly depending on the cause of a health care encounter and the primary payer. In addition, the amount paid per charge is changing over time. Transparent accounting of hospital spending requires a detailed assessment of the substantial and growing gap between charges and payments. Understanding what is driving this divergence and generating accurate spending estimates can inform efforts to contain health care spending.

IntroductionGeorge Floyd’s death in 2020 galvanised large protests around the country, including the emergence of the Capitol Hill Autonomous Zone (CHAZ) in Seattle, Washington, a non-policed, organised protest region that may have differing injury risks than other regions. We sought to quantitatively describe characteristics of injuries related to protests documented at visits to two nearby major emergency departments, including the only Level 1 trauma centre in the state.MethodsUsing the International Classification of Diseases, 10th Revision code inclusion criteria, we identified 1938 unique patient visits across the two emergency departments from 29 May 2020 and 1 July 2020. We reviewed provider notes to identify keywords to determine if the visit was related to the CHAZ protest. We quantitatively described demographics and injury characteristics.ResultsWe identified 48 injury visits related to the protest, with 25 from assault, 11 from crowd-control weapons and 8 from ground-level falls. Crowd-control weapons consisted of five visits from pepper spray, five from tear gas and a smaller number from flash-bang grenades, rubber bullets or other projectiles or a baton. In terms of body region injuries, 23 involved the head, 13 involved the knee and lower leg and 11 involved the thorax. Five patients required transfer to the operating room for surgery and admission and two died.DiscussionThe demonstrations during the CHAZ in Seattle in 2020 resulted in several violent injuries. Given the high proportion of assault and head injuries, these injury patterns can help prepare healthcare workers and first responders to plan care needs during protests.

Background The COVID-19 pandemic has left no one untouched. Resident trainees have been driven to reconsider virtually every component of their daily lives. The purpose of this pilot study is to evaluate the impact of the COVID-19 pandemic on Obstetrics and Gynecology (OBGYN) residency training and education. Methods A cross-sectional pilot study was conducted between 2/2022 and 5/2022. A survey was created and distributed to OBGYN residents. The survey queried the effects of the pandemic on OBGYN residents’ procedure skills training and mental health. Results A total of 95 OBGYN residents across programs affiliated with each American College of Obstetricians and Gynecologists (ACOG) district participated in the survey. Among them, just over half ( n  = 52, 55%) self-identified as under-represented minorities. A significant majority, 80% ( n  = 81), felt their gynecological training was inadequate, with 70% of fourth-year residents expressing a lack of confidence in their ability to independently practice gynecology after graduation. This lack of confidence among fourth-year residents suggests a notable disparity in readiness for independent gynecological practice, linked to meeting ACGME requirements before completing their residency ( p  = 0.013). Among the residents who reported a negative impact of the pandemic on their mental health ( n  = 76, 80%), about 40% ( n  = 31) had contemplated self-harm or knew a colleague who considered or attempted suicide ( p  < 0.001). This issue was especially pronounced in residents experiencing burnout ( n  = 44, 46%), as nearly half ( n  = 19, 43%) reported suicidal thoughts or knew someone in their program who had such thoughts or engaged in self-harm ( p  = 0.048). Conclusions Residents expressed concerns about reduced hands-on gynecological training and doubts about their readiness for independent practice post-residency, highlighting the need for enhanced support through mentorship and revised training curriculums. Additionally, despite the availability of mental health resources to address pandemic-induced burnout, their underuse suggests a need for more accessible time for residents to use at their discretion and flexible training schedules that encourage mental health support resource utilization.

Background Most analyses of gaps in human resources for health (HRH) do not consider training and the transition of graduates into the labour market. This study aims to explore the labour market for Peru’s recent medical, nursing, and midwifery graduates as well as their transition into employment in the Ministry of Health’s (MOH) system. Methods Data from four different datasets, covering 2007–2013, was used to characterize the patterns of recently trained physicians, nurses, midwives, and postgraduate-trained physicians that enter employment in the MOH system, and scenario analyses were used to describe how this rate of entry needs to adapt in order to fill current HRH shortages. Results HRH graduates have been increasing from 2007 to 2011, but the proportions that enter employment in the MOH system 2 years later range from 8 to 45% and less than 10% of newly trained medical specialists. Scenario analyses indicate that the gap for physicians and nurses will be met in 2027 and 2024, respectively, while midwives in 2017. However, if the number of HRH graduates entering the MOH system doubles, these gaps could be filled as early as 2020 for physicians and 2019 for nurses. In this latter scenario, the MOH system would still only utilize 56% of newly qualified physicians, 74% of nurses, and 66% of midwives available in the labour market. Conclusion At 2013 training rates, Peru has the number of physicians, nurses, and midwives it needs to address HRH shortages and meet estimated HRH gaps in the national MOH system during the next decade. However, a significant number of newly qualified health professionals do not work for the MOH system within 2 years of graduation. These analyses highlight the importance of building adequate incentive structures to improve the entry and retention of HRH into the public sector.

The threat to public health posed by drug-resistant bacteria is rapidly increasing, as some of healthcare’s most potent antibiotics are becoming obsolete. Approximately two-thirds of the world’s antibiotics are derived from natural products produced by Streptomyces encoded biosynthetic gene clusters. Thus, to identify novel gene clusters, we sequenced the genomes of four bioactive Streptomyces strains isolated from the soil in San Diego County and used Bacterial Cytological Profiling adapted for agar plate culturing in order to examine the mechanisms of bacterial inhibition exhibited by these strains. In the four strains, we identified 104 biosynthetic gene clusters. Some of these clusters were predicted to produce previously studied antibiotics; however, the known mechanisms of these molecules could not fully account for the antibacterial activity exhibited by the strains, suggesting that novel clusters might encode antibiotics. When assessed for their ability to inhibit the growth of clinically isolated pathogens, three Streptomyces strains demonstrated activity against methicillin-resistant Staphylococcus aureus . Additionally, due to the utility of bacteriophages for genetically manipulating bacterial strains via transduction, we also isolated four new phages (BartholomewSD, IceWarrior, Shawty, and TrvxScott) against S . platensis . A genomic analysis of our phages revealed nearly 200 uncharacterized proteins, including a new site-specific serine integrase that could prove to be a useful genetic tool. Sequence analysis of the Streptomyces strains identified CRISPR-Cas systems and specific spacer sequences that allowed us to predict phage host ranges. Ultimately, this study identified Streptomyces strains with the potential to produce novel chemical matter as well as integrase-encoding phages that could potentially be used to manipulate these strains.