Brighter Bites is a school-based health promotion program that delivers fresh produce and nutrition education to low-income children and their families across six cities in the U.S. This paper provides a perspective on how, despite COVID-19-related school closures, Brighter Bites pivoted rapidly to collaborate with medical and public health institutions to improve health and food literacy among their families. Through these partnerships, Brighter Bites was able to rapidly provide accurate, evidence-based information related to COVID-19 and other social needs, including food, housing, transportation, and access to healthcare, to help fill a needed gap in vulnerable communities.

Artificial Intelligence (AI) applications in medicine have grown considerably in recent years. AI in the forms of Machine Learning, Natural Language Processing, Expert Systems, Planning and Logistics methods, and Image Processing networks provide great analytical aptitude. While AI methods were first conceptualized for radiology, investigations today are established across all medical specialties. The necessity for proper infrastructure, skilled labor, and access to large, well-organized data sets has kept the majority of medical AI applications in higher-income countries. However, critical technological improvements, such as cloud computing and the near-ubiquity of smartphones, have paved the way for use of medical AI applications in resource-poor areas. Global health initiatives (GHI) have already begun to explore ways to leverage medical AI technologies to detect and mitigate public health inequities. For example, AI tools can help optimize vaccine delivery and community healthcare worker routes, thus enabling limited resources to have a maximal impact. Other promising AI tools have demonstrated an ability to: predict burn healing time from smartphone photos; track regions of socioeconomic disparity combined with environmental trends to predict communicable disease outbreaks; and accurately predict pregnancy complications such as birth asphyxia in low resource settings with limited patient clinical data. In this commentary, we discuss the current state of AI-driven GHI and explore relevant lessons from past technology-centered GHI. Additionally, we propose a conceptual framework to guide the development of sustainable strategies for AI-driven GHI, and we outline areas for future research. Keywords: • Artificial Intelligence • AI Framework • Global Health • Implementation • Sustainability • AI Strategy   Copyright © 2020 Hadley et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ObjectiveTo offer learning opportunities to medical students during the pandemic and address technical challenges for operating room involvement, the Scott Department of Urology at the Baylor College of Medicine designed and evaluated a 2-week virtual elective course.Materials and MethodsA manual for a virtual sub-internship was created by members of the Society of Academic Urologists, structured around core competencies. Our curriculum incorporated the manual to design a virtual experience. The course combined live surgical case streaming, one-on-one didactics, and virtual participation during in-person clinic sessions. The surgical streaming was enabled through a nominal investment of $150 for equipment. A post-course evaluation was distributed to participating students.ResultsThe course evaluation received a 91% response rate from 11 enrolled fourth-year medical students. There was a very high level of satisfaction with the quality of the educational experience (M=5.8 +/-0.4). Open comments on course strengths highlighted the surgical streaming aspect of the experience, and 80% of evaluation respondents reported that one-on-one time with physicians was a strength of the virtual format.ConclusionsOur curriculum effectively engaged medical students during a 2-week virtual urology elective. The surgical video streaming format is unique even among virtual rotations nationwide and may be adapted for any learners within or beyond an institution. Our curriculum provides an example for programs to incorporate these inexpensive streaming techniques and for students to gain exposure in their surgical areas of interest.

Background Several techniques have been described for placement of inflatable penile prostheses (IPP) reservoirs, with variable satisfaction. Standard placement in the Space of Retzius can present with several complications and may be technically difficult in patients with a violated space. Concerns with ectopic reservoir placement have included reservoir herniation and lack of reservoir concealability. Aim To present a novel technique to achieve reservoir concealment with decreased postoperative complications as an alternative to standard approaches of ectopic reservoir placement. Methods We describe our novel low submuscular reservoir (LSM) placement with transfascial fixation (TFF) for inflatable penile prostheses. Outcomes Patient satisfaction with reservoir concealment, complication rate or need for additional surgeries. Results A total of 31 cases successfully underwent our technique. The low submuscular placement with TFF of the IPP reservoir offers an optimal approach for reservoir placement with a high degree of patient satisfaction with significant ease of placement compared to alternative methods. Clinical Implications Penile prosthetic surgeons should be familiar with several techniques for concealment of reservoir as an option to improve patient satisfaction. Strengths and Limitations Given the small sample size of patients who have undergone this novel technique, current literature regarding the topic is limited. Conclusion Low submuscular reservoir placement with transfascial fixation for IPPs is a technically feasible approach that can be employed to achieve patient satisfaction and decrease the risk of reservoir herniation.

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BackgroundRespiratory-related complaints prompt most pediatric visits to Karl Heusner Memorial Hospital Authority's (KHMHA) Emergency Department (ED) in Belize. We developed and taught a novel pediatric respiratory emergencies module for generalist practitioners there. We assessed the curriculum's clinical impact on pediatric asthma emergency management.ObjectiveThis study assesses the clinical impact of a pediatric emergency medicine curriculum on management of pediatric asthma emergencies at KHMHA in Belize City, Belize.MethodsWe conducted a randomized chart review of pediatric (aged 2–16 y) visits for asthma-related diagnosis at the KHMHA ED between 2015 and 2018 to assess the training module's clinical impact. Primary outcomes included time to albuterol and steroids. Secondary outcomes included clinical scoring tool (Pediatric Respiratory Assessment Measure [PRAM]) usage, ED length of stay, usage of chest radiography, return visit within 7 days, and hospital admission rates. Kaplan-Meier survival analysis and Cox proportional hazard regression were used.ResultsTwo hundred eighty-three pediatric asthma-related diagnoses met our inclusion criteria. The patients treated by trained and untrained physician groups were demographically and clinically similar. The time to albuterol was significantly faster in the trained (intervention) group compared with the untrained (control) physician group when evaluating baseline of the group posttraining (P < 0.05). However, the time to steroids did not reach statistical significance posttraining (P = 0.93). The PRAM score utilization significantly increased among both control group and intervention group. The untrained physician group was more likely to use chest radiography or admit patients. The trained physician group had higher return visit rates within 7 days and shorter ED length of stay, but this did not reach statistical significance.ConclusionsThe curriculum positively impacted clinical outcomes leading to earlier albuterol administration, increased PRAM score use, obtaining less chest radiographs, and decreased admission rates. The timeliness of systemic steroid administration was unaffected.

0.89 was then applied to the data (Jenkins, T. et al. 2018) Associations between biological sperm age, chronological age, fertility biomarkers, and comorbidities were examined using supervised and unsupervised learning techniques.Analysis was completed on all samples; however, we chose to sub-stratify samples from patients that were treated with FSH, HCG, anastrozole, or had history of testosterone use.By initially examining oligospermic men considered ''truly infertile'', associations were seen between predicted sperm age and semen parameters associated with infertility.RESULTS: The predicted epigenetic sperm age was observed to be negatively correlated with testosterone levels (R¼ -0.3) as well as with the % sperm motility (R¼ -0.31). Higher predicted sperm age was also observed in patients with a high body mass index (BMI) (R¼0.5), a factor associated with male infertility. Epigenetic sperm age was more highly correlated with % motility and BMI than chronological age at collection (R ¼ -0.27, R¼ 0.23 respectively).Expanding the sample set to all untreated patients, we still observed a negative correlation between epigenetic sperm age and % motility (R¼ -0.2), and testosterone (R¼ -0.2), but the correlations were less pronounced.We also found a statistically significant correlation between hyper-accelerated aging of epigenetic sperm and Cardiovascular risk (p ¼ 0.02).CONCLUSIONS: Epigenetic studies have highlighted the relationship between lifestyle and fertility, including effects of alcohol use, smoking, and obesity on DNA methylation profiles within germ cells. We have shown that altered epigenetics have been associated with non-chronological, accelerated sperm aging and reproductive failure. Here we observed associations between epigenetically-determined sperm age with both semen parameters and BMI. This finding provides further evidence that environmental and epigenetic factors contribute to the health of sperm.IMPACT STATEMENT: If replicated, this use of epigenetic profiling to predict sperm health will become a useful tool in informing discussions with patients regarding the impact of lifestyle and paternal preconception health on fertility success.

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