War in Europe: health implications of environmental nuclear disaster amidst war

Introduction to Treating Patients Exposed to Chemical, Biological, Radiological, and Nuclear (CBRN) Threats: A Military Medical Case-Based Curriculum

Introduction

Ensuring proficiency in responding to, evaluating, and treating chemical, biological, radiological, and nuclear (CBRN) casualties is a critical component of military medical student education. To meet this objective, we developed a case-based CBRN curriculum that can serve as a model to address potential curricular gaps for civilian prehospital, UME, and GME programs.

Methods

The curriculum was administered in two sessions, 1 month apart, each with individual student preparation, including an optional asynchronous online module and a review of clinical practice guidelines. Session one consisted of a 2-hour introductory lecture, followed by a student reflection. Session two consisted of a 1-hour small-group case study, designed as a multimodal exercise with a corresponding computer-based worksheet and knowledge check.

Results

Forty-five teams consisting of three to four second-year medical students (N = 170) completed the sessions and course survey. Sixty-four percent of student teams were extremely or quite satisfied with what they learned, 62% found the materials very or quite relevant to their needs, and 69% rated the instructional materials as extremely or quite understandable. Student feedback included designating additional time for worksheet completion.

Discussion

A case-based training on CBRN patient care earned positive ratings for the clarity of instruction, the impact on students as learners, and the feasibility of the training. Future training evolutions could track student completion of prework, extend the allotted time for activity completion, and evaluate curricular effectiveness through pre-post measurement of students' confidence in their ability to care for a CBRN patient.

Trends of Eurasian Perch (Perca fluviatilis) mtDNA ATP6 Region Genetic Diversity within the Hydro-Systems of the Eastern Part of the Baltic Sea in the Anthropocene

The intraspecific genetic diversity of freshwater fish inhabiting hydro-systems of the macrogeographic area spreading from the Black to Baltic Seas requires comprehensive investigation from fundamental and practical perspectives. The current study focused on the involvement of the mtDNA ATP6 region in the adaptability and microevolution of Perca fluviatilis within phylogeographic and anthropogenic contexts. We sequenced a 627 bp fragment encompassing the ATP6 region and used it for genetic analysis of 193 perch caught in Latvia, Lithuania, Belarus, and Ukraine, representing natural and anthropogenically impacted populations. We evaluated patterns of intraspecific genetic diversity in the ATP6 region and phylogeographic trends within the studied area compared with previously established D-loop trends. Evaluation of ATP6 coding sequence variability revealed that among 13 newly detected haplotypes, only two were caused by non-synonymous substitutions of amino acids of the protein. PCoA revealed three genetic groups (I-III) based on the ATP6 region that encompassed four previously described genetic groups established based on the mtDNA D-loop. The two mtDNA regions (D-loop and ATP6) have microevolved at least partially independently. Prolonged anthropogenic impacts may generate new point mutations at the ATP6 locus, but this phenomenon could be mainly concealed by natural selection and reparation processes.

Sales of Iodine-Containing Drugs in Europe Following the Beginning of the War Between Russia and Ukraine

This cross-sectional study investigates sales of over-the-counter iodine-containing drugs in 20 European countries between January 2021 and March 2022.