Pipeline programs address health disparities by promoting academic achievement and entry of low-income ethnic and racial minority youth into healthcare fields. The Health Career Academy (HCA) is a 3-year pipeline program for high school students from low-income, ethnic, and racial minority communities. Health professional students serve as program mentors. The HCA has been implemented in nine US sites, with partnerships between 17 health professional schools and 17 high schools. A total of 386 10th grade students and 95 11th grade students enrolled as participants in the 2015-2016 HCA program. In post-participation surveys, 10th grade students reported that the HCA helped them learn about different healthcare career options, plan for how to reach career goals, and understand how healthcare workers care for patients. Eleventh grade participants noted the program made them aware of the importance of public health and taught them about medical conditions, self-care, and safety. Eighty-six percent of 10th graders and 71% of 11th graders reported that they are considering healthcare careers. Students' favorite aspects of the HCA included the following: time with mentors, learning about science and health, team collaboration and hands-on experiences, field trips, and team presentations. Teachers noted the following as most important in the program: interaction with mentors and healthcare professionals, learning broadly applicable skills, stimulation of interest in health-related careers, presentation skills, and creating optimism about furthering education. The HCA is well received by participants and can be replicated successfully at multiple sites nationally. By providing mentorship, increasing exposure to health professionals and health careers, offering high-level science and health curriculum, and fostering collaboration and presentation skills, the HCA has potential to increase interest in health professions among racial and ethnic minority youth from low-income communities.

Anticoagulation for stroke prevention in atrial fibrillation (AF) is effective. Pivotal trials RE-LY, ROCKET AF, ARISTOTLE, and ENGAGE-AF TIMI 48 tested novel agents against warfarin (W). In RE-LY, an open-label trial, dabigatran 150 mg BID (D150) was superior (35%) and 110 mg BID (D110) was noninferior to W. D150 reduced ischemic strokes by 25% and intracerebral bleeds by 74%, but increased major GI bleeds by 0.5 % per year. In ROCKET AF, a double-blind study, rivaroxaban 20 mg daily, downtitrated to 15 mg daily (if CrCl was <49) was noninferior for efficacy and safety, with an increase in GI bleeds. In ARISTOTLE, a double-blind study, apixaban 5 mg BID (downtitrated to 2.5 mg BID if two of the following were present: age, >80; weight, <60 kg; or serum creatinine, >1.5 mg) was superior for safety (31%), efficacy (21%), and all-cause mortality (11%). In ENGAGE-AF TIMI 48, edoxaban 60 mg once daily (30 mg once daily if CrCl 30-50 ml/min, weight <60 kg, or concomitant verapamil or quinidine) was noninferior to W for efficacy, but reduced major bleeding (20%). To translate clinical trials to practice, understanding the disease and each anticoagulant is essential. For all novel agents, rapid anticoagulation, absence of monitoring, and a short half-life differentiate them from W. Bleed rates were either noninferior or lower than for W, without an antidote. Patient compliance is critical. Knowledge of renal function is essential and maintaining patients on therapy is key.