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To improve medical students' ability and willingness to obtain occupational histories from their patients.General medicine faculty and internal medicine teaching residents, who participated as instructors, and medical students during their required internal medicine clerkships.The primary teaching hospitals of two medical schools.During alternate months, students participated in problem-based sessions that included occupational health objectives (intervention) or attended the standard small-group didactic sessions (control). Process evaluations were collected from students and faculty in the intervention group following each session. Outcome evaluation was performed using chart audit and multiple-choice testing to compare the intervention and control groups.Intervention students participated in at least one problem-based session incorporating occupational aspects of disease into clinical internal medicine. Instructors received information packets and materials but had no other expertise in occupational medicine.The great majority of ratings on the process evaluations showed that the students were "moderately" to "extremely" interested in the session attended. No student rated any session to be a "waste of time," and over 90% of students would recommend the session being evaluated to a friend. Chart audit showed that students in the intervention group recorded slightly more occupational information than did those in the control group (an average of 2.97 vs. 2.37 pieces of information, p = 0.06). When the most commonly documented data (employment status and job title) were ignored, the difference between group means (1.1 vs. 0.91) was significant (p = 0.03), suggesting that intervention students were more likely to probe further into a patient's occupational history. Both groups of students collected less occupational information from women than from men (t = 3.22, p = 0.0035). Multiple-choice tests revealed no difference between the two groups in overall medical knowledge or occupational medicine knowledge.Problem-based learning with specific occupational content is well accepted by students and modestly improves their occupational history taking.

We present the first report of clinical experience with a 12 French double-lumen cannula in a newborn supported with venovenous extracorporeal membrane oxygenation. This cannula was used because the internal jugular vein could not accommodate a 14F double-lumen catheter. This newborn was on bypass for 94 h, and the highest plasma free hemoglobin noted at the end of that period was 56 mg/dl. The infant was successfully weaned from extracorporeal membrane oxygenation and discharged home at 35 days of age. We suggest that this 12F catheter may be beneficial and deserves further evaluation.

In this chapter, the authors describe the role of communication in the process of curricular reform at the eight schools that participated in The Robert Wood Johnson Foundation's "Preparing Physicians for the Future: Program in Medical Education." The collective experience of these eight schools suggests that despite its general neglect in the discourse on educational innovation, good communication is a decisive element of any successful reform initiative. The authors focus this chapter on effective communication patterns for supporting educational reform. First, the authors discuss a four-stage model of change--recognizing the need for change, and planning, implementing, and institutionalizing change--and describe the role of communication in each of them. They outline the communication strategies needed to promote a sense of ownership among all participants; structures and mechanisms for supporting positive communication; and common lessons learned by all schools about successful communication.

The authors describe, to their knowledge, the first management of acute airway obstruction in a newborn infant using Extracorporeal Membrane Oxygenation (ECMO). The infant had a primary diagnosis of gram negative sepsis complicated by pulmonary hemorrhage resulting in a left main stem bronchus obstruction. Despite full ventilatory support, the infant could not be adequately oxygenated. The infant was placed on venovenous ECMO. Airway management also included vigorous physiotherapy, suctioning, and bronchoscopy. The infant was successfully weaned from ECMO after 208 hours. The authors suggest that ECMO could be useful to manage life threatening airway obstruction in the neonate.

Stabilization and delayed operation for patients with congenital diaphragmatic hernia (CDH) is now widely accepted. When preoperative extracorporeal membrane oxygenation (ECMO) is needed, most centers have CDH repaired on ECMO to minimize the risk of postoperative deterioration. The authors adopted a policy of weaning from ECMO before repair in an effort to avoid hemorrhagic risks. They reviewed their experience with CDH patients who required ECMO for stabilization before repair but for whom post-ECMO repair was planned. The records of all high-risk CDH patients with a gestational age of at least 34 weeks were reviewed. Eighteen patients were identified. None of the eight who were stabilized and operated on without ECMO required bypass postoperatively; all survived. Ten were placed on bypass, nine for stabilization before repair. Of the nine, seven (78%) were weaned from ECMO to conventional ventilation. Repair of the diaphragmatic defect was performed an average of 3.8 days later; none of these patients had severe pulmonary hypertension postoperatively, and all survived. Two could not be weaned before repair, one of whom had a complex congenital heart defect. This patient died. The other patient had repair on ECMO because of intrathoracic gastric volvulus. Severe blood loss prompted decannulation, and the patient died. One patient who was placed on bypass was transferred 10 days after having had repair elsewhere (at 4 hours of age). Pulmonary hypertension did not resolve, and the postmortem examination showed alveolar capillary dysplasia, with focal misalignment of the pulmonary vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

In F. graminearum, the transcriptional regulator Tri6 is encoded within the trichothecene gene cluster and regulates genes involved in the biosynthesis of the secondary metabolite deoxynivalenol (DON). The Tri6 protein with its Cys2His2 zinc-finger may also conform to the class of global transcription regulators. This class of global transcriptional regulators mediate various environmental cues and generally responds to the demands of cellular metabolism. To address this issue directly, we sought to find gene targets of Tri6 in F. graminearum grown in optimal nutrient conditions. Chromatin immunoprecipitation followed by Illumina sequencing (ChIP-Seq) revealed that in addition to identifying six genes within the trichothecene gene cluster, Tri1, Tri3, Tri6, Tri7, Tri12 and Tri14, the ChIP-Seq also identified 192 additional targets potentially regulated by Tri6. Functional classification revealed that, among the annotated genes, ∼40% are associated with cellular metabolism and transport and the rest of the target genes fall into the category of signal transduction and gene expression regulation. ChIP-Seq data also revealed Tri6 has the highest affinity toward its own promoter, suggesting that this gene could be subject to self-regulation. Electro mobility shift assays (EMSA) performed on the promoter of Tri6 with purified Tri6 protein identified a minimum binding motif of GTGA repeats as a consensus sequence. Finally, expression profiling of F. graminearum grown under nitrogen-limiting conditions revealed that 49 out of 198 target genes are differentially regulated by Tri6. The identification of potential new targets together with deciphering novel binding sites for Tri6, casts new light into the role of this transcriptional regulator in the overall growth and development of F. graminearum., Author Summary Our knowledge of mechanisms involved in the activation and biosynthesis of DON comes largely from in vitro culture studies. Cumulated knowledge suggests that the physiological status of the fungus and the availability of nutrients are the main determining factors for DON production. Integration of various environmental cues to coordinate expression of secondary metabolic genes is thought to be mediated by a combination of global and pathway-specific transcription factors. While the global transcriptional factors respond to broad range of environmental cues such as the availability of carbon and nitrogen, the pathway-specific transcriptional factors regulate genes within a gene cluster. In F. graminearum, the transcriptional regulator Tri6 is encoded within the trichothecene gene cluster and regulates genes involved in the synthesis and transport of DON. In this report, we utilized ChIP-Seq to demonstrate that Tri6 can potentially bind to promoters and regulate genes not involved in the synthesis of DON and furthermore, many of these non-trichothecene genes are involved in various aspects of cellular metabolism, including transport and energy. Expression profiling revealed that many of the target genes are differentially regulated by Tri6, thus validating our hypothesis that Tri6 is a global regulator involved in cellular metabolism.

This study explored several research questions concerning strategies typically said to be beneficial for female political candidates. Six 60‐second videotaped political commercials were produced featuring a female “candidate”, each containing either a “masculine” or a “feminine” strategy. The strategies were aggressive, nonaggressive, career, family, ambitious, and nonambitious. Each political commercial was inserted into a set of four locally produced, nonpolitical ads. Six groups of students were randomly assigned to each of the six treatment groups. After viewing the commercials, subjects were asked to fill out a questionnaire to measure response to the candidate and to the ads through semantic differentials and Likert‐scale questions. Results from the study indicate that the “aggressive” strategy worked better in comparison with the “nonaggressive” strategy and the “career” strategy worked better in comparison with the “family” strategy. Few significant differences were found between the “ambitious” a...

Fusarium graminearum is a broad host pathogen threatening cereal crops in temperate regions around the world. To better understand how F. graminearum adapts to different hosts, we have performed a comparison of the transcriptome of a single strain of F. graminearum during early infection (up to 4 d post-inoculation) of barley, maize, and wheat using custom oligomer microarrays. Our results showed high similarity between F. graminearum transcriptomes in infected wheat and barley spike tissues. Quantitative RT-PCR was used to validate the gene expression profiles of 24 genes. Host-specific expression of genes was observed in each of the three hosts. This included expression of distinct sets of genes associated with transport and secondary metabolism in each of the three crops, as well as host-specific patterns for particular gene categories such as sugar transporters, integral membrane protein PTH11-like proteins, and chitinases. This study identified 69 F. graminearum genes as preferentially expressed in developing maize kernels relative to wheat and barley spikes. These host-specific differences showcase the genomic flexibility of F. graminearum to adapt to a range of hosts.

✓ Forty rabbits were inoculated with Streptococcus pyogenes or Staphylococcus aureus to produce cerebral abscesses. One-third of the rabbits received no treatment and served as controls. One-third received dexamethasone (Decadron) plus an appropriate antibiotic. One-third received only the appropriate antibiotic in the same dosage. The animals were sacrificed 10 days after inoculation and the brains examined. In the control group, an abscess at the stage of granulation tissue encapsulation containing the inoculated organisms was found. The surrounding brain showed a marked inflammatory response. In the Decadron plus antibiotic group, necrotic lesions were found containing the inoculated organisms and surrounded by relatively normal brain. In the group treated with antibiotic alone, healed glial scars were found in relatively normal brain. Our findings are discussed with reference to the medical literature regarding the influence of glucocorticoids on the inflammatory response and the efficacy of antibiotics when this response is suppressed.

Background Arctic Mesorhizobium strain N33 was isolated from nodules of the legume Oxytropis arctobia in Canada’s eastern Arctic. This symbiotic bacterium can grow at temperatures ranging from 0 to 30 °C, fix nitrogen at 10 °C, and is one of the best known cold-adapted rhizobia. Despite the economic potential of this bacterium for northern regions, the key molecular mechanisms of its cold adaptation remain poorly understood. Results Using a microarray printed with 5760 Arctic Mesorhizobium genomic clones, we performed a partial transcriptome analysis of strain N33 grown under eight different temperature conditions, including both sustained and transient cold treatments, compared with cells grown at room temperature. Cells treated under constant (4 and 10 °C) low temperatures expressed a prominent number of induced genes distinct from cells treated to short-term cold-exposure (