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Background: Ensuring the strength of the physician workforce is essential to optimizing patient care. Challenges that undermine the profession include inequities in advancement, high levels of burnout, reduced career duration, and elevated risk for mental health problems, including suicide. This narrative review explores whether physicians within four subpopulations represented in the workforce at levels lower than predicted from their numbers in the general population—women, racial and ethnic minorities in medicine, sexual and gender minorities, and people with disabilities—are at elevated risk for these problems, and if present, how these problems might be addressed to support patient care. In essence, the underlying question this narrative review explores is as follows: Do physician workforce disparities affect patient care? While numerous articles and high-profile reports have examined the relationship between workforce diversity and patient care, to our knowledge, this is the first review to examine the important relationship between diversity-related workforce disparities and patient care. Methods: Five databases (PubMed, the Cochrane Library of Systematic Reviews, EMBASE, Web of Knowledge, and EBSCO Discovery Service) were searched by a librarian. Additional resources were included by authors, as deemed relevant to the investigation. Results: The initial database searches identified 440 potentially relevant articles. Articles were categorized according to subtopics, including (1) underrepresented physicians and support for vulnerable patient populations; (2) factors that could exacerbate the projected physician deficit; (3) methods of addressing disparities among underrepresented physicians to support patient care; or (4) excluded (n=155). The authors identified another 220 potentially relevant articles. Of 505 potentially relevant articles, 199 (39.4%) were included in this review. Conclusions: This report demonstrates an important gap in the literature regarding the impact of physician workforce disparities and their effect on patient care. This is a critical public health issue and should be urgently addressed in future research and considered in clinical practice and policy decision-making.

Objective To describe types of recommendations represented in a curated online evidence library, report on the quality of evidence-based recommendations pertaining to diagnostic imaging exams, and assess underlying knowledge representation. Materials and Methods The evidence library is populated with clinical decision rules, professional society guidelines, and locally developed best practice guidelines. Individual recommendations were graded based on a standard methodology and compared using chi-square test. Strength of evidence ranged from grade 1 (systematic review) through grade 5 (recommendations based on expert opinion). Finally, variations in the underlying representation of these recommendations were identified. Results The library contains 546 individual imaging-related recommendations. Only 15% (16/106) of recommendations from clinical decision rules were grade 5 vs 83% (526/636) from professional society practice guidelines and local best practice guidelines that cited grade 5 studies (P Discussion Most recommendations were grade 5, largely because studies to test and validate many recommendations were absent. Recommendation types vary in amount and complexity and, accordingly, the structure and syntax of statements they generate. However, they can be represented in single-decision, branching, and score-based representations. Conclusion In a curated evidence library with graded imaging-based recommendations, evidence quality varied widely, with decision rules providing the highest-quality recommendations. The library may be helpful in highlighting evidence gaps, comparing recommendations from varied sources on similar clinical topics, and prioritizing imaging recommendations to inform clinical decision support implementation.

AimTo determine the association between dementia and age-related macular degeneration (AMD) using meta-analysis.MethodsWe searched in the MEDLINE, EMBASE, Web of Knowledge, PsycInfo and Cochrane database of systematic reviews for studies published from March 1959 to March 2018. We included cross-sectional, case–control and cohort studies that evaluated the association of dementia/Alzheimer's disease (AD) with AMD (as outcome) and the association of AMD with dementia/AD (as outcome). Studies that compared cognitive functions between AMD and controls were also included. The summary outcomes, namely odds ratio (OR), relative risk, mean differences and corresponding 95% CIs, were estimated using random effects models. We performed sensitivity analysis based on study quality and individual study effect to control for potential biases.ResultsAmong 2159 citation records, we identified 21 studies consisting of 7 876 499 study subjects for meta-analysis. Patients with dementia (padjusted≤0.017, OR≥1.24, I2≤9%) or AD (p=0.001, ORunadjusted=2.22, I2=50%) were at risk for AMD, particularly for late AMD (padjusted2=0). AMD was also significantly associated with increased risk of AD/cognitive impairment (padjusted=0.037, OR=2.42, I2=38%). Moreover, patients with AMD had poorer cognitive functions when compared with controls, including Mini-Mental State Examination (p2≤79%) and Trail Making Test A (p2=0). Sensitivity analysis and Egger’s test indicated our results were less likely biased.ConclusionsA significant association between dementia/AD and AMD calls for greater clinical awareness. The cost-effectiveness of routine screening for the other condition in patients with primary diagnosis of dementia/AD or AMD requires further study.

Objective For health information technology tools to fully inform evidence-based decisions, recommendations must be reliably assessed for quality and strength of evidence. We aimed to create an annotation framework for grading recommendations regarding appropriate use of diagnostic imaging examinations. Methods The annotation framework was created by an expert panel (clinicians in three medical specialties, medical librarians, and biomedical scientists) who developed a process for achieving consensus in assessing recommendations, and evaluated by measuring agreement in grading the strength of evidence for 120 empirically selected recommendations using the Oxford Levels of Evidence. Results Eighty-two percent of recommendations were assigned to Level 5 (expert opinion). Inter-annotator agreement was 0.70 on initial grading (κ = 0.35, 95% CI, 0.23-0.48). After systematic discussion utilizing the annotation framework, agreement increased significantly to 0.97 (κ = 0.88, 95% CI, 0.77-0.99). Conclusions A novel annotation framework was effective for grading the strength of evidence supporting appropriate use criteria for diagnostic imaging exams.

Objective: The research provides an understanding of pandemic information needs and informs professional development initiatives for librarians in disaster medicine. Methods: Utilizing a multisite, comparative case series design, the researchers conducted semi-structured interviews and examined supplementary materials in the form of organizational documents, correspondence, and websites to create a complete picture of each case. The rigor of the case series was ensured through data and investigator triangulation. Interview transcripts were coded using NVivo to identify common themes and points of comparison. Results: Comparison of the four cases revealed a distinct difference between “client-initiated” and “librarian-initiated” provision of pandemic information. Librarian-initiated projects utilized social software to “push” information, whereas client-initiated projects operated within patron-determined parameters to deliver information. Health care administrators were identified as a key audience for pandemic information, and news agencies were utilized as essential information sources. Librarians' skills at evaluating available information proved crucial for selecting best-quality evidence to support administrative decision making. Conclusions: Qualitative analysis resulted in increased understanding of pandemic information needs and identified best practices for disseminating information during periods of high organizational stress caused by an influx of new cases of an unknown infectious disease.

The paper gives examples of the bioinformatics services provided in a variety of different libraries by librarians with a broad range of educational background and training.Two investigators sent an email inquiry to attendees of the "National Center for Biotechnology Information's (NCBI) Introduction to Molecular Biology Information Resources" or "NCBI Advanced Workshop for Bioinformatics Information Specialists (NAWBIS)" courses. The thirty-five-item questionnaire addressed areas such as educational background, library setting, types and numbers of users served, and bioinformatics training and support services provided. Answers were compiled into program vignettes.The bioinformatics support services addressed in the paper are based in libraries with academic and clinical settings. Services have been established through different means: in collaboration with biology faculty as part of formal courses, through teaching workshops in the library, through one-on-one consultations, and by other methods. Librarians with backgrounds from art history to doctoral degrees in genetics have worked to establish these programs.Successful bioinformatics support programs can be established in libraries in a variety of different settings and by staff with a variety of different backgrounds and approaches.

Background Nocturnin was originally identified by differential display as a circadian clock regulated gene with high expression at night in photoreceptors of the African clawed frog, Xenopus laevis. Although encoding a novel protein, the nocturnin cDNA had strong sequence similarity with a C-terminal domain of the yeast transcription factor CCR4, and with mouse and human ESTs. Since its original identification others have cloned mouse and human homologues of nocturnin/CCR4, and we have cloned a full-length cDNA from mouse retina, along with partial cDNAs from human, cow and chicken. The goal of this study was to determine the temporal pattern of nocturnin mRNA expression in multiple tissues of the mouse. Results cDNA sequence analysis revealed a high degree of conservation among vertebrate nocturnin/CCR4 homologues along with a possible homologue in Drosophila. Northern analysis of mRNA in C3H/He and C57/Bl6 mice revealed that the mNoc gene is expressed in a broad range of tissues, with greatest abundance in liver, kidney and testis. mNoc is also expressed in multiple brain regions including suprachiasmatic nucleus and pineal gland. Furthermore, mNoc exhibits circadian rhythmicity of mRNA abundance with peak levels at the time of light offset in the retina, spleen, heart, kidney and liver. Conclusion The widespread expression and rhythmicity of mNoc mRNA parallels the widespread expression of other circadian clock genes in mammalian tissues, and suggests that nocturnin plays an important role in clock function or as a circadian clock effector.

Histochemical procedures can be used to detect the cellular distribution of iron in the brain. The objective of the present study was to determine if the cellular distribution of iron enrichment is conserved between animals on different branches of the phylogenetic tree. This information can facilitate our understanding of the role of iron enrichment in cells of the brain. The animals studied were the mouse, rat, chicken, frog, fish and fly. In order to optimize the detection of iron, two histochemical staining methods and three fixatives per staining method were examined for each species. The results indicated that there was no single cell type that displayed iron enrichment in each of the species examined. In three out of five species in the phylum chordata, iron was enriched in oligodendrocytes; the exceptions to this were the fish and frog, which had iron enrichment in neurons but not oligodendrocytes. Iron was enriched in ependymal cells and endothelial cells in four out of the five species in the phylum chordata with the fish and the mouse being the respective exceptions. Myelin was stained in the mouse and rat, and microglia were occasionally observed in the rat and chicken. Astrocyte staining was not observed in any of the species examined. In the fly third instar larvae, iron enrichment was found in border glia and in neuropil. The absence of a conserved staining pattern between species suggests that iron enrichment probably does not play a role in the main functions that have been attributed to those cells that were stained. These findings, taken together with previously published data on the distribution of ferritin and transferrin, suggests that iron-enriched cells serve as stores of iron for the brain.

Ecdysteroid binding proteins have been found in nuclei of Drosophila melanogaster embryos. Comparison of results derived from Scatchard analysis, analogue binding competition, and sucrose gradient centrifugation has revealed no significant differences between the properties of the putative embryonic receptor and those of the receptor found in imaginal disks or Kc cells.

1. 1. Eleven protein systems were investigated via electrophoresis in three color morphs of Asellus brevicauda . 2. 2. Genetic variability was present in all but two protein systems. 3. 3. The variability is strongly color dependent with fixed differences occurring at two α-gpdh loci between the white and dark color types. 4. 4. These and other differences suggest that A. brevicauda at Cave Springs Cave, IL, consists of a subspecies complex.

In Drosophila melanogaster the yolk protein (YP) genes are normally expressed only in the fat body and follicular epithelium of adult females--never in males or in larvae. We describe here a first step toward a genetic examination of the developmental controls that restrict the activity of the YP genes to adult female tissues. A YP1 promoter that contains the tissue-, temporal-, and sex-specific controlling elements for expression was fused to the reporter gene, alcohol dehydrogenase (Adh). The gene fusion was transformed into an Adh-deficient genotype. As assayed by a number of criteria, that the fusion gene is expressed in the same physiological manner as the endogenous yolk protein genes. The fusion gene's activity is modulated in trans by a temperature-sensitive allele of the sex determination gene, tra-2. The Adh enzyme serves as a selectable marker and therefore these flies are suitable for use in genetic screens for trans-acting mutations that affect the expression of the yolk protein genes.

An extracellular matrix (ECM) lies between the upper and lower epithelial layers of the wing imaginal discs of moths. Organization and composition of this extracellular matrix, as revealed by staining with ruthenium red, tannic acid, and alcian blue, changes in concert with levels of hormones in the haemolymph. The ECM of the wing imaginal disc is an environment for cellular movements. Reorganization of the matrix and increase in ecdysteroid level is coupled with the proximal → distal migration of tracheal cells as well as the distal → proximal outgrowth of sensory neurons.

We describe our analysis of IMP-L2, one of a set of six ecdysone-inducible genes in imaginal discs of Drosophila whose transcripts are associated with membrane-bound polysomes. The spatial and temporal patterns of expression of the IMP-L2 transcript were analyzed. This transcript is first expressed in imaginal discs in areas that are precursors of head and thoracic epithelium, particularly the peripodial epithelia. It is later expressed in the imaginal histoblasts, precursors of the adult abdomen. The appearance of IMP-L2 transcript in each of these tissues precedes the spreading and fusion of the separate imaginal anlagen to form the continuous adult epidermis.

Ecdysterone stimulates a 2- to 15-fold increase in the synthesis of four small heat-shock proteins (hsp) in Drosophila line S3 cells. This is accompanied by a rapid and coincident increase in the abundance of small hsp transcripts. A parallel in vivo situation is now described in imaginal discs isolated from pupariating larvae. In neither system are the high-molecular-weight heat-shock proteins, or their RNAs, induced by hormone. Nor does induction occur in variant cell lines which have acquired resistance to ecdysterone. Other genes within or contiguous to the small hsp cluster are not induced by either ecdysterone or high temperature. Induction by ecdysterone appears to be a primary hormone response.

We posed the question of what services an academic library can best provide to support the NIH Public Access Policy. We approached the answer to this question through education, collaboration, and tool-building. As a result, over the last four years we have engaged over 1,500 participants in discussions of public access to research results, forged alliances with dozens of partners, and built online tools to ease the process of complying with the NIH policy. We conclude that librarians working in collaboration with other key constituencies can have a positive impact on improving access to the results of scientific research.