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Purpose: Meeting scholarly activity requirements continues to be a challenge in many family medicine (FM) residency programs. Studies comprehensively describing FM resident scholarship have been limited. We sought to identify institutional factors associated with increased scholarly output and meeting requirements of the Accreditation Council for Graduate Medical Education (ACGME)., Objectives: Our goals were to: (1) describe scholarly activity experiences among FM residents compared with ACGME requirements; (2) classify experiences by Boyer's domains of scholarship; and (3) associate experiences with residency program characteristics and scholarly activity infrastructure., Methods: This was a cross-sectional survey. The survey questions were part of an omnibus survey to FM residency program directors conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA). All ACGME-accredited US FM residency program directors, identified by the Association of Family Medicine Residency Directors, were sampled., Results: Of the 691 eligible program directors, 298 (43%) completed the survey. The respondents reported that 25% or more residents exceeded ACGME minimum output, 17% reported that 25% or more residents published their work, and 50% reported that 25% or more residents delivered conference presentations. Programs exceeding ACGME scholarship requirements exhibit robust infrastructure characterized by access to faculty mentorship, scholarly activity curricula, Institutional Review Board, medical librarian, and statistician., Conclusions: These findings suggest the need for codified ACGME requirements for scholarly activity infrastructure to ensure access to resources in FM residency programs. By fostering FM resident engagement in scholarly activity, programs help to create a culture of inquiry, and address discrepancies in funding and output among FM residency programs., (© 2024 Annals of Family Medicine, Inc.)

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the safety and effectiveness of shorter versus longer duration antibiotic regimens for the treatment of suspected neonatal sepsis., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Disentangling inputs of aeolian dust, ice-rafted debris (IRD), and eroded continental detritus delivered by ocean currents to marine sediments provide important insights into Earth System processes and climate. This study uses Sr-Nd-Pb isotope ratios of the continent-derived (lithogenic) fraction in deep-sea core TN057-6 from the subantarctic Southern Ocean southwest of Africa over the past 150,000 y to identify source regions and quantify their relative contributions and fluxes utilizing a mixing model set in a Bayesian framework. The data are compared with proxies from parallel core Ocean Drilling Program Site 1090 and newly presented data from potential South America aeolian dust source areas (PSAs), allowing for an integrated investigation into atmospheric, oceanic, and cryospheric dynamics. PSA inputs varied on glacial/interglacial timescales, with southern South American sources dominating up to 88% of the lithogenic fraction (mainly Patagonia, which provided up to 68%) during cold periods, while southern African sources were more important during interglacials. During the warmer Marine Isotope Stage (MIS) 3 of the last glacial period, lithogenic fluxes were twice that of colder MIS2 and MIS4 at times, and showed unique isotope ratios best explained by Antarctic-derived IRD, likely from the Weddell Sea. The IRD intrusions contributed up to 41% at times and followed Antarctic millennial warming events that raised temperatures, causing instability of icesheet margins. High IRD was synchronous with increased bioavailable iron, nutrient utilization, high biological productivity, and decreased atmospheric CO 2 . Overall, TN057-6 sediments record systematic Southern Hemisphere climate shifts and cryospheric changes that impacted biogeochemical cycling on both glacial/interglacial and subglacial timescales., Competing Interests: Competing interests statement:The authors declare no competing interest.

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the safety and effectiveness of shorter versus longer duration antibiotic regimens for the treatment of culture-positive neonatal sepsis with or without meningitis., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

The Antarctic Circumpolar Current (ACC) represents the world's largest ocean-current system and affects global ocean circulation, climate and Antarctic ice-sheet stability 1-3 . Today, ACC dynamics are controlled by atmospheric forcing, oceanic density gradients and eddy activity 4 . Whereas palaeoceanographic reconstructions exhibit regional heterogeneity in ACC position and strength over Pleistocene glacial-interglacial cycles 5-8 , the long-term evolution of the ACC is poorly known. Here we document changes in ACC strength from sediment cores in the Pacific Southern Ocean. We find no linear long-term trend in ACC flow since 5.3 million years ago (Ma), in contrast to global cooling 9 and increasing global ice volume 10 . Instead, we observe a reversal on a million-year timescale, from increasing ACC strength during Pliocene global cooling to a subsequent decrease with further Early Pleistocene cooling. This shift in the ACC regime coincided with a Southern Ocean reconfiguration that altered the sensitivity of the ACC to atmospheric and oceanic forcings 11-13 . We find ACC strength changes to be closely linked to 400,000-year eccentricity cycles, probably originating from modulation of precessional changes in the South Pacific jet stream linked to tropical Pacific temperature variability 14 . A persistent link between weaker ACC flow, equatorward-shifted opal deposition and reduced atmospheric CO 2 during glacial periods first emerged during the Mid-Pleistocene Transition (MPT). The strongest ACC flow occurred during warmer-than-present intervals of the Plio-Pleistocene, providing evidence of potentially increasing ACC flow with future climate warming., (© 2024. The Author(s).)

Background: Admission to a neonatal intensive care unit (NICU) for prematurity or illness is necessary for approximately 20% of newborns in Australia, resulting in parent-infant separation. Web cameras in the NICU provide a virtual link for parents to remain remotely connected to their infant during admission. Web camera use is increasing; however, there is limited evidence on the impact of web cameras on parents, infants, and neonatal staff., Objective: There were two objectives: (1) to determine the attitudes of parents and staff toward web cameras in the NICU and (2) to compare parental depression, anxiety, and stress levels using validated scales before and after web camera implementation in the NICU., Methods: A pre- and postevaluation survey was administered before and after implementation of the NICVIEW camera system in a tertiary NICU in Sydney, Australia. The NICVIEW camera system provides secure real-time viewing of infants and can be accessed from any device with an internet connection. Surveys were administered to parents of inpatients and staff, and included open- and closed-ended questions and Likert scales. Survey questions aimed to determine parent and staff attitudes and use of web cameras before and after implementation. In addition, pre- and postimplementation parental levels of depression, anxiety, and stress, as measured by the 21-item version of the Depression Anxiety Stress Scale (DASS-21) and Parental Stressor Scale: Neonatal Intensive Care Unit, were recorded., Results: In total, 94 parents and 109 staff members completed the pre- and postimplementation surveys. Post implementation, 43 of 44 (98%) parents supported web cameras, and 40 of 42 (95%) parents stated that they used web cameras. The most common reasons for support from parents included web cameras making parents feel more at ease, facilitating parent-infant bonding, increasing parental confidence in staff, and allowing others to see infants. There was no significant difference between the parental groups for the depression, anxiety, or stress scales measured by DASS-21. Staff support for web cameras increased significantly from 34 of 42 (81%) participants before to 64 of 67 (96%) participants after implementation (P=.01). Following implementation, there was a resolution in staff concerns about web cameras having an adverse impact on staff roles and privacy and security concerns., Conclusions: Web camera use in a tertiary Australian NICU was strongly supported by parents and staff and may reduce parental stress, facilitate parent-infant bonding, and encourage positive parent-staff engagement. Web cameras are a feasible method of providing continuity of care for families and should be considered as a standard of care in similarly resourced settings., (© Alexandra A Legge, Jennifer L Middleton, Shelley Reid, Adrienne Gordon. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org).)

Curriculum mapping provides a systematic approach for analyzing the conformity of an educational program with a given set of standards. The Chiang Mai University Faculty of Veterinary Medicine and the University of Minnesota College of Veterinary Medicine joined together in an educational twinning project to map their Doctor of Veterinary Medicine curricula against core competencies identified by the World Organisation for Animal Health (OIE) as critically important for Day 1 veterinary graduates to meet the needs for global public good services. Details of curriculum coverage for each specific and advanced competency were collected through a review of syllabi and course descriptions, followed by in-depth interviews of key faculty members. The depth of coverage of each competency was estimated by the tabulating the number of hours assigned. The teaching methods and levels of learning were also captured. While the overall design of the curricula conformed to the OIE Guidelines for Veterinary Education Core Curricula, the mapping process identified variability in the depth and breadth of coverage on individual competencies. Coverage of the Day 1 Specific Competencies was greater early in the curricula. More gaps existed in terms of the Advanced Competencies than the specific core competencies. Discussion of the identified gaps with faculty members led to opportunities for strengthening the curricula by adjustments of individual courses throughout the curricula. Documentation of teaching methods also led to professional development of new pedagogical skills and redesign of the teaching methods for particular subjects.

Background: Many residency programs have struggled to meaningfully meet the ACGME quality improvement (QI) requirements. Similarly, our residents were receiving limited QI education, and their longitudinal projects were ineffective., Aim: Create an integrated didactic and experiential learning environment that equips residents to become leaders of QI., Setting and Participants: Internal medicine (IM) residency program of 45 residents in a large community hospital., Program Description: This curriculum included eight content areas. Games, real-life application, and project celebrations cultivated engagement. Sessions occurred during residents' 2-week outpatient rotations. Project development was standardized., Program Evaluation: The QI Knowledge Application Tool-Revised (QIKAT-R) and separate surveys were used before and after the curriculum's implementation to evaluate resident QI knowledge and confidence, respectively. We also tracked QI scholarship and faculty engagement. Mean QIKAT-R scores improved significantly from 7.0 (SD 2.9) at baseline to 16.6 (SD 4.7) post-curriculum (n = 37 pairs, p = 0.043). Residents' adverse event reporting increased from 44% (19/43) at baseline to 90% (28/31) post-curriculum. Seven presentations were accepted for local, regional, and national conferences, compared with one presentation the preceding year., Discussion: A QI curriculum can be successfully integrated in a "4 + 2" program.

Risk management decisions associated with live poultry movement during a highly pathogenic avian influenza (HPAI) outbreak should be carefully considered. Live turkey movements may pose a risk for disease spread. On the other hand, interruptions in scheduled movements can disrupt business continuity. The Secure Turkey Supply (STS) Plan was developed through an industry-government-academic collaboration to address business continuity concerns that might arise during a HPAI outbreak. STS stakeholders proposed outbreak response measure options that were evaluated through risk assessment. The developed approach relies on 1) diagnostic testing of two pooled samples of swabs taken from dead turkeys immediately before movement via the influenza A matrix gene real-time reverse transcriptase polymerase chain reaction (rRT-PCR) test; 2) enhanced biosecurity measures in combination with a premovement isolation period (PMIP), restricting movement onto the premises for a few days before movement to slaughter; and 3) incorporation of a distance factor from known infected flocks such that exposure via local area spread is unlikely. Daily exposure likelihood estimates from spatial kernels from past HPAI outbreaks were coupled with simulation models of disease spread and active surveillance to evaluate active surveillance protocol options that differ with respect to the number of swabs per pooled sample and the timing of the tests in relation to movement. Simulation model results indicate that active surveillance testing, in combination with strict biosecurity, substantially increased HPAI virus detection probability. When distance from a known infected flock was considered, the overall combined likelihood of moving an infected, undetected turkey flock to slaughter was predicted to be lower at 3 and 5 km. The analysis of different active surveillance protocol options is designed to incorporate flexibility into HPAI emergency response plans.

Objectives: Acid-suppressive therapy (AST) is widely used for gastrointestinal prophylaxis in hospitalized patients, particularly to prevent stress-related mucosal bleeding in critically ill individuals. Previous reports suggest gross overutilization and continuation of unnecessary therapy, which have been linked to several adverse effects., Methods: Retrospective chart review at a large tertiary care hospital, evaluating the use of AST for ulcer prophylaxis in accordance with American Society of Health-System Pharmacists' guidelines and the less commonly studied nonsteroidal anti-inflammatory drug-related ulcer prophylaxis guidelines., Results: A total of 119 (39.3%) patients who received AST met either American Society of Health-System Pharmacists guidelines or nonsteroidal anti-inflammatory drug-related prophylaxis guidelines. Subjects whose AST was appropriate were older, had a higher Charlson Comorbidity Index (P < 0.001), and were more often men (P = 0.005). The rate of discontinuation at discharge was 70.7%; subjects whose prescriptions were not discontinued were older, had a higher Charlson Comorbidity Index, and longer hospital and intensive care unit lengths of stay (P < 0.001). Family medicine physicians, hospitalists, and surgeons prescribed AST similarly; internal medicine physicians demonstrated higher adherence with guidelines than all others (P = 0.02). Adherence varied by etiology; cardiology patients were treated with the highest level of appropriateness (53.6%), whereas those admitted for gastrointestinal diagnoses demonstrated the lowest (17.6%, P = 0.03)., Conclusions: Inappropriate prescribing of AST for ulcer prophylaxis remains problematic. There may be differences in prescribing habits of physicians of different specialties. Age and comorbidity scores were associated with inappropriate prescribing and continuation of medication at discharge. Interventions to raise prescribers' awareness of ulcer risk factors in hospitalized patients, both in the intensive care unit and those who are noncritically ill, are needed.

The regulatory response to an outbreak of highly pathogenic avian influenza (HPAI) in the United States may involve quarantine and stop movement orders that have the potential to disrupt continuity of operations in the U.S. turkey industry--particularly in the event that an uninfected breeder flock is located within an HPAI Control Area. A group of government-academic-industry leaders developed an approach to minimize the unintended consequences associated with outbreak response, which incorporates HPAI control measures to be implemented prior to moving hatching eggs off of the farm. Quantitative simulation models were used to evaluate the movement of potentially contaminated hatching eggs from a breeder henhouse located in an HPAI Control Area, given that active surveillance testing, elevated biosecurity, and a 2-day on-farm holding period were employed. The risk analysis included scenarios of HPAI viruses differing in characteristics as well as scenarios in which infection resulted from artificial insemination. The mean model-predicted number of internally contaminated hatching eggs released per movement from an HPAI-infected turkey breeder henhouse ranged from 0 to 0.008 under the four scenarios evaluated. The results indicate a 95% chance of no internally contaminated eggs being present per movement from an infected house before detection. Sensitivity analysis indicates that these results are robust to variation in key transmission model parameters within the range of their estimates from available literature. Infectious birds at the time of egg collection are a potential pathway of external contamination for eggs stored and then moved off of the farm; the predicted number of such infectious birds was estimated to be low. To date, there has been no evidence of vertical transmission of HPAI virus or low pathogenic avian influenza virus to day-old poults from hatching eggs originating from infected breeders. The application of risk analysis methods was beneficial for evaluating outbreak measures developed through emergency response planning initiatives that consider the managed movement of hatching eggs from monitored premises in an HPAI Control Area.

Milk and dairy products are an important source of choline, a nutrient essential for human health. Infant formula derived from bovine milk contains a number of metabolic forms of choline, all contribute to the growth and development of the newborn. At present, little is known about the factors that influence the concentrations of choline metabolites in milk. The objectives of this study were to characterize and then evaluate associations for choline and its metabolites in blood and milk through the first 37 weeks of lactation in the dairy cow. Milk and blood samples from twelve Holstein cows were collected in early, mid and late lactation and analyzed for acetylcholine, free choline, betaine, glycerophosphocholine, lysophosphatidylcholine, phosphatidylcholine, phosphocholine and sphingomyelin using hydrophilic interaction liquid chromatography-tandem mass spectrometry, and quantified using stable isotope-labeled internal standards. Total choline concentration in plasma, which was almost entirely phosphatidylcholine, increased 10-times from early to late lactation (1305 to 13,535 µmol/L). In milk, phosphocholine was the main metabolite in early lactation (492 µmol/L), which is a similar concentration to that found in human milk, however, phosphocholine concentration decreased exponentially through lactation to 43 µmol/L in late lactation. In contrast, phosphatidylcholine was the main metabolite in mid and late lactation (188 µmol/L and 659 µmol/L, respectively), with the increase through lactation positively correlated with phosphatidylcholine in plasma (R2 = 0.78). Unlike previously reported with human milk we found no correlation between plasma free choline concentration and milk choline metabolites. The changes in pattern of phosphocholine and phosphatidylcholine in milk through lactation observed in the bovine suggests that it is possible to manufacture infant formula that more closely matches these metabolites profile in human milk.

Domestic broiler chickens rapidly accumulate fat and are naturally hyperglycemic and insulin resistant, making them an attractive model for studies of human obesity. We previously demonstrated that short-term (5 h) fasting rapidly upregulates pathways of fatty acid oxidation in broiler chickens and proposed that activation of these pathways may promote leanness. The objective of the current study was to characterize adipose tissue from relatively lean and fatty lines of chickens and determine if heritable leanness in chickens is associated with activation of some of the same pathways induced by fasting. We compared adipose gene expression and metabolite profiles in white adipose tissue of lean Leghorn and Fayoumi breeds to those of fattier commercial broiler chickens. Both lipolysis and expression of genes involved in fatty acid oxidation were upregulated in lean chickens compared with broilers. Although there were strong similarities between the lean lines compared with broilers, distinct expression signatures were also found between Fayoumi and Leghorn, including differences in adipogenic genes. Similarities between genetically lean and fasted chickens suggest that fatty acid oxidation in white adipose tissue is adaptively coupled to lipolysis and plays a role in heritable differences in fatness. Unique signatures of leanness in Fayoumi and Leghorn lines highlight distinct pathways that may provide insight into the basis for leanness in humans. Collectively, our results provide a number of future directions through which to fully exploit chickens as unique models for the study of human obesity and adipose metabolism.

Viruses contribute to the mortality of marine microbes, consequentially altering biological species composition and system biogeochemistry. Although it is well established that host cells provide metabolic resources for virus replication, the extent to which infection reshapes host metabolism at a global level and the effect of this alteration on the cellular material released following viral lysis is less understood. To address this knowledge gap, the growth dynamics, metabolism and extracellular lysate of roseophage-infected Sulfitobacter sp. 2047 was studied using a variety of techniques, including liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based metabolomics. Quantitative estimates of the total amount of carbon and nitrogen sequestered into particulate biomass indicate that phage infection redirects ∼75% of nutrients into virions. Intracellular concentrations for 82 metabolites were measured at seven time points over the infection cycle. By the end of this period, 71% of the detected metabolites were significantly elevated in infected populations, and stable isotope-based flux measurements showed that these cells had elevated metabolic activity. In contrast to simple hypothetical models that assume that extracellular compounds increase because of lysis, a profile of metabolites from infected cultures showed that >70% of the 56 quantified compounds had decreased concentrations in the lysate relative to uninfected controls, suggesting that these small, labile nutrients were being utilized by surviving cells. These results indicate that virus-infected cells are physiologically distinct from their uninfected counterparts, which has implications for microbial community ecology and biogeochemistry.

Background: Physicians may hesitate to implement electronic health record (EHR) systems because they fear a decrease in patient satisfaction. We conducted a systematic review to determine whether physician EHR use in the patient room affects patient satisfaction., Methods: We searched the literature using MEDLINE (Ovid), EMBASE, CINAHL, Cochrane Library, PsycINFO, Proceedings First, and ProQuest Digital Dissertations. Our inclusion criteria were a description of physician EHR use in the examination room, EHR use in an outpatient setting, setting in the United States, publication year no earlier than 2000, and measurement of patient satisfaction. We included both qualitative and quantitative research. We included 7 articles in the final analysis: 3 cross-sectional, and 4 pre-design and post-design., Results: Several studies had methodological concerns. Six studies found that physician EHR use had either a positive or neutral effect on patient satisfaction. One study found a negative effect on the physicians' perception of patient satisfaction. The reported statistical results from these studies were not homogenous enough for meta-analysis., Conclusion: Studies examining physician EHR use have found mostly neutral or positive effects on patient satisfaction, but primary care researchers need to conduct further research for a more definitive answer.

African Americans have poorer levels of hypertensive control than their white counterparts in the US population. Multiple studies have examined the factors that contribute to this discrepancy, but no literature review has yet attempted to place these findings within the framework of health behavior theory. The Health Belief Model (HBM) and social cognitive theory (SCT) are 2 complementary models of health behavior theory that provide a unifying structure to interpret this broad body of literature. Inaccurate lay public understanding of hypertensive illness and its consequences contributes to decreased perceived severity and susceptibility to hypertension; lower rates of compliance with lifestyle recommendations reflect several common perceived barriers along with low self-efficacy and outcome efficacy regarding hypertensive treatments. Public health workers and health care providers must understand these factors within a socioecological perspective if they are to design effective interventions to assist African Americans in meeting antihypertensive treatment goals.

An estimated 250 physicians will commit suicide this year. In this essay, the author shares her grief and guilt over the suicide of a colleague while reflecting on both the scale of this largely unacknowledged problem and the stigma that prevents our profession from adequately addressing it. Physicians are as vulnerable to depression as is the general population, but they seek care at lower rates and commit suicide at higher rates. Fears regarding loss of professional stature and respect often prevent depressed physicians from accessing needed mental health services. This same stigma can also compound the mourning process of the colleagues and family of those physicians who complete suicide. As a profession, physicians must strengthen existing resources for impaired colleagues and work collaboratively to destigmatize treatment for mental illnesses.

In the academic year 1989-90, the department of surgery at one college of medicine revised its third-year clerkship to focus on students' learning decision-making skills and critical thinking (cognitive skills) and acquiring knowledge about surgery. Learning to perform procedures and tasks (psychomotor skills) would be accomplished in the required fourth-year acting internships. Problem-based learning (PBL) was chosen as the clerkship's primary instructional method. Comprehensive student and program evaluation systems were established. The response by faculty and students has been very positive. Students believe that the new clerkship has helped them increase their abilities in resource use, time management, and retention of knowledge. Faculty have noted students' increased eagerness and enthusiasm for learning.

Saccharomyces cerevisiae was incubated in aerosol cans containing YM broth and dichlorofluoromethane (f-21). The presence and number of viable cells were determined by inoculating (1% vol/vol) YM broth and by the plate count procedure (YM agar). Inactivation of the yeast was greater or more rapid when: (i) the thermodynamic activity (saturation value) of f-21 became greater through increasing the concentration of chemical from 0.5 to 1.5% (wt/wt) in a given volume (20, 40, or 80 ml) of broth, or by holding the concentration of chemical constant but increasing the volume of broth in the test vessel, (ii) the temperature of treatment was increased (7, 22, 37, and 47 C), (iii) samples with 1.5% (wt/wt) f-21 were agitated, (iv) young (8 h) rather than old (36 h or 10 days) cells were treated, and (v) cells were grown in YM broth without, rather than with, glucose. Adjusting the pH (6.3 to 4.0) of broth before treatment, pretreating the substrate with f-21, or distilling the chemical before use had no effect on viability of cells when treated with f-21. Yeast cells inactivated by f-21, chlorine, or heat were more resistant to disruption by sonic treatment than were viable cells.

During graduate training, students often undertake some teaching responsibilities, which provides useful experience for a future career in academia. However, they receive little guidance to prepare them for this role. This article describes some of the attempts that have been made to overcome this deficiency, with emphasis on the specially developed teaching course offered to graduate students at the University of Kentucky; this provides instruction on planning, implementing and evaluating instruction, and classroom training in instructional skills. Evaluation suggests that the programme is relevant and effective, and provides a useful model for other medical schools.