Estimating variances and covariances for bivariate animal models using scaling and transformation

International audienc

Keeping Rural Medical Students Connected to their Roots: A “Home for the Holidays” Immersion Experience

Keeping Rural Medical Students Connected to their Roots: A “Home for the Holidays” Immersion Experience Abstract Introduction Preclinical medical students with an initial affinity for rural practice often experience urban disruption during training. Longer summer rural immersion experiences have been shown to be somewhat effective in keeping rural students connected to their rural roots. Some students cannot adapt their schedules to these longer experiences. In response, a brief practice experience near home during the winter break of the academic year was established. Methods Nineteen detailed rural practice assessments were completed by preclinical medical students during school years 2009-2014 and essays and anonymous evaluations of the experience were analyzed. Results All students reported the four components of the experience increased understanding of rural medicine and all but 2 reported it was relevant to their career objectives. These two, at this early stage in training, decided rural practice was not for them and subsequently chose sub-specialty training. Six of the 12 (50%) who have completed medical school chose a family medicine residency. The themes in the essay portion included insights into rural lifestyle, returning home, health system organization issues, and patient expectations and traditions. Conclusions Initial experience with a “home for the holidays” approach for rural immersion of rural medical students was successful in reconnecting these students to their roots, and 17/19 (90%) reported their intention to choose rural practice

Rural Medical Student Opinions About Rural Practice: Does Choice of College Make a Difference?

Purpose While many programs assume medical students who attended rural colleges are more likely to practice in smaller towns later, there are few studies to support this assumption. This study examines aspects of medical students’ opinions about rural living and rural practice based on where they attended college. Method Students with rural upbringing were identified and administered a previously published rural health opinion survey. The opinion survey was administered across three academic years, from 2015 to 2017, and included a total of three scales and nine subscales for analysis. Factor analysis was used to identify the nine subscales. Results Respondents who attended small town colleges tended to have much stronger opinions about the positive aspects of small town living. Small town college attendees also had stronger positive opinions regarding rural practice than their larger college counterparts. Discussion These preliminary data indicate considering a medical school applicants’ choice of college may provide insight into their opinions about future rural practice. Additional research is needed to collect a larger dataset to examine the association of college choice with opinions about rural practice

Do medical residents with rural upbringing show less decline in empathy during training? A report from a rural family medicine residency

Abstract Purpose Our focus in this study was to determine if demographic variables, including specifically rural upbringing, showed any association with a measure of empathy among family medicine residents at a rural site. Methods We surveyed 40 residents annually using the Jefferson Scale of Empathy (JSE) from 2016 to 2020 and compared scores between residents with rural vs urban hometowns. The response rate was 98/99 (99%) of completed survey opportunities. Findings There was no significant difference in JSE scores of rural vs urban residents at baseline, and both groups showed a decline after the PG-1 year. However, the rural-raised residents showed a significantly different rebound after the PG-2 and PG-3 year, with the urban-raised residents actually showing a slight continuing decline (p=.023 and p=.033). Conclusion These preliminary findings among family medicine residents at a rural site suggest that rural background residents might regain empathy better than urban background residents during the course of their training. Further study should validate our findings and address possible explanations, including the importance of cultural concordance with the patient population served. This and other hypotheses will be explored in further studies with focus groups and other contemporaneous measures

Emerging infectious diseases in an island ecosystem: the New Zealand perspective.

Several unique features characterize infectious disease epidemiology in New Zealand. Historically, well-organized, government-run control programs have eliminated several zoonoses. More recently, however, communicable disease control has been mixed. Rates of rheumatic fever, tuberculosis, and enteric infectious are high, and rates of meningococcal disease are increasing. These diseases are over-represented in New Zealanders of Polynesian descent, who generally live in more deprived and overcrowded conditions than do those of European descent. Measles and pertussis epidemics are recurring because of inadequate vaccine coverage, despite a well-developed childhood immunization program. A progressive response to the HIV epidemic has resulted in relatively low rates of infection, particularly among injecting drug users; however, the response to other sexually transmitted infections has been poor. A key challenge for the future is to build on successful strategies and apply them to persisting and emerging infectious disease threats in a small, geographically isolated country with limited economic resources

Changes In Rural Affinity Among Rural Medical Students As They Experience Education In An Urban Setting

Abstract Introduction The maldistribution of physicians in the United States has led to a shortage of healthcare providers in rural areas and rural patients being underserved. A physician’s connections to rural settings, including upbringing and medical training, often influence the decision to practice in rural areas. This study examines opinions from medical students who participated in a regional rural campus track, which includes summer immersion programs, rural-focused sessions, and clinical rotations. The authors hypothesized that Rural Track students experience urban disruption, and their opinions about rural living and practice would become increasingly less positive over time while students lived at the urban campus for preclinical coursework. Materials and Methods The Rural Health Opinion Survey (RHOS), a previously published measure of opinions concerning living and practicing in rural areas, was administered to students at one public medical school located in Louisville, Kentucky. Factor analysis was performed on each of the three sections of the survey (items related to rural living, patients in rural areas, and physicians in rural areas), and composite subscale scores were calculated for each student. The first phase of this large longitudinal study reported here uses t-tests to compare pre- and post-test scores for 36 students in the Rural Track program. Scores of M1/M2 students who were based at the urban campus were also compared to M3/M4 students who had returned to the rural campus. Results Ninety-two percent (36/39) of Rural Track students completed both pre- and post-surveys, and of these respondents, 89% percent (32/36) grew up in a hometown with fewer than 30,000 people. Overall scores were not significantly different between Rural Track M1/M2 in the urban setting and the Rural Track M3/M4 students based at the rural campus. M3/M4 students showed a differential positive opinion over time of rural comfortable living that approached significance and agreed less that the rural physician workload is heavier. M1/M2 students expressed more positive opinions over time about availability of quality service. Both groups showed strong agreement over time that rural patients are more motivated. Discussion Our hypothesis that Rural Track students on the urban campus would show increasingly less positive opinions about rural health and practice was not supported. Students may not have experienced urban disruption because of the Rural Track curriculum elements, and/or time in the urban environment may have reinforced rural affinity by providing new perspective on the positive aspects of rural settings. Further research and efforts are necessary to identify critical points of reconnection for medical students and to support rural affinity within medical school curriculum. Upcoming research efforts will address the overall hypothesis that Rural Track students’ continued connection to rural settings generates more positive opinions about rural living and practice as compared to opinions from students with rural backgrounds who spend all four years of medical school in the urban setting

Keeping Rural Medical Students Connected to their Roots: A “Home for the Holidays” Immersion Experience

Introduction Preclinical medical students with an initial affinity for rural practice often experience urban disruption during training. Longer summer rural immersion experiences have been shown to be somewhat effective in keeping rural students connected to their rural roots. Some students cannot adapt their schedules to these longer experiences. In response, a brief practice experience near home during the winter break of the academic year was established. Methods Nineteen detailed rural practice assessments were completed by preclinical medical students during school years 2009-2014 and essays and anonymous evaluations of the experience were analyzed. Results All students reported the four components of the experience increased understanding of rural medicine and all but 2 reported it was relevant to their career objectives. These two, at this early stage in training, decided rural practice was not for them and subsequently chose sub-specialty training. Six of the 12 (50%) who have completed medical school chose a family medicine residency. The themes in the essay portion included insights into rural lifestyle, returning home, health system organization issues, and patient expectations and traditions. Conclusions Initial experience with a “home for the holidays” approach for rural immersion of rural medical students was successful in reconnecting these students to their roots, and 17/19 (90%) reported their intention to choose rural practice

SAXS reveals highly flexible interdomain linkers of tandem acyl carrier protein–thioesterase domains from a fungal non‐reducing polyketide synthase

Menisporopsin A is a fungal bioactive macrocyclic polylactone requiring only reducing (R) and non-reducing (NR) polyketide synthases (PKSs) to guide a series of esterification and cyclolactonization reactions with no structural information pertaining to these PKSs. Here we report the solution characterization of singlet and doublet acyl carrier protein (ACP2 and ACP1-ACP2)-thioesterase (TE) domains from NR-PKS, involved in menisporopsin A biosynthesis. Small angle X-ray scattering (SAXS) studies in combination with homology modelling reveal that these polypeptides adopt a distinctive Beads-on-aString configuration, characterized by the presence of highly flexible interdomain linkers. These models provide a platform for studying domain organization and interdomain interactions in fungal NR-PKSs, which may be of value in directing the design of functionally optimised polyketide scaffolds