Hospitalist involvement in family medicine residency training: A CERA study

BACKGROUND AND OBJECTIVES: Little is known about the impact of hospitalists on family medicine residencies. We surveyed family medicine residency directors to assess attitudes about hospitalists and their involvement in residency teaching. METHODS: Questions were included in the 2012 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency directors. Univariate statistics were used to describe programs, directors, and our questions on the use of hospitalists. Bivariate statistics were used to examine relationships between the use of hospitalists to teach and program characteristics. RESULTS: Forty-one percent (n=175) of residency directors completed the hospitalist section of the CERA survey. Sixty-six percent of residency programs were community based/university affiliated. The majority of directors who have, or are planning to develop, a hospitalist service currently use an internal medicine service (92.5%), followed by family medicine (39.1%), pediatrics (35.4%), OB/laborists (18.0%), and combined services (8.7%). The majority of programs with a hospitalist training track (or plans to develop one) indicated that this was for a family medicine service. Sixty percent of programs that have a hospitalist service involve hospitalists in teaching. Twenty percent of directors reported that hospitalists serve as family medicine faculty, and 63% viewed them as good educators. However, 85% reported no reduction in inpatient teaching by family medicine faculty despite using hospitalist teaching services. CONCLUSIONS: Hospitalists have a significant educational role in family medicine resident training. Further research is needed to explore how hospitalists and family medicine faculty can collaborate to promote enhanced efficiency and effectiveness as residency teachers

DNA end resection by Dna2–Sgs1–RPA and its stimulation by Top3–Rmi1 and Mre11–Rad50–Xrs2

The repair of DNA double-strand breaks (DSBs) by homologous recombination requires processing of broken ends. For repair to start, the DSB must first be resected to generate a 3′-single-stranded DNA (ssDNA) overhang, which becomes a substrate for the DNA strand exchange protein, Rad51 (ref. 1). Genetic studies have implicated a multitude of proteins in the process, including helicases, nucleases and topoisomerases. Here we biochemically reconstitute elements of the resection process and reveal that it requires the nuclease Dna2, the RecQ-family helicase Sgs1 and the ssDNA-binding protein replication protein-A (RPA). We establish that Dna2, Sgs1 and RPA constitute a minimal protein complex capable of DNA resection in vitro. Sgs1 helicase unwinds the DNA to produce an intermediate that is digested by Dna2, and RPA stimulates DNA unwinding by Sgs1 in a species-specific manner. Interestingly, RPA is also required both to direct Dna2 nucleolytic activity to the 5′-terminated strand of the DNA break and to inhibit 3′ to 5′ degradation by Dna2, actions that generate and protect the 3′-ssDNA overhang, respectively. In addition to this core machinery, we establish that both the topoisomerase 3 (Top3) and Rmi1 complex and the Mre11–Rad50–Xrs2 complex (MRX) have important roles as stimulatory components. Stimulation of end resection by the Top3–Rmi1 heterodimer and the MRX proteins is by complex formation with Sgs1 (refs 5, 6), which unexpectedly stimulates DNA unwinding. We suggest that Top3–Rmi1 and MRX are important for recruitment of the Sgs1–Dna2 complex to DSBs. Our experiments provide a mechanistic framework for understanding the initial steps of recombinational DNA repair in eukaryotes

Utilisation de la toxine botulinique dans les pathologies spastiques

RésuméLa toxine botulinique de type A est un complexe purifié de neurotoxine dérivé de la bactérie anaérobe Clostridium botulinum. Au Canada, un seul des sept sérotypes de la bactérie est actuellement commercialisé sous le nom de Botox. La toxine botulinique de type A est impliquée en clinique dans le traitement de l’hyperactivité musculaire produite par une stimulation excessive de la libération d’acétylcholine. Actuellement, le Botox est approuvé officiellement dans le traitement du strabisme, du blépharospasme, de la dystonie cervicale et de la paralysie cérébrale chez les enfants atteints du pied bot équin. Il existe également d’autres applications cliniques non reconnues de la toxine. En général, les effets indésirables sont transitoires et varient selon la région anatomique visée. Le Botox est un produit nécessitant des conditions particulières d’entreposage et de manipulation. Bien peu d’études cliniques ont été réalisées jusqu’à maintenant afin de connaître les doses optimales, les caractéristiques des patients pouvant bénéficier d’un tel traitement, les techniques d’injection optimales ainsi que les bénéfices cliniques des autres sérotypes de la toxine.AbstractBotulinum toxin type A is a purified complex of neurotoxin that is derived from Clostridium botulinum anaerobic bacteria. In Canada, only one of the seven serotypes of the bacteria is actually marketed under the name Botox. Botulinum toxin type A is used clinically for the treatment of muscular hyperactivity produced by excessive stimulation of acetylcholine release. At the moment, Botox is officially approved for treatment of strabismus, blepharospasm, cervical dystonia and cerebral palsy in children with talipes equinus. There are also other clinical applications of the toxin that are not recognized. Adverse reactions are transient and vary depending on the anatomic area aimed. Botox requires specific storage and handling conditions. Few clinical studies have been made until now to know the optimum doses, characteristics of patients that could benefit from such a treatment, optimum injection techniques as well as clinical benefits of other toxin serotypes

Bess and Hearing Screening: Portending the Challenges in Children

This article summarizes the significant contributions of Fred H. Bess to the early detection of hearing loss in infants and children. Based on public health and educational policy, Bess challenged audiologists to view hearing screening as a responsibility that brought with it the need to develop screening tools that are effective in identifying hearing loss - whether for use with infants, preschoolers, or school-age children - and that adhere to important screening principles. A review of his influence on pertinent guidelines, position statements, and recommendations highlights his belief that early identification of hearing loss is critical if children are to overcome the significant obstacles presented by even mild and unilateral hearing losses. This section is followed by a review of seminal papers that stimulated research in universal newborn hearing screening programs and the detection of unilateral and minimal hearing loss. We conclude with a review of selected studies that build on Bess\u27s earlier work and strive to drive our field forward to practices that are both evidence-based and effective in detecting hearing loss in children

The impact of otitis media with effusion on early phonetic inventories: A longitudinal prospective investigation

This prospective investigation examined the effects of otitis media with effusion (OME) on early speech production. Two groups of infants, the otitis media positive (OME+; n = 8), and the otitis media negative (OME-; n = 8) were defined according to otitis media (OM) history during the first year of life. OM documentation was based on results from tympanometry, pneumatic otoscopy, and behavioural audiometry collected bimonthly beginning at age 2 months. Phonetic transcriptions were completed from infants' recorded babbling samples at 10, 12 and 14 months of age. No differences were found between the two groups on rate of vocalizations (i.e. consonants produced per minute). Differences between the two groups were seen in place and manner of articulation. OME+ infants produced more bilabial stops than OME- infants who, in turn, produced more alveolar stops and nasals than did their OME+ counterparts. Furthermore, within the OME+ group, children with poorer hearing thresholds showed preference for bilabial stops, whereas children with better hearing thresholds showed more diversity in their phonetic inventories