Public health training in internal medicine residency programs: a national survey

BACKGROUND: The IOM recommends public health training for all physicians. Data characterizing such training of internal medicine (IM) residents are lacking. PURPOSE: To describe the current state of public health education at IM residency programs, characterize programs offering public health education, and quantify interest in expanding training opportunities. METHODS: IM residency program directors from the 380 Accreditation Council for Graduate Medical Education-accredited residency programs in the U.S were invited to participate in a cross-sectional survey. Responses were received from 127 programs (33%). Data were collected July-December 2012 and analyzed in January 2013. Participants were queried on domestic public health training offered, perceived resident interest in and satisfaction with this training, and interest in expanding training. RESULTS: Eighty-four respondents (66%) provide some form of public health training, but structure and content vary widely. In many programs offering public health training, few residents (\u3c10%) receive it. Although 93 programs (73%) integrate public health into core curricula, only three topics were common to a majority of these programs. Sixty-six respondents (52%) offer clinical training at community-based health centers. Most residency program directors (90%) are very or somewhat interested in expanding their public health training. CONCLUSIONS: This study characterizes the structures and content of public health training across IM residency programs. The wide range highlights the diverse definition of public health training used by IM residency program directors and lack of universal public health competencies required for IM physicians. Opportunities exist for collaboration among residency programs and between IM and public health educators to share best practices

Keck Observations Confirm a Super-Jupiter Planet Orbiting M Dwarf OGLE-2005-BLG-071L

We present adaptive optics imaging from the NIRC2 instrument on the Keck II telescope that resolves the exoplanet host (and lens) star as it separates from the brighter source star. These observations yield the K-band brightness of the lens and planetary host star, as well as the lens-source relative proper motion, µ_(rel,H), in the heliocentric reference frame. The µ_(rel,H) measurement allows for the determination of the microlensing parallax vector, π_E, which had only a single component determined by the microlensing light curve. The combined measurements of µ_(rel,H) and K L provide the masses of the host star, M_(host) = 0.426 ± 0.037 M⊙, and planet, m_p = 3.27 ± 0.32M_(Jupiter) with a projected separation of 3.4 ± 0.5 au. This confirms the tentative conclusion of a previous paper that this super-Jupiter mass planet, OGLE-2005-BLG-071Lb, orbits an M dwarf. Such planets are predicted to be rare by the core accretion theory and have been difficult to find with other methods, but there are two such planets with firm mass measurements from microlensing, and an additional 11 planetary microlens events with host mass estimates <0. 0.5M⊙ and planet mass estimates >2 Jupiter masses that could be confirmed by high angular follow-up observations. We also point out that OGLE-2005-BLG-071L has separated far enough from its host star that it should be possible to measure the host-star metallicity with spectra from a high angular resolution telescope such as Keck, the Very Large Telescope, the Hubble Space Telescope, or the James Webb Space Telescope

Adaptive Optics Imaging Breaks the Central Caustic Cusp Approach Degeneracy in High Magnification Microlensing Events

We report new results for the gravitational microlensing target OGLE-2011-BLG-0950 from adaptive optics (AO) images using the Keck observatory. The original analysis by Choi et al. 2012 reports degenerate solutions between planetary and stellar binary lens systems. This is due to a degeneracy in high magnification events where the shape of the light curve peak can be explained by a source approach to two different cusp geometries with different source radius crossing times. This particular case is the most important type of degeneracy for exoplanet demographics, because the distinction between a planetary mass or stellar binary companion has direct consequences for microlensing exoplanet statistics. The 8 and 10-year baselines between the event and the Keck observations allow us to directly measure a relative proper motion of $4.20\pm 0.21\,$mas/yr, which confirms the detection of the lens star system and directly rules out the planetary companion models that predict a ${\sim}4 \times$ smaller relative proper motion. The combination of the lens brightness and close stellar binary light curve parameters yield primary and secondary star masses of $M_{A} = 1.12^{+0.06}_{-0.04}M_\odot$ and $M_{B} = 0.47^{+0.04}_{-0.03}M_\odot$ at a distance of $D_L = 6.70^{+0.55}_{-0.30}\,$kpc, and a primary-secondary projected separation of $0.39^{+0.05}_{-0.04}\,$AU. Since this degeneracy is likely to be common, the high resolution imaging method described here will be used to disentangle the central caustic cusp approach degeneracy for events observed by the \textit{Roman} exoplanet microlensing survey using the \textit{Roman} images taken near the beginning or end of the survey.Comment: Revised version, 19 pages, 8 figures. AJ, 164, 21

Structural insights into Clostridium perfringens delta toxin pore formation

Clostridium perfringens Delta toxin is one of the three hemolysin-like proteins produced by C. perfringens type C and possibly type B strains. One of the others, NetB, has been shown to be the major cause of Avian Nectrotic Enteritis, which following the reduction in use of antibiotics as growth promoters, has become an emerging disease of industrial poultry. Delta toxin itself is cytotoxic to the wide range of human and animal macrophages and platelets that present GM2 ganglioside on their membranes. It has sequence similarity with Staphylococcus aureus β-pore forming toxins and is expected to heptamerize and form pores in the lipid bilayer of host cell membranes. Nevertheless, its exact mode of action remains undetermined. Here we report the 2.4 Å crystal structure of monomeric Delta toxin. The superposition of this structure with the structure of the phospholipid-bound F component of S. aureus leucocidin (LukF) revealed that the glycerol molecules bound to Delta toxin and the phospholipids in LukF are accommodated in the same hydrophobic clefts, corresponding to where the toxin is expected to latch onto the membrane, though the binding sites show significant differences. From structure-based sequence alignment with the known structure of staphylococcal α-hemolysin, a model of the Delta toxin pore form has been built. Using electron microscopy, we have validated our model and characterized the Delta toxin pore on liposomes. These results highlight both similarities and differences in the mechanism of Delta toxin (and by extension NetB) cytotoxicity from that of the staphylococcal pore-forming toxins

Exposure effects on count outcomes with observational data, with application to incarcerated women

Causal inference methods can be applied to estimate the effect of a point exposure or treatment on an outcome of interest using data from observational studies. For example, in the Women’s Interagency HIV Study, it is of interest to understand the effects of incarceration on the number of sexual partners and the number of cigarettes smoked after incarceration. In settings like this where the outcome is a count, the estimand is often the causal mean ratio, i.e., the ratio of the counterfactual mean count under exposure to the counterfactual mean count under no exposure. This paper considers estimators of the causal mean ratio based on inverse probability of treatment weights, the parametric g-formula, and doubly robust estimation, each of which can account for overdispersion, zero-inflation, and heaping in the measured outcome. Methods are compared in simulations and are applied to data from the Women’s Interagency HIV Study

An agriculture and health inter-sectorial research process to reduce hazardous pesticide health impacts among smallholder farmers in the Andes

Authors are also recipients of the Teasdale-Corti grant (103460-068)Work with multiple actors is needed to shift agriculture away from pesticide use, and towards greater sustainability and human health, particularly for vulnerable smallholder farmers. This research in potato and vegetable farming communities in the Andean highlands worked with partners from various sectors over several projects. Increased involvement in organic agriculture was associated with greater household food security and food sovereignty. More diversified, moderately developed agricultural systems had lower pesticide use and better child nutrition. The Ecuadorian Ministry of Health has rolled out pesticide poisoning surveillance modeled on this research

Engaging Undergraduates in Science Research: Not Just About Faculty Willingness.

Despite the many benefits of involving undergraduates in research and the growing number of undergraduate research programs, few scholars have investigated the factors that affect faculty members' decisions to involve undergraduates in their research projects. We investigated the individual factors and institutional contexts that predict faculty members' likelihood of engaging undergraduates in their research project(s). Using data from the Higher Education Research Institute's 2007-2008 Faculty Survey, we employ hierarchical generalized linear modeling to analyze data from 4,832 science, technology, engineering, and mathematics (STEM) faculty across 194 institutions to examine how organizational citizenship behavior theory and social exchange theory relate to mentoring students in research. Key findings show that faculty who work in the life sciences and those who receive government funding for their research are more likely to involve undergraduates in their research project(s). In addition, faculty at liberal arts or historically Black colleges are significantly more likely to involve undergraduate students in research. Implications for advancing undergraduate research opportunities are discussed

Modulations of the Chicken Cecal Microbiome and Metagenome in Response to Anticoccidial and Growth Promoter Treatment

With increasing pressures to reduce or eliminate the use of antimicrobials for growth promotion purposes in production animals, there is a growing need to better understand the effects elicited by these agents in order to identify alternative approaches that might be used to maintain animal health. Antibiotic usage at subtherapeutic levels is postulated to confer a number of modulations in the microbes within the gut that ultimately result in growth promotion and reduced occurrence of disease. This study examined the effects of the coccidiostat monensin and the growth promoters virginiamycin and tylosin on the broiler chicken cecal microbiome and metagenome. Using a longitudinal design, cecal contents of commercial chickens were extracted and examined using 16S rRNA and total DNA shotgun metagenomic pyrosequencing. A number of genus-level enrichments and depletions were observed in response to monensin alone, or monensin in combination with virginiamycin or tylosin. Of note, monensin effects included depletions of Roseburia, Lactobacillus and Enterococcus, and enrichments in Coprococcus and Anaerofilum. The most notable effect observed in the monensin/virginiamycin and monensin/tylosin treatments, but not in the monensin-alone treatments, was enrichments in Escherichia coli. Analysis of the metagenomic dataset identified enrichments in transport system genes, type I fimbrial genes, and type IV conjugative secretion system genes. No significant differences were observed with regard to antimicrobial resistance gene counts. Overall, this study provides a more comprehensive glimpse of the chicken cecum microbial community, the modulations of this community in response to growth promoters, and targets for future efforts to mimic these effects using alternative approaches

Mixed-effects models for health care longitudinal data with an informative visiting process: A Monte Carlo simulation study.

Electronic health records are being increasingly used in medical research to answer more relevant and detailed clinical questions; however, they pose new and significant methodological challenges. For instance, observation times are likely correlated with the underlying disease severity: Patients with worse conditions utilise health care more and may have worse biomarker values recorded. Traditional methods for analysing longitudinal data assume independence between observation times and disease severity; yet, with health care data, such assumptions unlikely hold. Through Monte Carlo simulation, we compare different analytical approaches proposed to account for an informative visiting process to assess whether they lead to unbiased results. Furthermore, we formalise a joint model for the observation process and the longitudinal outcome within an extended joint modelling framework. We illustrate our results using data from a pragmatic trial on enhanced care for individuals with chronic kidney disease, and we introduce user-friendly software that can be used to fit the joint model for the observation process and a longitudinal outcome