Nutrition in Medical Education: Where do we stand and what needs to be explored?

Introduction: Dietary interventions and nutrition care improve patient outcomes and reduce healthcare costs. Despite status as a necessary topic in medical school education, many U.S. medical schools do not adequately prepare future physicians for everyday nutritional challenges in clinical practice. There is immense research behind the necessity of nutrition education but little concerning the methods of implementing this change. The purpose of this work was to review the current innovations of nutrition curriculum in the literature and discuss future directions for our medical school. Method: A systematic search of scientific literature databases was performed to examine existing literature about the current state of nutrition curriculum and identify current methods of improving nutrition curriculum. A database search of the undergraduate GW SMHS curricula helped us map where nutrition is currently taught and look into ways to expand and integrate it. Results: Shortcomings in sufficient nutrition education result from lack of proficient faculty, low funding, and lack of established core curricula with guidelines and protocols. Additionally, international medical schools have recognized their deficiency in nutrition education compared to U.S. standards. U.S. institutions making headway in new nutrition education programs include The University of North Carolina, Chapel Hill, Boston University School of Medicine, Southern Illinois School of Medicine, University of Nevada School of Medicine, Northwestern University Feinberg School of Medicine, University of Colorado School of Medicine, Mercer University School of Medicine, and various institutions introducing “culinary medicine”. Successful nutrition integration should be spread longitudinally across all years with an emphasis on active-learning techniques over rote memorization. Creativity, chief support, an established taskforce, trained faculty, and evaluation methods are essential tools to enhance medical curriculum. Looking at GW SMHS curricula, nutrition is concentrated in the Pre-Clinical years with very little emphasis in the Clinical years, a common trend across most medical schools. Medical students may be more confident incorporating nutrition into patient care if nutrition were spread proportionally across all years to combine basic foundations with clinical application. Conclusion: Expanding nutrition curriculum at The George Washington University School of Medicine could involve utilizing the Nutrition in Medicine project developed by The University of North Carolina, Chapel Hill or bringing in internationally renowned chef José Andrés to expand on his previous culinary courses and incorporate nutrition fundamentals into the medical curriculum. Future directions need to evaluate existing programs, current initiatives, and their effectiveness in order to be able to improve programs across the continuum

Confirmation of metastases by fine needle aspiration biopsy in patients with gynecologic malignancies

Fine needle aspirations (FNA) were performed on 48 patients treated for gynecologic malignancies and suspected of having recurrence of their disease. The suspected sites of metastases were peripheral lymph nodes (38 patients) and the retroperitoneal region (10 patients). Metastatic tumors were detected in 22 out of the 48 patients (45%) by FNA, with 9 patients having additional confirmation by excisional biopsies. Of the remaining patients, 9 had unsatisfactory specimens, and 2 had false-negative results. The report emphasizes the efficacy of this procedure, especially when positive results are obtained. Open biopsy can be restricted to those patients with negative or unsatisfactory results and a high clinical suspicion of metastasis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23788/1/0000026.pd

The Gemini/HST Cluster Project: Structural and Photometric Properties of Galaxies in Three z =0.28-0.89 Clusters

We present the data processing and analysis techniques we are using to determine structural and photometric properties of galaxies in our Gemini/HST Galaxy Cluster Project sample. The goal of this study is to understand cluster galaxy evolution in terms of scaling relations and structural properties of cluster galaxies at redshifts 0.15 < z < 1.0. To derive parameters such as total magnitude, half-light radius, effective surface brightness, and Sersic n, we fit r^{1/4} law and Sersic function 2-D surface brightness profiles to each of the galaxies in our sample. Using simulated galaxies, we test how the assumed profile affects the derived parameters and how the uncertainties affect our Fundamental Plane results. We find that while fitting galaxies which have Sersic index n < 4 with r^{1/4} law profiles systematically overestimates the galaxy radius and flux, the combination of profile parameters that enter the Fundamental Plane has uncertainties that are small. Average systematic offsets and associated random uncertainties in magnitude and log r_e for n > 2 galaxies fitted with r^{1/4} law profiles are -0.1+-0.3 and 0.1+-0.2 respectively. The combination of effective radius and surface brightness, log r_e - \beta log _e, that enters the Fundamental Plane produces offsets smaller than -0.02+-0.10. This systematic error is insignificant and independent of galaxy magnitude or size. A catalog of photometry and surface brightness profile parameters is presented for three of the clusters in our sample, RX J0142.0+2131, RX J0152.7-1357, and RX J1226.9+3332 at redshifts 0.28, 0.83, and 0.89 respectively.Comment: 31 pages, 15 figure

The z=0 Galaxy Luminosity Function: I. Techniques for Identification of Dwarf Galaxies at ~10 Mpc

We present a program to study the galaxy luminosity function (GLF) of the Leo I and Coma I Groups at ~10 Mpc. We have surveyed over seven square degrees in Leo I and ~11 square degrees in Coma I. In this paper, we detail the method we have developed and implemented for identifying on morphological grounds low-surface-brightness, M_R < -10 dwarf galaxies at a distance of 10 Mpc. We also describe extensive Montecarlo simulations of artificial galaxies which we use to tune our detection algorithms and evaluate our detection efficiency and parameter recovery as a function of mu_R(0) and R_T. We find for a sub-set of our Leo I data that at the 90% completeness level we can detect dwarfs comparable to Antlia and Sculptor. Finally, we describe preliminary follow-up observations which confirm we are detecting dwarf spheroidals in Leo I at 10 Mpc.Comment: 14 pages, 22 figures, accepted for publication in ApJS, for eps versions of figures, see http://www.ucolick.org/~flint/GLF/Paper1

Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit

Objectives: People working in long-term care homes (LTCH) face difficult decisions balancing the risk of spread of infection with the hardship that infection control and prevention (ICP) measures put on residents. The Dementia Isolation Toolkit (DIT) was developed to address the gap in ethical guidance on how to safely and effectively isolate people living with dementia while supporting their personhood. In this study, we report the results of a survey of LTCH staff on barriers and facilitators regarding isolating residents, and on the use and impact of the DIT. Design: Online survey. Setting and Participants: Participants (n=208) were staff working on-site in LTCH in Ontario, Canada since March 1, 2020, with direct or indirect experience with the isolation of LTCH resi-dents. Methods: LTCH staff were recruited through provincial LTCH organizations, social media, and the DIT website. Survey results were summarized, and three groups compared, those: 1) unfamiliar with, 2) familiar with, and 3) users of the DIT. Results: 61% of respondents identified distress of LTCH staff about the harmful effects of isola-tion on residents as a major barrier to effective isolation. Facilitators for isolation included delivery of 1:1 activity in the resident’s room (81%) and designating essential caregivers to provide support (67%). Almost all respondents (84%) reported an increase in moral distress. DIT users were less likely to report an impact of moral distress on job satisfaction (OR 0.41, 95% CI 0.19-0.87) with 48% of users reporting it was helpful in reducing their level of distress. Conclusions and Implications: Isolation as an ICP measure in LTCH environments creates mor-al distress in staff which is a barrier to its effectiveness. ICP guidance to LTCH would be strength-ened with the inclusion of a dementia-specific ethical framework that addresses how to minimize the harms of isolation on both residents and staff

Prevalence, causes, and consequences of moral distress in healthcare providers caring for people living with dementia in long-term care during a pandemic

Healthcare providers caring for people living with dementia may experience moral distress when faced with ethically challenging situations, such as the inability to provide care that is consistent with their values. The COVID-19 pandemic produced conditions in long-term care homes (LTCHs) that could potentially contribute to moral distress. We conducted an online survey to examine changes in moral distress during the pandemic, its contributing factors and correlates, and its impact on the well-being of LTCH staff. Survey participants (n=227) working in LTCHs across Ontario, Canada were recruited through provincial LTCH organizations. Using a Bayesian approach, we examined the association between moral distress and staff demographics and roles, and characteristics of the LTCH. We performed a qualitative analysis of the survey's free-text responses. More than 80% of LTCH healthcare providers working with people with dementia reported an increase in moral distress since the start of the pandemic. There was no difference in the severity of distress by age, sex, role, or years of experience. The most common factors associated with moral distress were lack of activities and family visits, insufficient staffing and high turnover, and having to follow policies and procedures that were perceived to harm residents with dementia. At least two-thirds of respondents reported feelings of physical exhaustion, sadness/anxiety, frustration, powerlessness, and guilt due to the moral distress experienced during the pandemic. Respondents working in not-for-profit or municipal homes reported less sadness/anxiety and feelings of not wanting to go to work than those in for-profit homes. Front-line staff were more likely to report not wanting to work than those in management or administrative positions. Overall, we found that increases in moral distress during the pandemic negatively affected the well-being of healthcare providers in LTCHs, with preliminary evidence suggesting that individual and systemic factors may intensify the negative effect

Genetic Variation and Population Substructure in Outbred CD-1 Mice: Implications for Genome-Wide Association Studies

Outbred laboratory mouse populations are widely used in biomedical research. Since little is known about the degree of genetic variation present in these populations, they are not widely used for genetic studies. Commercially available outbred CD-1 mice are drawn from an extremely large breeding population that has accumulated many recombination events, which is desirable for genome-wide association studies. We therefore examined the degree of genome-wide variation within CD-1 mice to investigate their suitability for genetic studies. The CD-1 mouse genome displays patterns of linkage disequilibrium and heterogeneity similar to wild-caught mice. Population substructure and phenotypic differences were observed among CD-1 mice obtained from different breeding facilities. Differences in genetic variation among CD-1 mice from distinct facilities were similar to genetic differences detected between closely related human populations, consistent with a founder effect. This first large-scale genetic analysis of the outbred CD-1 mouse strain provides important considerations for the design and analysis of genetic studies in CD-1 mice

A randomized, double-blind, placebo-controlled trial of coenzyme Q10 in Huntington disease

Objective: To test the hypothesis that chronic treatment of early-stage Huntington disease (HD) with high-dose coenzyme Q10 (CoQ) will slow the progressive functional decline of HD. Methods: We performed a multicenter randomized, double-blind, placebo-controlled trial. Patients with early-stage HD (n = 609) were enrolled at 48 sites in the United States, Canada, and Australia from 2008 to 2012. Patients were randomized to receive either CoQ 2,400 mg/d or matching placebo, then followed for 60 months. The primary outcome variable was the change from baseline to month 60 in Total Functional Capacity score (for patients who survived) combined with time to death (for patients who died) analyzed using a joint-rank analysis approach. Results: An interim analysis for futility revealed a conditional power of <5% for the primary analysis, prompting premature conclusion in July 2014. No statistically significant differences were seen between treatment groups for the primary or secondary outcome measures. CoQ was generally safe and well-tolerated throughout the study. Conclusions: These data do not justify use of CoQ as a treatment to slow functional decline in HD