Associations between quality indicators of internal medicine residency training programs

<p>Abstract</p> <p>Background</p> <p>Several residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these potential measures of program quality.</p> <p>Methods</p> <p>Survey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression.</p> <p>Results</p> <p>Fifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p < 0.05). PGY3 IM-ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p < 0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation.</p> <p>Conclusions</p> <p>Associations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification.</p

Macronutrient Intake, Diagnosis Status, and Glycemic Control Among US Hispanics/Latinos With Diabetes

CONTEXT: Diet modification is a mainstay of diabetes management. US Hispanics/Latinos are disproportionately affected by diabetes, but few studies have examined dietary intake among US Hispanics/Latinos with diabetes, and little is known regarding the influence of diabetes awareness on dietary intake. OBJECTIVE: We evaluated macronutrient intake and its associations with diabetes awareness and glycemic control among US Hispanics/Latinos with diabetes. PARTICIPANTS: This analysis included 3310 diabetic adults aged 18–74 years from the Hispanic Community Health Study/Study of Latinos (2008–2011). MAIN OUTCOME MEASURES: Diabetes was defined as diagnosed (based on medical history or antihyperglycemic medication use) or undiagnosed diabetes (based on fasting glucose ≥ 126 mg/dL, glycated hemoglobin [HbA1c] ≥ 6.5%, or 2 h glucose ≥ 200 mg/dL in the absence of a physician diagnosis). Dietary intake was assessed using two 24-hour recalls. RESULTS: Among Hispanic/Latino adults with diabetes, 21.2%, 55.7%, and 71.2% met the American Diabetes Association recommendations for fiber (≥14 g per 1000 kcal), saturated fat (<10% of total energy), and cholesterol intake (<300 mg), respectively. Compared with those with undiagnosed diabetes, people with diagnosed diabetes consumed less carbohydrate (50.3 vs 52.4% of total energy; P = .017), total sugar (19.1 vs 21.5% of total energy; P = .002), added sugar (9.8 vs 12.1% of total energy; P < .001), and more total fat (30.7 vs 29.3% of total energy; P = .048) and monounsaturated fat (11.5 vs 10.7% of total energy; P = .021). Association between diabetes awareness and low total and added sugar intake was observed in individuals of Mexican and Puerto Rican background but not in other groups (P for interaction < .05). Among people with diagnosed diabetes, those with HbA1c of 7% or greater consumed more total fat, saturated fat, and cholesterol than those with HbA1c less than 7% (all P < .05). CONCLUSIONS: Among US Hispanics/Latinos with diabetes, fiber intake is low, and diabetes awareness is associated with reduced carbohydrate and sugar intake and increased monounsaturated fat intake. Sugar intake may require special attention in certain Hispanic/Latino background groups

The GALAH survey: An abundance, age, and kinematic inventory of the solar neighbourhood made with TGAS

The overlap between the spectroscopic Galactic Archaeology with HERMES (GALAH) survey and Gaia provides a high-dimensional chemodynamical space of unprecedented size. We present a first analysis of a subset of this overlap, of 7066 dwarf, turn-off, and sub-giant stars. These stars have spectra from the GALAH survey and high parallax precision from the Gaia DR1 Tycho-Gaia Astrometric Solution. We investigate correlations between chemical compositions, ages, and kinematics for this sample. Stellar parameters and elemental abundances are derived from the GALAH spectra with the spectral synthesis code SPECTROSCOPY MADE EASY. We determine kinematics and dynamics, including action angles, from the Gaia astrometry and GALAH radial velocities. Stellar masses and ages are determined with Bayesian isochrone matching, using our derived stellar parameters and absolute magnitudes. We report measurements of Li, C, O, Na, Mg, Al, Si, K, Ca, Sc, Ti, V, Cr, Mn, Co, Ni, Cu, Zn, Y, as well as Ba and we note that we have employed non-LTE calculations for Li, O, Al, and Fe. We show that the use of astrometric and photometric data improves the accuracy of the derived spectroscopic parameters, especially log g. Focusing our investigation on the correlations between stellar age, iron abundance [Fe/H], and mean alpha-enhancement [α/Fe] of the magnitude-selected sample, we recover the result that stars of the high-α sequence are typically older than stars in the low-α sequence, the latter spanning iron abundances of −0.7 8 Gyr) have lower angular momenta Lz than the Sun, which implies that they are on eccentric orbits and originate from the inner disc. Contrary to some previous smaller scale studies we find a continuous evolution in the high-α-sequence up to super-solar [Fe/H] rather than a gap, which has been interpreted as a separate “high-α metal-rich” population. Stars in our sample that are younger than 10 Gyr, are mainly found on the low α-sequence and show a gradient in Lz from low [Fe/H] (Lz >  Lz, ⊙) towards higher [Fe/H] (Lz <  Lz, ⊙), which implies that the stars at the ends of this sequence are likely not originating from the close solar vicinity.Open Access funding provided by Max Planck Society. S.B. and K.L. acknowledge funds from the Alexander von Humboldt Foundation in the framework of the Sofja Kovalevskaja Award endowed by the Federal Ministry of Education and Research. S.B. acknowledges support from the Hunstead Fund for Astrophysics at the University of Sydney and the National Science Foundation under Grant No. PHY-1430152 (JINA Center for the Evolution of the Elements). K.L. acknowledges funds from the Swedish Research Council (Grant nr. 2015-00415_3) and Marie Sklodowska Curie Actions (Cofund Project INCA 600398). L.D. gratefully acknowledges a scholarship from Zonta International District 24 and support from ARC grant DP160103747. L.C. is the recipient of an ARC Future Fellowship (project number FT160100402). S.L.M. acknowledges financial support from the Australian Research Council through grant DE140100598. K.C., G.T., and T.Z. acknowledge support by the core funding grant P1-0188 from the Slovenian Research Agency. D.M.N. was supported by the Allan C. and Dorothy H. Davis Fellowship. Parts of this research were conducted by the Australian Research Council Centre of Excellence for All Sky Astrophysics in 3 Dimensions (ASTRO 3D), through project number CE170100013

The GALAH survey: observational overview and Gaia DR1 companion

The Galactic Archaeology with HERMES (GALAH) survey is amassive observational project to trace the MilkyWay's history of star formation, chemical enrichment, stellar migration and minor mergers. Using high-resolution (R ≃ 28 000) spectra, taken with the High Efficiency and Resolution Multi-Element Spectrograph (HERMES) instrument at the Anglo-Australian Telescope, GALAH will determine stellar parameters and abundances of up to 29 elements for up to one million stars. Selecting targets from a colour-unbiased catalogue built from 2MASS, APASS and UCAC4 data, we expect to observe dwarfs at 0.3-3 kpc and giants at 1-10 kpc. This enables a thorough local chemical inventory of the Galactic thin and thick discs, and also captures smaller samples of the bulge and halo. In this paper, we present the plan, process and progress as of early 2016 for GALAH survey observations. In our first two years of survey observing we have accumulated the largest high-quality spectroscopic data set at this resolution, over 200 000 stars. We also present the first public GALAH data catalogue: stellar parameters (Teff, log(g), [Fe/H], [α/Fe]), radial velocity, distance modulus and reddening for 10 680 observations of 9860 Tycho-2 stars, 7894 of which are included in the first Gaia data release.SLM and DBZ acknowledge support from Australian Research Council grants DE140100598 and FT110100743. JPM is supported by a UNSW Vice-Chancellor’s Research Fellowship. KL and SB acknowledge funds from the Alexander von Humboldt Foundation in the framework of the Sofja Kovalevskaja Award endowed by the Federal Ministry of Education and Research as well as funds from the Swedish Research Council (Grant no. 2015-00415_3) and Marie Sklodowska Curie Actions (Cofund Project INCA 600398). This work was partly supported by the European Union FP7 programme through ERG grant number 320360

ABUNDANCES, STELLAR PARAMETERS, AND SPECTRA FROM THE SDSS-III/APOGEE SURVEY

The SDSS-III/Apache Point Observatory Galactic Evolution Experiment (APOGEE) survey operated from 2011–2014 using the APOGEE spectrograph, which collects high-resolution (R ~ 22,500), near-IR (1.51–1.70 µm) spectra with a multiplexing (300 fiber-fed objects) capability. We describe the survey data products that are publicly available, which include catalogs with radial velocity, stellar parameters, and 15 elemental abundances for over 150,000 stars, as well as the more than 500,000 spectra from which these quantities are derived. Calibration relations for the stellar parameters (Teff , log g, [M/H], [a/M]) and abundances (C, N, O, Na, Mg, Al, Si, S, K, Ca, Ti, V, Mn, Fe, Ni) are presented and discussed. The internal scatter of the abundances within clusters indicates that abundance precision is generally between 0.05 and 0.09 dex across a broad temperature range; it is smaller for some elemental abundances within more limited ranges and at high signal-to-noise ratio. We assess the accuracy of the abundances using comparison of mean cluster metallicities with literature values, APOGEE observations of the solar spectrum and of Arcturus, comparison of individual star abundances with other measurements, and consideration of the locus of derived parameters and abundances of the entire sample, and find that it is challenging to determine the absolute abundance scale; external accuracy may be good to 0.1–0.2 dex. Uncertainties may be larger at cooler temperatures (Teff < 4000 K). Access to the public data release and data products is described, and some guidance for using the data products is provided

Ginger inhibits cell growth and modulates angiogenic factors in ovarian cancer cells

<p>Abstract</p> <p>Background</p> <p>Ginger (<it>Zingiber officinale </it>Rosc) is a natural dietary component with antioxidant and anticarcinogenic properties. The ginger component [6]-gingerol has been shown to exert anti-inflammatory effects through mediation of NF-κB. NF-κB can be constitutively activated in epithelial ovarian cancer cells and may contribute towards increased transcription and translation of angiogenic factors. In the present study, we investigated the effect of ginger on tumor cell growth and modulation of angiogenic factors in ovarian cancer cells <it>in vitro</it>.</p> <p>Methods</p> <p>The effect of ginger and the major ginger components on cell growth was determined in a panel of epithelial ovarian cancer cell lines. Activation of NF-κB and and production of VEGF and IL-8 was determined in the presence or absence of ginger.</p> <p>Results</p> <p>Ginger treatment of cultured ovarian cancer cells induced profound growth inhibition in all cell lines tested. We found that <it>in vitro</it>, 6-shogaol is the most active of the individual ginger components tested. Ginger treatment resulted in inhibition of NF-kB activation as well as diminished secretion of VEGF and IL-8.</p> <p>Conclusion</p> <p>Ginger inhibits growth and modulates secretion of angiogenic factors in ovarian cancer cells. The use of dietary agents such as ginger may have potential in the treatment and prevention of ovarian cancer.</p

The GALAH+ Survey : Third Data Release

© 2021 The Author(s) Published by Oxford University Press on behalf of the Royal Astronomical Society. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1093/mnras/stab1242The ensemble of chemical element abundance measurements for stars, along with precision distances and orbit properties, provides high-dimensional data to study the evolution of the Milky Way. With this third data release of the Galactic Archaeology with HERMES (GALAH) survey, we publish 678 423 spectra for 588 571 mostly nearby stars (81.2% of stars are within 75 stellar clusters. We derive stellar parameters $T_\text{eff}$, $\log g$, [Fe/H], $v_\text{mic}$, $v_\text{broad}$ & $v_\text{rad}$ using our modified version of the spectrum synthesis code Spectroscopy Made Easy (SME) and 1D MARCS model atmospheres. We break spectroscopic degeneracies in our spectrum analysis with astrometry from $Gaia$ DR2 and photometry from 2MASS. We report abundance ratios [X/Fe] for 30 different elements (11 of which are based on non-LTE computations) covering five nucleosynthetic pathways. We describe validations for accuracy and precision, flagging of peculiar stars/measurements and recommendations for using our results. Our catalogue comprises 65% dwarfs, 34% giants, and 1% other/unclassified stars. Based on unflagged chemical composition and age, we find 62% young low-$\alpha$, 9% young high-$\alpha$, 27% old high-$\alpha$, and 2% stars with $\mathrm{[Fe/H]} \leq -1$. Based on kinematics, 4% are halo stars. Several Value-Added-Catalogues, including stellar ages and dynamics, updated after $Gaia$ eDR3, accompany this release and allow chrono-chemodynamic analyses, as we showcase.Peer reviewe

Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: the ACHIEVE trial

<p>Abstract</p> <p>Background</p> <p>Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group.</p> <p>Methods/Design</p> <p>A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m²) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months.</p> <p>Discussion</p> <p>Evidence-based approaches to the high burden of obesity and cardiovascular disease risk in person with serious mental illness are urgently needed. The ACHIEVE Trial is tailored to persons with serious mental illness in community settings. This multi-site randomized clinical trial will provide a rigorous evaluation of a practical behavioral intervention designed to accomplish and sustain weight loss in persons with serious mental illness.</p> <p>Trial Registration</p> <p>Clinical Trials.gov NCT00902694</p

Blood glucose, blood pressure, and cholesterol testing among adults with diabetes before and during the COVID-19 pandemic, USA, 2019 vs 2021

Introduction Regular blood glucose/A1c, blood pressure (BP), and cholesterol (ABC) testing is important for diabetes management. It is unknown whether pandemic-related disruptions in medical care were negatively associated with ABC testing among US adults with diagnosed diabetes.Research design and methods A cross-sectional analysis was conducted among adults ≥18 years with diagnosed diabetes who participated in the 2019 or 2021 National Health Interview Survey (n=3355 and n=3127, respectively). Adults with diabetes self-reported sociodemographic and diabetes-related characteristics, ABC testing in the past year, and delays or not getting medical care due to the pandemic (2021 only). Descriptive statistics were used to determine differences in ABC testing in 2019 vs 2021. Logistic regression models were used to assess the association between delays or not getting medical care due to the pandemic and ABC testing, adjusting for sociodemographic characteristics, diabetes duration, and diabetes medication use.Results Overall, the prevalence of having a blood glucose/A1c or a BP test in the past year was high (&gt;90%) but it was significantly lower in 2021 compared with 2019 (A1c: 94.2% vs 96.8%, p&lt;0.001; BP: 96.8% vs 98.4%, p=0.002, respectively). Cholesterol testing remained stable (93.0% in 2021 vs 94.5% in 2019, p=0.053). In logistic regression analysis, after full adjustment, adults who reported delaying or not getting medical care when needed due to the pandemic were 50% less likely to get an ABC test in the past year compared with those who promptly received medical care (A1c: adjusted OR (aOR)=0.44, 95% CI 0.29–0.68; BP: aOR=0.48, 95% CI 0.27–0.85; cholesterol: aOR=0.48, 95% CI 0.31–0.75).Conclusions Disruptions in medical care during the pandemic were associated with a decrease in ABC testing. Future research is needed to assess whether blood glucose/A1c and BP testing returns to prepandemic levels and if reductions in these tests result in excess diabetes-related complications