Blood-feeding patterns of <it>Anopheles </it>mosquitoes in a malaria-endemic area of Bangladesh

<p>Abstract</p> <p>Background</p> <p>Blood-feeding patterns of mosquitoes are crucial for incriminating malaria vectors. However, little information is available on the host preferences of <it>Anopheles </it>mosquitoes in Bangladesh. Therefore, the objective of the present study was to determine the hematophagic tendencies of the anophelines inhabiting a malaria-endemic area of Bangladesh.</p> <p>Methods</p> <p>Adult <it>Anopheles </it>mosquitoes were collected using light traps (LTs), pyrethrum spray (PS), and human bait (HB) from a malaria-endemic village (Kumari, Bandarban, Bangladesh) during the peak months of malaria transmission (August-September). Enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) were performed to identify the host blood meals of <it>Anopheles </it>mosquitoes.</p> <p>Results</p> <p>In total, 2456 female anopheline mosquitoes representing 21 species were collected from the study area. <it>Anopheles vagus </it>Doenitz (35.71%) was the dominant species followed by <it>An. philippinensis </it>Ludlow (26.67%) and <it>An. minimus </it>s.l. Theobald (5.78%). All species were collected by LTs set indoors (n = 1094), 19 species were from outdoors (n = 784), whereas, six by PS (n = 549) and four species by HB (n = 29). Anopheline species composition significantly differed between every possible combination of the three collection methods (χ²test, P < 0.001). Host blood meals were successfully detected from 1318 (53.66%) <it>Anopheles </it>samples belonging to 17 species. Values of the human blood index (HBI) of anophelines collected from indoors and outdoors were 6.96% and 11.73%, respectively. The highest values of HBI were found in <it>An. baimai </it>Baimaii (80%), followed by <it>An. minimus </it>s.l. (43.64%) and <it>An. annularis </it>Van den Wulp (37.50%). <it>Anopheles baimai </it>(<it>B_i</it>= 0.63) and <it>An. minimus </it>s.l. (<it>B_i</it>= 0.24) showed strong relative preferences (<it>B_i</it>) for humans among all hosts (human, bovine, goats/sheep, and others). <it>Anopheles annularis</it>, <it>An. maculatus </it>s.l. Theobald, and <it>An. pallidus </it>Theobald exhibited opportunistic blood-feeding behavior, in that they fed on either humans or animals, depending on whichever was accessible. The remaining 12 species preferred bovines as hosts.</p> <p>Conclusions</p> <p>The observed high anthropophilic nature of <it>An. baimai</it>, <it>An. minimus </it>s.l., and <it>An. annularis </it>revealed these species to be important malaria vectors in hilly areas of Bangladesh. Higher values of HBI in outdoor-resting mosquitoes indicated that indoor collection alone is not adequate for evaluating malaria transmission in the area.</p

Doctor role modelling in medical education : BEME Guide No. 27

Aim: The aim of this review is to summarise the evidence currently available on role modelling by doctors in medical education. Methods: A systematic search of electronic databases was conducted (PubMed, Psyc- Info, Embase, Education Research Complete, Web of Knowledge, ERIC and British Education Index) from January 1990 to February 2012. Data extraction was completed by two independent reviewers and included a quality assessment of each paper. A thematic analysis was conducted on all the included papers. Results: Thirty-nine studies fulfilled the inclusion criteria for the review. Six main themes emerged from the content of high and medium quality papers: 1) the attributes of positive doctor role models; 2) the personality profiles of positive role models; 3) the influence of positive role models on students’ career choice; 4) the process of positive role modelling; 5) the influence of negative role modelling; 6) the influence of culture, diversity and gender in the choice of role model. Conclusions: This systematic review highlights role modelling as an important process for the professional development of learners. Excellence in role modelling involves demonstration of high standards of clinical competence, excellence in clinical teaching skills and humanistic personal qualities. Positive role models not only help to shape the professional development of our future physicians, they also influence their career choices. This review has highlighted two main challenges in doctor role modelling: the first challenge lies in our lack of understanding of the complex phenomenon of role modelling. Second, the literature draws attention to negative role modelling and this negative influence requires deeper exploration to identify ways to mitigate adverse effects. This BEME review offers a preliminary guide to future discovery and progress in the area of doctor role modelling

Changing Habits of Practice: Transforming Internal Medicine Residency Education in Ambulatory Settings

PURPOSE: The majority of health care, both for acute and chronic conditions, is delivered in the ambulatory setting. Despite repeated proposals for change, the majority of internal medicine residency training still occurs in the inpatient setting. Substantial changes in ambulatory education are needed to correct the current imbalance. To assist educators and policy makers in this process, this paper reviews the literature on ambulatory education and makes recommendations for change. METHODS: The authors searched the Medline, Psychlit, and ERIC databases from 2000 to 2004 for studies that focused specifically on curriculum, teaching, and evaluation of internal medicine residents in the ambulatory setting to update previous reviews. Studies had to contain primary data and were reviewed for methodological rigor and relevance. RESULTS: Fifty-five studies met criteria for review. Thirty-five of the studies focused on specific curricular areas and 11 on ambulatory teaching methods. Five involved evaluating performance and 4 focused on structural issues. No study evaluated the overall effectiveness of ambulatory training or investigated the effects of current resident continuity clinic microsystems on education. CONCLUSION: This updated review continues to identify key deficiencies in ambulatory training curriculum and faculty skills. The authors make several recommendations: (1) Make training in the ambulatory setting a priority. (2) Address systems problems in practice environments. (3) Create learning experiences appropriate to the resident's level of development. (4) Teach and evaluate in the examination room. (5) Expand subspecialty-based training to the ambulatory setting. (6) Make faculty development a priority. (7) Create and fund multiinstitutional educational research consortia