Comment former la relève de chercheurs en médecine : enseigner l’évaluation par les pairs en faisant participer les étudiants à un comité de lecture

Implication StatementThe peer review process is a critical step in producing sound scientific literature, traditionally conducted by professionals well-established in their field. It is uncommon for students, even at the graduate level, to contribute. Faculty created a novel course in which 18 medical students (nine per year) delivered peer reviews to the Canadian Medical Education Journal (CMEJ). The positive feedback and competency gained is described in the students’ Letter to the Editor. While this course was initially created to benefit students, it has also helped to address a known deficit in peer reviewers.Énoncé des implications de la rechercheL’évaluation par les pairs est une étape essentielle de la production d’une littérature scientifique sérieuse. Traditionnellement faite par des professionnels confirmés dans leur domaine de compétences, il est rare que les étudiants, même ceux des cycles supérieurs, participent aux comités de lecture. Un cours novateur a permis à 18 étudiants en médecine (9 par année) de réaliser des évaluations par les pairs pour la Revue canadienne de l’éducation médicale (CMEJ). Les commentaires positifs et les compétences acquises sont décrits dans une lettre des étudiants à l’éditeur.4 Bien qu’à l’origine ce cours ait été créé pour profiter aux étudiants, il a également contribué à combler un déficit notoire de pairs évaluateurs

Physician-Patient Relationships and Their Effect on T2DM Patient Treatment Adherence

Type 2 diabetes (T2DM) is a health epidemic that continues to worsen. A major concern is that treatment adherence rates hover around 50%, despite the introduction of new medications, treatments, and technology. Lack of adherence by patients can lead to complications like blindness, kidney disease, and amputations. While there have been many studies conducted to evaluate patient factors related to adherence, fewer studies have been conducted to evaluate the role of the physician-patient relationship. The purpose of this study was to examine the correlation between the physician-patient relationship and patient treatment adherence, and examine the moderators of age, education, ethnicity, and income. Gender was included as a moderator in a secondary analysis. Two theories formed the theoretical framework of this study: biopsychosocial model and self-efficacy theory. This quantitative nonexperimental study was completed with survey data collected from 92 participants in the United States ages 18 or older who were under treatment for T2DM for at least a year, and who had seen their physician at least once in the previous year. Correlational and regression analyses were conducted using data from the modified Clinician and Group Survey and the Diabetes Management Self-Questionnaire. The physician-patient relationship predicted treatment adherence, and gender moderated the relationship. These findings suggest the importance of the physician-patient relationship as a factor in patient treatment adherence. This has important implications for social change because an understanding of which physician factors lead to treatment adherence may help improve patient outcomes, reduce T2DM complications, improve patient quality of life, and reduce healthcare costs

Medical students’ personal experiences, religion, and spirituality explain their (dis)comfort with a patient’s religious needs

Background: Physicians often avoid discussing patients’ religious and spiritual concerns, even though most patients (i.e., 50-94%) want integrated care.  To address this gap, medical students interviewed a Standardized Patient (SP) who was upset because the daughter did not confront her fiancée about converting to Orthodox Judaism.  Students reflected on how their own religion and spirituality affected engaging with their patient. Methods: With a 97% response rate, 231 first-year medical students responded to open-ended questions about their patient encounter.  For this quantitative content analysis, we used inductive reasoning, identifying three themes:  (1) impact of students’ own religion on their comfort, (2) change in comfort, and (3) their learning. We used deductive reasoning to compare qualitative results from half of the students who began the curriculum with a questionnaire about their own spirituality with the other students completing afterwards. Results: Most students said being religious positively influenced their comfort, whether they were also Orthodox Jewish or from a different religion. Among uncomfortable students (6.5%), some attributed this to not being religious. Some students (4.8%) grew more comfortable discussing the religious issue, and 18.2% became uncomfortable due to lacking knowledge of Orthodox Judaism and the awkwardness of the topic.  Students who had completed the questionnaire beforehand gave more comments about connecting with their patients than students who completed the questionnaire afterwards (X2=11.047, p<.001). Conclusions: Students’ own religion influenced their comfort with discussing religious concerns, with some feeling more connected and others becoming uncomfortable. This finding helps inform medical educators about teaching mind-body-spirit care

A Pronounced Inflammatory Activity Characterizes the Early Fracture Healing Phase in Immunologically Restricted Patients

Immunologically restricted patients such as those with autoimmune diseases or malignancies often suffer from delayed or insufficient fracture healing. In human fracture hematomas and the surrounding bone marrow obtained from immunologically restricted patients, we analyzed the initial inflammatory phase on cellular and humoral level via flow cytometry and multiplex suspension array. Compared with controls, we demonstrated higher numbers of immune cells like monocytes/macrophages, natural killer T (NKT) cells, and activated T helper cells within the fracture hematomas and/or the surrounding bone marrow. Also, several pro-inflammatory cytokines such as Interleukin (IL)-6 and Tumor necrosis factor α (TNFα), chemokines (e.g., Eotaxin and RANTES), pro-angiogenic factors (e.g., IL-8 and Macrophage migration inhibitory factor: MIF), and regulatory cytokines (e.g., IL-10) were found at higher levels within the fracture hematomas and/or the surrounding bone marrow of immunologically restricted patients when compared to controls. We conclude here that the inflammatory activity on cellular and humoral levels at fracture sites of immunologically restricted patients considerably exceeds that of control patients. The initial inflammatory phase profoundly differs between these patient groups and is probably one of the reasons for prolonged or insufficient fracture healing often occurring within immunologically restricted patients. View Full-Tex

A Comparison of Groundwater Storage Using GRACE Data, Groundwater Levels, and a Hydrological Model in Californias Central Valley

The Gravity Recovery and Climate Experiment (GRACE) measures changes in total water storage (TWS) remotely, and may provide additional insight to the use of well-based data in California's agriculturally productive Central Valley region. Under current California law, well owners are not required to report groundwater extraction rates, making estimation of total groundwater extraction difficult. As a result, other groundwater change detection techniques may prove useful. From October 2002 to September 2009, GRACE was used to map changes in TWS for the three hydrological regions (the Sacramento River Basin, the San Joaquin River Basin, and the Tulare Lake Basin) encompassing the Central Valley aquifer. Net groundwater storage changes were calculated from the changes in TWS for each of the three hydrological regions and by incorporating estimates for additional components of the hydrological budget including precipitation, evapotranspiration, soil moisture, snow pack, and surface water storage. The calculated changes in groundwater storage were then compared to simulated values from the California Department of Water Resource's Central Valley Groundwater- Surface Water Simulation Model (C2VSIM) and their Water Data Library (WDL) Geographic Information System (GIS) change in storage tool. The results from the three methods were compared. Downscaling GRACE data into the 21 smaller Central Valley sub-regions included in C2VSIM was also evaluated. This work has the potential to improve California's groundwater resource management and use of existing hydrological models for the Central Valley

Hyperspectral Mapping of the Invasive Species Pepperweed and the Development of a Habitat Suitability Model

Mapping and predicting the spatial distribution of invasive plant species is central to habitat management, however difficult to implement at landscape and regional scales. Remote sensing techniques can reduce the impact field campaigns have on these ecologically sensitive areas and can provide a regional and multi-temporal view of invasive species spread. Invasive perennial pepperweed (Lepidium latifolium) is now widespread in fragmented estuaries of the South San Francisco Bay, and is shown to degrade native vegetation in estuaries and adjacent habitats, thereby reducing forage and shelter for wildlife. The purpose of this study is to map the present distribution of pepperweed in estuarine areas of the South San Francisco Bay Salt Pond Restoration Project (Alviso, CA), and create a habitat suitability model to predict future spread. Pepperweed reflectance data were collected in-situ with a GER 1500 spectroradiometer along with 88 corresponding pepperweed presence and absence points used for building the statistical models. The spectral angle mapper (SAM) classification algorithm was used to distinguish the reflectance spectrum of pepperweed and map its distribution using an image from EO-1 Hyperion. To map pepperweed, we performed a supervised classification on an ASTER image with a resulting classification accuracy of 71.8%. We generated a weighted overlay analysis model within a geographic information system (GIS) framework to predict areas in the study site most susceptible to pepperweed colonization. Variables for the model included propensity for disturbance, status of pond restoration, proximity to water channels, and terrain curvature. A Generalized Additive Model (GAM) was also used to generate a probability map and investigate the statistical probability that each variable contributed to predict pepperweed spread. Results from the GAM revealed distance to channels, distance to ponds and curvature were statistically significant (p < 0.01) in determining the locations of suitable pepperweed habitats

The Changing California Coast: The Effect of a Variable Water Budget on Coastal Vegetation Succession

The land-ocean interface along the central coast of California is one of the most diverse biogeographic regions of the state. This area is composed of a species-rich mosaic of coastal grassland, shrubland, and forest vegetation types. An acceleration of conifer encroachment into shrublands and shrub encroachment into grasslands along the coast has been recently documented. These vegetation changes are believed to be driven primarily by fire suppression and changing grazing patterns. Climatic variables such as precipitation, fog, cloud cover, temperature, slope, and elevation also play an important role in vegetation succession. Our study area is located along the central California coast, which is characterized by a precipitation gradient from the relatively wetter and cooler north to the drier and warmer south. Some studies indicate changing fog patterns along this coast, which may greatly impact vegetation. A decrease in water availability could slow succession processes. The primary objective of this project is to determine if vegetation succession rates are changing for the study area and to identify climate and ecosystem variables which contribute to succession, specifically the transition among grassland, shrubland, and forest. To identify vegetation types and rates of succession, we classified two Landsat TM 5 scenes from 1985 to 2010 with a resulting overall accuracy of 82.4%. Vegetation succession was correlated to changes in maximum and minimum temperatures, precipitation, and elevation for each sub-region of the study area. Fog frequency was then compared between the northern and southern regions of the study area for determining the spatial relation between fog frequency and the percent of vegetation change

Methylome and epialleles in rice epilines selected for energy use efficiency

Epigenetics offers important opportunities in breeding to improve the potential yield in a wide variety of crops. Starting from a pure breeder seed lot of a rice (Oryza sativa ssp. indica) inbred population, repeated testing for improved cellular respiration rates and energy use efficiency (EUE) over three generations identified performant epilines with distinct epigenetic signatures and with improved seed yield in field trials. Epiline DNA methylomes were characterized by genome-wide bisulfite sequencing to discern cytosine methylation changes in relation to transcriptome and phenotype. Regional methylation changes were dispersed over the epiline genomes. A number of upstream-associated differentially methylated regions (DMRs) correlated with differentially expressed genes (DEGs) with a role in particular molecular functions like transmembrane transport and protein kinase activity. Targeted bisulfite sequencing confirmed epiline DMRs that anti-correlated with DEGs, identifying putative epialleles that were susceptible for cytosine methylation changes that might affect gene expression and contribute to the phenotype. Chromatin immunoprecipitation sequencing revealed the extensive enrichment of gene-associated histone H3 lysine-4 trimethylation (H3K4me3), which correlated with gene activation and reduced cytosine methylation. Our data indicate that seed formation is prone to epigenetic changes that might be used as a resource in crop improvement

Landscape determinants and remote sensing of anopheline mosquito larval habitats in the western Kenya highlands

BACKGROUND: In the past two decades the east African highlands have experienced several major malaria epidemics. Currently there is a renewed interest in exploring the possibility of anopheline larval control through environmental management or larvicide as an additional means of reducing malaria transmission in Africa. This study examined the landscape determinants of anopheline mosquito larval habitats and usefulness of remote sensing in identifying these habitats in western Kenya highlands. METHODS: Panchromatic aerial photos, Ikonos and Landsat Thematic Mapper 7 satellite images were acquired for a study area in Kakamega, western Kenya. Supervised classification of land-use and land-cover and visual identification of aquatic habitats were conducted. Ground survey of all aquatic habitats was conducted in the dry and rainy seasons in 2003. All habitats positive for anopheline larvae were identified. The retrieved data from the remote sensors were compared to the ground results on aquatic habitats and land-use. The probability of finding aquatic habitats and habitats with Anopheles larvae were modelled based on the digital elevation model and land-use types. RESULTS: The misclassification rate of land-cover types was 10.8% based on Ikonos imagery, 22.6% for panchromatic aerial photos and 39.2% for Landsat TM 7 imagery. The Ikonos image identified 40.6% of aquatic habitats, aerial photos identified 10.6%, and Landsate TM 7 image identified 0%. Computer models based on topographic features and land-cover information obtained from the Ikonos image yielded a misclassification rate of 20.3–22.7% for aquatic habitats, and 18.1–25.1% for anopheline-positive larval habitats. CONCLUSION: One-metre spatial resolution Ikonos images combined with computer modelling based on topographic land-cover features are useful tools for identification of anopheline larval habitats, and they can be used to assist to malaria vector control in western Kenya highlands