Nosocomial or not? A combined epidemiological and genomic investigation to understand hospital-acquired COVID-19 infection on an elderly care ward.

BACKGROUND: COVID-19 has the potential to cause outbreaks in hospitals. Given the comorbid and elderly cohort of patients hospitalized, hospital-acquired COVID-19 infection is often fatal. Pathogen genome sequencing is becoming increasingly important in infection prevention and control (IPC). AIM: To inform the understanding of in-hospital SARS-CoV-2 transmission in order to improve IPC practices and to inform the future development of virological testing for IPC. METHODS: Patients detected COVID-19 positive by polymerase chain reaction on Ward A in April and May 2020 were included with contact tracing to identify other potential cases. Genome sequencing was undertaken for a subgroup of cases. Epidemiological, genomic, and cluster analyses were performed to describe the epidemiology and to identify factors contributing to the outbreak. FINDINGS: Fourteen cases were identified on Ward A. Contact tracing identified 16 further patient cases; in addition, eight healthcare workers (HCWs) were identified as being COVID-19 positive through a round of asymptomatic testing. Genome sequencing of 16 of these cases identified viral genomes differing by two single nucleotide polymorphisms or fewer, with further cluster analysis identifying two groups of infection (a five-person group and a six-person group). CONCLUSION: Despite the temporal relationship of cases, genome sequencing identified that not all cases shared transmission events. However, 11 samples were found to be closely related and these likely represented in-hospital transmission. This included three HCWs, thereby confirming transmission between patients and HCWs.

Professional development in geriatrics for community-based generalist faculty.

Generalist physicians provide most primary care for older people. Increasingly, undergraduate clinical education occurs in community sites. Hence, community-based generalist faculty members need continuing education in geriatrics to support clinical practice and teaching. The Geriatrics Scholars Program provided continuing medical education (CME) in geriatrics over a 3-year period to 88 participants. Sixty physicians completed 30 or more hours of education and were designated Geriatrics Scholars. On an anonymous exit survey, Scholars reported being better equipped to care for elderly patients and to teach geriatrics and improved patient care in specific aspects of geriatrics, including medication use, cognition, and functional assessment. In summary, community-based generalist faculty who participated in a substantial, 3-year program of geriatrics CME reported that their care of older people and their teaching of geriatrics were enhanced.

Effects of Temperature and Photoperiod on the Reproductive Biology and Diapause of Oobius agrili (Hymenoptera: Encyrtidae), an Egg Parasitoid of Emerald Ash Borer (Coleoptera: Buprestidae).

Oobius agrili Zhang and Huang (Hymenoptera: Encyrtidae) is a solitary egg parasitoid of the invasive emerald ash borer, Agrilus planipennis Fairmaire (Coleoptera: Buprestidae), and has been introduced to the United States for classical biological control. We characterized the weekly survivorship, fecundity, and diapause patterns of both diapaused and nondiapaused populations of O. agrili under four different temperature-photophase combinations: 30°C (warm) and 20°C (cold) temperatures with both long-day (16 h) and short-day (8 h) photophase. Results of this study showed that regardless of the length of photophase, parental parasitoids of both diapaused and nondiapaused O. agrili survived significantly longer at 20°C than at 30°C. Both populations also laid their eggs faster at 30°C compared with those at 20°C. Higher proportions of the progeny produced by both populations of O. agrili were induced into diapause by short-day (8 h) photophase, regardless of rearing temperature. In addition, the diapaused parasitoids in the short-day photophase treatment at both warm and cold temperatures produced increasing proportions of diapaused progeny over time, whereas no significant differences were observed in the proportions of diapaused progeny by the nondiapaused parasitoids over different sampling times. These findings suggest that O. agrili should be continuously reared under warm temperature and long-day photoperiod (to avoid diapause for increased reproduction). In addition, we recommend that diapaused adults be used for field releases in early summer when temperatures are still relatively low (∼20°C) and host eggs are available so that they can produce multiple generations prior to overwintering.

Optimum number of technical replicates for the measurement of compression of lamb meat.

Up to six (average 4.63) replicate compression values were collected on cooked m. semimembranosus of lambs that had been raised at six sites across southern Australia (n=1817). Measurements on each sample were made with one of two Lloyd Texture analyser machines, with each machine having a 0.63 cm diameter plunger. Based on a log normal model with common variance on the log scale for within sample replicate results, estimates of the within sample variability of compression values were obtained, resulting in a quality control procedure for compression testing based on the coefficient of variation.

Application of small angle X-ray scattering synchrotron technology for measuring ovine meat quality.

A small angle X-ray scattering (SAXS) synchrotron was used to evaluate 100 ovine m. longissimus lumborum, representing lamb (n=50) and sheep (n=50). The diffraction of X-rays gives information on muscle myofibril structure and fat content. The linear relationships between SAXS measures with measures such as, shear force, intramuscular fat content (IMF) and collagen content/solubility, were investigated. A relationship was found between the d-spacing of the actin/myosin fibril spacing (SAX1 and SAX2) and the cross sectional area of the rhombohedral unit cell (Cell area) and shear force after 1 and 5day ageing. There was a positive relationship between IMF and a SAXS Fat area measure. There was a muscle site effect on SAX1, SAX2 and Cell area, with the cranial site having a larger distance between myofibrils. The potential of SAXS as a powerful research tool to determine not only the structural components of ovine tenderness, but also the fat content related to IMF is evident.

Understanding primary care residency choices: a test of selected variables in the Bland-Meurer model.

PURPOSE: This study tested the predictive validity of variables related to student characteristics of the Bland-Meurer Model of Career Decision-Making. METHOD: A study was conducted using Association of American Medical Colleges' Graduate Student Questionnaire and career data from one medical school. Logistic regression analyses generated predictive models of primary care residency choice, including family medicine, general internal medicine, and pediatrics for 555 medical school graduates over five years. RESULTS: Variables predictive of primary care residency choice were gender; student ratings of psychiatry, surgery, and internal medicine clerkships; not having participated in a research project in medical school; attitudes toward "the changing health care system on physicians" and "access to medical care"; and planned practice in a medically underserved area. Results differed for each field within each residency choice. CONCLUSIONS: The Bland-Meurer Model may be used for variable selection in multivariate predictive models of family medicine, internal medicine and pediatrics residency choice. The authors' results may help guide admissions decisions, while providing medical educators and health care policymakers with a clearer picture of residency choice and a better understanding of how to meet the demands of selected patient populations.

Simultaneous conditioning in honeybees (Apis mellifera).

Honeybees (Apis mellifera) were classically conditioned with odor as conditioned stimulus (CS), sucrose as unconditioned stimulus (US), and proboscis extension as response. The purpose of Experiment 1 (Ns = 26 and 27) was to look for facilitation of forward conditioning by CS-US overlap, but rapid conditioning without overlap left little room for improvement. In 2 further experiments, CS and US were simultaneous, and response to odor alone was measured in subsequent tests. In Experiment 2, a Simultaneous group (N = 25) responded more to the training odor than did an Unpaired control group (N = 25). In Experiment 3, a differentially conditioned Simultaneous group (N = 29) responded more to an odor paired with sucrose in training (S+) than to an odor presented alone (S-). The implications of the results for the problem of the role of amount of reward in honeybee learning are considered.

Predicting career decisions in primary care medicine: a theoretical analysis.

Entering the 1960s, more than half of the medical doctors in the United States were family physicians, pediatricians, or general internists. Today, about one-third of all U.S. physicians are primary care practitioners. Although opinions vary on the optimal ratio of primary care to specialty physicians, in the mid-1990s, the consensus among leaders in medicine was that more primary care physicians would be needed to ensure access to quality care. The target output of graduates was set for a minimum of 50% primary care physicians, and medical school admission committees responded. The present study examines research related to career decision making in primary care medicine. We address career decision making in primary care with the expectation that selection of a medical residency is based on multiple factors, and multivariate statistical techniques comprise the most appropriate statistical procedure for developing predictive models of medical student residency choice. Additional multivariate studies for simultaneous analysis of multiple dependent and multiple independent variables are needed to determine whether health policy planners and medical schools should continue to address the distribution of primary care physicians through medical school admissions. Further to enabling prediction, researchers must renew efforts to base investigations on theoretical models, summarizing and organizing previous research, and providing one another with means to focus future studies while building on previous work.

The effects of acute test anxiety on NBME Part I performance.

This study examined the associated effects of acute test-taking anxiety on the performance of a class of second-year medical students who took Part I of the National Board of Medical Examiners (NBME) Examination. The study is a follow-up of a previous study that examined the related effects of chronic anxiety on NBME Part I performance. The purpose of this study was to observe whether there was a relationship between acute anxiety and NBME performance and, further, if there were distinguishable differences in the effects of acute and chronic test anxiety on NBME performance. The first study indicated a significant relationship between chronic anxiety and NBME performance. The results of the present study indicate a relationship between acute test anxiety and NBME performance, but not to the extent associated with chronic anxiety, thus chronic test anxiety may be a more critical factor affecting test performance on critical examinations such as the NBME. Implications concerning anxiety and test performance are discussed.

How, when, and why do physicians choose careers in academic medicine? A literature review.

PURPOSE: Medicine has different pathways in which physicians pursue their vocation. Clinical practice, research, and academia are common paths. The authors examined the literature to identify research-based factors influencing physicians to choose a career path in academic medicine. METHOD: In the fall of 2006, the authors searched the PubMed database from 1960 to 2006 using the term career academic medicine. Review of articles resulted in the identification of nine themes relating to academic medicine career paths. The authors summarized the important and relevant articles to capture what the literature contributed as a whole to the larger question, "How, when, and why do physicians choose an academic career in medicine?" RESULTS: A synthesis of articles revealed that (1) values are essential to understanding the decision to enter a career in academic medicine, (2) factors associated with academic medicine career choice include research-oriented programs, gender, and mentors and role models, (3) an obstacle to pursuing this career path is loss of interest in academic careers during residency as residents learn about factors associated with academic careers in medicine, and (4) debt may be a barrier to choosing an academic career in medicine for some individuals in some specialties. CONCLUSIONS: Despite the study findings, the larger question (stated above) remains essentially unanswered in the literature. The authors propose a call to action by various professional groups and organizations to use rigorous and complex research efforts to seek answers to this very important question.

Study of Selected Outcomes of Medical Students Who Fail USMLE Step 1.

PURPOSE: Passage of the United States Medical Licensing Exam (USMLE) is required to obtain a medical license in the United States. Currently the majority of US medical schools require passage of USMLE Step 1 for either promotion to the third year or graduation from medical school. Virginia Commonwealth University School of Medicine (VCUSOM) requires that students take the USMLE but does not require passing of USMLE Step 1 for promotion or graduation. This policy enabled the authors to analyze performance outcomes during clinical rotations and monitor the residency match for a group of students who failed USMLE Step 1 on the first attempt. METHODS: Third year clerkship grades and residency match results were reviewed for 64 students of the graduating classes of 1999-2005 who failed Step 1 on the first attempt. An equal number of students who passed Step 1 were randomly selected from each class as a comparison group. Average clinical performance ratings, NBME subject exam scores and final third year clerkship grades for the two groups were compared. Residency match rates and specialty certification were also compared. RESULTS: The USMLE Fail Group had more Pass and fewer Honors clerkship grades than the comparison group. Subject exam scores were significantly lower in the USMLE Fail Group in all clerkships. Clinical performance ratings were significantly lower in the Fail group in three out of six clerkships: Internal Medicine, Pediatrics, and Psychiatry. However, 82% of the USMLE Fail Group later passed USMLE Step 1 and 2. Fifty-nine of the 64 students in the USMLE Fail Group matched for a residency, whereas all of the students in the Pass Group matched for a residency. CONCLUSION: Students who fail USMLE Step 1 have lower final clerkship grades due in part to lower NBME subject exam scores. The majority of these students, however, successfully pass USMLE Step 1 prior to graduation, go on to graduate medical training, and become board certified in their specialty.

The Self-Directed Learning Readiness Scale: a factor analysis study.

BACKGROUND: The practice of medicine demands that its physician practitioners are self-directed, life-long learners. The Self-Directed Learning Readiness Scale (SDLRS) intends to measure adults' readiness to engage in self-directed learning. PURPOSE: The present study assesses the underlying factor structure of the SDLRS for a sample of entering medical students. METHODS: Over a period of 6 years, 972 first year medical students at the Virginia Commonwealth University School of Medicine completed the SDLRS. To summarise the inter-relationships among variables, a principal axis factor analysis with oblique rotation was used on the 58 SDLRS items. A series of confirmatory factor analyses using LISREL 8.54 was performed to further examine the measurement model underlying the SDLRS. RESULTS: A 4-factor confirmatory model representing 4 correlated substantive factors and a reverse coding method factor fits these data well. CONCLUSIONS: Medical educators should hold limited expectations of the SDLRS to measure medical students' readiness to engage in self-directed learning. The definitions and theoretical assumptions that inform readiness for self-directed learning should be reconsidered. Alternative approaches to studying self-directed learning should be explored.

Teaching peer review at Michigan State University.

Two groups of students at Michigan State University participated in an exercise intended to teach them the process of peer review. Neither group of students completed the exercise beyond the initial steps. The authors discuss the concerns of the students and make suggestions for implementing a program of peer review in undergraduate medical school curricula.

A course on teaching for house officers.

A pilot course on clinical teaching methods was given to 11 volunteer third-year medical residents. The course consisted of four weekly two-hour sessions designed to cover the areas in which house officers do the most teaching. Both clinical and nonclinical educators participated as faculty members in an attempt to create balance in perspective. A homogeneous group was invited to volunteer to create an atmosphere in which trust, common experience, and clinical experience could be used to maximum advantage by the faculty. A relaxed "nonclassroom" atmosphere was created that facilitated interchange. The course was uniformly well received. Though only a pilot course, the experience suggests that formal education in the field of clinical teaching is well received by house staff members.

Evaluation of an oncology curriculum.

This report describes and presents an evaluation of the undergraduate component of the Cancer Education Program at The Bowman Gray School of Medicine. New learning objectives on cancer were introduced into the second and third year of the Medical School curriculum. A twenty-five question multiple choice examination measured the accomplishment of the new objectives. Students in the class of 1985, who did not receive instruction on the new objectives as part of their formal medical education, served as a control. Students in the classes of 1986 and 1987, who respectively received partial and full exposure to the new objectives, served as experimental groups. Despite limitations in the evaluation procedure, data obtained from the study suggested the possibility of a small but meaningful increase in overall knowledge and specific gains in both students' knowledge and their perceptions of being better prepared to deal with psychosocial aspects of cancer.

Electrifying a medical school course: a case study.

BACKGROUND: At Virginia Commonwealth University School of Medicine, the Dean charged the curriculum office to "electrify the curriculum." An instructional development team chose a 2nd-year course to serve as a model e-course and to provide evaluation data for a 2-year study. DESCRIPTION: The instructional development process used instructional and Web design principles. An evaluation plan included a number of data collection methods: e-mail surveys, a focus group, student diaries, and comprehensive end-of-course student assessments. The e-course allowed students to take advantage of learning opportunities that traditional face-to-face instruction normally does not. EVALUATION: Students found access to multiple images; interactivity; and meaningful, efficient navigation within the site to be useful. Web-based instruction shows promise to aid students in the transition from concept acquisition to complex "doctor thinking." It does not replace the need for human teachers. CONCLUSION: The authors conclude with instructional design suggestions to exploit the power of Web-based teaching for the enhancement of complex learning.

Expression measurement of many genes simultaneously by quantitative RT-PCR using standardized mixtures of competitive templates.

Progress toward complete sequencing of all human genes through the Human Genome Project has already resulted in a need for methods that allow quantitative expression measurement of multiple genes simultaneously. It is increasingly recognized that relative measurement of multiple genes will provide more mechanistic information regarding cell pathophysiology than measurement of individual genes one by one or by methods that do not allow direct intergene comparison. In this study, previously described quantitative reverse transcription-polymerase chain reaction methods were modified in an effort to provide a rapid, simple method for this purpose. Internal standard competitive templates (CTs) were prepared for each gene and were combined in a single solution containing CTs for more than 40 genes at defined concentrations relative to one another. Any subsequent dilution of the CT mixture did not alter the relationship of one CT to another. Because the same CT standard solution or a dilution of it was used in all experiments, data obtained from different experiments were easily compared. The use of multiple CT mixtures with different housekeeping gene to target gene ratios provided a linear dynamic range spanning the range of expression of all genes thus far evaluated. CT stock solutions were used to simultaneously quantify the expression of 25 genes relative to beta-actin and glyceraldehyde-3-phosphate dehydrogenase in normal and malignant bronchial epithelial cells. Because the CT concentrations were known, data in the form of both absolute messenger RNA (mRNA) copy number and mRNA relative to housekeeping gene mRNA were obtained. The methods and reagents described will allow rapid, quantitative measurement of multiple genes simultaneously, using inexpensive and widely available equipment. Furthermore, the CT standard solution may be distributed to other investigators for interlaboratory standardization of experimental conditions.