Medical School Characteristics, Policies, and Practices That Support Primary Care Specialty Choice: A Scoping Review of 5 Decades of Research.

BACKGROUND AND OBJECTIVES: The United States, like many other nations, faces a chronic shortage of primary care physicians. The purpose of this scoping review was to synthesize literature describing evidence-based institutional practices and interventions that support medical students' choices of primary care specialties, published in the United States, Canada, Australia, and New Zealand. METHODS: We surveyed peer-reviewed, published research. An experienced medical librarian conducted searches of multiple databases. Articles were selected for inclusion based on explicit criteria. We charted articles by topic, methodology, year of publication, journal, country of origin, and presence or absence of funding. We then scored included articles for quality. Finally, we defined and described six common stages of development of institutional interventions. RESULTS: We reviewed 8,083 articles and identified 199 articles meeting inclusion criteria and 41 related articles. As a group, studies were of low quality, but improved over time. Most were quantitative studies conducted in the United States. Many studies utilized one of four common methodologic approaches: retrospective surveys, studies of programs or curricula, large-scale multi-institution comparisons, and single-institution exemplars. Most studies developed groundwork or examined effectiveness or impact, with few studies of planning or piloting. Few studies examined state or regional workforce outcomes. CONCLUSIONS: Research examining medical school interventions and institutional practices to support primary care specialty choice would benefit from stronger theoretical grounding, greater investment in planning and piloting, consistent use of language, more qualitative methods, and innovative approaches. Robust funding mechanisms are needed to advance these goals.

Polycyclic aromatic hydrocarbons in a highly industrialized urban estuary: inventories and trends.

The abundance and composition of polycyclic aromatic hydrocarbons (PAHs) in sediments of the main stem and southern branch of the Elizabeth River (VA, USA), a highly industrialized urban estuary in the Chesapeake Bay (USA) watershed, were examined relative to historical and toxic effects levels. Total PAH concentrations in Elizabeth River sediments exceeded those observed in Baltimore Harbor and the Anacostia River, two other regions of concern in the Chesapeake Bay. The sigmaPAH concentrations from samples collected in the vicinity of two former wood-treatment facilities in the Elizabeth River had the highest sigmaPAH when compared to coastal and estuarine systems around the world. Using a linearized diffusion model equation, as much as 69% of the variability in channel sediment sigmaPAH distribution could be ascribed to inputs associated with former wood-treatment facilities along the southern branch of the Elizabeth River. Comparison of PAH levels measured in channel samples to data collected during the early 1980s demonstrated a general trend toward reduction in contaminant concentrations for most regions of the Elizabeth River channel; however, steady-state and increased sediment PAH concentrations in the vicinity of the former wood-treatment facilities were observed. Based on examination of the contaminant levels in Elizabeth River sediments using established sediment-quality criteria, the southern branch of the river remains a clear hazard to benthic and pelagic organisms.

2,4,6-Trinitrotoluene mineralization and bacterial production rates of natural microbial assemblages from coastal sediments.

The nitrogenous energetic constituent, 2,4,6-Trinitrotoluene (TNT), is widely reported to be resistant to bacterial mineralization (conversion to CO(2)); however, these studies primarily involve bacterial isolates from freshwater where bacterial production is typically limited by phosphorus. This study involved six surveys of coastal waters adjacent to three biome types: temperate broadleaf, northern coniferous, and tropical. Capacity to catabolize and mineralize TNT ring carbon to CO(2) was a common feature of natural sediment assemblages from these coastal environments (ranging to 270+/-38 µg C kg(-1) d(-1)). More importantly, these mineralization rates comprised a significant proportion of total heterotrophic production. The finding that most natural assemblages surveyed from these ecosystems can mineralize TNT ring carbon to CO(2) is consistent with recent reports that assemblage components can incorporate TNT ring carbon into bacterial biomass. These data counter the widely held contention that TNT is recalcitrant to bacterial catabolism of the ring carbon in natural environments.