Perceptions of the Professional Development Value of Honorary Fellowship Award Experiences.

OBJECTIVE: Professional societies engage in activities with the aim of nurturing highly talented early career members of their field. Little is known about the value of honorary fellowship awards given annually by professional societies. Following up on the only known prior study of this topic, authors queried fellowship awardees in one psychiatric society to better understand the perceived value of honorary fellowships and other outcomes, such as subsequent involvement in professional societies. METHODS: The authors queried former participants in the Laughlin and Psychiatry Resident-In-Training Examination® (PRITE®) Programs regarding their fellowship experiences and their subsequent involvement in The American College of Psychiatrists and other psychiatry membership organizations. The authors obtained frequency data and analyzed responses using t-tests and chi-squared tests. Associations between the outcomes and demographic characteristics such as age, gender, and fellowship type was tested. RESULTS: Responses were gathered from 143 individuals who had participated in the Laughlin Fellowship and 22 in the PRITE Fellowship. Respondents felt that that the fellowship experience had been helpful professionally. Laughlin fellows were older and more likely to have assumed a leadership role in professional organizations (60 % vs 36 %, p = 0.04). Laughlin fellows also more strongly endorsed professional recognition as a benefit at the time of receiving their award. Survey respondents reported increased participation in professional organizations and assumed leadership roles in The College and other professional organizations subsequent to the fellowship experience. CONCLUSIONS: On the whole, fellows were generally positive about their experiences. Many respondents became involved with The College subsequent to their fellowship, but a larger proportion became involved with other organizations, including in leadership roles. Professional societies with early career programs such as the Laughlin Fellowship and the PRITE Fellowship appear to identify and support future leaders as intended, but these leaders may engage more with other professional societies.

Storable, neglected, and underutilized species of Southern Africa for greater agricultural resilience.

The Southern African region suffers from drought and food system uncertainty with increased risks due to climate change, natural disasters, and global catastrophes. Increasing crop diversity with more appropriate and resilient crops is an effective way of increasing food system resilience. We focus on crop species that are native or naturalized to an area because of their increased resilience than those that are not naturally occurring. Additionally, crops that are easily stored are more useful in times of drought and disaster. In this systematic review, we use scientific interest in neglected and underutilized species (NUS) from Southern Africa to help define next steps toward their cultivation and development as a marketable crop. We found that although scientific interest is minimal for storable Southern African NUS, these crops are worth scaling up due to their economic and nutritional value. We outline next actionable steps and specific NUS for production in a more agrobiodiverse and resilient agriculture system.

Nutritional properties of raw and cooked Azolla caroliniana Willd., an aquatic wild edible plant.

Azolla caroliniana Willd. is an understudied wild edible plant native to the Eastern United States. Other species of Azolla have been used across the world for several thousand years as a livestock feed and as "green manure." The use of Azolla for human consumption is thought to be limited by its high total polyphenolic content (TPC). However, the TPC and nutritional content of A. caroliniana has not been thoroughly studied. We measured TPC and other nutrients before and after cooking methods designed to lower TPC. We found that TPC was 4.26 g gallic acid equivalent (GAE) kg-1 DW in raw A. caroliniana. All cooking methods significantly lowered TPC. Protein content was 19% DW, and the apparent protein digestibility was 78.45%. Our yield was 173 g FW m-2 day-1 and 5.53 g DW m-2 day-1. Azolla caroliniana is a high-yielding plant with great potential for cultivation and domestication.

Azolla as a Safe Food: Suppression of Cyanotoxin-Related Genes and Cyanotoxin Production in Its Symbiont, Nostoc azollae.

The floating freshwater fern Azolla is the only plant that retains an endocyanobiont, Nostoc azollae (aka Anabaena azollae), during its sexual and asexual reproduction. The increased interest in Azolla as a potential source of food and its unique evolutionary history have raised questions about its cyanotoxin content and genome. Cyanotoxins are potent toxins synthesized by cyanobacteria which have an anti-herbivore effect but have also been linked to neurodegenerative disorders including Alzheimer's and Parkinson's diseases, liver and kidney failure, muscle paralysis, and other severe health issues. In this study, we investigated 48 accessions of Azolla-Nostoc symbiosis for the presence of genes coding microcystin, nodularin, cylindrospermopsin and saxitoxin, and BLAST analysis for anatoxin-a. We also investigated the presence of the neurotoxin ß-N-methylamino-L-alanine (BMAA) in Azolla and N. azollae through LC-MS/MS. The PCR amplification of saxitoxin, cylindrospermospin, microcystin, and nodularin genes showed that Azolla and its cyanobiont N. azollae do not have the genes to synthesize these cyanotoxins. Additionally, the matching of the anatoxin-a gene to the sequenced N. azollae genome does not indicate the presence of the anatoxin-a gene. The LC-MS/MS analysis showed that BMAA and its isomers AEG and DAB are absent from Azolla and Nostoc azollae. Azolla therefore has the potential to safely feed millions of people due to its rapid growth while free-floating on shallow fresh water without the need for nitrogen fertilizers.

Food resilience in a dark catastrophe: A new way of looking at tropical wild edible plants.

A global sun-blocking catastrophe is more plausible than anyone would like to think. Models have consistently shown the devastating effects these events could have to the world's agricultural systems for upwards of 15 years. New shade-, drought-, and cool-tolerant crops and more food stockpile sources must be found if there would be any hope of feeding the global population in such a scenario. Wild edible plants (WEPs) are important buffers of food security to indigenous peoples, impoverished peoples, and those in areas with erratic growing seasons across the globe. Here, we suggest WEP species that have the potential to be scaled up through cultivation in post-catastrophe conditions, and the use of foraged food stockpiles to function as stop-gap foods until conventional agriculture returns. We also propose policy initiatives for habitat protection, education programs, and general preparedness.

Predictors of metabolic monitoring among schizophrenia patients with a new episode of second-generation antipsychotic use in the Veterans Health Administration.

BACKGROUND: To examine the baseline metabolic monitoring (MetMon) for second generation antipsychotics (SGA) among patients with schizophrenia in the Veterans Integrated Service Network (VISN) 16 of the Veterans Health Administration (VHA). METHODS: VISN16 electronic medical records for 10/2002-08/2005 were used to identify patients with schizophrenia who received a new episode of SGA treatment after 10/2003, in which the VISN 16 baseline MetMon program was implemented. Patients who underwent MetMon (MetMon+: either blood glucose or lipid testing records) were compared with patients who did not (MetMon-), on patient characteristics and resource utilization in the year prior to index treatment episode. A parsimonious logistic regression was used to identify predictors for MetMon+ with adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Out of 4,709 patients, 3,568 (75.8%) underwent the baseline MetMon. Compared with the MetMon- group, the MetMon+ patients were found more likely to have baseline diagnoses or mediations for diabetes (OR [CI]: 2.336 [1.846-2.955]), dyslipidemia (2.439 [2.029-2.932]), and hypertension (1.497 [1.287-1.743]), substance use disorders (1.460 [1.257-1.696]), or to be recorded as obesity (2.052 [1.724-2.443]). Increased likelihood for monitoring were positively associated with number of antipsychotics during the previous year (FGA: 1.434 [1.129-1.821]; SGA: 1.503 [1.290-1.751]). Other significant predictors for monitoring were more augmentation episodes (1.580 [1.145-2.179]), more outpatient visits (1.007 [1.002-1.013])), hospitalization days (1.011 [1.007-1.015]), and longer duration of antipsychotic use (1.001 [1.001-1.001]). Among the MetMon+ group, approximately 38.9% patient had metabolic syndrome. DISCUSSION: This wide time window of 180 days, although congruent with the VHA guidelines for the baseline MetMon process, needs to be re-evaluated and narrowed down, so that optimally the monitoring event occurs at the time of receiving a new episode of SGA treatment. Future research will examine whether or not patients prescribed an SGA are assessed for metabolic syndrome following the index episode of antipsychotic therapy, and whether or not such baseline and follow-up monitoring programs in routine care are cost-effective. CONCLUSION: The baseline MetMon has been performed for a majority of the VISN 16 patients with schizophrenia prior to index SGA over the study period. Compared with MetMon- group, MetMon+ patients were more likely to be obese and manifest a more severe illness profile.

Relationship between Resident-In-Training Examination in psychiatry and subsequent certification examination performances.

OBJECTIVE: This study analyzed the relationship between performance on The American College of Psychiatrists' Psychiatry Resident-In-Training Examination (PRITE) and the ABPN Part 1 examination. METHODS: Pearson correlation coefficients were used to examine the relationship between performance on the 2002 PRITE and the 2003 Part 1 examination for 297 examinees. RESULTS: The correlation between the PRITE global psychiatry and the Part 1 psychiatry scores was 0.59, and the correlation between the PRITE global neurology and the Part 1 neurology scores was 0.39. CONCLUSION: Although the PRITE and the Part 1 examination have different purposes and are developed independently, the significant correlations between scores on the two tests support the use of PRITE results to guide preparation for the Part 1 examination. Guidelines for PRITE scores associated with poor performance on the Part 1 examination are provided.

Healthcare resource utilization, adherence and persistence with antipsychotic therapy among schizophrenia patients with vs. without pre-existing metabolic syndrome.

OBJECTIVE: To assess the association between pre-existing metabolic syndrome and health outcomes among veterans with schizophrenia. METHODS: The Veterans Integrated Service Network 16 data (VISN16) for 10/2002 - 08/2005 were used to identify patients (n = 593) with schizophrenia (ICD-9 codes: 250.xx) who were switched to a new antipsychotic agent in response to metabolic monitoring as part of a VISN 16 metabolic monitoring program. Two groups (patients with pre-existing metabolic syndrome [MetSyn+] and without [MetSyn-]) were compared on resource utilization, antipsychotic adherence (medication possession ratio: MPR) and persistence (time to all-cause discontinuation of the switched antipsychotic) over 1 year. RESULTS: About one-third of the patients who have undergone metabolic monitoring before the medication switch (35.2%) had metabolic syndrome. The two groups did not significantly differ on healthcare resource utilization, MPR, or time to all-cause medication discontinuation. Adherence and persistence levels were relatively poor for both groups (mean MPR = 0.33 for MetSyn+; MPR = 0.38 for MetSyn-). The median time to all-cause medication discontinuation was 50 days for both groups. CONCLUSIONS: In this retrospective study of patients with schizophrenia, the presence of pre-existing metabolic syndrome did not appear to impact patients' healthcare resource utilization or their adherence and persistence with antipsychotic medication.

Maintenance of certification in psychiatry.

The American Board of Medical Specialties (ABMS) developed 6 core competencies for physicians of all specialties and a maintenance of certification (MOC) program for board-certified physicians. The MOC program incorporates the 6 competencies into 4 component areas: professional standing, self-assessment and lifelong learning, cognitive expertise, and performance in practice. These 4 components are designed to promote a cycle of lifelong learning, self-assessment and peer review, and incorporation of best practices in order to improve the quality of health care in clinical practice. The American Board of Psychiatry and Neurology is a member board of the ABMS and has adapted the competencies and MOC requirements for psychiatrists and neurologists.

The ABPN Maintenance of Certification Program for psychiatrists: past history, current status, and future directions.

OBJECTIVE: To describe the American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification Program, its underlying rationale, how it will be implemented now, and what it might look like in the future. METHODS: The authors describe the philosophical foundation, specific components, and the implementation timeline of the ABPN Maintenance of Certification Program; the development of specific products that might be used by ABPN diplomates to meet its requirements; and several unanswered questions about its current status and future development. RESULTS: The ABPN Maintenance of Certification Program consists of specific requirements pertaining to professional standing, self-assessment and lifelong learning, performance in practice, and cognitive expertise that will be implemented incrementally over the next decade. CONCLUSION: The ABPN Maintenance of Certification Program has been implemented in a manner that is as consistent as possible with its underlying philosophical beliefs as well as the current and expected public and political concerns, diplomate needs, and the requirements of organizations responsible for licensure, credentialing, privileging, accreditation, professional development, and physician reimbursement.

Assessment of psychopharmacology on the American Board of Psychiatry and Neurology examinations.

OBJECTIVE: To report the assessment of psychopharmacology on the certification and recertification exams in general psychiatry and in the subspecialties administered by the American Board of Psychiatry and Neurology (ABPN). METHODS: The ABPN's core competencies for psychiatrists were reviewed. The number of items addressing psychopharmacology or neuropharmacology was determined for each examination. For the multiple-choice certification exams, item performance was reviewed. The grade cards of failing candidates were reviewed for the oral certification exam. RESULTS: A significant number of the core competencies involved psychopharmacology. The percent of items addressing the topic varied by examination but was substantial in general. Performance on these items on the multiple-choice certification exam was similar to performance in other areas. However, a majority of those who failed the patient section of the oral examination had inadequate performance in the area of drug treatment, indicating that trainees may need additional experience with applying psychopharmacological knowledge in the context of patient cases. CONCLUSION: This review indicated that knowledge of psychopharmacology was a significant component of the ABPN's core competencies and of its certification and recertification exams.