Modeling and optimization of microwave-assisted extraction of total phenolics content from mango (Mangifera indica) peel using response surface methodology (RSM) and artificial neural networks (ANN).

Mango (Mangifera indica) is a fruit highly consumed for its flavor and nutrient content. The mango peel is rich in compounds with biological functionality, such as antioxidant activity among others. The influence of microwave-assisted extraction variables on total phenol compounds (TPC) and antioxidant activity (TEAC) of natural extracts obtained from mango peel var. Tommy and Sugar were studied using a response surface methodology (RSM) and Artificial Neural Networks (ANN). TPC of mango peel extract var. Tommy was significantly influenced by time extraction (X1), solvent/plant ratio (X2) and concentration of ethanol (X3) and while mango peel extract var. Sugar was influenced by X2. TEAC by ABTS was significantly influenced by X3. Maximum of TPC (121.3 mg GAE / g of extract) and TEAC (1185.9 µmol Trolox/g extract) for mango peel extract var. Tommy were obtained at X1=23.9s, X2=12.6mL/gand X3=63.2%, and for mango peel extract var. Sugar, the maximum content of TPC (224.86 mg GAE/g extract) and TEAC (2117.7 µmol Trolox/g extract) were obtained at X1=40s, X2=10mL/g and X3=74.9%. The ANN model presented a higher predictive capacity than the RSM (RANN2>RRSM2,RMSEANN

Risk-Adjusting Mortality in the Nationwide Veterans Affairs Healthcare System.

BACKGROUND: The US Veterans Affairs (VA) healthcare system began reporting risk-adjusted mortality for intensive care (ICU) admissions in 2005. However, while the VA's mortality model has been updated and adapted for risk-adjustment of all inpatient hospitalizations, recent model performance has not been published. We sought to assess the current performance of VA's 4 standardized mortality models: acute care 30-day mortality (acute care SMR-30); ICU 30-day mortality (ICU SMR-30); acute care in-hospital mortality (acute care SMR); and ICU in-hospital mortality (ICU SMR). METHODS: Retrospective cohort study with split derivation and validation samples. Standardized mortality models were fit using derivation data, with coefficients applied to the validation sample. Nationwide VA hospitalizations that met model inclusion criteria during fiscal years 2017-2018(derivation) and 2019 (validation) were included. Model performance was evaluated using c-statistics to assess discrimination and comparison of observed versus predicted deaths to assess calibration. RESULTS: Among 1,143,351 hospitalizations eligible for the acute care SMR-30 during 2017-2019, in-hospital mortality was 1.8%, and 30-day mortality was 4.3%. C-statistics for the SMR models in validation data were 0.870 (acute care SMR-30); 0.864 (ICU SMR-30); 0.914 (acute care SMR); and 0.887 (ICU SMR). There were 16,036 deaths (4.29% mortality) in the SMR-30 validation cohort versus 17,458 predicted deaths (4.67%), reflecting 0.38% over-prediction. Across deciles of predicted risk, the absolute difference in observed versus predicted percent mortality was a mean of 0.38%, with a maximum error of 1.81% seen in the highest-risk decile. CONCLUSIONS AND RELEVANCE: The VA's SMR models, which incorporate patient physiology on presentation, are highly predictive and demonstrate good calibration both overall and across risk deciles. The current SMR models perform similarly to the initial ICU SMR model, indicating appropriate adaption and re-calibration.

Toxicity of zoledronic acid after intravenous administration: A retrospective study of 95 dogs.

BACKGROUND: There is a paucity of veterinary literature on the safety or outcome of zoledronic acid (ZA) use in dogs for either bone pain or hypercalcemia. HYPOTHESIS/OBJECTIVES: The primary aim was to report the adverse events in dogs receiving intravenous administration of ZA. ANIMALS: Ninety-five dogs with ZA use. METHODS: A retrospective cohort study was performed; all dogs that received at least 1 dose of ZA and had a serum biochemistry profile performed before and after treatment were reviewed. Diagnosis, indication for treatment, adverse events and survival times were recorded. RESULTS: Ninety-five dogs met the inclusion criteria. Thirty-one (33%) received multiple intravenous infusions of ZA (range, 2-7), making a total of 166 administrations in all dogs. The dose range was 0.13 to 0.32 mg/kg, given at intervals of 4 to 6 weeks. Thirteen adverse events were recorded in 10 dogs: azotemia (n = 8), vomiting (n = 2), pancreatitis (n = 1), cutaneous ulceration (n = 1), and diarrhea (n = 1). Zoledronic acid could not be confirmed as the cause of azotemia in any case. The change in serum creatinine concentration from dose to dose was not related to the total dose received (P = .46). Five dogs (5%) changed Veterinary Comparative Oncology Group Common Terminology Criteria (VCOG-CTAE) renal/genitourinary grade after administration of ZA; their total dose 0.4 mg/kg (range, 0.26-0.66) was not significantly different to the group which did not change VCOG-CTAE renal/genitourinary grade 0.35 mg/kg (range, 0.2-1.50; P = .93). CONCLUSIONS AND CLINICAL IMPORTANCE: Multiple doses of ZA were well tolerated in dogs within this study. A small number of dogs developed progressive azotemia which was not associated with cumulative dose.

Patient and Public Involvement Within Orthopaedic Research: A Systematic Review.

BACKGROUND: We performed a systematic review of patient and public involvement in randomized controlled trials (RCTs) in the field of orthopaedic surgery. We assessed the prevalence, extent, and quality of patient and public involvement (PPI) in current academic orthopaedic practice. METHODS: A literature search of the Cochrane, MEDLINE, and Embase databases was performed; we identified RCTs that were published between 2013 and 2020 in the 10 orthopaedic surgery journals with the highest impact factors. Inclusion of studies was based on set criteria, and they were analyzed for their validity. The results were assessed for the rate and the quality of PPI reporting. The Wright and Foster guidelines and the GRIPP2-SF (Guidance for Reporting Involvement of Patients and the Public-2 short form) checklist were used to assess PPI reporting. This review was reported in line with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. RESULTS: An initial 2,107 results were identified. After the screening process, 475 full-text articles were identified and reviewed. Two papers that described PPI were included in this review. One paper used PPI to inform the research question, the choice of primary outcome, the oversight of the study schedule, and the dissemination of the results. The second article used PPI to design the study protocol. Both articles poorly reported the impact of PPI on the research. CONCLUSIONS: To our knowledge, this systematic review is the first to describe the prevalence, extent, and quality of PPI reporting in orthopaedic RCTs. Barriers to adequate PPI reporting are multifactorial and stem from a lack of systematic uptake of PPI guidelines and a lack of compulsory PPI reporting from publishing bodies. CLINICAL RELEVANCE: PPI can improve the quality of clinical trials by focusing on the clinical questions and outcomes that are most important to patients. This article assesses the prevalence of PPI reporting in orthopaedic RCTs.

Food mobility and the evolution of grasping behaviour: a case study in strepsirrhine primates.

Manual grasping is widespread among tetrapods but is more prominent and dexterous in primates. Whether the selective pressures that drove the evolution of dexterous hand grasping involved the collection of fruit or predation on mobile insects remains an area of debate. One way to explore this question is to examine preferences for manual versus oral grasping of a moving object. Previous studies on strepsirrhines have shown a preference for oral grasping when grasping static food items and a preference for manual grasping when grasping mobile prey such as insects, but little is known about the factors at play. Using a controlled experiment with a simple and predictable motion of a food item, we tested and compared the grasping behaviours of 53 captive individuals belonging to 17 species of strepsirrhines while grasping swinging food items and static food items. The swinging motion increased the frequency of hand-use for all individuals. Our results provide evidence that the swinging motion of the food is a sufficient parameter to increase hand grasping in a wide variety of strepsirrhine primates. From an evolutionary perspective, this result gives some support to the idea that hand-grasping abilities evolved under selective pressure associated with the predation of food items in motion. Looking at a common grasping pattern across a large set of species, this study provides important insight into comparative approaches to understanding the evolution of the hand grasping of food in primates and potentially other tetrapod taxa.

Holding-on: co-evolution between infant carrying and grasping behaviour in strepsirrhines.

The origin and evolution of manual grasping remain poorly understood. The ability to cling requires important grasping abilities and is essential to survive in species where the young are carried in the fur. A previous study has suggested that this behaviour could be a pre-adaptation for the evolution of fine manipulative skills. In this study we tested the co-evolution between infant carrying in the fur and manual grasping abilities in the context of food manipulation. As strepsirrhines vary in the way infants are carried (mouth vs. fur), they are an excellent model to test this hypothesis. Data on food manipulation behaviour were collected for 21 species of strepsirrhines. Our results show that fur-carrying species exhibited significantly more frequent manual grasping of food items. This study clearly illustrates the potential novel insights that a behaviour (infant carrying) that has previously been largely ignored in the discussion of the evolution of primate manipulation can bring.

Biology and ecology of Irukandji jellyfish (Cnidaria: Cubozoa).

Irukandji stings are a leading occupational health and safety issue for marine industries in tropical Australia and an emerging problem elsewhere in the Indo-Pacific and Caribbean. Their mild initial sting frequently results in debilitating illness, involving signs of sympathetic excess including excruciating pain, sweating, nausea and vomiting, hypertension and a feeling of impending doom; some cases also experience acute heart failure and pulmonary oedema. These jellyfish are typically small and nearly invisible, and their infestations are generally mysterious, making them scary to the general public, irresistible to the media, and disastrous for tourism. Research into these fascinating species has been largely driven by the medical profession and focused on treatment. Biological and ecological information is surprisingly sparse, and is scattered through grey literature or buried in dispersed publications, hampering understanding. Given that long-term climate forecasts tend toward conditions favourable to jellyfish ecology, that long-term legal forecasts tend toward increasing duty-of-care obligations, and that bioprospecting opportunities exist in the powerful Irukandji toxins, there is a clear need for information to help inform global research and robust management solutions. We synthesise and contextualise available information on Irukandji taxonomy, phylogeny, reproduction, vision, behaviour, feeding, distribution, seasonality, toxins, and safety. Despite Australia dominating the research in this area, there are probably well over 25 species worldwide that cause the syndrome and it is an understudied problem in the developing world. Major gaps in knowledge are identified for future research: our lack of clarity on the socio-economic impacts, and our need for time series and spatial surveys of the species, make this field particularly enticing.

The development of academic geriatric medicine in the United States 2005 to 2010: an essential resource for improving the medical care of older adults.

Academic geriatric medicine programs are critical for training the physician workforce to care effectively for aging Americans. This article updates the progress made by U.S. medical schools from 2005 to 2010 in developing these programs. Academic leaders in geriatrics in accredited allopathic and osteopathic medical schools were surveyed in the winter of 2010 (60% response rate), and results were compared with findings from a similar 2005 survey (68% response rate). Physician faculty in geriatrics increased from 9.6 (mean) full-time equivalents (FTEs) in 2005 to 11.2 by 2010. In 2010, faculty and staff effort was mostly devoted to clinical practice (mean = 37%) and education (mean = 33%), with only seven responding schools devoting more than 40% of faculty effort to research. Schools that have been designated as Centers of Excellence had a median 20 FTE physician faculty, compared with seven at the other schools (P < .001). In 2010, 27% of medical schools required a geriatrics clerkship, and 87% (n = 83) had an elective geriatric clerkship. In summary, more fellows and faculty were recruited and trained in 2010 than in 2005, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, but few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. New approaches to training the entire physician workforce to care for older adults will be required to ensure adequate medical care for aging Americans.

National survey of geriatric psychiatry fellowship programs: comparing findings in 2006/07 and 2001/02 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs' Geriatrics Workforce Policy Studies Center.

OBJECTIVE: : To document the development of geriatric psychiatry (GP) fellowship training in the United States through 2008. METHODS: : A cross-sectional survey of the 56 U.S. GP fellowship programs was conducted in summer 2007. Longitudinal data from the American Medical Association and the Association of American Medical Colleges' National Graduate Medical Education Census and data from the Accreditation Council for Graduate Medical Education were also analyzed. RESULTS: : Thirty-seven (66%) of 56 program directors responded. The number of fellowship programs has decreased over the past 7 years. During 2006/07, 72 fellows were in training, as compared with 94 fellows in 2001/02. Application rates declined significantly with a mean of 4.3 applications per program in 2006/07 as compared with the mean of 10 applications per program in 2001/02. The fill rate for first-year GP fellowship positions dropped from 61% in 2001/02 to 48% in 2006/07. During 2006/07, 67% of programs reported having two or fewer first-year fellows and 16% had no first-year fellows. Seventeen programs reported having no United States medical school graduates as first-year fellows. CONCLUSION: : The number of GP fellows in training has declined by 23% from 2001/02 to 2006/07. This decline has occurred at the same time when the number of older adults continues to expand rapidly. It is critical that an adequate number of geriatric psychiatrists be trained to support and educate general psychiatrists in the care of the elderly. Specific strategies need to be developed urgently to stimulate interest in careers in clinical and academic GP.

Occupational exposure to trichloroethylene and cancer risk for workers at the Paducah Gaseous Diffusion Plant.

OBJECTIVE: The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals. MATERIALS AND METHODS: We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members. Trichloroethylene (TCE) is a specific concern for this workforce; exposure to TCE occurred primarily in departments that clean the process equipment. The Life Table Analysis System (LTAS) program developed by NIOSH was used to calculate the standardized mortality ratios for the worker cohort and standardized rate ratio relative to exposure to TCE (the U.S. population is the referent for ageadjustment). LTAS calculated a significantly low overall SMR for these workers of 0.76 (95% CI: 0.72-0.79). A further review of three major cancers of interest to Kentucky produced significantly low SMR for trachea, bronchus, lung cancer (0.75, 95% CI: 0.72-0.79) and high SMR for Non-Hodgkin's lymphoma (NHL) (1.49, 95% CI: 1.02-2.10). RESULTS: No significant SMR was observed for leukemia and no significant SRRs were observed for any disease. Both the leukemia and lung cancer results were examined and determined to reflect regional mortality patterns. However, the Non-Hodgkin's Lymphoma finding suggests a curious amplification when living cases are included with the mortality experience. CONCLUSIONS: Further examination is recommended of this recurrent finding from all three U.S. Gaseous Diffusion plants.

Spinal cord nephroblastoma in dogs: 11 cases (1985-2007).

OBJECTIVE: To evaluate clinical features and outcome of dogs with a confirmed spinal cord nephroblastoma and to describe the use of Wilms tumor-1 (WT-1) immunohistochemical staining to confirm a diagnosis of nephroblastoma in dogs. DESIGN: Retrospective case series. Animals-11 dogs with a spinal cord nephroblastoma. PROCEDURES: Medical records of dogs with a spinal cord nephroblastoma were reviewed. Information extracted included signalment, history, clinical signs, results of diagnostic testing, tumor location, treatment, and outcome. The diagnosis was confirmed through histologic review and WT-1 immunohistochemical staining of a tumor sample. In dogs with negative results for staining with WT-1, staining for cytokeratin, vimentin, and glial fibrillar acidic protein was performed. RESULTS: 11 dogs had a spinal cord tumor with a histologic appearance and immunohistochemical staining consistent with a nephroblastoma. Positive results for staining with WT-1 were detected in 9 of 11 dogs. Age at admission ranged from 5 to 48 months (median, 14 months). Nine dogs were female. All had progressive paraparesis, paraplegia, or ataxia. Duration of clinical signs ranged from 2 to 60 days (median, 14 days). Median survival time was 30 days from the time of diagnosis. Median survival time in dogs treated via surgical resection was 70.5 days. CONCLUSIONS AND CLINICAL RELEVANCE: The prognosis for dogs with a spinal cord nephroblastoma appeared to be poor, although combined surgical resection and radiation therapy may provide a good functional outcome. Results for staining with WT-1 can be used to support a diagnosis of nephroblastoma.

Surgical treatment of a meningoencephalocele in a cat.

OBJECTIVE: To report the clinical signs, imaging findings and surgical treatment of a meningoencephalocele in a cat. STUDY DESIGN: Case report. ANIMAL: Domestic shorthaired cat, 4 months old. METHODS: A parietal meningoencephalocele was identified and characterized by magnetic resonance and computed tomography (CT) imaging. The abnormal tissue was excised and submitted for histopathology, and the meningeal and skull defects were reconstructed. RESULTS: The cat made a full recovery and the episodes of aggression, restlessness and apparent discomfort that occurred before surgery ceased after surgical treatment. The cat was clinically normal 1 year postoperatively. CONCLUSION: Surgical management of meningoencephalocele in cats may be a viable treatment option.

Evaluation of stroboscopic signs.

OBJECTIVE: Clinicians interpret the stroboscopic examination by systematically rating several parameters or "signs." This can be time consuming and experience dependent. The significance of each of these signs is unknown. Some signs may be redundant, whereas others may be more independent, thus reflecting a unique aspect of the exam assessment. We wanted to determine which stroboscopic signs are more independent and clinically relevant. This may lead to a more efficient and reliable method of stroboscopic exam evaluation. STUDY DESIGN: Retrospective. METHOD: One hundred and eighty one consecutive adult patients with dysphonia of various pathologies were studied. Severity of dysphonia was judged, and a set of seven stroboscopic signs for each stroboscopic exam was rated by our voice team. A principal component factor analysis was performed, and the two factors that accounted for the most variance in the original rating data were determined. These two independent factors were then investigated for clinical usefulness. RESULTS: Several individual stroboscopic signs of vocal fold vibration correlated with the "Vibration Factor" (VF) (mucosal wave, amplitude, vibratory behavior, and periodicity) and the vocal fold edge correlated with the "Edge Factor" (EF). Scores for VF and EF were used to differentiate between general categories of vocal fold pathology and related to the severity of dysphonia. Severity of dysphonia correlated with the VF to a greater degree than the EF. Furthermore, these two factor scores could be accurately estimated using only three stroboscopic signs (amplitude, vibratory behavior, and edge). CONCLUSION: The results of the study support the concept that a small set of stroboscopic ratings is an adequate representation of the information derived from the original, more comprehensive sign rating protocol. A focused rating system may provide an efficient method for stroboscopic evaluation, contributing to the differentiation of various vocal fold pathologies and correlating to clinician ratings of severity of dysphonia.

National survey of geriatric medicine fellowship programs: comparing findings in 2006/07 and 2001/02 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs Geriatrics Workforce Policy Studies Center.

This article documents the development of geriatric medicine fellowship training in the United States through 2009. Results from a national cross-sectional survey of all geriatric medicine fellowship training programs conducted in 2007 is compared with results from a similar survey in 2002. Secondary data sources were used to supplement the survey results. The 2007 survey response rate was 71%. Sixty-seven percent of responding programs directors have completed formal geriatric medicine fellowship training and are board certified in geriatrics, and 29% are board certified through the practice pathway. The number of Accreditation Council for Graduate Medical Education-accredited fellowship programs has slowly increased, from 120 (23 family medicine (FM) and 97 internal medicine (IM)) in 2001/02 to 145 in 2008/09 (40 FM and 105 IM), resulting in a 21% increase in fellowship programs and a 13% increase in the number of first-year fellows (259 to 293). In 2008/09, the growth in programs and first-year slots, combined with the weak demand for geriatrics training, resulted in more than one-third of first-year fellow positions being unfilled. The number of advanced fellows decreased slightly from 72 in 2001/00 to 65 in 2006/07. In 2006/07, 55% of the advanced fellows were enrolled at four training programs. In 2008/09, 66% of fellows were international medical school graduates. The small numbers of graduating geriatric medicine fellows are insufficient to care for the expanding population of older frail patients, train other disciples in the care of complex older adults, conduct research in aging, and be leaders in the field.

Geriatrics education in psychiatric residencies: a national survey of program directors.

OBJECTIVE: The authors describe the current characteristics of geriatrics training within general psychiatry training programs. METHODS: In the fall of 2006, a survey was mailed and made available online to all U.S. psychiatric residency program directors (N=181). RESULTS: The response rate was 54% (n=97). Of the responding psychiatry programs, 96% (n=93) required a clinical experience in geriatrics, with a mean of 54.9 half days of required clinical training. The predominant training sites were inpatient geriatric psychiatry acute care units, ambulatory care experiences precepted by one or more geriatric psychiatrists, and outpatient geriatric psychiatry assessment centers. The mean number of physician faculty per residency program available to teach geriatrics was 2.8 full-time equivalents, and the mean number of physicians certified in geriatric psychiatry was 3.2 per program. Conflicting time demands with other curricula was ranked as the most significant barrier to expanding geriatrics training. CONCLUSION: Variability in the amount of time devoted to geriatrics training exists across general psychiatric residency programs. Some residents spend very little time in specific required geriatric psychiatry clinical experiences and have limited exposure to well-trained geriatric psychiatrists. Therefore, some psychiatrists who will take care of older patients in the future may be ill prepared to do so.

Application of a decision support tool for anticoagulation in patients with non-valvular atrial fibrillation.

BACKGROUND: Atrial fibrillation affects more than two million Americans and results in a fivefold increased rate of embolic strokes. The efficacy of adjusted dose warfarin is well documented, yet many patients are not receiving treatment consistent with guidelines. The use of a patient-specific computerized decision support tool may aid in closing the knowledge gap regarding the best treatment for a patient. METHODS: This retrospective, observational cohort analysis of 6,123 Ohio Medicaid patients used a patient-specific computerized decision support tool that automated the complex risk-benefit analysis for anticoagulation. Adverse outcomes included acute stroke, major gastrointestinal bleeding, and intracranial hemorrhage. Cox proportional hazards models were developed to compare the group of patients who received warfarin treatment with those who did not receive warfarin treatment, stratified by the decision support tool's recommendation. RESULTS: Our decision support tool recommended warfarin for 3,008 patients (49%); however, only 9.9% received warfarin. In patients for whom anticoagulation was recommended by the decision support tool, there was a trend towards a decreased hazard for stroke with actual warfarin treatment (hazard ratio 0.90) without significant increase in gastrointestinal hemorrhage (0.87). In contrast, in patients for whom the tool recommended no anticoagulation, receipt of warfarin was associated with statistically significant increased hazard of gastrointestinal bleeding (1.54, p = 0.03). CONCLUSIONS: We have shown that our atrial fibrillation decision support tool is a useful predictor of those at risk of major bleeding for whom anticoagulation may not necessarily be beneficial. It may aid in weighing the benefits versus risks of anticoagulation treatment.

Estimation of radon exposures to workers at the Fernald Feed Materials Production Center 1952-1988.

The Feed Materials Production Center (FMPC) at Fernald, Ohio produced uranium metal products for use in Department of Energy defense programs. Radium-contaminated waste material was stored on-site in two K-65 silos on the west side of the facility and provided a source of 222Ra. The initial objective of this study was to estimate radon exposures to employees at FMPC working from 1952 to 1988. A modified Gaussian plume model was used to estimate exposures to workers. In an effort to validate these model-based estimates, we used 138 CR-39 film assays from window glass sampled in buildings throughout the site. Results from the CR-39 assays indicated a second substantial source of radon, the smaller Q-11 silos located in the production area. A response-surface regression analysis using a cubic spline model was fit to the CR-39 data to estimate 210Po surface activity levels at geographic coordinates throughout the facility. Knowledge of the age of the glass, the amount of contaminated waste in the Q-11 silos, and 210Po decay rates were used to estimate annual exposures to radon decay products (WLM: working level months). Estimated WLM levels associated with the Q-11 source term indicated that employees working in the vicinity during the period when they were filled with radium-contaminated waste (1952-1958) received substantially higher radon exposures than those from the K-65 source during this period. Results of the two models, corresponding to the K-65 and Q-11 sources, were combined to estimate WLM levels by year for each of the 7143 Fernald workers during the period 1952-1988. Estimated cumulative exposures to individual workers ranged from <0.5 to 751 WLM. Estimated radon exposures from this newly discovered source have important implications for future epidemiologic studies of lung cancer in workers at the Fernald facility.

The development of academic geriatric medicine: progress toward preparing the nation's physicians to care for an aging population.

Academic geriatric medicine programs are critical for training the physician workforce to care effectively for aging Americans. This article describes the progress made by medical schools in developing these programs. Academic leaders in geriatrics at all 145 accredited allopathic and osteopathic medical schools in the United States were surveyed in the winter of 2005 (68% response rate) and results compared with findings from a similar 2001 survey. Physician faculty in geriatrics at U.S. medical schools increased from 7.5 (mean) full-time equivalents (FTEs) in 2001 to 9.6 FTEs in 2005. Faculty and staff effort is mostly devoted to clinical practice (mean 36.9%) and education (mean 34.6%). A small number of programs focus on research; only six responding schools devote more than 40% of faculty effort to research. Seventy-one percent reported that their medical school required a geriatrics medical student clerkship or that their geriatric training was integrated into a required clinical rotation. In summary, from 2001 to 2005, more fellows and faculty have been recruited and trained, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, although few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. An expanded investment in training the physician workforce to care for older adults will be required to ensure adequate care for aging Americans.