Benefits, Barriers, and Motivators to Training Dietetic Interns in Clinical Settings: A Comparison between Preceptors and Nonpreceptors.

BACKGROUND: The shortage of supervised practice sites in dietetics is associated with fewer numbers of preceptors available to supervise interns, especially in the clinical setting. OBJECTIVE: To identify clinical dietitians' perceived benefits and challenges of training dietetic interns and to determine key motivators that would entice nonpreceptors to volunteer for the role. DESIGN: Registered dietitian nutritionists working in clinical settings completed a semi-structured, audiotaped interview followed by a brief questionnaire. PARTICIPANTS: Clinical dietitians working in hospitals, long-term care facilities, and outpatient clinics (n=100) participated: 54 preceptors and 46 nonpreceptors. STATISTICAL ANALYSIS: Qualitative analysis was conducted using an iterative process to identify and code common themes. T tests were used to compare mean differences between the opinions of preceptors and nonpreceptors. RESULTS: Preceptors had approximately 5 more years of experience (mean=14.27±12.09 years) than nonpreceptors (mean=8.83±9.72 years) (P< 0.01). Furthermore, preceptors reported twice as many benefits to mentoring interns (mean=6.7 mentions/participant) as nonpreceptors (mean=3.4 mentions/participant), including knowledge gains and staying current. Lack of time was consistently noted as a barrier in interviews and rated as the greatest barrier in the survey. Both groups rated receiving continuing professional education units (CPEUs) for precepting as the greatest potential motivator for taking on interns. CONCLUSIONS: Incentive programs should be developed to entice nonpreceptors to take on interns. These programs should include extensive training on the preceptor role and how to alleviate the burden of time spent supervising interns and should provide a significant number of CPEUs to make the added workload worthwhile.

Effect of a School Choice Policy Change on Active Commuting to Elementary School.

PURPOSE: The purposes of this study were to assess the effect of restricting school choice on changes in travel distance to school and transportation mode for elementary school students. DESIGN: Study design was pre-post (spring 2010-fall 2010) quasi-experimental. SETTING: Study setting was all public elementary schools in Minneapolis, Minnesota. SUBJECTS: Subjects comprised approximately 20,500 students across 39 schools. INTERVENTION: Study assessed a school choice policy change that restricted school choice to a school closer to the family's home. MEASURES: School district transportation data were used to determine distance to school. Direct observations of student travel modes (two morning and two afternoon commutes at each time point) were used to assess transportation mode. ANALYSIS: Chi-square and independent-sample t-tests were calculated to describe the schools. Repeated measures general linear models were used to assess changes in travel distance to school and observed commuting behavior. RESULTS: Distance to school significantly decreased (1.83 ± .48 miles to 1.74 ± .46 miles; p = .002). We failed to observe any significant changes in morning (+.7%) or afternoon (-.7%) active commuting (both p = .08) or the number of automobiles in the morning (-7 autos per school; p = .06) or afternoon (+3 autos per school; p = .14). CONCLUSION: The more restrictive school choice policy decreased distance to school but had no significant effect on active commuting. Policy interventions designed to increase active commuting to school may require additional time to gain traction and programmatic support to induce changes in behavior.

Thiazolides as novel antiviral agents. 2. Inhibition of hepatitis C virus replication.

We report the activities of a number of thiazolides [2-hydroxyaroyl-N-(thiazol-2-yl)amides] against hepatitis C virus (HCV) genotypes IA and IB, using replicon assays. The structure-activity relationships (SARs) of thiazolides against HCV are less predictable than against hepatitis B virus (HBV), though an electron-withdrawing group at C(5') generally correlates with potency. Among the related salicyloylanilides, the m-fluorophenyl analogue was most promising; niclosamide and close analogues suffered from very low solubility and bioavailability. Nitazoxanide (NTZ) 1 has performed well in clinical trials against HCV. We show here that the 5'-Cl analogue 4 has closely comparable in vitro activity and a good cell safety index. By use of support vector analysis, a quantitative structure-activity relationship (QSAR) model was obtained, showing good predictive models for cell safety. We conclude by updating the mode of action of the thiazolides and explain the candidate selection that has led to compound 4 entering preclinical development.

Thiazolides as novel antiviral agents. 1. Inhibition of hepatitis B virus replication.

We report the syntheses and activities of a wide range of thiazolides [viz., 2-hydroxyaroyl-N-(thiazol-2-yl)amides] against hepatitis B virus replication, with QSAR analysis of our results. The prototypical thiazolide, nitazoxanide [2-hydroxybenzoyl-N-(5-nitrothiazol-2-yl)amide, NTZ] 1 is a broad spectrum antiinfective agent effective against anaerobic bacteria, viruses, and parasites. By contrast, 2-hydroxybenzoyl-N-(5-chlorothiazol-2-yl)amide 3 is a novel, potent, and selective inhibitor of hepatitis B replication (EC(50) = 0.33 µm) but is inactive against anaerobes. Several 4'- and 5'-substituted thiazolides show good activity against HBV; by contrast, some related salicyloylanilides show a narrower spectrum of activity. The ADME properties of 3 are similar to 1; viz., the O-acetate is an effective prodrug, and the O-aryl glucuronide is a major metabolite. The QSAR study shows a good correlation of observed EC(90) for intracellular virions with thiazolide structural parameters. Finally we discuss the mechanism of action of thiazolides in relation to the present results.

Histopathological observations on liver, kidney and gonad of plaice (Pleuronectes platessa) taken from the Mersey estuary.

The Mersey estuary is the most contaminated estuary in British waters. Detailed studies are underway on the pathology of flounder (Platichthys flesus) from the Mersey and on flounder from the nearby, but less contaminated, Dee estuary. Flounder breed offshore but spend a lot of time in the estuaries, penetrating into freshwater. These flatfish are in close contact with sediments and will be exposed to exenobiotic stored in the sediments. Plaice (Pleuronectes platessa) are flatfish which enter the Mersey with the tidal flow but spend less time in the estuary than flounder and are less likely to show evidence of pollutant exposure. Over 20 plaice were collected from the Mersey. Samples of the liver, kidney and gonad were fixed in 10% formal saline, processed into paraffin wax and 5 microm sections cut and stained with haematoxylin and eosin. Liver changes consisted of variable amounts of glycogen/lipid storage product, minor perivenular and perivascular fibrosis, and helminth parasitisation. No tumours or foci of cellular alteration, necrosis and inflammation were seen. In the gonad only changes consistent with normal gonadal cycling was seen. These studies provide evidence that plaice show little or no evidence of toxic pathological damage resulting from their stay in the estuary.