Whole-Foods, Plant-Based Diet Perceptions of Medical Trainees Compared to Their Patients: A Cross-Sectional Pilot Study.

Purpose: To evaluate medical trainees' and patients' perceptions of the utility of a whole-foods, plant-based (WFPB) diet for chronic disease management. Methods: A cross-sectional study using two original survey tools was implemented. Quantitative and qualitative data were collected from trainees and patients to evaluate perceived motivations and barriers to WFPB diet implementation. Results: Two hundred trainees and 52 patients responded to the surveys. Nearly half (48%) of patients were willing to try a WFPB diet, expressing a desire for additional information and help with its practical application. Over half (53%) of trainees were willing to recommend a WFPB diet to patients but expressed concern about its acceptability and feasibility. Patients perceived significantly more barriers related to personal enjoyment of animal products while trainees perceived more socioeconomic barriers. Conclusion: Poor diet has been identified as the United States' leading risk factor for mortality from chronic diseases. Plant-predominant diets, such as a WFPB diet, are associated with improved health outcomes and may be an acceptable solution for many patients. WFPB dietary modification could be pursued with a motivational interviewing approach that targets patients' individual goals. Medical providers should address their own assumptions regarding the dietary changes their patients are willing to make.

A Place for Plant-Based Nutrition in US Medical School Curriculum: A Survey-Based Study.

Purpose. To evaluate medical students' and family medicine residents' perceptions of their current degree of nutrition training in general and regarding a whole-foods, plant-based (WFPB) diet. Methods. An original survey instrument was administered to medical students and family medicine residents. Quantitative and qualitative data were collected to evaluate perceptions of nutrition education in medical training, a WFPB diet, and ideas for nutrition-focused curricular reform. Results. Of the 668 trainees surveyed, 200 responded (response rate = 30%). Of these, 22% agreed that they received sufficient nutrition education in medical school and 41% agreed that a WFPB diet should be a focus. Respondents with personal experiences with a plant-based diet were more willing to recommend it to future patients. Common ideas for curricular reform were instruction on a WFPB diet along with other healthy dietary patterns, patient counseling, a dedicated nutrition course, and electives. Conclusions. Nutrition education in US medical training needs improvement to address the growing burden of obesity-related chronic disease. Proper nutrition and lifestyle modification should therefore play a larger role in the education of future physicians. A focus on plant-predominant diets, such as the WFPB diet, may be an acceptable and effective addition to current medical school curriculum, and deserves further study.

Immunogenicity and Safety of Typhoid Conjugate Vaccine in Healthy Indian Subjects: A Randomized, Active-controlled, Comparative Clinical Trial.

OBJECTIVE: To compare the immunogenicity and safety of an investigational typhoid Vi conjugate vaccine (Test TCV) with a marketed typhoid Vi conjugate vaccine (Comparator TCV). DESIGN: Randomized, controlled trial. SETTING: Tertiary care and multispecialty hospitals. PARTICIPANTS: 240 healthy subjects of 6 months to 45 years. Pediatric (<18 years) subjects were enrolled after day 21 safety assessment of adult subjects. INTERVENTION: Participants received a single-dose of test TCV or comparator TCV at baseline and were followed up for 6 weeks post-vaccination. MAIN OUTCOME MEASURE: Primary variable was to demonstrate non-inferiority of the test TCV with the comparator TCV for seroconversion post-vaccination (³4-fold rise in antibody titre). Secondary variables were seroconversion in the adult and pediatric cohorts, and geometric mean titre of antibodies while the safety was based on reported adverse events. RESULTS: A total of 117 subjects (Adult-58, Pediatric-59) and 119 subjects (Adult-60, Pediatric-59) in test and comparator group, respectively completed the study. The seroconversion rate with test TCV (overall-94.8%, adult-96.6% and pediatric-93.1%) was non-inferior to comparator TCV (overall-91.6%, adult-91.7% and pediatric-91.5%). The geometric mean titres of antibodies (EU/mL) at baseline (test TCV: overall-7.6, adult-10.0, and pediatric-5.7; and comparator TCV: overall-8.0, adult-12.0, and pediatric-5.3) and at end of study (test TCV: overall-1121.0, adult-1411.0 and pediatric-891.1; and comparator TCV: overall-1104.0, adult-1199.0 and pediatric-1014.0) were also comparable between the groups (P>0.05 for all). The most common adverse event was injection-site pain followed by fever in both the groups. CONCLUSIONS: The immunogenicity and safety of test TCV is comparable to already marketed comparator TCV.

A Problem-Based Learning Session on Pregnancy Options, Counseling, and Abortion Care.

Introduction: Before their clinical rotations, medical students have limited exposure to women's health issues, particularly abortion. Methods: We piloted a problem-based learning (PBL) module to introduce second-year medical students at the University of Louisville School of Medicine to counseling patients about pregnancy options. Students were divided into groups of 10 and met for two 2-hour sessions. In the first session, learners were presented with a case about a woman diagnosed with Zika virus who was considering pregnancy termination. Students discussed the case and developed learning objectives to research. One week later, students reconvened and shared what they had learned individually. Students were asked to complete pre- and post-PBL surveys. PBL facilitators also completed a survey evaluating the module. Results: Fifty-eight percent of students felt informed or very informed about abortion after the PBL, compared to 30% before (p < .001). Students' mean quiz score increased from 29% on the pretest to 40% on the posttest (p < .001). Ninety-three percent of facilitators believed this PBL provided students with tools to better counsel about abortion, but only 56% of faculty felt adequately trained to facilitate this discussion. Discussion: Students appreciated this PBL as an opportunity to discuss pregnancy options counseling and to clarify their own values surrounding abortion provision. Despite their positive response to the module, students identified barriers that would prevent them from implementing knowledge learned from this module in practice.

Immunogenicity and safety of the first indigenously developed Indian tetravalent influenza vaccine (split virion) in healthy adults ≥ 18 years of age: A randomized, multicenter, phase II / III clinical trial.

This phase II / III clinical trial was conducted to evaluate the immunogenicity and safety of the Tetravalent Influenza vaccine (Split virion) I.P. (TetIV) developed indigenously in the country for the first time by M/s Cadila Healthcare Limited, India containing two influenza A and two influenza B strains, one of each, Yamagata (B/Phuket) and Victoria (B/Brisbane) lineage and also compare it to that of an licensed seasonal Trivalent Influenza vaccine (TriIV) of Sanofi Pasteur India Private Limited, containing the two influenza A and only the Yamagata lineage (B/Phuket) strain. Three hundred and fifty subjects of either sex, aged more than 18 years of age, were randomized in a 1:1 ratio to receive either the TetIV or TriIV. Immunogenicity assessments (antibody against A/H1N1, A/H3N2, B/Phuket and B/Brisbane) were done by Haemagglutination Inhibition assay at baseline and 21 d after vaccination. Solicited (local and systemic) and unsolicited adverse events were recorded for up to 42 d following vaccination. The TetIV was found to fulfill the criteria set by the European and the US regulatory authorities and WHO guidance on the requirements of clinical data for licensure of seasonal inactivated influenza vaccines. The seroconversion rates with TetIV were 93.5% for A/H1N1, 90.0% for A/H3N2, 70.0% for B/Phuket and 82.9% for B/Brisbane strain. There was no significant difference in the seroconversion and seroprotection rates at day 21 for A/H1N1, A/H3N2 and B/Phuket in the two groups while the TetIV was superior to the TrivIV for the seroconversion and the seroprotection rate for the B/Brisbane strain (Victoria lineage). Both the vaccines were well tolerated by all the study participants; addition of the fourth strain in the TetIV did not compromise the safety as compared to TriIV. The most common systemic adverse event reported in both the groups was headache followed by fever.

Multiplex sorting of foodborne pathogens by on-chip free-flow magnetophoresis.

This study reports multiplex sorting of Salmonella typhimurium and Escherichia coli 0157, from broth cultures and from pathogen-spiked skinned chicken breast enrichment broths by employing microfluidic free-flow magnetophoresis. Magnetic beads of different sizes and magnetite content, namely Dynabeads anti-salmonella and Hyglos-Streptavidin beads together with the corresponding pathogen-specific biotinylated recombinant phages, were utilised as affinity solid phases for the capture and concentration of viable S. typhimurium and E. coli 0157. Following optimisation, the protocol was used to demonstrate continuous magnetophoretic sorting of the two pathogen-bound magnetic bead populations from mixed cultures and from pathogen-spiked chicken pre-enrichment broths under the influence of a Halbach magnet array. For example, in the latter case, a pure population of S. typhimurium-bound Dynabeads (72% recovery) was sorted from a 100 µL mixture containing E. coli 0157-bound Hyglos beads (67% recovery) within 1.2 min in the presence of 0.1% Tween 20. This proof-of-principle study demonstrates how more than one pathogen type can be simultaneously isolated/enriched from a single food pre-enrichment broth (e.g. Universal food enrichment broth).

Direct Observation of Treatment Provided by a Family Member as Compared to Non-Family Member among Children with New Tuberculosis: A Pragmatic, Non-Inferiority, Cluster-Randomized Trial in Gujarat, India.

BACKGROUND: The World Health Organization recommends direct observation of treatment (DOT) to support patients with tuberculosis (TB) and to ensure treatment completion. As per national programme guidelines in India, a DOT provider can be anyone who is acceptable and accessible to the patient and accountable to the health system, except a family member. This poses challenges among children with TB who may be more comfortable receiving medicines from their parents or family members than from unfamiliar DOT providers. We conducted a non-inferiority trial to assess the effect of family DOT on treatment success rates among children with newly diagnosed TB registered for treatment during June-September 2012. METHODS: We randomly assigned all districts (n = 30) in Gujarat to the intervention (n = 15) or usual-practice group (n = 15). Adult family members in the intervention districts were given the choice to become their child's DOT provider. DOT was provided by a non-family member in the usual-practice districts. Using routinely collected clinic-based TB treatment cards, we compared treatment success rates (cured and treatment completed) between the two groups and the non-inferiority limit was kept at 5%. RESULTS: Of 624 children with newly diagnosed TB, 359 (58%) were from intervention districts and 265 (42%) were from usual-practice districts. The two groups were similar with respect to baseline characteristics including age, sex, type of TB, and initial body weight. The treatment success rates were 344 (95.8%) and 247 (93.2%) (p = 0.11) among the intervention and usual-practice groups respectively. CONCLUSION: DOT provided by a family member is not inferior to DOT provided by a non-family member among new TB cases in children and can attain international targets for treatment success. TRIAL REGISTRATION: Clinical Trials Registry-India, National Institute of Medical Statistics (Indian Council of Medical Research) CTRI/2015/09/006229.

On-chip acoustophoretic isolation of microflora including S. typhimurium from raw chicken, beef and blood samples.

Pathogen analysis in food samples routinely involves lengthy growth-based pre-enrichment and selective enrichment of food matrices to increase the ratio of pathogen to background flora. Similarly, for blood culture analysis, pathogens must be isolated and enriched from a large excess of blood cells to allow further analysis. Conventional techniques of centrifugation and filtration are cumbersome, suffer from low sample throughput, are not readily amenable to automation and carry a risk of damaging biological samples. We report on-chip acoustophoresis as a pre-analytical technique for the resolution of total microbial flora from food and blood samples. The resulting 'clarified' sample is expected to increase the performance of downstream systems for the specific detection of the pathogens. A microfluidic chip with three inlets, a central separation channel and three outlets was utilized. Samples were introduced through the side inlets, and buffer solution through the central inlet. Upon ultrasound actuation, large debris particles (10-100 µm) from meat samples were continuously partitioned into the central buffer channel, leaving the 'clarified' outer sample streams containing both, the pathogenic cells and the background flora (ca. 1 µm) to be collected over a 30 min operation cycle before further analysis. The system was successfully tested with Salmonella typhimurium-spiked (ca. 10(3)CFU mL(-1)) samples of chicken and minced beef, demonstrating a high level of the pathogen recovery (60-90%). When applied to S. typhimurium contaminated blood samples (10(7)CFU mL(-1)), acoustophoresis resulted in a high depletion (99.8%) of the red blood cells (RBC) which partitioned in the buffer stream, whilst sufficient numbers of the viable S. typhimurium remained in the outer channels for further analysis. These results indicate that the technology may provide a generic approach for pre-analytical sample preparation prior to integrated and automated downstream detection of bacterial pathogens.

Senior Medical Student Mock Interview Program in Pediatrics.

OBJECTIVES: Residency interviews play an integral part in medical residency placement. We aimed to develop and evaluate a mock interview program for fourth-year medical students interested in a pediatric specialty. METHODS: A mock interview program for fourth-year medical students interested in pediatrics was developed and implemented. Preinterview quantitative data and postinterview qualitative data were collected. Fifty-nine students completed the program across three consecutive academic years. Preinterview surveys were completed regarding comfort and confidence levels specific to aspects of the interview process. Descriptive analyses were used. In addition, a focus group was held with nine of the participating students to obtain qualitative data via a paper blog process. Themes in student responses were identified through constant comparative analysis. RESULTS: Before the mock interview, students were most uncomfortable with introductory and closing remarks and their confidence levels varied by topic. A thematic analysis of focus group data identified five themes (preparation, stress reduction, interview process familiarity, confidence of skills, and receiving feedback) for which the mock interviews were most helpful. CONCLUSIONS: Implementation of a mock interview program was feasible and acceptable for senior medical students and may improve comfort and confidence levels in the residency interview process. Further longitudinal research is needed.

Photovoice in Kenya: Using a Community-Based Participatory Research Method to Identify Health Needs.

Photovoice, a community-based participatory research method, was utilized to delineate the health-related needs of a small rural community in Kenya. Within the Cherangany Constituency, 13 women were recruited and trained in digital photography and appropriate ethical conduct in photography (respect for privacy, consent, and confidentiality). Both individual and group interviews were conducted with the participants, and data were transcribed and analyzed for common themes by both the participants and the researcher. Common themes present in the photos were coded and prioritized in order of importance: (a) school fees, (b) water, (c) hospital fees, (d) sanitation, (e) orphans, (f) widows, (g) lack of jobs/capital, (h) disabilities, and (i) presence of disease. Data from this study will be utilized for (a) development of culturally competent health education, (b) site-specific education/training of incoming medical teams, and (c) informative meetings with local leaders regarding health and associated challenges.

Membrane filter-assisted surface enhanced Raman spectroscopy for the rapid detection of E. coli O157:H7 in ground beef.

Consumption of food contaminated with Escherichia coli O157:H7 is one of the major concerns in ensuring food safety. Techniques that are simple and suitable for fast screening to detect and identify pathogens in the food chain is vital to ensure food safety. In this work, we propose a simple and rapid technique to detect low levels of E. coli O157:H7 using membrane filtration and silver intensification steps in combination with surface enhanced Raman spectroscopy (SERS) analysis. The target bacteria can be captured and separated efficiently by two different antibody bearing nanoparticle complexes (magnetic nanoparticles and gold nanoparticles with a Raman reporter). After centrifugal filtration, the bacteria-nanoparticle complexes left on the filter membrane were localized by silver intensification process before probing by SERS. Extremely low concentration of E. coli O157:H7 (~10 CFU/mL) could be detected within 1h and 3h from both pure culture and ground beef samples, respectively. This method can potentially be used as an effective pathogen screening tool for routine monitoring.

Safety and immunogenicity study of a new purified chick embryo cell rabies vaccine Vaxirab-N (Pitman-Moore strain) manufactured in India.

Zydus Cadila Health care, India developed a new purified chick embryo cell rabies vaccine (PCECV, Vaxirab-N; 1 mL) by adapting Pitman-Moore strain of virus on to the chick embryo fibroblast cell line in 2006. During 2007-10, a series of safety and immunogenicity studies were conducted as per ICH-GCP guidelines after obtaining permission from Drug Controller General of India. In the first study, Vaxirab-N was administered to 35 healthy adult volunteers by intramuscular (IM) route using pre exposure regimen. The geometric mean concentration (GMC) of rabies virus neutralizing antibody (RvnAb) of 7.5 IU/mL on day 35. In the second study, Vaxirab-N was administered to 35 healthy adult volunteers using simulated post- exposure prophylaxis regimen by IM route. A GMC of 6.3 IU/mL on day 14, 13.2 IU/mL on day 28 and 8.6 IU/mL on day 90 was obtained. In the third study, Vaxirab-N administered by intradermal (ID) route using Updated Thai Red Cross (TRC) regimen in 36 healthy adult volunteers showed GMC of 7.8 IU/mL on day 14, 11.5 IU/mL on day 28 and 6.0 IU/mL on day 90. The 4th study was multi centric and Vaxirab-N was administered to 129 animal bite cases by IM route using post-exposure Essen regimen. The GMC following this schedule was 8.2 IU/mL on day 14, 13.01 IU/mL on day 28, 7.92 IU/mL on day 90 and 3.72 IU/mL on day 180. Mild to moderate adverse events were reported to Vaxirab-N but no serious adverse events were reported in any of these studies. In conclusion, Vaxirab-N developed by Zydus Cadila was found to be safe and immunogenic by both intramuscular and intradermal route and is recommended for rabies prophylaxis (CTRI No. 2010/091/000055 and 2010/091/000509).

Twelve tips for using social media as a medical educator.

BACKGROUND: We now live, learn, teach and practice medicine in the digital era. Social networking sites are used by at least half of all adults. Engagement with social media can be personal, professional, or both, for health-related and educational purposes. Use is often public. Lapses in professionalism can have devastating consequences, but when used well social media can enhance the lives of and learning by health professionals and trainees, ultimately for public good. Both risks and opportunities abound for individuals who participate, and health professionals need tips to enhance use and avoid pitfalls in their use of social media and to uphold their professional values. AIMS AND METHODS: This article draws upon current evidence, policies, and the authors' experiences to present best practice tips for health professions educators, trainees, and students to build a framework for navigating the digital world in a way that maintains and promotes professionalism. RESULTS AND CONCLUSIONS: These practical tips help the newcomer to social media get started by identifying goals, establishing comfort, and connecting. Furthermore, users can ultimately successfully contribute, engage, learn, and teach, and model professional behaviors while navigating social media.

The responsible use of online social networking: who should mentor medical students.

BACKGROUND: As medical students become more active in online social networking (OSN), there are increasing concerns regarding violations of patient privacy and a lack of professionalism. PURPOSE: Students need to be mentored, but who is best suited to the task? We hypothesized that residents are closer to students in usage and attitudes toward online communication than are faculty. If so, they would be more credible as mentors. METHODS: We surveyed faculty (N = 16), 1st-year residents (N = 120), and 3rd-year medical students (N = 130) to compare attitudes about OSN and the online usage patterns. RESULTS: We found residents to be more like students in usage patterns of personal electronic media and in their choice of the mentoring techniques that should be used. CONCLUSION: Residents say they were not prepared to mentor students without additional guidance but were more confident than faculty members that they had the knowledge to do so.

Why physicians should share PDA/smartphone findings with their patients: a brief report.

Many physicians use PDAs/smartphones in the presence of their patients. But how do patients perceive this behavior? This study tested the hypothesis that participants with increased knowledge about medical applications of PDAs/smartphones have more positive perceptions of physicians using them. The authors assigned 250 patients and/or family members in medical or pharmacy waiting rooms at 2 universities to either the control group or the treatment group. The treatment group viewed a brief presentation about how and why physicians use PDAs/smartphones, whereas the control group received no new information. All participants completed a survey about their knowledge (7 items) and perceptions (13 items) of physician use of PDAs/smartphones. The treatment group showed more favorable perceptions (p < .05) on 5 out of 13 survey items. In addition, in the control group, those who showed "high knowledge" had more favorable perceptions (p < .05) on 8 out of 13 survey items compared with control group participants with "low/moderate knowledge" levels. The authors concluded that even a small amount of information increases measurable perceptions. This study suggests that perhaps physicians should take time to share their PDA/smartphone findings with their patients to improve patients' perceptions of their use.

Bacteriophage-based rapid and sensitive detection of Escherichia coli O157:H7 isolates from ground beef.

We investigated the efficacy of bacteriophage-based detection technology to detect Escherichia coli O157:H7 from ground beef. The assay involved a short enrichment period of 8 h followed by capture of the pathogen on O157-specific immunomagnetic beads. The captured cells were treated with O157-specific lytic bacteriophage, CSLO157. Upon phage-induced lysis, the enzyme adenylate kinase, which was released from the lysed cells, was measured in terms of relative light units using luciferin-luciferase assay. The plaque forming efficiency (e.g., phage susceptibility) and ability to capture cells with immunomagnetic beads were examined using an array of 74 E. coli O157:H7 isolates obtained from various clinical and foodborne samples. Immunmagnetic beads successfully captured all 74 isolates; however, only 53 isolates showed susceptibility toward the bacteriophage. Susceptible isolates were further classified into two broad groups, moderately sensitive isolates, which generated phage titer ∼ 10(7)pfu/mL (group I, n=15), and highly susceptible isolates, which generated high phage titer ∼ 10(9)pfu/mL (group II, n=38). We selected 15 isolates (9 from group I and 6 from group II) and individually spiked beef samples (ca. 3-8 cells/25 g beef) to evaluate the bacteriophage-based detection system. Eight out of nine isolates from group I and all six isolates from group II were successfully detected. Pathogenic E. coli strains belonging to other serogroups (12 serogroups, 67 isolates) as well as nontarget microorganisms (n=18) were not lysed by the bacteriophage and hence were not detected. The method is high-throughput compatible, is rapid, and can provide live culture the following day by streaking an aliquot before phage lysis on conventional selective agar media.

Improving residents' teaching skills: a program evaluation of residents as teachers course.

BACKGROUND: The role of residents as teachers is recognized as an important part of medical education. However, residents may not possess the practical skills needed to teach medical students effectively. AIM: In response to a Liaison Committee on Medical Education citation concerning surgery residents' teaching skills, the University of Louisville School of Medicine instituted a campus-wide residents as teachers program based on the bringing education and service together curriculum. METHODS: This evaluation plan is grounded on Kirkpatrick's four levels model. Levels 1 and 2 data included post-session learner questionnaires (2007 and 2008) and open-ended facilitator questionnaires (2008). Levels 3 and 4 data included third year medical students' responses to CourseEval questions on residents as teachers (2005-2006 and 2007-2008) and data from third year medical student focus groups (2008). RESULTS: Levels 1 and 2 data analysis showed statistically significant improvements from session to session in Year I and significant improvements between Years I and II. Levels 3 and 4 data analysis showed third year students' perceptions of most residents as teachers remained high and improved significantly in the surgery clerkship. CONCLUSION: Short-term and long-term measures show this curriculum to be successful for an interdisciplinary group of residents.

Developments in polymeric devices for oral insulin delivery.

BACKGROUND: Development of improved oral insulin administration is necessary for the treatment of diabetes mellitus, to overcome the problem of daily subcutaneous injections. The vast amount of literature data on oral insulin delivery prompted us to cover this area in a review. OBJECTIVE: Insulin delivery using polymeric devices is discussed, with an ultimate aim of addressing the technological development in this area. METHODS: The development of oral delivery devices for insulin using hydrogels and micro/nanoparticles is discussed with reference to polymers. These efforts must be directed to increase the residence time of insulin near the intestinal absorptive cells. RESULTS/CONCLUSION: The published results on oral insulin delivery devices, particularly on inter-polymer complexes of the grafted copolymers, are discussed in greater depth. The use of absorption enhancers like cyclodextrins, bile salts and surfactants is covered. The state-of-the-art technology and challenges in this area are discussed, with typical examples.

Assessing Medical Students', Residents', and the Public's Perceptions of the Uses of Personal Digital Assistants.

Although medical schools are encouraging the use of personal digital assistants (PDAs), there have been few investigations of attitudes toward their use by students or residents and only one investigation of the public's attitude toward their use by physicians. In 2006, the University of Louisville School of Medicine surveyed 121 third- and fourth-year medical students, 53 residents, and 51 members of the non-medical public about their attitudes toward PDAs. Students were using either the Palm i705 or the Dell Axim X50v; residents were using devices they selected themselves (referred to in the study generically as PDAs). Three survey instruments were designed to investigate attitudes of (a) third- and fourth-year medical students on clinical rotations, (b) Internal Medicine and Pediatrics residents, and (c) volunteer members of the public found in the waiting rooms of three university practice clinics. Both residents and medical students found their devices useful, with more residents (46.8%) than students (16.2%) (p < 0.001) rating PDAs "very useful." While students and residents generally agreed that PDAs improved the quality of their learning, residents' responses were significantly higher (p < 0.05) than students'. Residents also responded more positively than students that PDAs made them more effective as clinicians. Although members of the public were generally supportive of PDA use, they appeared to have some misconceptions about how and why physicians were using them. The next phase of research will be to refine the research questions and survey instruments in collaboration with another medical school.