Predation-resistant Pseudomonas bacteria engage in symbiont-like behavior with the social amoeba Dictyostelium discoideum.

The soil amoeba Dictyostelium discoideum acts as both a predator and potential host for diverse bacteria. We tested fifteen Pseudomonas strains that were isolated from transiently infected wild D. discoideum for ability to escape predation and infect D. discoideum fruiting bodies. Three predation-resistant strains frequently caused extracellular infections of fruiting bodies but were not found within spores. Furthermore, infection by one of these species induces secondary infections and suppresses predation of otherwise edible bacteria. Another strain can persist inside of amoebae after being phagocytosed but is rarely taken up. We sequenced isolate genomes and discovered that predation-resistant isolates are not monophyletic. Many Pseudomonas isolates encode secretion systems and toxins known to improve resistance to phagocytosis in other species, as well as diverse secondary metabolite biosynthetic gene clusters that may contribute to predation resistance. However, the distribution of these genes alone cannot explain why some strains are edible and others are not. Each lineage may employ a unique mechanism for resistance.

Philosophically, is obesity really a disease?

The question of whether obesity should be regarded as a disease remains controversial. One source of controversy can be addressed by distinguishing between two ways in which the word "obesity" is used. In medicine, the word "obesity" now typically refers to some or all of a set of interrelated dysfunctions of metabolism, adipose tissue, and dietary intake regulation. In other contexts, such as government-funded public education programs, the word "obesity" refers to a body mass index (BMI) category taken to indicate excess body fat. The result is that when medical experts say, "Obesity is a disease," the majority of outside medicine inevitably takes this to mean "being fat is a disease." In order to address this ambiguity, we apply key philosophical accounts of disease to the two different senses of "obesity." We draw two major conclusions: First, although obesity as understood in clinical medicine meets the criteria to be considered a disease, obesity as defined by BMI does not. Second, adequately addressing this disease requires us to distinguish it clearly and unambiguously from high BMI. Making this distinction would help both the public and policymakers to better understand the disease of obesity, facilitating advances in both prevention and treatment.

An Innovative Model of Pediatric Emergency Department Mental Health Care: Protocol for a Multicenter Type 1 Effectiveness-Implementation Cluster Randomized Trial.

Over the past decade, visits to American and Canadian emergency departments (EDs) for child and youth mental health care have increased substantially.1,2 Acute mental health crises can occur as a result of a variety of concerns, including those that are life threatening (eg, suicide attempts), pose safety concerns (eg, suicidal intentions, aggressive behaviors, alcohol and other drug use), and are physically distressing to the child or youth (eg, panic attacks). ED health care providers play a vital role in assessing the safety and well-being of the child or youth and referring them to services for ongoing care.3,4 During the ED visit, assessment and care should pinpoint risks, inform treatment, and consider family needs and preferences as part of a patient-centered approach. Yet, this approach to care is not widely adopted in EDs. Most EDs do not require the use of pediatric-specific mental health tools to guide assessments or have patient-centered procedures in place to guide the care of patients with mental health emergencies.5-7 Our team believes these limitations have led to the provision of acute mental health care that can lack sufficient quality and efficiency. This study protocol describes a trial designed to evaluate if a novel mental health care bundle that was co-designed with parents and youth results in greater improvements in the well-being of children and youth 30 days after seeking ED care for mental health and/or substance misuse concerns compared with existing care protocols. We hypothesize that the bundle will positively impact child and youth well-being, while also providing cost-effective health care system benefits.

Evaluation of parent and youth experiences in advisory groups as part of a mental healthcare clinical trial: protocol for a mixed-method study.

INTRODUCTION: Patient engagement in healthcare research is a necessity to ensure that research objectives align with priorities, outcomes and needs of the population under study, and to facilitate ease of implementation and adoption of findings. In clinical trials, there is an increasing focus on patient engagement during the planning and conduct of clinical trials due to the potential for ethical and methodological benefits. As patient engagement in clinical trials increases, there is a need to evaluate the approaches of these activities to contribute evidence on what is most appropriate and successful. The purpose of this study is to evaluate patient engagement processes and the activities of patient partners during and after a paediatric mental healthcare trial. METHODS AND ANALYSIS: Using a mixed-methods study design, we will evaluate patient partners' engagement activities across set time-points during the trial and after trial completion. In this study, the term 'patient partner' is inclusive of two groups of people with lived experience: (1) caregivers (parents, formal/informal caregivers and family), and (2) youth (aged 15-24 years). Engagement will be evaluated using the participant and project questionnaires of the Public and Patient Engagement Evaluation Tool (PPEET), followed sequentially by semi-structured interviews. Quantitative data from the PPEET questionnaire will be analysed and reported using descriptive statistics. Data from open-ended questions from the PPEET questionnaires and semi-structured interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION: Approval from Athabasca University Research Ethics Board will be obtained for this project. Findings will be disseminated at both academic and public venues whether in-person or online, and using platforms that are caregiver and youth friendly. TRIAL REGISTRATION NUMBER: NCT04902391.

Managing Postoperative Nausea With an Application of Ice Pack to the Posterior Upper Neck.

PURPOSE: Measure effectiveness of a non-pharmacological approach to manage postoperative nausea (PON) by applying an ice pack to the posterior upper neck. DESIGN: This was an observational quality improvement project. The sample included adults 18 years old and older who received general anesthesia (inhalation and/or intravenous), recovering in Phase I or Phase II postoperative care unit (PACU) experiencing very mild to moderate nausea. Exclusion criteria were patients who experienced severe nausea or were actively vomiting; were admitted for head or neck plastic surgery; were hypothermic (< 36.0°C); patients who refused the ice pack, or the provider stated that placing an ice pack to the patient's posterior upper neck was contraindicated. METHODS: Patients who experienced mild to moderate PON had an ice pack applied to the posterior upper neck as first line management. If the patient's nausea continued to progress or did not improve within five minutes of ice pack application the patient was offered a different non-pharmacological approach or pharmacological approach to prevent vomiting as per standards of care. Demographics were collected and patient's level of nausea was documented at the time of ice pack application and after five minutes. FINDINGS: Of the 70 patients included in this study, 61% reported ice pack application as effective in mitigating their nausea, 14% were unsure, and 24% reported not effective. There was a significant decrease in nausea between baseline (2.3 ± 0.6; range 1-3) and five minutes post application (1.5 ± 1.1; range 0-4). The within subject baseline-post change (↓0.9 ± 1.1; P < .001) reflected a decrease in nausea. CONCLUSIONS: Application of an ice pack to the posterior upper neck, may effectively decrease very mild to moderate PON.

The Gut Microbiota Protects Bees from Invasion by a Bacterial Pathogen.

Commensal microbes in animal guts often help to exclude bacterial pathogens. In honey bees, perturbing or depleting the gut microbiota increases host mortality rates upon challenge with the opportunistic pathogen Serratia marcescens, suggesting antagonism between S. marcescens and one or more members of the bee gut microbiota. In laboratory culture, S. marcescens uses a type VI secretion system (T6SS) to kill bacterial competitors, but the role of this T6SS within hosts is unknown. Using infection assays, we determined how the microbiota impacts the abundance and persistence of S. marcescens in the gut and visualized colocalization of S. marcescens with specific community members in situ. Using T6SS-deficient S. marcescens strains, we measured T6SS-dependent killing of gut isolates in vitro and compared the persistence of mutant and wild-type strains in the gut. We found that S. marcescens is rapidly eliminated in the presence of the microbiota but persists in microbiota-free guts. Protection is reduced in monocolonized and antibiotic-treated bees, possibly because different symbionts occupy distinct niches. Serratia marcescens uses a T6SS to antagonize Escherichia coli and other S. marcescens strains but shows limited ability to kill bee symbionts. Furthermore, wild-type and T6SS-deficient S. marcescens strains achieved similar abundance and persistence in bee guts. Thus, an intact gut microbiota offers robust protection against this common pathogen, whose T6SSs do not confer the ability to compete with commensal species. IMPORTANCE Bacteria living within guts of animals can provide protection against infection by pathogens. Some pathogens have been shown to use a molecular weapon known as a T6SS to kill beneficial bacteria during invasion of the mouse gut. In this study, we examined how bacteria native to the honey bee gut work together to exclude the opportunistic pathogen Serratia marcescens. Although S. marcescens has a T6SS that can kill bacteria, bee gut bacteria seem resistant to its effects. This limitation may partially explain why ingestion of S. marcescens is rarely lethal to insects with healthy gut communities.

Evolution of Interbacterial Antagonism in Bee Gut Microbiota Reflects Host and Symbiont Diversification.

Gram-negative bacteria frequently possess type VI secretion systems (T6SSs), protein complexes that are able to inject toxic proteins into nearby cells. Many aspects of T6SS structure and function have been characterized for model species, but less is known about the evolutionary processes that shape T6SS and effector (toxin) diversity in host-associated microbial communities. The bee gut microbiota is a simple community that has codiversified with bees for >80 million years. This study investigated how complements of T6SSs and effectors within the bee microbiota changed as bacteria and their hosts diversified into isolated species. We used protein homology to survey 198 isolate genomes of 9 Gram-negative species for genes encoding T6SS structural components; Rhs toxins, which are common T6SS effectors; and VgrG proteins, which are structural components associated with specific toxins. T6SS loci were present in 5 species clusters found only in bees, namely Apibacter spp., Gilliamella spp., Frischella perrara, "Candidatus Schmidhempelia bombi," and Snodgrassella alvi The distribution of T6SS loci suggests that at least 3 were present in the microbiota of the common ancestor of social bees and that loss of these genes in some bacterial lineages was linked to both host and bacterial speciation. Isolates differed enormously in repertoires of Rhs and VgrG proteins. We found that bacterial species employ different mechanisms for toxin acquisition and diversification and that species and strains sometimes lose the T6SS entirely, likely causing shifts in competitive dynamics within these communities.IMPORTANCE Antagonistic interactions between bacteria affect diversity and dynamics of host-associated communities, including gut communities that are linked to host health. In many bacterial communities, including human and honey bee gut microbiotas, antagonism is mediated by type VI secretion systems (T6SSs) that deliver lethal toxins to competing strains. In this study, we explored how T6SSs and associated toxins have evolved in the simple, host-specific gut microbiota of honey bees and bumble bees. Using comparative genomics, we explored the conservation, recombination, horizontal transfer, and loss of T6SSs and effectors during 80 million years of evolution of this bee-associated community. We find that that patterns of T6SS loss and retention are linked to differences in biology across host species, while trends in effector diversification are mostly specific to bacterial lineages.

Leadership Development for Future Medical School Deans: Outcomes of the AAMC Council of Deans Fellowship Program.

PURPOSE: To determine the outcomes of the Association of American Medical Colleges (AAMC) Council of Deans (COD) Fellowship Program with respect to participants' achieving the goals of becoming a medical school dean and developing leadership skills, and to ascertain fellows' views about the program's value, beneficial aspects, and areas for improvement. METHOD: The 37 COD fellows from 2002 to 2016 were invited to participate in a 2017 survey addressing demographics, training, current leadership position, and value of the program. The survey also included 3 open-ended questions. A 2018 web-based search was conducted to determine fellows' senior leadership roles since their program participation. RESULTS: The survey response rate was 73% (27/37). The majority of respondents were male (82%, 22), aged 51-70 (89%, 25), and white (82%, 22). The top 5 medical specialties reported were internal medicine, pediatrics, anesthesiology, psychiatry, and surgery. Most respondents (63%, 17) reported having a graduate degree. All reported being in leadership positions in academia and/or health care. The web-based search found that 27% (10/37) of the fellows became medical school deans (average tenure 5.6 years); 2 fellows became deans of other types of schools. Overall, survey respondents perceived the program as valuable. Respondents identified shadowing a dean mentor, attending COD meetings, and attending the AAMC Executive Development Seminar for Deans as the most valuable program components. The majority (88%, 23/26) indicated their fellow experience persuaded them to pursue being a dean; 2 (8%) indicated it did not. Respondents identified 4 key opportunities for program improvement: more sponsorship by deans, development of a learning community, enhanced mentoring, and coaching. CONCLUSIONS: The COD Fellowship Program appears to be successful in preparing senior faculty to become deans and assume other senior leadership roles in academia and/or health care. Fellows' feedback will be used to inform future revisions to the program.

Primary Care Practitioner Training in Child and Adolescent Psychiatry (PTCAP): A Cluster-Randomized Trial.

OBJECTIVES: Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs' pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves. METHODS: The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention (n practices = 7; n PCPs = 42) or to wait-list control (n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up. RESULTS: Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions (d = 1.81) and general concerns (d = 1.73), as well as in making necessary referrals (d = 1.27) and obtaining consults (d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes. CONCLUSION: PTCAP enhances PCPs' child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.

Implementation of a university faculty mentorship program.

OBJECTIVE: To implement a University Faculty mentorship program in the Division of Emergency Medicine. METHODS: A program based on a unique Schulich faculty mentorship policy was implemented with the help of a Provider Value Officer. The process involved creating a training program which defined the roles of the mentors and mentees and established the principles of an effective mentor-mentee relationship. Faculty received training on how to participate effectively in a Schulich faculty mentorship committee. Each committee consisted of a mentee, and two mentors at the associate professor level (one internal and one external). Thirteen distinct external divisions were represented. They were instructed to meet twice per year, as arranged by the mentee. The mentee created mentor minutes using a template, and then submitted the minutes to the members of the mentorship committee and the Chair/Chief of Emergency medicine. The Chair/Chief used the minutes during the annual Continuing Professional Development meeting. RESULTS: In less than a year, the division has successfully transformed its mentorship program. Using the above-mentioned process, 31 of 34 (91%) eligible assistant professors have functioning mentorship committees. Collaboration and participation between the different faculties has increased. Follow-up meetings with the Chair/Chief and the Provider Value Officer revealed the theme that, universally, participants have perceived Schulich Faculty Mentorship committees as beneficial and are happy with the "fit" of their mentorship committees. CONCLUSION: Through careful planning and training, a successful Faculty Mentorship program can be initiated in an academic division in less than a year with the help of a local champion given protected time.

A Study Protocol for the "Practitioner Training in Child and Adolescent Psychiatry" Cluster-randomized Pilot Study.

BACKGROUND: Primary care providers (PCPs) are increasingly called upon to assist in meeting the growing demand for paediatric mental health care in Canada, yet they report inadequate training and confidence to do so. The Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program was designed to fill this gap by teaching PCPs the skills needed to provide frontline care themselves, particularly in rural/remote regions where specialist resources are limited. This innovative educational intervention may improve paediatric mental health care capacity, but a pilot study is needed. METHODS: We designed a cluster randomized, controlled pilot of PTCAP. Random assignment to intervention or control (treatment-as-usual) will occur at the practice level. Participating PCPs (N=61) at sites randomized to intervention will receive eight hours of training in the use of practice guidelines and brief counseling techniques (i.e., common skills/elements) for addressing diagnosable conditions and more general, transdiagnostic concerns. Mental health care capacity at one-week post-intervention will be the primary outcome, assessed through self-report questionnaires of mental health care confidence, and through a more objective, observational assessment of trained skills. We will also examine retention of these skills at one-month follow-up. We expect use of trained common skills/elements to be associated with better child mental health outcomes on the Strengths and Difficulties Questionnaire (N = 250). DISCUSSION: As one of the first RCTs of its kind in Canada, this study will provide unique, preliminary evidence in regards to the feasibility and efficacy of the PTCAP intervention for enhancing rural, paediatric mental health care capacity.

CONTEXTE: Les prestataires de soins de première ligne (PSPL) sont de plus en plus sollicités pour aider à répondre à la demande croissante de soins de santé mentale pédiatriques au Canada, et pourtant, ils déplorent une formation et une confiance inadéquates pour ce faire. Le programme de Formation du médecin en psychiatrie de l'enfant et de l'adolescent (FMPEA) a été conçu pour combler cette lacune en enseignant aux PSPL les aptitudes nécessaires pour prodiguer eux-mêmes les soins de première ligne, particulièrement en région rurale/éloignée où les ressources de spécialistes sont limitées. Cette intervention éducative innovatrice peut améliorer la capacité des soins de santé mentale pédiatriques, mais une étude pilote est requise. MÉTHODES: Nous avons conçu un pilote contrôlé en grappes randomisées de la FMPEA. Cette assignation aléatoire de l'intervention ou du contrôle (traitement habituel) aura lieu au niveau de la pratique. Les PSPL participants (N = 61) aux endroits aléatoires de l'intervention recevront huit heures de formation en matière d'utilisation des lignes directrices de la pratique et de brèves techniques de consultation (c.-à-d., aptitudes/éléments communs) pour aborder les affections qui peuvent être diagnostiquées et des problèmes trans-diagnostiques plus généraux. À une semaine après l'intervention, la capacité des soins de santé mentale sera le principal résultat, évalué par des questionnaires auto-déclarés sur la confiance dans les soins de santé mentale, et par une évaluation observationnelle plus objective des aptitudes apprises. Nous examinerons également la rétention de ces aptitudes au suivi d'un mois. Nous prévoyons que l'utilisation des aptitudes/éléments communs appris soit associée à de meilleurs résultats de santé mentale des enfants au questionnaire des forces et des difficultés (N = 250). DISCUSSION: À titre d'un des premiers essais randomisés contrôlés (ERC) du genre au Canada, cette étude offrira des données probantes préliminaires uniques à l'égard de la faisabilité et de l'efficacité de l'intervention de FMPEA pour améliorer la capacité des soins de santé mentale pédiatriques en milieu rural.

Honey bees as models for gut microbiota research.

The gut microbiota of the honey bee (Apis mellifera) offers several advantages as an experimental system for addressing how gut communities affect their hosts and for exploring the processes that determine gut community composition and dynamics. A small number of bacterial species dominate the honey bee gut community. These species are restricted to bee guts and can be grown axenically and genetically manipulated. Large numbers of microbiota-free hosts can be economically reared and then inoculated with single isolates or defined communities to examine colonization patterns and effects on host phenotypes. Honey bees have been studied extensively, due to their importance as agricultural pollinators and as models for sociality. Because of this history of bee research, the physiology, development, and behavior of honey bees is relatively well understood, and established behavioral and phenotypic assays are available. To date, studies on the honey bee gut microbiota show that it affects host nutrition, weight gain, endocrine signaling, immune function, and pathogen resistance, while perturbation of the microbiota can lead to reduced host fitness. As in humans, the microbiota is concentrated in the distal part of the gut, where it contributes to digestion and fermentation of plant cell wall components. Much like the human gut microbiota, many bee gut bacteria are specific to the bee gut and can be directly transmitted between individuals through social interaction. Although simpler than the human gut microbiota, the bee gut community presents opportunities to understand the processes that govern the assembly of specialized gut communities as well as the routes through which gut communities impact host biology.

Mentoring needs of distributed medical education faculty at a Canadian medical school: a mixed-methods descriptive study.

INTRODUCTION: The Schulich School of Medicine & Dentistry in London, Ontario, has a mentorship program for all full-time faculty. The school would like to expand its outreach to physician faculty located in distributed medical education sites. The purpose of this study was to determine what, if any, mentorship distributed physician faculty currently have, to gauge their interest in expanding the mentorship program to distributed physician faculty and to determine their vision of the most appropriate design of a mentorship program that would address their needs. METHODS: We conducted a mixed-methods study. The quantitative phase consisted of surveys sent to all distributed faculty members that elicited information on basic demographic characteristics and mentorship experiences/needs. The qualitative phase consisted of 4 focus groups of distributed faculty administered in 2 large and 2 small centres in both regions of the school's distributed education network: Sarnia, Leamington, Stratford and Hanover. Interviews were 90 minutes long and involved standardized semistructured questions. RESULTS: Of the 678 surveys sent, 210 (31.0%) were returned. Most respondents (136 [64.8%]) were men, and almost half (96 [45.7%]) were family physicians. Most respondents (197 [93.8%]) were not formal mentors to Schulich faculty, and 178 (84.8%) were not currently being formally mentored. Qualitative analysis suggested that many respondents were involved in informal mentoring. In addition, about half of the respondents (96 [45.7%]) wished to be formally mentored in the future, but they may be inhibited owing to time constraints and geographical isolation. Consistently, respondents wished to have mentoring by a colleague in a similar practice, with the most practical being one-on-one mentoring. CONCLUSION: Our analysis suggests that the school's current formal mentoring program may not be applicable and will require modification to address the needs of distributed faculty.

INTRODUCTION: L'École de médecine et de dentisterie Schulich, à London en Ontario, offre un programme de mentorat à tout le personnel enseignant à temps plein. L'École aimerait étendre son programme aux médecins enseignants des établissements de formation médicale décentralisée. Le but de cette étude était de déterminer à quel mentorat, le cas échéant, ces médecins ont accès actuellement et d'établir leur intérêt pour le programme de mentorat de l'École et leur vision du programme le plus approprié pour répondre à leurs besoins. METHODS: Nous avons mené une étude en méthodologie mixte. Lors de la phase quantitative, nous avons envoyé des questionnaires à tous les médecins des établissements de formation médicale décentralisée afin d'obtenir des renseignements sur les caractéristiques démographiques de base ainsi que les expériences et besoins de mentorat. La phase qualitative comprenait quatre groupes de discussion composés de médecins enseignants décentralisés dans deux grands et deux petits centres des deux régions du réseau de formation décentralisée de l'École, soit Sarnia, Leamington, Stratford et Hanover. Les entrevues étaient d'une durée de 90 minutes et se composaient de questions semi-structurées normalisées. RESULTS: Sur les 678 questionnaires distribués, 210 (31 %) ont été retournés. La plupart des répondants (136 [64,8 %]) étaient des hommes et presque la moitié (96 [45,7 %]) étaient des médecins de famille. La plupart des répondants (197 [93,8 %]) n'agissaient pas comme mentors officiels auprès du personnel enseignant de l'École de médecine et de dentisterie Schulich et 178 (84,8 %) ne recevaient pas de mentorat officiel actuellement. L'analyse qualitative suggère que plusieurs répondants participaient à une forme quelconque de mentorat informel. De plus, environ la moitié des répondants (96 [45,7 %]) souhaitaient recevoir un mentorat officiel à l'avenir, mais avaient possiblement des contraintes liées au manque de temps et à l'isolement géographique. Les répondants ont systématiquement exprimé le désir d'obtenir un mentorat d'un collègue dans une pratique similaire et un mentorat individualisé, de façon pratique. CONCLUSION: Notre analyse suggère que le programme actuel de mentorat de l'École n'est peut-être pas applicable et nécessitera des modifications pour répondre aux besoins du personnel enseignant décentralisé.

Genome Sequences of Apibacter spp., Gut Symbionts of Asian Honey Bees.

Honey bees have distinct gut microbiomes consisting almost entirely of several host-specific bacterial species. We present the genomes of three strains of Apibacter spp., bacteria of the Bacteroidetes phylum that are endemic to Asian honey bee species (Apis dorsata and Apis cerana). The Apibacter strains have similar metabolic abilities to each other and to Apibacter mensalis, a species isolated from a bumble bee. They use microaerobic respiration and fermentation to catabolize a limited set of monosaccharides and dicarboxylic acids. All strains are capable of gliding motility and encode a type IX secretion system. Two strains and A. mensalis have type VI secretion systems, and all strains encode Rhs or VgrG proteins used in intercellular interactions. The characteristics of Apibacter spp. are consistent with adaptions to life in a gut environment; however, the factors responsible for host-specificity and mutualistic interactions remain to be uncovered.

Evaluating Training Programs for Primary Care Providers in Child/Adolescent Mental Health in Canada: A Systematic Review.

INTRODUCTION: The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. METHODS: A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. RESULTS: Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. DISCUSSION: Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. CONCLUSION: Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families.

INTRODUCTION: Le besoin de soins de santé mentale pour les enfants/adolescents s'accroît au Canada. Les soins de première ligne peuvent jouer un rôle clé pour combler ces besoins croissants, et pourtant, la plupart des prestataires de soins ne croient pas avoir de formation adéquate. Cet article examine la littérature canadienne sur les programmes de renforcement des capacités en pédopsychiatrie pour les prestataires de soins de première ligne, afin d'examiner comment ces programmes sont mis en oeuvre et évalués pour contribuer aux initiatives fondées sur les données probantes. MÉTHODES: Une revue systématique de la littérature et des articles révisés par les pairs publiés sur les initiatives de renforcement des capacités en soins de santé mentale aux enfants/adolescents pour les prestataires de soins de première ligne qui ont été mises en oeuvre au Canada. RÉSULTATS: Seize articles ont été repérés qui satisfaisaient aux critères d'inclusion, L'analyse a révélé que les initiatives de renforcement des capacités au Canada sont variées mais qu'il leur manque une méthodologie d'évaluation rigoureuse. Les prestataires de soins de première ligne acceptent volontiers les initiatives en vue d'accroître leur capacité en matière de soins de santé mentale et étaient satisfaits de la mise en oeuvre de la plupart des programmes. DISCUSSION: Des conclusions objectives sur l'efficacité de ces programmes de renforcement des capacités en soins de santé mentale sont difficiles étant donné la méthodologie d'évaluation de ces études. CONCLUSION: Des méthodes d'évaluation rigoureuses sont nécessaires pour prendre des décisions fondées sur les données probantes à l'égard des moyens de renforcer les capacités des soins de santé mentale pour enfants/adolescents dans les soins de première ligne. Les mesures des résultats doivent aller plus loin que l'auto-déclaration et adopter des mesures plus objectives, et devraient étendre la mesure des résultats des patients pour faire en sorte que ces initiatives mènent vraiment à de meilleurs soins pour les familles.

Diversification of Type VI Secretion System Toxins Reveals Ancient Antagonism among Bee Gut Microbes.

Microbial communities are shaped by interactions among their constituent members. Some Gram-negative bacteria employ type VI secretion systems (T6SSs) to inject protein toxins into neighboring cells. These interactions have been theorized to affect the composition of host-associated microbiomes, but the role of T6SSs in the evolution of gut communities is not well understood. We report the discovery of two T6SSs and numerous T6SS-associated Rhs toxins within the gut bacteria of honey bees and bumble bees. We sequenced the genomes of 28 strains of Snodgrassella alvi, a characteristic bee gut microbe, and found tremendous variability in their Rhs toxin complements: altogether, these strains appear to encode hundreds of unique toxins. Some toxins are shared with Gilliamella apicola, a coresident gut symbiont, implicating horizontal gene transfer as a source of toxin diversity in the bee gut. We use data from a transposon mutagenesis screen to identify toxins with antibacterial function in the bee gut and validate the function and specificity of a subset of these toxin and immunity genes in Escherichia coli Using transcriptome sequencing, we demonstrate that S. alvi T6SSs and associated toxins are upregulated in the gut environment. We find that S. alvi Rhs loci have a conserved architecture, consistent with the C-terminal displacement model of toxin diversification, with Rhs toxins, toxin fragments, and cognate immunity genes that are expressed and confer strong fitness effects in vivo Our findings of T6SS activity and Rhs toxin diversity suggest that T6SS-mediated competition may be an important driver of coevolution within the bee gut microbiota.IMPORTANCE The structure and composition of host-associated bacterial communities are of broad interest, because these communities affect host health. Bees have a simple, conserved gut microbiota, which provides an opportunity to explore interactions between species that have coevolved within their host over millions of years. This study examined the role of type VI secretion systems (T6SSs)-protein complexes used to deliver toxic proteins into bacterial competitors-within the bee gut microbiota. We identified two T6SSs and diverse T6SS-associated toxins in bacterial strains from bees. Expression of these genes is increased in bacteria in the bee gut, and toxin and immunity genes demonstrate antibacterial and protective functions, respectively, when expressed in Escherichia coli Our results suggest that coevolution among bacterial species in the bee gut has favored toxin diversification and maintenance of T6SS machinery, and demonstrate the importance of antagonistic interactions within host-associated microbial communities.

Strategies for Supporting Physician-Scientists in Faculty Roles: A Narrative Review With Key Informant Consultations.

PURPOSE: Physician-scientists are a population in decline globally. Solutions to reverse this decline often have focused on the training pipeline. Less attention has been paid to reducing attrition post training, when physician-scientists take up faculty roles. However, this period is a known time of vulnerability because of the pressures of clinical duties and the long timeline to securing independent research funding. This narrative review explored existing knowledge regarding how best to support physician-scientists for success in their faculty roles. METHOD: The authors searched the Medline, Embase, ERIC, and Cochrane Library databases for articles published from 2000 to 2016 on this topic and interviewed key informants in 2015 to solicit their input on the review results. RESULTS: The authors reviewed 78 articles and interviewed 16 key informants. From the literature, they developed a framework of organizational (facilitate mentorship, foster community, value the physician-scientist role, minimize financial barriers) and individual (develop professional and research skills) strategies for supporting physician-scientists. They also outlined key knowledge gaps representing topics either rarely or never addressed in the reviewed articles (percent research time, structural hypocrisy, objective assessment, group metrics, professional identity). The key informants confirmed the identified strategies and discussed how the gaps were particularly important and impactful. CONCLUSIONS: This framework offers a basis for assessing an organization's existing support strategies, identifying outstanding needs, and developing targeted programming. The identified gaps require attention, as they threaten to undermine the benefits of existing support strategies.

Honeybee gut microbiota promotes host weight gain via bacterial metabolism and hormonal signaling.

Social bees harbor a simple and specialized microbiota that is spatially organized into different gut compartments. Recent results on the potential involvement of bee gut communities in pathogen protection and nutritional function have drawn attention to the impact of the microbiota on bee health. However, the contributions of gut microbiota to host physiology have yet to be investigated. Here we show that the gut microbiota promotes weight gain of both whole body and the gut in individual honey bees. This effect is likely mediated by changes in host vitellogenin, insulin signaling, and gustatory response. We found that microbial metabolism markedly reduces gut pH and redox potential through the production of short-chain fatty acids and that the bacteria adjacent to the gut wall form an oxygen gradient within the intestine. The short-chain fatty acid profile contributed by dominant gut species was confirmed in vitro. Furthermore, metabolomic analyses revealed that the gut community has striking impacts on the metabolic profiles of the gut compartments and the hemolymph, suggesting that gut bacteria degrade plant polymers from pollen and that the resulting metabolites contribute to host nutrition. Our results demonstrate how microbial metabolism affects bee growth, hormonal signaling, behavior, and gut physicochemical conditions. These findings indicate that the bee gut microbiota has basic roles similar to those found in some other animals and thus provides a model in studies of host-microbe interactions.

Metabolism of Toxic Sugars by Strains of the Bee Gut Symbiont Gilliamella apicola.

Social bees collect carbohydrate-rich food to support their colonies, and yet, certain carbohydrates present in their diet or produced through the breakdown of pollen are toxic to bees. The gut microbiota of social bees is dominated by a few core bacterial species, including the Gram-negative species Gilliamella apicola We isolated 42 strains of G. apicola from guts of honey bees and bumble bees and sequenced their genomes. All of the G. apicola strains share high 16S rRNA gene similarity, but they vary extensively in gene repertoires related to carbohydrate metabolism. Predicted abilities to utilize different sugars were verified experimentally. Some strains can utilize mannose, arabinose, xylose, or rhamnose (monosaccharides that can cause toxicity in bees) as their sole carbon and energy source. All of the G. apicola strains possess a manO-associated mannose family phosphotransferase system; phylogenetic analyses suggest that this was acquired from Firmicutes through horizontal gene transfer. The metabolism of mannose is specifically dependent on the presence of mannose-6-phosphate isomerase (MPI). Neither growth rates nor the utilization of glucose and fructose are affected in the presence of mannose when the gene encoding MPI is absent from the genome, suggesting that mannose is not taken up by G. apicola strains which harbor the phosphotransferase system but do not encode the MPI. Given their ability to simultaneously utilize glucose, fructose, and mannose, as well as the ability of many strains to break down other potentially toxic carbohydrates, G. apicola bacteria may have key roles in improving dietary tolerances and maintaining the health of their bee hosts. IMPORTANCE: Bees are important pollinators of agricultural plants. Our study documents the ability of Gilliamella apicola, a dominant gut bacterium in honey bees and bumble bees, to utilize several sugars that are harmful to bee hosts. Using genome sequencing and growth assays, we found that the ability to metabolize certain toxic carbohydrates is directly correlated with the presence of their respective degradation pathways, indicating that metabolic potential can be accurately predicted from genomic data in these gut symbionts. Strains vary considerably in their range of utilizable carbohydrates, which likely reflects historical horizontal gene transfer and gene deletion events. Unlike their bee hosts, G. apicola bacteria are not detrimentally affected by growth on mannose-containing medium, even in strains that cannot metabolize this sugar. These results suggest that G. apicola may be an important player in modulating nutrition in the bee gut, with ultimate effects on host health.