Mucosal and systemic immunization elicited by Newcastle disease virus (NDV) transgenic plants as antigens

As a step towards developing a safe and effective edible vaccine against Newcastle disease virus (NDV), we have explored the use of plants genetically engineered to express viral proteins. We report the construction of transgenic potato plants expressing the genes coding for immunogenic proteins of NDV under the regulation of CaMV 35S promoter and its immunogenicity in mice. All mice receiving transgenic plant extracts in incomplete Freund adjuvant produced specific anti-NDV antibodies. Animals fed with transgenic leaves showed a specific response against NDV. Detection of IgA released from in vitro-cultured intestinal tissue fragments indicated the presence of IgA-secreting cells in the gut.     

Alterations of motor performance and brain cortex mitochondrial function during ethanol hangover

Ethanol has been known to affect various behavioral parameters in experimental animals, even several hours after ethanol (EtOH) is absent from blood circulation, in the period known as hangover. The aim of this study was to assess the effects of acute ethanol hangover on motor performance in association with the brain cortex energetic metabolism. Evaluation of motor performance and brain cortex mitochondrial function during alcohol hangover was performed in mice 6 hours after a high ethanol dose (hangover onset). Animals were injected i.p. either with saline (control group) or with ethanol (3.8 g/kg BW) (hangover group). Ethanol hangover group showed a bad motor performance compared with control animals (p < .05). Oxygen uptake in brain cortex mitochondria from hangover animals showed a 34% decrease in the respiratory control rate as compared with the control group. Mitochondrial complex activities were decreased being the complex I–III the less affected by the hangover condition; complex II–III was markedly decreased by ethanol hangover showing 50% less activity than controls. Complex IV was 42% decreased as compared with control animals. Hydrogen peroxide production was 51% increased in brain cortex mitochondria from the hangover group, as compared with the control animals. Quantification of the mitochondrial transmembrane potential indicated that ethanol injected animals presented 17% less ability to maintain the polarized condition as compared with controls. These results indicate that a clear decrease in proton motive force occurs in brain cortex mitochondria during hangover conditions. We can conclude that a decreased motor performance observed in the hangover group of animals could be associated with brain cortex mitochondrial dysfunction and the resulting impairment of its energetic metabolism.     

Program directors’ views of the importance and prevalence of mentoring in internal medicine residencies

Program directors establish priorities for residency programs. Their views of mentoring likely influence the tone about and availability of mentoring programs. This survey to all internal medicine program directors assessed attitudes toward mentoring, existence of formal mentoring programs, and features of the mentoring programs. The response was 60%. The majority (>60%) favored mentoring. Forty-nine percent of the residencies had structured mentoring programs. Programs differed in frequency of meetings, use of evaluations, and presence of curriculum. Overall, although program directors' attitudes are favorable and at least half have formal mentoring programs, the programs are largely unstructured, loosely monitored, and underevaluated.     

Using Cognitive Mapping to Define Key Domains for Successful Attending Rounds

BACKGROUND

Ward attending rounds are an integral part of internal medicine education. Being a good teacher is necessary, but not sufficient for successful rounds. Understanding perceptions of successful attending rounds (AR) may help define key areas of focus for enhancing learning, teaching and patient care.

OBJECTIVE

We sought to expand the conceptual framework of 30 previously identified attributes contributing to successful AR by: 1) identifying the most important attributes, 2) grouping similar attributes, and 3) creating a cognitive map to define dimensions and domains contributing to successful rounds.

DESIGN

Multi-institutional, cross-sectional study design.

PARTICIPANTS

We recruited residents and medical students from a university-based internal medicine residency program and a community-based family medicine residency program. Faculty attending a regional general medicine conference, affiliated with multiple institutions, also participated.

MAIN MEASURES

Participants performed an unforced card-sorting exercise, grouping attributes based on perceived similarity, then rated the importance of attributes on a 5-point Likert scale. We translated our data into a cognitive map through multi-dimensional scaling and hierarchical cluster analysis.

KEY RESULTS

Thirty-six faculty, 49 residents and 40 students participated. The highest rated attributes (mean rating) were “Teach by example (bedside manner)” (4.50), “Sharing of attending’s thought processes” (4.46), “Be approachable—not intimidating” (4.45), “Insist on respect for all team members” (4.43), “Conduct rounds in an organized, efficient & timely fashion” (4.39), and “State expectations for residents/students” (4.37). Attributes were plotted on a two-dimensional cognitive map, and adequate convergence was achieved. We identified five distinct domains of related attributes: 1) Learning Atmosphere, 2) Clinical Teaching, 3) Teaching Style, 4) Communicating Expectations, and 5) Team Management.

CONCLUSIONS

We identified five domains of related attributes essential to the success of ward attending rounds.KEY WORDS: medical education, clinical teaching, ward roundsAttending rounds (AR) form the clinical educational cornerstone for internal medicine training.¹ AR provide faculty an opportunity for exchanging information, illustrating communication skills, and demonstrating appropriate clinical decision making. However, performing each of these tasks effectively and simultaneously is challenging. Although the hospital environment offers many opportunities for learning and demonstration, distractions and interruptions complicate daily ward rounds. Additionally, the rapidly growing wealth of applicable medical knowledge and inclusion of learners at different stages of training add to the complexity of this activity; few other instructional settings include learners at both the beginning and end of a training path.² Attending physicians also shoulder responsibility for delivering the highest quality of patient care. Adding even more complexity, recent changes in resident work-hour restrictions and competing educational and service obligations demand that AR must be performed efficiently.³With these competing demands, we need a manageable, teachable framework for conducting successful rounds. Ward attending physicians currently receive little instruction or guidance on providing innovative and evidence-based instruction to all levels of trainees, exemplifying empathetic, patient-centered communication skills, and delivering high-quality patient care in an efficient and cost-effective manner, all within a highly complex environment. Although techniques for achieving excellence in clinical teaching and role-modeling have been described,^2,4–12 most were published prior to the institution of work-hour regulations, and few include the perspective of resident and student learners.This study introduces a framework of essential features for successful attending rounds, thus providing a guide for attending physicians who seek to improve their overall rounding performance. One could use this framework to improve ward rounds at the individual or departmental level by identifying domains of importance for successful rounds and providing specific examples to achieve excellence within each of these domains.In a previous multi-institutional study, we elicited 30 attributes that learners self-identified as important for successful rounds from structured focus groups of resident physicians.¹³ While this list is comprehensive of all aspects of AR, its length makes it cumbersome for practical use. Therefore, in the present study, we used consumer preference techniques to organize the contextual complexity of these defined components of successful AR, and thus tailor a framework based on the values and perspectives of the participants themselves.     

Advantages of the dental practice-based research network initiative and its role in dental education

Practice-based research networks (PBRNs) provide a novel venue in which providers can increase their knowledge base and improve delivery of care through participation in clinical studies. This article describes some aspects of our experience with a National Institute of Dental and Craniofacial Research-supported PBRN and discusses the role it can play in dental education. PBRNs create a structured pathway for providers to advance their professional development by participating in the process of collecting data through clinical research. This process allows practitioners to contribute to the goals of evidence-based dentistry by helping to provide a foundation of evidence on which to base clinical decisions as opposed to relying on anecdotal evidence. PBRNs strengthen the professional knowledge base by applying the principles of good clinical practice, creating a resource for future dental faculty, training practitioners on best practices, and increasing the responsibility, accountability, and scope of care. PBRNs can be the future pivotal instruments of change in dental education, the use of electronic health record systems, diagnostic codes, and the role of comparative effectiveness research, which can create an unprecedented opportunity for the dental profession to advance and be integrated into the health care system.