Managing expansions in medical students' clinical placements caused by curricular transformation: perspectives from four medical schools

Many challenges could occur that result in the need to handle an increase in the number of medical student clinical placements, such as curricular transformations or viral pandemics, such as COVID 19. Here, we describe four different institutions' approaches to addressing the impact of curricular transformation on clerkships using an implementation science lens. Specifically, we explore four different approaches to managing the 'bulge' as classes overlap in clerkships Curriculum leaders at four medical schools report on managing the bulge of core clinical placements resulting from reducing the duration of the foundational sciences curriculum and calendar shifts for the respective clerkship curriculum. These changes, which occurred between 2014 and 2018, led to more students being enrolled in core clinical rotations at the same time than occurred previously. Schools provided respective metrics used to evaluate the effectiveness of their bulge management technique. These data typically included number of students affected in each phase of their curricular transformation, performance on standardized examinations, and student and faculty feedback. Not all data were available from all schools, as some schools are still working through their 'bulge' or are affected by COVID-19. There is much to be learned about managing curricular transformations. Working on such endeavors in a learning collaborative such as the AMA Accelerating Change in Medical Education Initiative provided support and insights about how to survive, thrive and identifying lessons learned during curricular transformation.

Readiness of US Federally Qualified Health Centers to Provide HIV Pre-exposure Prophylaxis

We report the results of a survey on HIV pre-exposure prophylaxis (PrEP) perceptions, capacity, and barriers at federally qualified health centers (FQHCs) in high–HIV burden jurisdictions in the United States. Health care workers at FQHCs identified multiple barriers to, and strategies for, improving PrEP implementation.

The role of diet quality and dietary patterns in predicting muscle mass and function in men over a 15-year period

A growing body of evidence suggests that diet quality may predict muscle health. This study found that a "Traditional" dietary pattern predicted greater muscle mass, and an anti-inflammatory diet predicted greater muscle mass and better muscle function over 15 years. These findings reinforce the importance of optimising dietary behaviours for healthy ageing.

INTRODUCTION

Research investigating the roles of individual nutrients in muscle health fails to account for the synergistic relationships between foods and nutrients. This study aimed to investigate the predictive value of diet quality and dietary patterns for muscle mass and function in men over a 15-year period.

METHODS

This longitudinal study was conducted in 522 men from the Geelong Osteoporosis Study with complete dietary and muscle mass or muscle function data at both baseline and 15-year follow-up assessments. Dietary exposures were extracted from food frequency questionnaires and included the Australian Recommended Food Score, the Dietary Inflammatory Index (DII®), and three a posteriori dietary patterns: Plant-focused, Western, and Traditional (Anglo-Australian). Outcome variables included dual-energy X-ray absorptiometry-derived skeletal muscle index (SMI) and muscle function measured with the timed up-and-go (TUG) test.

RESULTS

An anti-inflammatory diet and higher scores on a Traditional dietary pattern both predicted greater SMI ((B: -0.04 (95%CI -0.08, -0.00) kg/m²) and (B: 0.12 (95%CI 0.04, 0.20) kg/m²), respectively), while a pro-inflammatory diet predicted slower TUG (B: 0.11 (95%CI 0.001, 0.21) sec) over the 15-year follow-up period. These associations remained significant following adjustment for confounding variables. There were no associations observed for other dietary exposures.

CONCLUSION

A Traditional dietary pattern higher in vegetables, wholegrain cereals, and animal protein was associated with greater skeletal muscle mass, and an anti-inflammatory diet, also rich in vegetables, fruit, and wholegrain cereals, was associated with greater skeletal muscle mass and better muscle function over 15 years.

Anxiety, PTSD, and stressors in medical students during the initial peak of the COVID-19 pandemic

Purpose

To assess psychological effects of the initial peak phase of the COVID-19 pandemic on United States (US) medical students in clinical training to anticipate sequelae and prepare for future outbreaks.

Methods

Authors emailed a cross-sectional survey in April-May, 2020 to students in clinical training years at six US medical schools which included validated General Anxiety Disorder (GAD-7) and Primary Care-PTSD (PC-PTSD-5) screening tools, and asked students about pandemic-related stress and specific concerns. Authors used quantitative and thematic analysis to present results.

Results

Of 2511 eligible students, 741 responded (29.5%). Most students (84.1%) reported at least “somewhat” increased levels of stress and anxiety related to the pandemic. On the GAD-7, 34.3% showed mild, 16.1% moderate, and 9.5% severe anxiety symptoms, with 39.6% demonstrating no/minimal symptoms. One quarter (25.4%) screened positive for PTSD risk symptoms. Top concerns of students chosen from a pre-populated list included inadequate COVID-19 testing, undiagnosed or asymptomatic spread and racial or other disparities in the pandemic. In thematic analysis, students’ reactions to removal from clinical learning included: understanding the need to conserve PPE (32.2%), a desire to help (27.7%), worry over infectious risk to others (25.4%) and self (21.2%), and lost learning opportunities (22.5%). Female students were significantly more likely to report anxiety and PTSD risk symptoms. Asian students had a greater risk of moderate anxiety and those underrepresented in medicine (UIM) had greater risk of moderate and severe anxiety symptoms compared to white students.

Conclusions

During the initial peak phase of COVID-19, over 60% of US medical students screened positive for pandemic-related anxiety and one quarter were at risk for PTSD. Female and UIM students were significantly more affected. Medical schools should consider broad support of students, and targeted outreach to female and UIM students.

Characterizing Host Plant Resistance to Melanaphis sacchari (Hemiptera: Aphididae) in Selected Sorghum Plant Introductions

Since 2013 Melanaphis sacchari (Zehnter) (Hemiptera: Aphididae), the sugarcane aphid, has been a threat to sorghum production in the United States. The development of resistant sorghum hybrids has been one of the main management strategies. However, plant resistance can be overcome over time and new resistance genes need to be identified and introduced into adapted sorghum hybrids to secure sorghum production. Sorghum plant introduction (PI) genotypes were screened for resistance to M. sacchari through laboratory, greenhouse, and field assays. In addition, the feeding parameters of M. saccahri were analyzed and detailed in seven sorghum genotypes through EPG assays. Results showed sorghum genotypes PI 524770, PI 564163, and PI 643515 expressed resistance to M. sacchari consistently in laboratory, greenhouse, and field tests. EPG analysis suggested sorghum genotypes PI 524770 and PI 564163 express antibiosis to M. sacchari while PI 643515 expresses both antibiosis and antixenosis. Increasing the number of sorghum hybrids resistant to M. sacchari is key to improving integrated pest management of M. sacchari. By utilizing host plant resistance, sorghum producers can decrease insecticide applications while enhancing biological control.

Post-Clerkship Curricular Reform: Specialty-Specific Tracks and Entrustable Professional Activities to Guide the Transition to Residency

The development of core entrustable professional activities (EPA) for entering residency and Accreditation Council for Graduate Medical Education's milestones have spurred thinking about the fourth year of medical school as a transition to residency. In this monograph, we lay out our specialty focused post-clerkship curriculum and report learner and residency director perceptions over the first three years of implementation. Ongoing curricular monitoring has reinforced core principles but has also informed actionable quality improvement efforts. EPA-focused learning experiences, integration of specialty-specific milestones, addition of the feedforward process, and accessible mentorships have been key curricular elements to guide the transition to residency.

Office of Medical Education: Opportunities for Trainees to Engage and Lead in Curricular Innovation and Reform

INTRODUCTION

The AAMC prioritizes promoting a diverse and culturally competent workforce which is thought to have a positive impact on the health of people living in the US. There is a lack of diversity in the current landscape of academic medicine and strategies are needed to effect change. This module introduced undergraduate and graduate medical trainees to leadership skills and opportunities in curriculum innovation and reform by learning about and interacting with the office of medical education (OME) at their institutions.

METHODS

We implemented a workshop using small-group case discussions and didactics to help medical students and residents learn how to: (1) describe the structure and functions of an OME, (2) describe leadership competencies associated with various roles within the OME, and (3) identify opportunities for trainees to engage with the OME on curricular innovation and reform, especially advancing diversity and inclusion.

RESULTS

Across three sites, 45 learners completed partial or full workshop evaluations. Of learners, 22 (49%) were not knowledgeable and 13 (29%) were somewhat knowledgeable in identifying leadership opportunities for trainees to become engaged through the OME. There was a statistically significant increase in confidence after the workshop in "discussing an interdisciplinary approach to the creation of a medical education innovation," and, "assessing the need for curricula change." Over 90% of attendees agreed learning objectives were met.

DISCUSSION

This workshop succeeded in promoting awareness of the structure and function of OMEs and confidence in seeking opportunities to become engaged in medical education, especially in advancing diversity and inclusion.

Study of the X-ray radiation interaction with a multislit collimator for the creation of microbeams in radiation therapy

Microbeam radiation therapy (MRT) is a developing radiotherapy, based on the use of beams only a few tens of micrometres wide, generated by synchrotron X-ray sources. The spatial fractionation of the homogeneous beam into an array of microbeams is possible using a multislit collimator (MSC), i.e. a machined metal block with regular apertures. Dosimetry in MRT is challenging and previous works still show differences between calculated and experimental dose profiles of 10-30%, which are not acceptable for a clinical implementation of treatment. The interaction of the X-rays with the MSC may contribute to the observed discrepancies; the present study therefore investigates the dose contribution due to radiation interaction with the MSC inner walls and radiation leakage of the MSC. Dose distributions inside a water-equivalent phantom were evaluated for different field sizes and three typical spectra used for MRT studies at the European Synchrotron Biomedical beamline ID17. Film dosimetry was utilized to determine the contribution of radiation interaction with the MSC inner walls; Monte Carlo simulations were implemented to calculate the radiation leakage contribution. Both factors turned out to be relevant for the dose deposition, especially for small fields. Photons interacting with the MSC walls may bring up to 16% more dose in the valley regions, between the microbeams. Depending on the chosen spectrum, the radiation leakage close to the phantom surface can contribute up to 50% of the valley dose for a 5 mm × 5 mm field. The current study underlines that a detailed characterization of the MSC must be performed systematically and accurate MRT dosimetry protocols must include the contribution of radiation leakage and radiation interaction with the MSC in order to avoid significant errors in the dose evaluation at the micrometric scale.

Effects of the COVID-19 pandemic on medical students: a multicenter quantitative study

BACKGROUND

The COVID-19 pandemic disrupted the United States (US) medical education system with the necessary, yet unprecedented Association of American Medical Colleges (AAMC) national recommendation to pause all student clinical rotations with in-person patient care. This study is a quantitative analysis investigating the educational and psychological effects of the pandemic on US medical students and their reactions to the AAMC recommendation in order to inform medical education policy.

METHODS

The authors sent a cross-sectional survey via email to medical students in their clinical training years at six medical schools during the initial peak phase of the COVID-19 pandemic. Survey questions aimed to evaluate students' perceptions of COVID-19's impact on medical education; ethical obligations during a pandemic; infection risk; anxiety and burnout; willingness and needed preparations to return to clinical rotations.

RESULTS

Seven hundred forty-one (29.5%) students responded. Nearly all students (93.7%) were not involved in clinical rotations with in-person patient contact at the time the study was conducted. Reactions to being removed were mixed, with 75.8% feeling this was appropriate, 34.7% guilty, 33.5% disappointed, and 27.0% relieved. Most students (74.7%) agreed the pandemic had significantly disrupted their medical education, and believed they should continue with normal clinical rotations during this pandemic (61.3%). When asked if they would accept the risk of infection with COVID-19 if they returned to the clinical setting, 83.4% agreed. Students reported the pandemic had moderate effects on their stress and anxiety levels with 84.1% of respondents feeling at least somewhat anxious. Adequate personal protective equipment (PPE) (53.5%) was the most important factor to feel safe returning to clinical rotations, followed by adequate testing for infection (19.3%) and antibody testing (16.2%).

CONCLUSIONS

The COVID-19 pandemic disrupted the education of US medical students in their clinical training years. The majority of students wanted to return to clinical rotations and were willing to accept the risk of COVID-19 infection. Students were most concerned with having enough PPE if allowed to return to clinical activities.

BET proteolysis targeted chimera-based therapy of novel models of Richter Transformation-diffuse large B-cell lymphoma

Richter Transformation (RT) develops in CLL as an aggressive, therapy-resistant, diffuse large B cell lymphoma (RT-DLBCL), commonly clonally-related (CLR) to the concomitant CLL. Lack of available pre-clinical human models has hampered the development of novel therapies for RT-DLBCL. Here, we report the profiles of genetic alterations, chromatin accessibility and active enhancers, gene-expressions and anti-lymphoma drug-sensitivity of three newly established, patient-derived, xenograft (PDX) models of RT-DLBCLs, including CLR and clonally-unrelated (CLUR) to concomitant CLL. The CLR and CLUR RT-DLBCL cells display active enhancers, higher single-cell RNA-Seq-determined mRNA, and protein expressions of IRF4, TCF4, and BCL2, as well as increased sensitivity to BET protein inhibitors. CRISPR knockout of IRF4 attenuated c-Myc levels and increased sensitivity to a BET protein inhibitor. Co-treatment with BET inhibitor or BET-PROTAC and ibrutinib or venetoclax exerted synergistic in vitro lethality in the RT-DLBCL cells. Finally, as compared to each agent alone, combination therapy with BET-PROTAC and venetoclax significantly reduced lymphoma burden and improved survival of immune-depleted mice engrafted with CLR-RT-DLBCL. These findings highlight a novel, potentially effective therapy for RT-DLBCL.

Influence of Sorghum Cultivar, Nitrogen Fertilization, and Insecticides on Infestations of the Sugarcane Aphid (Hemiptera: Aphididae) in the Southern United States

The sugarcane aphid, Melanaphis sacchari Zehntner, is an economically damaging pest of sorghum, Sorghum bicolor (L.), across the southern United States. Field experiments investigated impacts of sorghum cultivar, nitrogen fertilization, and insecticides on M. sacchari infestations and sorghum yields in Louisiana and South Carolina in 2017 and 2018. In South Carolina, M. sacchari densities in unprotected plots peaked on 30-31 July of both years before declining by early- to mid-August. In Louisiana, infestations peaked on 26 and 12 July for 2017 and 2018, respectively, and declined by mid-August. Nitrogen fertilization influenced M. sacchari densities in Louisiana in 2018 with the highest-level infestations recorded from plots that received high N rates. Densities of M. sacchari on susceptible sorghum cultivar, DKS 38-88, were 1.5- to 2.3-fold greater than on DKS 37-07 in both years in Louisiana and in 2018 in South Carolina. Nitrogen fertilization was associated with improved sorghum yields in Louisiana experiments. Sorghum yields across experiments were 2- to 4-fold greater in plots protected with multiple insecticide applications than in unprotected plots. Yield from plots with insecticides sprayed once at currently used action thresholds differed from unprotected plots only in the 2018 Louisiana experiment. Results from these experiments indicate insecticidal protection of susceptible sorghum cultivars remains critical throughout much of the southern United States. Further research is needed to develop integrated management programs that incorporate fertilization manipulation, cultivar resistance, and insecticidal control.

Detailed Characterization of Melanaphis sacchari (Hemiptera: Aphididae) Feeding Behavior on Different Host Plants

Worldwide, Melanaphis sacchari Zehntner is reported on several plants in the family Poaceae, including important crops. In the United States, M. sacchari has been present primarily on sugarcane (Saccharum officinarum L.), but recently sorghum (Sorghum bicolor (L.) Moench) has become a main host. It is not clear how M. sacchari exploits sorghum or other plant species present in the Louisiana agro-ecoscape, but there is potential for these plants to be bridging hosts. Thus, this study determined the feeding behavior of M. sacchari on sorghum, rice, Oryza sativa (L.), sweetpotato, Ipomea batatas (L.), maize, Zea mays (L.), Johnsongrass, S. halepense (L.), and wheat Triticum aestivum (L.) using electrical penetration graphs. Melanaphis sacchari established sustained feeding on sorghum, Johnsongrass, wheat, and rice, only a negligent percentage on maize and no aphid fed on sweetpotato. Differences in Electrical Penetration Graph parameters among the plants in nonpenetrating total time and the lower number of probes, time to penetration initiation, proportion of individuals probing, number of probes shorter than 30 s, number of probes longer than 30 s but shorter than 3 min, pathway phase duration, and number of cell punctures during pathway phase, suggest epidermis and mesophyll factors affecting aphid feeding behavior. While the lack of differences in number of feeding occurrences, total time feeding, and number of sustained feeding occurrences shows that M. sacchari is able to feed on those plants, sieve element factors such as resistance or low nutritional quality prevent the growth of this population in field.

LGBTQ+ Health-a Novel Course for Undergraduate Students

The concept of providing focused, competency-based LGBTQ+ health education outside the setting of health professional programs, specifically for undergraduates, is quite uncharted. However, the issue at the core of our rationale is one shared by those with and without clinical exposure: how to best support the development of cultural competence in providers who are or will be caring for LGBTQ+ patients. Traditional health professional education programs have enacted a number of curricular initiatives in this regard, designed for advanced learners. By focusing specifically on the undifferentiated learner, we offer a new perspective on the timing of LGBTQ+ health-related education. Our course is not intended to supplant the critical learning and application that must occur in the clinic or hospital room. Rather, we present a framework for cultivating understanding of the healthcare issues faced by the LGBTQ+ community that may help a learner to acquire and apply skills subsequently with greater cultural competence.

National Findings from an LGBT Healthcare Organizational Needs Assessment

PURPOSE

LGBT populations require expanded access to healthcare that meets their unique needs. This article presents the primary findings of a training and technical assistance needs assessment conducted with healthcare organizations in geographically diverse areas of the United States to help determine gaps in LGBT health familiarity, preparedness, comfort, and practices.

METHODS

A total of 5980 staff members and 638 leaders from 18 healthcare organizations participated in online needs assessment surveys. Cross-sectional findings and significance were evaluated using descriptive statistics and two-sample t-tests.

RESULTS

Significantly more clinicians agreed that they were familiar with lesbian, gay, and bisexual health needs compared with being familiar with transgender health needs (81.7% vs. 68.3%, p = 0.005). The majority of clinicians rarely or never talked to their patients about sexual orientation (55.4%) or gender identity (71.9%), mostly due to believing that the topics were not relevant to care, concerns with making the patient uncomfortable or offending the patient, lack of experience, and not knowing the appropriate language for talking about the subjects. Nearly one-third of staff respondents did not know if sexual orientation or gender identity/expression was included in organizational nondiscrimination patient policies.

CONCLUSION

Although clinicians may self-report that they are familiar with LGBT health issues, gaps in practice and knowledge indicate the need for more training, especially in transgender health and in talking to patients about sexual orientation and gender identity. Healthcare organizations also need support in ensuring that their organizations create inclusive environments by educating staff and leadership on nondiscrimination policies.

Time Since First Acting on Same-Sex Attraction and Recreational Drug Use among Men Who Have Sex With Men (MSM): Is There an Effect of "Gay Age"?

BACKGROUND

Men who have sex with men (MSM) have higher rates of substance use compared to men who have sex with women. Among MSM, drug use is linked to higher-risk sexual behavior and acquisition of HIV and other sexually transmitted infections.

OBJECTIVES

We hypothesize that time since first acting on one's same sex attraction, or one's "gay age", could be predictive of drug using behavior.

METHODS

We examined this question among 176 MSM, aged 18-35, presenting at a public sexual health clinic. Behavioral data were captured using interviewer- and self-administered surveys and clinical data were extracted from medical records. We used modified Poisson regression to examine associations between gay age and recent recreational drug use, and separately, between gay age and recent marijuana use.

RESULTS

In total, 43% of participants reported recent marijuana use and 26% of participants reported recent use of other drugs. The associations between gay age and marijuana use and other drug use varied by HIV status. After adjustment for biological age, race, and education, a one-year increase in gay age was associated with significantly increased drug use among HIV-negative men (adjusted prevalence ratio (aPR): 1.08; 95% confidence interval (CI): 1.03-1.14), but we observed no association between gay age and drug use among HIV-positive men (aPR: 0.96, 95% CI: 0.86-1.07). Gay age was not associated with marijuana use in HIV-negative (aPR: 1.00, 95% CI: 0.95-1.04) or HIV-positive (aPR: 1.06, 95% CI: 0.98-1.14) men.

CONCLUSIONS

In summary, HIV-negative MSM who had experienced more time since first same-sex experience had significantly increased prevalence of recent drug use.

Infections and the relationship to treatment in neuromuscular autoimmunity

INTRODUCTION

This study aimed to identify infections in patients with myasthenia gravis, dermatomyositis, and chronic inflammatory demyelinating polyradiculoneuropathy, and to investigate the relationship between infection and immunomodulation.

METHODS

A retrospective chart review examined 631 patients with myasthenia gravis (n = 358), chronic inflammatory demyelinating polyradiculoneuropathy (n = 124), and dermatomyositis (n = 149) patients over a 10-year time period.

RESULTS

Infection rates were similar at approximately 19% in all 3 diseases. Of the infections in which a causative organism was identified, pneumonia, sepsis, and opportunistic infections were the leading diagnoses. A multivariate model demonstrated a significant association between infection and an increased dose of plasma exchange, mycophenolate mofetil, and corticosteroid therapy.

DISCUSSION

There are few large studies investigating rates of infections in patients with autoimmune neuromuscular disorders and the relationship to immunomodulation. This study not only demonstrates the remarkably similar infection rates across the 3 diseases studied, but also shows their relationship to commonly used immunotherapies. Muscle Nerve 57: 927-931, 2018.

Influence of Host Quality and Temperature on the Biology of Diaeretiella rapae (Hymenoptera: Braconidae, Aphidiinae)

Biological features of Diaeretiella rapae (McIntosh), an aphid parasitoid, are conditioned by temperature and host. However, studies of host quality changes due to temperature adaptability have not been performed previously. Therefore, this study evaluated the adaptability of Lipaphis pseudobrassicae (Davis) and Myzus persicae (Sulzer) to high temperature, high temperature effect on their quality as hosts for D. rapae, and on parasitoid's thermal threshold. Aphid development, survivorship, fecundity, and longevity were compared at 19 °C and 28 °C. Host quality in different temperatures was determined through evaluation of parasitoid biology. Thermal threshold of D. rapae was determined using development time data. At 28 °C, development time, rate of immature survival, and total fecundity rates were greater in L. pseudobrassicae than in M. persicae. Development time of D. rapae in L. pseudobrassicae was shorter than that in M. persicae at 28 °C and 31 °C for females and at 31 °C for males. The thermal threshold of D. rapae was 6.38 °C and 3.33 °C for females and 4.45 °C and 3.63 °C for males developed on L. pseudobrassicae and M. persicae, respectively. Diaeretiella rapae size gain was greater in L. pseudobrassicae than that in M. persicae at 25 °C and 28 °C. Lipaphis pseudobrassicae showed better adaptation than M. persicae to elevated temperatures, which resulted in a better quality host for D. rapae at temperatures of 28 °C and 31 °C and a higher lower thermal threshold when the parasitoid developed within L. pseudobrassicae. The host's adaptation to high temperatures is a determinant of host quality for the parasitoid at that same climatic condition.

Disseminated adenovirus infection causing severe ARDS

A previously healthy young man with a rare genetic condition presented with severe acute respiratory distress syndrome secondary to pneumonia with septic shock. He did not improve with conventional therapy for his known causal organism thus prompting further workup. He was found to be profoundly immunosuppressed raising our suspicion for atypical organisms. A bronchoalveolar lavage sample was positive via PCR for adenovirus which we suspect exacerbated a pre-existing bacterial pneumonia and led to a severe and non-responsive respiratory failure. His serum adenovirus load was markedly elevated. Treatment was started once the diagnosis of disseminated adenovirus infection was made; however, at that time patient was suffering from refractory hypoxaemia, respiratory acidosis, right heart failure and septic shock. Despite maximal supportive measures our patient ultimately expired over the course of 6 days.

Hg concentrations in fish from coastal waters of California and Western North America

The State of California conducted an extensive and systematic survey of mercury (Hg) in fish from the California coast in 2009 and 2010. The California survey sampled 3483 fish representing 46 species at 68 locations, and demonstrated that methylHg in fish presents a widespread exposure risk to fish consumers. Most of the locations sampled (37 of 68) had a species with an average concentration above 0.3μg/gwet weight (ww), and 10 locations an average above 1.0μg/gww. The recent and robust dataset from California provided a basis for a broader examination of spatial and temporal patterns in fish Hg in coastal waters of Western North America. There is a striking lack of data in publicly accessible databases on Hg and other contaminants in coastal fish. An assessment of the raw data from these databases suggested the presence of relatively high concentrations along the California coast and in Puget Sound, and relatively low concentrations along the coasts of Alaska and Oregon, and the outer coast of Washington. The dataset suggests that Hg concentrations of public health concern can be observed at any location on the coast of Western North America where long-lived predator species are sampled. Output from a linear mixed-effects model resembled the spatial pattern observed for the raw data and suggested, based on the limited dataset, a lack of trend in fish Hg over the nearly 30-year period covered by the dataset. Expanded and continued monitoring, accompanied by rigorous data management procedures, would be of great value in characterizing methylHg exposure, and tracking changes in contamination of coastal fish in response to possible increases in atmospheric Hg emissions in Asia, climate change, and terrestrial Hg control efforts in coastal watersheds.

Group Sex and Prevalent Sexually Transmitted Infections Among Men Who Have Sex with Men

We evaluated the direct relation between group sex and prevalent sexually transmitted infections (STI) in a cross-sectional study of men who have sex with men (MSM) presenting at an urban STI clinic in the Midwestern US. Among 231 men who enrolled and reported that they have sex with men, we collected behavioral data using a combination of interviewer and self-administered surveys and extracted STI data from electronic health records. We used modified Poisson regression to examine the unadjusted and adjusted associations between group sex participation and prevalent STI. One-quarter of participants (n = 58) reported group sex participation in the last 3 months. Eighteen percent of participants (n = 42) had gonorrhea and 19 % (n = 45) had chlamydial infection. Men who reported recent group sex were more likely to be HIV-positive, to report recent drug use, and to report unprotected receptive anal intercourse in the past 3 months. After adjustment for age, race, and recent drug use, recent participation in group sex was associated with prevalent gonorrhea infection (prevalence ratio [PR] = 2.11, 95 % confidence interval [CI] = [1.13, 3.95]) but not chlamydia infection (PR = 1.03, 95 % CI = [0.58, 1.84]). We performed a sensitivity analysis in which we also adjusted for unprotected receptive anal intercourse and the results were not substantively changed. In summary, participation in group sex in the past 3 months was associated with a more than twofold increased prevalence of gonorrhea, but not with chlamydia. These findings support group sex participation as a potential contributor to increased STI prevalence.

Partial Life History of Chrysodeixis includens (Lepidoptera: Noctuidae) on Summer Hosts

The soybean looper, Chrysodeixis includens (Walker) (Lepidoptera: Noctuidae), is a major defoliating pest of soybeans, Glycine max (L.) Merrill, in Louisiana. However, other alternate host crops in the agroecosystem have the potential to impact C. includens populations. Life table statistics of C. includens on four host plants were evaluated. C. includens larvae were fed leaves of three cotton Gossypium hirsutum L. cultivars 'DP 143 B2RF,' 'DP 174 RF,' and 'PHY 485 WRF'; cowpea Vigna unguiculata (L.) Walpers 'California Blackeye'; three soybean cultivars 'Lyon,' 'PI 227687,' and 'RC 4955'; and sweetpotato Ipomoea batatas (L.) Lamarck 'Evangeline.' All C. includens larvae reared on cotton cultivars DP 143 B2RF and PHY 485 WRF experienced 100% mortality during the first instar. Total developmental period of preadult C. includens was significantly shorter on cotton DP 174 RF and cowpea California Blackeye but longer on sweetpotato Evangeline. Sweetpotato Evangeline had the highest amount of leaf tissue consumed and soybean Lyon had the least. Pupal weight was highest when insects fed on cotton DP 174 RF and lowest on soybean PI 227687. Life table statistics showed that the highest intrinsic rate of increase and net reproductive rate were attained when insects were reared on cotton DP 174 RF and cowpea California Blackeye whilst the lowest were recorded on soybean PI 227687. This study provides valuable information on the role of alternative host crops on the partial life history of C. includens in Louisiana agroecosystems.