Host suppression and stability in a parasitoid-host system: experimental demonstration

We elucidate the mechanisms causing stability and severe resource suppression in a consumer-resource system. The consumer, the parasitoid Aphytis, rapidly controlled an experimentally induced outbreak of the resource, California red scale, an agricultural pest, and imposed a low, stable pest equilibrium. The results are well predicted by a mechanistic, independently parameterized model. The key mechanisms are widespread in nature: an invulnerable adult stage in the resource population and rapid consumer development. Stability in this biologically nondiverse agricultural system is a property of the local interaction between these two species, not of spatial processes or of the larger ecological community.

Immunofluorescence and histochemical studies of localized cutaneous amyloidosis

Lichen amyloidosus (LA) and macular amyloidosis (MA) are two forms of localized cutaneous amyloidosis in which the amyloid occurs as larger and smaller deposits respectively in the papillary dermis. The histogenesis of the amyloid of these conditions is unknown. By using an indirect immunofluorescence technique we showed that LA and MA do not react with antibodies against different previously characterized amyloid fibril proteins. These results indicate that the amyloid of LA and MA is different from other known types of amyloid. Protein AP, which was demonstrated in amyloid of MA and LA, is known to be present in all forms of amyloid and is of unknown significance. Antiserum against keratin did not react with the larger homogeneous amyloid bodies, but showed a weak reaction with some small deposits. Histochemical staining failed to show keratin in any of the tissues containing LA or MA.

Bioreducible poly(amido amine)s with different branching degrees as gene delivery vectors

Based on the knowledge that cationic polymers with different topographical structures behave differently in gene transfection process, herein, we synthesized three biodegradable poly(amido amine)s (PAAs) with the same repeating units and molecular weights except for degree of branching: linear PAA (LPAA), low-branched PAA (LBPAA), and high-branched PAA (HBPAA). We found that LBPAA could more effectively compact pDNA into positively charged nanoparticles than both HBPAA and LPAA. LBPAA polyplexes had the highest transfection efficiency among the three PAA polyplexes, and the difference in transfection efficiency is mainly attributed to the endocytosis rate. The cytotoxicity of PAAs was negligible at the transfection doses, probably due to the degradable disulfide bonds. Therefore, we could use branching as a parameter to simply tune a polymer's cellular uptake behavior and transfection efficiency.

Microdeposits of amyloid in sclerocalcific heart valves: a histochemical and immunofluorescence study

Amyloid associated with seven sclerotic and two normal aortic and mitral valves was studied. The sclerotic valve amyloid contained microfibrils with typical random orientation and a fibril width of 9.5-12.5 nm. The amyloid deposits demonstrated permanganate-resistant Congophilia and contained the amino acid tryptophan. Immunofluorescence studies showed P-component in amyloid deposits of 6 of 7 valves, but none of the sclerotic valves contained amyloid fibril proteins of the AL (primary), AA (secondary), AEt (medullary thyroid carcinoma) or ASc1 (senile cardiac) types. Two non-sclerotic valves, removed from a patient with systemic amyloidosis, showed permanganate-sensitive Congophilic amyloid deposits which contained amyloid fibril protein AA.

Training family medicine residents to practice collaboratively with psychology trainees

OBJECTIVE

This article will describe a training curriculum for family medicine residents to practice collaboratively with psychology (doctoral) trainees at the Wayne State University/Crittenton Family Medicine Residency program.

METHODS

The collaborative care curriculum involves a series of patient care and educational activities that require collaboration between family medicine residents and psychology trainees. Activities include: (1) clinic huddle, (2) shadowing, (3) pull-ins and warm handoffs, (4) co-counseling, (5) shared precepting, (6) feedback from psychology trainees to family medicine residents regarding consults, brief interventions, and psychological testing, (7) lectures, (8) video-observation and feedback, (9) home visits, and (10) research. The activities were designed to teach the participants to work together as a team and to provide a reciprocal learning experience.

RESULTS

In a brief three-item survey of residents at the end of their academic year, 83% indicated that they had learned new information or techniques from working with the psychology trainees for assessment and intervention purposes; 89% indicated that collaborating with psychology trainees enhanced their patient care; and 89% indicated that collaborating with psychology trainees enhanced their ability to work as part of a team. Informal interviews with the psychology trainees indicated that reciprocal learning had taken place.

CONCLUSIONS

Family medicine residents can learn to work collaboratively with psychology trainees through a series of shared patient care and educational activities within a primary care clinic where an integrated approach to care is valued.

Convergent Validity of the Early Memory Index in Two Primary Care Samples

Karliner, Westrich, Shedler, and Mayman (1996) developed the Early Memory Index (EMI) to assess mental health, narrative coherence, and traumatic experiences in reports of early memories. We assessed the convergent validity of EMI scales with data from 103 women from an urban primary care clinic (Study 1) and data from 48 women and 24 men from a suburban primary care clinic (Study 2). Patients provided early memory narratives and completed self-report measures of psychopathology, trauma, and health care utilization. In both studies, lower scores on the Mental Health scale and higher scores on the Traumatic Experiences scale were related to higher scores on measures of psychopathology and childhood trauma. Less consistent associations were found between the Mental Health and Traumatic Experiences scores and measures of health care utilization. The Narrative Coherence scale showed inconsistent relationships across measures in both samples. In analyses assessing the overall fit between hypothesized and actual correlations between EMI scores and measures of psychopathology, severity of trauma symptoms, and health care utilization, the Mental Health scale of the EMI demonstrated stronger convergent validity than the EMI Traumatic Experiences scale. The results provide support for the convergent validity of the Mental Health scale of the EMI.

Senile aortic amyloid. A third distinctive type of age-related cardiovascular amyloid

Aortic tissues from 22 elderly patients were analyzed by Congo red staining for amyloid deposits. All samples contained amyloid, which was resistant to the potassium permanganate reaction. Tryptophan was present in all amyloid deposits. The amyloid failed to react with antiserums to amyloid fibril protein ASc1 or human prealbumin, proteins previous demonstrated in generalized senile cardiac amyloid. It also differed from age-related isolated atrial amyloid, which has been shown to lack tryptophan. Deposits did not react with antiserums specific for amyloid fibril proteins of the A lambda IV, A lambda VI, AA, or AEt types. These results indicate that senile aortic amyloid is distinct from amyloid present in primary and secondary amyloidosis and appears to represent a third form of cardiovascular amyloid associated with the aging process.

Incoming resident experience and comfort with procedures designated as "basic"

BACKGROUND

Recent consensus guidelines have recommended uniformity in procedural training in family medicine residency programs. The consensus documentation suggestions are based on expectations of procedural training prior to residency. Few studies have evaluated the perceived baseline level of procedural competency prior to residency training.

METHODS

Twenty incoming PGY-1 residents completed a "procedural experience survey," asking respondents to identify their prior experience and current comfort levels with 19 "basic" procedures.

RESULTS

For seven procedures, no prior experience was the most common response. For 15 of the 19 procedures, at least one respondent reported no prior experience. The residents' self-reported comfort levels varied widely for each procedure.

CONCLUSIONS

The survey results showed that experience and comfort with procedures often performed in family medicine varies widely among incoming residents. This raises the question of whether documentation of resident competence in these procedures should be recommended as a baseline and monitored throughout residency training.

COVID-19-Induced Cardiomyopathy in a Young Nulliparous Woman

A young nulliparous woman presented with new-onset heart failure several weeks after an asymptomatic coronavirus disease 2019 (COVID-19) infection. Investigation revealed non-ischemic cardiomyopathy without apical ballooning. A literature review demonstrates other reported cases of COVID-19-induced cardiomyopathy; however, our patient was demographically unique from previously described cases, presented later, and did not have Takotsubo-like findings. Our patient continued to have evidence of cardiac remodeling and a reduced ejection fraction months after presentation. This case highlights the importance of surveilling for the post-infectious sequelae of COVID-19, along with the wide demographic range of patients susceptible to such outcomes.

Effect of PGY Training Year on Perceived Readiness to Perform Entrustable Professional Activities

This article was migrated. The article was marked as recommended. Background The Family Medicine for America's Health (FMAH) collaborative approved a set of Entrustable Professional Activities (EPAs) for the specialty, designed to serve as a set of activities that all practitioners in the specialty can be expected to perform. The extent to which family medicine residents feel equipped to perform EPAs is not known. Objective To assess the extent to which family medicine residents in all three PGY years feel ready to perform Entrustable Professional Activities. Methods This spring, eighteen residents were asked to complete the "ProMedica Monroe Family Medicine Entrustable Professional Activities Survey," which asks residents, for all 20 EPAs, to 1) identify their readiness to perform the EPA on a 9-point Likert scale, and 2) endorse their level of PGY training. Results Fifteen of out eighteen eligible participants completed the survey. Mean readiness levels across EPAs were 5.23/9 for PGY1s, 7.27 for PGY2s, and 8.17 for PGY3s. Residents reported higher readiness levels with inpatient care (7.67) and relationship building (7.80), but lower levels with mental health care (5.87) and obstetrical care (5.07). Conclusions Residents perceive increases in readiness to perform family medicine EPAs with each PGY year. Resident readiness levels are broadly similar across EPAs, with few outliers.

Behavioral health assessments and interventions of residents and psychology trainees during dual interviewing: a descriptive study

BACKGROUND AND OBJECTIVES

Family medicine residents increasingly work collaboratively with psychology trainees. One type of collaborative experience involves dual interviewing of clinic patients. The goal of this observational study was to provide an initial description of what occurs during dual interviews as it relates to behavioral health assessments and interventions.

METHODS

Psychology trainees provided detailed descriptions of 550 collaborative patient encounters involving 348 patients from the Wayne State University/Crittenton Family Medicine Residency clinic. Psychology trainees coded the frequency of behavioral health assessments and interventions by the resident, psychology trainee, or both.

RESULTS

Eighty percent of the encounters contained a behavioral health assessment, and 29% contained a behavioral health intervention. Most of these clinical activities were collaboratively done. Interestingly, residents and psychology trainees tended to provide different behavioral health interventions. Moreover, residents provided different behavioral health interventions in repeat dual interviews (n=202) as opposed to first-time visits (n=348), while psychology trainees did not.

CONCLUSIONS

Little is known about the process of dual interviewing, and this study is an important first step in describing how residents and psychology trainees actually interact during these encounters. More research is needed about the impact of dual interviewing on residents' behavior.

Amyloid of the seminal vesicles. A distinctive and common localized form of senile amyloidosis

Amyloid deposits were found subepithelially in the seminal vesicles of 34 of 209 consecutively studied men. The incidence increased with age and was found in 21% of men over 75 years. This senile seminal vesicle amyloidosis (SSVA) is a localized disorder, and the amyloid substance has unique histochemical and immunochemical properties not shared with any other amyloid described until now.

Irregularly shaped abdominal mass

Four years earlier, our patient had multiple abdominal surgeries. Now he had a nontender mass that was growing... and growing.

Improving Immunization Rates Using Lean Six Sigma Processes: Alliance of Independent Academic Medical Centers National Initiative III Project

BACKGROUND

Quality improvement education and work in interdisciplinary teams is a healthcare priority. Healthcare systems are trying to meet core measures and provide excellent patient care, thus improving their Hospital Consumer Assessment of Healthcare Providers & Systems scores. Crittenton Hospital Medical Center in Rochester Hills, MI, aligned educational and clinical objectives, focusing on improving immunization rates against pneumonia and influenza prior to the rates being implemented as core measures. Improving immunization rates prevents infections, minimizes hospitalizations, and results in overall improved patient care. Teaching hospitals offer an effective way to work on clinical projects by bringing together the skill sets of residents, faculty, and hospital staff to achieve superior results.

METHODS

WE DESIGNED AND IMPLEMENTED A STRUCTURED CURRICULUM IN WHICH INTERDISCIPLINARY TEAMS ACQUIRED KNOWLEDGE ON QUALITY IMPROVEMENT AND TEAMWORK, WHILE FOCUSING ON A SPECIFIC CLINICAL PROJECT: improving global immunization rates. We used the Lean Six Sigma process tools to quantify the initial process capability to immunize against pneumococcus and influenza.

RESULTS

The hospital's process to vaccinate against pneumonia overall was operating at a Z score of 3.13, and the influenza vaccination Z score was 2.53. However, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 1.96. Improvement in immunization rates of high-risk patients became the focus of the project. After the implementation of solutions, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 3.9 with a defects/million opportunities rate of 9,346 and a yield of 93.5%. Revisions to the adult assessment form fixed 80% of the problems identified.

CONCLUSIONS

This process improvement project was not only beneficial in terms of improved quality of patient care but was also a positive learning experience for the interdisciplinary team, particularly for the residents. The hospital has completed quality improvement projects in the past; however, this project was the first in which residents were actively involved. The didactic components and experiential learning were powerfully synergistic. This and similar projects can have far-reaching implications in terms of promoting patient health and improving the quality of care delivered by the healthcare systems and teaching hospitals.

Senile cardiac amyloid: evidence that fibrils contain a protein immunologically related to prealbumin

Antiserum specific for human prealbumin (HPA) was studied by indirect immunofluorescence on tissue sections of cardiac ventricles containing senile cardiac amyloid. The pattern of reactivity was identical to that previously reported for an antiserum specific for protein ASc1 (formerly designated ASCA present in these tissues. Anti-HPA failed to react with isolated atrial amyloid (IAA), primary amyloid (A lambda I, A lambda IV, A lambda VI), secondary amyloid (AA), amyloid associated with medullary carcinoma of the thyroid (AEt), pancreatic amyloid associated with adult onset diabetes, cerebral amyloid present in Alzheimer's disease or lichen amyloid. THe reaction of anti-HPA was completely blocked by purified human prealbumin but was not influenced by absorption with purified human albumin or proteins extracted from any amyloid types tested. The anti-HPA reaction was also completely blocked by purified protein ASc1, and the reaction of anti-ASc1 was similarly blocked by purified HPA. These studies suggest that senile cardiac amyloid of the ASc1 type contains prealbumin or a protein antigenically closely related to this molecule.