Quantitative Outcomes of "Y" Scheduling in an Internal Medicine-Pediatrics Residency Program: First Year Data.

Introduction Scheduling resident continuity clinic sessions and outpatient education in Internal Medicine-Pediatrics (Med-Peds) residency programs pose challenges. A minority of Med-Peds programs have switched to an "X + Y" schedule (each in weeks) specifically to separate inpatient rotations and other experiences ("X" schedule) from resident continuity clinics and other outpatient longitudinal clinical and educational experiences ("Y" schedule). Outside of focus groups, quantitative data from Med-Peds residents on overall and specific satisfaction with an outpatient "Y" schedule and its specific components have not been published.

Longitudinal propagation of aquatic disturbances following the largest wildfire recorded in New Mexico, USA.

Wildfire disturbance propagation along fluvial networks remains poorly understood. We use incident, atmospheric, and water-quality data from the largest wildfire in New Mexico's history to quantify how this gigafire affected surface runoff processes and mobilized wildfire disturbances into fluvial networks after burning 1382 km. Surface runoff post-fire increased compared to pre-fire conditions, and precipitation events that are frequently observed in the affected watershed (<2-year recurrence) and fell during the post-fire first rainy season resulted in uncorrelated, less frequently observed runoff events (10-year recurrence).

Meningococcal Vaccination:: An Update on Meningococcal Vaccine Recommendations for the Primary Care Physician.

Neisseria meningitidis is an aerobic, gram-negative, diplococcus bacterium that is a leading cause of meningitis and sepsis in the United States. Particularly at-risk groups include those with complement deficiencies, people using complement inhibitors, individuals with anatomic or functional asplenia, patients with HIV infection and travelers to endemic countries. There are currently three quadrivalent meningococcal vaccines (Serogroups A, C, W, Y) and two recombinant serogroup B vaccines available for use in the United States, and recommendations for vaccine use have changed rapidly in the past 10-15 years.

Disseminated Tuberculosis Involving Lung, Peritoneum, and Endometrium in an Immunocompetent 17-Year-Old Patient.

A 17-year-old Guatemalan female with a recent history of spontaneous abortion requiring dilation and curettage at 16 weeks' gestation presented two weeks post-procedure to a pediatric hospital for three days of worsening generalized abdominal pain, diarrhea, fevers, and cough. The patient's vital signs showed hypoxia, tachypnea, tachycardia, and hypotension; she was alert and oriented with a thin body habitus and suprapubic abdominal tenderness without rebound, guarding, or hepatosplenomegaly. She had no crackles, rales, or wheezing on lung examination.

Water quality impacts of urban and non-urban arid-land runoff on the Rio Grande.

Urban surface runoff from storms impacts the water quality dynamics of downstream ecosystems. While these effects are well-documented in mesic regions, they are not well constrained for arid watersheds, which sustain longer dry periods, receive intense but short-lived storms, and where stormwater drainage networks are generally isolated from sewage systems. We used a network of high-frequency in situ water quality sensors located along the Middle Rio Grande to determine surface runoff origins during storms and track rapid changes in physical, chemical, and biological components of water quality.

Clinic-Based Pediatric Disclosure Intervention Trial Improves Pediatric HIV Status Disclosure in Ghana.

Background: Disclosing HIV status to HIV-positive children is a major challenge facing families and health care providers. Despite recommendations for disclosure, rates remain low. We tested whether a pediatric HIV disclosure intervention delivered as an integral component of routine HIV health care in Ghana would improve disclosure to children.

Prevalence and correlates of depression among caregivers of children living with HIV in Ghana: findings from the Sankofa pediatric disclosure study.

Prior studies show an association between caregiver depression and child health outcomes. There has been little examination of depression among caregivers of HIV-infected children in sub-Saharan countries where pediatric HIV is concentrated. Using baseline data collected in the pediatric HIV disclosure intervention trial, Sankofa, we examined the prevalence and factors associated with depression among caregivers (N = 446) of children infected with HIV in Ghana.

High prevalence of non-adherence to antiretroviral therapy among undisclosed HIV-infected children in Ghana.

Adherence to antiretroviral therapy (ART) remains one of the greatest obstacles in pediatric HIV care. We sought to determine the prevalence of adherence to ART among undisclosed HIV-infected children and adolescents in Ghana. We analyzed baseline data from HIV-infected children and adolescents aged 7-18 years old enrolled in the SANKOFA Pediatric HIV disclosure intervention study in Ghana.

Spectrum of disease in HIV-positive patients presenting to a tertiary care hospital: a retrospective, cross-sectional review in Kumasi, Ghana.

Background: HIV remains a significant public health dilemma in West and Central Africa. HIV-related morbidity and mortality are unjustly high, yet little is known about the spectrum of complicating comorbidities in HIV-positive patients who are admitted to hospitals in these regions.

Methods: This study involved a retrospective chart review to determine the common comorbidities and mortality rate of HIV-infected patients admitted over a six month period to the internal medicine service at the Komfo Anokye Teaching Hospital (KATH), a tertiary care center in Ghana.

HIV Pre-Exposure Prophylaxis and Women: Survey of the Knowledge, Attitudes, and Beliefs in an Urban Obstetrics/Gynecology Clinic.

Uptake of HIV pre-exposure prophylaxis (PrEP) is low among women at risk for HIV acquisition. Of 468,000 women, whom the United States Centers for Disease Control and Prevention estimates to be eligible for PrEP, only 10,000 unique women have begun therapy through the third quarter of 2015. These data suggest insufficient HIV prevention efforts.

Impact of HIV-Status Disclosure on Adherence to Antiretroviral Therapy Among HIV-Infected Children in Resource-Limited Settings: A Systematic Review.

Pediatric HIV remains a significant global health dilemma, especially in resource-constrained nations. As access to ART increases around the world, areas of concern in pediatric HIV treatment include age-appropriate disclosure of HIV status to children and development of adherence habits over time. This review was conducted to synthesize quantitative associations reported between disclosure and adherence among children living with HIV in resource-limited settings.

Alternate pleckstrin homology domain orientations regulate dynamin-catalyzed membrane fission.

The self-assembling GTPase dynamin catalyzes endocytic vesicle scission via membrane insertion of its pleckstrin homology (PH) domain. However, the molecular mechanisms underlying PH domain-dependent membrane fission remain obscure. Membrane-curvature-sensing and membrane-curvature-generating properties have been attributed, but it remains to be seen whether the PH domain is involved in either process independent of dynamin self-assembly.

α₂- and β-adrenoceptors involvement in nortriptyline modulation of auditory sustained attention and impulsivity.

Rationale: The catecholamine innervation of the prefrontal cortex controls attentional focus and inhibits inappropriate behavioral responses. The mechanism of action with which norepinephrine (NE) reuptake inhibitors modulate these cognitive functions has not been fully investigated.

Objective: We investigated the effect of systemic administration of the NE reuptake blocker nortriptyline (NT) on attention and impulsivity using an auditory sustained attention task.

Layer-specific noradrenergic modulation of inhibition in cortical layer II/III.

Norepinephrine (NE) is released in the neocortex after activation of the locus coeruleus of the brain stem in response to novel, salient, or fight-or-flight stimuli. The role of adrenergic modulation in sensory cortices is not completely understood. We investigated the possibility that NE modifies the balance of inhibition acting on 2 different γ-aminobutyric acid (GABA)ergic pathways.

Nicotinic modulation of auditory attentional shift in the rat.

Numerous studies have demonstrated cognitive improvements resulting from the application of nicotine, especially in those tasks aimed at measuring attention. While the neuro-pharmacological relationship between nicotine and acetylcholine-driven attentional processes has been examined, studies tend to focus on the duration of time in which a subject can attend to a specific stimulus or series of stimuli rather than on the subjects' adaptive attentional capabilities. The present study addresses the possibility that the cholinergic agonist nicotine could improve performance on a task testing the ability to shift attention between sensory modalities under both normal and pharmacologically impaired conditions.

Effect of the environment on the dendritic morphology of the rat auditory cortex.

The present study aimed to identify morphological correlates of environment-induced changes at excitatory synapses of the primary auditory cortex (A1). We used the Golgi-Cox stain technique to compare pyramidal cells dendritic properties of Sprague-Dawley rats exposed to different environmental manipulations. Sholl analysis, dendritic length measures, and spine density counts were used to monitor the effects of sensory deafness and an auditory version of environmental enrichment (EE).