Literatura académica sobre el tema "Co-ordinated Medical Research Fellowships"

Abstract Introduction All leukocytes tested to date have functional circadian clocks, and nearly every arm of the immune response is subject to circadian regulation. Circadian clocks instruct the time-of-day-dependent, rhythmic expression of genes in a tissue- and cell-specific manner. In macrophages (mΦs), the circadian clock regulates several factors that are critical to executing effective immune responses. Tumor-associated mΦs are major contributors to immune suppression in the tumor microenvironment (TME). Evidence suggests that metabolically stressful factors in the TME such as acidic pH and nutrient limitation promote mΦ-mediated immune suppression, and recent data point to dysregulation of the circadian clock downstream of metabolic stress. Methods We study the effect of TME-associated metabolic stress on the circadian clock of mΦs in vitro by culturing bone marrow-derived mΦs in conditions mimicking acidic pH and nutrient limitations that have been observed in the TME. To study the impact of mΦ-intrinsic circadian rhythms on tumorigenesis in vivo, we use mice genetically engineered to have a myeloid cell-specific disruption of the circadian clock via deletion of the key clock protein BMAL1. Results Oscillation of core clock proteins is altered in mΦs subjected to TME-associated metabolic stress. Additionally, we observe increased tumor growth in mice co-injected with mΦs whose circadian clocks were disrupted compared to mice co-injected with mΦs whose circadian clocks were functional. Conclusion Our data suggests that stressful conditions associated with the TME can alter the mΦ circadian clock, and that a functional circadian clock in mΦs can suppress tumor growth in a syngeneic murine tumor model of pancreatic cancer. This research has been supported by the following fellowships and grants: 2021-Current: Wilmot Predoctoral Cancer Research Fellowship, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 2020-2021: NIH T32 Training Grant in Cellular, Biochemical & Molecular Sciences, University of Rochester Medical Center, Rochester, NY

9029 Background: Cancer clinical trials (CCTs) are vital to advancing treatment yet only 5-8% of people with cancer ever participate, with even lower rates among underserved groups. Teaching oncologists in training how to communicate about CCTs may improve the frequency and quality of patient-oncologist communication about CCTs and increase participation. However, little is known about interest in or feasibility of such training during Hematology-Oncology (Hem-Onc) graduate medical education (GME) fellowships. We aimed to determine Hem-Onc fellowship programs’: 1) current practices, needs, and preferences for CCT-related communication training; and 2) the acceptability and feasibility of implementing a CCT communication skills workshop. Methods: We recruited and surveyed program directors (PDs) from Hem-Onc fellowship programs across the U.S. PDs were recruited via email through the ASCO program directors’ community, a publicly accessible list of ACGME Hematology-Oncology programs, and co-authors’ professional networks. Participants were compensated with a $50 gift card. Survey data were analyzed using descriptive statistics and responses were measured on a 5-point Likert scale (1 = “strongly disagree” to 5 = “strongly agree”). Results: 40 PDs were surveyed, most representing programs in the Northeast (30%), Midwest (25.6%), Southeast (20.5), and Southwest (15.4%) U.S. Most were male (57%) and identified as White (55%), Asian (30%), Black/African American (2.5%) and Native American/Alaskan Native (2.5%). PDs stated their institutions prioritize CCT accrual (M=4.58, SD=.78) and clinical research training (M=4.20, SD=.85). They reported their GME CCT curriculum least often addressed: (1) How to talk to patients about CCTs when none are available (27.5%), and (2) How to help patients find CCTs at other institutions (17.5%). PDs rated their fellows’ CCT knowledge as lowest in: (1) Provider-level barriers to enrolling/referring patients in CCTs (M=3.41, SD=.91) and (2) System-level barriers to patient accrual to CCTs (M=3.33, SD=.95). Fellows’ lowest-rated CCT communication skills areas were: (1) Making shared decisions with patients about CCT participation (M=3.54, SD=1.14) and (2) Patient-centered communication (M=3.50, SD=1.15). PDs were interested in a CCT communication workshop (‘yes’=67.5%, ‘maybe’=32.5%) and said such training was feasible (M=4.28, SD=.78) and useful (M=4.47, SD=.78). Training preferences were live presentations (M=3.9, SD=1.03) and program-tailored virtual workshops (M=3.9, SD=1.08). Conclusions: Hem-Onc fellowship program leaders expressed a need for training that improves fellows’ CCT knowledge and patient-centered communication skills. By highlighting current practices, challenges, and preferences, this study is an important step towards implementing and scaling communication skills training in GME programs.

Abstract Background Applicants entering Infectious Disease (ID) fellowships are declining and shortages of ID physicians is a challenge recognized by the clinical workforce and Infectious Diseases Society of America (IDSA). There is increased awareness of more Advanced Practice Providers (APPs) being used within ID to expand and extend existing practices. However, little is known about APP utilization, APP clinical scope of practice, specific roles, and opportunities for education. Methods To evaluate physician perspectives on APP utilization in ID, we created an anonymous and voluntary survey using the REDCap data tool that was distributed by social media, key stakeholder emails, and IDSA online community forum between 12/1/2019-1/31/2020. In addition to collecting geographic information and the type of ID practice, participants were also surveyed about the use of APPs and any perceived barriers that may limit their use. Results 218 practicing ID physicians responded to the survey (Figure 1). 155 (71%) physicians work with APPs in their current practice (Figure 2); specifically, 56 (27%) with 1 APP, 62 (30%) with 2-4 APPs, 28 (13%) with 5-9 APPs, and 11 (5%) with > 10 APPs. Of respondents, 104 (48%) practiced at University/Medical schools, 80 (37%) in hospitals/clinics, and 28 (13%) in private practice (Table 1); most work in adult inpatient/outpatient ID. The main reasons selected by respondents for not using APPs in their practice included concerns around a lack of formal ID training 22 (15%), lack of time/lack of ability to assist with APP training 29 (20%), practice is already sufficiently staffed 19 (13%), and concern for physician revenue loss 16 (11%) (Table 1). Figure 1. Physician Responses by Region, n = 218 Figure 2. Physicians Utilizing APPs in Practice, n = 210 (*no response, 8) Table 1. Physician ID Practice Type, Setting, and Concerns Conclusion Results suggest that while collaboration between ID physicians and APPs exists to meet current needs, a lack of ID training is a limiting factor. Our findings demonstrate there is an opportunity for formal ID education and resource development both to enhance APPs clinical skills and address perceived knowledge gaps. Inclusion of APPs in the ID workforce may allow physicians to expand ID care into more resource limited areas to continue to provide high quality patient care. Disclosures Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)

Abstract Background The Foundation for Anesthesia Education and Research Medical Student Anesthesia Research Fellowship (MSARF) program is an 8-week program that pairs medical students with anesthesiologists performing anesthesia-related research. This study evaluated the proportion of students who published an article from their work, as well as the percentage of students who entered anesthesiology residency programs. Methods A list of previous MSARF participants (2005 to 2012), site, and project information was obtained. Searches for publications were performed using PubMed. The primary outcome was the publication rate for MSARF projects. The MSARF abstract-to-publication ratio was compared with the percentage of abstracts presented at biomedical meetings that resulted in publication as estimated by a Cochrane review (44%). For students who had graduated from medical school, match lists from the students’ medical schools were reviewed for specialty choice. Results Forty-two percent of the 346 MSARF projects were subsequently published. There was no difference between the MSARF abstract-to-publication ratio and the publication rate of articles from abstracts presented at scientific meetings (P = 0.57). Thirty percent (n = 105; 95% CI, 25 to 35%) of all the MSARF students were authors on a publication. Fifty-eight percent of the students for whom residency match data (n = 255) were available matched into anesthesiology residencies (95% CI, 52 to 64%). Conclusions The MSARF program resulted in many students being included as a co-author on a published article; the majority of these students entered anesthesiology residency programs. Future research should determine whether the program has a long-term impact on the development of academic anesthesiologists.

Social gerontology, as a distinct discipline, has been slower to develop in France than in Anglo-Saxon countries. Gerontological discourses have been dominated by the medical and physical sciences. At the same time, France has a long tradition of research on ageing that incorporates important social dimensions, particularly in demographic and economic fields. Current developments include research on pensions and related issues such as early-retirement or older people in the labour force; inter-generational relations or family solidarity; disabled elderly people and caring; and ageing among ethnic minority populations. These developments point in the direction of co-ordinated, multi-disciplinary approaches to the life course and ageing in the future.

Background Many medical professionals seek to do good through their careers, which may involve pursuing non-clinical options such as research, policy, or education in addition to clinical work. Working out which paths will lead to the largest social impact is a challenging question and of interest to many doctors. However, there are few, if any, services that use an impact-oriented framework to support doctors who want to make career decisions based on impact. Objectives To describe the development of an 8-week fellowship programme to introduce medical professionals to careers paths and focus areas which could lead to a particularly large social impact. And to evaluate the programme in terms of engagement, utility, changes in knowledge and career attitudes of participants. Methods The ADDIE instructional design model was used to design and evaluate this fellowship programme. An 8-week curriculum was designed by medical professionals and delivered to medical students and doctors around the world utilising a flipped learning style. Quantitative and qualitative data on the programme were collected and analysed. Results There was more demand for the programme than anticipated. We found that the fellowship was engaging and useful to medical students and doctors. It resulted in an increase in knowledge and skills on how to consider impact in one’s own career and a change in participants’ attitudes and behaviours, with some participants making changes to their career and charitable giving following the programme. Conclusions We believe an impact-orientated, practical co-curricular programme is valuable to medical professionals exploring impactful career options and there is demand for further programmes in this space.

Purpose The purpose of this paper is to reflect on research evidence and practice experience of transforming primary care to a more integrated and holistic model. Design/methodology/approach It is based on a scoping review which has been guided by primary care stakeholders and synthesises research evidence and practice experience from ten international case studies. Findings Adopting an inter-professional, community-orientated and population-based primary care model requires a fundamental transformation of thinking about professional roles, relationships and responsibilities. Team-based approaches can replicate existing power dynamics unless medical clinicians are willing to embrace less authoritarian leadership styles. Engagement of patients and communities is often limited due to a lack of capacity and belief that will make an impact. Internal (relationships, cultures, experience of improvement) and external (incentives, policy intentions, community pressure) contexts can encourage or derail transformation efforts. Practical implications Transformation requires a co-ordinated programme that incorporates the following elements – external facilitation of change; developing clinical and non-clinical leaders; learning through training and reflection; engaging community and professional stakeholders; transitional funding; and formative and summative evaluation. Originality/value This paper combines research evidence and international practice experience to guide future programmes to transform primary care.

Cryptosporidium is the leading cause of swimming pool outbreaks of gastroenteritis. Transmission occurs through the ingestion of oocysts that are passed in the faeces of an infected person or animal when an accidental faecal release event occurs. Cryptosporidium parasites present specific challenges for infection control as oocysts are highly resistant to chlorine levels used for pool disinfection, infected individuals can shed large numbers of oocysts, there is a long incubation period and shedding of oocysts occurs even after symptom resolution. The purposes of this review are to identify key barriers to limiting swimming pool-associated outbreaks of cryptosporidiosis and to outline needs for research and collaboration to advance co-ordinated management practices. We reviewed swimming pool-associated cryptosporidiosis outbreaks, disinfection teachniques, current regulations and the role of staff and patrons. Key barriers to limiting swimming pool-associated outbreaks of cryptosporidiosis are a lack of uniform national and international standards, poor adherence and understanding of regulations governing staff and patron behaviour, and low levels of public knowledge and awareness.

Abstract STUDY QUESTION Is one cycle of IVM non-inferior to one cycle of conventional in IVF with respect to live birth rates in women with high antral follicle counts (AFCs)? SUMMARY ANSWER We could not demonstrate non-inferiority of IVM compared with IVF. WHAT IS KNOWN ALREADY IVF with ovarian hyperstimulation has limitations in some subgroups of women at high risk of ovarian stimulation, such as those with polycystic ovary syndrome. IVM is an alternative ART for these women. IVM may be a feasible alternative to IVF in women with a high AFC, but there is a lack of data from randomized clinical trials comparing IVM with IVF in women at high risk of ovarian hyperstimulation syndrome. STUDY DESIGN, SIZE, DURATION This single-center, randomized, controlled non-inferiority trial was conducted at an academic infertility center in Vietnam from January 2018 to April 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 546 women with an indication for ART and a high AFC (≥24 follicles in both ovaries) were randomized to the IVM (n = 273) group or the IVF (n = 273) group; each underwent one cycle of IVM with a prematuration step versus one cycle of IVF using a standard gonadotropin-releasing hormone antagonist protocol with gonadotropin-releasing hormone agonist triggering. The primary endpoint was live birth rate after the first embryo transfer. The non-inferiority margin for IVM versus IVF was −10%. MAIN RESULTS AND THE ROLE OF CHANCE Live birth after the first embryo transfer occurred in 96 women (35.2%) in the IVM group and 118 women (43.2%) in the IVF group (absolute risk difference –8.1%; 95% confidence interval (CI) –16.6%, 0.5%). Cumulative ongoing pregnancy rates at 12 months after randomization were 44.0% in the IVM group and 62.6% in the IVF group (absolute risk difference –18.7%; 95% CI –27.3%, –10.1%). Ovarian hyperstimulation syndrome did not occur in the IVM group, versus two cases in the IVF group. There were no statistically significant differences between the IVM and IVF groups with respect to the occurrence of pregnancy complications, obstetric and perinatal complications, preterm delivery, birth weight and neonatal complications. LIMITATIONS, REASONS FOR CAUTION The main limitation of the study was its open-label design. In addition, the findings are only applicable to IVM conducted using the prematuration step protocol used in this study. Finally, the single ethnicity population limits the external generalizability of the findings. WIDER IMPLICATIONS OF THE FINDINGS Our randomized clinical trial compares live birth rates after IVM and IVF. Although IVM is a viable and safe alternative to IVF that may be suitable for some women seeking a mild ART approach, the current study findings approach inferiority for IVM compared with IVF when cumulative outcomes are considered. Future research should incorporate multiple cycles of IVM in the study design to estimate cumulative fertility outcomes and better inform clinical decision-making. STUDY FUNDING/COMPETING INTEREST(S) This work was partly supported by Ferring grant number 000323 and funded by the Vietnam National Foundation for Science and Technology Development (NAFOSTED) and by the Fund for Research Flanders (FWO). LNV has received speaker and conference fees from Merck, grant, speaker and conference fees from Merck Sharpe and Dohme, and speaker, conference and scientific board fees from Ferring; TMH has received speaker fees from Merck, Merck Sharp and Dohme, and Ferring; RJN has received conference and scientific board fees from Ferring, is a minor shareholder in an IVF company, and receives grant funding from the National Health and Medical Research Council (NHMRC) of Australia; BWM has acted as a paid consultant to Merck, ObsEva and Guerbet, and is the recipient of grant money from an NHMRC Investigator Grant; RBG reports grants and fellowships from the NHMRC of Australia; JS reports lecture fees from Ferring Pharmaceuticals, Biomérieux, Besins Female Healthcare and Merck, grants from Fund for Research Flanders (FWO), and is co-inventor on granted patents on CAPA-IVM methodology in the US (US10392601B2) and Europe (EP3234112B1); TDP, VQD, VNAH, NHG, AHL, THP and RW have no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work. TRIAL REGISTRATION NUMBER NCT03405701 (www.clinicaltrials.gov). TRIAL REGISTRATION DATE 16 January 2018. DATE OF FIRST PATENT’S ENROLMENT 25 January 2018.

“Castles in the clouds, flying by; men will build them till they die; don’t they know it’s all a lie, tumbling castles make them cry; still they try…1” Identity is shaped by thoughts, ideas, feelings and emotions; expressed in words, actions and expressions; and recorded for posterity in mentifacts and artifacts. “Paper” (or “plastic”) identity, found on various identification cards, electronic databases, resumés and curriculum vitaes, is not necessarily be the same as the “flesh and blood” or real-life identity known best to those with whom face-to-face interaction takes place over long periods of time in various day-to-day situations. Status is both achieved and ascribed, and the degree to which one or the other contributes more draws the thin line between the real and apparent. To achieve means “to carry out successfully (accomplish);” “to get or attain as a result of exertion (reach),” or “to attain a desired end or aim (to become successful).”2 To ascribe, on the other hand, comes from the restored spelling of the Middle English ascrive, etymologically derives from the Old French. ascrivre, "to attribute, inscribe," and the Latin ascribere "to write in, to add to in a writing," from ad- "to" + scribere "to write."3 To ascribe is to refer to a supposed cause, source, or author, and “suggests an inferring of cause, quality or authorship” as in the case of “forged paintings formerly ascribed to masters.”4 Achievement rightfully bestows an earned “headship,” implied in its etymology from the Old.French. achever "to finish," from the phrase à chef (venir) "at an end, finished," the Vulgate Latin *accapare, from the Latin ad caput (venire). Literally, both the Old.French and Latin phrases mean "to come to a head," from the Latin caput "head.”5 Ascription is flattery at best; but worse when self-generated and perpetuated. Are vicarious experiences that become “personal accomplishments,” casual visits and observations that become “further training and fellowships,” comments and editing (even supervisory positions) that metamorphose into “research and co-authorships” any different from the fictitious medals of a dictator? Awards beget awards. Those who are thus preceded by reputation may loom “larger than life.” Do such giants stand on feet of clay? Our circles are a microcosm of the nation and world around us. Public servants who believe the fictions crafted by themselves and their coutillons continue to claim the right to rule (rather than the obligation to serve). Are we dazzled by the dream? What do we aspire for? Et tu? _________________________ The first meeting of the Asia Pacific Association of Medical Journal Editors (APAME) was held in Seoul, the Republic of Korea last May 4-5, 2008 co-hosted by the World Health Organization Western Pacific Regional Office.6 APAME’s vision, it was agreed, would be to promote health care through the dissemination of quality health information in the Asia Pacific Region. The association also established the following aims: To upgrade publishing standards of health journals and books, paper-based or electronic; To develop an aggregated indexing system for health articles published in the Asia Pacific Region; and To enhance optimal access to health articles. The development of the Western Pacific Region Index Medicus (WPRIM) and the Global Health Library (GHL) are much-needed efforts to ensure the dissemination of and universal access to reliable health information essential to health development. These efforts will level the playing field for authors, editors, peer reviewers, publishers and subscribers in developing countries, elevating loco-regional research and publishing to the global arena. Following our continued compliance with established standards, we anticipate inclusion of the Philipp J Otolaryngol Head Neck Surg in the WPRIM. Through its President Gil M. Vicente, and the Board of Trustees, our Society blazes new trails to lead us beyond the confines of self-directed concerns toward new horizons of hope for our various publics, present and future. Efforts aimed at health-promotion and disease-prevention, side by side with involvement in ecological and environmental concerns may prove to be as, or even more important, than the equally quixotic pursuit of cutting-edge diagnostic and therapeutic advances. What use are these when they are beyond the reach of most? “When the time of our particular sunset comes, our ‘thing,’ our accomplishment, won’t matter a great deal. But the clarity and concern with which we have loved others will speak with vitality of the great gift of life we have been to each other.”7