American Indians and Alaska Natives (AI/AN) remain underrepresented in the academic medicine workforce and little is known about cultivating AI/AN medical students' interest in academic medicine careers. Five structured focus groups were conducted including 20 medical students and 18 physicians. The discussion guide explored factors influencing AI/AN trainees' academic medicine career interest and recommended approaches to increase their pursuit of academia. Consensual qualitative research was employed to analyze transcripts. Our research revealed six facilitating factors, nine dissuading factors, and five recommendations towards cultivating AI/AN pursuit of academia. Facilitators included the opportunity to teach, serving as a role model/mentor, enhancing the AI/AN medical education pipeline, opportunities to influence institution, collegiality, and financial stability. Dissuading factors included limited information on academic career paths, politics, lack of credit for teaching and community service, isolation, self-doubt, lower salary, lack of positions in rural areas, lack of focus on clinical care for AI/AN communities, and research obligations. Recommendations included heighten career awareness, recognize the challenges in balancing AI/AN and academic cultures, collaborate with IHS on faculty recruitment strategies, identify concordant role models/mentors, and identify loan forgiveness programs. Similar to other diverse medical students', raising awareness of academic career opportunities especially regarding teaching and community scholarship, access to concordant role models/mentors, and supportive institutional climates can also foster AI/AN medical students' pursuit of academia. Unique strategies for AI/AN trainees include learning how to balance AI/AN and academic cultures, collaborating with IHS on faculty recruitment strategies, and increasing faculty opportunities in rural areas.
Chronic groundwater overdraft threatens agricultural sustainability in California's Central Valley. Diverting flood flows onto farmland for groundwater recharge offers an opportunity to help address this challenge. We studied the infiltration rate of floodwater diverted from the Kings River at a turnout upstream of the James Weir onto adjoining cropland; and calculated how much land would be necessary to capture the available floodwater, how much recharge of groundwater might be achieved, and the costs. The 1,000-acre pilot study included fields growing tomatoes, wine grapes, alfalfa and pistachios. Flood flows diverted onto vineyards infiltrated at an average rate of 2.5 inches per day under sustained flooding. At that relatively high infiltration rate,10 acres are needed to capture one CFS of diverted flood flow. We considered these findings in the context of regional expansion. Based upon a 30-year record of Kings Basin surplus flood flows, we estimate 30,000 acres operated for on-farm flood recharge would have had the capacity to capture 80% of available flood flows and potentially offset overdraft rates in the Kings Basin. Costs of on-farm flood capture for this study were estimated at $36 per acre-foot, less than the cost for surface water storage and dedicated recharge basins.
To compare coccidioidomycosis case rates among groups of young adults in a disease-endemic region, we reviewed medical charts for serologic testing and coding. Case rates were higher for scholarship athletes than for other students and paralleled 5× more serologic testing. Our findings underscore the need to routinely test patients for coccidioidomycosis.
Patients present to primary care physicians with musculoskeletal complaints more often than they do for upper respiratory infections, hypertension, or diabetes. Despite this, instruction in musculoskeletal medicine for internal medicine residents represents less than 1% of their total didactic and clinical education time. We recognize the immense breadth of knowledge and skill required to train residents in the practice of internal medicine. This curriculum guideline defines a recommended training strategy, and supplies relevant resources, to improve musculoskeletal education among internal medicine residents to optimize patient care. This curriculum guideline was created by internists who are sports medicine specialists. Sports medicine physicians promote overall health and well-being while providing expertise in acute and chronic musculoskeletal conditions, as well as how disease affects exercise and using exercise as medicine for people with chronic disease.
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