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The promotion of reflective capacity within the teaching of clinical skills and professionalism is posited as fostering the development of competent health practitioners. An innovative approach combines structured reflective writing by medical students and individualized faculty feedback to those students to augment instruction on reflective practice. A course for preclinical students at the Warren Alpert Medical School of Brown University, entitled "Doctoring," combined reflective writing assignments (field notes) with instruction in clinical skills and professionalism and early clinical exposure in a small-group format. Students generated multiple e-mail field notes in response to structured questions on course topics. Individualized feedback from a physician-behavioral scientist dyad supported the students' reflective process by fostering critical-thinking skills, highlighting appreciation of the affective domain, and providing concrete recommendations. The development and implementation of this innovation are presented, as is an analysis of the written evaluative comments of students taking the Doctoring course. Theoretical and clinical rationales for features of the innovation and supporting evidence of their effectiveness are presented. Qualitative analyses of students' evaluations yielded four themes of beneficial contributions to their learning experience: promoting deeper and more purposeful reflection, the value of (interdisciplinary) feedback, the enhancement of group process, and personal and professional development. Evaluation of the innovation was the fifth theme; some limitations are described, and suggestions for improvement are provided. Issues of the quality of the educational paradigm, generalizability, and sustainability are addressed.

Recombinant vaccinia viruses containing the cloned hemagglutinin (HA) gene from influenza virus were constructed. The biological activity of these poxvirus vectors was demonstrated both in -vitro and in vivo. Expression of HA in cells infected with recombinant vaccinia was detected by using specific anti-HA antiserum and '5I-labeled protein A, showing that HA synthesized under the regulation of vaccinia virus was antigenic. Immunization of rabbits with these recombinant poxviruses resulted in the production of antibodies reactive with authentic influenza HA as detected by radioimmunoassay, by inhibition of HA erythrocyte agglutination, and by neutralization of influenza virus infectivity. The production of antibodies directed against influenza HA suggested that the. HA The utility of poxviruses as eukaryotic expression vectors can be categorized as follows: (i) definition of the regulatory events in the viral replication cycle by following the expression of a foreign gene from a variety of early or late promoters or by analysis of foreign genetic elements in a cytoplasmic location, (ii) as a eukaryotic expression vector for the synthesis of biological products, and (iii) in the construction of live recombinant vaccines directed against both human and veterinary infectious diseases.The biological activity of vaccinia recombinants expressing a cloned hemagglutinin (HA) gene from influenza virus as an example of the production of live vaccines by the' use of appropriately modified poxviruses is the subject of this communication.MATERIALS AND METHODS Construction of Chimeric Donor Plasmids for in Vivo Recombination. Plasmids were constructed, analyzed, and purified using standard techniques. Plasmids were constructed for insertion of plasmid pBR322, DNA into vaccinia as follows. Isolated vaccinia HindIII fragment F was circularized by ligation with T4 DNA ligase. This circularized fragment F was then cut with BamHI. The linear inverted fragment F was ligated to BamHI-cleaved pBR322 that had been treated with alkaline phosphatase (7) and used to transform (8) competent Escherichia coli RRL (9). Recombinant plasmids were screened by restriction analysis of minilysates (10). Two plasmids that contained the inverted HindIII fragment F in opposite orientation within pBR322 were designated pDP301A and pDP301B. A plasmid (pJZ102) containing the cDNA sequence of the HA gene of influenza strain A/PR/8/34 (HINI) inserted into the HindIII site of pBR322 was obtained from P. Palese (Mt. Sinai, New York). The HA sequence in pJZ102 was reversed at the HindIII site by cutting with HindIII and religating. Plasmids with the HA sequence in opposite orientation were then designated pJZL2XA and pJZ102B. For insertion of the HA sequence directly into the BamHI site within the HindIII fragment F of vaccinia, a plasmid containing a Pst I subclone of the HindIII fragment F was constructed using plasmid pBR325 (11). To have a plasmid that contained only a single BamHI site, the BamHI site of pBR325 was removed by cleaving pBR325 ...

A total of 41 Clostridium botulinum serotype E strains from different geographic regions, including Canada, Denmark, Finland, France, Greenland, Japan, and the United States, were compared by multilocus sequence typing (MLST), amplified fragment length polymorphism (AFLP) analysis, variable-number tandem-repeat (VNTR) analysis, and botulinum neurotoxin (bont) E gene sequencing. The strains, representing environmental, food-borne, and infant botulism samples collected from 1932 to 2007, were analyzed to compare serotype E strains from different geographic regions and types of botulism and to determine whether each of the strains contained the transposon-associated recombinase rarA, involved with bont/E insertion. MLST examination using 15 genes clustered the strains into several clades, with most members within a cluster sharing the same BoNT/E subtype (BoNT/E1, E2, E3, or E6). Sequencing of the bont/E gene identified two new variants (E7, E8) that showed regions of recombination with other E subtypes. The AFLP dendrogram clustered the 41 strains similarly to the MLST dendrogram. Strains that could not be differentiated by AFLP, MLST, or bont gene sequencing were further examined using three VNTR regions. Both intact and split rarA genes were amplified by PCR in each of the strains, and their identities were confirmed in 11 strains by amplicon sequencing. The findings suggest that (i) the C. botulinum serotype E strains result from the targeted insertion of the bont/E gene into genetically conserved bacteria and (ii) recombination events (not random mutations) within bont/E result in toxin variants or subtypes within strains.

Purpose Anti-obesity prejudices affect the quality of care obese individuals receive. The authors sought to determine the prevalence of weight-related biases among medical students and whether they were aware of their biases. Method Between 2008 and 2011, the authors asked all third-year medical students at Wake Forest School of Medicine to complete the Weight Implicit Association Test (IAT), a validated measure of implicit preferences for “fat” or “thin” individuals. Students also answered a semantic differential item assessing their explicit weight-related preferences. The authors determined students’ awareness of their biases by examining the correlation between students’ explicit preferences and their IAT scores. Results Of 354 medical students, 310 (88%) completed valid surveys and consented to participate. Overall, 33% (101/310) self-reported a significant (“moderate” or “strong”) explicit anti-fat bias. No students self-reported a significant explicit anti-thin bias. According to the IAT scores, over half of students had a significant implicit weight bias: 39% (121/310) had an anti-fat bias and 17% (52/310) an anti-thin bias. Two-thirds of students (67%, 81/121) were unaware of their implicit anti-fat bias. Only male gender predicted an explicit anti-fat bias (odds ratio 3.0, 95% confidence interval 1.8 – 5.3). No demographic factors were associated with an implicit anti-fat bias. Students’ explicit and implicit biases were not correlated (Pearson r = 0.03, P = .58). Conclusions Over one-third of medical students had a significant implicit anti-fat bias; few were aware of that bias. Accordingly, medical schools’ obesity curricula should address weight-related biases and their potential impact on care.