Comparing research activities of women and men faculty in departments of internal medicine.

The findings from a questionnaire prepared by the Association of Professors of Medicine and the Association of American Medical Colleges were published in two reports in 1986 and 1987. These reports assessed the research activities of full-time members of departments of internal medicine in 1982 and 1983. The purpose of the present study was to analyze the data of the earlier reports in order to compare the research activities of women and men who were full-time faculty in departments of medicine during the time period originally surveyed. More than half of the faculty women who responded (52%) were less than 40 years old, compared with 23% of the faculty men. Sixty-seven percent of the women held the rank of instructor or assistant professor, in contrast to 40% of the men holding these ranks. Although the faculty of both genders reported generally the same proportions of time devoted to research, the women researchers with M.D. degrees had significantly less National Institutes of Health (NIH) grant support than did their counterparts who were men. Since this difference may have been a function of age, the authors compared NIH grant support of the faculty men and women with M.D. degrees who were 40-59 years old. Even in this older group, significantly fewer of the faculty women had NIH grant support than did the men (16% versus 30%). Furthermore, the percentage of designated laboratory space was significantly lower among the faculty women, regardless of degree (M.D., M.D./Ph.D., or Ph.D.). Further investigation is warranted to monitor the progress of women attempting to develop their research careers and to assess their overall clinical teaching and administrative roles in departments of medicine.

Research activities of faculty in academic departments of medicine.

To assess the involvement of current medical faculty in research, a research activities questionnaire and a faculty roster form were sent to all full-time, salaried faculty of departments of medicine in medical schools in the United States. Valid responses from 7483 faculty members were received from 119 medical schools. About 88% of respondents are men; 83% have M.D. degrees; 8% have a Ph.D. degree; and 7% have both degrees. Twenty-four percent of the faculty who have done research had little preparation for a research career. However, 45% of faculty with M.D. degrees had 2 or more years of research training. Seventy-seven percent of faculty with only an M.D. degree reported research activity from 1982 to 1983; the median effort of all faculty with an M.D. is 25%. Faculty with both degrees are more involved in research and the median effort for those with a Ph.D. is 95%.

The impact of a quality assurance program on postgraduate training in internal medicine.

The development of a quality assurance program as part of residency training in internal medicine is described. In addition to ensuring quality, the program allows both the faculty and the resident to assess individual performance more precisely than previously possible. The residents become increasingly thorough and improve problem-solving skills over the three-year program. They are provided the tools to manage quality in their own practice.

The kinetics of early inflammatory events during experimental pneumonia due to Legionella pneumophila in guinea pigs.

An animal model of Legionella pneumophila pneumonia was developed to study aerosol infection, pathogenesis, and pulmonary host defense mechanisms. Guinea pigs were exposed in an inhalation facility that limited the aerosol of L pneumophila to the snout. Bronchoalveolar lavage was used to sample airspace cells, secretions, and bacteria during developing infection in 79 exposed animals and 13 uninfected controls. An influx of polymorphonuclear neutrophils followed exponential bacterial growth during the initial three days of infection and coincided with limitation of the increase in bacteria recovered. A macrophage influx occurred at three to five days. Bacteria were eliminated from the lung by 11 days after exposure. Albumin in lavage fluid peaked at two days. Most viable L pneumophila organisms were associated with alveolar macrophages, whereas most of the bacteria associated with polymorphonuclear neutrophils were nonviable. Recruited, and possibly immune, defenses appear to be required for successful resolution of legionella pneumonia.

Rifampin and minocycline in meningococcal disease.

Military recruits in four companies were given minocycline, rifampin, ampicillin, or placebo for five days. All antibiotics reduced the rate of carriage of Neisseria meningitidis during treatment, but the effect was significantly more prolonged with minocycline and rifampin. The only difference between these two drugs lay in the isolation of rifampin-resistant meningococci from 17 recruits who received that antibiotic. No isolates were found to be resistant to minocycline. During an outbreak of meningococcal disease among military recruits, minocycline (100 mg every 12 hr) was administered to 8,721 trainees for five days. No new cases of meningococcal disease occurred for the next four weeks. Six new cases then developed among recruits who had begun their training after the initial course of treatment. A second cycle of minocycline, followed in one week by administration of group C polysaccharide vaccine, terminated the outbreak.

Protein and antibody in lavage fluid of guinea pigs with Legionella pneumophila pneumonia.

Guinea pigs were infected in an inhalation facility that limited an aerosol of L. pneumophila to the snout, as previously reported in detail (Davis et al., 1982). Individual animals were sacrificed for study either immediately after exposure, at 16 hours, at days one through seven, or at 11 days. Bronchoalveolar lavage was carried out to obtain fluid to study the following: total protein, albumin and immunoglobulin G (IgG) concentrations, and the titer of antibody to L. pneumophila. Antibody also was measured in serum obtained at the time of sacrifice. Concentrations of total protein, albumin, and IgG in lavage fluids peaked 2 days after exposure and correlated with the appearance of maximal numbers of polymorphonuclear cells in the lungs. Presumably, this increased protein resulted from exudation of serum across the alveolar-capillary membrane, which loses its integrity secondary to pneumonia. However, the ratio of IgG/albumin was elevated in animals studied 11 days after exposure even though the concentration of albumin was normal by this time. One possible explanation for this observation is that IgG was being produced in the lung. Antibody in lavage fluid was detected 7, and 11 days post-exposure, and might be important in the recovery of guinea pigs from this infection.

Legionnaires' pneumonia after intratracheal inoculation of guinea pigs and rats.

We have developed a model of legionnaires' pneumonia in guinea pigs and rats. A reproducible population of Legionella pneumophila was obtained in late exponential growth phase and inoculated into the trachea of young animals. Either immunologic or microbiologic evidence of infection was demonstrated in 27 or 28 guinea pigs and 19 of 20 rats that had been inoculated with 10(5) to 10(7) colony-forming units. An acute pneumonia that resembled human legionnaires' disease was produced in both species, and Legionella antigen was closely related to inflammation in the distal air spaces. A fatal illness was produced in guinea pigs, and pneumonia was more extensive than in rats. Extrapulmonary inflammatory lesions, particularly splenic necrosis, were more frequent in guinea pigs than in rats. Each rodent species has potential advantages for testing specific questions and both should be useful for future investigations.

Legionnaires' pneumonia after aerosol exposure in guinea pigs and rats.

We developed an animal model of Legionnaires' pneumonia to permit study of aerosol infection, pathogenesis, and pulmonary host defense mechanisms in this disease. Guinea pigs and rats were exposed in a nose-only inhalation facility for 30 min to an aerosol of Burlington serogroup 1 Legionella pneumophila. Lungs contained 10(3) to 10(4) L. pneumophila immediately after exposure. Both guinea pigs and rats developed pneumonia, with 100% infectivity by microbiologic, histologic, and serologic criteria. Guinea pigs demonstrated illness, fever, and 56% mortality; rats showed little illness and 11% mortality. In both species, diffuse patchy pneumonitis coalesced and consolidated as the disease progressed. Aerosol challenge with 3H-L. pneumophila showed exponential growth of the bacteria in the lungs of both species. Guinea pigs and rats can be infected by aerosol exposure to L. pneumophila to produce a disease that closely simulates human Legionnaires' pneumonia. Rapid initial intrapulmonary growth suggests that resident lung defense mechanisms are quite ineffective against L. pneumophila, and that recruited or immunospecific defenses may be more critical in the outcome of infection. The difference in severity of illness between guinea pigs and rats may be exploited for different experimental designs.

Pharmacokinetics of cefamandole and ampicillin in experimental meningitis.

The penetration of cefamandole and ampicillin into the cerebrospinal fluid of rabbits with and without pneumococcal meningitis was evaluated. In normal animals, a mean maximum concentration of 0.22 +/- 0.13 microgram of cefamandole per ml was measured in the spinal fluid after a dose of 150 mg/kg given intramuscularly; with 25 and 50 mg/kg doses, no antibiotic was detected in the cerebrospinal fluid. With ampicillin, in intramuscular doses of 200 and 300 mg/kg, the mean maximum concentrations encountered in the cerebrospinal fluid were 1.59 +/- 0.4 and 1.47 +/- 0.44 microgram/ml, respectively. Penetration of cefamandole, and to a lesser extent ampicillin, was increased after 24 h of experimental meningitis. With cefamandole, the concentration of drug in the cerebrospinal fluid exceeded the usual inhibitory concentration for Haemophilus influenzae only with the 150 mg/kg dose. After 48 h of meningitis, there was a trend toward higher levels of antibiotic in the cerebrospinal fluid, but the difference between animals infected 24 versus 48 h was not statistically significant. In animals with meningitis, serum concentrations after 150 mg of cefamandole per kg and both ampicillin doses studied were 32 to 38% lower than the serum levels achieved in normal rabbits after identical doses of antibiotic.

The Vermont epidemic of Legionnaires' disease.

Sixty-nine laboratory-documented cases of Legionnaires' disease occurred in Vermont between 1 May and 31 December 1977. Clinical manifestations were similar to those in the 1976 Philadelphia epidemic. Case-control studies suggested that Legionnaires' disease patients were more likely to present with headache or diarrhea than were patients with pneumonia of presumed nonbacterial cause. The case-fatality ratio for patients treated with erythromycin was 4%, compared with 17% in patients not treated with erythromycin. Thirteen patients had been hospitalized throughout the 10 days preceding onset of illness, equaling the maximal known incubation period. This suggests either acquisition or reactivation of infection in the hospital. However, even during the week of peak disease activity, cases occurred in patients with no recent hospital contact. The only community factor possibly associated with acquisition was home air conditioning. This prevalence of seroreactivity to the Legionnaires' disease bacterium in various community populations was as high as 26%, suggesting a possible endemic area.

Legionnaires' disease in Vermont, May to October 1977.

Thirty-two confirmed and 24 highly probable cases of Legionnaires' disease occurred in Vermont between May 1 and Oct 15, 1977. Confirmed cases had positive results for direct fluorescent antibody testing of lung tissue or fourfold rise in antibody titer. Highly probable cases had one elevated titer (greater than or equal to 1:256) and a compatible illness. Forty-eight (86%) had underlying chronic disease, and 22 (39%) were immunocompromised. Prominent early symptoms were fever, cough, chills, and malaise. All but one patient had verified pneumonia. Courses ranged from a pneumonia not requiring hospitalization to respiratory failure necessitating support with mechanical ventilation. Seventeen patients died. Although the clinical presentation was variable, rapid development of high fever and leukocytosis together with negative cultures of lower respiratory tract secretions strongly suggested the diagnosis in an epidemic setting.