The National Institutes of Health Fogarty International Center Global Health Scholars and Fellows Program: Collaborating Across Five Consortia to Strengthen Research Training.

As demand for global health research training continues to grow, many universities are striving to meet the needs of trainees in a manner complementary to research priorities of the institutions hosting trainees, while also increasing capacity for conducting research. We provide an overview of the first 4 years of the Global Health Program for Fellows and Scholars, a collaboration of 20 U.S. universities and institutions spread across 36 low- and middle-income countries funded through the National Institutes of Health Fogarty International Center. We highlight many aspects of our program development that may be of interest to other multinational consortia developing global health research training programs.

Recruiting post-doctoral fellows into global health research: selecting NIH Fogarty International Clinical Research Fellows.

From 2008 to 2012, the National Institutes of Health (NIH) Fogarty International Clinical Research Fellows Program (FICRF) provided 1-year mentored research training at low- and middle-income country sites for American and international post-doctoral health professionals. We examined the FICRF applicant pool, proposed research topics, selection process, and characteristics of enrollees to assess trends in global health research interest and factors associated with applicant competitiveness. The majority (58%) of 67 US and 57 international Fellows were women, and 83% of Fellows had medical degrees. Most applicants were in clinical fellowships (41%) or residencies (24%). More applicants proposing infectious disease projects were supported (59%) than applicants proposing non-communicable disease (NCD) projects (41%), although projects that combined both topic areas were most successful (69%). The numbers of applicants proposing research on NCDs and the numbers of these applicants awarded fellowships rose dramatically over time. Funding provided to the FICRF varied significantly among NIH Institutes and Centers and was strongly associated with the research topics awarded.

The impact of neighborhood, family, and individual risk factors on toddlers' disruptive behavior.

Disadvantaged neighborhoods confer risk for behavior problems in school-aged children but their impact in toddlerhood is unknown. Relations between toddlers' disruptive behavior and neighborhood disadvantage, family disadvantage, violence or conflict exposure, parent depressive symptoms, and parenting behavior were examined using multilevel, multigroup (girl-boy) models. Participants were 1,204 families (mean child age = 24.7 months). Unique associations between disruptive behavior and all risk factors were observed, but the effect of neighborhood disadvantage was negligible when all of the more proximal factors were accounted for. The results suggest both that children in disadvantaged neighborhoods are at greater risk of behavior problems than children in nondisadvantaged neighborhoods and that optimal prevention/intervention work with these children will attend to proximal risk factors.

Recruiting trainees for a global health research workforce: the National Institutes of Health Fogarty International Clinical Research Scholars Program selection process.

Between 2004 and 2012, the National Institutes of Health Fogarty International Clinical Research Scholars (FICRS) Program provided 1-year mentored research training at low- and middle-income country sites for American and international health science doctoral students. We describe the centralized application process, US applicant characteristics, and predictors of selection/enrollment. FICRS received 1,084 applicants representing many health professions and biomedical disciplines at 132 US academic institutions; 219 students from 72 institutions were accepted and enrolled. Medical/osteopathic students comprised 88.9% of applicants and 85.8% of enrollees. Applicants from institutions with higher applicant numbers were two times as likely to be selected. In 2012, FICRS was decentralized among 20 institutions in five consortia (Global Health Fellows), with autonomous selection processes that emphasize post-doctoral trainees. If academia, government, or charitable foundations offer future opportunities to health professions students for international research, the FICRS experience predicts that they can attract substantial numbers of motivated trainees from diverse backgrounds.

Acute emergence of Elizabethkingia meningoseptica infection among mechanically ventilated patients in a long-term acute care facility.

OBJECTIVE: To describe an outbreak of infection associated with an infrequently implicated pathogen, Elizabethkingia meningoseptica, in an increasingly prominent setting for health care of severely ill patients, the long-term acute care hospital. DESIGN: Outbreak investigation. SETTING: Long-term acute care hospital with 55 patients, most of whom were mechanically ventilated. METHODS: We defined a case as E. meningoseptica isolated from any patient specimen source from December 2007 through April 2008, conducted an investigation of case patients, obtained environmental specimens, and performed microbiologic testing. RESULTS: Nineteen patients had E. meningoseptica infection, and 8 died. All case patients had been admitted with respiratory failure that required mechanical ventilation. Among the 8 individuals who died, the time from collection of the first specimen positive for E. meningoseptica to death ranged from 6 to 43 days (median, 16 days). Environmental sampling was performed on 106 surfaces; E. meningoseptica was isolated from only one swab. Three related pulsed-field gel electrophoresis patterns were identified in patient isolates; the environmental isolate yielded a fourth, unrelated pattern. CONCLUSION: Long-term acute care hospitals with mechanically ventilated patients could serve as an important transmission setting for E. meningoseptica. This multidrug-resistant bacterium could pose additional risk when patients are transferred between long-term acute care hospitals and acute care hospitals.