ABSTRACT
BACKGROUND AND OBJECTIVES: Interest in global health (GH) has increased significantly among medical trainees in the past 3 decades. Despite the potential for family medicine to be a major contributor to GH, there are no recent, large-scale studies of GH education and experiences in family medicine training. This study was designed to assess current opportunities, educational activities, resident interest, perceived program benefits, and barriers to international and domestic GH training in US family medicine residencies. METHODS: Data for this study were elicited as part of a 2015 survey conducted by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA). The nationwide, web-based survey was sent to 452 family medicine residency program directors. RESULTS: A total of 257 program directors completed the GH portion of the survey. A total of 74.3% of programs offered international or domestic GH experiences. Program directors identified preparing physicians to practice underserved medicine and teaching community medicine or public health as primary goals for GH training. Program directors also reported that GH opportunities were important for attracting future residents. Programs offered a variety of preparatory activities to their residents. Funding and time constraints were identified as the primary barriers to GH training in residency. CONCLUSIONS: Global health continues to be a focus of interest in the training of family medicine residents while attracting the passion of student applicants and residents.
Subject(s)
Family Practice/education , Global Health , Internationality , Internship and Residency/organization & administration , Physician Executives/organization & administration , Curriculum , Developing Countries , Education, Medical, Graduate , Financial Support , Humans , Surveys and Questionnaires , Time FactorsABSTRACT
Thyroid storm is a rare and life-threatening state of thyroid hormone excess. Rapid recognition of thyroid storm is key to decreasing the morbidity and mortality of this condition. Clinical manifestations of thyroid storm include unexplained weight loss, hyperactivity and irritability. The most common causes of thyrotoxicosis are Graves' disease, toxic multinodular goitre and toxic adenoma. We present a rare case of thyroid storm induced by dual nivolumab and ipilimumab immunotherapy in a patient receiving treatment for advanced melanoma. In this case, our patient was admitted for thyroid storm 1â month after initiating treatment with nivolumab and ipilimumab immunotherapy. The patient was treated with ß-blockers, antithyroid medications and systemic steroids resulting in an improvement in thyroid function testing and symptoms.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antineoplastic Agents/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Melanoma/drug therapy , Thyroid Crisis/chemically induced , Female , Humans , Ipilimumab , Nivolumab , Young AdultABSTRACT
The hypothalamic neuropeptide orexin mediates arousal, sleep, and naturally rewarding behaviors, including food intake. Male sexual behavior is altered by orexin receptor-1 agonists or antagonists, suggesting a role for orexin-A in this naturally rewarding behavior. However, the specific role of endogenous orexin-A or B in different elements of male sexual behavior is currently unclear. Therefore, the current studies utilized markers for neural activation and orexin cell-specific lesions to test the hypothesis that orexin is critical for sexual motivation and performance in male rats. First, cFos expression in orexin neurons was demonstrated following presentation of a receptive or non-receptive female without further activation by different elements of mating. Next, the functional role of orexin was tested utilizing orexin-B conjugated saporin, resulting in orexin cell body lesions in the hypothalamus. Lesions were conducted in sexually naive males and subsequent sexual behavior was recorded during four mating trials. Lesion males showed shortened latencies to mount and intromit during the first, but not subsequent mating trials, suggesting lesions facilitated initiation of sexual behavior in sexually naive, but not experienced males. Likewise, lesions did not affect sexual motivation in experienced males, determined by runway tests. Finally, elevated plus maze tests demonstrated reduced anxiety-like behaviors in lesioned males, supporting a role for orexin in anxiety associated with initial exposure to the female in naive animals. Overall, these findings show that orexin is not critical for male sexual performance or motivation, but may play a role in arousal and anxiety related to sexual behavior in naive animals.
