Predicting the distribution pattern changes of dye plant habitats caused by climate change.

Climate change has accelerated the habitat loss and fragmentation of wildlife. Dye plants of "Fengxiang dyeing" are important indigenous natural resources for traditional printing and dyeing craft in southwest China, is of practical and cultural importance for dozens of ethnic minorities. However, lack of the spatial distribution information of these plants has hampered holistic and efficient conservation management measures. We analyzed the potentially suitable areas of four dye plants (Liquidambar formosana, Strobilanthes cusia, Persicaria tinctoria and Indigofera tinctoria) necessary for "Fengxiang dyeing" based on their geographical distribution sites under different climatic situations using the maximum entropy (MaxEnt) model. The results showed that temperature, precipitation and elevation were the most important factors affecting the suitable geographical areas of the four dye plants. Under the current climate conditions, the overlapping suitable habitat areas of the four plants were mainly in the four southern provinces of China, including Guizhou, Guangxi, Guangdong and Hainan. L. formosana was used as the base plant for combination with the other three plants under the two future climate scenarios (SSP126 and SSP585), and the overlapping suitable habitat areas of the obtained seven combination patterns were considered suitable for potential craft development. Five patterns showed an increase, while two patterns showed a decreasing trend with the increasing carbon emission. The prediction results showed that the overlapping suitable habitat center of the four plants will gradually move to the northeast, indicating that the overlapping suitable habitat area and craft distribution area will be changed. These results provide the basis for understanding the spatial distribution pattern changes of dye plants caused by climate change and establishing measures for protecting and developing printing and dyeing craft.

Crosslinked biomimetic coating modified stainless-steel-mesh enables completely self-cleaning separation of crude oil/water mixtures.

The development of high-flux, durable and completely self-cleaning membranes is highly desired for separation of massive oil/water mixtures. Herein, differently crosslinked poly(2-methacryloyloxylethyl phosphorylcholine) (PMPC) brush grafted stainless steel mesh (SSM) membranes (SSM/PMPCs) were fabricated by integrating of mussel inspired universal adhesion and crosslinking chemistry with surface-initiated activators regenerated by electron transfer atom transfer radical polymerization (SI-ARGET-ATRP). The durability and self-cleaning performance of the prepared SSM membranes were evaluated by separating sticky crude oil/water mixtures in a continuous recycling dead-end filtration device. The water filtration flux driven by gravity reached 60,000 L⋅m-2⋅h-1 with a separation efficiency of over 99.98%. Furthermore, zero-flux-decline was observed during a 5 h continuous filtration when assisted by mechanical stirring. More significantly, such a completely self-cleaning separation of the well crosslinked SSM/PMPC2 membrane under optimized flux and stirring conditions had been operated cumulatively for 190 h in 30 days without any additional cleaning. These significant advances are more promising for practical applications in crude oil-contaminated water treatments and massive oil/water mixture separation.

The impact of climate change on the distribution of rare and endangered tree Firmiana kwangsiensis using the Maxent modeling.

The upsurge in anthropogenic climate change has accelerated the habitat loss and fragmentation of wild animals and plants. The rare and endangered plants are important biodiversity elements. However, the lack of comprehensive and reliable information on the spatial distribution of these organisms has hampered holistic and efficient conservation management measures. We explored the consequences of climate change on the geographical distribution of Firmiana kwangsiensis (Malvaceae), an endangered species, to provide a reference for conservation, introduction, and cultivation of this species in new ecological zones. Modeling of the potential distribution of F. kwangsiensis under the current and two future climate scenarios in maximum entropy was performed based on 30 occurrence records and 27 environmental variables of the plant. We found that precipitation-associated and temperature-associated variables limited the potentially suitable habitats for F. kwangsiensis. Our model predicted 259,504 km2 of F. kwangsiensis habitat based on 25 percentile thresholds. However, the high suitable habitat for F. kwangsiensis is only about 41,027 km2. F. kwangsiensis is most distributed in Guangxi's protected areas. However, the existing reserves are only 2.7% of the total suitable habitat and 4.2% of the high suitable habitat for the plant, lower than the average protection area in Guangxi (7.2%). This means the current protected areas network is insufficient, underlining the need for alternative conservation mechanisms to protect the plant habitat. Our findings will help identify additional F. kwangsiensis localities and potential habitats and inform the development and implementation of conservation, management, and cultivation practices of such rare tree species.

Simultaneous engineering of nanofillers and patterned surface macropores of graphene/hydroxyapatite/polyetheretherketone ternary composites for potential bone implants.

Incorporating bioactive nanofillers and creating porous surfaces are two common strategies used to improve the tissue integration of polyetheretherketone (PEEK) material. However, few studies have reported the combined use of both strategies to modify PEEK. Herein, for the first time, dual nanoparticles of graphene oxide (GO) and hydroxyapatite (HAp) were incorporated into PEEK matrix to obtain ternary composites that were laser machined to create macropores with diameters ranging from 200 µm to 600 µm on the surfaces. The surface morphology and chemistry, mechanical properties, and cellular responses of the composites were investigated. The results show that micropatterned pores with a depth of 50 µm were created on the surfaces of the composites, which do not significantly affect the mechanical properties of the resultant composites. More importantly, the incorporation of GO and HAp significantly improves the cell adhesion and proliferation on the surface of PEEK. Compared to the smooth surface composite, the composites with macroporous surface exhibit markedly enhanced cell viability. The combined use of nanofillers and surface macropores may be a promising way of improving tissue integration of PEEK for bone implants.

The complete chloroplast genome of Firmiana danxiaensis, an endangered species endemic to Danxia landform in Southern China.

We sequenced the complete chloroplast of Firmiana danxiaensis (Malvaceae), which is 161,253 bp in size and consists of a large single-copy region (LSC) of 90,142 bp and a short single copy region (SSC) of 20,067 bp. It was separated by two inverted repeats (IRs) regions of 25,522 bp for each. The GC content of the whole genome, LSC, SSC, and IRs region was 36.87%, 34.68%, 31.24%, and 42.97%, respectively. The overall base content was A (31.07%), T (32.05%), C (18.80%), and G (18.08%). The genome contained 127 genes, including 82 protein-coding sequences, 37 tRNA genes, and 8 rRNA genes. Phylogenetic analysis showed that F. danxiaensis is sister to F. simplex, and supported there was a close relationship among F. danxiaensis, F. simplex, and F. pulcherrima.

Pollen aggregation by viscin threads in Rhododendron varies with pollinator.

Pollen grains can be dispersed singly or variously aggregated in groups. Whether the evolution of pollen aggregation is driven by the pollinator remains unexplored. We hypothesize that an extensive pollen aggregation is favored under a scarcity of pollinators. Variation in pollen aggregation by viscin threads in 13 Rhododendron species was measured as it is related to pollen removal in a visit. Visitation rates of functional pollinator groups that vary in their grooming behavior were investigated in each species. Pollen deposited on stigmas in the field was also sampled. Seven Rhododendron species were infrequently pollinated by low-intensity grooming animals, including birds, butterflies and moths. The other six species were more frequently pollinated by bees with a high intensity of pollen grooming. Bird- and Lepidoptera-pollinated species produced longer pollen-connecting threads that connected more pollen grains. Phylogenetically independent contrast analysis of the 13 species showed that pollinator visitation frequency was negatively related to amounts of pollen removal per visit but not to stigmatic pollen loads. The finding of interspecific patterns in pollen removal related to pollinator visitation frequency suggests pollinator-mediated selection on pollen packaging strategies, supporting the hypothesis of floral evolution via pollen export.

Nectar properties and the role of sunbirds as pollinators of the golden-flowered tea (Camellia petelotii).

PREMISE OF THE STUDY: Properties of floral nectar have been used to predict if a plant species is pollinated by birds. To see whether winter-flowering plants evolve nectar properties corresponding to bird pollinators, nectar properties of several Camellia species (including the golden-flowered tea), as well as the role of floral visitors as effective pollinators, were examined. METHODS: Potential pollinators of Camellia petelotii were identified at different times of day and under various weather conditions. A bird exclusion experiment was used to compare the pollination effectiveness of birds and insects. Nectar sugar components (fructose, glucose, and sucrose) from C. petelotii growing wild and another seven Camellia species and 22 additional cultivars (all in cultivation) were examined by high-performance liquid chromatography (HPLC). KEY RESULTS: The sunbird Aethopyga siparaja and honeybees were the most frequent floral visitors to C. petelotii. Honeybee visits were significantly reduced in cloudy/rainy weather. The fruit and seed set of flowers with birds excluded were reduced by 64%, indicating that bird pollination is significant. For the wild populations of C. petelotii, a bagged flower could secrete 157 µL nectar; this nectar has a low sugar concentration (19%) and is sucrose-dominant (87%). The eight Camellia species and 22 cultivars had an average sugar concentration of around 30% and a sucrose concentration of 80%, demonstrating sucrose-dominant nectar in Camellia species. CONCLUSIONS: The nectar sugar composition of Camellia species was characterized by sucrose dominance. In addition, the large reduction in seed set when birds are excluded in the golden-flowered tea also supports the suggestion that these winter-flowering plants may have evolved with birds as significant pollinators.

Evidence for passerine bird pollination in Rhododendron species.

When insect activity is limited at low temperature, birds may be comparatively more important pollinators than insects for flowering plants. It has been thought that many large-flowered Rhododendron species are pollinated by local birds in the Himalayan regions because most of these species flower in spring at high elevation with cool atmospheric temperature. However, experimental evidence for the role of bird pollination in this hyperdiverse genus remains scarce. To examine the role of birds and insects in pollination, we observed floral visitors to 15 Rhododendron species with different floral sizes and abundant flowering individuals in the eastern Himalayas, Southwest China. To examine the role of birds and insects in female reproductive success in each species, cages were used to exclude birds but not insects from visiting flowers and net bags were used to exclude all floral visitors. Inflorescences where visitation was excluded did not produce fruits in any of the Rhododendron species, indicating that sexual reproduction in these species depended on pollinator visitation. Bird visits were generally less frequent than bee visits in the studied species. However, in the nine species on which bird visitors were observed, fruit and/or seed set were greatly reduced in inflorescences caged to exclude birds but not bees, compared to open-pollinated inflorescences. In the other six species on which bird visitation was not observed, fruit and seed set did not differ significantly between caged and open inflorescences except in one species (R. wardii). Manipulations to achieve selective exclusion of visitors demonstrated that birds could be effective pollinators for 10 out of 15 studied Rhododendron species in the eastern Himalayas. Floral characteristics of these Rhododendron species and weather conditions might favour the evolution of bird pollination systems in the East Himalayas.

Expansion of HIV care and treatment in Yunnan Province, China: treatment outcomes with scale up of combination antiretroviral therapy.

Effective health care models to scale up combination antiretroviral therapy (ART) are needed in rural southwestern China. We aimed to evaluate the ART treatment outcomes and their associations with patients' demographic characteristics and pre-treatment clinical features in a scaled-up provincial ART program serving eight heavily HIV-affected prefectures in Yunnan Province. We abstracted information from a computerized database for adults initiating ART between July 2007 and September 2008. Survival functions of mortality and treatment failure were calculated by age group, gender, transmission mode, and baseline CD4 count. Multivariable Cox regression analyses were conducted to find independent associations of various demographic and baseline clinical features with outcome variables. Of the 1967 patients in the mortality analysis, there were 110 deaths, of which 16 were coded as accidents or suicides. Adjusted hazard ratios (AHR) associated with mortality were greater for patients with baseline CD4 counts <100 cells/µl vs. patients with CD4 counts ≥200 cells/µl, for male vs. female, for single vs. married, and for those acquired HIV through injection drug use (IDU) vs. other modes of transmission. Successful treatment was 81.3% at six months after treatment started. Immunologic treatment failure was associated with baseline CD4 counts but not with demographic characteristics. Overall loss to follow-up rate was 2.1%. Collaboration between clinics and community networks are distinctive features of Yunnan's model for scaling up ART across a diverse, poor, and rural population. This study finds that the strategy can succeed even if 40% of the patients have a history of IDU.

A system for individualized prosthetic modeling of the femoral head.

The matching quality between the femoral head prosthesis and the acetabulum plays an important role in the operative treatment of femoral head prosthetics and femoral head replacement. To obtain the optimal model of the femoral head prosthesis for the target sufferer, an individualized modeling system is shown in this paper. It can recover the necrotic femoral heads into the satisfactory models. These models can well match with the acetabulum. This new system affords a theoretical model for the accurate operation position fixing in the orthopedic clinic. And this system also provides an innovative practical means for the individualized modeling of the artificial femoral head prosthesis.

The utilization of antenatal care among rural-to-urban migrant women in Shanghai: a hospital-based cross-sectional study.

BACKGROUND: Improving utilization of antenatal care is a critical strategy for achieving China's Millennium Development Goal of decreasing the maternal mortality ratio (MMR). While overall utilization has increased recently in China, an urban vs. rural disparity in access remains. Here we aim to assess utilization of antenatal care in rural-to-urban migrant women and identify its risk and protective factors. METHODS: Migrant women who had been living in Shanghai for more than six months, delivered in one of the two study hospitals between August 2009 and February 2010, and provided written consent were interviewed using a structured questionnaire. RESULTS: Of 767 women, 90.1% (691) made at least one antenatal care visit, while 49.7% (381) had adequately utilized antenatal care (i.e., made five or more antenatal care visits). Only 19.7% of women visited an antenatal care center during the first trimester (12 weeks). Women between the ages of 25 and 30 and women older than 30 were more likely than younger women to have adequately utilized antenatal care (AOR=2.2 and 1.9, 95%CI=1.4-3.5 and 1.1-3.2, respectively). Women whose husbands held Shanghai residency status (AOR=4.9, 95%CI=2.2-10.9) or who had more than 10 years of education (AOR=1.8, 95%CI=1.2-2.9), previously experienced a miscarriage or abortion (AOR=2.2, 95%CI=1.3-3.8), had higher household income (AOR=1.6, 95%CI=1.0-2.5) were more likely to have adequately utilized antenatal care. Women from high-income households were also more likely to receive antenatal care during the first 12 weeks (AOR=3.5, 95%CI=1.7-5.5). CONCLUSIONS: Many migrant women in Shanghai did not receive adequate antenatal care and initiated antenatal care later than the optimal first 12 weeks of pregnancy. Poor antenatal care utilization was associated with low socioeconomic status, education, and certain demographic factors. Tailored health education for both migrant women and their husbands should be strengthened to improve maternal health. Financing supports should be provided to improve the utilization of antenatal care.

Variations in the relationship between maternal depression, maternal sensitivity, and child attachment by race/ethnicity and nativity: findings from a nationally representative cohort study.

This study uses data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort to examine the relationship between maternal depression, maternal sensitivity, and child attachment, specifically among Hispanic and Asian American mothers and their young children, and to explore the role of cultural variation and nativity in the associations between these variables. Data used in this study were collected from biological mothers on two occasions, when their children were approximately 9 and 24 months of age. Trained observers completed a direct assessment of child attachment security and an observational measure of maternal sensitivity, data on maternal depression was obtained via maternal report. Hierarchical logistic regression models were used to predict odds of child insecure attachment. The risk of child insecure attachment associated with chronic maternal depression was found to be much higher for Hispanic mothers than for Asians. In contrast, mothers' foreign-born status was a stronger risk factor than depression for insecure child attachment among Asian Americans. Maternal sensitivity significantly reduced the odds of Asian American children being insecurely attached by more than half. Among the full sample of mothers, which included U.S.-born non-Hispanic White mothers and U.S.-born non-Hispanic Black mothers, decreased maternal sensitivity mediated the association between chronic depression and child insecure attachment. However, this mediation was not found in stratified analyses of Hispanic and Asian mothers. Finally, mothers' nativity did not influence the extent to which maternal depression or sensitivity was associated with child attachment. These findings suggest that the associations between maternal depression, sensitivity, and child attachment are culturally specific, and that mothers' immigrant status may be a risk factor in some racial/ethnic groups but protective in others.

Health status and health services access and utilization among Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese children in California.

OBJECTIVES: We examined health status and health services access and utilization of Chinese, Filipino, Japanese, Korean, South Asian, Vietnamese, and non-Hispanic White children in California. METHODS: We analyzed aggregated data from the 2003 and 2005 California Health Interview Survey (648 Chinese, 523 Filipino, 235 Japanese, 308 Korean, 314 South Asian, 264 Vietnamese, and 8468 non-Hispanic White children aged younger than 12 years), examining the relationship between Asian ethnicities and outcomes. RESULTS: Compared with non-Hispanic White children, Korean children were 4 times more likely to lack health insurance; Filipino children were twice as likely to not have had recent contact with a doctor; Chinese, Korean, and Vietnamese children were less likely to have visited an emergency room in the past year; and Chinese, Korean, and Vietnamese children were more likely to be in fair or poor health. Age, gender, poverty, citizenship-nativity status, health insurance, and parental marital and child health statuses were related to most outcomes. CONCLUSIONS: Asian ethnicities have heterogeneous health care access and utilization patterns, suggesting the need for targeted outreach to different Asian ethnic groups.

State-level health care access and use among children in US immigrant families.

OBJECTIVES: We examined the association between children's state of residence and their access to health care among specific types of immigrant families: foreign-born children, US-born children with 1 foreign-born parent, US-born children with both foreign-born parents, and nonimmigrant families. METHODS: We analyzed data from 12 400 children from the 2003 National Survey of Children's Health in the 6 states with the highest proportion of immigrants (California, Florida, Illinois, New York, New Jersey, and Texas). RESULTS: Multivariable analyses indicated that among foreign-born children, those living in California, Illinois, and Texas were more likely to lack access to health care compared with those living in New York. Among foreign-born children with 1 or 2 US-born parents, Texas children were most likely to lack health insurance. Within nonimmigrant families, children from California, Florida, and Texas had significantly more access and use problems. CONCLUSIONS: Our findings document differential health care access and use among states for specific immigrant family types.

Self-reported HIV testing behaviors among a sample of southeast Asians in an urban setting in the United States.

In light of the abruptness and severity of the HIV/AIDS epidemic in Asia, there has been growing concern in recent years about the HIV/AIDS risks with the steady rate of Asian and Pacific Islander (AAPI) migration to the United States. Little is known, however, about existing HIV risks among non-MSM (men who have sex with men) AAPIs. The purpose of this study was to examine self-reported HIV testing behaviors and their correlates among a sample of 604 Southeast Asians living in a U.S. urban setting. The HIV testing rate among our sample adults is 30.8%, lower than the median HIV testing rate in the U.S. adult population by state, lower than that of the general adult testing rate in the study city, and lower than that of the AAPI MSM population. A low sexually transmitted infection (STI) testing rate as a proxy for low perceived sexual risks and a dearth of HIV knowledge were associated with the low HIV testing rate. Traditional health care access measures, such as availability of medical insurance and a personal doctor, cannot explain the low HIV testing rate in this predominantly immigrant population. Culturally and linguistically appropriate HIV prevention campaigns could increase the awareness of HIV/STI risk in this AAPI population.

Substance use among Asian Americans and Pacific Islanders sexual minority adolescents: findings from the National Longitudinal Study of Adolescent Health.

PURPOSE: We assessed the prevalence, incidence, and correlates of substance use among Asian American individuals transitioning from adolescence to young adulthood. METHODS: Data were obtained from the National Longitudinal Study of Adolescent Health, Wave II (1996) and Wave III (2001). Information on substance use was abstracted from a nationally representative sample of 1108 Asian Americans and Pacific Islanders (AAPIs) from both Waves. Weighted prevalence, incidence, and patterns of smoking, binge drinking, marijuana use, and other drug use were analyzed by sexual orientation and gender. Multiple logistic regression analyses were conducted to investigate the unique contribution of being a sexual minority in relation to four types of substance use by gender. RESULTS: A link between sexual orientation and substance use behaviors among AAPIs did not emerge until young adulthood. Significant increases in the incidence and prevalence of all four types of substance use (tobacco, binge drinking, marijuana, and other drugs) were found among sexual minority AAPIs. Specifically being an AAPI sexual minority young woman, compared with being a heterosexual young woman, a heterosexual young man, or a sexual minority young man, was significantly associated with substance use after controlling for demographic characteristics, problem behaviors, and substance use during adolescence. Also the highest prevalence of substance use was found among AAPI sexual minority women. CONCLUSIONS: These findings add greater urgency to addressing the role of sexual orientation in designing substance abuse programs.

Substance use among a sample of foreign- and U.S.-born southeast Asians in an urban setting.

Asian Americans (AA) are thought to have the lowest rates of substance use. This study examined substance use prevalence among 494 urban-dwelling Southeast Asians using snowball techniques. Prevalence estimates were age-adjusted proportionate to the U.S. Asian population. Findings show beer and alcohol consumption approximated the national percentage among 25-44 year olds. U.S.-born were about three times likelier to have past month substance use. Foreign-born Vietnamese were likelier than U.S.-born to use all substances except for beer. U.S.- and foreign-born beer consumption rates were similar. Future research is needed to delineate substance use determinants and patterns in foreign and U.S.-born AA sub-groups.

The diagnosis and treatment of HIV-infected children in China: challenges and opportunities.

BACKGROUND: HIV-infected children in China have not been well studied. This national survey describes the demographic characteristics and the associated diagnostic and antiretroviral treatment (ART) efforts directed toward surviving HIV-infected children. METHODS: A cross-sectional study was conducted in the 6 provinces with the highest HIV prevalence: 4 former plasma donation (FPD) provinces and 2 intravenous drug use (IDU) provinces. A survey on demographics and treatment-related issues was distributed to the parents or guardians of all living HIV-infected children identified through the national case reporting system. Descriptive and bivariate analyses were performed on completed surveys. RESULTS: Six hundred ninety-two (62.4%) of the total 1108 surveys were returned, and 650 were eligible for analysis. The average age in FPD provinces (mean +/- SD: 8.1 +/- 3.2 years) was significantly older than in IDU provinces (mean +/- SD: 5.4 +/- 2.2 years; P < 0.001). The average lag time from the probable date of transmission to a diagnosis for patients with mother-to-child transmission (MTCT) was 6.7 +/- 3.1 years in the FPD provinces and 4.7 +/- 1.9 years in the IDU provinces (P < 0.001). On the basis of the CD4 cell count or World Health Organization staging, 29.8% (144 of 484) of children from all 6 provinces who were not on ART needed it. CONCLUSIONS: This first national pediatric survey indicates that the age and time required for diagnosis were greater in HIV-infected children from FPD provinces compared with those from IDU provinces. In addition, this survey highlights the prolonged delay in the diagnosis and initiation of ART for children in China. Aggressive efforts to identify HIV-positive pregnant women, scale up prevention of MTCT activities, and expand early diagnosis and treatment are urgently needed.

Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers.

OBJECTIVES: This report presents the national estimates of maternal depressive symptomatology prevalence and its socio-demographic correlates among major racial/ethnic-nativity groups in the United States. We also examined the relationship of mental health-seeking patterns by race/ethnicity and nativity. METHODS: Using the Early Childhood Longitudinal Survey-Birth Cohort Nine-month data, we present the distribution of Center for Epidemiological Study-Depression (CES-D) score by new mothers' nativity and race/ethnicity. The mental health-seeking pattern study was limited to mothers with moderate to severe symptoms. Weighted prevalence and 95% confidence intervals for depression score categories were presented by race/ethnic groups and nativity. Multi-variable logistic regression was used to obtain the adjusted odds ratios of help-seeking patterns by race/ethnicity and nativity in mothers with moderate to severe symptoms. RESULTS: Compared to foreign-born mothers, mothers born in the U.S. were more likely to have moderate to severe depressive symptoms in every racial/ethnic group except for Asian/Pacific Islanders. These US-born mothers were also more likely to be teenagers, lack a partner at home, and live in rural areas. Among Asians, Filipina mothers had the highest rate of severe depressive symptoms (9.6%), similar to those of US-born black mothers (10.2%). Racial/ethnic minorities and foreign-born mothers were less likely to consult doctors (OR: 2.2 to 2.5) or think they needed consultation (OR: 1.9 to 2.2) for their emotional problems compare to non-Hispanic White mothers. CONCLUSION: Our research suggests that previous "global estimates" on Asian American mental health underestimated sub-ethnic group differences. More efforts are needed to overcome the barriers in mental health services access and utilizations, especially in minority and foreign-born populations.

A cross-cultural pediatric residency program merger.

Academic health centers, health systems, and, to a lesser degree, medical schools and residency programs have merged, consolidated, or formed strategic alliances. There are few published reports of residency program mergers, and only one involving a merger between a historically black college and university (HBCU) and a predominantly white institution.This case study describes a merger between two dissimilar urban pediatric residency programs. The Howard University Hospital (HUH) pediatric residency program is affiliated with a HBCU, and the Children's National Medical Center (CNMC) pediatric residency program, is affiliated with a leading children's hospital which had relatively few underrepresented minority physicians or residents. The pediatric residency program merger between HUH and CNMC occurred in 2003 and presented organizational, cultural, and programmatic challenges and opportunities for both institutions. However, there was a sharp contrast between the opinions of the HUH and CNMC residents with respect to the perceived effect of the merger on residency training, patient care, and the individual institutions. Increasing the size and diversity of CNMC's resident pool and the granting of accreditation for the community health track were positive outcomes, but the magnitude of the institutional change process and the disruption to residents' routines and schedules were significant challenges. The merger served as an impetus to embed cultural competency guiding principles and expectations into the organizational fabric of the combined residency program.