External and Internal Microbiomes of Antarctic Nematodes are Distinct, but More Similar to each other than the Surrounding Environment.

Host-associated microbiomes have primarily been examined in the context of their internal microbial communities, but many animal species also contain microorganisms on external host surfaces that are important to host physiology. For nematodes, single strains of bacteria are known to adhere to the cuticle (e.g., Pasteuria penetrans), but the structure of a full external microbial community is uncertain. In prior research, we showed that internal gut microbiomes of nematodes (Plectus murrayi, Eudorylaimus antarcticus) and tardigrades from Antarctica's McMurdo Dry Valleys were distinct from the surrounding environment and primarily driven by host identity. Building on this work, we extracted an additional set of individuals containing intact external microbiomes and amplified them for 16S and 18S rRNA metabarcoding. Our results showed that external bacterial microbiomes were more diverse than internal microbiomes, but less diverse than the surrounding environment. Host-specific bacterial compositional patterns were observed, and external microbiomes were most similar to their respective internal microbiomes. However, external microbiomes were more influenced by the environment than the internal microbiomes were. Non-host eukaryotic communities were similar in diversity to internal eukaryotic communities, but exhibited more stochastic patterns of assembly compared to bacterial communities, suggesting the lack of a structured external eukaryotic microbiome. Altogether, we provide evidence that nematode and tardigrade cuticles are inhabited by robust bacterial communities that are substantially influenced by the host, albeit less so than internal microbiomes are.

Life at extreme elevations on Atacama volcanoes: the closest thing to Mars on Earth?

Here we describe recent breakthroughs in our understanding of microbial life in dry volcanic tephra ("soil") that covers much of the surface area of the highest elevation volcanoes on Earth. Dry tephra above 6000 m.a.s.l. is perhaps the best Earth analog for the surface of Mars because these "soils" are acidic, extremely oligotrophic, exposed to a thin atmosphere, high UV fluxes, and extreme temperature fluctuations across the freezing point. The simple microbial communities found in these extreme sites have among the lowest alpha diversity of any known earthly ecosystem and contain bacteria and eukaryotes that are uniquely adapted to these extreme conditions. The most abundant eukaryotic organism across the highest elevation sites is a Naganishia species that is metabolically versatile, can withstand high levels of UV radiation and can grow at sub-zero temperatures, and during extreme diurnal freeze-thaw cycles (e.g. - 10 to + 30 °C). The most abundant bacterial phylotype at the highest dry sites sampled (6330 m.a.s.l. on Volcán Llullaillaco) belongs to the enigmatic B12-WMSP1 clade which is related to the Ktedonobacter/Thermosporothrix clade that includes versatile organisms with the largest known bacterial genomes. Close relatives of B12-WMSP1 are also found in fumarolic soils on Volcán Socompa and in oligotrophic, fumarolic caves on Mt. Erebus in Antarctica. In contrast to the extremely low diversity of dry tephra, fumaroles found at over 6000 m.a.s.l. on Volcán Socompa support very diverse microbial communities with alpha diversity levels rivalling those of low elevation temperate soils. Overall, the high-elevation biome of the Atacama region provides perhaps the best "natural experiment" in which to study microbial life in both its most extreme setting (dry tephra) and in one of its least extreme settings (fumarolic soils).

Writing for publication: a workshop to prepare faculty as medical writers.

BACKGROUND AND OBJECTIVES: A 2 1/2-day Writing for Publication Workshop was presented to faculty and fellows for 5 successive years, 1991-1995. This paper describes the workshop curriculum and reports evaluation results. METHODS: A three-part evaluation plan incorporated both quantitative and qualitative methods. First, a nine-item questionnaire was administered to the 1992-1995 participants immediately prior to and after the workshop to identify perceived change in knowledge and skills. Second, a follow-up qualitative interview was administered to the 1991 and 1992 participants to identify their perceptions of the workshop's usefulness. Third, pre- and postworkshop publications of the 1991 and 1992 participants were analyzed to identify types of publications and significant differences in rates of publication. RESULTS: Eighty individuals participated in the five workshops given during the 1991-1995 period. Pre/post self-assessment data indicated significant increases in perceived knowledge and skill in all nine areas of assessment. The follow-up interview data showed that participants felt that the workshop motivated them to begin and sustain writing projects, gave them skills that made their writing more effective, and demystified the submission and publication processes. Analysis of the difference between pre- and postworkshop rates of publication showed a significant increase in the rate of publication. CONCLUSIONS: The evaluation findings indicate that the Writing for Publication Workshop met its educational objectives. Future curricula to prepare faculty as medical writers need to be tested using quasi-experimental designs to determine their impact on publication productivity and quality.

CQI longitudinally applied to integrated service outcomes.

Citing data collected between 1987 and 1994 at the St. Paul-Ramsey Medical Center, Ramsey Clinic and Ramsey Foundation, Paul A. Sommers, Ph.D., executive vice president and chief administrative officer of Ramsey, Michael G. Luxenberg, president of Professional Data Analysts, and Eric. P. Sommers of the River Falls Clinic, write how CQI has been introduced. The key is the application of inferential evaluation.

A consolidated approach to physician/hospital bonding--Ramsey Clinic style.

This article describes the results made by Ramsey Clinic during the second year following consolidation of the Clinic with a Hospital (St. Paul-Ramsey Medical Center); a medical education/research Foundation (Ramsey Foundation) into a public benefit corporation (Ramsey HealthCare, Inc.). Many issues inspired Ramsey Clinic to examine ways and means to stabilize its growth and development as a multi-specialty physician and dentist group practice in the highly competitive health care environment of Minneapolis-St. Paul, MN. Influencing the need to change were such elements as shrinking reimbursement for physicians from government and other third party payers; increasing malpractice and general liability premiums; as well as, escalating competition among area health care providers reflected by significant variations in charges for similar services and exclusivity agreements with HMO's and PPO's for select services. In the fall of 1987, Ramsey Clinic consummated its consolidation as a subsidiary member of Ramsey HealthCare, Inc., a public benefit corporation established by an Act of the Legislature of the State of Minnesota, 1986 Laws of Minnesota, Chapter 462. As a public benefit corporation, Ramsey HealthCare, Inc. was chartered to "engage in the provision and delivery of health care and related services." Ramsey Clinic serves as the physician organization for the corporation. An article appeared in the March/April 1989 issue of the Group Practice Journal titled "A Natural Partnership" which described the Ramsey approach and illustrated 1988 results following consolidation. Continued change has resulted in further integration of services among the subsidiaries with a focus on expense reduction, revenue enhancement and increased operating efficiencies. This article provides a longitudinal follow-up on operational amalgamations and 1989 results.

A natural partnership. Physician and hospital: the Ramsey Clinic model.

This article describes the progress made by Ramsey Clinic during the first year following consolidation of this unique health care service in the highly competitive health care environment of Minneapolis-St. Paul, MN.

Family physicians for underserved areas. The role of residency training.

Graduates of four rural and four urban family practice programs were interviewed to determine the nature of their practices and the factors that had influenced their practice location decisions. All programs gave residents substantial experience providing continuity of care for underserved populations. Of the 158 physicians surveyed, 58 (46%) were working in areas designated as underserved. The percentage of physicians in underserved areas was higher than that reported in other studies and was much higher than would be expected if practice sites were selected on the basis of population distribution alone. Notable differences in personal and practice characteristics were found between the physicians who chose to work in underserved areas and those who did not and between those who established practices in rural and in urban underserved areas.

What physicians should know about consumer satisfaction.

Physicians must recognize the contemporary role consumers play in the delivery process. Although it is common knowledge that without consumers there would be little need for the elaborate health systems in existence today, few physicians actively plan for, implement and systematically evaluate services delivered. The rising cost of malpractice insurance in this age of spiraling materials and equipment expense, is forcing more physicians to consider better ways of serving and keeping their patients. This article describes one approach, consumer satisfaction.