Spatiotemporal trends of illegal activities from ranger-collected data in a Ugandan national park.

Within protected areas, biodiversity loss is often a consequence of illegal resource use. Understanding the patterns and extent of illegal activities is therefore essential for effective law enforcement and prevention of biodiversity declines. We used extensive data, commonly collected by ranger patrols in many protected areas, and Bayesian hierarchical models to identify drivers, trends, and distribution of multiple illegal activities within the Queen Elizabeth Conservation Area (QECA), Uganda. Encroachment (e.g., by pastoralists with cattle) and poaching of noncommercial animals (e.g., snaring bushmeat) were the most prevalent illegal activities within the QECA. Illegal activities occurred in different areas of the QECA. Poaching of noncommercial animals was most widely distributed within the national park. Overall, ecological covariates, although significant, were not useful predictors for occurrence of illegal activities. Instead, the location of illegal activities in previous years was more important. There were significant increases in encroachment and noncommercial plant harvesting (nontimber products) during the study period (1999-2012). We also found significant spatiotemporal variation in the occurrence of all activities. Our results show the need to explicitly model ranger patrol effort to reduce biases from existing uncorrected or capture per unit effort analyses. Prioritization of ranger patrol strategies is needed to target illegal activities; these strategies are determined by protected area managers, and therefore changes at a site-level can be implemented quickly. These strategies should also be informed by the location of past occurrences of illegal activity: the most useful predictor of future events. However, because spatial and temporal changes in illegal activities occurred, regular patrols throughout the protected area, even in areas of low occurrence, are also required.

Career development for women in academic medicine: Multiple interventions in a department of medicine.

OBJECTIVE: To determine the gender-based career obstacles for women in an academic department of medicine and to report the interventions to correct such obstacles (resulting from the evaluation) and the results of these interventions. DESIGN: Intervention study, before-after trial, with assessment of faculty concerns and perceived change through structured, self-administered questionnaires. SETTING: The Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md. PARTICIPANTS: Full-time faculty. INTERVENTIONS: Multifaceted intervention from 1990 through 1995 to correct gender-based career obstacles reported by women faculty, including problem identification, leadership, and education of faculty, and interventions to improve faculty development, mentoring, and rewards and to reduce isolation and structural career impediments. MAIN OUTCOME MEASURES: Retention and promotion of deserving women faculty, salary equity, quality of mentoring, decreased isolation from information and colleagues, integration of women faculty into the scientific community, and decreased manifestations of gender bias. RESULTS: Junior women were retained and promoted, reversing previous experience, with a 550% increase in the number of women at the associate professor rank over 5 years (from 4 in 1990 to 26 in 1995). Interim 3-year follow-up showed a 183% increase in the proportion of women faculty who expected they would still be in academic medicine in 10 years (from 23% [7/30] in 1990 to 65% [30/46] in 1993). One half to two thirds of women faculty reported improvements in timeliness of promotions, manifestations of gender bias, access to information needed for faculty development, isolation, and salary equity. Men also reported improvements in these areas. CONCLUSIONS: The outcomes reported here indicate that it is possible to make substantive improvements in the development of women's careers, that an institutional strategy to this end can be successful in retaining women in academic medicine, and that such interventions are likely to benefit all faculty. Long-term interventions appear essential.

Evaluation of a model curriculum on substance abuse at The Johns Hopkins University School of Medicine.

Beginning in 1985, The Johns Hopkins University School of Medicine developed a model curriculum on alcohol abuse to enhance the education of medical students in issues related to the abuse of alcohol and other drugs. By 1987, preclinical courses (given in years one and two) reflected the goals of the curriculum; however, integration of the curriculum into the clinical courses (given in years three and four) was only partially successful. This paper reports on nine annual surveys of students (the classes of 1989-1992) that were conducted from 1987 to 1990 to measure the effects of the curriculum, using previously validated instruments to record the students' knowledge, attitudes, beliefs in role responsibility, and confidence in clinical skills. Significant improvements occurred in the students' attitudes, beliefs in role responsibility, and confidence in skills during their preclinical years. These positive changes were stronger, and better sustained during the clinical years, in students who participated in special programs or elective courses focusing on substance abuse; the positive changes were not always sustained in other students. The authors suggest that enhanced experiential sessions, elective programs, and greater emphasis during the clinical years on issues relating to substance abuse are necessary for maintaining the desirable educational outcomes of a substance abuse management curriculum, and that an intensive program against a backdrop of curriculum reform is a useful model.

Detection of alcoholism in hospitalized children and their families.

The study sought to measure provider recognition of family alcohol-related problems among hospitalized children and to identify characteristics distinguishing "positive" families. The study sample (N = 147) was drawn from admissions to the general pediatric medical service of a metropolitan teaching hospital. Positivity was assessed through parent and patient interviews that included standard alcohol abuse screening instruments. Provider recognition was assessed through record review and physician interview. Of the 22 families screened positive, only one was so identified by the child's attending or resident physician. Positive and "negative" families were similar in most respects, although parents in positive families were more likely to report stress and sleeping problems and adolescents were more likely to report being troubled by a parent's drinking. The similarity of positive and negative families and the low pediatrician recognition rate suggest that alcohol problems are likely to go unnoticed without a conscious screening effort.

Knowledge, attitudes, and reported practices of medical students and house staff regarding the diagnosis and treatment of alcoholism.

Although alcoholism is prevalent in both general and inpatient populations, barriers to its timely diagnosis and effective treatment exist. These are often attributed to physicians' inadequate understanding and skill development and negative attitudes toward the disease. All Johns Hopkins' medical students and house staff, during 1986 through 1987, received a self-administered survey of their attitudes, skills, perceived role responsibility, knowledge, and reported practices with regard to alcoholism. Results indicate a strong relationship between perceived role responsibility, confidence in skills, and reported screening and referral practices among students and house staff. Knowledge levels strengthened the association between skills and practices for medical students. House staff perceived less of a responsibility for screening than medical students. There was a trend toward lower confidence and more negative attitudes among house staff than medical students. The results point to areas where educational interventions can be improved to enhance quality of care and outcomes for this major chronic disease.

Characteristics, diagnosis, and treatment of alcoholism in elderly patients.

The purpose of this study is to examine the ability of physicians to diagnose alcoholism in the elderly patient and to define characteristics specific to the elderly patient with alcoholism. During a 3-month period, all new admissions to the medical service of The Johns Hopkins Hospital were screened for alcoholism with two screening tests (the CAGE questionnaire and Short Michigan Alcohol Screening Test). The prevalence of screen-positive alcoholism was 27% in patients under 60 years of age and 21% in patients 60 years and older. Elderly patients with alcoholism were more likely to be black (P less than .01), but did not differ significantly in any other way from elderly patients who did not have alcoholism. Although 60% of screen-positive young patients with alcoholism were identified by their houseofficers, only 37% of elderly patients with screen-positive alcoholism were so identified (P less than .05). The elderly patients with alcoholism were significantly less likely to be diagnosed by their houseofficer if they were white, female, or had completed high school (P less than .01). Even when diagnosed, elderly patients with alcoholism were less likely than younger patients with alcoholism to have treatment recommended by their houseofficers (P less than .05) and, if treatment were recommended, it was less likely to be initiated (P less than .05). These data suggest that current medical education is deficient in providing physicians with the skills to detect and treat elderly patients with alcoholism.

Prevalence, detection, and treatment of alcoholism in hospitalized patients.

As part of an institution-wide program to enhance the education of physicians in diagnosing and treating alcohol dependence and abuse, a comprehensive survey was conducted in which all new admissions to the adult inpatient services of The Johns Hopkins Hospital were screened for alcoholism. The prevalence of screen-positive alcoholism, by department, was as follows: medicine (25%), psychiatry (30%), neurology (19%), obstetrics-gynecology (12.5%), and surgery (23%). Detection rates by the house staff and faculty physicians caring for those patients who screened positively were less than 25% in surgery and obstetrics-gynecology, between 25% and 50% in neurology and medicine, and greater than 50% in psychiatry. However, physicians were less likely to identify as alcoholic those patients with higher incomes, higher education, or private medical insurance; women; and those who denied heavy alcohol intake. Physician-instituted treatment rates for those patients diagnosed by the physician as having nonrecovered alcoholism were less than 50% in surgery and obstetrics-gynecology, between 50% and 75% in medicine and neurology, and 100% in psychiatry. The extent to which the physicians intervened while the patient was hospitalized correlated with the patient's reported change in alcohol use after discharge. Recommendations based on these data are being incorporated into the medical education curriculum.

Incomplete anaerobiosis as a cause of metronidazole 'resistance'.

Clostridium welchii, used as a control, was found to grow well in a microaerophilic jar used for campylobacters but appeared resistant to a metronidazole disc although the campylobacter was sensitive. Minimum inhibitory concentrations for six strains of Cl. welchii were up to 64-fold higher in these conditions than when grown anaerobically. Zones of inhibition with both Cl. welchii and Bacteroides fragilis varied with the amount of air admitted to anaerobic jars.

The Compu-pet 100: a versatile dispenser-diluter for the mechanization of microbiological techniques.

The Compu-pet 100 diluter/dispenser is a versatile and accurate instrument which can be employed for a wide variety of microbiological tests and techniques. Time in performing tests is often more than halved when the diluter is used. Large numbers of tests can be performed with minimal fatigue.