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PubMed2000

Final report of the FOPE II Pediatric Generalists of the Future Workgroup.

The Future of Pediatric Education II (FOPE II) Project was a 3-year, grant-funded initiative, which continued the work begun by the 1978 Task Force on the Future of Pediatric Education. Its primary goal was to proactively provide direction for pediatric education for the 21st century. To achieve this goal, 5 topic-specific workgroups were formed: 1) the Pediatric Generalists of the Future Workgroup, 2) the Pediatric Specialists of the Future Workgroup, 3) the Pediatric Workforce Workgroup, 4) the Financing of Pediatric Education Workgroup, and 5) the Education of the Pediatrician Workgroup. The FOPE II Final Report was recently published as a supplement to Pediatrics (The Future of Pediatric Education II: organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century. Pediatrics. 2000;105(suppl):161-212). It is also available on the project web site at: This report reflects the deliberations and recommendations of the Pediatric Generalists of the Future Workgroup of the Task Force on FOPE II. The report looks at 5 factors that have led to changes in child health needs and pediatric practice over the last 2 decades. The report then presents a vision for the role and scope of the pediatrician of the future and the core attributes, skills, and competencies pediatricians caring for infants, children, adolescents, and young adults will need in the 21st century. Pediatrics 2000;106(suppl):1199-1223; pediatrics, medical education, children, adolescents, health care delivery.

Adolescent↗
PubMed2005

Understanding the foundation: the state of generalist search education in library schools as related to the needs of expert searchers in medical libraries.

PURPOSE: The paper explores the current state of generalist search education in library schools and considers that foundation in respect to the Medical Library Association's statement on expert searching. SETTING/SUBJECTS: Syllabi from courses with significant searching components were examined from ten of the top library schools, as determined by the U.S. News & World Report rankings. METHODOLOGY: Mixed methods were used, but primarily quantitative bibliometric methods were used. RESULTS: The educational focus in these searching components was on understanding the generalist searching resources and typical users and on performing a reflective search through application of search strategies, controlled vocabulary, and logic appropriate to the search tool. There is a growing emphasis on Web-based search tools and a movement away from traditional set-based searching and toward free-text search strategies. While a core set of authors is used in these courses, no core set of readings is used. DISCUSSION/CONCLUSION: While library schools provide a strong foundation, future medical librarians still need to take courses that introduce them to the resources, settings, and users associated with medical libraries. In addition, as more emphasis is placed on Web-based search tools and free-text searching, instructors of the specialist medical informatics courses will need to focus on teaching traditional search methods appropriate for common tools in the medical domain.

Curriculum↗
PubMed1990

The academic generalist: an endangered species revived.

The role of a generalist in academic medicine has been diminished because of the proliferation of specialized research and treatment in the hands of the subspecialist. Yet many observers believe that this has resulted in gaps in research and teaching concerning common health problems, especially those seen in office practice. To correct this trend, The Robert Wood Johnson Foundation has supported for 10 years a fellowship program to prepare academic pediatric generalists. A total of 111 pediatricians have completed the fellowship. Two thirds are now in full-time academic positions. By late 1988, they had published 332 papers and had received more than $20 million in grant support. A majority of departments of pediatrics have relabeled their divisions of ambulatory pediatrics as divisions of general pediatrics and have broadened these divisions' responsibilities. In spite of some difficulty obtaining research support, the carers of these fellows and the changes in pediatric departments support the thesis that there is a need for and a rebirth of academic general pediatrics.

Education, Medical↗
PubMed1998

Twenty-year trends in the Ohio generalist physician workforce.

BACKGROUND: Many factors contribute to the variations seen in physician workforce projections, including assumptions about attrition, new physician entry, and geographic requirements. Our study offers data for bench-marking future research into this complex issue. METHOD: At 5-year intervals starting in 1975, data were collected for each Ohio county by local physician census takers. RESULTS: Total Ohio family physician rates per population did not increase appreciably during the 20-year period. A decrease in the number of allopathic family physicians was balanced by an increase in the number of osteopathic family physicians, many of whom were graduates of the state's first osteopathic medical school, which graduated its first class in 1980. Rates of general internists and general pediatricians increased. In 1975, the percentage of physicians older than 59 years was higher for family physicians than for general internists and general pediatricians. By 1995, this disparity in age distribution had greatly decreased. Rural family physician rates per 100,000 population decreased, and urban rates increased, while both urban and rural rates increased for general internists and general pediatricians. CONCLUSIONS: Variations in accounting for clinical time used for non-generalist clinical and nonclinical activities may explain a large part of the difference between generalist head count and full-time equivalency (FTE) study results; together these activities can be said to make up a "fourth compartment" contributing to improper specialty designation. The decrease in the percentage of family physicians older than 59 years indicates that the future supply of practicing family physicians is not in jeopardy. The rural family physician workforce is decreasing, while the general internist and general pediatrician rural workforce is increasing, but the total rural workforce is still well below the urban workforce. Neither component of the rural workforce appears to have stabilized.

Adult↗
PubMed1993

The shortage of generalist physicians and federal funding of graduate medical education.

Graduate Medical Education (GME) payments through the Health Care Financing Administration (HCFA) represent the largest portion of federal funding in direct support of training for health professionals. Whatever the benefits of these funds, they clearly have not served as a positive factor in addressing the emerging shortfall of generalist physicians. Therefore, a variety of options are being discussed for restructuring the incentives associated with HCFA GME funds. Seven principal alternatives that have been proposed to address these problems are the following: modification of hospital GME payments, GME payments to medical schools, GME payments to residency programs, GME transfers through Medicare part B, GME transfers to the Health Resources and Service Administration, GME transfers to states through block grants, and GME payments to academic consortia. Unfortunately, each of these approaches offers substantial disadvantages and faces important opposing constituencies. To address these weaknesses, combined strategies and "all payor" federal mechanisms of GME financing have recently been proposed. These compromise approaches have their own administrative and political liabilities as well. Revisions in current HCFA GME payments may be preferable as a first step, but more comprehensive approaches involving all payor financing with mechanisms that reconnect medical school training with primary care practice will likely be required to ensure efficient and effective reform. Such major shifts in the federal funding of GME will not be quick in coming, however, and will doubtless be characterized by a compromise of policy effectiveness with political feasibility.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1999

Non-absorption of ingested lipophilic and amphiphilic allelochemicals by generalist grasshoppers: the role of extractive ultrafiltration by the peritrophic envelope.

The role of the peritrophic envelope in the non-absorption of three allelochemicals ingested by generalist grasshoppers was examined. This study tested the hypothesis that the association of lipophilic and amphiphilic allelochemicals with lipid aggregates (mixed micelles) reduces their permeability through the peritrophic envelope, a process similar to extractive ultrafiltration. Each of three allelochemicals (digitoxin, ouabain, and xanthotoxin) were solubilized in a lysolecithin suspension and injected separately into the midgut lumens of adult Melanoplus sanguinipes (Orthoptera: Acrididae). The low permeability of digitoxin through the peritrophic envelope was consistent with the extractive ultrafiltration of this compound. By comparison, ouabain and xanthotoxin permeability coefficients were 7- and 12-fold higher, respectively, than those of digitoxin. The results of extractive ultrafiltration assays confirmed that digitoxin is effectively extracted in lysolecithin micelles, but that neither ouabain nor xanthotoxin aggregates efficiently with these micelles.

Animals↗
PubMed2002

The role of the generalist obstetrician-gynecologist in the early detection of ovarian cancer.

The purpose of this Committee Opinion is to define the role of the generalist obstetrician-gynecologist in the early detection of ovarian cancer. Currently, it appears that the best way to detect early ovarian cancer is for both the patient and her clinician to have a high index of suspicion of the diagnosis in the symptomatic woman. In evaluating symptoms, physicians should perform a physical examination, including a pelvic examination. In premenopausal women with symptoms, a CA 125 measurement has not been shown to be useful in most circumstances. In postmenopausal women with a pelvic mass, a CA 125 measurement may be helpful in predicting a higher likelihood of a malignant tumor than a benign tumor, which may be useful in making consultation or referral decisions or both. A woman with a suspicious or persistent complex adnexal mass requires surgical evaluation by a physician trained to appropriately stage and debulk ovarian cancer. Data suggest that currently available screening tests do not appear to be beneficial for screening low-risk, asymptomatic women. An annual gynecologic examination with an annual pelvic examination is recommended for preventive health care.

Female↗
PubMed2000

Susceptibility of Vespula vulgaris (Hymenoptera: vespidae) to generalist entomopathogenic fungi and their potential for wasp control.

The pathogenicity of Vespula vulgaris wasp workers and larvae to a range of fungi was determined. All fungi were isolated in New Zealand and included isolates from Vespula, known generalist insect pathogens, and isolates generally nonpathogenic to insects. Workers and larvae were highly susceptible to pathogenic isolates at high spore concentrations (>1.75 x 10(5) cfu/individual). Eight isolates, two of Metarhizium anisopliae, five of Beauveria bassiana, and one of Aspergillus flavus were pathogenic while a single isolate of M. flavouiride var. novazealandicum, Cladosporium sp., and Paecilomyces sp. were not. The transfer of spores between workers, and between workers and larvae, was also investigated using several different application methods. Transfer of spores occurred between treated and untreated individuals, and for some of the application methods sufficient spores were transferred to cause mortality of the nontreated individuals. These findings are related to the potential of fungi for the control of wasps.

Animals↗
PubMed1994

Implementation issues in generalist education.

Devising a strategy for the implementation of a generalist medical educational program can be aided by grouping the many issues to be addressed into developmental stages. In this way, problems can be anticipated and resources marshalled. Initially, leadership and institutional support for the program must be developed. Next, detailed financial, curricular, and site planning must be undertaken. Implementation of the program must contend with faculty, site, and trainee concerns while consolidating financial and institutional support. Finally, in institutionalizing the program, financing must be secured and ongoing evaluation should provide information necessary to regularly reassess the program and renew its goals.

Adult↗
PubMed2026

Genomic signatures of host-range divergence in the generalist Beauveria bassiana and the specialist Beauveria brongniartii.

Entomopathogenic fungi of the genus Beauveria are widely used biological control agents that infect diverse insect hosts and can also associate with plants as rhizosphere colonizers and endophytes. Within this genus, Beauveria bassiana is a cosmopolitan generalist, whereas Beauveria brongniartii exhibits a narrower host range, primarily targeting soil-dwelling coleopteran larvae with limited evidence of plant colonization. To explore genomic differentiation associated with this ecological divergence, the commercially exploited B. brongniartii strain BIPESCO2 and B. bassiana ATHUM 4946 were sequenced using Oxford Nanopore technology, followed by comparative genomic analyses across multiple strains. Orthology identified species-specific gene families, although overall genome architecture and core gene content were highly conserved. The CAZyme repertoires were nearly identical, indicating retention of a versatile enzymatic toolkit supporting plant association, saprotrophy, and insect pathogenicity. In contrast, biosynthetic gene clusters displayed substantial variation, including structural remodeling of Beauveria-specific virulence-associated clusters and expansion of type I polyketide synthase clusters in B. brongniartii. Effector prediction revealed a conserved core of largely uncharacterized proteins alongside species-specific orthogroups enriched in adhesion-, immunity-, and cuticle-interaction domains. Together, these findings indicate that host-range divergence in Beauveria is associated with compartmentalized genomic differentiation, particularly in secondary metabolism and a limited subset of lineage-specific virulence factors, rather than in the conserved core infection machinery.

Beauveria↗
PubMed2003

Habitat age increases reproduction and nutritional condition in a generalist arthropod predator.

We studied the nutritional and reproductive response of Poecilus cupreus (synonymous with Pterostichus cupreus), one of the most abundant carabid beetles in arable land, to the succession in sixteen 1- to 4-year-old wildflower areas. A total of 390 male and 373 female beetles was examined. Each female was dissected and the number of ripe eggs counted. The nutritional state was expressed by a condition factor, which was calculated for each individual based on the observed weight and elytra length of male and female P. cupreus. Carabids in the 1-year-old wildflower areas contained significantly less ripe eggs than those from the 4-year-old areas. The condition factor of female and male beetles was significantly lower in 1- than 2- to 4-year-old areas. We examined the influence of habitat parameters (vegetation cover, soil water content, coarse and fine sand, pore volume, habitat size and age, surrounding landscape structure) on the reproductive success and nutritional state of P. cupreus in the 16 wildflower areas. The number of eggs was best explained by habitat age, accounting for 53.4% of the variability. The variation in the condition factor of female and male beetles was best explained by habitat age, which accounted for 73% and 71% of the variation, respectively. Moreover, the beetles' reproductive potential and nutritional condition were significantly associated with vegetation cover, and occasionally also with soil water content. The potential of wildflower areas as a reservoir for the generalist predator P. cupreus was shown to increase with successional age.

Animals↗
PubMed2004

Performance of a generalist grasshopper on a C3 and a C4 grass: compensation for the effects of elevated CO2 on plant nutritional quality.

The increasing CO2 concentration in Earth's atmosphere is expected to cause a greater decline in the nutritional quality of C3 than C4 plants. As a compensatory response, herbivorous insects may increase their feeding disproportionately on C3 plants. These hypotheses were tested by growing the grasses Lolium multiflorum C3) and Bouteloua curtipendula C4) at ambient (370 ppm) and elevated (740 ppm) CO2 levels in open top chambers in the field, and comparing the growth and digestive efficiencies of the generalist grasshopper Melanoplus sanguinipes on each of the four plant x CO2 treatment combinations. As expected, the nutritional quality of the C3 grass declined to a greater extent than did that of the C4 grass at elevated CO2; protein levels declined in the C3 grass, while levels of carbohydrates (sugar, fructan and starch) increased. However, M. sanguinipes did not significantly increase its consumption rate to compensate for the lower nutritional quality of the C3 grass grown under elevated CO2. Instead, these grasshoppers appear to use post-ingestive mechanisms to maintain their growth rates on the C3 grass under elevated CO2. Consumption rates of the C3 and C4 grasses were also similar, demonstrating a lack of compensatory feeding on the C4 grass. We also examined the relative efficiencies of nutrient utilization from a C3 and C4 grass by M. sanguinipes to test the basis for the C4 plant avoidance hypothesis. Contrary to this hypothesis, neither protein nor sugar was digested with a lower efficiency from the C4 grass than from the C3 grass. A novel finding of this study is that fructan, a potentially large carbohydrate source in C3 grasses, is utilized by grasshoppers. Based on the higher nutrient levels in the C3 grass and the better growth performance of M. sanguinipes on this grass at both CO2 levels, we conclude that C3 grasses are likely to remain better host plants than C4 grasses in future CO2 conditions.

Adaptation, Physiological↗
PubMed2005

The involvement of volatile infochemicals from spider mites and from food-plants in prey location of the generalist predatory mite Neoseiulus californicus.

We investigated volatile infochemicals possibly involved in location of the generalist predatory mite Neoseiulus californicus to plants infested with spider mites in a Y-tube olfactometer. The predators significantly preferred volatiles from lima bean leaves infested with Tetranychus urticae to uninfested lima bean leaves. Likewise, they were attracted to volatiles from artificially damaged lima bean leaves and those from T. urticae plus their visible products. Significantly more predators chose infested lima bean leaves from which T. urticae plus their visible products had been removed than artificially damaged leaves, T. urticae, and their visible products. These results suggest that N. californicus is capable of exploiting a variety of volatile infochemicals originating from their prey, from the prey-foodplants themselves, and from the complex of the prey and the host plants (e.g., herbivore-induced volatiles). We also investigated predator response to some of the synthetic samples identified as volatile components emitted from T. urticae-infested lima bean leaves and/or artificially damaged lima bean leaves. The predators were attracted to each of the five synthetic volatile components: linalool, methyl salicylate, (Z)-3-hexen-1-ol, (E)-2-hexenal, and (Z)-3-hexenyl acetate. The role of each volatile compound in prey-searching behavior is discussed.

Acetates↗
PubMed1999

Generalist versus specialist care for acute myocardial infarction.

Early studies conflict regarding improved patient outcomes with cardiologist-directed care for acute myocardial infarction (AMI). We sought to assess the magnitude and mechanism of the influence of physician specialty on inpatient mortality for AMI. Using data from the Pennsylvania Health Care Cost Containment Council and elsewhere, we developed age-stratified logistic regression models of inpatient mortality, utilizing a split sample strategy for model development and validation. Referral bias and physician caseload were explicitly addressed. We analyzed 30,351 admissions for AMI. In patients < 65 years old, the adjusted odds ratio (OR) for mortality with cardiologist care was 0.89 (95% confidence interval [CI] 0.640 to 1.24, p = 0.49) relative to generalist care. In patients > or = 65 years of age, the adjusted OR was 0.86 (95% CI 0.72 to 1.03, p = 0.10). Caseload was significantly higher among cardiologists and was inversely related to inpatient mortality. Mortality models with caseload but not physician designation or physician designation without caseload found each predictor statistically significant in the absence of the other (OR for cardiologist care 0.82, 95% CI 0.71 to 0.95, p = 0.007; OR for patients with low volume physicians relative to high volume 1.27, 95% CI 1.05 to 1.51, p = 0.014). Older patients of physicians with higher case loads had a lower risk adjusted inpatient mortality for AMI. This probably explains the trend toward better outcomes among patients of cardiologists rather than noncardiologists.

Age Factors↗
PubMed1982

A new flexible sigmoidoscope for the generalist.

The control of colorectal cancer has become increasingly important because of its high incidence in the United States of more than 115,000 cases annually. Although 50% of neoplastic lesions of the colon arise in the distal 25 cm of the bowel, endoscopic examination of this area has not been generally accepted. Recent studies with flexible sigmoidoscopes as substitutes for the rigid proctosigmoidoscope, primarily by endoscopists, have shown an increased yield of neoplastic lesions, with excellent patient acceptance. This study reports the development of an initial trial in 200 patients with a 30-cm flexible sigmoidoscope designed mainly for the nonendoscopist general physician for routine office use as a substitute for the rigid proctosigmoidoscope. The instrument provided an excellent examination in minimum time and with good patient and physician acceptance. Widespread application of such instruments by generalists in routine office practice could have a significant impact on the control of colorectal cancer.

Adult↗
PubMed2003

The role of the generalist obstetrician-gynecologist in the early detection of ovarian cancer.

The purpose of this Committee Opinion is to define the role of the generalist obstetrician-gynecologist in the early detection of ovarian cancer. Currently, it appears that the best way to detect early ovarian cancer is for both the patient and her clinician to have a high index of suspicion of the diagnosis in the symptomatic woman. In evaluating symptoms, physicians should perform a physical examination, including a pelvic examination. In pre-menopausal women with symptoms, a CA 125 measurement has not been shown to be useful in most circumstances. In postmenopausal women with a pelvic mass, a CA 125 measurement may be helpful in predicting a higher likelihood of a malignant tumor than a benign tumor, which may be useful in making consultation or referral decisions or both. A woman with a suspicious or persistent complex adnexal mass requires surgical evaluation by a physician trained to appropriately stage and debulk ovarian cancer. Data suggest that currently available screening tests do not appear to be beneficial for screening low-risk, asymptomatic women. An annual gynecologic examination with an annual pelvic examination is recommended for preventive health care.

Carcinoembryonic Antigen↗
PubMed2001

Food choice causes interrupted feeding in the generalist grasshopper Schistocerca americana: further evidence for inefficient decision-making.

Individual grasshoppers were observed foraging on either single food plant species or binary mixtures of them. Individuals ate slightly less on the mixtures, but grew faster on them. In the mixtures, individuals fed regularly from both plant species, typically eating both within a single meal. Feeding bouts were longer on the preferred plant species in the mixture. The pattern of foraging behavior was markedly different in mixtures and single food treatments. In mixtures, although the total length of time engaged in ingestion over the day was slightly less than in single food treatments, there were relatively more short feeding bouts and more gaps between feeding bouts within meals, so that the time spent in activities associated with the food was markedly longer on mixtures. This is discussed in terms of efficiency and the problem of choice that faces individual generalists. The efficiency factor and its impact on vigilance is added to the other costs of being a polyphagous herbivore.

Journal Article↗
PubMed1999

The nutritional significance of sterol metabolic constraints in the generalist grasshopper Schistocerca americana.

Sterols are essential nutrients for grasshoppers, as well as all other insects, but metabolic constraints can limit which phytosterols support normal growth and development. In the current study, the generalist grasshopper Schistocerca americana was used to address two questions related to grasshopper sterol nutrition: (1) how does sterol quantity influence growth and survival, and (2) how do mixtures of suitable and unsuitable sterols at different concentrations influence growth and survival? Results from the first experiment indicated that this grasshopper species had a minimum sterol requirement of 0.05% dry weight; as sterol quantity increased above this concentration, however, survival and performance were not enhanced. Results from the second experiment revealed two novel aspects of sterol nutrition in grasshoppers: (1) when suitable sterols were limiting, most individuals could not use unsuitable sterols to meet the minimum sterol requirement (i.e. no sparing occurred), and (2) above a certain threshold, unsuitable sterols were deleterious even when suitable sterols were present at a concentration that alone permits normal growth and development. We discuss these physiological findings in terms of how sterol metabolic constraints in grasshoppers might influence foraging.

Journal Article↗