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PubMed2005

Out of Tanganyika: genesis, explosive speciation, key-innovations and phylogeography of the haplochromine cichlid fishes.

BACKGROUND: The adaptive radiations of cichlid fishes in East Africa are well known for their spectacular diversity and their astonishingly fast rates of speciation. About 80% of all 2,500 cichlid species in East Africa, and virtually all cichlid species from Lakes Victoria (approximately 500 species) and Malawi (approximately 1,000 species) are haplochromines. Here, we present the most extensive phylogenetic and phylogeographic analysis so far that includes about 100 species and is based on about 2,000 bp of the mitochondrial DNA. RESULTS: Our analyses revealed that all haplochromine lineages are ultimately derived from Lake Tanganyika endemics. We find that the three most ancestral lineages of the haplochromines sensu lato are relatively species poor, albeit widely distributed in Africa, whereas a fourth newly defined lineage - the 'modern haplochromines' - contains an unparalleled diversity that makes up more than 7% of the worlds' approximately 25,000 teleost species. The modern haplochromines' ancestor, most likely a riverine generalist, repeatedly gave rise to similar ecomorphs now found in several of the species flocks. Also, the Tanganyikan Tropheini are derived from that riverine ancestor suggesting that they successfully re-colonized Lake Tanganyika and speciated in parallel to an already established cichlid adaptive radiation. In contrast to most other known examples of adaptive radiations, these generalist ancestors were derived from highly diverse and specialized endemics from Lake Tanganyika. A reconstruction of life-history traits revealed that in an ancestral lineage leading to the modern haplochromines the characteristic egg-spots on anal fins of male individuals evolved. CONCLUSION: We conclude that Lake Tanganyika is the geographic and genetic cradle of all haplochromine lineages. In the ancestors of the replicate adaptive radiations of the 'modern haplochromines', behavioral (maternal mouthbrooding), morphological (egg-spots) and sexually selected (color polymorphism) key-innovations arose. These might be - together with the ecological opportunity that the habitat diversity of the large lakes provides - responsible for their evolutionary success and their propensity for explosive speciation.

Animals↗
PubMed2006

Perceived conflict in the couple and chronic illness management: preliminary analyses from the Quebec Health Survey.

BACKGROUND: The quality of the relationship with the spouse/partner appears crucial among patients with multiple chronic conditions where illness management is complex and multifaceted. This study draws on data from the Quebec Health Survey (QHS) to examine, among patients with one or more chronic conditions, the relation between marital status, the perceived conflict with the spouse/partner, and what the patients do to manage their illness as well as how they perceive their health. METHODS: Data from the QHS 1998 were used. The sample included 7547 coupled adults who had one or more chronic health problems lasting more than 6 months. Independent variables included marital status, perceived conflict with the spouse/partner, and the number of chronic conditions. Illness management was defined broadly as a measure of the patient's efforts at self-care and an illness status indicator, including visits to the generalist and the specialist, the use of telephone health line in the last 12 months, self-rated general health, mental health, and a measure of psychological distress. Linkages between the independent variables and illness management were assessed for males and females separately with logistic regressions, while accounting for the survey sampling design and household clustering. RESULTS: Female patients who did not live with their partner and had never been married were more likely to report a negative perception of their general health and a higher psychological distress than those who were married. Perceived conflict with the partner was linked to a negative perception of mental health and a higher psychological distress among both men and women. Compared to patients with only one chronic condition, males who reported more than one chronic condition were more likely to have consulted a generalist prior to the survey and used the telephone health line, whereas females were more likely to have consulted a specialist. Both males and females with more than one chronic condition were more likely to have a negative perception of their general health and mental health. CONCLUSION: The study provides a useful preliminary measure of the importance of living arrangements and the quality of the couple relationship in chronic illness management broadly conceived as a measure of the patient's efforts at self-care and an illness status indicator. Results of this study prod us to examine more closely, within longitudinal designs, the influence of living arrangements and the presence of conflict in the couple on chronic illness management as well as the modifying effect of gender on these associations.

Adult↗
PubMed2006

Are Canadian General Internal Medicine training program graduates well prepared for their future careers?

BACKGROUND: At a time of increased need and demand for general internists in Canada, the attractiveness of generalist careers (including general internal medicine, GIM) has been falling as evidenced by the low number of residents choosing this specialty. One hypothesis for the lack of interest in a generalist career is lack of comfort with the skills needed to practice after training, and the mismatch between the tertiary care, inpatient training environment and "real life". This project was designed to determine perceived effectiveness of training for 10 years of graduates of Canadian GIM programs to assist in the development of curriculum and objectives for general internists that will meet the needs of graduates and ultimately society. METHODS: Mailed survey designed to explore perceived importance of training for and preparation for various aspects of Canadian GIM practice. After extensive piloting of the survey, including a pilot survey of two universities to improve the questionnaire, all graduates of the 16 universities over the previous ten years were surveyed. RESULTS: Gaps (difference between importance and preparation) were demonstrated in many of the CanMEDS 2000/2005 competencies. Medical problems of pregnancy, perioperative care, pain management, chronic care, ambulatory care and community GIM rotations were the medical expert areas with the largest gaps. Exposure to procedural skills was perceived to be lacking. Some procedural skills valued as important for current GIM trainees and performed frequently (example ambulatory ECG interpretation) had low preparation ratings by trainees. Other areas of perceived discrepancy between training and practice included: manager role (set up of an office), health advocate (counseling for prevention, for example smoking cessation), and professional (end of life issues, ethics). CONCLUSION: Graduates of Canadian GIM training programs over the last ten years have identified perceived gaps between training and important areas for practice. They have identified competencies that should be emphasized in Canadian GIM programs. Ongoing review of graduate's perceptions of training programs as it applies to their current practice is important to ensure ongoing appropriateness of training programs. This information will be used to strengthen GIM training programs in Canada.

Adult↗
PubMed2005

Educational and labor wastage of doctors in Mexico: towards the construction of a common methodology.

BACKGROUND: This paper addresses the problem of wastage of the qualified labor force, which takes place both during the education process and when trained personnel try to find jobs in the local market. METHODS: Secondary sources were used, mainly the Statistical yearbooks of the National Association of Universities and Higher Education Institutions (ANUIES in Spanish). Also, the 2000 Population Census was used to estimate the different sources of labor market wastage. The formulas were modified to estimate educational and labor wastage rates. RESULTS: Out of every 1000 students who started a medical training in 1996, over 20% were not able to finish the training by 2000. Furthermore, out of every 1000 graduates, 31% were not able to find a remunerated position in the labor market that would enable them to put into practice the abilities and capacities obtained at school. Important differences can be observed between generalists and specialists, as well as between men and women. In the case of specialists and men, lower wastage rates can be observed as compared to the wastage rates of generalists and women. A large percentage of women dedicate themselves exclusively to household duties, which in labor terms represents a wastage of their capacity to participate in the production of formal health services. CONCLUSION: Women are becoming a majority in most medical schools, yet their participation in the labor market does not reflect the same trend. Among men, policies should be formulated to incorporate doctors in the specific health field for which they were trained. Regarding women, specific policies should target those who are dedicated full-time to household activities in order to create the possibility of having them occupy a remunerated job if they are willing to do so. Reducing wastage at both the educational and labor levels should improve the capacity of social investment, thereby increasing the capacity of the health system as a whole to provide services, particularly to those populations who are most in need.

Journal Article↗
PubMed2026

Diet change reveals asymmetric response in gene expression and microbial composition across the digestive tract of two closely related herbivores.

BACKGROUND: Understanding what shapes variation in organisms' capacity to utilize novel resources is essential to predicting how species will respond to environmental change. For herbivores, exposure to toxic phytochemicals in novel plants may limit persistence in new habitats. We investigated the behavioral, physiological, genetic, and microbial consequences of diet switching in two closely related species of rodent herbivores that each consume differentially toxic plants in their native habitat, and that maintain different dietary strategies (i.e., relative dietary specialist versus relative generalist). RESULTS: In reciprocal laboratory feeding trials, we exposed wild-caught woodrats (genus Neotoma) to toxins characteristic of either familiar or novel plant secondary compounds. We measured changes in food and water intake, locomotor activity, gut microbial composition, and gene expression across the digestive tract following feeding trials. The dietary generalist responded minimally, but the specialist responded strongly when exposed to the novel diet. This response included behavioral and genetic components including increased water intake, reduction in locomotor activity, increased differential expression of detoxification genes, and a greater shift in gut microbial composition. CONCLUSIONS: The dietary specialist exhibited a strong response to diet switching that corresponded with ecologically relevant shifts in behavior and physiology that would have negative fitness consequences. Although the dietary specialist had a strong genetic and microbial response to novel plant secondary compounds, this response would likely be insufficient to overcome the immediate challenge of exposure to novel dietary toxins in the wild. Our results underscore the link between feeding strategy and the capacity to shift to novel dietary resources in response to environmental change.

Animals↗
PubMed2001

Community-oriented primary care: a model for public health nursing.

The American Public Health Association defines public health nursing as the "practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences." In 1993, celebrating the centennial anniversary of its founding, nurse leaders recognized systemic changes have required nurses to function in clinical, illness-oriented roles rather than in their more traditional community and public health roles. With nurses' public health skills atrophying, these leaders urged members of the profession to eschew specialization and return to their generalist roots founded on the principles of community-based prevention and health promotion. Soon the Public Health Functions Project, designed in part to identify skills and curriculum needs of an array of practicing public health workers, examined the public health nursing profession. Its recommendations seek to ensure that public health nurses are trained to respond to current challenges that face public health. In this essay, we describe how a fellowship program that predated this national project by almost a decade anticipated the recommendations for shaping public health nursing by enrolling midcareer nurses in a program that taught the principles and practice of community-oriented primary care. Such principles represent a merger of clinical care with population health sciences; its more recent expressions teach clinicians to work as partners with communities to identify and address health problems. In reporting on this program, we show how nurses in practice can embrace their generalist roots, meet current challenges, and play a lead role in realizing the nation's goals for the year 2010. These aims incorporate recent recommendations for preparing public health nurses for change in the health care system.

Boston↗
PubMed2004

Acoustical stress and hearing sensitivity in fishes: does the linear threshold shift hypothesis hold water?

Mammals exposed to loud aerial sounds exhibit temporary threshold shifts (TTS) that are linearly related to increases of sound pressure above baseline hearing levels. It was unknown if this relationship held true for aquatic ectotherms such as fishes. To test this linear threshold shift hypothesis (LINTS) in fishes, we examined the effects of increased ambient sound on hearing of two species differing in hearing capabilities: goldfish (Carassius auratus; a hearing specialist) and tilapia (Oreochromis niloticus; a hearing generalist). Fish were exposed to 1-28 days of either quiet (110 dB re 1 microPa) or continuous white noise. First, we examined the effect of noise sound pressure level (SPL; 130, 140, 160 or 170 dB re 1 microPa) on goldfish hearing thresholds after 24 h of noise exposure. Second, in a long-term experiment using 170 dB re 1 microPa white noise, we continuously exposed goldfish and tilapia for either 7 or 21-28 days. In both experiments, we measured alterations in hearing capabilities (using auditory brainstem responses) of noise-exposed fish. While tilapia exposed to noise for 28 days showed little or no hearing loss, goldfish exhibited considerable threshold shifts that reached an asymptote of up to 25 dB after only 24 h of exposure. There was a positive linear relationship between noise-induced TTS and the sound pressure difference between the noise and the baseline hearing thresholds in goldfish but not in tilapia. A similar relationship was found for published noise-induced threshold shifts in birds and mammals, but the slope of the linear relationship was greater in these groups than for fish. The linear threshold shift relationship provides insights into differential susceptibility of hearing specialist and generalist fishes to noise-induced hearing loss for a given SPL and provides a framework for future research on noise-induced threshold shifts in fishes and other animals.

Acoustic Stimulation↗
PubMed2005

Prey capture kinematics of ant-eating lizards.

While morphological and behavioral feeding specializations are obvious in many vertebrate groups, among lizards there appear to be few dietary specialists. By comparing the prey capture kinematics and overall feeding behavior in two highly specialized ant-eating lizards (Moloch horridus and Phrynosoma platyrhinos) with those of two closely related dietary generalists (Pogona vitticeps and Uma notata), we investigate whether dietary specialization has been accompanied by changes in the function and use of the feeding system. We quantified kinematic variables from high-speed video recordings (200-250 frames s(-1)) of each species feeding on ants. Prey capture was strikingly different in M. horridus to that of other species, being characterized by a suite of unusual behaviors including the lack of a body lunge, faster tongue protrusion, reduced prey processing and, most notably, the ability to modulate the slow open phase of the gape cycle. In concert, these traits make a single feeding event in M. horridus faster than that in any other iguanian lizard studied to date. Prey capture behavior in P. platyrhinos is kinematically more similar to U. notata and P. vitticeps than to M. horridus, but the ant specialists are similar in that both lack distinct prey processing behaviors, resulting in faster overall capture and feeding events. While ant feeding in P. vitticeps is faster than feeding on other prey, the duration of a single feeding event is still four times longer than in either ant specialist, because of extensive prey processing. Additionally, a phylogenetic comparison of ant specialist lizards with dietary generalists revealed that ant-eating lizards require significantly less time to capture and process prey. Thus there are not only significant behavioral modifications in these ant-eating lizards, but also multiple strategies among specialists, suggesting differing selective pressures or phylogenetic constraints in the evolution of ant eating in lizards.

Animals↗
PubMed2005

Are hearing sensitivities of freshwater fish adapted to the ambient noise in their habitats?

Several groups of fishes, among them two thirds of all freshwater fishes, have developed hearing specializations that enhance auditory sensitivity and broaden frequency ranges compared with hearing non-specialists (generalists), which lack such adaptations. It has been speculated that the enhanced sensitivities of these so-called hearing specialists have evolved in quiet habitats such as lakes, backwaters of rivers, slowly flowing streams or the deep sea. To test this hypothesis, noise levels and frequency spectra of four different freshwater habitats near Vienna, Austria (Danube River, Triesting stream, Lake Neusiedl, backwaters of the Danube River), were recorded and played back to native fish species while simultaneously measuring their auditory thresholds using the auditory evoked potential (AEP) recording technique. As a representative of hearing specialists, we chose the common carp (Cyprinus carpio, Cyprinidae) and for the hearing generalists the European perch (Perca fluviatilis, Percidae). Data show that the carp's hearing is only moderately masked by the quiet habitat noise level of standing waters (mean threshold shift 9 dB) but is heavily affected by stream and river noise by up to 49 dB in its best hearing range (0.5-1.0 kHz). In contrast, the perch's hearing thresholds were only slightly affected (mean up to 12 dB, at 0.1 kHz) by the highest noise levels presented. Our results indicate that hearing abilities of specialists such as carp are well adapted to the lowest noise levels encountered in freshwater habitats and that their hearing is considerably masked in some parts of their distribution range. Hearing in non-specialists such as perch, on the other hand, is only slightly or not at all impaired in all habitats.

Acoustic Stimulation↗
PubMed2006

How well do specialist feeders regulate nutrient intake? Evidence from a gregarious tree-feeding caterpillar.

Nutritional regulation is a powerful mechanism used by generalist feeders to obtain the balance of nutrients they require from nutritionally diverse, perhaps unbalanced, foods. We examined nutritional regulation in a species with a narrow individual diet breadth: the forest tent caterpillar, Malacosoma disstria. Fourth instar caterpillars were provided with artificial foods consisting of different ratios of protein to digestible carbohydrate in no-choice, choice and compensatory feeding experiments. In the no-choice test, caterpillars were confined to a single food source of varying protein/carbohydrate ratio for the duration of the fourth larval stadium. Caterpillars performed best on equal-ratio and slightly protein-biased diets. Significant reductions in performance were only observed on extremely protein- or carbohydrate-biased diets. Daily consumption of the three acceptable intermediate diets was consistent with volumetric regulation, but the timing of the moult to the next instar appeared linked instead to protein intake. In the choice test, caterpillars were provided with two complementary foods, one biased toward protein and the other toward carbohydrate, for the duration of the stadium. The caterpillars fed randomly from the two food sources presented to them, except for the extremely protein-biased diet (P:C ratio of 35:7), which they avoided. The compensatory feeding experiment tested whether forest tent caterpillars deprived of either protein or digestible carbohydrate would select a food containing the deficient nutrient. Insects were conditioned on either protein-only, carbohydrate-only, protein-and-carbohydrate or no-nutrient foods, then offered a choice between protein-only and carbohydrate-only foods. Unlike previously studied generalist feeders, our caterpillars did not compensate for protein deficiency and showed only very weak evidence of compensation for carbohydrate deficiency. Forest tent caterpillars are colonial trail-laying forest folivores that are generally confined to a single host plant and hence do not experience much diversity in food nutrient ratios. We show that forest tent caterpillars do not independently regulate protein and carbohydrate intake. These findings are consistent with predictions that nutritional regulation abilities should be less important in animals with narrower diet breadths.

Animal Nutritional Physiological Phenomena↗
PubMed2006

A qualitative study of the educational potential of joint teleconsultations at the primary-secondary care interface.

We conducted an evaluation of joint teleconsultations involving specialists, general practitioners (GPs) and their patients. Semistructured interviews (n = 39) and focus groups (2 groups with specialists; 6 groups with GPs) were used to collect data to explore participants' views on the educational aspect of joint teleconsultations, and to seek examples of learning that had taken place. The results showed that the teleconsultation was a complex situation in which some learning took place for the generalists, but overall participants were disappointed. Three themes emerged that could enhance the educational potential in future: generalists' reasons for referral as an influence on perceived learning; lack of clarity among clinicians regarding their role and conduct; and the presence of patients as an inhibitor in doctor-doctor interactions.

Attitude of Health Personnel↗
PubMed2002

AHSCs: the complex simplicity of service.

The literate and effective dissection of the problems of the modern Academic Health Sciences Centre (AHSC) represents a significant contribution by Lozon and Fox. However, the fundamental issues may be both simpler and more intractable than they describe. The hospitals, medical schools and research institutes that compose the AHSC have individually and collectively drifted away from an ethos of service with the patient at its centre. Systems theory teaches us that "emergent behaviour' wherein the AHSC becomes more than the sum of its parts will only be achieved when there is commitment to a common purpose aided by mutual respect and the generalist perspective necessary for its full expression. As social and health trends underscore and support the need for aggregative and problem focused education and research, it is not clear that AHSCs are reacting in an effective way - increased isolation from community and generalist care leaves highly specialized institutions vulnerable to criticism of both irrelevance and sub-optional care. A re-affirmation of unambiguous commitment to both study (research and educate) as well as serve those who suffer provides the most likely avenue to make the 21st century'the best of times 'for the AHSC.

Academic Medical Centers↗
PubMedDate not supplied

Framework for a clinical career structure in nursing.

There is an urgent need to define and clarify a clinical career structure in nursing. The development of a career structure is hindered by the proliferation of titles currently used by nurses when developing their knowledge and skills. It is proposed that the term nurse practitioner be replaced by either generalist or specialist nursing practitioner, depending on the individual's bias, and that nurses with a bias towards medicine be designated paramedical nurse practitioners. A three-band clinical career structure is suggested, based on these categories. This structure would allow nurses to develop their knowledge and competency while either remaining in a broader, generalist area or specializing in a particular field. This structure includes an advanced nursing practitioner level to accommodate those nurses with extensive experience of clinical nursing situations. It is imperative that the nursing profession decides its career pathways, otherwise they may find others doing it for them.

Career Mobility↗
PubMed2001

Discharge planning and social work practice.

Current health care practice discharge planning has emerged as a major professional function in hospital settings. To examine the tasks involved in discharge planning and how frequently they are being performed, 124 Alabama hospitals were contacted with a 72% rcsponse rate. Of the 178 surveys returned by discharge planners the core tasks were identified and ranked in terms of performance frequency. The results revealed that the tasks performed typically resembled that of generalist social workers. When specialization occurred, it was related to the populations served and not the specialized tasks or methods utilized. From this data recommendations are made for linking advanced generalist social work practice to discharge planning activities.

Alabama↗
PubMed2002

Examination of racial imbalance for children in foster care: implications for training.

Concerned with the high number of African American children in out-of-home care in an East Texas county, the regional administrator of a state public child welfare agency asked its IV-E partnered university to examine the kinds of training the agency might need to address the problem. A semi-annual time-series model from January 1997 to June 1999 was constructed to track the proportion of African American children at three critical case junctures: investigation, case opening, and removal of the child to out-of-home care. In addition, the study analyzed characteristics of the county's population, including racial changes and poverty. The study found that African American children were referred to public child welfare at twice the rate of Anglo children, with the ratio increasing during case progression. The study also found a higher proportion of African American children in the community and a higher poverty rate, particularly for African American children, than what was previously understood. The study not only provided details of racial distribution over time and over case disposition, but also highlighted the importance of understanding problems within a community and organizational context. The study further suggests that training include generalist and advanced generalist social work education, considering practice with systems of all sizes, to assess, prevent, treat and evaluate interventions designed for the safety, permanency and well-being of children.

Adolescent↗
PubMed2006

Research, macro practice and aging in the social work education curriculum.

This paper presents a model that used a macro emphasis for teaching research using older adults. Faculty developed the teaching model to address three key areas of concern in the education of Bachelor of Social Work (BSW) students for generalist practice: (1) research, (2) macro-level practice, and (3) aging. The paper explores the nature of these concerns and draws upon previous literature to delineate a teaching model designed to strengthen these areas of generalist practice by integrating content on macro-level concerns and aging into the curriculum of a research course. The development and evaluation of the research course within the context of a community and college project are described, as are the benefits for students, the social work program and the community. Preliminary findings indicate some support for the use of such a model.

Aged↗
PubMedDate not supplied

How are health plans supporting physician practice? The physician perspective.

IPA-model HMOs are now the dominant organizational structures for delivering "managed care" in the United States. Are they taking advantage of opportunities to support physician practices in ways that arguably could improve care? In this paper we report the findings from a survey of generalist and specialist physicians in nineteen health plans. Not surprisingly, we found that generalists are much more likely than specialists are to be the target of health plans' efforts to support care delivery. However, our survey data indicate that these opportunities generally are not being fully exploited; also, efforts that plans do make to provide information to support care often are not seen as useful by physicians.

Attitude of Health Personnel↗
PubMed1996

Asthma: better outcome at lower cost? The role of the expert in the care system.

Asthma is a common disease for which morbidity and mortality have been increasing. This despite advances in the scientific understanding of asthma and in the pharmacologic armamentarium available to treat it. The dichotomy between knowledge and outcomes led us to review asthma from a systems perspective. We have presented data first to document failure in the current system of care and then to examine factors associated with improved outcomes. We found a disparity in outcome and costs when care given by experts was contrasted with care given by generalists. We conclude that "expert-based" care systems are superior from the perspective both of the patient and of the insurer; medical outcomes are better at lower overall cost. Managed care companies are in a unique position to identify asthmatics and to shift them from generalist to expert-based care when appropriate.

Asthma↗