Rapid and accurate detection of malaria parasites in blood is needed to institute proper therapy. We developed and used a real-time PCR assay to detect and distinguish four Plasmodium spp. that cause human disease by using a single amplification reaction and melting curve analysis. Consensus primers were used to amplify a species-specific region of the multicopy 18S rRNA gene, and SYBR Green was used for detection in a LightCycler instrument. Patient specimens infected at 0.01 to 0.02% parasitemia densities were detected, and analytical sensitivity was estimated to be 0.2 genome equivalent per reaction. Melting curve analysis based on nucleotide variations within the amplicons provided a basis for accurate differentiation of Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. For assay validation, 358 patient blood samples from the National University Hospital in Singapore and Evanston Northwestern Healthcare in Illinois were analyzed. Of 76 blinded patient samples with a microscopic diagnosis of P. falciparum, P. vivax, or P. ovale infection, 74 (97.4%) were detected by real-time PCR, including three specimens containing mixed P. falciparum-P. vivax infections. No Plasmodium DNA was amplified in any of the 82 specimens sent for malaria testing but that were microscopically negative for Plasmodium infection. In addition, 200 blood samples from patients whose blood was collected for reasons other than malaria testing were also determined to be negative by real-time PCR. Real-time PCR with melting curve analysis could be a rapid and objective supplement to the examination of Giemsa-stained blood smears and may replace microscopy following further validation.

Students at the University of Botswana, an at-risk group, have previously been shown to have high levels of risky sexual behavior despite widespread knowledge that these behaviors might lead to HIV-1 infection. As there have recently been considerable efforts focused on HIV-1 prevention in Botswana through nationwide media education campaigns and the opening of voluntary counselling and testing centers, re-evaluation of HIV-related knowledge, attitudes, and practices among students is needed. A cross-sectional survey was administered to 393 students chosen via a random cluster method. Respondents were 50% junior and 50% senior students with 42% males. Half (52%) were “single”, 44% were “in a relationship”, and 4% were “married”. The mean percentage of knowledge questions answered correctly was 96%. 98% agreed that all sexually active adults should know their status and that condom use is important, but only 56% believed getting tested was common and 66% believed that it was common for students to always use a condom. As with the previous survey, we again found that students had excellent knowledge yet perceived use of testing services and condoms remain lower than might be predicted based on knowledge scores.

Background: Core clinical competencies have been established at the graduate and post-graduate levels by organizations such as the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME). However, some clinical competencies are less well addressed by a traditional inpatient-based medical school curriculum. These include those related to continuity of care in the outpatient setting, and to healthcare delivery, structure, and financing. The purpose of this study is to determine if the addition of voluntary extracurricular clinical activities, specifically, a student-run outpatient clinic, to the traditional medical school curriculum can help students to practice and thus achieve proficiency in underrepresented aspects of the core competencies.Methods: In 2010 we administered an online 11-question survey to current Mount Sinai School of Medicine (MSSM) students in which they self-assessed their exposure, both in formal curricular experiences and extracurricular clinical activities, to clinical tasks and activities related to 8 core competencies. Students reported how often they perform the clinical tasks in both inpatient and outpatient settings or with pediatric and adult patients, and also how often they participate in 29 extracurricular activities, including MSSM’s student-run clinic, the East Harlem Health Outreach Partnership (EHHOP). Data from 126 completed surveys were analyzed by students’ curricular level (preclinical v. clinical) and level of participation in each extracurricular activity; associations were sought between participation in the activity and exposure to the clinical tasks under study.Results: For preclinical medical students, EHHOP participation was associated with statistically significant, time commitment-dependent increases in exposure to 7 of the 15 clinical tasks in the target exposure domain (adult patients in the outpatient setting). There was one statistically significant association between EHHOP participation and exposure to a task in the control domain (pediatric patients and/or the inpatient setting), specifically working with an interdisciplinary team in the inpatient setting. Clinical students also reported significant, participation-dependent increases in exposure to 11 of 15 tasks in the target domain. There were no significant associations between EHHOP participation and control domain scores. For the 5 other extracurricular activities with large enough membership to allow similar analysis, only 12 (of a possible 208) significant results were obtained; none occurred consistently within a given domain.Conclusions: Volunteering at an extracurricular, school-sponsored ambulatory clinic for uninsured patients was significantly associated with exposure to the core competencies under study. No pattern of association was observed for the 5 other activities with sufficient membership to allow similar analysis. Despite limitations inherent in the nonrandomized cohort design, the data warrant further study of the pedagogical efficacy of student-run free clinics.