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Recent data do not exist regarding fourth-year medical students' performance of and attitudes toward procedural and interpretive skills, and how these differ from third-year students'.Cross-sectional survey conducted in February 2006 of 122 fourth-year students from seven U.S. medical schools, compared with their responses in summer 2005. Students estimated their cumulative performance of 22 skills and reported self-confidence and perceived importance using a five-point Likert-type scale.The response rate was 79% (96/122). A majority reported never having performed cardioversion, thoracentesis, cardiopulmonary resuscitation, blood culture, purified protein derivative placement, or paracentesis. One fifth of students had never performed peripheral intravenous catheter insertion, phlebotomy, or arterial blood sampling. Students reported increased cumulative performance of 17 skills, increased self-confidence in five skills, and decreased perceived importance in three skills (two-sided P.05).A majority of fourth-year medical students still have never performed important procedures, and a substantial minority have not performed basic procedures.

Volcanic plumes resulting from explosive volcanic eruptions present a variety of hazards depending on their behavior. Buoyant plumes heat and entrain enough of the surrounding air to rise high into the atmosphere, disrupting air traffic and causing regional ash fall. Alternatively, collapsed plumes produce dangerous fast-moving lateral flows of hot ash and gas. The transition between these behaviors and the nature of each hazard is dependent on the fluid dynamics of the volcanic plume, which is largely determined by the conditions at the vent. Most treatments of volcanic plumes for hazard assessment assume that the eruptive fluid exits the vent at pressures equal to atmospheric pressure or that pressure equalizes quickly with little effect on the flow. Here we show that vent pressures greater than atmospheric lead to rapid expansion of the plume and the development of standing shock waves that change the behavior of the entire eruption column. We simulate two volcanic plumes with the same heat flow (J s �1 ) at the vent; one exits the vent at atmospheric pressure (pressure-balanced) and the other at four times atmospheric pressure (overpressured). The two simulated plumes have the same radius after the initial rapid decompression of the overpressured case. These plumes show drastically different behavior due to the presence of standing shock waves in the overpressured case despite having the same heat flow at the vent and the same area available for entrainment of ambient air. Both simulated plumes exhibit buoyant rise but the overpressured plume collapses with a regular periodicity. These simulations suggest that the dynamics of a steady-state overpressured vent may result in plumes that oscillate between buoyant rise and collapse, providing a mechanism for the deposition of intraplinian pyroclastic flows. © 2008 Elsevier B.V. All rights reserved.

Objectives Prompt and successful cardiopulmonary resuscitation during a sudden cardiac arrest can be hindered by multiple variables, ie, ineffective communication, stress, lack of training, and an unfamiliar environment, such as a new hospital facility. The main objective of the study was to use high-fidelity simulations to orient Code Blue Teams (CBTs) to critical events in a new hospital facility. A secondary objective was to elucidate factors that may have contributed to responses by debriefing teams. Methods Mock Code Blue exercises using high-fidelity simulation were implemented in real workplace settings to orient CBTs to critical events. We measured arrival time of first responder, crash cart to code site, first six CBT responders, first chest compression, and first electrical shock. After each mock code, participants were debriefed to assess any barriers to effective response and decision making. Results Twelve mock codes were conducted at different locations of the new facility. Sixty-nine percent of the participants reported that the training was beneficial. The median time of arrival of the first responders was 42 seconds and the first CBT member was 66 seconds. The median time to initiation of chest compressions was 80 seconds, crash cart arrival was 68 seconds, and first electrical shock was 341 seconds. An additional outcome of the study was the identification of facility and systems issues that had the potential to impact patient safety. Conclusions Clinical simulation can be effectively used to orient CBTs and identify critical safety issues in a newly constructed healthcare facility.

This FEDS Note shows how we report the value of corporate equities outstanding in the Financial Accounts and describes how we estimate each of its components.

During the last three decades, the countries of the developed world have been engulfed by the 'second demographic transition', which involves new family relations, less and later marriage, declining fertility rates, population ageing, postponement of child-bearing and smaller households, among other trends. It is being increasingly argued that such population dynamics are having a powerful transformative effect on the inner city, by diversifying and redensifying its social landscapes, and creating a 'splintered' urban form. Based on the findings of a recent EU Framework 5 research project, this paper investigates the demographic contingencies of this process-also known as reurbanisation-in four European cities: Leipzig (Germany), Ljubljana (Slovenia), Bologna (Italy) and Leon (Spain). Analyses of census and municipal registry data, as well as on-site questionnaire surveys and interviews, have revealed that the reviewed cities are being populated with, and fragmented by, multiple migration trends and new household structures connected to the second demographic transition.

Electrophilic tri-substituted ethylene monomers, alkyl ring-substituted 2-phenyl-1,1-dicyanoethylenes, RC6H4CH=C(CN)2 (where R is 2-OCH3, 3-OCH3, 4-OCH3, 2-OC2H5, 3-OC2H5, 4-OC2H5, 4-OC3H7, 4-OC4H9, 4-OC6H11), were synthesized by piperidine-catalyzed Knoevenagel condensation of ring-substituted benzaldehydes and malononitrile, and characterized by CHN elemental analysis, IR, 1H- and 13C-NMR. Novel co-polymers of the ethylenes and vinyl acetate were prepared at equimolar monomer feed composition by solution co-polymerization in the presence of a radical initiator (ABCN) at 70°C. The composition of the co-polymers was calculated from nitrogen analysis, and the structures were analyzed by IR, 1H- and 13C-NMR, GPC, DSC and TGA. High T g of the co-polymers, in comparison with that of polyvinyl acetate, indicates a substantial decrease in chain mobility of the co-polymer due to the high dipolar character of the tri-substituted ethylene monomer unit. The gravimetric analysis indicated that the co-polymers decomp...

It has recently come into question whether the term ‘gentrification’ can capture the wide array of contemporary demographic processes in the inner city. There is also a need to extend the gentrification debate beyond the Anglo-American context, while understanding the urban implications of contemporary demographic processes. In response to such challenges we examine the changing population geographies of the city of Bologna, with the aim of establishing, whether the concept of ‘reurbanisation’ can provide a more useful encapsulation of its recent sociospatial transformations. Upon investigating the spatial patterns and movements of relevant population structures at various scales within the city, we have found that Bologna is the site of multifaceted and multidirectional demographic trends. In their entirety, these dynamics are leading to the social diversification, ‘residentialisation’, and fragmentation of the urban fabric. Such processes cannot be subsumed under the notion of gentrification because they do not involve major housing renovation and are spread throughout the inner city in a diffused and fragmented manner. ‘Reurbanisation’ is a more appropriate term to describe them.

Compliance with the Accreditation Council for Graduate Medical Education resident duty hours rules has created unique educational and patient-care challenges for the general medicine inpatient teaching (GMIT) teams at Texas A&M/Scott & White Memorial Hospital, including multiple patient hand-offs, multiple resident absences during teaching time, and loss of continuity of care for individual patients, all of which may have compromised patient safety. The Texas A&M/Scott & White Memorial Hospital internal medicine residency program initially complied with the duty hours rules by having residents take call every fourth night, followed by a six-hour post-call day. This system proved to be inefficient because it significantly disrupted patient care and resident education. Residents reported that this call system frequently caused them to approach the 80-hour limit and that they had difficulty leaving post-call because of unfulfilled responsibilities. They also reported sleep interruption and inadequate time to prepare for and attend educational conferences.After determining the peak admission times at the hospital, program leaders designed a call system during which the primary call team takes admissions from 12:00 pm to 8:00 pm each day, then leaves by 10:00 pm and returns after 10 hours for a full post-call day. After-hours admissions are managed by hospitalists. The solution did require hiring additional hospitalists for night-call coverage. The new structure has greatly improved the residents' experience on the GMIT teams. The entire team works together on call and post-call. Rounds and inpatient teaching continue normally on post-call days. Residents attend clinics and conferences post-call. Hand-offs are reduced greatly, and residents report that they are better rested. Residents also state that the new call system significantly enhances their education, patient care, and personal life.

Over the past 10 years, geodynamo simulations have grown rapidly in sophistication. However, it is still necessary to make certain approximations in order to maintain numerical stability. In addition, models are forced to make assumptions about poorly known parameters for the Earth's core. Different magnetic Prandtl numbers have been used and different assumptions about the presence of radiogenic heating have been made. This study examines some of the consequences of different approximations and assumptions using the Glatzmaier–Roberts geodynamo model. Here, we show that the choice of magnetic Prandtl number has a greater influence on the character of the magnetic field produced than the addition of a plausible amount of radiogenic heating. In particular, we find that prescribing a magnetic Prandtl number of unity with Ekman number limited by current computing resources, results in magnetic fields with significantly smaller intensities and variabilities compared with the much more Earth-like results obtai...

Undergraduate research is the most rewarding way for science students to become exposed to the process of scientific investigation. Water quality studies offer the unique advantages of being easily designed by the students and analytically approachable. This two-part, 14-month study involved several students in the delineation of groundwater flow patterns and water chemistry analysis in the karst terrane of Rutherford County, Tennessee. The groundwater traces were conducted using fluorescent dyes and an optical brightener, and the students were able to clearly document that urban runoff entering sinkholes was feeding the springs. They then proceeded to design a water chemistry study on four springs located within the Upper Stones River Watershed. They measured temperature, conductivity, dissolved oxygen, and oxygen demanding organics. The employment of some simple statistics allowed the students to demonstrate that the most urban spring, Murfree, had the highest coefficient of variation (CV) for temperature (17.8°C) and one of the lower conductivities (346 microsiemens). It had the lowest average dissolved oxygen concentration (4.3 mg/L), with concentrations that frequently fell below 4 mg/L. In addition, it had the highest recorded chemical oxygen demand (COD) at 33 mg O2/L. In the end, through regional and national presentations, the students documented their conclusion that the most urban spring was impacted by urbanization and surface water runoff. The project has resulted in several students pursuing advanced scientific degrees, obtaining desirable environmental science jobs, pursing competitive fellowships, and writing scientific papers.

Whether attending physicians, residents, nurses, and medical students agree on what constitutes medical student abuse, its severity, or influencing factors is unknown.We surveyed 237 internal medicine attending physicians, residents, medical students, and nurses at 13 medical schools after viewing five vignettes depicting potentially abusive behaviors.The majority of each group felt the belittlement, ethnic insensitivity, and sexual harassment scenarios represented abuse but that excluding a student from participating in a procedure did not. Only a majority of attending physicians considered the negative feedback scenario as abuse. Medical students rated abuse severity significantly lower than other groups in the belittlement scenario (p.05). Respondents who felt abused as students were more likely to rate behaviors as abusive (p.05).The groups generally agree on what constitutes abuse, but attending physicians and those abused as students may perceive more behaviors as abusive.

During the last three decades, the household has become the focus of a wide range of sociodemographic processes, including the destabilization of traditional patterns of marriage, cohabitation and divorce; the growing fluidity of ties of kin and friendship; and increasingly complex transitions through the life course. However, these dynamics - which are often summarized under the common heading of the `second demographic transition' - have been marginalized in the mainstream geographical literature. In this paper, we draw attention to the extensive, albeit fragmented, body of sociological, economic, feminist and geographical insights into the changing social geometry of the household. Recent developments in these domains have affirmed the pivotal role of the household in shaping the geographies of gender, home and everyday life. We underline the importance of households as agents of urban transformation, arguing in favour of the further incorporation of household demography into the interpretation of contemporary urban problems and trends.

European household structures and their geography have been transformed in recent decades as a response to the interplay of demographic events and changing lifestyles. The formation of new households generally outstrips the rate of population increase, as more numerous and smaller households result from changing patterns of marriage, child-bearing, divorce and longevity. This paper tests some of the underlying hypotheses of the ‘second demographic transition’ using data from the most recent (1999) French population census. It provides an analysis of changing national household structures over the last quarter of the twentieth century and highlights the importance of smaller households, with particular emphasis on the rise of living alone. Trends identified in earlier work have intensified during the 1990s. In discussing the geography of new household forms, the paper focuses particularly on the evolution of major central cities and argues for more explicit links between their distinctive population and household structures and wider socio-economic change.

The 1980s was a significant decade in the demography of Inner London. Population increase replaced decades of decline, and household numbers grew even faster. One-person households accounted for most of the growth in household numbers, and the greatest increase was among younger and middle-aged adults. The authors examine the characteristics and changing geography of one-person households in Inner London, particularly between 1981 and 1991, within the context of broader demographic and socioeconomic changes during the decade. In particular, the characteristics of those people who migrated to live alone in Inner london are examined, and questions raised about the relationship between household changes, residential mobility, occupational structures, and housing markets. Reference is also made to the London Borough of Tower Hamlets to explain some of the processes underlying household change. One-person households are an integral part of wider economic and social processes underway in large urban areas and form a leading edge of new ways of urban living.

To identify an appropriate model of human renin-angiotensin system (RAS) involvement in fetal origins of adult disease, we quantitated renal ANG II AT1 and AT2 receptors (AT1R and AT2R, respectively) in fetal (90-day gestation, n = 14), neonatal (3-wk, n = 5), and adult (6-mo, n = 8) microswine by autoradiography (125I-labeled [Sar1Ile8]ANG II+cold CGP-42112 for AT1R,125I-CGP-42112 for AT2R) and by whole kidney radioligand binding. The developmental pattern of renal AT1R in microswine, like many species, exhibited a 10-fold increase postnatally ( P < 0.001), with maximal postnatal density in glomeruli and lower density AT1R in extraglomerular cortical and outer medullary sites. With aging, postnatal AT1R glomerular profiles increased in size ( P < 0.001) and fractional area occupied ( P < 0.04), with no change in the number per unit area. Cortical levels of AT2R by autoradiography fell with age from ≅5,000 fmol/g in fetal kidneys to ≅60 and 20% of fetal levels in neonatal and adult cortex, respectively ( P < 0.0001). The pattern of AT2R binding in postnatal pig kidney mimicked that described in human and simian, but not rodent, species: dense AT2R confined to discrete cortical structures, including pre- and juxtaglomerular, but not intraglomerular, vasculature. Our results provide a quantitative assessment of ANG II receptors in developing pig kidney and document the concordance of pigs and primates in developmental regulation of renal AT1R and AT2R.

Objective — To identify vascular cells capable of responding to angiotensin II (Ang II) generated in conduit arteries, we examined the Ang II type 1 receptor (AT1R) and Ang II type 2 receptor (AT2R) in the thoracic aorta (TA) and abdominal aorta (AA) and branches in 90-day fetal, 3-week postnatal, and 6-month adult microswine. Methods and Results — By autoradiography ( 125 I-[Sar 1 Ile 8 ]-Ang II with or without AT1R- or AT2R-selective analogues or 125 I - CGP 42112), there were striking rostrocaudal differences in (1) AT2R binding at all ages (prominent in AA wall and branches, sparse in TA wall and branches) and (2) a non-AT2R binding site for CGP 42112 (consistently evident in postnatal TA and branches but absent in AA and branches). Furthermore, patterns of AT2R distribution in infradiaphragmatic arteries were developmentally distinct. In fetal AAs, high-density AT2Rs occupied the inner 60% of the medial-endothelial wall. In postnatal AAs, AT2Rs were sparse in the medial-endothelial wall but prominent in a circumferential smooth muscle α-actin–negative cell layer at the medial-adventitial border, occupying ≈20% to 25% of the AA cross-sectional area. AT1R density in the TA and AA medial-endothelial wall increased with age, whereas AT2R density decreased after birth. Conclusions — A novel AT2R-positive cell layer confined to postnatal infradiaphragmatic arteries physically links adventitial and medial layers, appears optimally positioned to transduce AT2R-dependent functions of local Ang II, and suggests that adventitial Ang II may elicit regionally distinct vascular responses.

The use of cannabis for medical purposes, evident throughout history, has become a topic of increasing interest. Yet on the present medical evidence, cannabis-based treatments will only be appropriate for a small number of people in specific circumstances. Experience with cannabis as a recreational drug, and with use of psychoactive drugs that are prescribed and abused, should inform harm reduction in the context of medical cannabis.

Obesity is now the second leading cause of death and disease in the United States leading to health care expenditures exceeding $147 billion dollars. The socioeconomically disadvantaged and racial/ethnic minority groups are at significantly increased risk for obesity. Despite this, low income and minority individuals are underrepresented in the current obesity treatment literature. Additionally, weight loss outcomes for these high risk groups are well below what is typically produced in standard, well-controlled behavioral interventions and reach and access to treatment is often limited. The use of telecommunications technology may provide a solution to this dilemma by expanding dissemination and allowing for dynamic tailoring. Further gains may be achieved with the use of material incentives to enhance uptake of new behaviors. Regardless of what novel strategies are deployed, the need for further research to improve the health disparities associated with obesity in disadvantaged groups is critical. The purpose of this manuscript is to review the weight loss intervention literature that has targeted socioeconomically disadvantaged and racial/ethnic minority populations with an eye toward understanding outcomes, current limitations, areas for improvement and need for further research.

Philip E. Ogden in his reports on the state of population geography attempts to provide evidence of the continued interest of geographers in the field of population studies thus making a plea for its enhanced status. Ogden also tries to provide a critique of the approaches of population geographers as demonstrated by the material reviewed in the period from late 1995 to early 1999. He notes items of geographical interest from the wider literature. In the process three points about the field are identified: 1) the challenge must be to strengthen population geography by engaging more fully in the wider methodological and theoretical debates in human geography; 2) population geographers need to forge stronger links with other branches of discipline; and 3) the relationship between population geography and other disciplines is important and represents a particular challenge. In this final report Ogden seeks to reinforce these points by focusing on three main aspects: the long-term view of demographic change; the continuing importance of the geography of populations; and migration which remains the area where geographers make the most notable and increasingly original contributions.

The role of the telephone in medical practice is important, but often problematic. Mistakes in telephone diagnosis and triage can have severe consequences. An effective office system can reduce liability risks, and in some cases telephone contact can substitute for office visits. Internists feel unprepared to provide telephone care. Therefore, residency education needs to focus on documentation, consultant availability, and performance feedback. Research should focus on improving outcomes, reimbursement issues, and technologic advances. This article describes internists' telephone interactions with ambulatory patients, preparation for telephone medicine, and aspects of office telephone systems and makes comparisons with other primary care fields.

This paper is a summary report of the “Teamed Internships Program” (TIP), an Advanced Technological Education (ATE) grant through the National Science Foundation (NSF). This three-year project created internships encompassing regional industries, federal research facilities, and two- and four-year educational institutions. The project cultivated teamwork and communication skills for environmental technician and engineering students, developed instructional materials, and provided valuable contacts with industry. To foster faculty and teacher enhancement and student interest in environmental science and technology, insights from the program were incorporated into instructional materials and educational modules for dissemination to local secondary schools.

The past two decades have seen profound changes in European patterns of demographic behaviour, family formation and household structure. One aspect of the 'second demographic transition' is the appearance of new and more varied household forms, especially in the large cities. Data are analysed here for France's 10 largest cities for the period 1975-90, with particular reference to their central areas. While some continue to experience population decline through out-migration, for most the 1980s saw a reversal of their demographic fortunes, thus adding further evidence to the hypothesis of reurbanisation observed elsewhere. Analysis of household change shows large increases in numbers in most cities, even where overall population is declining. Households are becoming smaller, with up to 75 per cent of households in central cities consisting of 1 or 2 persons. The increase in 1-person households, to which particular attention is paid in this paper, has been rapid. The paper also demonstrates the decline in 'traditional families' in the cities. The rise of living alone is linked to age, gender, social status and ethnicity, with young professionals, especially women, at the cutting edge of household change.

Ethnic groups in the 1991 Census. Ceri Peach. The 1991 British census was the first to pose a question on ethnic origin. It revealed a non-European origin population of 3 million, or 5,5% of the British population; nearly half of this number had been born in Britain. Indians constitute the largest group and together with the Pakistanis and Bangladeshis, they account for nearly half of the ethnic population. The ethnic minorities are highly concentrated into the largest urban centres. However, there are large contrasts between the socio-economic profiles of the different groups with a high degree of professionalisation of the Indians and Chinese and a more blue collar profile of the Caribbean, Pakistani and Bangladeshi populations. The Bangladeshis appear particularly disadvantaged. There are signifiant differences in the degrees of ethnie segregation of the different groups., Les groupes ethniques au recensement de 1991. Ceri Peach. Le recensement britannique de 1991 a été le premier à poser une question sur l'origine ethnique. Il a révélé que la population d'origine non européenne s'élevait à trois millions de personnes, soit 5,5 % de la population britannique. Près de la moitié sont nés en Grande Bretagne. Les Indiens constituent le groupe le plus nombreux, et avec les Pakistanais et les Bangladais ils représentent près de la moitié de la population des minorités ethniques. Ces minorités sont fortement concentrées dans les plus grands centres urbains. Cependant, on observe de profonds contrastes entre les profils socio-économiques des différents groupes : un haut degré de professionnalisation chez les Indiens et les Chinois et un profil plutôt col bleu parmi les Caribéens, les Pakistanais et les Bangladais, ces derniers étant particulièrement défavorisés. Les divers groupes connaissent des différences significatives en terme de ségrégation ethnique., Los grupos étnicos en el censo de la población britanica de 1991. Ceri Peach. El censo de la población de 1991 fue el primero con una pregunta sobre la cuestión del origen étnico. Puso de manifiesto que la población de origen no europeo en Gran Bretaña se eleva a tres millones de personas, es decir, el 5,5 % de la población britanica. Cerca de la mitad de esta población no europea ha nacido en Gran Bretaña. Los Indios junto a los Paquistanies y los originarios de Bangladesh constituyen casi la mitad de la población étnica. Las minorías se encuentran concentradas de manera importante en los centras urbanos mas grandes. No obstante, se observan profundos contrastes entre los pérfiles socio-económicos de los diferentes grupos. Así, encontramos entre los Indios y los Chinos un alto grado de cualificación profesional y en contraste, encontramos un perfil profesional mas bien no cualificado entre los Caribenos, los Paquistanies y los originarios de Bangladesh, siendo estos los mas desfavorecidos. Existen diferencias significativas de nivel de segregación entre los diferentes grupos., Peach Ceri. Les groupes ethniques au recensement britannique de 1991. In: Revue européenne des migrations internationales, vol. 15, n°1,1999. Migration et ethnicité au Royaume-Uni. pp. 13-37.

Las minoróas étnicas en Gran Bretaña : aspectos geográficos de sus migraciones internas recientes y de sus dinámicas demográficas. David Owen. Este artículo analiza la movilidad de las minorias étnicas dentro de Gran Bretaña en relación con los cambios en lo concerniente a la distribución espacial de la población en la década de los ochenta. Así, los cambios que han afectado a los grupos étnicos entre 1981 y 1991 revelan un movimiento de desurbanización de la población blanca y un rápido crecimiento de los grupos étnicos minoritarios en las ciudades más grandes. En las corrientes migratorias hacia las localidades mas pequeñas, mas rurales, mas lejanas, la población blanca ha dominado. La movilidad de los grupos étnicos minoritarios se ha orientado hacia un « eje de urbanización » que se extiende desde Londres hasta Manchester. Pero estos grupos están también abandonando el centro de Londres para instalarse en los suburbios.

Objectives To: (1) develop a pharmaceutical care multicenter outcomes research project using clinical pharmacy residents and preceptors; (2) develop two research protocols to document pharmacists' impact on clinical, economic, and humanistic outcomes of therapy; (3) develop and implement a data collection process and methodology for outcomes research; (4) evaluate the effectiveness of the multicenter outcomes research process; and (5) prepare clinical pharmacy preceptors and residents to conduct outcomes research. Design and Setting Two research protocols were developed, each a randomized, parallel, open-label evaluation of patients at 10 Department of Veterans Affairs and 1 university medical center. One protocol focused on patients with chronic obstructive pulmonary disease (COPD) and the other on patients with hypertension. The study evaluated pharmacists' management of these two patient groups. Patients and Other Participants 133 patients with hypertension and 98 patients with COPD; 33 pharmacy directors and preceptors; 45 pharmacy residents. Main Outcome Measures Clinical, economic, and humanistic outcomes of pharmacists' interventions. The processes of developing a multicenter outcomes study were evaluated, including the data collection process. Results The two study protocols and an educational program for study participants were developed. A data collection process was developed and implemented, with the paper process being successful and the computer data collection process not implemented due to time constraints. Overall, the multicenter outcomes research process was successful. Conclusion The study provides a framework of processes and sites for the future development of other outcomes research studies. Clinical, economic, and humanistic outcomes are reported in Parts 2 and 3.

To determine whether residents perceived oral, face-to-face feedback about their continuity clinic performance as better than a similar, written version.Single-blind, randomized controlled trial.Two university-based, internal medicine residency clinics.All 68 internal medicine and combined program (medicine-pediatrics, medicine-psychiatry, medicine-neurology, and preliminary year) residents and their clinic preceptors.Residents at each program were separately randomized to oral or written feedback sessions with their clinic preceptors. The oral and written sessions followed similar, structured formats. Both groups were later sent questionnaires about aspects of the clinic. Sixty-five (96%) of the residents completed the questionnaire. Eight of the 19 questions dealt with aspects of feedback. A feedback scale was developed from the survey responses to those eight questions (alpha = .86). There were no significant differences in the responses to individual questions or in scale means (p.20) between the two feedback groups. When each university was analyzed separately, one had a higher scale mean (3.10 vs 3.57, p = .047), but within each university, there were no differences between the oral and written feedback groups (p.20).No differences were observed between the oral and written feedback groups. In attempting to provide better feedback to their residents, medical educators may better apply their efforts to other aspects, such as the frequency of their feedback, rather than the form of its delivery.

This paper reviews the general patterns of demographic change, historical population geography and migration and works that were published during 1995-96. The review includes works of geographers, demographers, historians, and others, where there are clear geographical implications. The aim of the review is to show that population geography thrives and indicates some of the challenges it faces in the light of developments both in related areas of geography and beyond the discipline in, for example, demography and history. The paper begins by examining recent methodological and substantive trends in economic, social and cultural geography. Then, it demonstrates the relevance of demographic phenomena to those fields where they are largely ignored.

This paper examines the increase of one-person households during the 1980s in England and Wales and France set within the broader context of household change in Europe as a whole....One-person households vary geographically by age with younger one-person households found especially in larger urban areas; older one-person households have a more varied distribution although rural and traditional retirement areas have particular concentrations. Increases in numbers are a result of both compositional changes in the population (increasing numbers of divorced and never-marrieds as well as increasing numbers of elderly) and also an increasing propensity to live alone especially among younger age groups. (EXCERPT)

McCLeery Alison, Ogden Philip E. Compte-rendu de colloque : Méditerranée et migration. In: Revue européenne des migrations internationales, vol. 13, n°1,1997. pp. 215-220.

Mistreatment in the learning environment is a topic of great concern for medical schools and medical students who wish to train in healthy learning environments. On the 2012 Association of American Medical Colleges Graduation Questionnaire, 47.1% of students responded that they had personally experienced some type of mistreatment. The most commonly reported forms of mistreatment included public humiliation, being subjected to offensive remarks, and being asked to perform personal service. Because the particular behaviors constituting these forms of mistreatment are not specified, educators have struggled to teach students how to interpret behaviors in the learning environment. This resource is an interactive workshop for rising clinical students on mistreatment education. The goal of this module is to provide students with a nuanced approach to mistreatment. We focus on the gray areas that often lead students to wonder, “Have I been mistreated?” The scenario scripts are designed to serve as triggers for discussion about mistreatment in clinical settings. The accompanying slide set is used with the scenario scripts to facilitate interaction. The pocket cards help students interpret common situations that may occur during clinical training. These scenario scripts, along with the accompanying slide set and pocket cards, are designed to help students work through the nuanced aspects of mistreatment. The slide set may also be used to raise awareness among residents and faculty about appropriate and inappropriate behaviors.

Low-level mixed radioactive wastes containing cellulose-based materials and plutonium have been generated during various nuclear processing activities. Biological digestion of the organic- or cellulose- based material was examined as an environmentally acceptable and effective method of treatment for these and other similar wastes. Cellulase enzyme was used to initiate biodegradation prior to 90% destruction of the cellulose material by a sewage sludge consortium. Plutonium did not significantly effect the biodegradation. Bench-scale experimental data were used to design a batch treatment system. A cost and sensitivity analysis was performed to determine the optimal reactor size, materials of construction and media type. The sensitivity analysis indicated that while a 12-month treatment scenario using a carbon steel ball mill, sludge digester and vacuum thickener was the least expensive scenario evaluated on a levelized cost basis ($800 per ton of waste degraded per month), the 12-month scenario using stainless steel construction and the alternative dewatering system offered the most cost-effective treatment alternative and better corrosion resistance (levelized cost of $1130 per ton per month). The dewatering system consisting of a disk centrifuge and sludge dryer is capable of doubling the sludge solids content and produce an overall waste reduction of 67%. The proposed waste treatment system offers a cost savings of up to 31% compared to conventional disposal practices.

The last four decades have seen the establishment of close migratory links between the French Caribbean islands of Martinique and Guadeloupe and the metropole....The present paper focuses on the...complex migratory links--including continuing emigration from the islands for work and education return migration and circulation--which have come to characterise the 1980s....The paper aims also to contribute to the broader conceptualisation of migration and mobility. The principal conclusions reveal that the more straightforward labour migration of the years from 1963 to 1981 has been replaced by some considerable return migration (amongst young adults particularly) and circulation....The paper also demonstrates that the role of migration in reducing population growth and fertility in the islands has been much altered during the course of the 1980s. (EXCERPT)

Simulation-based medical education (SBME) has become a regular feature of undergraduate and graduate medical education in Internal Medicine. Within undergraduate medical education, this teaching modality is used to facilitate medical knowledge acquisition and to teach and assess clinical skills, diagnostic reasoning, basic technical skills, and patient communication. SBME also allows students to practice roles with hospital teams prior to residency. In Internal Medicine residency training programs, SBME is used to teach procedural skills and hospital teamwork, such as code teams; practice infrequent events; and evaluate competencies. Continuing medical education also utilizes SBME to actively engage physicians and facilitate lifelong learning. In Canada, Internal Medicine certification requirements have an integrated simulation component. While this practice is not widespread outside Canada, it may be a common element in Internal Medicine certification and recertification in the future.

BACKGROUND Little is known about how internal medicine residents train for and practice telephone management. To address this deficiency, a national survey of program directors at accredited internal medicine training sites was conducted to evaluate residents' training for and practice of telephone medicine. METHOD A 43-item questionnaire was mailed in December 1993 to all program directors at the 416 accredited internal medicine training sites in the United States. A limited questionnaire, regarding the most essential training questions, was mailed to all non-responders. RESULTS The response rate was 60% (250) for the full questionnaire. Only 15 (6%) of the programs offered formal training in telephone management to their residents. This training usually consisted of single lectures (nine programs) or reading materials (seven programs). The respondents felt that formal training in telephone management was very important (155, 62%) and that such training should be a part of every internal medicine curriculum (150, 60%). CONCLUSION Few internal medicine programs offered training in telephone management. When training occurred, it was usually limited and informal. Most program directors felt that training was important and that current training efforts were unsatisfactory, emphasizing the need for curriculum development and implementation in telephone management.

A cDNA encoding human urokinase was inserted into the Autographa californica nuclear polyhedrosis virus (AcNPV) genome at the polyhedrin gene locus under control of a duplicated copy of the late, basic protein gene promoter. The insect-derived urokinase was produced predominantly in the form of single-chain, pro-urokinase, with a molecular mass of 50 kDa, and demonstrated fibrinolytic activity. Synthesis and secretion of urokinase was first detected at 6 hours post-infection and continued steadily throughout the infection period. Comparisons with urokinase synthesised using the very late AcNPV polyhedrin gene promoter revealed that, although the polyhedrin promoter is intrinsically stronger, the yield of secreted urokinase was higher using the basic protein gene promoter. These data support the hypothesis that the host cell secretory pathway is compromised in the very late stages of baculovirus infection and may provide an explanation for why, in general, secreted and membrane-targeted proteins are not produced to the high levels observed with other proteins, when using very late baculovirus gene promoters.

Chemically modified haemoglobin solutions represent a potential alternative to the transfusion of donor blood. The theoretical advantages of these products include an oxygen delivery potential greater than that of conventional plasma expanders, prolonged shelf-life, universal compatibility and the absence of pathogenic viruses. Principal concerns have been safety issues including renal toxicity, coagulopathy and vasoactivity. The proposed indications for these solutions are primarily resuscitation of patients in haemorrhagic shock and perioperative haemodilution during elective surgery. Three products have now undergone phase I safety trials in human subjects and phase II safety and efficacy trials are planned in the near future.

[1] Volcanic plumes are often studied using one-dimensional analytical models, which use an empirical entrainment ratio to close the equations. Although this ratio is typically treated as constant, its value near the vent is significantly reduced due to flow development and overpressured conditions. To improve the accuracy of these models, a series of experiments was performed using particle image velocimetry, a high-accuracy, full-field velocity measurement technique. Experiments considered a high-speed jet with Reynolds numbers up to 467,000 and exit pressures up to 2.93 times atmospheric. Exit gas densities were also varied from 0.18 to 1.4 times that of air. The measured velocity was integrated to determine entrainment directly. For jets with exit pressures near atmospheric, entrainment was approximately 30% less than the fully developed level at 20 diameters from the exit. At pressures nearly three times that of the atmosphere, entrainment was 60% less. These results were introduced into Plumeria, a one-dimensional plume model, to examine the impact of reduced entrainment. The maximum column height was only slightly modified, but the critical radius for collapse was significantly reduced, decreasing by nearly a factor of two at moderate eruptive pressures.

We characterize wave propagation along an infinitely long crack or conduit in an elastic solid containing a compressible, viscous fluid. Fluid flow is described by quasi-one-dimensional mass and momentum balance equations with a barotropic equation of state, and the wall shear stress is written as a general function of width-averaged velocity, density, and conduit width. Our analysis focuses on small perturbations about steady flow, through a constant width conduit, at an unperturbed velocity determined by balancing the pressure gradient with drag from the walls. Short wavelength disturbances propagate relative to the fluid as sound waves with negligible changes in conduit width. The elastic walls become more compliant at longer wavelengths since strains induced by opening or closing the conduit are smaller, and the fluid compressibility becomes negligible. As wavelength increases, the sound waves transition to crack waves propagating relative to the fluid at a slower phase velocity that is inversely proportional to the square-root of wavelength. Associated with the waves are density, velocity, pressure, and width perturbations that alter drag. At sufficiently fast flow rates, crack waves propagating in the flow direction are destabilized when drag reduction from opening the conduit exceeds the increase in drag from increased fluid velocity. This instability may explain the occurrence of self-excited oscillations in fluid-filled cracks.

• Background: Transforming growth factor-β (TGF-β) plays an important role in the pathogenesis of many ocular diseases, including proliferative vitreoretinopathy. We examined the effect of TGF-β on the phagocytosis of rod outer segments by retinal pigment epithelium (RPE), which is a major function of RPE, and investigated the dependence of this effect on the protein kinase C (PKC) pathway. • Methods: Phagocytotic uptake of fluoresceinated bovine rod outer segments was determined by flow cytometry. RPE cells were treated with TGF-β1 or TGF-β2 and their effects on phagocytosis were examined. The effects of various PKC inhibitors (calphostin C, staurosporine, and extended exposure to phorbol 12-myristate 13-acetate, PMA) and a stimulator (brief exposure to PMA) on RPE phagocytosis was evaluated. • Results: Both TGF-β1 and TGF-β2 up-regulated RPE phagocytosis and PMA abolished the upregulating effect of TGF-β. In contrast, PKC inhibition by staurosporine and calphostin C resulted in increased phagocytosis. A combination of TGF-β and PKC inhibitor treatment did not produced any additive effect on phagocytosis. • Conclusion: We concluded that TGF-β up-regulates human RPE phagocytosis, but that this effect is counteracted by PKC activation. It is possible that this TGF-β-induced effect is due, in part, to a negative modulation of the PKC-dependent pathway.

Macrophages are invariably present in the intraocular membranes of patients with traumatic proliferative vitreoretinopathy (PVR). There are two sources from which these macrophages could be recruited: adjacent tissues and the systemic circulation. In the study described herein, the role of circulating white blood cells and monocytes in experimental, traumatic PVR was studied. The circulating white blood cells of 20 rabbits were depleted by intravenous injection of strontium-89. Posterior perforating eye injury with subsequent intravitreal injection of autologous whole blood or autologous activated macrophages was then performed on these leukopenic animals. The experiments demonstrated that severe bone marrow depression reduced significantly the incidence of retinal detachments in eyes receiving whole blood, and reduced the severity of retinal detachments in eyes injected with activated macrophages. An association between the degree of leukopenia, monocytopenia, and protection from retinal detachment was demonstrated. These results support the hypothesis that macrophage infiltration is an important component of intraocular cellular proliferation, but does not exclude the role of other types of white blood cells in the pathogenesis of PVR.

It is clear from the trials described here that the number of different products being tested and the potential variation between batches of the same product present major problems in evaluating the safety and efficacy of hemoglobin-based oxygen carriers. The recent CBER "Points to Consider" document [42] makes clear that an understanding of the safety of oxygen carriers in humans is of paramount importance. In the event of phase II or indeed phase III trials being approved, the need may still remain for additional phase I or preclinical studies, particularly as unwanted or toxic properties of the solutions affect efficacy. It is likely that demonstrating safety and efficacy in acute hemorrhagic shock will be the most difficult task, as this is a complex clinical indication and is often accompanied by multisystem damage. The use of a hemoglobin-based oxygen carrier in this setting must have a distinct advantage over a plasma expander alone. In the application of perioperative transfusion, a decreased requirement for red cell transfusion has already been accepted as a basis for the efficacy for erythropoietin. However, in the case of a hemoglobin-based oxygen carrier, the reduction of red cell requirement in perioperative procedures would need to be balanced against any adverse drug reactions or unacceptable hemodynamic effects that may be caused by the product. It appears that there are still numerous hurdles to overcome in the development of hemoglobin-based red cell substitutes. Before these products can become established in medical practice, it is imperative that the potential mechanisms of toxicity of cell-free hemoglobin are clearly understood. Approval of hemoglobin-based oxygen carriers for clinical use will depend not only on clear demonstration of both safety and efficacy but also on risk-versus-benefit issues. Our understanding of the physiological effects of these products will evolve as progress is made in their clinical evaluation.

Octreotide, a somatostatin analog, was evaluated for its effects on long-term survival in a mouse model of endotoxemia and for its effects on endotoxin-induced suppression of human leukocyte migration. Swiss Webster mice were simultaneously rendered endotoxemic with a single intraperitoneal injection of 800 micrograms E. coli Lipopolysaccharide (LPS) and treated with one of four doses of subcutaneous (s.c.) octreotide (1.0 mg/kg in 0.4 ml saline, 0.1 mg/kg in 0.4 ml saline, 0.1 mg/kg in 0.04 ml saline, or 0.001 mg/kg in 0.04 ml saline) or saline alone (fluid-resuscitated control group: 0.4 ml saline s.c.; or non-fluid-resuscitated control group: 0.04 ml saline s.c.). Octreotide was continued with or without supplemental s.c. fluid resuscitation (0.4 ml saline) at eight hour intervals for either twenty-four or forty hours. There was no statistical significance to differences in long-term survival between comparable groups of octreotide treated vs saline treated animals during the entire fourteen day period of observation. Fluid resuscitation during the first forty hours following endotoxemia induction delayed death, but did not significantly improve long-term survival. In vitro work was conducted to determine the effect of octreotide on endotoxin-induced suppression of human leukocyte migration. Octreotide at concentrations ranging from 3.05 x 10(-5) Molar to 3.05 x 10(-11) Molar had no significant effect on leukocyte migration. In this study octreotide treatment failed to improve long-term survival in mice with endotoxemia and did not alter endotoxin-induced suppression of leukocyte migration.

The end-Permian extinction decimated up to 95% of carbonate shell-bearing marine species and 80% of land animals. Isotopic excursions, dissolution of shallow marine carbonates, and the demise of carbonate shell-bearing organisms suggest global warming and ocean acidification. The temporal association of the extinction with the Siberia flood basalts at approximately 250 Ma is well known, and recent evidence suggests these flood basalts may have mobilized carbon in thick deposits of organic-rich sediments. Large isotopic excursions recorded in this period are potentially explained by rapid venting of coal-derived methane, which has primarily been attributed to metamorphism of coal by basaltic intrusion. However, recently discovered contemporaneous deposits of fly ash in northern Canada suggest large-scale combustion of coal as an additional mechanism for rapid release of carbon. This massive coal combustion may have resulted from explosive interaction with basalt sills of the Siberian Traps. Here we present physical analysis of explosive eruption of coal and basalt, demonstrating that it is a viable mechanism for global extinction. We describe and constrain the physics of this process including necessary magnitudes of basaltic intrusion, mixing and mobilization of coal and basalt, ascent to the surface, explosive combustion, and the atmospheric rise necessary for global distribution.

Objective: The overall goal of the study was to understand the accuracy of self-reported weight over a 6-month Web-based obesity program. Materials and Methods: As part of a larger study, subjects (n=323; 93% female; 28% African American) were randomized to a 6-month Internet-based behavioral weight loss program with weekly group meetings delivered either: (1) entirely by online synchronous chats or (2) by a combination of online chats plus monthly in-person group sessions. Observed weights were obtained at 0 and 6 months for all participants. Self-reported weights were submitted weekly to the study Web site. Differences in Observed and Reported weights were examined by gender, race, and condition. Results: Observed and Reported weight were significantly correlated at 0 and 6 months (r=0.996 and 0.996, ps