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Background Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. Methods In 2009, 59 internal medicine and family medicine residents (postgraduate year 2–3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n = 32) and The University of Texas Medical School at Houston (n = 27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. Results While 53% of residents agreed/strongly agreed they had “sufficient knowledge of advance directives, given my years of training,” 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that “didactic sessions on advance directives should be offered by my hospital, residency program, or medical school.” A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: “Advance directives should only be discussed with patients over 60,” “I have sufficient knowledge of advance directives, given my years of training,” and “I believe my experience with advance directives is adequate for the situations I routinely encounter.” Conclusion Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

This study examines the changing demography of the Spanish city of Leon, and aims to explore the manner in which its urban fabric was reshaped by processes of reurbanization, a dynamic whereby the inner city becomes more attractive to a wide variety of household types and social groups. We draw on sociodemographic analyses of municipal census data, as well as a customized questionnaire survey of local residents. Empirical evidence is provided both for the city as a whole and two inner-city districts, Casco Antiguo and El Ejido. Among other findings, it is argued that, although the contiguous built-up area of the city is clearly losing its inhabitants through out-migration and aging, there are a series of small-scale migration flows that increasingly concentrate "nontraditional" households in and around the city center. This is accompanied by an increasing trend toward "city-mindedness" as a residential choice and housing preference among both in-migrants and the long-time residential population. Overall, ...

Dysfunction of the retinal pigment epithelium (RPE) is a major component of many degenerative disorders of the retina. We have developed a modified pars plana technique for subretinal implantation of homologous, cultured, carbon-loaded RPE cells in the rabbit. The natural history and morphologic behavior of the implanted RPE cells for up to 6 weeks after transplantation were observed in successful procedures.

Increasing concern over viral contamination of blood is spurring the development of a blood substitute which can effectively replace the oxygen-carrying capabilities of transfused erythrocytes. Solutions of chemically modified haemoglobin represent one option being evaluated for this role. More recently, recombinant-DNA techniques have enabled production of human haemoglobin in host expression systems, and progress is being made towards the creation of a genetically engineered molecule incorporating the properties required of a blood substitute.

Single-plate Molteno implants were installed in two stages in glaucomatous monkey eyes. This device shunts aqueous from the anterior chamber to periocular orbital tissues. The mechanism of aqueous filtration and absorption was explored using flow studies, fluorescently labeled microspheres and histological examination of tissues. Flow studies indicated that the capsule around the explant functions by a passive mechanism, shunting aqueous into the extracellular space. Outflow is proportional to capsule surface area. Latex microspheres (0.2 mum and smaller) passed freely through the capsule, giving the impression of an open sieve. The presence of microspheres in the episcleral wall of the capsule indicates that all surfaces contribute to filtration. A concentration gradient of particles in the extracapsular space, away from the bleb surface, suggests that the capsule itself limits filtration rate.

The authors analyze the French governments organized support of labor migration from the islands of Martinique and Guadeloupe to France. "The specific goal here is to examine the origins and early workings of the organized migration policy during the 1960s....[The paper] has three principal aims: first to set these flows in the broader contexts of Caribbean emigration and of French immigration; second to trace the origins of the state institutional framework of migration during the 1950s and 1960s particularly the setting up of the migration agency the Bureau for Migration from the Overseas Departments... and opposition to it; and third to assess the early workings of the policy through the records of individual migrants." (EXCERPT)

A cDNA encoding human urokinase-type plasminogen activator was inserted downstream from the polyhedrin promoter of the baculovirus Autographa californica nuclear polyhedrosis virus. A protein of similar M r to urokinase (UK) was synthesized and approx. 90% was secreted from recombinant virus-infected Spodoptera frugiperda cells. Zymography and Western blotting analysis of the insect-derived protein demonstrated that it was comprised solely of the high- M r ,- form of UK. No low- M r - UK was detected. Amidolytic activity assays showed that 96 % of the insect cell-derived UK was in the single-chain proenzyme form. The yield of UK from insect cells was 1986 international units/ml/106 infected cells.

The contention of this article is that the debate on ‘immigration’ in France needs to take into account a number of issues which are frequently underestimated or ignored. It argues for an appreciation of the complexity of both the historical background to immigration and the current economic and social status of migrants and their descendants. First, the surge of migration over the last three decades, and the role of the French state, must be seen in the context of economic and demographic issues that have dominated French thinking for a century or more. Second, ‘immigrants’ cannot be treated as a homogeneous group. The very meaning of the word needs to be carefully defined in the light of the very varied status of groups by place of birth and nationality. Many of the current stereotypes are, it is argued, false and inimical to balanced discussions of the issue. Thirdly, the article reassesses the role of state policy since 1945 and reviews the varying impact of controls on migration. Finally, th...

The Saccharomyces cerevisiae glycerol-3-phosphate dehydrogenase (GUT2) promoter and part of the protein-coding region have been isolated on a 6.3-kb genomic DNA fragment. Nucleotide sequence analysis shows that the promoter has many structural features in common with yeast glycolytic enzyme promoters. Chromosomal mapping indicates that this genomic fragment is located on chromosome XII. The GUT2 promoter has been used to construct a recombinant human albumin (reHA) secretion vector; yeast transformed with this vector secrete reHA into the culture supernatant.

The disciform response of age-related macular degeneration and other diseases is determined by the development of subretinal neovascularization (SRN). Experimental animal models of SRN based on disruption of Bruch's membrane have been studied extensively during the past decade. Argon laser photocoagulationinduced SRN in primates is one such model, but this is associated with extensive retinal damage. Because the injured retina could be angiogenic, and is not present in clinical SRN, this model might be more relevant if this factor could be eliminated. The current study was conducted with the primary aim of producing a rabbit model of SRN that minimizes retinal damage. Argon laser endophotocoagulation was applied beneath the retina of albino rabbits to achieve this goal. Although argon photocoagulation does not cause clinically apparent SRN (i.e., associated with leaking and pooling of fluorescein) in the rabbit, all laser lesions produced in the current study contained microscopic SRN. A rabbit SRN model would be highly desirable as a step toward, other animal models, perhaps involving nonhuman primates, which might ultimately be clinically more relevant.

Clinical performance evaluations of medical students often fail to identify significant deficiencies. Many physicians are unwilling to give a poor or failing performance evaluation. Consequently, many clinical rotation grades are inflated and do not reflect actual student performance. We developed a computer-based faculty development tutorial designed to teach faculty members to use defined standards in the evaluation process and to give accurate performance grades to students and residents.We administered the tutorial to 25 family medicine faculty members. Immediate posttests and 3-month posttests were given to determine their mastery of the material. Grades were tracked for 2 years prior to the intervention and for the year following the intervention. After the 1-year intervention, the clerkship director went to each site and met directly with each faculty member. The computer tutorial material was reviewed again with faculty members. Grades for this academic year were tracked and compared with the control years and first intervention year.The faculty demonstrated mastery of the material and retention at 3 months, yet the grades for the first year following the computer tutorial by itself did not change. However, after establishing a face-to-face intervention, the grades were significantly lower overall, compared to the control (88.3 versus 91.8).Self-directed, computer-based faculty development resulted in knowledge mastery and retention but was by itself not enough to change faculty grading practices. An additional face-to-face intervention did change grading practices. Faculty development via independent study may provide basic knowledge, but it must be combined with direct interaction, feedback, and policy change to influence clinical grading practices.

JOURNAL OF GEOPHYSICAL RESEARCH, VOL. 113, B02204, doi:10.1029/2007JB005133, 2008 Numerical simulations of volcanic jets: Importance of vent overpressure Darcy E. Ogden, 1 Kenneth H. Wohletz, 2 Gary A. Glatzmaier, 1 and Emily E. Brodsky 1 Received 24 April 2007; revised 5 October 2007; accepted 5 November 2007; published 29 February 2008. [ 1 ] Explosive volcanic eruption columns are generally subdivided into a gas-thrust region and a convection-dominated plume. Where vents have greater than atmospheric pressure, the gas-thrust region is overpressured and develops a jet-like structure of standing shock waves. Using a pseudogas approximation for a mixture of tephra and gas, we numerically simulate the effects of shock waves on the gas-thrust region. These simulations are of free-jet decompression of a steady state high-pressure vent in the absence of gravity or a crater. Our results show that the strength and position of standing shock waves are strongly dependent on the vent pressure and vent radius. These factors control the gas-thrust region’s dimensions and the character of vertical heat flux into the convective plume. With increased overpressure, the gas-thrust region becomes wider and develops an outer sheath in which the erupted mixture moves at higher speeds than it does near the column center. The radius of this sheath is linearly dependent on the vent radius and the square root of the overpressure. The sheath structure results in an annular vertical heat flux profile at the base of the convective plume, which is in stark contrast to the generally applied Gaussian or top-hat profile. We show that the magnitude of expansion is larger than that predicted from previous 1D analyses, resulting in much slower average vertical velocities after expansion. These new relationships between vent pressure and plume expansion may be used with observations of plume diameter to constrain the pressure at the vent. Citation: Ogden, D. E., K. H. Wohletz, G. A. Glatzmaier, and E. E. Brodsky (2008), Numerical simulations of volcanic jets: Importance of vent overpressure, J. Geophys. Res., 113, B02204, doi:10.1029/2007JB005133. 1. Introduction [ 2 ] In large, explosive volcanic eruptions, the eruptive fluid issues from the vent as a high speed, compressible gas with entrained solid particulates. It is important to quantify the behavior of this gas-thrust region because it provides a connection between the fluid dynamics in the conduit and that of the buoyant column. If the eruptive fluid velocity is at or greater than sonic and vent pressure is higher than atmospheric pressure, the dynamics will be complicated by the presence of standing shock waves that can drastically alter the distribution of the vertical heat flux necessary for eruption column stability. The fluid dynamics and structure of a compressible jet issuing from a sonic nozzle into an ambient atmosphere of lower pressure are well known from experimental, analytical and computational studies [e.g., Crist et al., 1966; Young, 1975; Norman et al., 1982; Figure 1]. Although application of compressible jet dynamics to explosive volcanic eruptions was first sug- gested over 25 years ago by Kieffer [1981], the concept has Earth & Planetary Sciences Department, University of California at Santa Cruz, Santa Cruz, California, USA. Los Alamos National Laboratory, Los Alamos, New Mexico, USA. Copyright 2008 by the American Geophysical Union. 0148-0227/08/2007JB005133$09.00 yet to be widely applied in modeling and analysis of explosive eruption columns. [ 3 ] In this paper, we present computational results that quantify the important effects of vent pressure on the fluid dynamics of volcanic jets and show that overpressured jets produce vertical heat flux profiles that are drastically different than those of pressure-balanced jets. (Note: to avoid confusion, here we use the physics convention and consider ‘‘heat flux’’ the thermal energy transfer per area per unit time (J m 2 s 1 ) and ‘‘heat flow’’ the thermal energy transfer integrated over an entire area per time (J s 1 ). In volcanology literature, the term ‘‘heat flux’’ is often used to mean either of these things [e.g., Woods, 1988; Mastin, 2007]). The simulations shown here are time-dependent, though they assume a steady vent condition. Through these simulations, we quantify the effects of vent pressure and radius on plume radius and heat flux distribution after expansion of the jet. This may allow the prediction of major features of the eruptive structure. We do not consider the effects of variations in conduit dynamics, buoyancy, or the presence of a crater in order to focus only on the effects of vent pressure and radius alone. This study is not a complete picture of the complicated flow dynamics of a volcanic eruption. Rather, the results presented here could be consid- ered the ‘‘simplest case’’ to which one could compare the dynamics resulting from more complicated simulations and observations of high-pressure volcanic jets. B02204 1 of 18

The specific cake resistances of thin layers of fine latexes and of yeast cells have been determined from flux data for pressure drops of up to 100 kPa in a static filtration device. A single correlation has been developed that relates the cake resistance to particle diameter for monodisperse rigid latex spheres with diameters between 1.0 and 6.7 μm. The specific resistance of the yeast cell layers was found to be almost 50 times larger than that of the rigid latex spheres of the same median diameter The relative viscosities of a 7.3 μm latex and yeast cell suspensions have been measured in a cone-and-plate viscometer. Empirical correlations relating the relative viscosity to the solids volume fraction were developed from linear regression of the data for each suspension. A correlation was also developed that relates the relative viscosity of the yeast cell suspension to the cell count. The effective shear-viscosities were not observed to exhibit a significant shear-rate dependence. However, an apparent v...

The Association of Professors of Medicine (APM) is the national organization of departments of internal medicine at the US medicalschools and numerous affiliated teaching hospitals as represented by chairs and appointed leaders. As the official sponsor of TheAmerican Journal of Medicine, the association invites authors to publish commentaries on issues concerning academic internalmedicine.For the latest information about departments of internal medicine, please visit APM’s website at www.im.org/APM.

Recent data do not exist on medical students' performance of and attitudes toward procedural and interpretive skills deemed important by medical educators.A total of 171 medical students at seven medical schools were surveyed regarding frequency of performance, self-confidence, and perceived importance of 21 procedural and interpretive skills.Of the 122 responding students (71% response rate), a majority had never performed lumbar puncture, thoracentesis, paracentesis, or blood culture, and students reported lowest self-confidence in these skills. At least one-quarter of students had never performed phlebotomy, peripheral intravenous catheter insertion, or arterial blood sampling. Students perceived all 21 skills as important to learn and perform during medical school.Through the third year of medical school, a majority of students had never performed important procedures, and a substantial minority had not performed basic procedures. Students had low self-confidence in skills they rarely performed, but perceived all skills surveyed as important.

The CHARA Array is a six 1-m telescope optical/IR interferometric array located on Mount Wilson California, designed and built by the Center for High Angular Resolution Astronomy of Georgia State University. In this paper we describe the main elements of the Array hardware and software control systems as well as the data reduction methods currently being used. Our plans for upgrades in the near future are also described.

Adoption is a widespread phenomenon in birds and generally occurs at a low frequency within a species (reviewed in Rohwer 1986, Meek and Robertson 1991). Adoption of fledglings is common in seabirds due to the mobility of chicks soon after hatch (e.g. Hebert 1988, Morris et al. 1991, Pierotti 1991, Brown et al. 1995). In songbirds, studies of adoption have focussed on the behavior of replacement males during the nestling stage (Meek and Robertson 1991). Little is known about fledgling adoption in songbirds because the fledgling period is poorly described for many species (Smith 1978, Moreno 1984). We report two cases of fledgling adoption in the Hooded Warbler (Wilsonia citrina) observed in the course of an intensive study of fledgling care (Evans Ogden 1994). In passerines, the main hypotheses for the adaptive significance of adoption by males are: (1) increased opportunities for fathering offspring with the offspring's mother in the future (Power 1975, Rohwer 1986); and, (2) as a result of extrapair matings, the adopting bird may be the genetic parent of the young it adopts (Meek and Robertson 1991). The first hypothesis is supported by comparative evidence that adoption tends to occur in species where females are likely to renest with the adoptive male (Rohwer 1986). Recent reports that extrapair fertilizations occur at high frequency in many Temperate Zone passerines (e.g. Westneat 1987, 1993, Morton et al. 1990, Stutchbury et al. 1994) indicate that the extrapair-paternity hypothesis for adoption may be more important than previously recognized. We used DNA fingerprinting of Hooded Warblers to examine whether extrapair paternity played a role in adoption. Our study was conducted from May through August 1991-1993 in Crawford Co., Pennsylvania (41?N, 79?W). The study site is a 150-ha continuous hardwood forest that supported about 40 breeding pairs of Hooded Warblers each year. Adults were captured with mist nets, banded with U.S. Fish and Wildlife aluminum bands, and individually color banded. Each brood member that fledged also was banded with an aluminum band, and all nestlings within a brood were given color-band combinations different from those of other broods. For most adults and nestlings, we collected 30 to 100 uL of blood for use in parentage analysis. Multilocus DNA fingerprinting (with Jeffrey's probe 33.16) was used to determine actual paternity of the adopted fledgling (for detailed methods, see Stutchbury et al. 1994). Unrelated adults had a band-sharing coefficient of 0.301 ? 0.017 (n = 22), so young were considered unrelated to their social father if they had a band-sharing coefficient of less than 0.42 and had more than two novel bands when compared with their social parents. Territories of color-banded males were mapped by following singing individuals and noting border disputes. The social father was the male that defended the territory at the time of egg laying and fed the young at nests on the territory. The social mother was the female that incubated the eggs and fed the young. Each year, we systematically attempted to locate family groups after fledging to determine the period of fledgling care and food-delivery rates to fledglings. In Hooded Warblers we rarely saw both parents feeding a given fledgling. Instead, the brood was usually divided and each parent assumed full care of one or two fledglings (Evans Ogden 1994). When the social mother attempted a second brood, the male assumed full care of all fledglings from the first brood. In the forested habitat, it was difficult to see young fledglings and determine color-band combinations to confirm the nest from which they fledged. To identify whether or not a parent had adopted fledglings, we used only those cases where adults were seen feeding color-banded fledglings on more than two occasions. Using these criteria, we observed fledgling care by 17 parents from 13 different families. Two of these 17 parents (12%) were observed to adopt young (i.e. they fed young on their own territory that had fledged from a neighbor's nest). Below we describe the two case histories in detail. The cases were similar in that the social father of the fledglings was no longer present on his territory at the time of adoption, and the social mother had renested to attempt a second brood. The second case was perhaps unnatural, because the social father died accidentally during handling early in the nestling stage. In the first case, a fledgling was fed by a neighboring male on the adjacent territory, beginning when the fledgling was 28 days old postfledging. At this time, the adoptive male was also feeding two of his own young (nine days postfledgling) on his territory.

For the past decade, three-dimensional time-dependent computer models have been used to predict and explain how the geomagnetic field is maintained by convection in the Earth's fluid core. Geodynamo models have simulated magnetic fields that have surface structure and time dependence similar to the Earth's field, including dipole reversals. However, no dynamo model has yet been run at the spatial resolution required to simulate a broad spectrum of turbulence, which surely exists in the Earth's fluid core. Two-dimensional simulations of magnetoconvection show how the structure and time dependence of even the large-scale features change dramatically when the solution becomes strongly turbulent. Although these two-dimensional turbulent simulations lack the important effects of three-dimensional spherical geometry, based on their results one must question how geophysically realistic the large-scale dynamo mechanism is in current three-dimensional laminar simulations. Whatever the answer, we look forward to new discoveries from the next generation of turbulent dynamo models.

Pregnant animals are less able to maintain mean arterial pressure (MAP) during hemorrhage compared with nonpregnant animals, but the hemodynamic basis of this difference is unknown. The hypothesis that pregnancy attenuates responses of cardiac output, as well as total peripheral resistance (TPR) and femoral conductance, to hemorrhage was tested in conscious rabbits in both the pregnant and nonpregnant state ( n = 10). During continuous slow blood loss (2% of the initial blood volume per minute), MAP was maintained initially in both groups. However, MAP then abruptly decreased to

"The 1990 French census and the 1991 British census both report that over one-quarter of all housing is occupied by people living alone.... Migration is often an occasion to leave home and live alone. Leaving the parental home...is tending to become an essential step on the way to securing an executive position, especially for women. Two longitudinal statistical sources, the Longitudinal Study in England and the Continuous Demographic Sample in France, are used to describe the main residential changes. The findings show remarkable similarities between the two countries in this regard." (EXCERPT)

Background: The abuse of medical students on clinical rotations is a recognized problem, but the effects on students and their responses warrant further study. Purpose: To determine the severity of student abuse and the effects of abuse on students during the internal medicine clerkship. Methods: Internal medicine clerks at 11 medical schools (N = 1,072) completed an exit survey. Students were asked whether they had been abused. If they had, they were asked about the severity of the abuse, whether they reported it, and its effects on them. Results: Of the responding students, 123 (11%) believed they had been abused. Only 31% of the students who felt abused reported the episodes to someone. The most common consequences of the events included poor learning environments, lack of confidence, and feelings of depression, anger, and humiliation. Conclusion: Students described a variety of personal and educational effects of abuse. They generally did not report abuse because of fear of retaliation and the belief ...

The “operational definition” of scientific merit is the priority score given to a proposal by a study section; the pragmatic definition of a strong proposal is simply any proposal that is funded. Between extremes of proposals lies a group of proposals whose science is sound and with principal investigators that are well trained and productive. This chapter is dedicated to the proposal that lie in the “gray zone” of funding as they are not better written, and thus are difficult for reviewer to read and understand. The gold standard of proposal writing is exemplified by any article in the Scientific American. These are written for readers who are scientists but are unfamiliar with the area of the particular article. The prose is kept simple, specialized words and abbreviations are avoided, and every page has at least one diagram or figure. Probably the most common weakness of proposals that are based on good science but are poorly written is failure to identify and test important hypotheses. A proposal cannot be strong unless its scientific content is strong. Strong science in this context implies inherent scientific validity as well as relevance to targeted areas of research. It also implies use of state-of the- art techniques and experimental designs. The appearance of the proposal, how it is assembled, its neatness, and how closely it resembles published material have an impact on the way an investigator is perceived by the nonassigned reviewers. It is well worth the extra trouble necessary to deliver a professional looking document that meets the expectations of the reviewer.

The design of a project involves conceptualization of a logical sequence of experiments that test specific corollaries of an important hypothesis. Designs of individual experiments can be clever or innovative, intuitive, powerful, straightforward or complex, naive or sophisticated, and effective or inappropriate. Experimental design reveals much about the depth of the thinking of the principal investigator (PI). The form PHS 398 instructions state that one should describes the research design and the procedures to be used to accomplish the specific aims of the project. Include how the data will be collected, analyzed, and interpreted as well as the data sharing plan as appropriate. Also describe any new methodology and its advantage over existing methodologies. Potential difficulties and limitations of the proposed procedures and alternative approaches to achieve the aims should also be acknowledged. A tentative sequence or timetable for the project should be provided. It is essential that the design follows the lead of the specific aims, and that the experiments be organized according to the relevant aim and hypothesis. If one has followed the suggested page allocation, one should have about 13 pages left for design and methods.

This chapter explores the elements of literature cited and appendixes of research proposal, literature cited, list of all references. The list may include, but may not replace, the list of publications required in the progress report for competing continuation applications. Each reference must include the title, names of all authors, book or journal, volume number, page numbers, and year of publication. The reference[s] should be limited to relevant and current literature. While there is not a page limitation, it is important to be concise and to select only those literature references pertinent to the proposed research. References are not considered part of the 25 pages allotted to the research plan. There must be neither too few nor too many citations. An average proposal should probably include not more than about 75 referenced papers. To submit more than this number is to risk being accused of uncritical reading of the literature. References that are cited merely to support a statement in the proposal and appear without critical comment about the citation should be kept to a minimum. Such references are generally classic and are mentioned to show that the principal investigator (PI) is familiar with the literature. It is seldom necessary to cite directly any literature that is older than 10 years, since it will usually be included in recent reviews of the subject. It is more effective to limit references to highly pertinent recent papers, and to present these in more detail with thoughtful discussion of their relation to the proposed project.

Publisher Summary More than 80% of National Institutes of Health (NIH) R01 grant proposals are submitted with “modular” budgets. Before budgets became modular they were scrutinized by every member of a study section, probably with the negative intent of discovering an impropriety. Members of sections who have laboratory or clinical experience in the area of proposed research know what the going rate is for the goods and services requested, and have a good sense of levels of effort required for different types of research. If they see anything that seemed out of the bounds of their experience, they question it. Too much attention is paid to minor differences in experimental preferences. This sometimes has a negative impact on considered evaluation of the science. This quibbling over pennies has been stopped by removing most detail from the budget presentation. The modular budget greatly simplifies the burden of the principal investigator (PI), and this is good. If the study section feels the budget is too large, it imposes cuts in increments. Detailed instructions for filling out the budget are given in the PHS 398 application packet, and are supplemented by instructions and sample forms presented at the “NIH Modular Research Grant Applications.”