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Paromomyidae are one of several families of plesiadapiforms that flourished during the Paleocene in North America soon after the extinction of non-avian dinosaurs some 66 million years ago. Although they are often among the best-represented plesiadapiforms in mammalian faunas in both North America and Europe, the early history of paromomyids is poorly understood, and their fossil record at higher latitudes is comparatively depauperate. We report here on the discovery of two new species of paromomyids from Paleocene deposits in southwestern Alberta: Edworthia greggi new species is the second known species of the basal paromomyid Edworthia Fox, Scott, and Rankin, 2010 whereas Ignacius glenbowensis new species is among the most abundantly represented species of Ignacius Matthew and Granger, 1921. These new discoveries document, for the first time, parts of the upper dentition of Edworthia, and the new species of Ignacius represents the first new, pre-Clarkforkian species of the genus to be described in nearly 100 years. A comprehensive phylogenetic analysis of nearly all known paromomyid taxa (including the new species described herein) recovered both species of Edworthia near the base of the paromomyid tree in a polytomy with Paromomys depressidens Gidley, 1923 and a paraphyletic Ignacius. The new paromomyids from Alberta not only increase the known taxonomic diversity of Edworthia and Ignacius but also add significantly to knowledge of the dental anatomy of these poorly known genera and further add to a uniquely Canadian complement of Paleocene plesiadapiforms.UUID: http://zoobank.org/a2f31cfe-09b9-4168-b09f-9d0c3d0af342

A large collection of dentigerous jaws quarried from the Gao Mine locality, late Paleocene, Paskapoo Formation, central Alberta, Canada, documents a new species of the early Paleogene phenacodontid “condylarth” Ectocion Cope, 1882. The new species, Ectocion stockeyae, the smallest of the genus, occurs well before the abrupt global warming at the Paleocene–Eocene Thermal Maximum, an event purportedly causing the rapid evolution of “dwarfed” mammals, including a species of Ectocion; however, there is no evidence of increased temperatures at Gao Mine to account for the small size of Ectocion stockeyae, raising questions of the relationship between temperature and body size in Ectocion. Ectocion stockeyae also exhibits sexual dimorphism of the canines, a pattern in mammals often associated with a population structure in which the males are relatively few and polygynous, resulting in intense male rivalry for mating success. The sample of Ectocion stockeyae from Gao Mine includes a substantial majority of “juvenile” individuals retaining deciduous posterior premolars, many even after eruption of the molars had been completed, suggesting short life spans, accelerated growth, and rapid dental development in this species as expressed in Schultz’s Rule.

Although multituberculates are among the best-represented mammals of the Late Cretaceous and early Paleogene in North America, their evolution during the first several tens to hundreds of thousands of years following the Cretaceous–Paleogene (K–Pg) impact event is largely obscure. A better understanding of the early Paleogene record of multituberculates is crucial, for their dominance in early Paleocene mammalian faunas is unquestionably a result of rapid evolution during the immediate post-impact interval, and they accordingly played an important role in the evolution of mammalian communities more generally. I report on a new multituberculate from the early Paleocene of southwestern Alberta, in rocks of the Willow Creek Formation, the first such occurrence in this otherwise poorly known unit. The new multituberculate, Aenigmamys aries gen. et sp. nov., most closely resembles the ptilodontid Kimbetohia campi in comparable parts of the dentition and sheds light on the early evolution of Ptilodontidae, one of the major cimolodontan families that diversified during the Paleocene. The presence of Aenigmamys in mammalian faunas that lived soon after the K–Pg boundary implies a still-deeper evolutionary history for Ptilodontidae that may have extended into the Late Cretaceous. Aenigmamys is part of a new mammalian fauna from southwestern Alberta, the taxonomic composition of which includes a diversity of multituberculates, cimolestans, primates, and condylarths. The fauna correlates with those of middle Puercan age from other parts of the Western Interior of North America, and its high taxonomic diversity further corroborates previous hypotheses that multituberculate recovery — and mammalian recovery more generally — occurred relatively quickly after the K–Pg extinction event.

Multituberculates were among the most taxonomically diverse mammals of the early Paleocene, having survived the catastrophic Cretaceous-Paleogene mass extinction and radiating soon thereafter. Although their evolution during the early Paleocene saw the advent of increasingly specialized dentitions, multituberculates generally remained small, rarely exceeding body sizes greater than those of extant rabbits. A conspicuous exception is the Taeniolabidoidea, a primarily North American clade whose members include the largest multituberculates yet discovered. Taeniolabidoidea includes several genera, with one of these,Catopsalis, being speciose and geographically wide ranging. Until recently, the chronological succession ofCatopsalisappeared to document a trend of increasing body size. We report here on a new species ofCatopsalisfrom the early Paleocene of Alberta that violates this trend and suggests that the evolutionary history ofCatopsalisis considerably more complex.Catopsalis kakwanew species is not only the smallest species ofCatopsalis, but is the smallest taeniolabidoid so far discovered, with an estimated body mass between 400 g and 660 g. In contrast to previous studies, we used recently proposed regressions based on lower cheek tooth row length to estimate body masses for North American taeniolabidoids. Our results propose more modest body mass estimates, particularly for the largest taeniolabidoids. The occurrence ofC.kakwan. sp. in the late early Paleocene implies either a significant ghost lineage, or reversal of several characters, including body size, during the latter part of the early Paleocene; the more likely of these scenarios must await a better understanding of the phylogenetic position ofC.kakwan. sp.UUID:http://zoobank.org/66d85345-49b8-4a46-ba6e-a4d4369cb3e0urn:lsid:zoobank.org:pub:AF7A5659-9068-4F2F-A6EC-5522A2BBA4CB

Despite wide use by the public, limited evidence is available for many complementary and integrative health (CIH) practices. Thus, clinical researchers knowledgeable about CIH disciplines are necessary to study the efficacy and effectiveness of CIH practices to benefit the public health. To partially address the need for clinical researchers versed in CIH, the authors of this study report the design of an interprofessional clinical research training program focused on CIH, the Building Research across Interdisciplinary Gaps (BRIDG) program, supported by a 5-year T90/R90 grant from the National Center for Complementary and Integrative Health. The T90-supported arm of the program trains doctoral-level CIH providers in clinical research at the research-intensive University of Washington. The R90-supported arm of the program trains researchers with conventional backgrounds in the practices of CIH at the clinic-intensive National University of Natural Medicine. The "Translational Science Spectrum" provides a common conceptual framework for both programs. Specific program elements include: individualized didactic training in clinical research and CIH disciplines; placement with clinical research mentors; placement with clinical mentors in CIH disciplines; shared and independent research project development; and interdisciplinary experiences through seminars and retreats. Program evaluation includes annual completion of the Clinical Research Appraisal Inventory (CRAI), which queries confidence in research skills and methods and periodic evaluation of training elements using the Supplemental Kellogg Logic-World Health Organization model, which emphasizes relevance, adequacy, efficiency, effectiveness, process, impact, equity, and sustainability. The BRIDG program exemplifies a new standard in interprofessional clinical research training, made possible through strong collaboration between disparate research- and clinically intensive institutions.

The fossil record of the earliest primates, purgatoriid plesiadapiforms, has become increasingly well documented during the past two decades, but their dietary preferences remain poorly understood. While the available evidence, which consists mostly of isolated teeth and incomplete jaws with teeth, suggests that purgatoriids were insectivorous to omnivorous, we describe here a new species of Purgatorius, Purgatorius pinecreeensis sp. nov., that extends the range of purgatoriid dental disparity toward greater omnivory than had been known before. Purgatorius pinecreeensis sp. nov., from the early Paleocene (Puercan) Ravenscrag Formation of southwestern Saskatchewan, differs from other species of Purgatorius in having slightly lower crowned teeth with a lower trigonid relative to talonid, blunter and more swollen major cusps, more transverse lower molar paracristids, and m3 with a more robustly developed posterior lobe. Taken together, these specializations enhanced the capacity for crushing and grinding at the expense of orthal shear, and represent the first instance of a modest degree of bunodonty in the family. The discovery of P. pinecreeensis sp. nov., along with other recently reported basal plesiadapiforms from the Puercan and Torrejonian of the northern Western Interior, lends additional support to the notion of a significant primate radiation soon after the Cretaceous–Paleogene extinction event.

Scott, Craig S. (2019): Horolodectidae: a new family of unusual eutherians (Mammalia: Theria) from the Palaeocene of Alberta, Canada. Zoological Journal of the Linnean Society 185: 431-458, DOI: 10.1093/zoolinnean/zly040

The Frenchman and Ravenscrag formations of southwestern Saskatchewan, Canada, record an apparently continuous sequence of nonmarine clastic sediments across the Cretaceous–Paleogene (K–Pg) boundary. Extensive exposures of these fossil-rich sediments occur in the Frenchman River Valley, near the towns of Ravenscrag, Eastend, and Shaunavon, and have been a focus of study since the 1970s. Despite this long history of investigation, a comprehensive account of the geographic and stratigraphic positions of many of the significant fossil localities has yet to be published. Given this state of affairs, the goals of this paper are to (i) document the geographic locations, stratigraphic positions, and lithologies of 11 key vertebrate microfossil localities, including several new localities that have been recently discovered, and (ii) provide an update on the status of these fossil localities, the majority of which have not been sampled in the last 20 years. Four fossil localities are known from the lower Paleocene Ravenscrag Formation, all of which are Puercan in age: Rav W-1 (Pu2), French Fry (Pu1), Croc Pot (?Pu2), and Pine Cree (?Pu2). With the exception of Rav W-1, which has since been lost as a consequence of quarry reclamation, all of the Ravenscrag Formation localities remain accessible and continue to be productive. Seven vertebrate microfossil localities from the upper Maastrichtian Frenchman Formation are reported here, all of which are Lancian in age: Long Fall, Fr-1, By Gar Gap, Hairpin, Wounded Knee, Wounded C, and Gryde. With the exception of Long Fall and Wounded Knee, which have been lost through reclamation or construction, all of the Frenchman Formation localities are accessible and remain productive.

Although stagodontid marsupials are among the most distinctive mammals of Late Cretaceous age in North America, there remain significant gaps in knowledge of their dental anatomy, particularly that of the stratigraphically oldest genus, Eodelphis Matthew, 1916. We report here on stagodontid specimens from the Judithian Belly River Group of southeastern Alberta, Canada, that document what was until now previously unknown parts of the upper and lower premolar dentition of Eodelphis browni Matthew, 1916 and Eodelphis cutleri (Smith Woodward, 1916). The new information further confirms the distinctiveness of both nominal species of Eodelphis, and bolsters previous hypotheses suggesting a close phylogenetic relationship between E. cutleri and the advanced stagodontid Didelphodon Marsh, 1889. Although the new specimens from Alberta suggest that the problematic holotype of “Boreodon matutinus” Lambe, 1902 is an upper third premolar, a referral to Eodelphis cannot be made with confidence and the name should continue to be treated as a nomen dubium. Lastly, we report the first occurrence of Didelphodon in strata of the Belly River Group, extending the geological age of the genus into the Judithian, co-eval with species of Eodelphis, and suggesting a significant prior and as yet undiscovered evolutionary history.

Ursolestes perpetior gen. et sp. nov. is a large purgatoriid plesiadapiform primate from the middle/late Puercan (earliest Paleocene) Simpson Quarry, Montana, USA. It differs from Purgatorius Van Valen and Sloan, 1965, the only other known purgatoriid and the oldest discovered primate, in its substantially larger body size as inferred from the dimensions of the known parts of its dentition, while resembling Purgatorius in possessing a large lower canine, unreduced p1, and in the upper molars, a protocone twist and weakly developed postprotocone fold; moreover, the m3 of U. perpetior possesses an expanded, plesiadapiform-like posterior lobe of the talonid that supports the hypoconulid. The large lower canine and the greater development of trenchant molar crests suggest that U. perpetior was more insectivorous, differing appreciably from the omnivorous niche long hypothesized for Purgatorius and purportedly marking the insectivore–primate transition. Hence, U. perpetior adds significant new knowledge regarding the breadth of the adaptive zone occupied by purgatoriids in their position at the very beginnings of primate evolution.

The University of Washington (UW) Institute for Translational Health Sciences (ITHS), funded by a Clinical and Translational Sciences Award program, has supplemented its initial Kellogg Logic Model–based program evaluation with the eight judgment-based evaluative elements of the World Health Organization’s (WHO) Health Services Assessment Model. This article describes the relationship between the two models, the rationale for the decision to supplement the evaluation with WHO evaluative elements, the value-added results of the WHO evaluative elements, and plans for further developing the WHO assessments.

Although the known record of Mesozoic eutherian mammals has been significantly enriched in recent years, early eutherian evolution is still not well understood. Among the more controversial of Mesozoic eutherians is Paranyctoides Fox, which was described in 1979 from the Judithian Dinosaur Park Formation, Alberta, Canada. It is a rare taxon and therefore has been identified in only a few other North American Late Cretaceous local faunas since. Within the past decade, dental and gnathic remains discovered in Central Asia have also been referred to Paranyctoides, thereby expanding the geographic range of the genus substantially and making it the only Late Cretaceous eutherian ostensibly occurring in both continents. As a result of our detailed study of Paranyctoides, however, we find that the Central Asian species lack the diagnostic characters of Paranyctoides and must be referred to other taxa. We conclude that this genus was limited to North America, ranging from Aquilan to Lancian time, and accordingly we recognize as valid only the following species: Paranyctoides sternbergi (Judithian, Alberta), P. maleficus (Aquilan, Alberta), Paranyctoides Wahweap sp. A and sp. B (Judithian, Utah), Paranyctoides Kaiparowits sp. A and sp. B (Judithian, Utah). Another purported species of Paranyctoides, P. megakeros, from the Lancian of Wyoming, is a junior synonym of Alostera saskatchewanensis.

Beginning in 1962 and extending to the present, Richard C. Fox and colleagues have named 87 species of fossil vertebrates (1 fish, 4 amphibians, 2 choristoderes, 12 lizards, 1 crocodile, 1 dinosaur, 2 “pelycosaurs”, 2 non-mammalian therapsids, and 62 mammals) and numerous new supraspecific taxa. Virtually all of these species continue to be accepted, although the higher-level assignments of several have been altered. The vast majority of the named species were founded on specimens, collected during the mid-1960s to early 2000s by field parties under Fox’s direction, from the Late Cretaceous (late Santonian to late Maastrichtian) and Paleocene of Alberta and Saskatchewan, Canada, and that are housed at the University of Alberta Laboratory for Vertebrate Paleontology. Here we present (i) an annotated list of all fossil vertebrate species named by Richard Fox between 1962 and 2012, (ii) updated information on the stratigraphic nomenclature and age estimates for the eight localities in Alberta that yielded holotypes for all the Cretaceous mammal species named by Richard Fox from that province, and (iii) new photographs for the holotypes of the one non-mammalian therapsid and 43 Late Cretaceous and Paleocene mammal species named by Richard Fox before 1995.

Most trainees in combined pulmonary and critical care medicine fellowship programs complete in-service training examinations (ITEs) that test knowledge in both disciplines. Whether ITE scores predict performance on the American Board of Internal Medicine Pulmonary Disease Certification Examination and Critical Care Medicine Certification Examination is unknown.To determine whether pulmonary and critical care medicine ITE scores predict performance on subspecialty board certification examinations independently of trainee demographics, program director competency ratings, fellowship program characteristics, and prior medical knowledge assessments.First- and second-year fellows who were enrolled in the study between 2008 and 2012 completed a questionnaire encompassing demographics and fellowship training characteristics. These data and ITE scores were matched to fellows' subsequent scores on subspecialty certification examinations, program director ratings, and previous scores on their American Board of Internal Medicine Internal Medicine Certification Examination. Multiple linear regression and logistic regression were used to identify independent predictors of subspecialty certification examination scores and likelihood of passing the examinations, respectively.Of eligible fellows, 82.4% enrolled in the study. The ITE score for second-year fellows was matched to their certification examination scores, which yielded 1,484 physicians for pulmonary disease and 1,331 for critical care medicine. Second-year fellows' ITE scores (β = 0.24, P0.001) and Internal Medicine Certification Examination scores (β = 0.49, P0.001) were the strongest predictors of Pulmonary Disease Certification Examination scores, and were the only significant predictors of passing the examination (ITE odds ratio, 1.12 [95% confidence interval, 1.07-1.16]; Internal Medicine Certification Examination odds ratio, 1.01 [95% confidence interval, 1.01-1.02]). Similar results were obtained for predicting Critical Care Medicine Certification Examination scores and for passing the examination. The predictive value of ITE scores among first-year fellows on the subspecialty certification examinations was comparable to second-year fellows' ITE scores.The Pulmonary and Critical Care Medicine ITE score is an independent, and stronger, predictor of subspecialty certification examination performance than fellow demographics, program director competency ratings, and fellowship characteristics. These findings support the use of the ITE to identify the learning needs of fellows as they work toward subspecialty board certification.

Plesiadapidae are a family of Paleogene mammals thought to have phylogenetic affinities with modern Primates. We describe previously unpublished dentitions and the first skull and isolated petrosals of the plesiadapid Pronothodectes gaoi, collected from middle Tiffanian localities of the Paskapoo Formation in Alberta. Other species of Pronothodectes, traditionally considered the most basal members of the Plesiadapidae, occur at earlier, Torrejonian horizons in Montana, Wyoming, and Alberta. Classification of P. gaoi as a species of Pronothodectes has proved controversial; accordingly, we use the newly available samples and the more extensively preserved specimens to re-evaluate the generic affinities of this species. Included in our study are comparisons with craniodental material known for other plesiadapids and plesiadapiforms. Cladistic analysis of craniodental characters is used to assess the hypothesis that P. gaoi and other species in this genus are basal members of the Plesiadapidae. The new dental evidence confirms that P. gaoi lacks derived character states of other plesiadapids except for a variably present fissuring of the m3 hypoconulid. Moreover, several aspects of the cranium seem to be more primitive in P. gaoi (i.e., more like nonplesiadapid plesiadapiforms) than in later occurring plesiadapids, such as Plesiadapis tricuspidens and Plesiadapis cookei. Cladistic analysis of craniodental morphology supports a basal position of P. gaoi among species of Plesiadapidae, with the exception of other species of Pronothodectes. The basicranium of P. gaoi preserves a laterally placed bony canal for the internal carotid neurovascular system, suggesting that this was the ancestral condition for the family. Am J Phys Anthropol, 2012. © 2012 Wiley Periodicals, Inc.

Mixodectidae (Mammalia, Archonta) are an unusual, poorly known family of dermopteran-like mammals that have been discovered at several North American localities of primarily early Paleocene age. Among the three or four recognized mixodectid genera, Eudaemonema Simpson is perhaps one of the least understood, being known from only a few localities of late Torrejonian and earliest Tiffanian age. This paper reports on a new species of Eudaemonema from the late Paleocene of Alberta, Canada, that significantly extends the geographic and stratigraphic ranges of the genus. Eudaemonema webbi sp. nov. is known from middle and late Tiffanian localities in central and south central Alberta, and it represents the youngest and northernmost species of Eudaemonema so far discovered. E. webbi differs from the genotypic species E. cuspidata in being larger and in having a suite of dental characters (e.g., molariform posterior premolars, enlarged molar protocone and hypocone, development of a second grinding platform on the lower molars) that suggests an increased emphasis on grinding during mastication. E. webbi possesses several dental features (e.g., broad, shelf-like molar paraconid–paracristid, lingually shifted molar hypoconulid) that resemble those of cynocephalids (Mammalia, Dermoptera), with these resemblances interpreted herein as convergent. The occurrence of E. webbi at Gao Mine extends the stratigraphic range of Eudaemonema into the late Tiffanian (Ti5) and represents the youngest known record of Mixodectidae.

New specimens of an as yet unidentified carnivoran from the earliest Paleocene of Saskatchewan are described. The new specimens augment the evidence on which the contentious earliest (middle Puercan) occurrence of Carnivora is based, provide novel information of the lower dentition of the earliest carnivorans, and provides evidence for the earliest taxonomic diversity in Carnivora.

A primitive paromomyid plesiadapiform primate,Edworthia lerbekmoinew genus and species, is described from a recently discovered locality in the Paskapoo Formation, exposed at a road cut in Edworthy Municipal Park, Bow River Valley, Calgary, Alberta, Canada. The new taxon, probably middle Torrejonian (To2) in age, is based on two dentary fragments containing well-preserved dentitions that bracket p2-4, m1-3. With the exception of the basalParomomys, E. lerbekmoidiffers from all other paromomyids in retaining p2, but p2 in the new paromomyid is single-rooted, not two-rooted as inParomomys. E. lerbekmoidiffers further fromParomomysin having an enlarged anterior alveolus for a tooth immediately anterior to p2, hypothesized to be il. Unlike other paromomyids with an enlarged il, however, this tooth inE. lerbekmoiwas obliquely, not horizontally, oriented and its alveolus opens dorsally, in the alveolar row, not anteriorly, as in other paromomyids in which il is greatly enlarged. This suggests thatE. lerbekmoirepresents a previously unknown paromomyid lineage that evolved from an ancestor having obliquely oriented lower incisors as in the basal primatePurgatorius, not from an ancestor in which il was already subhorizontal in orientation, as inParomomys.If this working hypothesis is correct or whether in the future some other evolutionary scenario will better account for the unique anterior dentition inE. lerbekmoi, the new paromomyid nonetheless demonstrates that crucial aspects of the earliest history of the important plesiadapiform family Paromomyidae remain to be discovered.

Cyriacotheriidae are a family of unusual small-bodied pantodonts known from the Paleocene of the Western Interior of North America. Cyriacotheriids possess a suite of dental characters similar to that of pantodonts (e.g., molar dilambdodonty, lingual molar hypoconulids), as well as several divergent features (e.g., molarized premolars, strong molar conules) that have been interpreted as “dermopteran-like.” the unusual combination of pantodont and dermopteran-like characters, combined with a limited fossil record, has made attempts at understanding the broader relationships of Cyriacotheriidae difficult. This paper reports on a new genus and two new species of cyriacotheriids from the Paleocene of Alberta, Canada, with both species significantly older than those of the only previously described cyriacotheriid,Cyriacotherium.Collectively, the dentitions of these new taxa exhibit derived characters seen inCyriacotherium(e.g., robust molar conules, strong molar dilambdodonty) in addition to a number of plesiomorphies seen in more basal pantodonts (e.g., conspicuous molar entoconids, deep premolar ectoflexus) and, importantly, posterior premolars that are weakly molariform and non-dilambdodont. A phylogenetic analysis of the new cyriacotheriid, basal pantodonts, dermopterans, and dermopteran-like eutherians resulted in Cyriacotheriidae nesting within a monophyletic Pantodonta. the results strengthen previous hypotheses regarding the pantodont affinities of the family, and suggest that the dermopteran-like features seen in the more derivedCyriacotheriumwere acquired convergently. Although the discovery of new cyriacotheriids sheds light on the evolutionary history of the family, it cannot resolve the ongoing questions of pantodont origins; nonetheless, their discovery in strata of early Paleocene age indicates that significant parts of the evolutionary history of Cyriacotheriidae, and North American pantodonts more generally, have yet to be discovered.

The majority of graduating US medical students reported inadequate nutrition training over the past decade. This trend could in part be due to the lack of valid measures to assess the relationship between adequacy of nutrition training and proficiency on nutrition topics deemed essential. The study's objective was to test the hypothesis that self-reported nutrition proficiency is positively correlated with the perceived adequacy (quality, quantity, coverage and importance) of nutrition training of University of Washington medical students.Cross-sectional e-mail survey of 1st to 4th year medical students (n = 708), including a survey prompt and three e-mail follow-up measures. To reduce and interpret the survey data, principal components analysis was employed, followed by Varimax rotation with Kaiser normalization. To assess internal consistency reliability, alpha (alpha) of nutrition proficiency items and factors was determined.A 44.5% response rate was achieved (n = 315 respondents). The 31-item questionnaire was reduced to 6 factors, explaining 60.2% of the total variance (alpha = 0.947). Self reported nutrition proficiency was positively correlated with the perceived quality, quantity and coverage of nutrition training in all 6 essential nutrition factors or topics determined after factor analysis (P0.01).Quality and coverage may be effective gauges of adequacy of nutrition training and related nutrition proficiency in medical education. Current national medical education evaluation measures focus on the quantity of nutrition instruction. The lowest reported proficiency topics; nutrition and disease management, micronutrients and complementary and alternative medicine are recommended for particular curricular emphasis.

An incomplete lower jaw with teeth documents the presence of a new genus and species of placental mammal from the Upper Cretaceous (Lancian; late Maastrichtian) Frenchman Formation, Saskatchewan, Canada. This new mammal is characterized by highly compressed lower molars that decrease in size from m1 to m3 and superficially resemble the molars of Tertiary Mesonychia. These resemblances, however, are interpreted as convergent, and the new mammal is classified in its own family and incertae sedis at the ordinal level. This new mammal thus joins other recent discoveries in western Canada of mammals of Tertiary aspect (Condylarthra; Taeniodonta) occurring in the Late Cretaceous.

A new genus and species of erinaceid lipotyphlan (Mammalia, Insectivora) from the late Paleocene of western Canada is described. Oncocherus krishtalkai gen. et sp. nov. is known from three late Tiffanian localities in central Alberta and southeastern Saskatchewan and is but one of several erinaceomorph and soricomorph taxa known from the Late Paleocene of western Canada. Oncocherus possesses apomorphies that link it to other primitive erinaceids (e.g., enlarged upper and lower fourth premolars, lower molars markedly decreasing in size from m1-m3, talonid basins V-shaped), yet its affinity with any of the recognized erinaceid subfamilies is uncertain. Although Oncocherus is phenetically, and probably phylogenetically, closest to Litolestes Jepsen, the genus is clearly distinguished from Litolestes and other erinaceid taxa by its proportionately larger and more inflated premolars and lower crowned molars, features that were likely adaptations for durophagy. Oncocherus joins a number of endemic mammalian taxa that were apparently confined to more northerly latitudes of the Western Interior of North America during the Late Paleocene.

A new eutherian mammal of uncertain taxonomic position is described on the basis of well-preserved dental and gnathic specimens collected from localities in the Paleocene Paskapoo Formation of Alberta, Canada. Horolodectes sunae new genus and species is represented by seven incomplete maxillae, eleven incomplete dentaries, and numerous isolated teeth, together preserving nearly all of the postcanine dentition. The unusual dentition of Horolodectes n. gen. consists of trenchant, posteriorly leaning premolars in combination with comparatively primitive molars, suggestive of a masticatory cycle that consisted primarily of shearing and, to a lesser degree, horizontal grinding. Included among the specimens of Horolodectes is an incomplete dentary of an immature individual, with the teeth having been in various stages of eruption at the time of death. Although the dentition of Horolodectes broadly resembles that of apheliscine hyopsodontids, pentacodontine pantolestids, and “ungulatomorphs” among eutherian mammals, significant differences in the coronal structure of the teeth prevent unequivocal referral of Horolodectes to any of these groups, or to any known eutherian order.

Neoplagiaulacid multituberculates are among the most numerous and best represented members of early Cenozoic North American mammal faunas, achieving their greatest diversity during the Paleocene. Despite their relatively dense record in the Torrejonian (middle Paleocene) and Tiffanian (late Paleocene), the study of early Cenozoic neoplagiaulacids has been limited more often than not to isolated teeth or, more rarely, incomplete skull, gnathic, or postcranial remains. The current study reports on new neoplagiaulacid multituberculates from the Paleocene Paskapoo Formation of central Alberta, Canada, at localities along the Blindman River near the City of Red Deer. The exceptionally well-preserved specimens consist of incomplete articulated and associated skull and gnathic remains, and collectively document four new species: Ectypodus elaphus, Neoplagiaulax serrator, Neoplagiaulax paskapooensis, and Neoplagiaulax cimolodontoides. Neoplagiaulax paskapooensis is the most dentally complete neoplagiaulacid so far discovered, with a single specimen documenting for the first time left and right I2 and I3 in situ with the cheek teeth, along with the associated lower dentition. Specimens of Neoplagiaulax cimolodontoides record important details of the rostrum and palate, and provide the first direct evidence of incisor replacement in Neoplagiaulax. The new neoplagiaulacids, together with other multituberculates from the Blindman River localities, document unusually high multituberculate diversity in the latter half of the Tiffanian in western Canada. Despite superficial similarity to some European species of Neoplagiaulax, the new taxa from the Paskapoo Formation apparently show no closer relationship to these than do other North American congeners, suggesting parallel evolution in endemic North America and western European clades.

Since 1908, the peculiar North American primate Picrodus Douglass, 1908 (Picrodontidae; Plesiadapiformes) has been thought to contain only a single species, P. silberlingi Douglass, 1908, of late Paleocene age. However, new collections from the Paskapoo Formation, Alberta, Canada, reveal that instead a rich complex of Picrodus species lived during the Paleocene. Three of these, Picrodus calgariensis, P. canpacius, and P. lepidus, are described herein as new. Others, represented by more fragmentary specimens from Canada and the United States, are included in this paper, but are not named. P. calgariensis, from Who Nose? (late Torrejonian), Calgary, is the most primitive known species of Picrodus, having molars with little crenulation of the enamel. P. canpacius, from Cochrane 2 (earliest Tiffanian), northwest of Calgary, most resembles P. silberlingi sensu stricto, but differs in P4 structure, denser enamel crenulation, and weaker molar cusps. P. lepidus, from DW-2 (middle Tiffanian), near Red Dee...

Peer-reviewed publications and extramural reputation are criteria used to evaluate clinician-educators for promotion. There is concern that these criteria may be disadvantageous to clinician-educators in generalist fields relative to their specialist counterparts.To determine whether medicine subspecialists had more peer-reviewed publications and academic activities outside their home institution than general internal medicine (GIM) faculty, and to explore possible explanations for observed differences.Cross-sectional survey of all clinician-educators in a department of medicine at a leading public U.S. medical school. The survey assessed clinical duties, publications, and professional activities.Seventy-one percent (42/59) of clinician-educator faculty responded. GIM clinician-educators spent fewer months on inpatient services (p = 0.01), but more time in clinic (p = 0.05). Specialist clinician-educators had more peer-reviewed publications (p = 0.003), but total publications since entering a clinician-educator track was similar (p0.2). After multiple linear regression, only academic rank (p = 0.001) and subspecialty membership (p = 0.005) remained significant predictors of peer-reviewed publication. GIM faculty reported spending more scholarly time on "activities unlikely to result in publication" (p0.01). A greater proportion of specialists served on extramural committees (72% vs. 41%, p = 0.05) and lectured outside their home institution in the preceding year (92% vs. 59%, p = 0.02).In this single-institution survey, specialist clinician-educators reported more peer-reviewed publications and greater participation in other reputation-enhancing activities than did GIM clinician-educators.

The Institute for International Medical Education has published "Global Minimum Essential Requirements (GMERs) in Medical Education."This study examined attitudes of a sample of Chinese medical students toward the GMERs.Matriculating and graduating West China School of Medicine Sichuan University medical students were administered parallel surveys during the 2001 to 2002 academic years.Both cohorts produced similar response profiles. The majority in both groups rated the 7 GMER domains as either important or very important for their medical education. Matriculating students rated professional values, attitudes, behavior, and ethics as most important, whereas graduating students valued clinical skills highest. Population health and health systems received the lowest importance ratings from both groups. Please note that this study was conducted before the SARS outbreak. As a result of the SARS experience, attitudes toward population health and health systems might have changed.Although medical students ascribe importance to the GMERs, efforts are needed to increase the perceived importance of the population health and health systems domain.

A new species of the ptilodontid multituberculate genus Prochetodon (Mammalia, Allotheria) from the Paleocene Paskapoo Formation of Alberta, Canada, is described. Prochetodon speirsae sp. nov. is the oldest discovered species of the genus, extending the temporal range of Prochetodon earlier into the Paleocene. It exhibits a mosaic of primitive and derived dental features suggestive of a position phylogenetically intermediate between Ptilodus and Prochetodon. Newly discovered specimens from the late Paleocene Gao Mine locality are referred tentatively to Prochetodon foxi. The occurrence of a primitive form of Prochetodon in sediments of early Tiffanian age suggests the evolutionary history of the genus is more complex than previously appreciated. Prochetodon joins a number of well-documented, progressive mammalian taxa making their first appearance in the Western Interior of North America at higher latitudes, well before their first known occurrence in the United States, suggesting a possible origin and immigration from currently unsampled habitats.

The Paskapoo Formation in central and south central Alberta, Canada, preserves continental sediments of Paleocene age. Outcrops of the formation on Nose Creek in northeast Calgary, at a locality called Who Nose?, have yielded fossil mammals from the middle part of the epoch. To date, some 400 dental specimens representing eight mammalian orders have been recovered, among them numerous well-preserved jaws. Newly named taxa include new species ofParectypodusandBaiotomeus(Multituberculata); new species ofParectypodus, Litomylus(Condylarthra), andCyriacotherium(Pantodonta) are left unnamed. Biostratigraphic correlation indicates a late Torrejonian age for the local fauna based on the presence of the plesiadapid primatePronothodectes matthewi. Faunal comparisons suggest a close similarity to the penecontemporaneous Gidley Quarry fauna, Montana, with a taxonomic diversity consistent with other co-eval faunas in the Western Interior of the United States. The specimens from Who Nose? constitute the largest collection of Torrejonian mammals from Canada, offering a unique perspective on mammalian diversity from an otherwise poorly represented interval in western Canada.

Background: Despite concerted scientific, educational, and congressional calls to increase nutrition coverage in medicine for more than half a century, most graduating medical students report an inadequate quality and quantity of nutrition training. Furthermore, practicing physicians report a lack of confidence and related proficiency in nutrition counseling skills because of inadequate training. Assessment of nutrition proficiency and related training of practicing physicians may support the prioritization of nutrition topics to be included in medical education. Objective: We tested the hypothesis that the perceived adequacy of nutrition training (quality and quantity) of family physicians in Washington State is positively correlated with self-reported nutrition proficiency in 5 nutrition factors determined after confirmatory factor analysis. Design: A randomized mail survey method (n = 778 possible respondents), which involved one mass-mailing follow-up, was used. Results: A 39.3% response rate was achieved (n = 306 respondents). The 31-item questionnaire was reduced to 5 factors, explaining 48.5% of the total variance (a = 0.916). Perceived quality (poor to excellent) of nutrition training was positively correlated with self-reported nutrition proficiency scores for all 5 factors (P < 0.01). No significant differences were noted between zip code or sex and mean nutrition proficiency scores for all 5 factors. Conclusion: The examination of correlations between perceived quality of education and self-reported proficiency may be a useful gauge of effectiveness of nutrition training in medicine. Prioritization of nutrition information based on proficiency levels, including information on complementary and alternative medicines and nutritional management of disease, merits further investigation.

Changes in graduate medical education associated with full implementation of the Balanced Budget Act of 1997 have required medical schools to review and revise their curricula. As limited funding increases pressures to streamline training, residencies will potentially expect an entry level of skill and competence that is greater than that which schools are currently providing. To determine whether medical school curricular requirements correlate with residency needs, this multidisciplinary pilot study investigated expectations and prerequisites for postgraduate specialty training.A questionnaire about 100 skills and competencies expected of new first-year residents was sent to 50 U.S. residency directors from surgery, internal medicine, family medicine, pediatrics, and obstetrics-gynecology programs. Each director was asked to state expectations of a first-year resident's competence in each skill at entry to residency and after three months of training. Skills deemed most appropriately acquired in residency were also identified. Competencies included diagnosis, management, triage, interpretation of data, informatics and technology, record keeping, interpersonal communications, and manual skills.A total of 39 residency directors responded, including seven surgery, nine medicine, seven family medicine, eight pediatrics, and eight obstetrics-gynecology. In addition to physical examination skills, 13 competencies achieved more than 70% agreement as being entry-level skills. There was wide variability as to the relative importance of the remaining skills, with residency directors expecting to devote significant resources and time in early training to ensure competence.Medical schools should consider the expectations of their students' future residency directors when developing new curricula. Assuring students' competencies through focused curricular change should save both time and resources during residency.

Psychiatry residency training programs were characterized on four dimensions in a pilot study of seven West Coast schools. Residents and faculty rated their programs on academic versus clinical, community-based versus institution-based, private versus public practice, and biological versus psychological orientation. Faculty and residents from the same schools differed only on the academic-clinical dimension. Significant differences existed between schools on each axis. Variation in ratings on the biological-psychological axis suggests that claims to a “biopsychosocial” orientation may be too broad to be meaningful. This method of dimensional ratings appears appropriate for program assessment and deserves further development.

PURPOSE To assess the content and quality of dean's letters since the publication of guidelines recommended by the Association of American Medical Colleges (AAMC) in 1989. METHOD In 1998, the dean's letter writers at all 124 U.S. medical schools were surveyed. The questionnaire incorporated items from two previous surveys (1981 and 1992). In addition, samples of dean's letters (n = 451) from all U.S. medical schools for the graduating class of 1998 were rated based on the AAMC's guidelines. RESULTS The response rate of the 1998 survey (66%) was lower than those of the two previous surveys (87% for 1992 and 85% for 1981). Schools that prepared letters that followed the AAMC's guidelines were somewhat more likely to have responded. According to the letter writers in 1998, close to 300,000 letters (approximately 1,050,000 pages total) were sent to residency directors, at an estimated cost of $26,000 per school. A total of 65% of schools produced adequate dean's letters based on the 1989 AAMC's guidelines, compared with 55% in 1992. Many schools were organizing the dean's letter in more readable formats, and more schools provided information that allowed for a comparison of students within the same school. CONCLUSION The improvements in dean's letters are encouraging, but ten years after the AAMC's guidelines, 35% of U.S. schools still produce unacceptable letters. With the addition of the electronic submission of information, it is time to review further improvements to the dean's letter.

A recent paper by Fanti and Miyashita (2009. A high latitude vertebrate fossil assemblage from the Late Cretaceous of west-central Alberta, Canada: Evidence for dinosaur nesting and vertebrate latitudinal gradient. Palaeogeography, Palaeoclimatology, Palaeoecology 275, 37–53) reports on a new assemblage of terrestrial vertebrate fossils from the Campanian (Late Cretaceous) of northern Alberta. In addition to the several dinosaur and microvertebrate specimens reported by Fanti and Miyashita (2009), the new assemblage also contains two mammalian teeth, identified by the authors as pertaining to “Cimolodon sp.” and “Didelphodon sp.” The taxonomic identifications of these teeth are either highly questionable or simply incorrect, and the accompanying descriptions are replete with errors; as a result of these lapses, at least part of the biogeographic conclusions drawn by the authors about the Kleskun Hills Park area is also rendered incorrect. While the discovery of a Late Cretaceous high-latitude vertebrate fauna in Alberta is unquestionably important, the significance of the Kleskun Hills mammalian taxa, both taxonomically and biogeographically, should be reconsidered.

Computing and biomedical informatics technologies are providing almost instantaneous access to vast amounts of possibly relevant information. Although students are entering medical school with increasingly sophisticated basic technological skills, medical educators must determine what curricular enhancements are needed to prepare learners for the world of electronic information.The purpose was to examine opinions of academic affairs and informatics administrators, curriculum deans and recently matriculated medical students about prematriculation competence and medical education learning expectations.Two surveys were administered: an Information Literacy Survey for curriculum/informatics deans and a Computing Skills Survey for entering medical students.Results highlight differences of opinion about entering competencies. They also indicate that medical school administrators believe that most basic information skills fall within the domain of undergraduate medical education.Further investigations are needed to determine precise entry-level skills and whether information literacy will increase as a result of rising levels of technical competence.

Some call it "medical bigotry," and others describe it as the "hidden curriculum," but, by any name, the superficial and demeaning comments that students hear about particular career choices are thought to play a major role in discouraging the selection of primary care careers. This paper explores the frequency and effect of "badmouthing" on career choice with the hypothesis that it is more frequently heard about primary care disciplines but has relatively little influence on actual career choice.In 1993, 129 (79%) of the 163 University of Washington School of Medicine graduates responded to a two-page questionnaire about badmouthing. This information was used to refine the questionnaire. In 1994, 1,447 graduating students from nine medical schools were surveyed with the revised questionnaire. The schools were chosen to represent schools that had high, medium, and low proportions of students going into primary care careers.A total of 1,114 questionnaires were returned, for a response rate of 77%. Badmouthing was heard frequently (76% of the responding students) and often occurred as early as the first and second years of medical school. The students heard badmouthing about their career choices most frequently when they selected surgery (91%) and family medicine (87%) and least frequently when they chose pediatrics (57%), p.001. The students reported that the influence on career choice was low in general, but 186 students (17% of all respondents) did report altering their choices based on badmouthing.Primary care fields and non-primary care fields were equally affected by career changes due to badmouthing. This study indicates that badmouthing, while pervasive across all disciplines and an unattractive aspect of the educational experience, cannot alone account for the low proportion of graduates choosing primary care careers.

To examine the relationship between resident physicians' perceptions of their preventive cardiology practices and a chart audit assessment of their documented services.A criterion standard comparison of two methods used to assess resident physicians' practices: self-report and chart audit.Physician ambulatory care in a residency program.Coronary artery disease (CAD) risk factor assessment was evaluated by self-report for 72 resident physicians and by chart audit of randomly selected records of 544 of their patients who did not have CAD or a debilitating chronic disease during a one-year period.Measurements of the residents' perceived CAD risk factor assessment practice by self-report, and chart audit assessments of their recorded care.The relationship between self-reported and chart audit assessments of CAD risk factors.Chart audit assessment of CAD risk factor management was highly significantly (p0.01) lower than self-reported behaviors for evaluation of cigarette smoking, diet, physical activity, stress, plasma cholesterol, blood pressure, and body weight/obesity.Three different interpretations of these findings are apparent. 1) Physician self-report is a poor tool for the measurement of clinical behavior, and therefore research of physician behavior should not rely solely on self-reported data; 2) physicians' chart recording of their clinical practice is insufficient to reflect actual care; or 3) neither is an accurate measure of actual practice.

Graduating nursing students' abilities to assess clients for substance use were evaluated using two standardized patient (SP) cases. In the comprehensive health history case (unprompted), 55% of the study participants assessed alcohol use and 20% assessed drug use. When prompted to conduct a substance use history, at least 90% of the subjects asked about the quantity and frequency of alcohol use and 80% asked about drug use. However, in the prompted case, fewer than 10% of the subjects linked current alcohol and drug (AOD) use with risks and consequences, nor did they ask the SP if he had considered decreasing substance use. The mean score for communication skills used in the two assessment interviews were 3.65 and 3.56 on a 1 to 6 Likert scale. These data point out the need for additional emphasis on instructing students to include AOD questions as part of routine assessments, what questions to ask in a substance use assessment, and how to act on the information received. The use of SPs is one way to obtain valid information about students' assessment competencies.

Purpose To compare results from 1981 and 1992 national surveys of the writers of medical school dean's letters, and to rate the 1992 letters based on the guidelines recommended by the Association of American Medical Colleges (AAMC). Method In early 1992 a survey was administered to the dean's letter writers at all 125 U.S. medical schools with fully accredited four-year programs; the survey incorporated many items from a 1981 survey. In addition, 550 dean's letters from all U.S. medical schools for the graduating class of 1992 were collected and rated based on guidelines published by the AAMC in 1989. Results The response rate of the 1992 survey was comparable to that of the 1981 survey (85% and 87%, respectively). In both surveys, slightly more than half the schools used more than one letter writer; however, the 1992 letters were longer and there were more of them, in spite of the fact that there were approximately 700 fewer graduates. In 1992 the estimated total cost per school was $25,000 (comparable data were not collected in 1981). The ratings of the letters revealed that only 38% of the schools introduced their letters as letters of "evaluation," as recommended by the AAMC, and that 15% of the schools failed to use the AAMC guidelines for format. When the schools were rated for overall quality (i.e., format combined with information about the students' performance in comparison with that of peers), 55% of the schools passed and 45% failed. Conclusion Several recommendations for improving dean's letters are discussed, including the following: (1) all dean's letters should be formatted according to the AAMC guidelines; (2) each school should have one person responsible for central overview of the school's letters; and (3) for comparative performance information, schools should at least give the percentages of grades given in the required clerkships, and it would be preferable for them to employ systems that group students into four to six groups and to indicate the percentage of students in each group.

The University of Washington School of Medicine conducted a series of internal surveys to investigate senior students’ capabilities with respect to clinical skills and behaviors. The surveys examined faculty opinion regarding essential clinical skills and sought their estimates of potential problem areas. They also identified those clinical skills and behaviors on which students reported whether they had ever been expected to demonstrate proficiency. Three questions were addressed: (a) What behaviors and skills should all undergraduate medical students in this institution be expected to demonstrate before graduation? (b) Do senior medical students at this institution appear to be learning skills that faculty believe are essential? (c) How should skills that are considered essential by the institution's faculty be evaluated? This approach to institutional self‐study is presented as a model for determining how a medical school that does not have a comprehensive performance‐based evaluation system can determ...

As part of the National Center for Complementary and Alternative Medicine (CAM) R25 Education Grant Program, a faculty development program for integrating CAM into the nursing curriculum was instituted in 2003-2006. The Integrating CAM program was composed of a number of elements; the primary strategy included a series of 4-week didactic and experiential summer CAM "Camps," attended by 27 faculty members. Camps were designed to influence faculty integration of CAM material into course offerings. The Integrating CAM program was evaluated via a series of faculty and student surveys regarding CAM competencies, attitudes, and perceptions. For more than half of the faculty (out of the 43 who responded), the program yielded a moderate-to-strong influence on incorporation of CAM material into course content and moderate-to-great increases in both enthusiasm for CAM and perceived CAM knowledge gains. Students at all levels (undergraduate, master's, and doctoral; n = 184) reported that their courses contained CAM content; for 70% of students, their CAM knowledge increased; for 50% of students, level of CAM interest increased. Self-reported student CAM competencies were significantly greater in 2006-2007 (n = 191) than those in 2003-2004 (n = 143). Results support the strategy of broadly infusing the nursing curriculum with CAM content via faculty development.

We report results of a seven-year prospective cohort study of physicians' attitudes about and intentions to provide 27 preventive care services in their future practices. Respondents in the cohort were surveyed three times: first, during orientation to medical school; second, during their third year of medical school; and finally, following completion of their third-year of residency training. The majority of preventive care services were viewed as more important to clinical practice in primary care than in non-primary care specialties. Positive attitudes toward preventive care services generally persisted among both primary and non-primary care physicians. Respondents expressed only fair to medium levels of confidence in the ability of physicians in their specialty areas to provide any of the preventive services examined. Respondents reported low levels of confidence in the ability of primary care physicians to provide nutritional counseling, though they ranked it as important. Respondents were fairly or moderately confident in the ability of primary care physicians to provide counseling about smoking cessation, health, AIDS education, and substance abuse. Participants ranked smoking cessation counseling, health counseling, AIDS education, cancer detection education, and substance abuse counseling and education as very important. In general, physicians were less likely to plan on providing preventive services than they were to expect their residency programs to prepare most or all to provide the services. Findings document the need to prepare physicians better to provide preventive services.

Summary. This paper describes a collaborative survey of Chinese medical school teacher opinion concerning clinical behaviours and skills that Chinese students should be expected to demonstrate prior to graduation from medical school. Selected teachers from four Chinese medical schools indicated whether each of 77 objectives was: essential for every student to know or demonstrate prior to graduation; useful but not essential; or not applicable to their educational programmes. Results show teachers' expectations regarding some of the behaviours and skills Chinese medical school teachers consider to be important for students to learn. Forty-nine per cent of the exit objectives were regarded as essential by 75% or more of the teachers. The most essential objectives involved performing clinical procedures, collaborating and communicating with health care professionals, conducting organ system examinations, formulating hypotheses and defining problems. Other essential objectives were concerned with communicating with patients and their families, maintaining currency within the discipline, and recognition, evaluation and triage of patients with life-threatening or chronic conditions. Exit objectives related to health promotion and risk assessment were regarded as useful but not essential at the undergraduate level. Implications for Chinese medical education are discussed.

The relationship between oral contraceptive use and other coronary artery disease risk factors was examined in 215 nonsmoking women grouped as never, current, or previous users. Current oral contraceptive users had higher triglyceride levels (p less than or equal to 0.001) than other groups, higher systolic blood pressure, and lower plasma HDL-cholesterol levels (p less than or equal to 0.05) than previous users. The effect of oral contraceptive use on plasma triglyceride values persists on multivariate regression analysis independently of age, body mass index, dietary sodium and cholesterol intake, cigarette smoking, and level of physical activity. Oral contraceptive use also has an independent relationship to the plasma total cholesterol/HDL- cholesterol ratio. These findings indicate that oral contraceptive use is adversely associated with plasma lipid and lipoprotein values.

This paper describes a 1988-1989 collaborative mail survey of faculty opinion about clinical behaviors and skills that students should be expected to demonstrate prior to graduation from undergraduate medical school (hereafter called "exit objectives"). Selected faculty from 12 American and Canadian medical schools indicated whether each of 77 objectives was essential for every student to know or demonstrate prior to graduation; useful but not essential at the undergraduate level; or not applicable to their undergraduate program. Their responses provide a glimpse into faculty expectations regarding some of the exit behaviours and skills they deemed essential. Forty-two percent (32) of the 77 objectives were regarded as essential by 75% or more of the faculty members who responded. Essential objectives involved conducting organ system examinations, formulating problems and hypotheses, and gathering fundamental interview, physical, and screening examination data, including emergency examinations of the airway and circulatory systems. Other essential objectives involved collaboration and communication, demonstrating concern for legal and ethical values, and keeping abreast of current information within the discipline. Exit objectives related to the diagnosis and management of specific conditions were regarded as useful but not essential at the undergraduate level. Implications for medical education are discussed.

Graduate doctors are the primary output of medical education programmes. It is important for institutions to identify systematically the types of medical activities in which their former students are involved in order to determine the effectiveness of the curriculum, assessing academic standards and reviewing admissions policies. Information was obtained from a survey of men and women graduates from three of the early graduation classes of King Abdulaziz University College of Medicine in Saudi Arabia about postgraduate medical training, certification, practice patterns, and other curriculum issues. Information collected from 151 graduates (90%) indicated that 96% were practising medicine in a variety of medical specialties and subspecialties. Six were not practising at the time of the study. Significant differences were found in the specialties being practised when men and women were compared. Men tended to practise in medicine, surgery, dermatology, urology, ENT, ophthalmology and orthopaedics, while women concentrated in obstetrics and gynaecology and paediatrics. Certification beyond medical school was earned by 49% with no significant difference being found comparing men to women. Men earned the majority of their postgraduate certifications outside Saudi Arabia while most women earned theirs in Saudi Arabia. Graduates indicated that departments in the basic sciences were least helpful in preparing them as doctors, while selected clinical departments were most helpful. It was concluded from the study that the curriculum goals of the College of Medicine, namely a curriculum of international standards producing graduates to take leadership roles in both teaching and medical practice, were realized in part by the graduates surveyed.

OBJECTIVES To assess the effectiveness of a stress reduction elective on Year 2 medical students and to assess the sustainability of any noted improvement. METHODS A new elective entitled 'Mind-Body Medicine: an Experiential Elective' was offered to Year 2 medical students. It was based on a course developed by the Center for Mind-Body Medicine. Enrolled students were surveyed on the first (time 1) and last (time 2) days of the elective and again 3 months later (time 3). Four validated self-report instruments were used to examine effects on anxiety, stress, mood states and depression. A comparison group of non-enrolled classmates completed the same instruments during the same timeframes. The study began in autumn 2004 and ended in June 2005. RESULTS Participating students had higher initial anxiety scores than students in the comparison group. Anxiety in the study group declined significantly during the course, with enrolled students becoming indistinguishable from non-enrolled counterparts. These decreased anxiety levels were sustained for 3 months following the conclusion of the course. CONCLUSIONS This elective was successful in attracting students who were more anxious than their peers. Enrolees had higher baseline anxiety levels than their peers. The course decreased anxiety levels. The significant drop in anxiety scores of the study group suggests that this mind-body elective was an effective way to decrease anxiety in these pre-clinical medical students. Decreases in anxiety were sustained 3 months after the course ended, indicating that the benefits of the course may be longlasting.

Nurses have important roles in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) treatment and educational programs. Chinese senior nursing students completed a survey on HIV/AIDS knowledge, attitudes, and practice intentions. A weak positive relationship between attitudes and practice intentions (r = .140, P = .036) was noted. No significant associations between knowledge levels, attitudes, and practice intentions were found. Although the majority exhibited adequate knowledge of basic HIV transmission mechanisms, many disconcerting misconceptions were evident. Although most were empathetic to people with HIV/AIDS, stigmatization of high-risk groups persisted. Improved patient care will require intensified educational efforts and more positive attitudes toward persons with HIV/AIDS.

Salivary venoms are a rarity in mammals, found only in the duck-billed platypus, the Caribbean Solenodon, and a few shrews. Until now there were no known extinct mammals so equipped, but well preserved specimens of a small pantolestid insectivore have now been found with a venom delivery apparatus involving specialized teeth similar in function but structurally distinct from those of living venomous mammals. The specimens are about 60 million years old, from the late Palaeocene sediments in central Alberta that contain some exceptionally well preserved mammalian fossils. Numerous non-mammalian vertebrates have evolved lethal venoms to aid either in securing prey or as protection from predators, but modern mammals that use venoms in these ways are rare, including only the duck-billed platypus (Ornithorhynchus), the Caribbean Solenodon, and a few shrews (Soricidae) (Order Insectivora)1. Here we report evidence of a venom delivery apparatus in extinct mammals, documented by well-preserved specimens recovered from late Palaeocene rocks in Alberta, Canada2,3. Although classified within Eutheria, these mammals are phylogenetically remote from modern Insectivora4 and have evolved specialized teeth as salivary venom delivery systems (VDSs) that differ markedly from one another and from those of Solenodon and shrews. Our discoveries therefore show that mammals have been much more flexible in the evolution of VDSs than previously believed, contradicting currently held notions that modern insectivorans are representative of the supposedly limited role of salivary venoms in mammalian history. Evidently, small predatory eutherians have paralleled colubroid snakes5 in evolving salivary venoms and their delivery systems several times independently.