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Medical licensing boards use competence assessment and educational intervention programs as tools in disciplinary actions. Few studies measure the impact of these remedial interventions on the quality of care provided by participants after such interventions. CPEP, the Center for Personalized Education for Professionals, provides clinical competence assessment/educational intervention services and practice monitoring, primarily for physicians complying with board orders due to substandard care. Depending on the board requirements, some physicians complete an assessment/educational intervention and, after completion, subsequently undergo practice monitoring (Intervention Group). Others participate in the practice monitoring without first completing an assessment/educational intervention (Non-Intervention Group). CPEP conducted a retrospective study of chart reviews (n=2073) performed as part of each group’s participation in the Practice Monitoring Program. When compared to the charts from the Intervention Group, charts from the Non-Intervention Group were more than five times more likely to demonstrate care below standard (P < 0.0001) and almost four times more likely to have documentation issues that prohibited the monitor’s ability to determine the quality of care (P < 0.0001). This study suggests that completion of a competence assessment/education intervention program is an effective means of achieving acceptable quality of care that is sustained over time (average 18 months) after completion of the intervention.

Korinek’s article assesses the contribution of Imperial Plots to the writing of queer western histories, particularly women’s histories. The “single” English women who strike out for the west, individually and in pairs, challenge our preconceived notions of the presumed heterosexuality of all prairie settlers. Furthermore, Korinek argues that Carter’s research insights in this award-winning volume deserve to have a wide audience beyond the fields of gender histories, ideally integrated into scholarly and popular histories of the Canadian prairies and Canadian social histories., L’article de Korinek évalue la contribution d’Imperial Plots à l’écriture de l’histoire des gais dans l’Ouest, en particulier de l’histoire des femmes. Les Anglaises « célibataires » qui partaient pour l’Ouest, seules ou à deux, remettent en question nos idées préconçues voulant que tous les colons eussent été hétérosexuels. En outre, Korinek soutient que les résultats de la recherche de Carter, dans son ouvrage primé, méritent d’avoir une audience plus large que celle du champ de l’histoire du genre, et que, dans l’idéal, ce livre devrait être intégré à l’histoire, vulgarisée autant que scientifique, de la Prairie et de l’histoire sociale canadienne.

Purpose To identify factors associated with physician performance in a comprehen­ sive competence assessment. Method The authors conducted a retrospective analysis of 683 physicians referred for assessment at the Center for Personalized Education for Physicians from 2000 to 2010, who were evaluated as either safe or unsafe to return to practice. Multivariate logistic regression was used to determine factors predictive of unsafe assessment outcome. Covariates included personal characteristics (e.g., age), practice context (e.g., solo practice), and referral information (e.g., previous board license action). Results Older physicians were more likely to have unsafe assessment outcomes (odds ratio [OR] = 1.07; P < .001). Board­ certified individuals were less likely to have poor assessment outcomes (OR = 0.40; P = .003) than uncertified individuals. Physicians in solo practice were more likely (OR = 2.15; P = .037) to be deemed unsafe than physicians in other settings. Physicians with a practice scope that matched their training were less likely (OR = 0.29; P = .023) to have unsafe assessment outcomes than those whose did not. Physicians with current or previous board action (suspension, revocation, limitation, or stipulation) were more likely to be deemed unsafe (OR = 2.47; P = .003) than those without. Conclusions Findings suggest that important predictors of physician performance on competence assessment include personal characteristics, practice context, and reasons for assessment referral. These findings have implications for development of policies and programs designed to assess risk of poor physician performance and quality of care improvement efforts through organizational/practice design or remedial education.

Objective To determine whether population-specific normative data should be employed when screening neurocognitive functioning as part of physician fitness for duty evaluations. If so, to provide such norms based on the evidence currently available. Methods A comparison of published data from four sources was analyzed. Data from the two physician samples were then entered into a meta-analysis to obtain full information estimates and generate provisional norms for physicians. Results Two-way analysis of variance (Study x Index) revealed a significant main effect and an interaction. Results indicate differences in mean levels of performance and standard deviation for physicians. Conclusions Reliance on general population normative data results in under-identification of potential neuropsychological difficulties. Population specific normative data are needed to effectively evaluate practicing physicians.

As a work of queer history this article historicizes same-sex desire in Winnipeg from the 1930s through the late 1960s. This research asks provocative questions about how the nature of place (a major prairie capital city) and space (commercial venues, public parks, and private homes) permitted, constructed, and constrained queer activities. Beginning with the earliest oral history recollections of Depression-era same-sex activity, this article charts the changes caused by the Second World War, more liberalized liquor laws in the 1950s, and the expanding economy in the 1960s. Ultimately, it illustrates that Winnipeg functioned as a "queer capital" for residents of Manitoba, Northwestern Ontario, and, less frequently, parts of Saskatchewan. Reframing the city of Winnipeg through a queer lens offers a novel addition to our history of this well-known city; it makes an important contribution to the national and international literature of queer urban development; and, finally, it offers a prairie perspective on the formation of social spaces and identities prior to the establishment of dedicated, local gay and lesbian organizations. Œuvre inspiree de l'histoire queer, le present article historicise le desir pour les personnes du m'me sexe du Winnipeg des annees 1930 jusqu'a celui de la fin des annees 1960. Cette recherche pose des questions percutantes, se demandant comment la nature du lieu (une grande capitale des Prairies) et de l'espace (endroits commerciaux, parcs publics et maisons privees) a permis, construit et g'ne les activites queer. S'appuyant d'abord sur les premiers recits tires de l'histoire orale de l'activite homosexuelle au temps de la depression, cet article retrace les changements qu'ont provoques la Deuxieme Guerre mondiale, l'assouplissement des lois sur les boissons alcoolisees dans les annees 1950 et l'essor economique des annees 1960. Il en arrive a la conclusion que Winnipeg faisait alors office de > pour les residents du Manitoba, du Nord-Ouest de l'Ontario et, dans une moindre mesure, de certaines parties de la Saskatchewan. Recadrer la ville de Winnipeg en l'examinant sous la loupe de l'identite queer jette un nouvel eclairage sur l'histoire que nous avons de cette ville bien connue. En effet, non seulement cela enrichit-il grandement la litterature nationale et internationale sur le developpement urbain queer, mais permet egalement d'examiner dans la perspective des Prairies la formation d'espaces sociaux et d'identites sociales avant l'etablissement d'organismes locaux voues a la cause des gais et lesbiennes.

Radial and longitudinal strain assessment in the carotid artery wall using speckle tracking

We assessed the effect of phalloidin, known to detach nebulin from actin in skeletal myofibrils, on the isometric force of skinned lamprey cardiac muscle, which has nebulin in amounts comparable to that in skeletal muscle. In contrast to mammalian cardiac muscle, which contains much less nebulin and reacts to phalloidin only by an increase in force, the lamprey cardiac muscle responds to phalloidin by a pronounced (∼ 50%) reduction in isometric force, thereby resembling the behavior of skeletal muscle. These results support our hypothesis that nebulin detachment from actin underlies phalloidin-induced force loss and suggest a role of actin-nebulin interaction in contractile function.

Maclean's has been valorised for its decision to publish articles on homosexuality in the 1960s, but Chatelaine's foray into lesbian material has been neglected. The historiography of lesbian history for those decades points to bar culture, friendship networks and, less frequently, pulp novels as ways in which lesbians discovered themselves and each other. This work challenges that presumption and proves that this mainstream women's magazine contained not only traditional images of heterosexual wives and mothers but also of lesbians. "Girlfriends" examines the micropractice of reading a massmarket women's magazine from a queer perspective. Alors que Maclean 's a 6t6 mis en vedette pour avoir accepte de publier des articles traitant de ['homosexualite au cours des annees 1960, l'interet porte par Chatelaine au materiel lesbien a ete neglig6. L'historiographie de l'histoire lesbienne pendant ces d6c6nnies porte principalement sur la culture de bar, les reseaux d'amiti6 et, moins souvent, les romans a sensation comme moyens pour les lesbiennes d'apprendre a se connaitre. L'article refute cette perception et montre que les revues pour femmes h grand public propageaient des images traditionnelles non seulement des femmes et des me res heterosexuelles mais aussi des lesbiennes. "Girlfriends" propose une pratique de lecture serr6e d'un magazine de femmes a grand tirage A partir d'une perspective lesbienne. Middle-class women's magazines, as Chatelaine was and is, are supposed to entice their readers with affordable recipes, light-fiction, articles on Hollywood entertainers and heavy doses of fashion, beauty and interior decorating features. Yet this Canadian women's magazine was, by American standards, very unconventional.' Throughout its history, the magazine's editors, associate editors and most of its editorial staff were women and from 1958 to 1977 the magazine was edited by an avowed and committed feminist named Doris Anderson. The magazine regularly published feminist editorial essays and articles along with romance fiction, departmental features and a hefty dose of brand-name advertising from North American corporations. Any given copy of the magazine required readers to negotiate a variety of messages - from the liberal and often feminist messages of editorials, through the frequently unconventional article topics, to the more standard women's magazine fare of romance fiction and departmental features and, finally, at the other end of the spectrum, the most conservative component - the advertising - that glorified the comfortable world of suburban consumption. During this era, Chatelaine had four different editors. The first, Byrne Hope Sanders, completed her 24-year tenure as editor in January 1952. Her successor, newspaper columnist Lotta Dempsey, edited the magazine for less than a year before she abandoned the periodical to return to writing. On short notice, Maclean Hunter installed Maclean's stalwart John Clare, the only male editor. Clare continued until a more willing and suitable candidate was located. Doris Anderson, a staff writer at Chatelaine, became editor with the September 1957 issue. Editorial turbulence and neglect was generally reflected in the product, a slim, old-fashioned and dowdy periodical. In 1958, partly as a business initiative and partly on Anderson's direction, the magazine was re-modelled to make it more au courant and relevant for Canadian women. In the 1960s, editorial continuity and the remodelling served Chatelaine well as it attempted to reposition itself as a more trendy magazine, which would appeal to a younger audience. Circulation and advertising figures shot upwards, and Maclean Hunter knew that they had a hit on their hands regardless of what many of their corporate executives might personally think of the changes to the editorial content. Anderson's revamped Chatelaine was the premier Canadian women's magazine of the era and the only Canadian women's magazine to be published between 1957 and 1969. …

Polemique sur l'ordination des femmes au 20 e siecle dans l'Eglise canadienne malgre l'egalite des droits.

INTRODUCTION: Limited information exists to describe physicians who return to practice after absences from patient care. The Center for Personalized Education for Physicians (CPEP) is an independent, not-for-profit organization that provides clinical competency assessment and educational programs for physicians, including those reentering practice. This article studies the medical licensure status, performance and correlates between physician characteristics and performance on initial assessment. METHODS: Sixty-two physicians who left practice voluntarily and without discipline or sanction and who were returning to practice in the same discipline as their previous practice participated in the CPEP reentry program. Physicians completed an objective clinical skills assessment including clinical interviews by specialty-matched board-certified physicians, simulated patient encounters, a documentation exercise and a cognitive function screen. Physicians were rated from 1 (no or limited educational needs) to 4 (global, pervasive deficits). Performance scores were compared based on select physician characteristics. RESULTS: Twenty-five (40.3 percent) participants were female; participants' average age was 53.7 years (female 48.1 years; male 57.5 years). Physicians left practice for family issues (30.6 percent), health issues (27.4 percent), retirement or nonmedical career change (17.7 percent), and change to medical administration (14.5 percent). Females were more likely than males to have left practice for child rearing (P < 0.0001). Approximately one-quarter (24.2 percent) of participants achieved a performance rating of 1 (best-performing group); 35.5 percent achieved a rating of 2; 33 percent achieved a rating of 3; 6.5 percent achieved a rating of 4 (worst-performing group). Years out of practice and increasing physician age predicted poorer performance (P = 0.0403, P = 0.0440). A large proportion of physicians presenting without an active license achieved active licensure; how many of these physicians actually returned to practice is not known. DISCUSSION: Physicians who leave practice are a heterogeneous group. Most participants' performance warranted some formal education; few demonstrated global educational needs. The data from this study justify mandates that physicians demonstrate competence through an objective testing process prior to returning to practice. Emerging patterns regarding the performance of the reentering physician may help guide future policy.

Research suggests that there are concerns about the neuropsychological functioning of physicians who undergo physician competency evaluation. Academic health center faculty often participate in the evaluation and remediation of these physicians. The purpose of this study was to compare the cognitive abilities between a group of physicians referred for competency evaluations and a control group.Using the MicroCog, a computerized neuropsychological screen originally designed for physicians, the authors compared the cognitive performance of 267 physicians referred for competency evaluations with a control group of 68 recruited physicians. Physicians referred for competency evaluations took the MicroCog as a part of their evaluation at CPEP, the national Center for Personalized Education for Physicians, from January 1997 to January 2004. The control group comprised practicing physicians whose competency was not in question.Compared with the control group, the competency evaluation group had a greater proportion of physicians with scores suggesting possible cognitive impairment and performed significantly lower on scores of processing speed, processing accuracy, and cognitive proficiency. The control group of physicians performed significantly better than the age- and education-corrected normative sample.Because there were significant neuropsychological differences between physicians referred for competency evaluations and physicians whose competency was not in question, it is important that neuropsychological screening be included as part of physicians' competency evaluations.

The effect of phalloidin, an agent detaching nebulin from actin in skeletal muscle, on the isometric force in lamprey skinned cardiac muscle, which has nebulin in amounts comparable to that in skeletal muscle, has been studied. We found that, unlike mammalian cardiac muscle expressing nebulin less abundantly and responding to phalloidin by a force increase, lamprey cardiac muscle responds to phalloidin by a force decrease (approximately 50% decrease), thereby resembling the response of skeletal muscle. These results support our hypothesis that nebulin detachment from actin underlies phalloidin-induced force loss and suggest a role of actin-nebulin interaction in contractile function.

Tantalum capacitors play an important part in modem electronics. They are used in the most demanding of circuit applications, because of their outstanding characteristics, such as: compatibility with Surface Mounted Technology, small size, ability to operate over relatively wide temperature spectrum, and high reliability. Whereas the production of capacitors more than tripled over the last eight years, the amount of powders needed for this increase grew by no more than 10%. One of the main reasons for this development has been the achievement of powder producers to increase the capacitance/g of Tantalum powder. Today there are powders available with a CV/g value of 40-50 K and higher. The development of high CV powders was a complicated process made possible by using finer powders, the introduction of sophisticated agglomeration techniques and deoxidization. High capacitance powders have to be sintered at lower temperatures or shorter sinter times to preserve the high surface area. The lowering of sintering temperature results in decreasing the purification of the powder during sintering. Therefore, high capacitance powders have to be purer before the sintering than low capacitance powders of the past.

The variation of the photocurrent with temperature is found to obey the relation i = i0e−E/RT in naphthalene, stilbene, diphenyl, terphenyl, β-methylanthracene, anthracene, azulene, and pyrene. The activation energies have been measured and are found to increase in the above order. These activation energies show no apparent correlation with the corresponding activation energy of semiconduction, and it is suggested they are associated with the charge carrier transport process.

The spectral response, voltage dependence, and intensity dependence of the surface photocurrent in naphthalene, terphenyl, pyrene, stilbene, and azulene have been measured. Pyrene and naphthalene have a high sensitivity for photoconduction at the long-wavelength edge of the optical absorption spectrum. In the spectral response of pyrene three peaks appear at 4475 Å, 4275 Å, and 4100 Å. It is suggested that these peaks are due to weak optical absorptions to energy levels which are highly efficient in promoting conduction. It is possible that a similar effect occurs in naphthalene, where maximum photoconductivity coincides with a weak absorption reported by McClure and Schnepp. Azulene only shows photoconductivity at wavelengths corresponding to absorption to the second singlet state.

The variation of the photocurrent and dark current on melting naphthalene and biphenyl was studied. A large increase in the value of the photocurrent was observed. This change is very similar to that of the dark current. It is concluded that the increased mobilities of the charge carriers in the melt are mainly responsible for the change in both cases. The existence of photoconduction in the non-crystalline state is discussed.

In order to investigate further the nature of the proton resonance shifts accompanying hydrogen bonding, and their relation to the properties of the hydrogen bond, the resonance shift of the acceptor molecule chloroform, interacting in turn with a variety of donor molecules, was measured. The donor liquids chosen were (Et)3N, (Et)2O, PrF, (Me)CO, and EtCN. These are all virtually non-associated in the pure state and may be expected to form simple 1:1 hydrogen-bonded complexes with chloroform, whose existence was confirmed by measuring the binary freezing-point phase diagrams. The difference between the proton shift of chloroform at infinite dilution in each of the donor solvents and at infinite dilution in inert hydrocarbon solvents was taken as the "association" shift representing the difference between chloroform in the hydrogen bonded complex and unassociated chloroform. These shifts correlate well with the expected hydrogen bond strengths in each system and the relative donor strength of the individual solvent molecules. The proton resonance technique appears as a promising method for measuring these properties.

The effects of various complexing agents on the homogeneous reduction of mercuric salts by molecular hydrogen in aqueous solution were determined. In all cases the kinetics suggest that the rate-determining step is a bimolecular reaction between a mercuric ion or complex and a hydrogen molecule, probably leading to the formation of an intermediate mercury atom. The reactivity of various mercuric complexes was found to decrease in the following order: HgSO4 > Hg++ > HgAc2, HgPr2 > HgCl2 > HgBr2 > Hg(EDA)2++. Addition of anions such as OH−, CO3=, Ac−, Pr−, and Cl−, in excess of the amounts required to form stable mercuric complexes, was found to increase the rate. An interpretation of these effects is given.

Thirty-one patients with measureable metastatic colorectal cancer refractory to 5-fluorouracil-containing regimens received dihydroxyanthracenedione (DHAD, NSC 301739) on a 5-day I.V. schedule administered every 4 weeks. Good-risk patients received DHAD at the starting daily dose of 4 mg/m2 while patients who had had therapy with radiation or myelosuppressive drugs such as mitomycin C or a nitrosourea compound received an initial daily dose of 3 mg/m2. There were no complete or partial remissions in this study. Eight of 30 evaluable patients had disease stabilization. The dose-limiting toxic effect was myelosuppression; neutropenia was more severe than thrombocytopenia. The myelosuppression was more severe in patients who had poor bone marrow reserves and abnormal pretreatment liver functions (serum alkaline phosphatase and serum glutamic oxaloacetic transaminase) levels greater than or equal to 1.5 times normal). DHAD administered by the 5-day dose schedule as used in this study is not effective against colorectal cancer.

Thirty patients with measurable metastatic colorectal cancer refractory to 5-fluorouracil-containing regimens, received AZQ (1,4-cyclohexadiene-1,4-dicarbamic acid, 2,5-bis(1-aziridinyl)3,6,dioxo,diethylester, NSC 182986) on a 5-day intravenous schedule administered every 4 weeks. Good risk patients received AZQ at the starting daily dose of 8 mg/m2, while patients who had had therapy with radiation or myelosuppressive drugs such as mitomycin C or a nitrosourea compound received an initial daily dose of 6 mg/m2. There were no complete or partial remissions. Only one of 27 evaluable patients had objective tumor regression. Five additional patients had disease stabilization. The dose-limiting toxicity was myelosuppression, with thrombocytopenia being more severe than neutropenia. The myelosuppression occurred late in the treatment cycle (day 20), was more severe with repeated treatments, and was more severe in patients who had poor bone marrow reserves. AZQ administered by the 5-day dose schedule as used in this study is not effective against colorectal cancer.