Deception by applicants to family practice residencies

BACKGROUND AND OBJECTIVES

Our residency program experienced applicants who actively misrepresented qualifications, background, or abilities. The experiences of other family practice residencies were unknown. This study 1) determined what information family practice residency directors required from applicants, 2) assessed whether this information was confirmed or verified, and 3) describes the deceptive application information discovered by program directors.

METHODS

A questionnaire was sent to directors of all accredited family practice residencies. Information was collected about required information, data confirmation, and the deception and misrepresentation perceived.

RESULTS

Thirty-two percent of the directors responded. Eight of 13 items on the Electronic Residency Application System were designated as required by more than half of responding directors. Only two of the items (licensure and certain facts in the personal statement) were confirmed by a majority of directors who required them. Deception was recognized by nearly half of respondents within the past 5 years. Most cases involved specialty choice or the personal statement of candidates and were recognized during the interview or by direct confirmation of data.

CONCLUSIONS

Most directors appear to accept application information at face value. Recognition of deception about application information was reported. Misrepresentation by applicants may be a more common event than previously realized and may require more thorough verification of application credentials.

Analysis of the activity of promoters from two photosynthesis-related genes psaF and petH of spinach in a monocot plant, rice

The subunit III of photosystem I and ferredoxin-NADP(+)-oxidoreductase are encoded by nuclear genes, namely psaF and petH. The activity of their promoters from spinach has been evaluated in transgenic tobacco earlier. Evaluation of the activity of these Dicotyledoneae-specific promoters has been carried out in a monocot system (i.e. rice) by transient gene expression system, based on electroporation-mediated gene delivery into protoplasts from leaves and roots. It has been found that various promoter deletions show higher activity in leaf protoplasts and elements for quantitative response are widely distributed. Transgenic rice has also been produced with a petH promoter and gus reporter gene construct. Although petH promoter is a weak promoter in comparison to the 35S promoter, it expresses well in green tissues and could be useful for plant genetic engineering.

Isolation, characterization, and cloning of porcine complement component C7

Activation of the complement system through the classical, alternative, or lectin pathway results in the formation of the terminal complement complex. C7 plays an integral role in the assembly of this complex with target cell membranes. To date, only human C7 has been cloned and characterized; thus, in this study, we characterized the porcine complement component C7. Porcine C7 was isolated by affinity chromatography as a single glycoprotein with an approximate molecular mass of 90 kDa and 100 kDa under reducing and nonreducing conditions, respectively. The full-length porcine C7 cDNA was isolated, and the predicted amino acid sequence exhibited 80% identity with human C7 with conservation of the cysteine backbone and two putative N-linked glycosylation sites. Porcine C7 mRNA expression was detected in all tissues investigated, except polymorphonuclear and mononuclear leukocytes. Addition of purified porcine C7 restored the hemolytic activity of C7-depleted human sera in a dose-dependent manner. A functionally inhibitory mAb against porcine C7 attenuated the hemolytic activity of human, rabbit, or rat sera, suggesting an important conserved C7 epitope among species. These data demonstrate that porcine and human C7 are highly conserved, sharing structural and functional characteristics.

Spire contains actin binding domains and is related to ascidian posterior end mark-5

Spire is a maternal effect locus that affects both the dorsal-ventral and anterior-posterior axes of the Drosophila egg and embryo. It is required for localization of determinants within the developing oocyte to the posterior pole and to the dorsal anterior corner. During mid-oogenesis, spire mutants display premature microtubule-dependent cytoplasmic streaming, a phenotype that can be mimicked by pharmacological disruption of the actin cytoskeleton with cytochalasin D. Spire has been cloned by transposon tagging and is related to posterior end mark-5, a gene from sea squirts that encodes a posteriorly localized mRNA. Spire mRNA is not, however, localized to the posterior pole. SPIRE also contains two domains with similarity to the actin monomer-binding WH2 domain, and we demonstrate that SPIRE binds to actin in the interaction trap system and in vitro. In addition, SPIRE interacts with the rho family GTPases RHOA, RAC1 and CDC42 in the interaction trap system. Thus, our evidence supports the model that SPIRE links rho family signaling to the actin cytoskeleton.

Residency orientation: what we present and its effect on our residents

BACKGROUND AND OBJECTIVES

This study describes the content of family practice residency orientation programs, presents data about resident satisfaction with orientation, and determines if residents feel prepared for residency duties.

METHODS

We surveyed program directors and first-year residents at 100 family practice residency programs. We used questionnaires to collect data about orientation activities; program demographics; and resident characteristics, satisfaction, and preparation.

RESULTS

Sixty-nine percent of directors and 68% of their residents responded. The activity most frequently presented was a social event with faculty, while the least frequently presented was an assessment of cognitive knowledge. Even though residents desire orientation to clinical programs, and directors wish to promote group cohesion, the greatest number of orientation activities were presented to introduce hospital services and administration. Eighty-seven percent of residents were at least "somewhat satisfied," and 83% felt at least "somewhat prepared" for clinical duties after completing orientations. Residents from military programs were more likely not to be satisfied with their orientations. Extreme satisfaction was associated with residents in community-based programs. Being totally prepared was associated with having had prior graduate medical education.

CONCLUSIONS

While residents had previously reported having clinical needs from an orientation, the most frequently reported activities were nonclinical. Most residents reported having been satisfied with their orientations and having felt prepared for their new duties. Directors should consider increasing the clinical content of their orientations, including an assessment of residents' knowledge and clinical skills.

Nucleotide sequence of psbQ gene for 16-kDa protein of oxygen-evolving complex from Arabidopsis thaliana and regulation of its expression

The psbQ gene encoding a 16-kDa polypeptide of the oxygen-evolving complex of photosystem II has been isolated from Arabidopsis thaliana and characterized. The gene consists of a 28 nucleotide long leader sequence, two introns and three exons encoding a 223-amino-acid precursor polypeptide. The first 75 amino acids act as a transit peptide for the translocation of the polypeptide into the thylakoid lumen. Expression studies show that the gene is light-inducible and expresses only in green tissues with high steady-state mRNA levels in leaves. Using this gene as a probe, restriction fragment length polymorphism between two ecotypes, Columbia and Estland, has also been detected.

Right from the start: the family practice orientation study

BACKGROUND AND OBJECTIVES

Orientation to a residency program introduces residents to the essential functions of their duties, clarifies expectations, and acclimates them to a new social group. This study identified the orientation goals of family practice residency directors and compared those goals to the perceived needs of first-year family practice residents.

METHODS

We surveyed program directors and PGY-1 residents at 100 accredited family practice residency programs. Questionnaires obtained descriptive information about orientation programs and resident demographics and assessed directors' goals and residents' needs from orientations.

RESULTS

The orientation goal ranked most highly by directors was development of group cohesion. The need ranked most highly by residents was introduction to call duties and inpatient problems. Ranked responses of each group were not well associated.

CONCLUSIONS

The orientation goals of program directors and the reported orientation needs of residents were poorly associated. Most directors chose nonclinical areas as their most important goals for orientation. In contrast, most residents valued clinically related information during orientation to residency.

Lack of effect of erythromycin and ketoconazole on the pharmacokinetics and pharmacodynamics of steady-state intranasal levocabastine

The single-dose effects of the cytochrome P-450 inhibitors erythromycin and ketoconazole on the steady-state pharmacokinetics and electrocardiographic repolarization pharmacodynamics of intranasal levocabastine, a potent and selective H1-receptor antagonist, were evaluated in healthy young male subjects. Two randomized, open-label, placebo-controlled, two-way crossover studies were performed. Levocabastine nasal spray was administered as two sprays per nostril (0.05 mg/spray) twice daily (for a total daily dose of 0.4 mg) for 6 days. On Day 7, a single dose of 0.2 mg was administered followed immediately by a single dose of either oral placebo, erythromycin 333 mg, or ketoconazole 200 mg. In all treatment groups, levocabastine was rapidly absorbed, with peak plasma concentrations reached at approximately 3 hours in the erythromycin study and 2.8 hours in the ketoconazole study. The mean terminal half-life was approximately 45 and 44 hours, respectively. In both studies, mean steady-state plasma concentrations and pharmacokinetics of levocabastine following the single doses of erythromycin or ketoconazole were not significantly different from corresponding values seen with the concomitant administration of the placebo. No clinically significant mean changes from baseline in QT or QTc (QT corrected for heart rate) intervals occurred in any of the treatment groups, and none of the subjects in either study experienced abnormally prolonged QTc intervals. Intranasal levocabastine was well tolerated, with no difference in the incidence of adverse events between treatment groups in either study; adverse events were generally mild in severity. Since levocabastine undergoes only minimal hepatic metabolism and is not a substrate for or an inhibitor of cytochrome P-450, the likelihood of systemic drug interactions with drugs affecting the cytochrome P-450 system is minimal.

An outbreak of post-surgical wound infections due to Mycobacterium abscessus

An outbreak of post-operative wound infections due to Mycobacterium abscessus is described. During a 5-month period 45 post-surgical patients developed wound infection, manifested by wound breakdown, cellulitis, and discharge and progressing slowly to suppuration and sinus formation. The majority (43/45) had undergone out-patient operations, and 40 had had surgery in the inguinal region. The source of infection was identified as contaminated tap water. A study revealed serious deficiencies in the disinfection and sterilisation techniques employed in the operating theatre (OT), including major defects in the autoclaving machine. The outbreak was controlled after several specific measures were instituted. The patients responded well to treatment with conventional first-line anti-tuberculous drugs administered for 3-8 months. The report highlights the necessity of strict monitoring of disinfection and sterilisation techniques in surgical units and OTs.

Study of azathioprine encapsulation into liposomes

The factors influencing the encapsulation of azathioprine (AZA) into liposomes were investigated to find out the conditions for its optimal entrapment. Similar studies for comparison were also carried out on 6-mercaptopurine (6-MP), of which AZA is a prodrug. AZA and also 6-MP show higher encapsulation efficiencies in MLVs as compared to LUVs. Variation in phospholipid composition does not seem to affect the loading capacity of either of the two drugs. The encapsulation efficiency of both the drugs improves upon addition of cholesterol in the bilayer, but the effect is seen only up to 30% cholesterol. Thereafter the effect becomes constant. AZA shows better incorporation in the positively charged liposomes as compared to those with neutral or negative charge. The entrapment of 6-MP is, however, found to be independent of the charge on the liposomes. Entrapment efficiency for both the drugs markedly depends on the pH of the hydration medium, yielding better entrapment efficiencies at high pH values. The rise in solute concentration initially causes increase in the entrapment of the two drugs which is followed by a decreasing phase.

Stability-indicating analysis of isoxazolyl penicillins using dual wavelength high-performance liquid chromatography

Stability-indicating high-performance liquid chromatography analytical procedures were developed for specific determination of four isoxazolyl penicillins during degradation under neutral and accelerated acid/alkali conditions. The chromatographic conditions were set so that the drug peak was well separated from the peaks of the degradation products. Peak homogeneity of the resolving drug peak was assessed by the shape of the ratio chromatogram. Good and reproducible separations were achieved on a reversed-phase column using a mobile phase consisting of acetonitrile and a solution of 20 mM potassium dihydrogen phosphate plus 10 mM tetramethylammonium chloride in water (adjusted to pH 5). Optimal separations for all four drugs were achieved within the range of 15-21% organic modifier in the mobile phase. The detection wavelengths were 220 nm and 240 nm. The stability-indicating nature of the methods was confirmed by the linearity of the pseudo-first order plots. The utility of dual-wavelength chromatography in establishment of stability-indicating assays is highlighted.

The Stanmore total hip arthroplasty. A 15- to 20-year follow-up study

An ongoing study was made of 804 primary Stanmore total hip prostheses implanted in 839 patients between 1973 and 1991. The earliest surviving implants were brought back for radiologic and clinical review in 1995 at an average of 17 years after surgery. The remainder of the patients still living were sent a questionnaire to assess their current status. Survivorship was 95% at 10 years, 85% at 15 years, and 73% at 20 years. The average Merle d'Aubigné-Postel score was excellent up until 14 years. Patient satisfaction remained high until 22 years. Overall, 10% of the prostheses had failed. The results of this study suggest that the Stanmore prosthesis is capable of producing satisfactory long-term results that compare favorably with those of other cemented prostheses.

Effect of human milk prostaglandins and lactoferrin on respiratory syncytial virus and rotavirus

The effect of lactoferrin and prostaglandins E and F2 alpha on the growth of rotavirus and respiratory syncytial virus in cell culture was investigated. Lactoferrin inhibited the growth of respiratory syncytial virus at a concentration tenfold lower than that normally present in human milk. The prostaglandins had no effect on either virus growth, even at a concentration of 100-fold more than that found in human milk. Lactoferrin may have some antiviral properties in human milk in addition to its known antibacterial functions.

Rapid release and deactivation of plasminogen activators in human endothelial cell cultures in the presence of thrombin and ionophore A23187

alpha-Thrombin, DFP-thrombin, and ionophore A23187 induce the rapid release (less than 5 minutes) of a variety of proteins, including t-PA forms (Mr 110 and 70 k, after SDS-PAGE) from primary cultures, and both t-PA and u-PA (Mr 90 and 54 k) from subcultured human HUVECs. All PA activity forms are rapidly decreased in the releasates by some unknown mechanism. gamma-Thrombin does not induce the release of PAs from cultured HUVECs.

Sonomicrometry: its application as a routine monitoring technique in cardiac surgery

We utilized ultrasonic-dimension crystals in approximately 50 patients during a three-year period to evaluate clinical sonomicrometry as a routine monitoring tool in patients undergoing cardiac operations. Standard research piezoelectric pulse transit ultrasonic transducers were modified with a hooked attachment in a tethered configuration to facilitate accurate alignment and quick insertion for the measurement of myocardial segment length changes. These segment crystals were used both intraoperatively and postoperatively to evaluate the left ventricular pressure-geometry relationships and to serve as a continuous monitor of myocardial function. The left ventricular pressure-volume relationship was varied by temporarily reapproximating the pericardium (pericardial closure resulted in a 12% reduction in fractional shortening, a 5% decrease in end-diastolic segment length, and an 8% increase in pulmonary artery diastolic pressure). During both the intraoperative and postoperative periods, we found good correlation between thermodilution, stroke volume, and myocardial dimensions; no correlation was noted between pulmonary artery diastolic pressure and stroke volume. No bleeding or major complications resulted from the use of these sonomicrometry transducers. Our initial clinical experience with sonomicrometry seems to support its use as a potentially valuable monitoring tool.

Comparative effects of ionic and nonionic contrast materials on indexes of isovolumic contraction and relaxation in humans

The effects of contrast media on left ventricular (LV) relaxation as assessed by the time constant of isovolumic relaxation have not previously been studied. A new nonionic contrast agent (iohexol) has been shown to have fewer deleterious effects than standard ionic agents. Nineteen patients received iohexol and sodium meglumine diatrizoate (Renografin-76) in a double-blind, crossover study during left and right coronary arteriography and with simultaneous high-fidelity micromanometer measurements of LV pressure. Neither agent induced significant changes in LV end-diastolic pressure after right or left coronary arteriography. After right coronary arteriography, neither agent produced significant deterioration of peak positive dP/dt or (dP/dt)/DP40 (dP/dt at a developed pressure of 40 mm Hg). However, after right coronary arteriography both agents caused a transient deterioration in peak negative dP/dt and the time constant of isovolumic relaxation (p less than 0.05 at 20 seconds after arteriography). After left coronary arteriography, sodium meglumine diatrizoate induced deterioration of systemic blood pressure (p less than 0.05), peak positive dP/dt (p less than 0.01), (dP/dt)/DP40 (p less than 0.05), peak negative dP/dt (p less than 0.01) and the relaxation time constant (p less than 0.01). These effects were not induced by iohexol. Thus, nonionic contrast media exert negligible alterations on LV function when used for coronary arteriography. The findings are of potential clinical importance in view of the large number of patients with depressed LV function who undergo coronary arteriography.

Terminology and anatomy of angulated coronary arteriography

Angulated views in coronary arteriography have been increasingly utilized because of their superiority in demonstrating lesions not well seen in standard right and left oblique projections. The importance of these angulated views has been repeatedly demonstrated. It is the purpose of this article to review some basic coronary anatomy angulation terminology, and then to describe the particular advantages of the angulated views in coronary arteriography. Illustrations of these particular views of both coronary systems will be provided.

Endocardial pacing site affects left ventricular end-diastolic volume and performance in the intact anesthetized dog

We investigated how pacing from different endocardial sites affects the left ventricular three-dimensional contraction pattern and performance in intact anesthetized dogs. We used data from the motion of radiopaque markers implanted in the left ventricular endocardium in an analysis based on the polar decomposition theorem to determine the left ventricle's three-dimensional principal directions and magnitudes of deformation, and its axis and angle of rotation during the cardiac cycle. This paper also derives a new procedure that permits statistical comparison of different left ventricular cavity deformation patterns. During normal sinus rhythm and pacing from the right atrium, left ventricular septum, left ventricular apex, and right ventricular apex, the principal directions of left ventricular deformation remained relatively fixed with respect to the left ventricle's anatomy, independent of heart rate and pacing site. These directions were oriented in septum-free wall, anterior-posterior, and apex-base directions. End-systolic pressure and volume did not vary significantly among pacing sites. End-diastolic volume varied significantly among pacing sites, with right ventricular apical pacing producing the smallest end-diastolic and stroke volume. These results reveal that beats produced by right ventricular apical pacing eject less blood compared with beats produced by right atrial, left ventricular septal, or left ventricular apical pacing.

Extravascular lung water in patients with congestive heart failure. Difference between patients with acute and chronic myocardial disease

Extravascular lung water was assessed using a double-indicator dilution technique (thermal-green dye) in 15 men who had radiographic and clinical evidence of cardiogenic interstitial and alveolar pulmonary edema. Eight patients had suffered an acute myocardial infarction and seven had a history of chronic congestive cardiomyopathy and worsening of previous clinical signs and symptoms. At the same level of pulmonary capillary wedge pressure and similar arterial oxygen tensions extravascular lung water was significantly greater in the group with chronic congestive cardiomyopathy (p less than .05). The two groups did not differ with respect to systemic arterial pressure, resistance, or cardiac index.

Left ventricular dynamic geometry in the intact and open chest dog

No approach to describing the heart's dynamic geometry has been widely adopted, probably because all require questionable assumptions of chamber shape, symmetry, or placement of the measuring devices. In other words, these approaches require assumptions about shape to reach conclusions about shape. We present an analysis that avoids such assumptions and provides an objective description of how the left ventricle deforms and rotates during the cardiac cycle. We only assume that the deformation of the left ventricular cavity is homogeneous, and explicitly validate this assumption. Our analysis yields the following new information about the contracting left ventricle: three principal directions of deformation and the relative length change alone these directions: the axis and angle of rotation, and relative volume. All these changes are referenced to the ventricle's configuration at end-diastole. We instrumented 13 dogs with tantalum screws without opening their chests. During systole, the three principal directions of deformation essentially are aligned along apex-base, anterior-posterior, and septum-free wall directions. There is little length change in the apex-base direction. The anterior and septal principal directions do not remain fixed with respect to the heart's anatomy during systole. During isovolumic relaxation and early filling, systolic shape changes are reversed. During slow filling, only small shape changes occur. Opening the pleura or performing a sternotomy and pericardiectomy makes the heart change orientation within the chest, but does not alter the magnitude of shortening, relative to the left ventricle's end-diastolic configuration.

Quality of care given to first time birth control patients at a free clinic

In an empirical study of the quality of care at a free clinic, criteria for optimal care for female first visits for birth control were established and 100 charts were reviewed, 50 in April 1974 and 50 in April 1975 with an interval in between of in-service training accompanied by new medical forms and procedures. An encouraging improvement in record keeping was observed. The authors feel it is important that free clinics concentrate on quality as well as quantity and accessibility of care.