The cost of medical education in an ambulatory neurology clinic

Decreased revenue from clinical services has required academic hospitals and physicians to improve productivity. Medical student education may be a significant hindrance to increased productivity and income. This study quantifies the amount of time spent by faculty members teaching medical students in an ambulatory neurology clinic as well as the amount of time students occupied rooms when seeing patients on their own. Over a three-week period in an ambulatory neurology clinic, an observer noted these quantities of time, and the opportunity costs of both amounts of time were determined. Attending physicians spent an average of 19.6 minutes per medical student per half-day teaching, which translates to an average cost of $20.78 per half-day clinic. Students spent an average of 49.9 minutes per half-day seeing patients in the absence of an attending physician, an opportunity cost to the clinic of $142.50 per student per half-day.     

Angiomatoid malignant fibrous histiocytoma

Summary The results of an histological, immunocytochemical and electron microscopic study of an angiomatoid malignant fibrous histiocytoma are reported. Our results support an histiocytic, rather than an endothelial origin for the tumor cells.     

Chronic experimental bacteremia in Yucatan micropigs

The Yucatan micropig has been used to develop an experimental model of chronic bacteremia. This animal exhibits clinical and biological characteristics that are close to those in humans, and the pharmacokinetic behaviours of many classes of drugs in this model are similar to those in man. Six adult female were intravenously inoculated with a mean Escherichia coli inoculum of 5.1 x 10(9) bacteria. During five days of spontaneous evolution, the medical follow-up includes biological, clinical and bacteriological parameters. A systemic inflammatory syndrome, a sepsis, an organ insufficiency and positive blood cultures mimic the human disease. In all animals there is an adynamia, a lack of motor coordination, an anorexia, a tachypnea, a fever, a leuconeutropenia followed by an hyperleucocytosis, an anemia, a thrombopenia, an acute tubulonephritis and an elevated sedimentation rate. In some cases, there is an increase of the C reactive protein, in others, an increase of IL-6 and IL-8. At day five, all animals are alive, and five micropigs have positive blood cultures. This chronic, reproducible model is thus suitable for further antibacterial treatments evaluations.     

A structured ePortfolio to handle a programme of professional competences assessment in the area of transfusion medicine]

In order to organize a nationwide program for the evaluation of professional practices in the area of blood transfusion, the French National Blood Transfusion Institute and the Nice-Sophia Antipolis University designed and implemented a web based service aimed at following-up and guiding the physicians involved in such an assessment program. The core component is a structured electronic portfolio (ePortfolio), the implementation of which was based on an object-oriented environment combined with a content management system. The modelling of the global evaluation system makes it possible to describe this type of portfolio according to six axes: an axis "objectives" (competencies accreditation); an axis "target" (heath care professionals); an axis "content" (numerical documents); an axis "structure" (matrix of answer defined in space and time); an axis "source" (single source peer-reviewed); an axis "level of evidence" (validation of the proof after its deposit by an identified and authenticated peer user, whole tracking of the exchanges and interactions between users and device).     

A homogeneous bioelectrochemical immunoassay for thyroxine

Thyroxine has been modified with a ferrocene derivative to produce an immunologically reactive conjugate which remains capable of functioning as an electron transfer mediator, shuttling electrons between an oxido-reductase enzyme and an electrode. On binding with an anti-thyroxine antibody the conjugate's ability to function as a mediator is impaired. The conjugate has been used as a tracer in an homogeneous competitive assay to quantify the total thyroxine concentration in serum, the assay being measured electrochemically after the addition of a suitable oxidoreductase enzyme (glucose oxidase) and its substrate (glucose) on completion of antibody/antigen binding. This results in a simple and sensitive assay for thyroxine.     

Modulation of polymorphonuclear cell adherence to glass by cyclic nucleotides

Can the inhibition of adherence to glass be correlated with some biochemical parameters of cell activation such as cyclic nucleotides? We noted that an increased content of cyclic AMP is related to an inhibition of polymorpho-nuclear cell (PMN) adherence and that an increase in cyclic GMP has an opposite effect. Thus, different aspects of PMN response can be elicited by an increase in one or the other nucleotides.     

Bayesian prediction of an epidemic curve

An epidemic curve is a graph in which the number of new cases of an outbreak disease is plotted against time. Epidemic curves are ordinarily constructed after the disease outbreak is over. However, a good estimate of the epidemic curve early in an outbreak would be invaluable to health care officials. Currently, techniques for predicting the severity of an outbreak are very limited. As far as predicting the number of future cases, ordinarily epidemiologists simply make an educated guess as to how many people might become affected. We develop a model for estimating an epidemic curve early in an outbreak, and we show results of experiments testing its accuracy.     

The role of chemokines in linking innate and adaptive immunity.

It is becoming clear that chemokine function is necessary to translate an innate-immune response into an acquired response. Dendritic cells activated by innate stimuli and loaded with foreign antigen travel to regional lymph nodes to activate the acquired-immune system. Subsequently, the activated acquired-immune cells move into tissue, where the innate immune system sets-off the danger signal. The chemokine system has emerged as an essential regulator of this dendritic cell and lymphocyte trafficking, which is necessary to turn an innate immune response into an adaptive response.     

A demonstration of classical conditioning of the human eyeblink to an olfactory stimulus.

While acquisition of the eyeblink conditioned response to a variety of stimuli has been widely studied, it has yet to be established that humans will demonstrate a conditioned response to an olfactory stimulus. In this study we present data to show that humans will demonstrate a classically conditioned eyeblink response to an olfactory stimulus. Ten participants were tested in a delay conditioning procedure with an olfactory stimulus presented in a heated, humidified stream of air via an olfactometer, allowing the precise control over stimulus duration necessary for delay conditioning. Trials on which odor alone was presented were administered to four additional participants. Establishing that humans will demonstrate an eyeblink conditioned response to an olfactory stimulus will allow further exploration of the pathways involved in classical conditioning and associative learning, as well as an analysis of conditioning pathways across sensory modalities.     

Academic Portfolio in the Digital Era: Organizing and Maintaining a Portfolio Using Reference Managers

The academic portfolio has become an integral part of the promotions process. Creating and maintaining an academic portfolio in paper-based or web-based formats can be a cumbersome and time-consuming task. In this article, we describe an alternative way to efficiently organize an academic portfolio using a reference manager software, and discuss some of the afforded advantages. The reference manager software Papers (Mekentosj, Amsterdam, The Netherlands) was used to create an academic portfolio. The article outlines the key steps in creating and maintaining a digital academic portfolio. Using reference manager software (Papers), we created an academic portfolio that allows the user to digitally organize clinical, teaching, and research accomplishments in an indexed library enabling efficient updating, rapid retrieval, and easy sharing. To our knowledge, this is the first digital portfolio of its kind.     

Aspergillus Terreus Causing Invasive Pulmonary Aspergillosis With Air-Crescent Sign

Aspergillus terreus is an uncommon cause of human disease. A patient with acute myelomonocytic leukemia is described who developed an invasive pulmonary infection with A terreus characterized by an air-crescent sign on chest roentgenogram. Previous reports of A terreus infections and the pathogenesis and significance of an air-crescent sign in invasive pulmonary aspergillosis are reviewed.     

Progesterone withdrawal causes endothelin release from cultured human uterine microvascular endothelial cells

BACKGROUND: Current theories on the physiology of menstrual bleeding in humans offers an explanation for the shedding of the endometrium as a result of a breakdown of the extracellular matrix due to an inflammatory reaction. The link between the fall in progesterone levels and these events is not clear. Neither has an explanation been presented for the vasoconstriction in the coiled arteries occurring during menses. We have hypothesized a chain of events where the fall in progesterone levels induces an upregulation of the thrombin receptor in the small uterine arteries leading to an increased thrombin response and subsequent endothelin release. METHODS: Endothelial cells from human umbilical cord (HUVECs) and from human small uterine arteries (UtMVECs) were cultured under conditions partly resembling the female hormonal cycle with progesterone withdrawal. RESULTS: Following progesterone increase and subsequent withdrawal, we found an increased production of thrombin receptor and an increased release of endothelin from UtMVECs compared with HUVECs. CONCLUSION: Endothelin release in response to progesterone withdrawal in UtMVECs can offer an explanation for the vasoconstriction seen in the coiled arteries during menses in humans.     

Self-management protocol for a moving-actuator type artificial heart

In this paper, we describe the development of a self-management protocol for a controller of a moving-actuator type artificial heart, AnyHeart. The developed protocol analyzes motor current signals and detects abnormal pumping statuses. If preset abnormal pumping statuses are detected by an implemented algorithm, a controller triggers an emergency management procedure and transmits an alarm message to predetermined medical and engineering staffs via a cellular phone network to notify them of an abnormal pumping status occurrence and its likely cause. Results of in vitro performance experiments showed that the developed protocol can detect simulated abnormalities in motor current, manage the operating status of the blood pump during an emergency, and transmit an alarm message as desired.     

大学生在归类学习中的策略运用研究

目的以大学生为被试，探讨不同性质的学习材料对归类学习时运用策略的影响。方法采用3种不同性质的学习材料：2维度MIP、无干扰维度；2维度MIP、加干扰维度；2维度MOP、加干扰维度，来探讨学习材料的性质对归类学习中运用策略的影响。结果当学习材料为2维度MIP、无干扰维度时，被试基本上运用规则策略进行归类；当学习材料为2维度MIP、加干扰维度时，被试基本上仍运用规则策略进行归类；当学习材料为2维度MOP、加干扰维度时，被试则基本上运用样例策略进行归类。结论实验材料的性质不同的确会引发不同的归类表征策略。     

The x-ray light valve: a low-cost, digital radiographic imaging system--spatial resolution

An x-ray light valve (XLV) coupled with an optical scanner has the potential to meet the need for a low-cost, high quality digital imaging system for general radiography. The XLV/scanner concept combines three well-established, and hence, low-cost technologies: An amorphous selenium (a-Se) layer as an x-ray-to-charge transducer, a liquid crystal (LC) cell as an analog display, and an optical scanner for image digitization. The XLV consists of an a-Se layer and LC cell in a sandwich structure which produces an optical image in the LC layer upon x-ray exposure. The XLV/scanner system consists of an XLV in combination with an optical scanner for image readout. Here, the effect of each component on the spatial resolution of an XLV/scanner system is investigated. A theoretical model of spatial resolution of an XLV is presented based on calculations of the modulation transfer function (MTF) for a-Se and a LC cell. From these component MTFs, the theoretical MTF of the XLV is derived. The model was validated by experiments on a prototype XLV/scanner system. The MTF of the scanner alone was obtained by scanning an optical test target and the MTF of the XLV/scanner system was measured using x rays. From the measured MTF of the scanner, the theoretical MTF of the XLV/scanner system was established and compared with the experimental results. Good general agreement exists between experimental and theoretical results in the frequency range of interest for general radiography, although the theoretical curves slightly overstate the measured MTFs. The experimental MTF of the XLV was compared with the MTF of two clinical systems and was shown to have the capability to exceed the resolution of flat-panel detectors. From this, the authors can conclude that the XLV has an adequate resolution for general radiography. The XLV/scanner also has the potential to eliminate aliasing while maintaining a MTF that exceeds that of a flat-panel imager.     

Case studies on treatment

Seven case studies of HIV-positive patients are presented along with recommendations on possible treatment. The cases discuss starting regimens for treatment-naive patients; treating an HIV-positive woman presenting with PCP; and treatment failure in an adherent patient despite drug changes. Other issues addressed in the case studies are antiviral therapy for an asymptomatic patient diagnosed with HIV in 1985; using AZT with various antiviral regimens; and an antiviral regimen for an HIV-positive patient with Kaposi's sarcoma.     

The multidimensional and developmental nature of infidelity: practical applications

When a partner has been unfaithful, an important therapeutic task is to assess factors that contributed to the affair and that may affect the individual's and couple's healing. This article provides a framework to assess multiple factors and their influence on an affair over time, as well as on responses to an affair. We address factors related to the person involved in an affair, his or her partner, their relationship, and the external context. These factors are considered across six phases of an affair: predisposition, approach, initial involvement, maintenance, disclosure or discovery, and response. A case study is presented to illustrate the usefulness of the framework in working with couples in which there has been an affair.     

Long-term posttreatment functioning among patients with unipolar depression: an integrative model

This study tested an integrative structural equation model of posttreatment functioning among 165 depressed patients followed for an average of 9 years after the end of an episode of treatment. The model examined (a) the link between life change and psychosocial resource change and (b) the role of resource change in mediating the relationship between life change and change in depression. An increase in the preponderance of negative over positive life events was associated with a decline in resources and an increase in depressive symptoms. A decline in resources was associated with an increase in depressive symptoms. The association between changes in events and depressive symptoms was completely mediated through resource change. These findings indicate that life stressors contribute to posttreatment depression through an erosion of personal and social resources.     

Increasing screening uptake amongst those intending to be screened: the use of action plans

This experimental study investigates an intervention designed to increase rates of antenatal screening uptake in those intending to undergo antenatal screening. Eighty-eight pregnant women intending to undergo prenatal screening were alternately allocated to standard care or asked to write a simple plan for attending or making an appointment. Twenty-five (63%) in the intervention group made an action plan. There was no difference in uptake of screening between the intervention group and the control group, nor between those making an action plan and the control group. Within the intervention group, those making an action plan had higher screening uptake (21/25, 84%) than those not making one (7/15, 47%; CI(95) difference = 8-66%, P = 0.017). Asking women who intend to undergo screening to make an action plan does not increase screening uptake. This result raises doubts about introducing simple action plans in a clinical situation as an effective means of changing behaviour.     

Sleep state instabilities in major depressive disorder: Detection and quantification with electrocardiogram‐based cardiopulmonary coupling analysis

Sleep disruption is an important aspect of major depressive disorder but lacks an objective and inexpensive means of assessment. We evaluated the utility of electrocardiogram (ECG)‐based cardiopulmonary coupling analysis to quantify physiologic sleep stability in patients with major depression. Relative to controls, unmedicated depressed patients had a reduction in high‐frequency coupling, an index of stable sleep, an increase in low‐frequency coupling, an index of unstable sleep, and an increase in very‐low‐frequency coupling, an index of wakefulness/REM sleep. The medicated depressed group showed a restoration of stable sleep to a level comparable with that of the control group. ECG‐based cardiopulmonary coupling analysis may provide a simple, cost‐efficient point‐of‐care method to quantify sleep quality/stability and to objectively evaluate the severity of insomnia in patients with major depression.