Critical incident stress debriefing (CISD): its role in the Armed Services--a personal opinion.

The controlled application of CISD in the Armed Services is of value. In a varied Army career covering service with both regular and specialist units, there are instances where in retrospect the opportunity to discuss an incident in a CISD environment or the receipt of a general health warning would have been welcomed and assisted the group (or the individual) concerned to return to operational effectiveness. Practical considerations aside a colleague and friend who has been closely involved with CISD in the Forces since its inception, cites a very good case for its defence.

Practitioner self-confidence and patient outcomes in acute low back pain.

Objective: To compare outcomes for patients with acute low back pain who received care from practitioners with different self-confidence scores on a 4-item scale.

Design: Cross-sectional survey of practitioners. Prospective cohort study of patient outcomes.

Does training location influence the clinical skills of medical students?

Purpose: To examine the benefits of the shift of medical education into ambulatory primary care settings by investigating whether medical students exposed to a common primary care problem (low back pain) in ambulatory care settings develop better clinical skills.

Method: In 1995, the authors categorized 420 students from all four North-Carolina medical schools into groups that had previously encountered patients with low back pain in ambulatory primary care settings, tertiary care settings, both, or neither. The clinical skills of the groups were determined using data collected during standardized-patient examination in which students took the history of, physically examined, and chose a diagnostic strategy for patients with acute, uncomplicated low back pain.

Having a baby: some disabled women's reproductive experiences.

Objective: To explore some of the social barriers disabled women face when they think about having a child, become pregnant, come into contact with the maternity and related services, and become mothers.

Design: A qualitative study involving in-depth semi-structured interviews with 17 disabled women. This was a follow-up study associated with a large health authority commissioned survey on the 'maternity preferences' of women of childbearing age resident in one city.

Counting the cost of an NRSA Primary Care Research Fellowship Program.

Background And Objectives: Concerns are often raised about the potential financial and logistical burdens that fellows (even those who receive federal funding) add to departmental budgets.

Methods: We collected data on patient care income, financial values of teaching, on-call and attending duties, and departmental costs for patient care overhead, administration, and supervision over a 1-year period for six fellows in the National Research Service Award (NRSA) Primary Care Research Fellowship Program at the University of North Carolina at Chapel Hill.

Results: Net receipts for clinical services ranged from $4,023 to $15,742, which, when adjusted for overhead costs, led to financial loss.

Heritable variation in stomatal responses to elevated CO2 in wild radish, Raphanus raphanistrum (Brassicaceae).

Rising atmospheric carbon dioxide may affect plant populations in the short term through effects on photosynthesis and carbon allocation, and over the long term as an agent of natural selection. To test for heritable effects of elevated CO2 on stomatal responses and plant fecundity in Raphanus raphanistrum, we grew plants from 12 paternal families in outdoor open-top chambers at ambient (35 Pa) or elevated (67 Pa) CO2. Contrary to results from a previous study of this species, total flower and fruit production were marginally lower under elevated CO2.

Recall and treatment decisions of primary care providers in response to Pap smear reports.

Introduction: Although the frequency of cervical cancer screening has been extensively studied, little is known about how clinicians decide to screen or recall patients for Pap smears. This study reports the management decisions made by office-based clinicians for 10 different Pap smear reports describing adequacy limitations and cytological diagnoses.

Methods: We surveyed 186 clinicians using a commercial laboratory in the southeastern United States and analyzed results by frequency and comparison statistics.

Response of soil biota to elevated atmospheric CO in poplar model systems.

We tested the hypotheses that increased belowground allocation of carbon by hybrid poplar saplings grown under elevated atmospheric CO would increase mass or turnover of soil biota in bulk but not in rhizosphere soil. Hybrid poplar saplings (Populus×euramericana cv. Eugenei) were grown for 5 months in open-bottom root boxes at the University of Michigan Biological Station in northern, lower Michigan.

A meta-analysis of elevated CO effects on woody plant mass, form, and physiology.

Quantitative integration of the literature on the effect of elevated CO on woody plants is important to aid our understanding of forest health in coming decades and to better predict terrestrial feedbacks on the global carbon cycle. We used meta-analytic methods to summarize and interpret more than 500 reports of effects of elevated CO on woody plant biomass accumulation and partitioning, gas exchange, and leaf nitrogen and starch content. The CO effect size metric we used was the log-transformed ratio of elevated compared to ambient response means weighted by the inverse of the variance of the log ratio.

Pachydermoperiostosis in childhood.

We report a family with pachydermoperiostosis (idiopathic hypertrophic osteoarthropathy) spanning four generations with 10 affected individuals, four of whom are children although pachydermoperiostosis is rare in childhood. In this family, with intermarriage, the inheritance is autosomal recessive and it is possible that there are individuals who are homozygous for the pachydermoperiostosis gene. These individuals do not appear to be more severely affected, although one of them had a cleft palate and congenital heart defect which may be a manifestation of being homozygous.

Latex protein levels in external condom catheters.

The Food and Drug Administration (FDA) allows for labeling medical products that have reduced levels of total water-extractable latex protein. The standard test method of the American Society for Testing and Materials (ASTM) for analysis of latex protein in natural rubber and its products is a colorimetric assay with a precipitation step called the modified Lowry assay. In an analysis of latex external condom catheters, we have documented a significant difference in protein levels between two brands of external condoms.

Internal and External Bacterial Counts from Shells of Eggs Washed in a Commercial-Type Processor at Various Wash-Water Temperatures .

The effects of two egg holding temperatures (15.5 and 26.7°C) and three wash-water temperatures (15.

Prevalence of subtypes of low back pain in a defined population.

Background: For two generations, some back care specialists have emphasized that clinical low back pain is composed of a number of specific syndromes, such as sacroiliitis or trigger points, but the prevalence of these syndromes outside of specialized clinics remains unknown. The purpose of this study was to describe the prevalence of subtypes of low back pain in a defined population.

Methods: The setting was a group model HMO with a population of 54,000.

Mechanisms of renal tubular cell hypertrophy: mitogen-induced suppression of proteolysis.

The combination of epidermal growth factor (EGF) plus transforming growth factor-beta 1 (TGF-beta 1) causes hypertrophy in renal epithelial cells. One mechanism contributing to hypertrophy is that EGF induces activation of the cell cycle and increases protein synthesis, whereas TGF-beta 1 prevents cell division, thereby converting hyperplasia to hypertrophy. To assess whether suppression of proteolysis is another mechanism causing hypertrophy induced by these growth factors, we measured protein degradation in primary cultures of proximal tubule cells and in cultured NRK-52E kidney cells.

The educational value of an OSCE in a family practice residency.

Purpose: To assess the educational value of an objective structured clinical examination (OSCE) administered in three consecutive years (1992-93 to 1994-95) to first-year residents in a family practice residency.

Method: Each year an OSCE was administered early in a family practice residency based at the University of North Carolina at Chapel Hill School of Medicine. The OSCE encompassed eight to ten stations, each 15 minutes long: ten minutes for tasks and five minutes for feedback.

Medical school culture and generalist education: perceptions of a medical school faculty.

As part of an initiative to promote the education of generalist physicians at the University of North Carolina, a series of meetings were held over a 12-month period between generalist senior faculty and faculty from a range of departments in the School of Medicine and other health professions schools. Through open discussion about generalist initiatives, we hoped to understand their issues, attitudes, and opinions regarding generalists and generalist education. The major themes arising from these dialogues were 1) uncertainty about the definition of the generalist physician, 2) beliefs about the poor clinical reputations of generalists, 3) lack of a scientific basis for generalist practice, and 4) beliefs that few new resources are needed to undertake and expand generalist education.

A model system for detection and isolation of a tumor cell surface antigen using antibody phage display.

To establish a screening procedure for tumor cell-surface reactive Fabs, we used a model antigen/antibody system including the epidermal growth factor receptor (EGF-R) and the anti-EGF-R monoclonal antibody 425. The 425 Fab was displayed on the surface of M13 filamentous phage. In a screening assay for 425 phage binding to tumor cell surfaces, biotinylated 425-phage bound specifically to EGF-R-positive A431 epidermoid carcinoma cells and not to K562 non-expressor erythroleukemia cells.

Effect of dietary vitamin E on the oxidative stability, flavor, color, and volatile profiles of refrigerated and frozen turkey breast meat.

In this study, the effect of varying dietary vitamin E levels on the oxidative stability, flavor, color, and volatile profiles of refrigerated and frozen turkey breast meat was examined. Nicholas turkey toms were reared on diets containing vitamin E levels as dl-alpha-tocopheryl acetate equivalent to the NRC recommendations (12 and 10 IU/kg from 0 to 8 and 9 to 18 wk, respectively) and 5x, 10x, and 25x the NRC diet. Two other diets were evaluated and included feeding the NRC diet until 15 and 16 wk followed by a diet containing 20x the NRC vitamin E level.

Physical properties of a single-motif erythrocyte spectrin peptide: a highly stable independently folding unit.

Spectrin is a long flexible rod-like actin cross-linking protein mostly comprised of many tandem homologous 106-residue motifs. In this study, the conformational stability and physical properties of a single homologous motif peptide, alpha1, were evaluated and compared to intact spectrin monomers and alphabeta heterodimers. It is interesting that while spectrin dimers elongate by about 3-fold in low ionic strength buffers relative to their size in physiological buffers, the single-motif peptide does not show significant changes in secondary structure in 10 mM phosphate buffer compared with isotonic buffer.

Collegial networking and faculty vitality.

Background: This research explored the relationship between collegial networking and faculty "vitality" among graduates of the family medicine faculty development fellowship at the University of North Carolina at Chapel Hill. Faculty vitality was defined by retention in full-time teaching, job satisfaction, academic activity, and contributions to the discipline.

Methods: A questionnaire was mailed to 170 family physician graduates of the 1980-1992 fellowship classes.

The influence of number of embryos transferred on pregnancy outcome in women undergoing in vitro fertilization and embryo transfer (IVF-ET).

The purpose of this study was to retrospectively examine the influence of number of embryos transferred on pregnancy outcome in women undergoing in vitro fertilization and embryo transfer (IVF-ET) between July 1990-December 1991 at the Royal Free Hospital, London, United Kingdom. This study included three groups of patients: group 1-the number of embryo used for transferring was one embryo, group 2-the number of embryos used for transferring was two embryos and group 3-the number of embryos used for transferring was three embryos. This study demonstrated that the clinical pregnancy rate increased significantly when transferring two or three embryos compared to one.

Molecular basis and haplotyping of the alphaII domain polymorphisms of spectrin: application to the study of hereditary elliptocytosis and pyropoikilocytosis.

Hereditary elliptocytosis (HE) and hereditary pyropoikilocytosis (HPP) are inherited disorders of erythrocyte shape that are frequently associated with abnormalities in alpha-spectrin, one of the principal structural proteins of the erythrocyte membrane skeleton. Five polymorphisms of the alpha-spectrin gene, located in a 6-kb interval of genomic DNA, were identified and analyzed in normal and mutant alpha-spectrin alleles. Three of these polymorphisms are due to single nucleotide substitutions in the alpha-spectrin gene coding region that lead to changes in the amino acid sequence.

Perceptions and opinions on the performance of Pap smears: a survey of clinicians using a commercial laboratory.

Office-based clinicians play a major role in cervical cancer screening in the United States, but little is known about their specific knowledge and understanding of the technical aspects of obtaining an adequate Pap smear. We surveyed 186 office-based clinicians using a major commercial laboratory for cytology services to obtain their opinions regarding the technical adequacy of Pap smears, collection procedures, and methods of communicating test results to patients. There was an 80.