Learning by doing and creation of the shared discovery curriculum.

Background: The Michigan State College of Human Medicine began as an experiment to teach medical students in community-based settings and to create a primary care workforce for the state. Decades later, CHM faced internal and external challenges that spurred creation of a new curriculum - the Share Discovery Curriculum - founded on learning by doing and other learning theories.

Methods: A curricular design group (CDG) developed guiding principles for reform.

An Exemplar Milestone Framework for Scaffolding a Competency-Based Medical School Curriculum.

Unlabelled: A strong competency and milestone framework is imperative for medical schools adopting competency-based education and assessment. Milestones can be used to align what is taught and what students are asked to demonstrate from matriculation to graduation. We describe the creation and implementation of our milestone framework as an exemplar.

Simulation 2.0: Integrating Basic Scientists and Clinicians in a Simulation Environment.

An increasing number of medical schools are implementing curricular changes that better integrate clinical and basic sciences throughout all four years of medical school. One of the most frequently cited reasons is to improve medical student clinical reasoning skills while simultaneously aiming to decrease the attrition of basic science knowledge. Multiple pedagogical strategies have been explored to achieve this goal.

Sea-level rise and archaeological site destruction: An example from the southeastern United States using DINAA (Digital Index of North American Archaeology).

The impact of changing climate on terrestrial and underwater archaeological sites, historic buildings, and cultural landscapes can be examined through quantitatively-based analyses encompassing large data samples and broad geographic and temporal scales. The Digital Index of North American Archaeology (DINAA) is a multi-institutional collaboration that allows researchers online access to linked heritage data from multiple sources and data sets. The effects of sea-level rise and concomitant human population relocation is examined using a sample from nine states encompassing much of the Gulf and Atlantic coasts of the southeastern United States.

Progress on a New Kind of Progress Test: Assessing Medical Students' Clinical Skills.

Problem: Progress testing of medical knowledge has advantages over traditional medical school examination strategies. However, little is known about its use in assessing medical students' clinical skills or their integration of clinical skills with necessary science knowledge. The authors previously reported on the feasibility of the Progress Clinical Skills Examination (PCSE), piloted with a group of early learners.

Progress testing 2.0: clinical skills meets necessary science.

Introduction: Progress testing has been widely used in medical schools to test scientific knowledge but has not been reported for assessing clinical skills.

Development: We designed a novel progress examination that included assessments of both clinical performance and underlying basic and social science knowledge. This Progress Clinical Skills Examination (PCSE) was given to 21 early medical students at the beginning and end of a 6-week pilot test of a new medical school curriculum.

Development and evaluation of a Health Record Online Submission Tool (HOST).

Introduction: Health records (HRs) are crucial to quality patient care. The Michigan State University College of Human Medicine begins teaching health record (HR) writing during the second-year clinical skills courses. Prior to this project, we used a cumbersome paper system to allow graduate assistants to grade and give feedback on students' HRs.

Symptomatic ileofemoral DVT after onset of oral contraceptive use in women with previously undiagnosed May-Thurner Syndrome.

Objective: May-Thurner syndrome is characterized by left common iliac obstruction secondary to compression of the left iliac vein by the right common iliac artery against the fifth-lumbar vertebra. This anatomic variant results in an increased incidence of left-sided deep venous thrombosis (DVT). Furthermore, while a preponderance of left-sided DVT has been demonstrated in women during pregnancy and oral contraceptive use, patients are not typically screened for this condition after developing a left-sided DVT.

Employee satisfaction and theft: testing climate perceptions as a mediator.

Employee theft of both property and time is an expensive and pervasive problem for American organizations. One antecedent of theft behaviors is employee dissatisfaction, but not all dissatisfied employees engage in withdrawal or theft behaviors. The authors tested a model of theft behavior by using an organization's climate for theft as an explanatory mechanism.

[Implications and details of the responsibility of radiologists in organized screening activities].

Medical responsibility in screening activities. In 1992 a national breast cancer screening programme was launched by the ministry of health in Luxembourg. This programme refers to the "European Guidelines for quality assurance in mammography".

Isoporphycene: The Fourth Constitutional Isomer of Porphyrin with an N(4) Core-Occurrence of E/Z Isomerism.

Liberation of the ligand from the nickel complex 1 obtained by template synthesis yielded isoporphycene (as the octaethyl derivative 2), the first constitutional isomer of porphyrin with an N(4) core for which E/Z isomerism is involved: Compound 2 is present as the E isomer, which is in rapid, presumably acid-catalyzed equilibrium with a small amount (2 %) of the Z isomer. The remaining unknown constitutional isomers of porphyrin are considerably higher in energy than the already rather labile isoporphycene, so that the latter should mark the border of existence for this type of structural variant of porphyrin.

Transcranial Doppler intraoperative monitoring during carotid endarterectomy: experience with regional or general anesthesia, with and without shunting.

To determine whether continuous transcranial Doppler (TCD) can significantly alter therapeutic conduct during carotid endarterectomy, a retrospective study of 117 carotid endarterectomies was done. There was no perioperative mortality; one perioperative stroke was recorded in a patient who was symptomatic preoperatively. Continuous TCD of the ipsilateral middle cerebral artery (MCA) was attempted in 99 cases, and successful in 90; nine patients (9.

Bone marrow diagnosis in lymphoproliferative disorders: comparison of results obtained from conventional histomorphology and immunohistology.

In this study we have investigated 313 bone marrow biopsies from 280 patients with lymphoproliferative disorders. Trephines were sectioned transversely to obtain one cylinder for cryostat sectioning and immunostaining and a second for histomorphological evaluation using a plastic-embedding technique. The results obtained by histomorphological and immunohistological evaluation were compared for their contribution to staging and classification.

Perineal hidradenitis suppurativa: presentation of two unusual complications and a review.

Two patients with advanced perineal hidradenitis suppurativa, complicated by fecal incontinence and squamous cell carcinoma, are presented. The first patient was a 58-year-old man who had a 30-year history of chronic recurring perianal abscesses and perineal sinuses. At the time of presentation, he had extensive perineal suppurative disease, and scarring and fixation of the anal sphincters with resultant fecal incontinence.

Effectiveness of prophylactic mastectomy in the prevention of breast tumors in C3H mice.

The effectiveness of prophylactic mastectomy in the prevention of breast tumors was studied in spontaneous breast-tumor-forming C3H mice. Prolactin levels were assayed to determine if this hormone was related to the incidence of mammary tumors. Two-hundred and fifty-six 1-month-old C3H mice were divided into four groups (control, 1; sham surgery, 2; mammectomy 50 percent, 3; and mammectomy 100 percent, 4).

Effects of phenylephrine on tissue gas tension, bleeding, infection, and lidocaine absorption.

In an attempt to find a vasoconstrictor with less detrimental local and systemic effects than epinephrine, the effects of phenylephrine, a pure alpha agonist, on tissue gas tension, bleeding, infection rates, and lidocaine absorption were studied. All concentrations of phenylephrine significantly reduced tissue PO2 within 10 minutes of injection, and reduction of PO2 was dose-dependent. Phenylephrine 1:10,000 produced significant bacterial growth when simultaneously injected with 6 X 10(6) Staphylococcus aureus.

Craniofacial biostereometrics.

We believe that biostereometrics can be useful to the craniofacial surgeon in providing a highly accurate, reproducible diagnostic and presurgical tool that is inexpensive and noninvasive. It can help visualize complex pathologic bony abnormalities, resolve ambiguous CT scans, and predict soft-tissue changes secondary to alterations in bony contours when used in conjunction with CT scans and cephalograms.

Management of burned long bones.

The management of severely burned and exposed supportive osseous tissues is not fully standardized. We present two patients in whom extensive debridement and decortication of the involved bone may have contributed to subsequent stress fractures. We propose an alternative therapeutic approach for this problem, including: minimal debridement of the bone, early coverage of the exposed bone with vascularized muscle, and adequate prophylactic protection.

A light and electron microscopic procedure for sequential double antigen localization using diaminobenzidine and benzidine dihydrochloride.

Very few double-antigen staining methods are available that are applicable to both light and electron microscopy. The objective of this study was to develop for localization of two neural antigens simultaneously a procedure which would be sensitive, simple to perform, offer permanent reaction products, and permit correlated light and ultrastructural analysis. The method employs sequential immunoperoxidase staining without antibody elution, in which the first sequence of antibodies is visualized with 3,3'-diaminobenzidine (DAB) and the second with benzidine dihydrochloride (BDHC).

The influence of stimulus repetition on the acoustic startle response and on responses of inferior colliculus neurons of mice.

The acoustic startle response (ASR) and discharges of single units in the inferior colliculus (IC) were evaluated as a function of the repetition rate and trial (stimulus 1-10 at each rate) of intense noise bursts in mice. The amplitude of the ASR was inversely proportional to both rate and trial. The mean number of discharges for the sample population of units of the central nucleus (ICC) and the external nucleus (ICX) were also inversely proportional to stimulus rate.

Attempts to improve tissue survival during ex vivo storage.

Ex vivo hypothermic perfusion has been shown to enhance short-term survival of organs before transplantation. The effects of perfusion, control of media pH, and systemic drug treatment were studied utilizing superficial epigastric free flaps in Sprague-Dawley rats. Viability of the flaps could be reliably maintained (9/10, 90%) for 72 hours using simple storage in phosphate-buffered Ringer's (pH 7.