The role of chemisorbed hydroxyl species in alkaline electrocatalysis of glycerol on gold.

The mechanism of energy conversion in a direct glycerol fuel cell (DGFC) is governed by the anode supported heterogeneous steps of glycerol electro-oxidation. In aerated alkaline electrolytes, glycerol also participates in a base catalyzed process, which can release certain species mixing with the anode catalyzed surface products. As a result, selective probing of the surface catalytic reactions involving such systems can be difficult. The present work addresses this issue for a gold anode by using the analytical capability of cyclic voltammetry (CV). In addition, surface plasmon resonance measurements are used to optically probe the adsorption characteristics of the electrolyte species. The net exchange current of the oxidation process and the transfer coefficient of the rate determining step are evaluated by analyzing the CV data. The interfacial reactions and their products on Au are identified by measuring the number of electrons released during the electro-oxidation of glycerol. The results indicate that these reactions are facilitated by the surface bound hydroxyl species on Au (chemisorbed OH(-) and faradaically formed Au-OH). By comparing the findings for stationary and rotating electrodes, it is shown that, convective mass transport is critical to maintaining efficient progression of the consecutive oxidation steps of glycerol. In the absence of hydrodynamic support, the main surface products of glycerol oxidation appear to be glyceraldehyde, glycerate and malonate, formed through a net six-electron route. In the presence of controlled convection, a ten-electron process is activated, where mesaxolate is the likely additional product.

Patients' and physicians' attitudes regarding the physician's professional appearance.

Although physician appearance has been a topic of interest to medical historians for more than two centuries, little objective investigation has been made into patients' and physicians' attitudes toward the physician's appearance. This study analyzed responses from 404 patients, residents, and staff physicians regarding their attitudes toward various aspects of the male and female physician's professional appearance. Positive responses from all participants were associated with traditional items of dress such as the dress, shirt and tie, dress shoes, and nylons, and for physician-identifying items such as a white coat and a name tag. Negative responses were associated with casual items such as blue jeans, scrub suits, athletic shoes, clogs, and sport socks. Negative ratings were also associated with overly feminine items such as prominent ruffles and female dangling earrings and such temporarily fashionable items as long hair on men, male earrings, and patterned hose on women. Overall, patients were less discriminating in their attitude toward physician appearance than physicians. Patients rated traditional items less positively and casual items less negatively. This study confirms the importance of the physician's appearance in physician-patient communication.

A survey of sued and nonsued physicians and suing patients.

To systematically assess the impact of malpractice litigation on the doctor-patient relationship and to collect data that might suggest effective tort reform, we surveyed 642 sued physicians, nonsued physicians, and suing patients in Wisconsin. Parallel forms of survey instruments obtained information regarding changes in physicians' practices, changes in attitudes toward patients or physicians, and changes in physical and emotional well-being as a result of malpractice litigation or the threat of the same. In addition, opinions regarding causes and deterrents of malpractice litigation were obtained. Results suggested that claims or threats of malpractice suits had a negative impact on physicians' practices and emotional well-being; that this negative impact was more pronounced when the sued physician had been more personally involved with his patient prior to the malpractice claim; and that suing patients' and sued physicians' understanding of their relationship before the malpractice claim significantly differed. All respondents viewed improved physician-patient communication as the most effective method of preventing malpractice claims. Informal, alternative dispute resolution mechanisms in hospitals and clinics and improved peer review may decrease litigation and its deleterious effects.

Radioimmunoscintigraphy of colon cancer with iodine-131-labeled B72.3 monoclonal antibody.

The monoclonal antibody B72.3 is a murine IgG1 that is reactive with a wide range of carcinomas while demonstrating little or no reactivity to normal adult tissues. We have shown (27) quantitative analyses demonstrating selective targeting of [131I]B72.3 IgG to metastatic colorectal cancer. We have also shown (28) that (a) B72.3 localization in metastases correlated with the percentage of tumor cells in the biopsy specimen; (b) B72.3 could localize in carcinomas of various degrees of differentiation with best localization in well-differentiated tumors and (c) [131I]B72.3 could penetrate tumor masses, as determined by autoradiographic studies. We report here the various parameters effecting radioimmunoscintigraphy with [131I]B72.3 IgG. Sixteen of 35 patients with colorectal carcinoma had positive scans (without blood-pool subtraction). High circulating TAG-72 antigen levels correlated with positive scans. No dose dependent differences were seen in biodistribution or tumor imaging. The plasma clearance and urinary excretion of [131I]B72.3 and [125I]BL-3 (nonspecific control) were not significantly different. No toxicity was noted. Approximately one-half of patients developed human anti-mouse immune response.

New method for the chelation of indium-111 to monoclonal antibodies: biodistribution and imaging of athymic mice bearing human colon carcinoma xenografts.

B72.3, a murine monoclonal antibody (MAb) that reacts with 85% of human colon carcinomas as well as other epithelial neoplasias, was labeled with 111In using four chelating agents: 1-(p-isothiocyanatobenzyl)-DTPA (SCN-Bz-DTPA), isobutylcarboxycarbonic anhydride (MA-DTPA), cyclic anhydride (CA-DTPA), and 1-(p-isothiocyanatobenzyl)-ethylenediaminetetraacetic acid (SCN-Bz-EDTA). Comparative biodistribution and imaging studies were performed in athymic mice bearing human colon carcinoma xenografts (LS-174T). Tumor uptake of radiolabel was very similar between the chelates (30% ID/g) and tumors were identified in scintigraphic images with all the chelate-antibody complexes. The uptake by normal organs, especially the liver, was greater for MA-DTPA, CA-DTPA, and SCN-Bz-EDTA chelate-B72.3 IgG (1.3:1 to 2.5:1) in comparison to that found with the B72.3-SCN-Bz-DTPA (approximately 5:1) and abdominal organ, and uptake was very prominent on imaging with these chelate-MAb complexes but was virtually absent in the mice injected with B72.3-SCN-Bz-DTPA. Purification of the MAb-chelate complex by Sephadex G-50 chromatography followed by HPLC using a TSK-3000 column provided better subsequent biodistribution and also resulted in clearer images as compared to MAb chelate complexes purified by less rigorous purification protocols. We conclude that the 111In-SCN-Bz-DTPA complex is superior, at least when bound to MAb B72.3, to other chelate-complexes currently in use.

Metabolic bone disease is present at diagnosis in patients with inflammatory bowel disease.

AIM: To establish whether bone disease is present at diagnosis in inflammatory bowel disease and to identify contributory metabolic abnormalities. METHODS: Newly diagnosed patients with inflammatory bowel disease (19 males, 15 females; mean age, 44 years; range, 17-79 years; 23 ulcerative colitis, 11 Crohn's disease) were compared against standard reference ranges and a control group with irritable bowel syndrome (eight males, 10 females; mean age, 40 years; range, 19-64 years). Bone mineral density (g/cm2, dual-energy X-ray absorptiometry: lumbar spine and femoral neck) and biochemical bone markers were measured. RESULTS: Femoral neck bone mineral density, T- and Z-scores (mean +/- s.d., respectively) were lower in inflammatory bowel disease patients than in irritable bowel syndrome controls (0.78 +/- 0.12 vs. 0.90 +/- 0.16, P = 0.0046; - 0.88 +/- 0.92 vs. 0.12 +/- 1.17, P = 0.0018; - 0.30 +/- 0.89 vs. 0.61 +/- 1.10, P = 0.0030). Lumbar spine bone mineral density and T-scores were also significantly lower in patients than controls (0.98 +/- 0.15 vs. 1.08 +/- 0.13, P = 0.0342; - 1.05 +/- 1.39 vs. - 0.14 +/- 1.19, P = 0.0304). Compared with controls, the urinary deoxypyridinoline : creatinine ratio was increased (7.66 vs. 5.70 nmol/mmol, P = 0.0163) and serum 25-hydroxy vitamin D was decreased (18.7 vs. 28.5 micro g/L, P = 0.0016); plasma osteocalcin and serum parathyroid hormone did not differ (P > 0.05). CONCLUSIONS: The bone mineral density is reduced at diagnosis, prior to corticosteroid treatment, in both Crohn's disease and ulcerative colitis. Our data suggest that this is attributable to increased resorption rather than decreased bone formation.

Clinical teaching rounds. A case-oriented faculty development program.

OBJECTIVE: To improve clinical teaching with emphasis on improving provision of feedback through a faculty development series modeled on clinical rounds. METHOD: Seven 1-hour conferences were held for the pediatric faculty during the academic year 1994-1995. Clinical rounds were emulated, with a simulated learner functioning as the patient with a chief complaint of some instructional problem. The conferences progressed from discussion about teaching in a particular situation, to videotapes of clinical teaching, and finally to live clinical teaching. Evaluation of the conferences was assessed by attendance records, participants' evaluations of the conferences, and comparing student and resident evaluations of faculty who attended (i.e., those who attended > or = 2) with faculty who did not attend. Comparisons were made for the academic year before and after the conferences using paired t tests. RESULTS: Forty percent of the faculty attended 2 or more conferences. Mean conference ratings were 4.00 to 4.35, (1 is poor; 5, excellent). Faculty who attended had a significant improvement in ratings for feedback (P = .01) and overall teaching effectiveness (P = .04). Ratings for faculty who did not attend did not change. CONCLUSION: These conferences were well received by the faculty and are an effective way to improve clinical teaching.

Making a case for the teaching scholar.

Medical schools are increasingly cognizant of their inability to critically evaluate faculty who support the core mission of education. To address this need, the Project on Scholarship was initiated by the Group on Educational Affairs (GEA) of the Association of American Medical Colleges. Building on and expanding previous definitions of scholarship and the associated criteria emerging in higher education, the project developed a set of "teacher as scholar" scenarios. These scenarios contained varied types of evidence for teaching scholarship and were discussed at the 1999 GEA regional meetings. Two major conclusions/recommendations emerged from these discussions: (1) the use of commonly accepted scholarship criteria (clear goals, appropriate methods, significant results, effective communication) provides a framework for identifying the types of evidence needed to document teaching scholarship, and (2) medical schools must create an infrastructure for promoting educational scholarship. This infrastructure must support the reliable and valid collection of evidence of educational scholarship and the continuous development of faculty as teaching scholars.

An alternative approach to defining the role of the clinical teacher.

BACKGROUND: A number of studies have attempted to identify the components of the clinical teacher role by examining learners' numerical ratings of items on researcher-generated lists. Some of these studies have also compared different groups' perceptions of clinical teaching, but have not directly compared the perceptions of first- and third-year residents. This study addressed two questions: (1) What do residents consider important components of the clinical teacher role? (2) Do first- and third-year residents perceive this role similarly? METHOD: A content analysis was performed on the comments written on evaluation forms by 268 residents about 490 clinical teachers over a five-year period (1980-81 through 1984-85) at a large family practice residency. Of 5,664 forms completed by the residents, 2,388 (42%) contained written comments; comments were on 1,024 (46%) of the first-year resident's forms, 701 (41%) of the second-year residents' forms, and 663 (39%) of the third-year residents' forms. Themes in these comments were coded into a coding dictionary of 157 categories, within 37 clusters, within four roles. RESULTS: The ten highest-ranked categories (Global; Teaching: General; Knowledgeable; Gives Resident Responsibility; Supportive; Miscellaneous; Interested in Teaching; Clinical Competence; Makes Effort to Teach; and Gives Resident Opportunity to Do Procedures) accounted for 41% of the themes coded. The first- and third-year residents differed in the clusters they used to describe their clinical teachers on evaluation forms (chi 2 = 149.86, df = 36, p < .0001). CONCLUSION: The results suggest that content analysis can be used to validly and reliably study residents' written evaluative comments about their teachers. This study contributes to the definition of the clinical teacher role, showing the relative importances of its components, and also supports Stritter's Learning Vector theory, finding the anticipated differences between the comments made by first- and third-year residents.

Medical and nursing students' attitudes about AIDS issues.

A 12-item questionnaire was administered in late 1987-early 1988 to 445 medical students, 133 medical school applicants, and 111 nursing students to assess any differences in their attitudes toward medicine-related AIDS issues. These groups were also given a 31-item test of their knowledge of AIDS issues. Significant differences by levels of knowledge were obtained for eight of the 12 attitude items. For example, the more knowledgeable the student, the less likely he or she was to refuse treatment to an AIDS patient, to require mandatory AIDS testing of physicians, or to require medical personnel to wear gloves. The findings strongly suggest that education has an important role in changing attitudes about AIDS in a direction that fosters better health care for AIDS patients.

Women physicians in dual-physician relationships compared with those in other dual-career relationships.

This study compared the career and domestic responsibilities of women physicians whose domestic partners were physicians (WP-Ps) with those of women physicians whose domestic partners were not physicians (WP-NPs). In 1988 the authors surveyed 602 women physicians in a large midwestern city regarding their career and domestic roles; 390 were physicians in training (students and residents), and 212 were physicians in practice (academic medicine and private practice). Overall, 382 (63%) responded; of the 382, 247 (65%) had domestic partners; of these 247, 91 (37%) were WP-Ps and 156 (63%) were WP-NPs. The WP-Ps were found to be twice as likely as the WP-NPs to interrupt their careers to accommodate their partners' careers. The WP-Ps also assumed significantly more domestic responsibilities and worked fewer hours practicing medicine than did the WP-NPs. The 163 women physicians in training (44-48%-of the WP-Ps and 119-76%-of the WP-NPs) demonstrated a more egalitarian division of labor overall, with no significant differences between the WP-Ps and the WP-NPs. The authors recommend that longitudinal studies be undertaken to determine whether women physicians in training continue this trend as they enter the practice of medicine.

Ambulatory teaching "lite": less clinic time, more educationally fulfilling.

Typically, the primary instructional method for ambulatory care education is direct interaction between a preceptor and a learner during a patient encounter. This paper describes instructional strategies teachers and learners can use in ambulatory care training that can occur before or after scheduled clinic hours, thus providing instruction without disrupting a preceptor's busy clinic. First, they describe how preceptors and clerkship or residency-program directors can orient learners prior to their arrival at assigned sites, so that learners are better prepared to assume their patient-care responsibilities. Then they discuss strategies for making use of various types of conferences and independent learning activities to enhance learners' clinical experiences. Conferences and independent study projects that occur before clinic hours can help learners bring a higher level of thinking and clinical sophistication to their role in the ambulatory care site; conferences and independent study activities that occur after clinic hours give learners an opportunity to reinforce and expand on what they have learned during clinic. In this way, learners' educational experiences are enhanced, the best use is made of preceptors' time and expertise, and clinic efficiency is not disrupted.

The costs versus the perceived benefits of an LCME institutional self-study.

PURPOSE: To calculate the costs versus the perceived benefits of an institutional self-study done to satisfy the requirements of the Liaison Committee on Medical Education's (LCME's) accreditation process. METHOD: From postcard questionnaires, the authors determined the hours spent over 18 months from 1994 to 1996 on the institutional self-study by 131 self-study committee members and 64 database compilers at the Medical College of Wisconsin. The committee members also rated the potential utility of the self-study process and the probability that the concerns identified by their subcommittees would be addressed. Administrative costs (self-study coordinating team's hours, supplies, and other expenses) were tracked using calendars and budget subaccount numbers. Personnel costs were calculated using salary data from the Association of American Medical Colleges and the College and Universities Personnel Administrators' survey. RESULTS: Supplies and equipment for the self-study cost $12,158, and the personnel costs, based on an 81% response rate, were estimated at $207,384, for a total of $219,542. The participants in the self-study rated the process as moderately useful, but believed that there was only a medium degree of probability that concerns they had identified would be addressed. CONCLUSION: Considering the costs of self-study, the process might be more useful if attention were focused less on identifying concerns and more on an institution's demonstrated ability to successfully respond to problems.

Understanding the careers of physician educators in family medicine.

PURPOSE: Little is known about what contributes to the career decisions of physician educators in family medicine. This study sought to understand the variables that influence these decisions and to identify key sources of vitality for physician educators in family medicine. METHOD: A national sample of randomly selected physician educators in family medicine responded to a postcard survey regarding their contribution(s) to education and career satisfaction. A series of exclusion criteria were applied to 399 useable responses, yielding 24 physician educators who participated in a semi-structured telephone interview focusing on their careers. Using qualitative research methods, themes were identified and categorized from the transcribed interviews and investigators' field notes. RESULTS: The career decisions and actions of physician educators in family medicine emanated from an underlying set of values and beliefs associated with "making the world better." Participants sought challenging, diverse, and stimulating positions from which they could have an impact in ways that were consistent with their values. Three major sources of vitality (learners, colleagues, and patients) complemented the desire for challenging positions. Physician educators in family medicine, however, continually struggled to balance their personal and professional lives. CONCLUSION: The study results highlight the key variables that draw faculty into education and sustain their vitality, and the professional and personal challenges that can derail or support their careers. This information can be used to recruit, develop, and retain successful and productive physician educators in family medicine.

Teaching and funding nutrition instruction in family practice education.

Nutrition instruction is accepted as an important element of physician education, but is often not a formal part of medical school or residency training. Personnel and funding are often cited as the major factors that limit nutrition instruction. Because family medicine residency programs have been in the forefront of nutrition instruction, a nationwide survey of these programs was conducted to examine the nature, staffing, and funding mechanisms for nutrition education. Results of the 1986 survey reported in this study indicate that registered dietitians were available to 89% of the programs in the United States and are supported by a combination of funding sources. The implications of these findings are discussed.

Medical students' perceptions of cheating.

In 1985, 683 students at a large private upper-midwestern medical school were surveyed concerning the appropriateness of traditional cheating behaviors and behaviors related to professional misconduct and dishonesty in patient care. They also rated the acceptability of various rationalizations for these behaviors. The students agreed that traditional forms of academic cheating are inappropriate, but they did not agree about the appropriateness of certain behaviors in the areas of patient care and professional misconduct.

Valuing educational scholarship at the Medical College of Wisconsin.

Since the late 1980s faculty and staff at the Medical College of Wisconsin (MCW) have actively sought to align their school's academic culture and promotional process with its mission of educational excellence and innovation. As one of the top 50 medical schools receiving NIH funds, MCW has well-established mechanisms to evaluate and recognize the scholarship of discovery. Understanding, evaluating, and recognizing the value of individuals engaged in the scholarship of teaching, however, required changes in individuals' beliefs and in the MCW's promotion processes and organizational infrastructure. Building on the successful introduction of the MCW's Educator's PortfolioCopyright, a tool for documenting educational scholarship, a multifaceted change strategy was implemented to influence underlying beliefs and values about clinician-educators. Retrospectively, this strategy was consistent with John Kotter's eight-step change model, which the authors apply as an organizing framework for this case report of educational evolution at the MCW. Through creating a guiding coalition, developing vision and strategy, generating short-term wins, and anchoring new approaches in the MCW's culture, the MCW has made substantive progress in recognizing and rewarding educational scholarship. Changing academic cultures to value education is itself an educational process, requiring persistence and the ability to teach others about educational scholarship and its associated criteria.

Comparing the transfusion medicine content of the NBME's examinations in 1984-1985 and 1989-1990.

Recognition of the seriousness of transfusion-transmitted diseases has been demonstrated by U.S. medical schools through the integration of transfusion medicine (TM) content into their curricula. To evaluate the degree to which these changes in curricula have been reflected in the National Board of Medical Examiners' (NBME) examinations, a study conducted in 1991 evaluated the proportions of TM-related items on Parts I and II of the NBME examinations for 1984-1985 versus 1989-1990. Both Part I (basic sciences) and Part II (clinical sciences) demonstrated significant gains in TM items between the comparison periods (p less than .001), with Part II having the higher gain. An analysis of students' knowledge revealed that students in 1989-1990 tended to perform better on TM items than on examination items generally. The increases in TM content and student performance on TM items on the 1989-1990 examinations suggest that the national effort to expand and improve teaching of TM in U.S. medical schools has been effective.

Scholarship in teaching: an imperative for the 21st century.

At some medical schools broader definitions of scholarship have emerged along with corresponding changes in their academic reward systems. Such situations are not common, however. The definition of scholarship generally applied by medical schools is unnecessarily narrow and excludes areas of legitimate academic activity and productivity that are vital to the fulfillment of the school's educational mission. The authors maintain that creative teaching with effectiveness that is rigorously substantiated, educational leadership with results that are demonstrable and broadly felt, and educational methods that advance learners' knowledge are consistent with the traditional definition of scholarship. Faculty whose educational activities fulfill the criteria above are scholars and must be recognized by promotion. The authors specifically address scholarship in education, focusing on teaching and other learning-related activities rather than on educational research, which may be assessed and rewarded using the same forms of evidence as basic science or clinical research. They build on Boyer's work, which provides a vocabulary for discussing the assumptions and values that underlie the roles of faculty as academicians. Next, they apply Glassick et al.'s criteria for judging scholarly work to faculty members' educational activities to establish a basis for recognition and reward consistent with those given for other forms of scholarship. Finally, the authors outline the organizational infrastructure needed to support scholars in education.

The diagnostic process in primary care: a comparison of general internists and family physicians.

This investigation examined the formulation of diagnostic hypotheses by general internists and family physicians in response to three patient cases (dyspnea, abdominal pain and syncope). The investigation was conducted in the United States. Physician responses to sequentially presented written clinical information were audiotaped. Each transcribed protocol was scored to enumerate and characterize the hypotheses considered by physicians in each specialty. Results of the analyses of variance of hypothesis measures revealed that internists generated more hypotheses than family physicians and that the internist's hypotheses were more specific and were less likely to be generated by other physicians. In addition, internists tended to consider hypotheses more closely related to the final diagnosis sooner in the case presentation than did family physicians. The findings of increased number, specificity, and uniqueness of hypothesis considered by internists are consistent with previously demonstrated differences in the amount and nature of diagnostic information collected by family physicians and internists.