How to improve plastic surgery knowledge, skills and career interest in undergraduates in one day.

INTRODUCTION: Plastic surgery now occupies a negligible component of many undergraduate curricula. The British Association of Plastic, Reconstructive and Aesthetic Surgeons Undergraduate Course aimed to introduce and improve students' plastic surgery knowledge and skills, as well as develop personal career interests. This research aims to quantify whether this was achieved. METHODS: Students attending the one-day course were invited to complete a questionnaire before and after the course. Questions were self-reflective and incorporated four key themes: (1) plastic surgery knowledge; (2) awareness of the work of a plastic surgeon; (3) ability to perform basic plastic surgical skills; (4) career interest in plastic surgery. Non-medical students were given an identical questionnaire to quantify public perception of the work of a plastic surgeon. RESULTS: 121 students attended from 17 universities across the UK, with 93 completing the questionnaire (77% response rate). Paired analyses compared mean or median scores of the students' answers before and after the course. After completing the course, medical students significantly improved in all four key themes (p<0.01). 93 non-medical students completed questionnaires. Medical students were significantly more accurate at identifying plastic surgery procedures than non-medical students (P < 0.01), which was further strengthened after completing the course (P < 0.001). CONCLUSION: This study demonstrates the positive educational impact of a one-day plastic surgery event for medical students and supports the need for plastic surgery education at an undergraduate level.

Adaptive divergence and the balance between selection and gene flow: lake and stream stickleback in the Misty system.

We investigated the interplay between natural selection and gene flow in the adaptive divergence of threespine stickleback (Gasterosteus aculeatus) that reside parapatrically in lakes and streams. Within the Misty Lake system (Vancouver Island, British Columbia), stickleback from the inlet stream (flowing into the lake) have fewer gill rakers and deeper bodies than stickleback from the lake--differences thought to facilitate foraging (benthic macroinvertebrates in the stream vs. zooplankton in the open water of the lake). Common-garden experiments demonstrated that these differences have a genetic basis. Reciprocal transplant enclosure experiments showed that lake and inlet stickleback grow best in their home environments (although differences were subtle and often not significant). Release-recapture experiments in the inlet showed that lake fish are less well-suited than inlet fish for life in the stream (higher mortality or emigration in lake fish). Morphological divergence in the wild and under common rearing was greater between the lake and the inlet than between the lake and the outlet. Genetic divergence (mitochondrial DNA and microsatellites) was greatest between the lake and the upper inlet (1.8 km upstream from the lake), intermediate between the lake and the lower inlet (0.9 km upstream), and least between the lake and the outlet stream (1.2 km downstream). Relative levels of gene flow estimated from genetic data showed the inverse pattern. The negative association between morphological divergence and gene flow is consistent with the expectation that gene flow can constrain adaptation. Estimated absolute levels of gene flow also implied a constraint on adaptation in the outlet but not the inlet. Our results suggest that natural selection promotes the adaptive divergence of lake and stream stickleback. but that the magnitude of divergence can be constrained by gene flow.

Closed-field titanium magnets for the retention of complex craniofacial prostheses.

Where reconstruction with autogenous tissue is contraindicated in craniofacial reconstruction, or declined by the patient, a prosthesis may be used. Originally made from latex, cellulose or acrylic resins, prostheses are now largely made of silicone. These prostheses were traditionally retained using adhesives, natural undercuts at retention sites or spectacles. However, these methods were unsatisfactory because of frequent loss of retention, skin reactions to adhesives or unnatural movements of the prosthesis. Osseointegration became a popular method of prosthesis retention, initially using a bar-and-clip device. The use of a bar attached to the implant has certain shortcomings, however, including rigidity of the prosthesis and the difficulty in maintaining hygiene at the implant site. We present our experience with the use of magnets to hold the prosthesis in place, which allows ease of use, improved hygiene and a more natural mobility of the prosthesis.

Evaluation of a breast self-examination (BSE) program in a breast diagnostic clinic.

The purpose of this study was to evaluate the short-term effectiveness of a breast self-examination (BSE) teaching program on women's knowledge about BSE, proficiency in performing BSE, and motivation to perform BSE. The program was developed for delivery by nurses in a breast diagnostic clinic, a clinic designed to meet the need for expeditious management of breast disease, current information about breast cancer risk, surveillance, and counselling. A convenience sample of 68 women attending the clinic in a regional cancer centre participated in a pre- and five month post-teaching program evaluation. The Toronto Breast Self Examination Instrument was used as the evaluation tool. There were statistically significant changes following the teaching program in the areas of knowledge about the correct technique for performing BSE, proficiency performing BSE, and confidence about finding changes when performing BSE. No significant changes were observed in motivation to practise BSE, although group scores did improve following the education. Participants found the video presentation and the review of BSE information pamphlets by the nurse to be the most helpful components of the BSE teaching program.

Historical contingency and ecological determinism interact to prime speciation in sticklebacks, Gasterosteus.

Historical contingency and determinism are often cast as opposing paradigms under which evolutionary diversification operates. It may be, however, that both factors act together to promote evolutionary divergence, although there are few examples of such interaction in nature. We tested phylogenetic predictions of an explicit historical model of divergence (double invasions of freshwater by marine ancestors) in sympatric species of three-spined sticklebacks (Gasterosteus aculeatus) where determinism has been implicated as an important factor driving evolutionary novelty. Microsatellite DNA variation at six loci revealed relatively low genetic variation in freshwater populations, supporting the hypothesis that they were derived by colonization of freshwater by more diverse marine ancestors. Phylogenetic and genetic distance analyses suggested that pairs of sympatric species have evolved multiple times, further implicating determinism as a factor in speciation. Our data also supported predictions based on the hypothesis that the evolution of sympatric species was contingent upon 'double invasions' of postglacial lakes by ancestral marine sticklebacks. Sympatric sticklebacks, therefore, provide an example of adaptive radiation by determinism contingent upon historical conditions promoting unique ecological interactions, and illustrate how contingency and determinism may interact to generate geographical variation in species diversity

PARALLEL EVOLUTION OF LAKE-STREAM PAIRS OF THREESPINE STICKLEBACKS (GASTEROSTEUS) INFERRED FROM MITOCHONDRIAL DNA VARIATION.

Three drainage systems in British Columbia, Canada, contain divergent parapatric lake-stream pairs of threespine sticklebacks (Gasterosteus aculeatus): Drizzle and Mayer Lakes on Graham Island, Queen Charlotte Islands, and Misty Lake on northeastern Vancouver Island. Ecological and morphological differences between members of all three lake-stream pairs are strikingly similar; lake fish are melanistic and slim bodied with smaller mouths and more gill rakers than the mottled-brown and robust-bodied stream sticklebacks. We estimated the level of genetic divergence between lake and stream fish in Misty Lake and tested hypotheses of single versus multiple origins of the pairs by assaying mitochondrial DNA (mtDNA) restriction site variation in samples from the three lake systems. MtDNA analysis revealed the existence of two highly divergent lineages differing by 2.7% in sequence. One lineage predominated in Misty stream fish (73%), whereas the other lineage predominated in Misty Lake samples (96%). Comparable forms (lake or stream) in the different lakes did not cluster together in terms of mtDNA nucleotide divergence, suggesting that the pairs have had independent origins. We concluded that: (1) divergent mtDNA lineages in North Pacific sticklebacks stem from historical isolation in the two major glacial refugia proposed for the North Pacific (Beringia and Cascadia); (2) the stream and lake pair in Misty Lake are distinct gene pools; (3) the divergence between parapatric lake and stream Gasterosteus represents parallel evolution having occurred at least twice in the North Pacific; and (4) different scales of evolutionary divergence exist in North Pacific Gasterosteus, that is, a relatively ancient divergence of mtDNA clades as well as recent (i.e., postglacial) divergence of ecotypes within major clades.

The effect of behavioural and morphological plasticity on foraging efficiency in the threespine stickleback (Gasterosteus sp.).

We conducted an experiment to assess the change in foraging efficiency resulting from diet-induced morphological and behavioural plasticity in a species of freshwater, threespine stickleback (Gasterosteus sp.). Different degrees of morphological and behavioural change were induced using two prey items commonly found in the diet of this species, allowing us to estimate the relative importance of each type of plasticity. The purpose of the experiment was twofold. First, earlier work had suggested that diet variability might be an important factor in the evolution of trophic morphological plasticity in sticklebacks. The present results extend this work by revealing the adaptive significance of morphological plasticity. The current experiment also qualitatively assessed the compatibility of the time scale of morphological change with that of the natural resource variability experienced by this species. The results indicate that diet-induced plasticity improves foraging efficiency continuously for up to 72 days of prey exposure. This is probably due in part to plasticity of the external trophic morphology but our results also suggest a complex interplay between morphology and behaviour. The time scale appears to be matched to that of natural diet variability although it is possible that some traits exhibit non-labile plasticity. Our discussion highlights the important distinction between conditions favouring the evolution of labile versus non-labile plasticity. The second objective of the experiment was to determine the relative importance of morphological and behavioural plasticity. Few studies have attempted to quantify the adaptive significance of morphological plasticity and no study to our knowledge has separated the effects of morphological and behavioural plasticity. Our experiment reveals that both behavioural and morphological plasticity are important and it also suggests a dichotomy between the two: behavioural plasticity predominately affects searching efficiency whereas morphological plasticity predominately affects handling efficiency.

Friendship and literacy through literature.

The exploratory research reported in this article was designed to determine the processes and outcomes of planning thematic literacy instruction in a holistic and contextualized manner. The work was conducted in an upper-elementary, self-contained setting for students identified as learning disabled. Specifically, the instructional activities included (a) interactive readings from literature on friendship, (b) personal written responses to the literature, (c) supported retellings of the literature, (d) performance related to the literature, and (e) journal writing on the topic of friendship. The outcomes are reported in terms of the use of intertextuality over the course of the 6-week unit, the emergence of theme as a salient feature in literature, and a change in the children's conceptions of friendship. More specific literacy outcomes are captured in case studies of 3 children.

Adolescents with learning disabilities: a comparative life-stream interpretation.

The subjective experiences of adolescents with learning disabilities (LD) were compared to those of their low-achieving and normally achieving peers. Three groups of juniors and seniors from one suburban high school district, 18 students with learning disabilities (15 males, 3 females), 17 low-achieving students (12 males, 5 females), and 20 average-achieving students (12 males, 8 females), were given electronic pagers and booklets for 1 week. They were signaled every 40 minutes during school hours, and every 2 hours after school. As soon as possible after receiving a signal, they responded to questions in their booklets. The questions provided subjective measures on levels of affect, activation, cognitive efficiency self-esteem, motivation, and feedback from others. The students with learning disabilities reported feeling more positive and active than either of the other groups during school hours, while after school there were no differences on any of the subjective measures for the three groups. Specific LD school practices are high-lighted for their probable impact on the heightened affect and activation of the students with learning disabilities.

Character displacement and replicate adaptive radiation.

Ecological character displacement is implicit in current views of adaptive radiation, but examples are few. The paucity of cases may be partly a problem of detection: statistical tests require that a consistent pattern of displacement be observed over independent lineages, yet opportunities for such replication may be few. Recent studies of fish in postglacial lakes and lizards on Caribbean islands reveal multiple speciation events accompanied by equivalent patterns of ecological and morphological divergence. These studies provide a wealth of new examples of apparent character displacement, and show that adaptive radiations may unfold in a predictable sequence.

Waiting in the emergency room: how to improve patient satisfaction.

The authors conducted a field experiment in which emergency-room patients of a metropolitan hospital were either given or not given an expected waiting time to see a physician. Patients were then surveyed through the mail on their satisfaction and perceptions of service quality. The results revealed that satisfaction levels were higher when patients believed that they had received information on expected waiting time. Regression analysis revealed that service quality dimensions of trust, responsiveness, and staff service were significant predictors of patient satisfaction. In addition, satisfaction was independently influenced by whether patients' prior timeliness expectations were confirmed. The authors discuss the results in terms of the concept that the situational context of the service may influence the quality dimensions that most affect consumer satisfaction.

Ecological character displacement and speciation in sticklebacks.

We present evidence of ecological character displacement among species of threespined sticklebacks that inhabit small lakes of coastal British Columbia. Geological data suggest that the populations resulted from multiple divergence and speciation events over the past 13,000 yr. In lakes with two species, one is invariably "limnetic" in morphology and habitat, and the other is "benthic." Other lakes contain a single form morphologically intermediate between sympatric species and exploiting both habitat's. Within solitary populations individuals exploit one habitat or the other according to their morphology, which underscores the divergent selection pressures operating on either side of the habitat boundary. Our results satisfy at least four of the six major criteria for demonstrating the occurrence of character displacement: (1) a statistical null model of no displacement is easily rejected; (2) variation between and within populations is genetically based; (3) differences in sympatry reflect evolutionary shifts, not merely the biased extinction of similar forms; and (4) morphology is closely linked to resource use. Minimal resource differences between one- and two-species lakes and the presence of competition between similar phenotypes are still to be established. Our data suggest that competition for food has played a critical role in the divergence between species. We consider the possibility that it also helped in species formation, which would expand its potential role in adaptive radiation.

Education on breast disease in an obstetrics and gynecology training program: a multidisciplinary approach.

Breast cancer affects one in ten women during their lifetime. Recognizing the importance of early detection in the prognosis of this condition, the American Board of Obstetrics and Gynecology has stated guidelines encouraging breast disease education in obstetrics and gynecology training programs. To fulfill this academic responsibility, we have organized a multidisciplinary Breast Disease Detection and Treatment Clinic where patients with abnormal mammograms or any breast-related complaints are evaluated and managed. In cooperation with the radiology department and general surgery service, a mammogram review conference has been instituted. Abnormal mammograms are reviewed with a radiologist. Our activities have been coordinated such that a general surgery staff member and resident are present during the breast clinic hours to review mammograms and to examine the patients with the gynecologist, providing immediate consultation. Needle aspiration of breast cysts, repeat imaging studies, and general surgery referrals for breast biopsies are performed as indicated. The patient receives integrated care of her breast problem in one visit, and our residents gain the experience of diagnosing and managing breast problems which, before establishment of this clinic, were referred to the general surgery department. This multidisciplinary approach developed in our institution helps us provide the most efficient care to our patients, while providing our residents with integrated teaching and training concerning the diagnosis and management of breast disease.

A traumatic splenic pseudocyst--historical review, diagnosis, and current mode of treatment.

A 30-year-old American Indian male with a history of chronic pancreatitis and prior blunt abdominal trauma was preoperatively diagnosed as having a splenic pseudocyst. The patient was successfully treated surgically with decapsulation of the pseudocyst instead of a splenectomy.

A simple inexpensive technique for placing drainage catheters through the skin.

A simple, inexpensive technique for placement of the T tube or Jackson-Pratt closed suction drainage catheter through the skin is described herein. This is an ideal procedure to use when treating a patient who has underlying ascites and is at a higher risk of having a leak develop through the standard procedures of placing drains.