Medical students' attitudes toward radiology: comparison of matriculating and graduating students

RATIONALE AND OBJECTIVES: To determine graduating medical students' perceptions of radiology and to document changes in their perceptions since they entered medical school. MATERIALS AND METHODS: A survey questionnaire was distributed to 213 graduating students. Questions were similar to those answered by the same group of students as they entered medical school nearly 4 years earlier. RESULTS: The survey was anonymously completed by 140 students. Seventy percent of students changed their choice of medical specialty since entering medical school. Factors with a major or important influence on specialty choice included intellectual excitement (96%), high patient contact (86%), opportunity for a good family life (72%), and regular hours (57%). Radiology was perceived to be a well-paid (89%), "high-tech" (86%) specialty with a healthy lifestyle (82%), regular hours (99%), and good family life (92%), but it was not perceived to offer high patient contact (1%) and was intellectually exciting to only 33% of students. This perception was unchanged from freshman year. CONCLUSIONS: This 4-year longitudinal study of a medical student class documents surprisingly little change in the perception of radiology throughout medical school. High patient contact and intellectual excitement, both factors of major or important influence on specialty choice, were thought to be lacking in radiology.     

A septin-based hierarchy of proteins required for localized deposition of chitin in the Saccharomyces cerevisiae cell wall

Just before bud emergence, a Saccharomyces cerevisiae cell forms a ring of chitin in its cell wall; this ring remains at the base of the bud as the bud grows and ultimately forms part of the bud scar marking the division site on the mother cell. The chitin ring seems to be formed largely or entirely by chitin synthase III, one of the three known chitin synthases in S. cerevisiae. The chitin ring does not form normally in temperature-sensitive mutants defective in any of four septins, a family of proteins that are constituents of the "neck filaments" that lie immediately subjacent to the plasma membrane in the mother-bud neck. In addition, a synthetic-lethal interaction was found between cdc12-5, a temperature-sensitive septin mutation, and a mutant allele of CHS4, which encodes an activator of chitin synthase III. Two-hybrid analysis revealed no direct interaction between the septins and Chs4p but identified a novel gene, BNI4, whose product interacts both with Chs4p and Cdc10p and with one of the septins, Cdc10p; this analysis also revealed an interaction between Chs4p and Chs3p, the catalytic subunit of chitin synthase III. Bni4p has no known homologues; it contains a predicted coiled-coil domain, but no other recognizable motifs. Deletion of BNI4 is not lethal, but causes delocalization of chitin deposition and aberrant cellular morphology. Overexpression of Bni4p also causes delocalization of chitin deposition and produces a cellular morphology similar to that of septin mutants. Immunolocalization experiments show that Bni4p localizes to a ring at the mother-bud neck that lies predominantly on the mother-cell side (corresponding to the predominant site of chitin deposition). This localization depends on the septins but not on Chs4p or Chs3p. A GFP-Chs4p fusion protein also localizes to a ring at the mother-bud neck on the mother-cell side. This localization is dependent on the septins, Bni4p, and Chs3p. Chs3p, whose normal localization is similar to that of Chs4p, does not localize properly in bni4, chs4, or septin mutant strains or in strains that accumulate excess Bni4p. In contrast, localization of the septins is essentially normal in bni4, chs4, and chs3 mutant strains and in strains that accumulate excess Bni4p. Taken together, these results suggest that the normal localization of chitin synthase III activity is achieved by assembly of a complex in which Chs3p is linked to the septins via Chs4p and Bni4p.     

Factors underlying unmet need for family planning in the Philippines

The prevalence of unmet need for family planning is a primary justification for family planning programs, but the causes of unmet need have not been much explored. This article investigates four explanations for unmet need: (1) as an artifact of inaccurate measurement of fertility preferences and contraceptive practice; (2) as a reflection of weakly held fertility preferences; (3) as a result of women's perceiving themselves to be at low risk of conceiving; (4) as due to excessive costs of contraception. The explanations are examined using quantitative and qualitative data collected in 1993 from currently married women and their husbands in two provinces in the Philippines. The results indicate that the preference-behavior discrepancy commonly termed "unmet need" is not an artifact of survey measurement. The most important factors accounting for this discrepancy are the strength of women's reproductive preferences, husbands' fertility preferences, and the perceived detrimental side effects of contraception. Inaccessible family planning services appear to carry little weight in this setting. Modification of services to make them more attentive to other obstacles to contraceptive use would improve their effectiveness in reducing unmet need.     

Using carbohydrate counting in diabetes clinical practice

Carbohydrate counting is a meal planning approach used with clients who have diabetes that focuses on carbohydrate as the primary nutrient affecting postprandial glycemic response. The concept of carbohydrate counting has been around since the 1920s, but it received renewed interest after being used as 1 of 4 meal planning approaches in the Diabetes Control and Complications Trial. In the trial, carbohydrate counting was found to be effective in meeting outcome goals and allowed flexibility in food choices. Recent practice pattern surveys have shown an increasing interest in and use of carbohydrate counting for medical nutrition therapy for persons with diabetes. Carbohydrate counting can be used by clients with type 1, type 2, and gestational diabetes. Three levels of carbohydrate counting have been identified based on increasing levels of complexity. Level 1, or basic, introduces clients to the concept of carbohydrate counting and focuses on carbohydrate consistency. Level 2, or intermediate, focuses on the relationships among food, diabetes medications, physical activity, and blood glucose level and introduces the steps needed to manage these variables based on patterns of blood glucose levels. Level 3, or advanced, is designed to teach clients with type 1 diabetes who are using multiple daily injections or insulin infusion pumps how to match short-acting insulin to carbohydrate using carbohydrate-to-insulin ratios. All 3 levels emphasize portion control and offer opportunities for using creative teaching methods, such as "food labs," and use of a variety of carbohydrate resource tools and publications. In this article, glycemic effects of protein, fat, and fiber intake are discussed for persons with type 1 and type 2 diabetes. Decision trees are introduced for each level of carbohydrate counting and show the usual progression through each level. Carbohydrate counting as a meal planning approach offers variability of food choices with the potential for improving glycemic control. Research opportunities are available for those interested in comparing carbohydrate counting with other meal planning approaches for clients with diabetes and the effects on clinical outcomes.     

Direct cloning of human 10q25 neocentromere DNA using transformation-associated recombination (TAR) in yeast

The transformation-associated recombination (TAR) procedure allows rapid, site-directed cloning of specific human chromosomal regions as yeast artificial chromosomes (YACs). The procedure requires knowledge of only a single, relatively small genomic sequence that resides adjacent to the chromosomal region of interest. We applied this approach to the cloning of the neocentromere DNA of a marker chromosome that we have previously shown to have originated through the activation of a latent centromere at human chromosome 10q25. Using a unique 1.4-kb DNA fragment as a "hook" in TAR experiments, we achieved single-step isolation of the critical neocentromere DNA region as two stable, 110- and 80-kb circular YACs. For obtaining large quantities of highly purified DNA, these YACs were retrofitted with the yeast-bacteria-mammalian-cells shuttle vector BRV1, electroporated into Escherichia coli DH10B, and isolated as bacterial artificial chromosomes (BACs). Extensive characterization of these YACs and BACs by PCR and restriction analyses revealed that they are identical to the corresponding regions of the normal chromosome 10 and provided further support for the formation of the neocentromere within the marker chromosome through epigenetic activation.     

HIV-1 Tat protein mimicry of chemokines

The HIV-1 Tat protein is a potent chemoattractant for monocytes. We observed that Tat shows conserved amino acids corresponding to critical sequences of the chemokines, a family of molecules known for their potent ability to attract monocytes. Synthetic Tat and a peptide (CysL24-51) encompassing the "chemokine-like" region of Tat induced a rapid and transient Ca2+ influx in monocytes and macrophages, analogous to beta-chemokines. Both monocyte migration and Ca2+ mobilization were pertussis toxin sensitive and cholera toxin insensitive. Cross-desensitization studies indicated that Tat shares receptors with MCP-1, MCP-3, and eotaxin. Tat was able to displace binding of beta-chemokines from the beta-chemokine receptors CCR2 and CCR3, but not CCR1, CCR4, and CCR5. Direct receptor binding experiments with the CysL24-51 peptide confirmed binding to cells transfected with CCR2 and CCR3. HIV-1 Tat appears to mimic beta-chemokine features, which may serve to locally recruit chemokine receptor-expressing monocytes/macrophages toward HIV producing cells and facilitate activation and infection.     

Expression of the head gene Lox22-Otx in the leech Helobdella and the origin of the bilaterian body plan

In six experiments using the speeded classification paradigm, we provide evidence that the ostensibly "separable" dimensions of size and orientation can produce patterns of either separability or asymmetric configurality, depending on the spatial arrangement of the stimuli. In all experiments, subjects classified large or small circles containing a single line in one of two possible orientations. When the line touched the circle's perimeter, thereby defining the diameter of the circle (Experiments 1-4), asymmetric configurality obtained: Variations in size interfered with classification by orientation, but variations in orientation did not interfere with classification by size, and redundancy gain was weak or absent. When the lines fell completely within (i.e., did not touch) the circles (Experiments 5 and 6), the results were consistent with separability: There was neither redundancy gain nor interference. Taken together, the results add to the growing body of evidence that classification of specific dimensional pairs as separable or integral may be less feasible than identifying the more general conditions that increase or decrease the psychological salience of dimensional structures and facilitate or interfere with selection of optimal processing strategies.     

Contrast-invariant orientation tuning in cat visual cortex: thalamocortical input tuning and correlation-based intracortical connectivity

The origin of orientation selectivity in visual cortical responses is a central problem for understanding cerebral cortical circuitry. In cats, many experiments suggest that orientation selectivity arises from the arrangement of lateral geniculate nucleus (LGN) afferents to layer 4 simple cells. However, this explanation is not sufficient to account for the contrast invariance of orientation tuning. To understand contrast invariance, we first characterize the input to cat simple cells generated by the oriented arrangement of LGN afferents. We demonstrate that it has two components: a spatial-phase-specific component (i.e., one that depends on receptive field spatial phase), which is tuned for orientation, and a phase-nonspecific component, which is untuned. Both components grow with contrast. Second, we show that a correlation-based intracortical circuit, in which connectivity between cell pairs is determined by the correlation of their LGN inputs, is sufficient to achieve well tuned, contrast-invariant orientation tuning. This circuit generates both spatially opponent, "antiphase" inhibition ("push-pull"), and spatially matched, "same-phase" excitation. The inhibition, if sufficiently strong, suppresses the untuned input component and sharpens responses to the tuned component at all contrasts. The excitation amplifies tuned responses. This circuit agrees with experimental evidence showing spatial opponency between, and similar orientation tuning of, the excitatory and inhibitory inputs received by a simple cell. Orientation tuning is primarily input driven, accounting for the observed invariance of tuning width after removal of intracortical synaptic input, as well as for the dependence of orientation tuning on stimulus spatial frequency. The model differs from previous push-pull models in requiring dominant rather than balanced inhibition and in predicting that a population of layer 4 inhibitory neurons should respond in a contrast-dependent manner to stimuli of all orientations, although their tuning width may be similar to that of excitatory neurons. The model demonstrates that fundamental response properties of cortical layer 4 can be explained by circuitry expected to develop under correlation-based rules of synaptic plasticity, and shows how such circuitry allows the cortex to distinguish stimulus intensity from stimulus form.     

Immunolymphoscintigraphy in breast cancer: evaluation using 131I-labeled monoclonal antibody B72.3

Resistance to the organophosphates temephos and chlorpyrifos, the carbamate propoxur, the pyrethroid permethrin, and the organochloride DDT was investigated in Tunisian populations of Culex pipiens pipiens (L.) collected between 1990 and 1996. Resistance to temephos was uniformly low, reaching 10-fold in the most resistant population. In contrast, resistance to chlorpyrifos was highly variable, reaching the highest level (> 10,000-fold) recorded worldwide. The chlorpyrifos-resistant populations also were highly resistant to propoxur. Some populations also showed high resistance to permethrin (up to 5,000-fold) and moderate resistance to DDT (approximately 20-fold). Bioassays conducted in the presence of synergists showed that increased detoxification had only a minor role in resistance, although several over-produced esterases known to be involved in organophosphate resistance were detected. To better understand the factors influencing the distribution of resistance in Tunisia, the polymorphism of genes involved in organophosphate resistance (i.e., over-produced esterases and insensitive acetylcholinesterase) was investigated in relation to the genetic structure of populations studied by analyzing the electrophoretic polymorphism of "neutral" genes. Over the area studied, and despite a high level of gene flow, resistance genes showed a patchy distribution. Results are discussed in relation to the selection pressure caused by insecticide treatments.