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BACKGROUND: Most of the published documents proposing teaching objectives for undergraduate clerkships were prepared by expert bodies. Seldom have the clinical teachers, who are critical to the learning process and to the implementation of the teaching objectives, been the actual proponents of its core content. OBJECTIVE: To develop a national-scale proposal of teaching objectives for the family medicine clerkship in medical school, using a consensus method and the actual, community-based teachers as the expert body. METHODS: The Delphi method was chosen for that purpose. In the first round all 189 family medicine teachers in Israeli medical schools were asked to propose five teaching objectives. In the second round the objectives, which were generated in the first round, were characterized by key words and were sent to the participants as a second round for ranking according to their importance. RESULTS: A total of 116 family medicine teachers (61.38%) responded in the first round and 91 of the 116 (78.5%) in the second round. They formulated 51 teaching objectives listed in order of importance, covering a wide array of themes and including knowledge, attitude and skills objectives. The most important objectives were common problems in primary care, recognition of the biopsychosocial model, and understanding the importance of the doctor-patient relationship. The structure of the list provides a unique insight into the relative importance of each objective in the context of the whole core content of the clerkship. CONCLUSIONS: Constructing a proposal for teaching objectives is feasible using the Delphi method and the field instructors as the selecting body. The process and its results can provide faculty with relevant and important suggestions on the content and structure of the family medicine clerkship.

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Physicians are frequently required to break bad news to their patients. Previous research has shown that inconvenience, incompetence, and difficulty in dealing with patients' feelings are the main complaints expressed by physicians after such an encounter. Current educational programs dealing with breaking bad news are usually short, given in lecture format, and are inadequate in addressing essential issues such as knowledge, personal beliefs and attitudes, and previous personal experiences of physicians in such situations. In the past 8 years our Dept. of Family Medicine has implemented a course in breaking bad news that addresses these issues. A senior family practitioner and a medical social worker conduct 14 sessions of discussions and role-playing for small groups of residents and primary care physicians. The program is based on: theory dealing with methods of managing stress and crisis intervention, clarifying personal attitudes, discussions of previous personal encounters of the participants, various modalities of communication, methods of addressing patients' feelings and emotions, and coping with the emotions of the one breaking the bad news. On a 1-5 Likert scale questionnaire the course received an overall score of 4.47 (SD 0.51). Participants noted that they gained relevant communication skills for future patient encounters. A reliable examination of practitioners' competence in breaking bad news is mandatory in order to assess the efficiency of such courses.

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Our research objective was to characterize the biochemical effect of streptomycin during postnatal rat cerebral cortex development using a sensitive method that preserves the in situ topological relationship. We found a decrease in the mannosylation of asparagine-linked oligosaccharides without affecting polypeptide synthesis, DNA synthesis or glucose and mannose disappearance from the medium in mini-tissue units derived from P5. In addition, the rate of Dolp-GlcNAc2 Man9 Glc3 synthesis and the oligosaccharide protein transferase activity did not change in the presence of the aminoglycoside. These findings strongly suggested that the alteration of protein mannosylation occurred downstream of G3 transfer to nascent polypeptides. Further, the mini-tissue units may be useful for the assessment of neurological toxicity of antibacterial agents.

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An important mandate of the Caribbean Epidemiology Centre, (CAREC) is the development of epidemiological capacity among member states. From 1979 to 1985, the Centre received a USAID grant for epidemiology training. However, migration, promotion and other demands led to a subsequent decline in overall epidemiological capacity. The call to renew training activities came from CAREC's Scientific Advisory Committee in 1990 and from Caribbean National Epidemiologists in 1991. Technical assistance was secured from the Emory School of Public Health, funded by the Fogarty International Center (NIH), while financial support was provided by the British Development Division in the Caribbean (BDDC), in late 1992. The resulting programme includes three operational objectives: to strengthen epidemiological skills for disease surveillance; outbreak investigation; evaluation of screening methods and to conduct community surveys; to increase knowledge of and facilitate experience with the design, organization and implementation of field research, questionnaire design data collection; and to increase microcomputer knowledge and skills for data analysis and interpretation. The programme applies adult education principles within a series of workshops and complementary field study activities. Trining activities commenced in the second quarter of 1993, and over 60 individuals had participated by the end of the year. Several evaluation instruments reveal positive outcomes in each of three sites to date. Major gains in knowledge have been demonstrated in pre/post-course testing. Multiple regression analysis reveals that the strongest predictor of post-course performance (including epidemiology, statistics, and computing) is pre-course performance in computing (AU)

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1. Prairie dog gallbladders mounted in a Ussing-type chamber and bathed with symmetrical Ringer's solutions exhibited a transepithelial resistance (Rt) of 51 +/- 5 omega cm2, a lumen negative potential difference (Vms) of 11.5 +/- 0.7 mV and a short-circuit current (Isc) of 6.9 +/- 0.3 microEq/hr/cm2. 2. Radioisotopic ion flux experiments revealed that the basal Isc of 6.9 +/- 0.3 microEq/hr/cm2 was mostly accounted for by net Na+ absorption of 3.2 +/- 0.5 microEq/hr/cm2 and net Cl- secretion of 2.9 +/- 0.3 microEq/hr/cm2. 3. In HCO3- free Ringer's, net Na+ flux was virtually abolished, net Cl- flux decreased by 50% and Isc was reduced by 77%. 4. 10(-3) M mucosal amiloride and DIDS reduced Isc by 28 and 24%, respectively. 5. Mucosal NaCl diffusion potentials indicated that the paracellular pathway was cation selective. 6. Thin section electron micrographs showed a single cell population in this epithelium suggesting that net Na+ absorption and Cl- secretion may emerge from the same cells. 7. We conclude that prairie dog gallbladder epithelium is an electrogenic tissue and, in contrast to gallbladders of most other species, simultaneously but independently absorbs Na+ and secretes Cl-.

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Anaerobic methane oxidation is a general process important in controlling fluxes of methane from anoxic marine sediments. The responsible organism has not been isolated, and little is known about the electron acceptors and substrates involved in the process. Laboratory evidence indicates that sulfate reducers and methanogens are able to oxidize small quantities of methane. Field evidence suggests anaerobic methane oxidation may be linked to sulfate reduction. Experiments with specific inhibitors for sulfate reduction (molybdate), methanogenesis (2-bromoethanesulfonic acid), and acetate utilization (fluoroacetate) were performed on marine sediments from the zone of methane oxidation to determine whether sulfate-reducing bacteria or methanogenic bacteria are responsible for methane oxidation. The inhibition experiment results suggest that methane oxidation in anoxic marine sediments is not directly mediated by sulfate-reducing bacteria or methanogenic bacteria. Our results are consistent with two possibilities: anaerobic methane oxidation may be mediated by an unknown organism or a consortium involving an unknown methane oxidizer and sulfate-reducing bacteria.

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A significant protection against the lethal effects of hypobaric and isobaric hypoxia is observed in mice treated with propranolol. Previous acclimatization to chronic hypoxia does not introduce variations on this protective effect of the beta adrenergic blocking drugs. Similar effects were found using histotoxic anoxia provoked by sodium azide administration. A significative reduction of body temperature is observed under the effects of the blockaders. These findings suggest a reduced need of oxygen in the treated animals. Neutralization of the effects of epinephrine released as a consequence of the hypoxic stress is proposed as the protection mechanism.

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A significant protection against the lethal effects of hypobaric and isobaric hypoxia is observed in mice treated with propranolol. Previous acclimatization to chronic hypoxia does not introduce variations on this protective effect of the beta adrenergic blocking drugs. Similar effects were found using histotoxic anoxia provoked by sodium azide administration. A significative reduction of body temperature is observed under the effects of the blockaders. These findings suggest a reduced need of oxygen in the treated animals. Neutralization of the effects of epinephrine released as a consequence of the hypoxic stress is proposed as the protection mechanism.

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A significant protection against the lethal effects of hypobaric and isobaric hypoxia is observed in mice treated with propranolol. Previous acclimatization to chronic hypoxia does not introduce variations on this protective effect of the beta adrenergic blocking drugs. Similar effects were found using histotoxic anoxia provoked by sodium azide administration. A significative reduction of body temperature is observed under the effects of the blockaders. These findings suggest a reduced need of oxygen in the treated animals. Neutralization of the effects of epinephrine released as a consequence of the hypoxic stress is proposed as the protection mechanism.

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