Melatonin induction of filamentous structures in non-neuronal cells that is dependent on expression of the human mt1 melatonin receptor.

Melatonin has gained recent popularity as a treatment for insomnia and other sleep disorders; however, its cellular effects are unknown. We report the effects of melatonin on the cellular morphology of Chinese hamster ovary (CHO) cells transformed to express the human melatonin receptors, mt1 and MT2. Our results show that melatonin exerts a strong influence on cellular shape and cytoskeletal organization in a receptor-dependent and possibly subtype-selective manner. The cell shape change that we see after a 5-h treatment of these non-neuronal cells with a pharmacological concentration of melatonin consists of the formation of long filamentous outgrowths that are reminiscent of the neurite processes produced by differentiating nerve cells. This morphological change occurs exclusively in cells expressing the mt1 receptor. We find that the microtubule and microfilament organization within these outgrowths is similar to that of neurites. Microtubules are required for the shape change to occur as Colcemid added in combination with melatonin completely blocks outgrowth formation. We demonstrate that the number of cells showing the altered cell shape is dependent on melatonin concentration, constant exposure to melatonin and that outgrowth frequencies increase when protein kinase A (PKA) is inhibited. Concomitant melatonin-dependent increases in MEK 1/2 and ERK 1/2 phosphorylation are noted in mt1-CHO cells only. The production of filamentous outgrowths is dependent on the translation of new protein but not the transcription of new mRNA. Outgrowth number is not controlled by centrosomes but is instead controlled by the polymerization state of the actin cytoskeleton. The results of this work show that the organization of the cytoskeleton is affected by processes specifically mediated or regulated by the mt1 receptor and may represent a novel alternative mechanism for the stimulation of process formation.

Utilization of lumbosacral spine radiographs for the evaluation of low back pain in the emergency department.

We sought to determine how often Emergency Physicians (EPs) order plain radiographs (XRs) of the lumbosacral spine in evaluating patients with low back pain (LBP). In addition, we sought to determine what history and physical examination findings were statistically associated with the use of an XR. Patients evaluated in our Emergency Department (ED) between April 1, 1995 and September 30, 1995 for LBP were identified retrospectively by their ICD-9 discharge code. The ED record was reviewed, and an odds ratio (OR) was calculated for each of several history and physical examination findings, to determine which of them increased the likelihood of having an XR. Forty of 214 patients (19%) with LBP had an XR done. Patient characteristics associated with the use of an XR were: a positive straight leg examination, age > 50 years, a history of trauma, and vertebral tenderness. In this series, only a small minority of patients with LBP had an XR done as part of their ED evaluation. The choice of which patients to image was determined by history and physical examination findings. We conclude that the EPs we studied are evaluating LBP as conservatively, if not more so, than physicians in other specialties.

The Pew National Dental Education Program at the University of Florida College of Dentistry.

The University of Florida College of Dentistry is located in a dynamic environment. Socially, economically, and demographically, the state of Florida manifests changes reflective of the entire nation, i.e., increasing numbers of elderly and minorities, a fluctuating, diversified economy, and altered cultural values. The explosive growth unique to this state has both positive and negative implications for all aspects of its culture and economy. The college resides in a maturing, research-oriented university facing vigorous competition from other major universities in the state. Within the Health Science Center, the college was occupied during the first decade of its existence with development of an innovative curriculum, and now it must turn its attention to a new emphasis on research and service. A process of strategic planning was conducted at the University of Florida College of Dentistry from January 1986 through June 1987. Four consultant groups representing the college, the university, organized dentistry in Florida, and outside consultants, were guided by a steering committee in a thorough evaluation of the external and internal environment of the institution.(ABSTRACT TRUNCATED AT 250 WORDS)

A clinical comparison of lidocaine and bupivacaine.

The drug of choice for local anesthesia in most emergency departments is lidocaine. However, it wears off shortly after suturing is complete and patients may experience pain after closure of the wound. We conducted a study to determine the degree of anesthesia obtained during and after repair of lacerations using lidocaine 1% versus bupivacaine 0.25%, a long-acting local anesthetic. Lidocaine and bupivacaine were administered in a double-blind, randomized fashion to 104 patients. Each patient was asked to rate his pain on a 0 to 10 scale (0, no pain; 10, severe pain) prior to administration of the anesthetic. They then rated pain on an identical scale at 30 minutes, and one, two, three, four, five, six, 12, 18, and 24 hours after completion of suturing. The mean baseline pain was 2.96 for the lidocaine group and 3.07 for the bupivacaine group. This decreased to less than 1.0 in both groups 30 minutes after infiltration. It remained low for the bupivacaine group for the next five hours, but increased almost to preanesthesia levels by two hours in the lidocaine group. A three-way analysis of variance revealed a significant difference (P less than .001) between the pain response of the two groups. There was no statistical difference (P greater than .05) between the age of the patients, size of laceration, and amount of drug used. The study shows that patients do experience pain after a wound is sutured and the anesthetic has worn off. It also demonstrates that bupivacaine significantly reduces the pain a patient may experience after repair of a wound.

Inquiry teaching in clinical periodontics.

Inquiry teaching is a strategy to develop skills in information retrieval and reasoning. Its framework is a method of systematic questioning by the teacher, who trains the learner's skill in information retrieval and thinking so that future clinical problems may be more readily solved. This paper describes the adaptation of the Inquiry Method to instruction in clinical periodontics. It describes a strategy that structures the interactions between the teacher and student to develop thinking skills related to patient care.

Grant writing and review for dental faculty.

Clinicians need to engage in scholarly activities to fulfill their university role. Current conditions within academia suggest that a good activity for practicing scientific skills is in the writing and reviewing of grant proposals. It is also important that writing for publication shares many of the same skills. This paper provides a guide for producing and reviewing grant proposals based on scientific merit.

Addressing the negative impact of scholarship on dental education.

Defined broadly, scholarship is the essence of academic and professional life. In several ways, however, scholarship as defined, perceived, and applied within the university has a negative impact on dental education. When scholarship is defined in terms of numbers of publications, faculty efforts are turned away from other important forms of scholarship. The review process for publication quality is unreliable, and the focus on numbers of publications encourages multiple authorship and papers of less practical significance. The proposed solution of nontenure tracks for clinicians creates its own difficulties. Broadening the definition of scholarship will encourage better clinical teaching, clinical judgment, and clinical assessment of student performance, and will result in more satisfied teachers, students, and alumni, and ultimately in better health care through improved judgments and decision processes. The perception that scholarship is a meaningless university hurdle for clinicians must be dispelled.

Another look at behavioral sciences in dentistry: perspectives on collaborative clinical research.

This paper explores the collaborative research relationships between clinical dentists and behavioral scientists in dental education. The emergence of behavioral sciences in dentistry is discussed and attention is given to the nature of professional roles in collaborative clinical research. Components for a model for collaborative clinical research are specified based on the research experiences of behavioral scientists with colleagues in prosthodontics and orthodontics.

Analysis of disagreement in the evaluation of clinical products.

This paper reports an analysis of factors that reduce agreement in clinical evaluation. Four instructors representing different restorative departments met regularly over a four-month period to study the evaluation process. Each participant selected a task from his discipline, identified critical errors made in performing the task, produced these errors in models and extracted teeth, and developed criteria and checklists to aid in categorizing and counting the errors. In weekly sessions the models were evaluated, and judgments were compared. Factors that reduced agreement were identified, discussed, and listed. In some sessions ongoing evaluation was reported orally, tape-recorded, and analyzed to elucidate the underlying mental processes. Analysis indicated that agreement was reduced by 16 factors, including unclear rules, the faculty member's memory, unstandardized aids to judgment, inconsistent observational methods, differences in ability, and differing tendencies to leniency.

The use of microfiche in testing clinical judgment.

This paper reports an investigation of the use of microfiche to replace other more bulky clinical materials in testing clinical judgment. Twenty-three students were administered two versions of tests of clinical judgment (micro-fiche and nonmicrofiche) regarding the treatment of partial edentulism. Each student served as both experimental subject and control. Results indicated that under the conditions of testing used, students preferred the nonmicrofiche version of the test. However, there was no significant difference in time of administration or grades resulting from the microfiche medium. Whether the test was given first or fourth in a series of five made a difference in time to take the test (p less than .01), and in the grade received (p less than .01). Tests taken in the first position took more time to complete and resulted in a higher grade. The rate of agreement in grading between the first and second grading session was 70 percent.

Curriculum considerations for correlating basic and clinical sciences.

An analysis of the problem of curriculum design for correlating basic and clinical sciences is presented. The analysis identifies six ways a dentist can profit from the basic sciences: (1) increased sensitivity to the environment, (2) improved judgement, (3) better explanations to patients, (4) enhanced ability to learn, (5) improved communication with health professionals, and (6) greater role diversity. Literature is reviewed related to four mental processes underlying functional knowledge: attending, associating with past learning, relation to future situations, and practicing mental applications. Implications are made for the design of dental curricula and instructional techniques based on factors that influence the recall and use of knowledge.

An analysis of behavioral contingencies in clinical teaching.

Principles of a contingency management were applied in analyzing student reports on clinical instruction. In behavioral science, a contingency is a relationship between a behavior and its effect. The analysis identifies contingencies arranged by clinical instructors that unintentionally interfere with learning. The faculty responded to the findings by planing changes to overcome the problems identified. Prior to the study, many of the problems uncovered were not recognized by the faculty. Students are usually not open about such sensitives areas of feedback. If dental faculty members of other institutions do not feel that similar findings apply to their schools, the authors recommend that they conduct an analogous study.

Teaching clinical judgment in periodontics.

Clinical judgment is a complex process that is difficult to develop. It is the essence of the health professional, yet most dental curricula do not emphasize the learning of the judgmental process. In this paper the judgmental process is analyzed into three components: input, mediation, and output. Following the analysis, suggestions for using these components are presented in four instructional phases: the introductory phase, the initial guidance phase, the application phase, and the feedback phase. While the illustrations used are drawn from periodontics, the principles are generalizable to the teaching of all clinical disciplines.

Essential features of a faculty evaluation program.

A faculty evaluation system should be developed by cooperation between evaluation specialists and dental faculty. The system should depend on a broad spectrum of data collected from a variety of sources in order to reduce personal bias and subjective judgments concerning the performance of all faculty members. Its primary purpose should be to help faculty improve and to this end should be linked to both a faculty development program and a reward system. The criteria for each faculty member's evaluation should be clearly specified in advance and be directly linked to his duties. Department and college goals must be considered as well as the individual faculty member's own interests. Standards or criteria for both rewards and sanctions should be clearly defined, and guidelines for the operation of the system should be given to each participant. The system itself should not cost more than the benefits derived from it justify, and adequate resources should be allocated to make the system effective.