ABSTRACT
OBJECTIVES: This study tested whether clinical experiences in family practice are associated with matching into family practice. METHODS: We conducted a prospective cohort study of 913 medical students who completed the Family Practice Preceptorship (FPP) at the University of Iowa from 1990-1996. Using univariate techniques and logistic regression, we compared the background and experiences of those who matched into family practice with those who chose other specialties. RESULTS: Twenty-nine percent (n=267) matched into family practice. Positive independent predictors of family practice match were hometown size less than 10,000 (odds ratio [OR] 1.8), anticipating choosing family practice at matriculation (OR 4.2), and liking to help others (OR 4.1). Negative independent predictors included parental income of at least $120,000 (OR .61), desiring to perform technical procedures (OR .51), and liking the scientific method and research (OR .54). The effect of an early summer clinical experience at a community hospital varied depending on the level of student interest in family practice at matriculation. Students who rated the educational value of the FPP as high or very high were significantly more likely to go into family practice (OR 2.9), even after adjusting for all other student characteristics. CONCLUSIONS: A number of student characteristics and preferences, early clinical experiences, and the perceived quality of a required family medicine preceptorship were significantly and independently associated with students matching into family practice.
Subject(s)
Clinical Competence , Education, Medical, Undergraduate , Family Practice/education , Preceptorship/organization & administration , Adult , Analysis of Variance , Cohort Studies , Female , Humans , Internship and Residency , Iowa , Logistic Models , Male , Odds Ratio , Preceptorship/standards , Probability , Program Evaluation , Prospective Studies , Students, MedicalABSTRACT
The time-course for the hydrolysis of the D linkage of chicken egg yolk sphingomyelin in a Triton X-100 mixed micelle and of lysophosphotidylcholine micelles, as catalyzed by brown recluse spider venom and brown recluse spider toxin, was followed by phosphorous-31 nuclear magnetic resonance spectroscopy. The overall rate of hydrolysis of sphingomyelin in mixed micelles was found to be an order of magnitude faster than the hydrolysis of lysophosphotidylcholine. Incorporation of lysophosphotidylcholine into mixed micelles with Triton X-100 inhibited the lipase activity of brown recluse spider venom and brown recluse spider venom toxin. The effects of increased rates of overall reaction were observed with increased temperature and also with decreased ionic strength. The presence of divalent calcium ions was found to be necessary for hydrolytic activity, but only in catalytic amounts (less than 1 mM).
Subject(s)
Phosphoric Diester Hydrolases/analysis , Phosphoric Diester Hydrolases/chemistry , Sphingomyelins/chemistry , Spider Venoms/chemistry , Animals , Hydrolysis , Lysophosphatidylcholines/chemistry , Magnetic Resonance Spectroscopy , Micelles , Osmolar Concentration , Phosphoric Diester Hydrolases/isolation & purification , Phosphoric Diester Hydrolases/pharmacology , Spider Venoms/isolation & purification , Spider Venoms/pharmacology , TemperatureABSTRACT
Hyperbaric oxygen (HBO) has been reported by some to be therapeutic for necrotic lesions induced by the venom of the brown recluse spider, Loxosceles reclusa. Others have reported no efficacy for this treatment. In this study, the effect of high pressure oxygen on an enzymatic activity of the toxin of this venom is reported. The time course for the hydrolysis of the phosphocholine ester bond of chicken egg yolk sphingomyelin, as catalyzed by brown recluse spider venom (BRSV) and venom treated with extended HBO (12 hr at 10 atmospheres), was followed by phosphorus-31 nuclear magnetic resonance spectroscopy. The venom and HBO-pretreated venom demonstrated sphingomyelinase D activity. Phospholipase C activity was not detected. The sphingomyelinase D activity of BRSV in three separate experiments was not altered by HBO. The HBO-pretreated venom, in all cases, did not exhibit an altered time course in the overall hydrolysis of the D linkage of sphingomyelin.
