The Effect of an Individualized Practice-Based CME Program on Physician Performance and Patient Outcomes

The Professional Competence Assurance Program (PROCAP) is an individualized educational program that examines physicians'' performance in ambulatory practice. It uses medical record review to identify deficiencies in the care process that guides development of the educational intervention. Medical care is reassessed one year later. This program was used with 51 private practitioners to assess the care of 1,229 hypertensive patients. The educational program included a computer printout comparing one physician''s performance with that of peers, readings targeted to management problems, and a conference call or group seminar with an expert stressing issues relevant to each physician''s performance. Postintervention assessment showed that physicians prescribed beta-blockers (P<.01) and vasodilators (P<.01) more often. Improvement (P<.05) occurred in the control of diastolic blood pressure (≤90 mm of mercury) and in several other criteria. These results show that well-designed, individualized continuing medical education addressing specific deficiencies can change physicians'' performance and patients'' intermediate outcome.     

New In-vitro Test for IgE-mediated Hypersensitivity in Man

A new simple and sensitive in-vitro method for the diagnosis of type 1 (IgE-mediated) hypersensitivity in man is described. Sliced human skin is passively sensitized by reaginic serum from allergic patients and the presence of antigen-specific IgE on the sensitized slices is detected by assay of antigen-evoked histamine release. Serum from 12 out of 14 patients with clinical respiratory allergy and positive skin tests gave significant antigen-specific histamine release. This method, which is essentially an in-vitro model of the Prausnitz-Küstner reaction, should prove of value in the diagnosis of human reaginic hypersensitivity in man.     

Cell junctions acting as intestinal valves in nematodes

Serial sections of the rectal valve in Aphelenchoides blastophthorus Franklin and the oesophago-intestinal valve in Thornenema wickeni Yeates were examined electron microscopically. Each valve when closed appears as a convoluted path of closely apposed (10 nm) pairs of three-layered cell membranes. Both valves serve to stop intestinal leakage, open briefly and rapidly by forcible dilatation and are closed by pressure from surrounding tissues, helped perhaps by intermolecular forces.     

Two cytoplasmic features of prophase in wheat root cells

Summary A study has been made of prophase in cells of wheat root. An advanced stage in the preparation of the mitotic spindle structure prior to nuclear membrane breakdown is described. The pre-prophase band of microtubules is found to be present in cells containing such cytoplasmic features of late prophase. Also at this time a vesicle-filled area is seen within the nucleus. This area is outside the nuclear membrane but isolated from the cytoplasm by conducting channels. It is proposed that this structure represents a mechanism for the transport of material from the nucleus into the cytoplasm.     

Genetic Determinants of Circadian Rhythmicity in Neurospora

Timex, a strain of Neurospora crassa which exhibits a circadian rhythm of conidia formation in growth-tube cultures, has been found to differ from wild-type strains by two genes. One gene, inv, is responsible for an invertase deficiency, whereas the second gene, bd, is of unknown function. Both genes map independently from other genes known to induce Neurospora rhythmicity. The inv gene is not essential for the timex phenotype because bd strains express that phenotype on certain media. Although inv strains do exhibit some rhythmicity of their own, the rhythmicity apparently is not a direct result of the invertase deficiency, since there is no correlation between invertase level and rhymicity in 29 strains tested. Of the 29 strains tested, 20 exhibited some rhythmicity in growth-tube cultures, suggesting that morphological manifestations of rhythmicity in Neurospora may result from the function or the loss of function of numerous genes, or both. There was no correlation in these strains between rhythmicity and (i) genetic background; (ii) geographical origin; or (iii) nutritional requirements.     

The ultrastructure of the marine blue green alga,Trichodesmium erythraeum,with special reference to the cell wall,gas vacuoles,and cylindrical bodies

Summary The marine blue green alga, Trichodesmium erythraeum, was studied with electron microscopy in an attempt to elucidate the structural basis for its rapid lysis when removed from its marine environment. In this connection, it was found that a thining of the electron-dense layer of the longitudinal wall at the site adjacent to transverse wall attachment was responsible for lysis. The underlying biochemical basis for this change has not been elucidated because of the extreme difficulties of maintaining and growing the alga in culture under defined conditions. Several other features of considerable interest also were found. Especially interesting is the very regular array of gas vacuoles in the form of a hollow cylinder which shields most of the photosynthetic system. It was suggested that the gas vacuoles might possibly function optically, having adaptive value in protecting the free-floating alga from excessive radiation. In addition, a detailed structure of the cylindrical bodies was presented, and its structure with the photosynthetic lamellae was compared. On the basis of sectoring to form fragments of double lamellar units from the cylindrical body which are identical in structure to the photosynthetic lamellae, it has been postulated that the cylindrical body may be the site of synthesis for the photosynthetic system in Trichodesmium erythraeum.     

Gene-Enzyme Relationships in Neurospora Invertase

A spontaneous, single-gene mutation responsible for a total lack of invertase activity in Neurospora crassa is described. The mutation is believed to lie in the structural gene for invertase, since an immunologically cross-reacting protein is made by the mutant strain. In addition, there was no evidence for a defect in regulation of invertase activity or synthesis by the following criteria. (i) The invertaseless condition was recessive in heterokaryons; (ii) no invertase inhibitor was found in mutant extracts by mixing experiments; and (iii) none of the several sugars able to induce activity in wild-type strains was able to induce activity in the mutant strain. It was also discovered that most of the wild-type enzyme (55 to 75%) cannot be washed free from the rapidly sedimenting cell debris. This finding provided additional support for the hypothesis that Neurospora invertase is located within or about the cell wall.