Program for licensure for international medical graduates in British Columbia: 7 years' experience

British Columbia has funded a program for licensure for international medical graduates since 1992, providing 2 entry positions per year for postgraduate training. Each year 25-35 candidates are eligible for the program, 13-16 enter the evaluation process, 4 go on to a clinical evaluation and 2 are offered funding by the Ministry of Health. Other candidates may access community funding if they meet the requirements of the program. Twenty of 26 candidates have successfully completed the postgraduate training and achieved full licensure; 6 are still in training. In this article we describe the development of the program, the evaluation and selection process, characteristics of the candidates and the outcomes of the program.     

Maternal mortality in British Columbia in 1971-86.

We reviewed the 56 maternal deaths in British Columbia in 1971-78 and 1979-86 identified through the provincial Ministry of Health and compared the findings with data for the two preceding 8-year periods. The maternal death rate, defined as the number of deaths directly or indirectly related to pregnancy or delivery per 100,000 live births, decreased from 42 in 1955-62 to 5 in 1979-86. In the same interval the number of direct obstetric deaths decreased from 100 to 10 and the number of indirect deaths from 29 to 8. The number of deaths due to abortion decreased from 32 to 1. There was no change in the number of deaths among North American Indians. There was also no change in the number of deaths due to hypertension, most of which were avoidable; these findings have stimulated intensive teaching efforts to increase recognition and improve management of the problem. Review of maternal deaths can help identify deficiencies in the quality of care and can direct measures aimed at further reducing the maternal death rate.     

Developments in the identification of human skeletal material (1968-1978).

A review of publications over the last ten years of methods in the field of physical anthropology for determining age, sex, race and stature of human skeletal material is presented. Comparisons are made with the types of papers published in the previous ten years (1958-1968) in six categories: (1) Visual examination of bones (2) Anthropometric measurements of bones (3) Anthropometric measurements with subsequent use of statistics in the form of discriminate function analyses (4) Time and sequence of eruption of the teeth (5) X-ray examination of the internal structure of bone sections (6) Microscopic examination of the internal structure of bone.     

Incidence of phenylketonuria in British Columbia, 1950-1971

The incidence of PKU in British Columbia in the 1950-1971 period is 1/18,750 which corresponds to that found in two other Canadian studies.^{2, 3} Evidence is presented which shows a trend toward a decline in incidence; however, this is not statistically significant. There is a preponderance of male cases in all age groups.     

Incidence of neural tube defects in liveborn and stillborn infants in British Columbia over a 10-year period.

Reports of an apparent decline in the incidence of neural tube defects (NTDs) have come from various parts of the world. If these findings are consistent they would have an important impact on prenatal diagnosis and on screening programs. The incidence of NTDs over a 10-year period was examined in British Columbia, a province that has a population-based health surveillance registry through which there is virtually complete ascertainment of liveborn infants with NTDs. The results showed a significant decrease in incidence only for stillborn infants with anencephaly. The increased use of ultrasonography and the subsequent termination of pregnancies in which the fetus has been found to have anencephaly may explain this observation.     

Refinements in pollicization: a 30-year experience

The thumb is a specialized organ with unique functions that cannot be replicated by any other digit. The most powerful technique for construction or reconstruction of a lost or missing thumb is index finger pollicization. In this article, the authors outline five technical refinements in this procedure that have evolved over the past 30 years in 313 cases. These refinements improve appearance and function, and include (1) modification of the incisions to produce a well-contoured web space, (2) metacarpal head positioning for optimal recreation of the carpal arch, (3) extrinsic tendon repositioning for improved pronation of the new thumb, (4) intrinsic tendon repositioning for maximal strength, and (5) thenar augmentation with an adipofascial flap in select cases for improved appearance.     

Day-care versus inpatient pediatric surgery: a comparison of costs incurred by parents.

The cost-effectiveness for parents of day-care pediatric surgery was assessed by comparing time and financial costs associated with two surgical procedures, one (squint repair) performed exclusively as a day-care procedure, the other (adenoidectomy) performed exclusively as an inpatient procedure. All but 1 of 165 eligible families participated. The children underwent surgery between February and July 1981. The day-care surgery group (59 families) incurred average total time costs of 16.1 hours, compared with 37.1 hours for the inpatient surgery group (105 families), as parents in the latter group remained with their child during the longer hospital stay. Parents from out of town incurred the greater time and financial costs. In both groups parents of younger children tended to spend more time at the hospital than parents of older children. Type of surgical management was not a significant factor in out-of-pocket expenses. Loss of income was associated with employment of the mother as a professional or a manager and may reflect inequalities in access to compassionate leave between men and women in equivalent positions. Opening day-care surgery facilities on weekends might reduce the financial burden on working mothers. Overall, day-care surgery was found to be cost-effective for families.     

Mobilizing physicians to conduct clinical intervention in tobacco use through a medical-association program: 5 years' experience in British Columbia.

During the last 5 years, a program run by the medical association in British Columbia has recruited 23% of the province''s general practitioners (GPs) to take an active, systematic approach to clinical intervention in tobacco use. Another 9% of GPs (considered "semi-active") regularly use the program''s educational materials for patients, and another 25% have been trained in intervention or have been given intervention materials or both. If the cessation rate (rate of patients who quit smoking who would not otherwise have done so) was 4% among physicians actively involved in intervention and 2% among physicians considered semi-active, in 1995 an estimated 4700 smokers quit and were followed by their GPs as a result of the program. Another 135,000 smokers received brief counselling from their GPs and were also followed. This article reviews the strategies and methods used in this program to mobilize physicians.     

Non-Caucasian rhinoplasty: a 16-year experience

Rhinoplasty was performed in 134 non-Caucasians over a 16-year period. The indications and techniques for operative approaches pertinent to achieving facial balance and symmetry in the non-Caucasian are described. Alar flaring is best addressed with alar base resection. Alar base resection does not significantly narrow alar width. Reduction in interalar distance is best performed with interalar reduction. If alar flare and wide interalar distance coexist, one should always consider a secondary or tertiary procedure. Planning a secondary procedure avoids devitalizing tissues and multiple super-imposed incisions and permits minor revisions. A simplified approach to removal of excessive tip fat is discussed. Methods of addressing complications peculiar to non-Caucasian rhinoplasties are described. In order to avoid racial incongruity, one must incorporate an alar narrowing procedure, i.e., interalar reduction or alar sill advancement. The results of this study reemphasize the importance of analyzing the nose with respect to the rest of the face in order to establish guidelines for these often difficult nasal reconstructions.     

A Decade of Experience: Cryptococcus gattii in British Columbia

It has been over a decade since Cryptococcus gattii was first recognized as the causative organism of an outbreak of cryptococcosis on Vancouver Island, British Columbia. A number of novel observations have been associated with the study of this emergent pathogen. A novel genotype of C. gattii, VGIIa was described as the major genotype associated with clinical disease. Minor genotypes, VGIIb and VGI, are also responsible for disease in British Columbians, in both human and animal populations. The clinical major genotype VGIIa and minor genotype VGIIb are identical to C. gattii isolated from the environment of Vancouver Island. There is more heterogeneity in VGI, and a clear association with the environment is not apparent. Between 1999 and 2010, there have been 281 cases of C. gattii cryptococcosis. Risk factors for infection are reported to be age greater than 50 years, history of smoking, corticosteroid use, HIV infection, and history of cancer or chronic lung disease. The major C. gattii genotype VGIIa is as virulent in mice as the model Cryptococcus, H99 C. neoformans, although the outbreak strain produces a less protective inflammatory response in C57BL/6 mice. The minor genotype VGIIb is significantly less virulent in mouse models. Cryptococcus gattii is found associated with native trees and soil on Vancouver Island. Transiently positive isolations have been made from air and water. An ecological niche for this organism is associated within a limited biogeoclimatic zone characterized by daily average winter temperatures above freezing.     

Developmental biology in Ecuador: a 30-year teaching experience

Developmental biology has been taught at the Pontificia Universidad Católica del Ecuador, in Quito for 30 years by the author. The experience of teaching development is described within the broader context of science in Latin America. It is recognized that developmental biology is poorly represented in research and teaching in this part of the world. The teaching of developmental biology to Ecuadorian students contributes to their intellectual training, by helping them to integrate concepts derived from various branches of biology. Moreover, the highly conserved molecular mechanisms of development provide extraordinary examples of the unity of biology, and many complex biological processes can be more easily grasped when studying embryos.     

Microbial community dynamics in a seasonally anoxic fjord: Saanich Inlet, British Columbia

Dissolved oxygen concentration plays a major role in shaping biotic interactions and nutrient flows within marine ecosystems. Throughout the global ocean, regions of low dissolved oxygen concentration (hypoxia) are a common and expanding feature of the water column, with major feedback on productivity and greenhouse gas cycling. To better understand microbial diversity underlying biogeochemical transformations within oxygen-deficient oceanic waters, we monitored and quantified bacterial and archaeal community dynamics in relation to dissolved gases and nutrients during a seasonal stratification and deep water renewal cycle in Saanich Inlet, British Columbia, a seasonally anoxic fjord. A number of microbial groups partitioned within oxygen-deficient waters including Nitrospina and SAR324 affiliated with the δ- proteobacteria , SAR406 and γ- proteobacteria related to thiotrophic gill symbionts of deep-sea clams and mussels. Microbial diversity was highest within the hypoxic transition zone decreasing dramatically within anoxic basin waters and temporal patterns of niche partitioning were observed along defined gradients of oxygen and phosphate. These results provide a robust comparative phylogenetic framework for inferring systems metabolism of nitrogen, carbon and sulfur cycling within oxygen-deficient oceanic waters and establish Saanich Inlet as a tractable model for studying the response of microbial communities to changing levels of water column hypoxia.     

Cardiac allografts: a 24-year South African experience

The history of using homologous cardiac valves dates back more than 30 years. Through the years emphasis was placed on the optimization of graft retrieval, preservation techniques and clinical application. A cardiac homograft valve bank was established at the Department of Cardiothoracic Surgery, University of the Free State, Bloemfontein in 1982. A retrospective analysis was performed on all allograft data since 1984. Since the first valve was successfully procured and transplanted in 1984, 2,540 aortic and pulmonary homografts were harvested from 1,792 donors, of which 1,545 [989 (64%) aortic and 556 (36%) pulmonary] were released for clinical use. Valves were discarded for various reasons, the main reasons being Human Immunodeficiency Virus (32.4%), Hepatitis B (9.6%) and venereal diseases (8.9%). The mean donor age was 26.98 years with a male predominance of 1,368 males versus 424 females. The average ischemic time was 33 h mainly due to medico-legal autopsies exceeding the desired 24 h time limit. The valves were disinfected in an antibiotic cocktail of Mefoxin, Piperacillin, Amikacin and Amphotericin B prior to cryopreservation. The surgical procedures utilizing the majority of homografts were aortic valve replacements (42.9%), aortic root replacements (19.3%) and right ventricular-pulmonary artery conduits (33.3%). The bank also supplied 23 other centers with homografts (402 aortic and 301 pulmonary). The Bloemfontein bank has established itself over the years as a viable and functional cardiac homograft bank. However, with increasing activity in the procurement arena and widened applications in the operating room the role of the homograft seems assured but availability still remains a major concern.     

Tay-Sachs disease carrier screening: a 21-year experience

This paper presents the findings of a community-based carrier screening program for Tay-Sachs disease, initiated on the University of Wisconsin-Madison campus in 1978. The Madison Community Tay-Sachs Screening Program (MCTSSP) is a collaborative, interdisciplinary program that organizes and conducts periodic screening for Tay-Sachs disease (TSD) for the purpose of identifying Tay-Sachs carriers. We present and analyze data on carrier detection with regard to various demographics, including family history of TSD, ancestry, gender, medication exposure, and illness. Individuals participating in the MCTSSP between 1978 and 1999 were primarily of the target population, and the carrier rate was within the expected range (1/25). Despite aggressive publicity efforts and a well-established program, attendance at the screens has declined. A recent survey of Jewish undergraduate students at the University of Wisconsin-Madison showed poor recall of family screen history and carrier status and reinforced the perception that utilization of the Madison screening program has been low. Ways to increase awareness of and interest in carrier screening for TSD are explored.