The ethically trained physician: myth or reality?

Through a questionnaire distributed to 300 physicians in the Toronto area, three aspects of their ethical awareness were examined: the formal codes, the need for consultation in making decisions and the need for training in medical ethics. Most of the physicians (81%) felt that they were facing ethical problems in their daily practice. A majority of these would try to solve the problems either themselves (30%) or through discussion with a colleague (43%). When they turned outside the profession it was sometimes to a lawyer (12%), which suggests concern with the legalities of some situations. Only a small proportion of the respondents were found to be familiar with two of the established codes of ethics, yet 13% would still turn to the code of the Canadian Medical Association for guidance. Finally, there was widespread recognition of the need for proper training in medical ethics and for the establishment of a specialty in this field.     

Our time will come: Is anuran community structure related to crop age?

An ongoing controversy involves the debate about the effects of man‐made land transformation on freshwater biodiversity. It has been suggested that agricultural areas provide habitats for many species of amphibians, but crop age may affect richness and community structure. In such modified landscapes, a nested structure has been commonly detected, although community structure may be season specific and guild specific. Here, we determined detectability associated with site‐specific and survey‐specific variables and examined nestedness patterns in anuran communities in natural areas and rice fields with different crop ages (10 and 20 years) in southern Brazil. We studied whether nestedness was associated with time since cultivation and whether these patterns were similar across guilds in these areas. Anuran detectability was related only with time after sunset. Community composition varied between crop ages. Aquatic and arboreal species were associated with native areas and showed a nested pattern. Fossorial species did not show significant nestedness. Our results showed that factors associated with crop age may affect guilds in different ways. These effects seem to be related to individual traits of species (habitat preferences, reproductive modes, plasticity). Incorporating species traits may enhance conservation strategies in agroecosystems.     

The protein folding problem: when will it be solved?

The protein folding problem can be viewed as three different problems: defining the thermodynamic folding code; devising a good computational structure prediction algorithm; and answering Levinthal's question regarding the kinetic mechanism of how proteins can fold so quickly. Once regarded as a grand challenge, protein folding has seen much progress in recent years. Folding codes are now being used to successfully design proteins and non-biological foldable polymers; aided by the Critical Assessment of Techniques for Structure Prediction (CASP) competition, protein structure prediction has now become quite good. Even the once-challenging Levinthal puzzle now seems to have an answer--a protein can avoid searching irrelevant conformations and fold quickly by making local independent decisions first, followed by non-local global decisions later.     

The PacELF programme: will mass drug administration be enough?

The Pacific Programme to Eliminate Lymphatic Filariasis is a regional, mass drug administration-based campaign in 22 countries and territories with the aim of eliminating filariasis transmission and alleviating the suffering caused by Wuchereria bancrofti. The challenges to filariasis elimination campaigns based on mass drug-administration alone are reviewed in this article. These challenges together with the previous successes of mosquito control campaigns in eliminating filariasis from regions in the Pacific argue for inclusion of entomology components in the control of filariasis and the monitoring of filariasis elimination programs.     

Can geriatrics survive?

Geriatrics has consistently failed to attract enough staff, and hence geriatric units often cannot provide a full service for the elderly. Meanwhile beds in general medical units may be blocked by elderly patients. This division between geriatric and medical units is arbitrary and wasteful. There are no clinical processes or techniques unique to geriatrics, which is probably why the specialty is unattractive; few doctors want to confine their attention only to the elderly. Geriatrics as a separate specialty should therefore be largely abandoned and the care of the elderly reintegrated into general medicine.     

The medical therapy of prostatic symptoms study: what will we learn?

Until recently, benign prostatic hyperplasia (BPH) was thought of as a relatively uncomplicated disease process resulting from age-related enlargement of the prostate gland, which was thought to cause all of the symptoms associated with the disease. Prostatectomy was considered the state-of-the art treatment of BPH. Advances in our understanding of the pathogenesis of BPH and the relationship among clinical signs and symptoms has allowed for the development of pharmacologic therapies for this disorder, namely, selective alpha-blockers and 5-alpha-reductase inhibitors. These 2 classes of drugs have been demonstrated to be safe and effective for the treatment of BPH. Evidence supports different mechanisms of action, suggesting that, when used in combination, these therapies may act synergistically. The Medical Therapy of Prostatic Symptoms study was designed, in part, to test this hypothesis. Initial results of the trial are presented in this article.     

The role of habitat in avian community composition: physiognomy or floristics?

Summary It has been proposed that within rather broad habitat types the distribution and abundance of bird species may be more closely associated with plant taxonomic composition than with the structure and configuration of the vegetation. Birds from a sample of eight representative grassland habitats in middle and western North America are consistent with this hypothesis. Over half (55%) of the variation in bird community composition was associated with floristic variation, but only a third (35%) was associated with physiognomy. Separating the interacting effects of floristics and physiognomy from each other served to accentuate the difference between them with respect to the avifauna. It is postulated that bird species/plant taxa associations, especially within similar habitat types, are mediated by the specific food resources that different plant taxa provide. Summary indices such as diversity measures obscure the taxonomic information content of plant or animal assemblages, and the use of such indices has likely impeded detection of the relationships described here.     

Pharmacogenomics: will the promise be fulfilled?

Tools such as genome resequencing and genome-wide association studies have recently been used to uncover a number of variants that affect drug toxicity and efficacy, as well as potential drug targets. But how much closer are we to incorporating pharmacogenomics into routine clinical practice? Five experts discuss how far we have come, and highlight the technological, informatics, educational and practical obstacles that stand in the way of realizing genome-driven medicine.     

Achalasia: will genetic studies provide insights?

Despite increasing understanding of the pathophysiology of achalasia, the etiology of this esophageal motility disorder remains largely unknown. However, the occurrence of familial achalasia and its association with well-defined genetic syndromes suggest the involvement of genetic factors. Mutant mouse models display gastrointestinal disturbances that are similar to those observed in achalasia patients. The candidate gene approach has revealed some promising results; however, it has not established conclusive links to specific genes so far. The aim of this review was to summarize current knowledge of the genetics of achalasia. We also discuss the extent to which our understanding of achalasia is likely to be enhanced through future molecular genetic research.     

Oxides of nitrogen and ozone: can our plants survive?

The authoritative talk by Professor Fowler (Fowler et al ., 1998), emphasized the huge increase in the rate of NO_x (NO and NO₂) emissions into the atmosphere due to fossil fuel combustion, from 1 Tg N y⁻¹ to over 20 Tg N y⁻¹ during the 100 yr between 1880 and 1980. He went on to predict that this rate of emission from anthropogenic sources would increase to 46 Tg N y⁻¹ by the year 2025. In addition, NO can also be released from the soil following microbial action, a process that is very dependent upon soil temperature, nitrogen availability and water content. Later in the meeting, Professor Raven (Raven & Yin, 1998) pointed out that terrestrial plants, though not necessarily each individual species, have over the past 450 million yr coped with large changes in nitrogenous compounds in the environment. Nevertheless, this is no basis for complacency about the current situation because the rates of change caused by man's activities are probably unprecedented. Furthermore, the fact that terrestrial plant life in some form can continue, despite massive changes in environmental chemistry, does not necessarily indicate that the systems on which we ourselves are dependent will be conserved.