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Objective: This study aims to analyze the prevalence of Candidaspp. colonization in oral leukoplakia and oral lichen planus lesions, verify the influence of systemic and local factors, besides identify and determine the in vitroantifungal susceptibility profile of Candidaspecies. Materials and Methods: Samples were collected by swabbing from oral lesions and healthy mucosa and cultured on Sabouraud Dextrose and CHROMagar® Candidaplates. Species identification was confirmed with MALDI-TOF MS analysis. Results: Candidaspp. was found in 36.8% of cases of oral leukoplakia and 18.2% of cases of oral lichen planus. Candida albicanswas the only species found in oral lichen planus lesions (n= 2, 100%) and the most prevalent in oral leukoplakia (n= 5, 76.4%). Among the non-albicans Candidaspecies found in oral leukoplakia were C. parapsilosis(n= 2, 25.5%) and C. tropicalis(n= 1, 14.1%). Candidaisolates were susceptible to all antifungals tested. Conclusion: C. albicanswas the most commonly found species in the studied lesions. No correlation was found between systemic and local factors with positive cases of oral lichen planus. However, smoking and alcohol consumption may be associated with positive cases of oral leukoplakia, especially the non-homogeneous clinical form. In addition, there is a possible predisposition to associated Candidacolonization in cases of epithelial dysplasia found in oral leukoplakia. The antifungal medications tested showed excellent efficacy against isolates.

Reducing soybean yield is key for decision-making, especially for rainfed crops. Models are tools that can help agriculture obtain this information quickly and practically. Therefore, the objective of this study was to simulate soybean yield as a function of the water sensitivity factor in rainfed cultivation via the CROPWAT model complemented with the Agroecological Zones Model. The experiment was carried out at the Lagoa Dourada farm in the central-southern region of the state of Mato Grosso, Brazil. Agrometeorological data were obtained from the INMET and ANA stations. For the purpose of simulating the maximum yield, the FAO Agroecological Zones Model was used in conjunction with the CROPWAT model to simulate the relative yield drop on the basis of the water sensitivity factor. The agroecological zone model overestimates the maximum yield of soybean in rainfed cultivation. CROPWAT allows the decrease in soybean yield in rainfed cultivation to be simulated on the basis of the water sensitivity factor (Ky).The water requirements of soybean simulated by CROPWAT were higher than the water consumption requirements for practically all harvests, except for the 2015/2016 harvest. The phases of greatest soil water depletion that influence the water sensitivity of soybeans under rainfed conditions during the eight harvests are F2and F3. The reduction of 1.0 units of water in the soil Ky=1 decreases the yield of soybean simulated in CROPWAT by 1.0 units. The models can be used in a complementary way to simulate the maximum yield and the decrease in yield in a satisfactory way.

Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point‐of‐care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.

Tumor targeting by genetically modified mesenchymal stromal/stem cells (MSCs) carrying anti-cancer molecules represents a promising cell-based strategy. We previously showed that the pro-apoptotic agent tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) can be successfully delivered by MSCs to cancer sites. While the interaction between TRAIL and its receptors is clear, more obscure is the way in which MSCs can selectively target tumors and their antigens. Several neuroectoderm-derived neoplasms, including glioblastoma (GBM), sarcomas, and neuroblastoma, express high levels of the tumor-associated antigen GD2. We have already challenged this cell surface disialoganglioside by a chimeric antigen receptor (CAR)-T cell approach against neuroblastoma. With the intent to maximize the therapeutic profile of MSCs delivering TRAIL, we here originally developed a bi-functional strategy where TRAIL is delivered by MSCs that are also gene modified with the truncated form of the anti-GD2 CAR (GD2 tCAR) to mediate an immunoselective recognition of GD2-positive tumors. These bi-functional MSCs expressed high levels of TRAIL and GD2 tCAR associated with a robust anti-tumor activity against GD2-positive GBM cells. Most importantly, the anti-cancer action was reinforced by the enhanced targeting potential of such bi-functional cells. Collectively, our results suggest that a truncated anti-GD2 CAR might be a powerful new tool to redirect MSCs carrying TRAIL against GD2-expressing tumors. This affinity-based dual targeting holds the promise to combine site-specific and prolonged retention of MSCs in GD2-expressing tumors, thereby providing a more effective delivery of TRAIL for still incurable cancers.

ABSTRACTAdventure and extreme sports (AESs) are associated with high risk of injury and even death. This has important ramifications for sport, education, medical and health professions and has led to discussions about the appropriateness of AESs for young people. For some, participation in AESs reflects social deviance. Research from this perspective has focused on testing this notion. However, in recent years research has questioned the perceived link to risk arguing that many acceptable activities might be ‘riskier’. Research from this perspective focuses on the positive side of AESs. Evidence points to a growing interest in AESs by young people and that AES activities might be useful to enhance the uptake of and adherence to physical activity, and support mental wellbeing in young people. This perspective suggests (1) AESs are important for the overall development of young people, (2) policy makers across sectors should recognize AESs when considering future interventions.

•The interest in neuroendoscopy is growing also because it guarantees surgical and aesthetic results,•Several tools are available to restore the bone and dural defect, but something has a negative effect;•BioGlue led to chronic inflammation also with non-infection granuloma thus representing a negative factor for wound closure.

Cells rely on focal adhesions (FAs) to carry out a variety of important tasks, including motion, environmental sensing, and adhesion to the extracellular matrix. Although attaining a fundamental characterization of FAs is a compelling goal, their extensive complexity and small size, which can be below the diffraction limit, have hindered a full understanding. In this study we have used single-molecule localization microscopy (SMLM) to investigate integrin β3 and paxillin in rat embryonic fibroblasts growing on two different extracellular matrix-representing substrates (i.e., fibronectin-coated substrates and specifically biofunctionalized nanopatterned substrates). To quantify the substructure of FAs, we developed a clustering method based on expectation maximization of a Gaussian mixture that accounts for localization uncertainty and background. Analysis of our SMLM data indicates that the structures within FAs, characterized as a Gaussian mixture, typically have areas between 0.01 and 1 μm2, contain 10–100 localizations, and can exhibit substantial eccentricity. Our approach based on SMLM opens new avenues for studying structural and functional biology of molecular assemblies that display substantial varieties in size, shape, and density.

Previous research has considered action and adventure sports using a variety of associated terms and definitions which has led to confusing discourse and contradictory research findings. Traditional narratives have typically considered participation exclusively as the pastime of young people with abnormal characteristics or personalities having unhealthy and pathological tendencies to take risks because of the need for thrill, excitement or an adrenaline ‘rush’. Conversely, recent research has linked even the most extreme forms of action and adventure sports to positive physical and psychological health and well-being outcomes. Here, we argue that traditional frameworks have led to definitions, which, as currently used by researchers, ignore key elements constituting the essential merit of these sports. In this paper, we suggest that this lack of conceptual clarity in understanding cognitions, perception and action in action and adventure sports requires a comprehensive explanatory framework, ecological dynamics which considers person-environment interactions from a multidisciplinary perspective. Action and adventure sports can be fundamentally conceptualized as activities which flourish through creative exploration of novel movement experiences, continuously expanding and evolving beyond predetermined environmental, physical, psychological or sociocultural boundaries. The outcome is the emergence of a rich variety of participation styles and philosophical differences within and across activities. The purpose of this paper is twofold: (a) to point out some limitations of existing research on action and adventure sports; (b) based on key ideas from emerging research and an ecological dynamics approach, to propose a holistic multidisciplinary model for defining and understanding action and adventure sports that may better guide future research and practical implications.

Services making use of information and communication technology (ICT) are of potential interest to face the challenges of our aging society. Aim of this article is to describe the possible field of application for ICT-supported services in the management of older adults, in particular those with functional impairment. The current status of ICT-supported services is described and examples of how these services can be implemented in everyday practice are given. Upcoming technical solutions and future directions are also addressed. An ICT-supported service is not only the technological tool, but its combination with clinical purposes for which it is used and the way it is implemented in everyday care. Patient’s satisfaction with ICT-supported services is moderate to good. Actual use of patients is higher than those of professionals but very variable. Frequency of use is positively related to clinical outcome. ICT offers a variety of opportunities for the treatment and prevention of frailty and functional decline. Future challenges are related to the intelligence of the systems and making the technologies even more unobtrusive and intuitive.

The aim of this study is to assess whether a complete analysis of all early cortical somatosensory-evoked potentials (SEPs) components and computed tomography (CT) scan features can provide a better prognostic measure than the early cortical component N20P25 alone, in patients with severe head injury.

The evolution of neurosurgery coincides with the evolution of visualization and navigation. Augmented reality technologies, with their ability to bring digital information into the real environment, have the potential to provide a new, revolutionary perspective to the neurosurgeon.

La malattia di von Hippel-Lindau è una sindrome neoplastica multisistemica a trasmissione autosomica dominante, penetranza completa ed espressività variabile causata da un difetto del gene VHL. La mancanza o l’insufficienza del prodotto proteico del gene VHL, attraverso la mancata distruzione di HIF e la conseguente iperespressione di geni coinvolti nell’angiogenesi, conduce allo sviluppo di svariati tumori, benigni o maligni, e cisti in molti sistemi ed apparati. Gli individui affetti ereditano la predisposizione allo sviluppo di lesioni al SNC quali emangioblastomi cerebellari, spin ali, del tronco cerebrale, delle radici nervose e sopratentoriali, ed inoltre emangioblastomi retinici e tumori del sacco endolinfatico. Le lesioni viscerali includono carcinomi renali a cellule chiare, feocromocitomi, cisti renali e pancreatiche, tumori endocrini del pancreas, cistoadenomi papillari dell’epididimo e del legamento largo, emangiomi del fegato e del polmone. Quindi nella malattia di von Hippel- Lindau vi sono almeno due neoplasie di ghiandole endocrine, la midollare del surrene e l’insula pancreatica. Inoltre, anche paragangliomi della testa e del collo sono stati descritti in pazienti con malattia di VHL. Le varie lesioni tipich e del von Hippel- Lindau mostrano una costante progressione nel tempo per cui, in questi pazienti, risulta fondamentale un follow-up clinico volto alla prevenzione delle complicanze. L’unica terapia attualmente disponibile è quella chirurgica ma sono in corso di valutazione trattamenti farmacologici con inibitori delle kinasi.

The growth responses of free and immobolized cultures of the marine alga Tetraselmis suecica (Chlorophyta, Prasinophyceae) were compared. Algal cells were immobilized in 2% calcium alginate solution; both entrapped and free cultures were maintained in synthetic sea water at 19‰ salinity and 14°C constant temperature. Algal growth was evaluated by cell abundance, growth constant (K) and generation time (gt), calculated from data obtained during the exponential phase. The biomass of T. suecica, in terms of chlorophyll a content, was also determined. Cell abundance of both immobilized and free cultures was quite similar. Analysis of the T. suecica life cycle showed the higher viability of the alga after immobilization in calcium aginate gel. In addition, the mean chlorophyll a content of the immobilized cells was higher in comparison to free cells. The growth rate of the entrapped cells, on the other hand, was lower. © Rapid Science Ltd. 1998

Abstract: In Antarctic sea waters the composition and structure of living communities and the morphology of species are strongly affected by low temperatures; furthermore, the environmental conditions and the adaptive strategies promoted evolution efforts and development of endemisms. Scanning electron microscopy can greatly contribute to the knowledge of structures, differentiating high-latitude organisms from similar species inhabiting other marine environments. This work reports some ultrastructural details of the mandibles of Metridia gerlachei (Copepoda, Calanoida) adult females sampled during the Italian Antarctic Campaign 1987/1988 in order to verify the known descriptions and to emphasize some characters related to feeding habits. The observation of mandibles by light and scanning electron microscopy allowed us to verify that the morphological characters are connected to behaviour, food uptake and diet composition, and confirmed the omnivory of the species. The ultrastructural observations reported here have improved our knowledge about the role of M. gerlachei in the Antarctic food web.

The new Faculty of Medicine at the University of Newcastle, NSW, has introduced an innovative undergraduate education programme. It has been just as determined to set up a comprehensive and systematic programme for evaluation of the effectiveness, efficiency and acceptability of its educational endeavours. This paper outlines these developments and the constraints during the first year of its operation — not only as a record of events, but also a possible guide for similar developments elsewhere.

Assessment of student progress and achievement may support or weaken the educational goals of an institution. This paper describes the assessment methods developed so far to support the undergraduate education programme in the Faculty of Medicine at Newcastle, New South Wales. Formative assessment designed for frequent, informal diagnostic feedback to the student is an integral part of the various learning experiences. It requires further development to be a useful guide to the required depth of study. It aims to assist students to integrate and apply their studies. Summative assessment is required for certification and as a formal indicator of cumulative learning. A great deal of effort has been devoted to relate it to higher level intellectual competence, to keep it open to student criticism, to take account of individual rates of learning and to use it diagnostically.

In recent years the systematic development of the skill of clinical reasoning has come to assume a high priority as an explicit aim of medical education. Clinical reasoning, it is con tended, is the application of general reasoning and problem-solving skills to the specific knowledge base of medicine. The results presented in this paper constitute a preliminary study designed to investigate the ability of first-year medical undergraduates to solve ab stract problems using a simple nonmedical knowledge base. Further studies are being car ried out and will continue to extend this into the specific medical knowledge base area. The potential implications for medical education and the development of clinical reasoning are discussed. (Med Decis Making 5:311-324, 1986)

A survey devised by Marshall (1978) to measure students' perceptions of their medical school was completed by undergraduates at two schools with radically different approaches to medical education. The survey proved to be reliable in terms of its internal consistency, and exhibited strong validity for a construct of school learning environment. Differences found between the two schools were not specific to medical education, which raised the prospect of the survey's extension to similar evaluations in any other educational institution.

ABSTRACT Between 1984 and 1986,888 final‐year medical students from The Universities of Sydney, Western Australia and Newcastle took part in trial examinations that comprised multiple‐choice questions, modified essay questions and a patient management problem. Differences in student performance among the schools were small'. In 1984 and 1985, Newcastle students performed less well than did Sydney students on multiple‐choice questions that were prepared by The University of Sydney, but there was no difference between the schools in 1986. Sydney students performed better than did Newcastle students on the multiple‐choice question paper that was prepared by The University of New South Wales in 1984, but in the last two years no differences have been detected between the schools in performance on this paper. The performance on modified essay questions in 1984 suggested that Newcastle students were stronger in behavioural sciences and weaker in pathological sciences than were Sydney students. Sydney students performed less well than did Newcastle students in the patient management problem in 1985, particularly in the area of the use of clinical investigations. On the one occasion of testing that involved students from The University of Western Australia (in 1985), these students performed best of the three schools in the patient management problem, and roughly equally with students from Sydney and Newcastle in the multiple‐choice question papers. Differences among the schools usually amounted to less than 10% and might have been accounted for by differences in familiarity with test instruments. We conclude that medical students are likely to graduate from The Universities of Sydney, Western Australia and Newcastle with similar levels of knowledge of internal medicine. Possible differences in problem‐solving ability require further study, particularly in the clinical setting.

A pilot study recently reported in this journal by Wakeford raised several important issues concerning the measurement and interpretation of students' perpeption of the learning environment in five British medical schools. Some of those issues are developed in this paper as a result of similar, more comprehensive, research involving students in five Australian medical schools. One issue is the almost inevitable problem of methodology associated with large scale surveys of this kind. Another is the prospect for educational reform within an educational institution based heavily on students' perceptions alone.

Special care has been taken to promote the educational merit of assessment for students in the new undergraduate medical curriculum at Newcastle University. The main challenge to academic staff has been to develop methods of assessment which are reliable and valid indices of competence within the constraints of the educational programme objectives. Among other things, considerable attention has been given to the assessment of sciences basic to medicine through assessment instruments developed from clinical problems - by no means an easy task.

This research looked at students' satisfaction with, and changes in approach to, learning during their first year in problem-based curricula for agriculture, architecture, medicine and paramedicine. While students at each school showed little change in approach apart from achievement orientation in the six-month period after entry to the course, there were different patterns of approach at each school. Satisfaction with their respective schools was uniformly high - notably in terms of their emotional climate, supportiveness, student and teacher interaction, and meaningful learning experiences. Correlations between students' approach to learning and degree of satisfaction with their course strongly support earlier claims and research findings on the merits of problem-based curricula, although they still need more careful definition to be useful to curriculum planners.

Greater dependence on students' ratings of their teachers for academic purposes requires a better understanding of the curricular factors likely to influence these ratings. This study examined first-year medical students' evaluation of their tutors in a faculty which has a clearly-defined educational philosophy and learning method but different approaches to the implementation of its curricular strands. Students' ratings were higher for tutors who were required to follow specific procedures and tasks in tutorial sessions, and more variable for tutors in strands which required no set routines. Caring for students and facilitating their learning were the most important qualities expected of all tutors. It is still not clear which of these qualities are trainable skills. However, their accurate assessment may require regular, intermittent criterion-based observations rather than a single end-of-term rating of perception.

Considerable stress is associated with undergraduate examinations. Traditional medical schools appear to regard such stress as inevitable and expect students to cope with their anxieties. The Newcastle medical school decided to develop curricular strategies for preventing (or at least reducing) such anxieties, rather than adopt medical or psychological treatment methods for students who subsequently appear unable to cope. Students and staff recommended changes to the original assessment programme after it had operated for four terms. This article reviews the changes and reports on students' greater satisfaction with them and the Newcastle medical school's attitude towards programme improvement. Suggestions are made for a more open, educational approach to student assessment by other learning institutions.

A two-stage process for the assessment of students' clinical competence at the end of each academic term has been introduced for medical undergraduates in their first year at The University of Newcastle, N.S.W. The first assessment, held in the week following the end of the learning phase for a term, enables students: to demonstrate their competence on pre-stated learning objectives; to review their peers' performance and the nature of acceptable (model) answers for each item in their written assessment; to examine their own scripts with their group tutor; and to receive early diagnostic advice and academic guidance to plan their remedial studies. The latter activity is vital for students judged “not-competent” overall at that stage, since they are given an opportunity to demonstrate their skills in a second assessment held nearer the end of term. Student evaluation of the assessment programmes after the first year of introduction has been invaluable in helping to make the system a viable process as an integral aspect of the Faculty's educational philosophy.

Two clinical cases are described in which percutaneous transluminal dilatation (PTD) determined the correction of hypertension and renal hypoperfusion due to renal artery stenosis of the transplanted kidney.

In this series, we print evaluation instruments, questionnaires, rating scales and similar resource materials useful to teachers, evaluators and planners. You may wish to adapt such instruments for your own purposes. The feature in this issue has been prepared by Grahame I. Feletti, Nicholas A. Saunders, Anthony J. Smith and Charles E. Engel. Further information is available from Charles E. Engel.

Educational programmes within the profession need a new approach if graduates are to be adequately prepared for their roles in the twenty-first century. This approach should emphasize two broad capabilities for professional practice -- one related to immediate performance after graduation, and the other recognizing the need for further education. Graduates can develop these capabilities if a set of essential competencies is defined, and if their assessment is treated as an integral part of the educational programme. This paper describes new instruments and procedures together with guidelines for ensuring their reliability and validity.

This paper examines the problems of fostering appropriate attitudes towards continuing education in undergraduates. It outlines the obligation for educators in the professions to promote actively progressive independence of student learning. It describes how this has been attempted as part of the undergraduate medical curriculum at the University of Newcastle, Australia.Strategies and problems of implementation in the students' learning, assessment and evaluation programmes are presented. The paper concludes with a partial answer to the focal question, 'Can progressive independence of learning be planned as an undergraduate objective, or is it simply an option for some students?'

-- Inquiry based learning is evolving as another curriculum model which may help to revitalize nursing and other professions education programs in the same way that problem based learning has rejuvenated medical education in the last 25 years. This paper briefly outlines both PBL and IBL approaches, and compares their philosophies, methods and context. Inquiry based learning may be more attractive to a wider range of vocational training and professions education programs because of its flexibility in choice of methods, less emphasis on teaching specific problem-solving paradigms, and less reliance on resource-intensive learning experiences.

While the purpose, theory and method of evaluation of educational programmes are well-documented, there is little published evidence on the actual evaluation of higher professional educational programmes and their outcomes. This paper outlines the background and development of programme evaluation in a new institution of higher professional education. It outlines current programme monitoring activities and their effects, and identifies the urgent and feasible tasks to be undertaken in the methodologically difficult and politically sensitive area of outcome evaluation.

Dialysis arthropathy is the most prominent dialysis-related amyloidosis feature. Alpha-1-antitrypsin (alpha-1-proteinase inhibitor) is the major circulating antiprotease. Twenty-three otherwise uncomplicated hemodialysis patients with well-documented dialysis arthropathy had a significantly (p < 0.05) lower serum mean concentration, 1,960 ± 410.4 mg/I of alpha-1-antitrypsin than 47 patients with no joint symptoms who had a mean concentration of 2,256.6 ± 424.5 mg/I. Decreased levels of the substance were detected in 13 (56.5%) of the 23 patients with dialysis arthropathy and in 13 (27.6%) of those 47 with no joint symptoms, the incidence in the former group being significantly (p < 0.05) higher than in the latter. In the dialysis arthropathy group, serum alpha-1-antitrypsin levels correlated inversely (r = −0.54, p < 0.01) with the dialysis duration and directly (r = 0.413, p < 0.05) with the corresponding beta-2-microglobulin determinations. We speculate that reduced antiprotease activity may play a role in amyloidogenesis in the setting of long-term hemodialysis.

There is convincing clinical and experimental evidence to support the notion that lipoprotein(a) [Lp(a)] is atherogenic. Patients undergoing chronic hemodialysis have an increased risk of atherosclerotic cardiovascular complications. In the present study, we investigated the possible relation between the alteration, if any, in serum Lp(a) and coronary artery disease in such patients. The mean serum concentration of Lp(a) tended to be higher in the 64 hemodialysis patients than in the 30 normal controls (15.1 ± 15.2 vs. 9.7 ± 10.4 mg/dl). However the difference did not reach statistical significance. The prevalence of levels above 30 mg/dl was 14% (9/64) and 10% (3/10), respectively, and the difference was also not statistically significant. Eleven hemodialysis patients with coronary artery disease had a significantly higher mean serum concentration of Lp(a) than the unaffected 53 (33.7 ± 18.4 vs. 11.1 ± 11.2 mg/dl, p < 0.001). Elevated levels were present in 63.6% (7/11) and 3.8% (2/53), respectively (p<0.01). Other parameters of lipid metabolism were not different between the two groups. We observed statistically significant positive correlations of Lp(a) to total cholesterol, LDL cholesterol and apolipoprotein B in controls, in hemodialysis patients as a whole and in those without coronary artery disease. No such correlations were obtained when hemodialysis patients with coronary artery disease were analysed separately. It is concluded that firstly, high serum levels of Lp(a) in hemodialysis patients are strongly associated with coronary artery disease, as well as in the general population; and secondly, abnormalities in the metabolism of Lp(a) may underlie atherogenesis in these patients, independently of alterations in other lipid constituents

This study examines patients' perceptions of their latest consultation with a primary-care physician. A new questionnaire measured patients' views on their “ideal” physician prior to the visit and their satisfaction on similar dimensions immediately afterward. Ratings by the 503 eligible patients (87% response rate) showed that all 43 items were relevant and that a shortened version could also be used successfully. Patients held high expectations for, but were also quite satisfied with, their physicians' actual behavior during the consultation. Factor analysis of perceptions supported other research findings and raised some anomalies in relation to overordering of investigations and waiting time. Other analyses showed which characteristics of physicians and patients were most influential on satisfaction and which dimensions of care were common or distinct to the 22 physicians involved in this study.

In this series, we print evaluation instruments, questionnaires, rating scales and similar resource materials useful to teachers, evaluators and planners. You may wish to adapt such instruments for your own purposes. The feature in this issue has been prepared by Nicholas A. Saunders, Charles E. Engel, and Grahame I. Feletti from whom further information is available.

We compared clinical supervisors' ratings of intern competence in Newcastle University graduates (whose medical school emphasizes community relevance and interpersonal skills) and in medical graduates of the Universities of Sydney and New South Wales, which have more traditional curricula. A 12-item anchored supervisor rating scale was used to assess the professional competence of 428 interns on five occasions throughout the intern year. Data analysis was performed using two factors of clinical competence and personal characteristics, as well as an average annual total score, linear regression analysis was employed to estimate the adjusted effects of age, sex, and graduating university on the three scores. All three scores were higher for interns who graduated at younger than 25 years, irrespective of university of graduation or sex. Women scored higher on average than men, and Newcastle graduates were rated significantly better on average than Sydney University graduates for the personal characteristics scores. At the beginning of the intern year, Newcastle graduates had higher total scores than graduates from the two other medical schools. By the end of the intern year, there was no difference in total scores for the three universities. The results of this study suggest that age, sex, and curriculum background are factors influencing aspects of performance at entry to the internship year and also the professional development of interns throughout that year.

Centuries of tradition have instilled in Swiss medical doctors a healthy skepticism for innovations in professional practice. This same attitude seems to apply to medical education, with Swiss medical associations and interest groups taking various initiatives in observing and reporting international changes. Recently, a small delegation of Swiss doctors representing practitioners—and professors from the medical schools in Geneva and Berne— visited selected North American medical schools that have adopted problem-based curricula. That visit led to insights being discussed at a national conference in Berne in 1989. The conference was well represented—with faculty and students from all five Swiss medical schools, invited health professionals, politicians, and administrators. The main challenge confronting any likely major curriculum reform in Switzerland will be whether faculty can accept the kind of educational principles now being implemented at the University of Berne and those recommended at the 1988 World Conference on Medical Education. The various professional associations in Switzerland need to continue effective liaison with the five medical faculties to ensure that any such change is given a fair chance.