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A vast sequence of quartz-rich sandstone was deposited over North Africa and Arabia during Early Palaeozoic times, in the aftermath of Neoproterozoic Pan-African orogeny and the amalgamation of Gondwana. This rock sequence forms a relatively thin sheet (1–3 km thick) that was transported over a very gentle slope and deposited over a huge area. The sense of transport indicates unroofing of Gondwana terranes but the exact provenance of the siliciclastic deposit remains unclear. Detrital zircons from Cambrian arkoses that immediately overlie the Neoproterozoic Arabian–Nubian Shield in Israel and Jordan yielded Neoproterozoic U–Pb ages (900–530 Ma), suggesting derivation from a proximal source such as the Arabian–Nubian Shield. A minor fraction of earliest Neoproterozoic and older age zircons was also detected. Upward in the section, the proportion of old zircons increases and reaches a maximum (40%) in the Ordovician strata of Jordan. The major earliest Neoproterozoic and older age groups detected are 0.95–1.1, 1.8–1.9 and 2.65–2.7 Ga, among which the 0.95–1.1 Ga group is ubiquitous and makes up as much as 27% in the Ordovician of Jordan, indicating it is a prominent component of the detrital zircon age spectra of northeast Gondwana. The pattern of zircon ages obtained in the present work reflects progressive blanketing of the northern Arabian–Nubian Shield by Cambrian–Ordovician sediments and an increasing contribution from a more distal source, possibly south of the Arabian–Nubian Shield. The significant changes in the zircon age signal reflect many hundreds of kilometres of southward migration of the provenance.

Participants of syringe exchange programs (SEPs) exhibit high rates of substance use disorder but remain extremely ambivalent about seeking treatment. This study evaluated the effectiveness of motivational interviewing (MI) for encouraging SEP participants to enroll in substance abuse treatment. New opioid-dependent registrants to the Baltimore Needle Exchange Program (BNEP) (n =302) completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and the Addiction Severity Index (ASI) and were randomly assigned to one of three treatment referral conditions: (1) MI, (2) job readiness (JR) (attention control), or (3) standard referral. Participants in each condition who expressed interest in treatment were referred to a treatment readiness group that provided further encouragement and referral to programs that were accepting new admissions. Participants were observed for 1 year following the intervention. The results showed that 10.9% of study participants enrolled in substance abuse treatment, although no condition effects were observed. White participants and those diagnosed with major depression were most likely to enter treatment. The results suggest that a single motivational interview is insufficient to motivate changes in treatment seeking in this population, whereas the identification of predictors of treatment enrollment is worthy of further investigation.

A century ago, William Osler helped create a new approach to medical education based largely on teaching by example. Osler himself is venerated as a paragon of clinical and pedagogic excellence, serving as an example for academic physicians to emulate. Today, role modeling is thought to be an integral component of medical education 1 – 8 and an important factor in shaping the values, attitudes, behavior, and ethics of medical trainees. 7 – 10 Role models have a strong influence on the career choices of medical students. 1 , 3 – 6 , 10 _ 23 Since 1966, 25 articles have reported on various aspects of role modeling in . . .

High‐magnitude and long‐duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high‐magnitude and long‐duration abstinence reinforcement. This study determined if employment‐based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs and use cocaine during methadone treatment. Participants could work 4 hr every weekday in a workplace where they could earn about $10.00 per hour in vouchers; they were required to provide routine urine samples. Participants who attended the workplace and provided cocaine‐positive urine samples during the initial 4 weeks were invited to work 26 weeks and were randomly assigned to an abstinence‐and‐work (n = 28) or work‐only (n = 28) group. Abstinence‐and‐work participants had to provide urine samples showing cocaine abstinence to work and maintain maximum pay. Work‐only participants could work independent of their urinalysis results. Abstinence‐and‐work participants provided more (p = .004; OR = 5.80, 95% CI = 2.03–16.56) cocaine‐negative urine samples (29%) than did work‐only participants (10%). Employment‐based abstinence reinforcement can increase cocaine abstinence.

To determine the prevalence, topics, methods, and intensity of ongoing faculty development (FD) in teaching skills. Mailed survey. Two hundred and seventy-seven of the 386 (72%) U.S. teaching hospitals with internal medicine residency programs. Prevalence and characteristics of ongoing FD. One hundred and eight teaching hospitals (39%) reported ongoing FD. Hospitals with a primary medical school affiliation (university hospitals) were more likely to have ongoing FD than non-university hospitals. For non-university hospitals, funding from the Health Resources Services Administration and >50 house staff were associated with ongoing FD. For university hospitals, >100 department of medicine faculty was associated. Ongoing programs included a mean of 10.4 topics (standard deviation, 5.4). Most offered half-day workshops (80%), but 22% offered > or =1-month programs. Evaluations were predominantly limited to postcourse evaluations forms. Only 14% of the hospitals with ongoing FD (5% of all hospitals) had \"advanced\" programs, defined as offering > or =10 topics, lasting >2 days, and using > or =3 experiential teaching methods. These were significantly more likely to be university hospitals and to offer salary support and/or protected time to their FD instructors. Generalists and hospital-based faculty were more likely to receive training than subspecialist and community-based faculty. Factors facilitating participation in FD activities were supervisor attitudes, FD expertise, and institutional culture. A minority of U.S. teaching hospitals offer ongoing faculty development in teaching skills. Continued progress will likely require increased institutional commitment, improved evaluations, and adequate resources, particularly FD instructors and funding.

OBJECTIVE:  To describe the medical care use and costs associated with migraine. DESIGN:  Retrospective case‐control design in which migraine case status was ascertained via validated telephone interview and linked with comprehensive claims data. Unadjusted and adjusted use and cost differences by migraine status were evaluated using exponential score tests and generalized estimating equations. SETTING AND PATIENTS:  We interviewed 8,579 individuals to identify migraine cases (N= 1,265) and a random sample of nonmigraine controls (N= 1,178) among eligible health plan enrollees aged 18 to 55. MEASURES:  Survey responses were used to categorize individuals meeting the International Headache Society's diagnostic criteria for migraine with or without aura as migraine cases and to collect information on comorbid psychiatric symptoms. Claims data were used to compile annual medical and pharmaceutical use and costs, presence of migraine diagnosis, and other diagnosed comorbidities. RESULTS:  Interview‐ascertained migraine cases used more outpatient visits (9.1 vs 6.8; P < .01), were more likely to be seen in the emergency department (20.7% vs 17.6%; P < .05), and were admitted to the hospital more (4.5% vs 2.8%; P < .05) compared to nonmigraine controls. Cases incurred significantly higher medical care costs ( $2,761 vs $ 2,064; P < .01). Multivariable model results indicate that much of this increase in costs is due to the presence of major depressive symptoms as well as other diagnosed comorbidities that are more common among those with migraine. CONCLUSIONS:  By combining validated telephone survey information to identify migraine cases and controls with comprehensive claims data, we found migraine cases incur higher medical care costs compared to controls. These increased costs are associated with the presence of psychiatric symptoms and other comorbidities.

Background: The long‐term impact of longitudinal faculty development programs (FDPs) is not well understood. Objective: To follow up past participants in the Johns Hopkins Faculty Development Program in Teaching Skills and members of a comparison group in an effort to describe the long‐term impact of the program. Design and Participants: In July 2002, we surveyed all 242 participants in the program from 1987 through 2000, and 121 members of a comparison group selected by participants as they entered the program from 1988 through 1995. Measurements: Professional characteristics, scholarly activity, teaching activity, teaching proficiency, and teaching behaviors. Results: Two hundred participants (83%) and 99 nonparticipants (82%) responded. When participants and nonparticipants from 1988 to 1995 were compared, participants were more likely to have taught medical students and house officers in the last year (both P<.05). Participants rated their proficiency for giving feedback more highly (P<.05). Participants scored higher than nonparticipants for 14 out of 15 behaviors related to being learner centered, building a supportive learning environment, giving and receiving feedback, and being effective leaders, half of which were statistically significant (P<.05). When remote and recent participants from 1987 through 2000 were compared with each other, few differences were found. Conclusions: Participation in the longitudinal FDP was associated with continued teaching activities, desirable teaching behaviors, and higher self‐assessments related to giving feedback and learner centeredness. Institutions should consider supporting faculty wishing to participate in FDPs in teaching skills.

Claims data are often used to identify and monitor individuals with particular conditions, but many health conditions are not easily recognizable from claims data alone. Patient characteristics routinely available in claims data were used to develop model-based claims signatures to identify migraineurs. A validated telephone interview was administered to 23,299 continuously enrolled managed care members aged 18–55 to identify 1,265 migraineurs and 1,178 controls. Responses were linked to medical and prescription claims. Claims variables were evaluated for sensitivity, specificity, and positive and negative predictive value in predicting migraine status. Regression models for predicting migraine status were developed. Regression-based claims signature models were successful in case-finding, as indicated by fairly sizable odds ratios (OR). In the full model (including demographic, medical, pharmacy, and comorbidity claims variables), a claim for a migraine drug, gender, and a claims-based headache diagnosis were strongly associated with migraine case status (OR = 3.9, 3.2, and 3.0, respectively). Using either medical or pharmacy claims provided highly specific and moderately sensitive case-findings. Strategies that combined medical and pharmacy information improved sensitivity and may increase the usefulness of claims for identifying migraine and improving the quality of migraine care.

Using a multidisciplinary approach, we have measured various indicators of DNA damage in peripheral lymphocytes of human populations potentially at increased risk for cancer. Sister chromatid exchanges (SCE) and polycyclic aromatic hydrocarbon (PAH)-DNA adducts were evaluated in a group of firefighters; chromosomal aberrations and hprt mutations were evaluated in a group of cancer patients undergoing radioimmunoglobulin therapy (RIT); SCE and acrolein-modified DNA were measured in cancer chemotherapy patients and in pharmacists preparing chemotherapy prescriptions; and SCE and PAH-DNA adducts are being measured in U.S. army troops stationed in Kuwait. Our results indicate that both SCE and PAH-DNA adduct levels were not elevated in firefighters, but that other factors such as smoking status and race were risk factors for increased SCE and PAH-DNA adducts. RIT was found to increase background rates of chromosome-type aberrations and frequencies of hprt mutations and there was a strong correlation between levels of therapy-induced chromosome damage sustained in vivo and in vitro sensitivity to radiation-induced chromosome damage. Peripheral blood lymphocytes of cancer patients treated with cyclophosphamide showed higher levels of SCE and had a higher incidence of acrolein adducts in DNA. Lymphocytes from pharmacists preparing antineoplastic drugs were found to acquire increased in vitro sensitivity to SCE induction by phosphoramide mustard with increased lifetime duration of drug handling. A prospective, longitudinal study was performed to identify environmental factors that modulate genetic damage in breast cancer patients. Women with benign breast masses and no apparent disease served as controls. Mutant frequency, cloning efficiency, and chromosomal aberration frequency did not differ significantly among the three groups. The results described and the data being gathered on troops stationed in Kuwait suggest that all the methodologies described can be useful in screening human populations for mutagenic exposures.