Faculty members of the department of medicine at a major medical center contribute a large number of hours teaching medical students and house staff. This effort is poorly compensated. Cost-containment efforts have the potential to jeopardize fragile social contracts at academic health centers whereby the faculty participates in teaching by contributing unreimbursed or underreimbursed time.

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Introduction: The current study aimed to assess recent acute myocardial infarction (AMI) mortality rates and trends in Romania between 1994 and 2017. This dataset is a necessity in the context of the current improvement of emergency protocols, medical addressability, and modernization of hospital infrastructure. Materials and Methods: The study is a retrospective analysis of an anonymized mortality database containing all deaths registered in Romania during 1994–2017. AMI crude mortality rates (CMR) and age-standardized mortality rates (ASMR) were calculated using the European Standard Population. Poisson regression was used for calculating the annual percentage change (APC) in mortality, subsequently used to make mortality predictions through the year 2030. Results: There were 197,152 AMI deaths in women (39.3% of total AMI), and 304,644 (60.7%) in men. Mortality rates were higher in men as compared with women for the entire time covered by the study. Based on the 1994–2017 ASMR dynamics, predictions for the year 2030 showed an overall AMI ASMR of 70.9 (95% CI 69.9–71.9), with gender analysis showing 46.8 (95% CI 45.8–47.9) in women and 104.1 (95% CI 102.3–105.8) in men. Conclusion: Acute myocardial infarction age-standardized mortality rates decreased significantly in Romania between 1994 and 2017 in close correlation to the implementation of national healthcare programs.

These data suggest fundamental inadequacies in the current paradigm for teaching physical examination skills. Standardized patient checklist data can provide an informative window into the efficacy of teaching practices.

The existence of a number of transient intermediates in the interconversion of I he red (Pr) and far-red (Pfr) forms of phytochrome has been demonstrated in this laboratory by flash-excitation technique.' It was also reported (Linschitz and Kasche,l Spruit') that at low temperatures the various stages of the reaction can be slowed down or stopped and that the first photoproduct of Pr, thus stabilized, is photoconvertible back to Pr. In this paper, we present a more complete account of these low-temperature studies, including the discovery of two new transient forms of phytochrome. The new results, although in agreement with our earlier flash observations, extend and clarify those observations and lead to a reinterpretation of the detailed pattern of the Pr Pfr reaction.Materials.-Phytochrome extracts in 0.5 M sucrose-0.1 M phosphate buffer were kindly provided by Dr. S. Hendricks and were the same as those used earlier.' 8 Samples withdrawn from the Deepfreeze were clarified by centrifugation at 20 for 1 hr at 80,000 X g and made up to 60 vol % glycerol at 0°. The solutions were stored at -20°when not in use and showed excellent stability and photoreversibility.Apparatus and Procedures.-The cryostat consisted of a cylindrical copper block soldered to the bottom of a brass can of the same diameter, and supported inside a Dewar flask fitted with plane windows. An axial channel to hold the sample cell and slots for passage of the spectrophotometer and cross-excitation beams were cut into the block. The sample cell was lowered into position through a tube soldered to the top of the cryostat block. Refrigerant baths (isopentane, C00-ethanol, or liquid nitrogen) were placed in the annular space between the central tube and outer can (above the copper block) and did not obstruct the light paths. For temperatures other than the C02 or liquid N2 points, methanol cooled in a dry-ice chamber or nitrogen evaporated from a liquid N2 Dewar was circulated through a copper coil immersed in isopentane. Sample temperatures were measured by a copper-constantan thermocouple dipped directly into the test solution just above the measuring beam. Absorption cells were made of 1-cm square Pyrex tubing sealed to long Pyrex tubes for handling in the cryostat. Cracking of the glycerol-buffer medium was not encountered above approximately -110°. At N2 temperature, cracking was marked, but optical measurements could still be made without difficulty. The cross-beam, admitted through an aperture in the side of the spectrophotometer (Cary 14) cell compartment, was of sufficient diameter to illuminate the entire sample. The exciting source was a 1000-watt projection lamp, which was used in conjunction with condensing lenses and water and interference filters. When necessary, filters were also placed in the measuring beam, at the rear wall of the sample compartment, to protect the photocell. Absorption changes could thus be followed, even during crossillumination, without interference from scattered light.Phytochrome concentrations in this work co...