Transmural differences in systolic wall thickening were analyzed in 13 conscious dogs by implanting sonomicrometers to continuously measure total wall thickness (WT) and outer WT approximately half the distance through the myocardium at a closely adjacent location. Inner WT was derived by subtraction of outer WT from total WT. Outer wall measurements spanned, on average, the outer 44 +/- 10% (+/- SD) of the wall; derived inner wall measurements spanned the remaining 56 +/- 10%. At rest the fractional contribution (FC) of the outer wall to total systolic wall thickening was 29 +/- 9%, which was significantly less than the FC of the inner wall, 71 +/- 9%. These data are in good agreement with simplified modeling of a cross section of the left ventricle as two concentric rings that predicts that the FC of inner and outer halves of the wall should be approximately 67 and 33%, respectively. During treadmill exercise, the extent of both inner and outer thickening increased significantly (30 and 29%, respectively) but the relative FC of the inner and outer wall remained the same. The data indicate that systolic wall thickening is nonuniform and that this nonuniformity remains constant during the increased inotropic and chronotropic stimulation associated with exercise.

The objective of this project was to compare faculty productivity in teaching and nonteaching clinical settings. We hypothesized that teaching activity would have no impact on productivity. A mixed model, repeated measures analysis of variance was used to analyze average relative value units (RVUs) billed and to test for differences between clinics. Data were drawn from 4,956 clinical encounters made within a student, resident, and faculty clinic. Average RVUs per visit were similar in the three settings. Resident supervision increased faculty productivity, while student supervision had no impact on billed RVUs. Thus, RVUs can be used as a measure of faculty clinical productivity in different settings in an academic medical center. Precepting students does not appear to affect clinical productivity.KEY WORDS: faculty productivity; relative value units; resident training; student education. J GEN INTERN MED 1997;12:715-717.cademic health science centers are coming under intense financial pressures; thus, efforts are under way at many institutions to optimize faculty clinical productivity. 1 Faculty clinical productivity has been measured in various ways: for example, number of patient visits, procedures performed, visits billed, and dollars collected. [2][3][4][5][6] These measures are inadequate if adjustments are not made for differences in practice characteristics such as the complexity of patients' diseases, variations in the length of time spent with patients, and differences in types of reimbursement for patients seen in various settings. Relative value units (RVUs) offer one way to measure productivity directly. The Health Care Financing Agency uses RVUs as the measure of physician productivity to calculate reimbursement for Medicare patients. According to this system, professional services (except for hospital based-services such as clinical pathology, radiology, and anesthesiology) are given a unique weight in RVUs based on the amount of time spent with patients and problem severity using Current Procedural Terminology (CPT4) codes. 7 Total RVUs reflect the practice costs and professional work associated with delivering a clinical service.At the same time as faculty are expected to optimize clinical productivity, many also have the added responsibility of supervising students and residents. The purpose of this study was to determine whether faculty clinical productivity, as measured by RVUs, is affected by teaching in outpatient clinics.Three clinics were compared: a medical student clinic characterized by episodes with case patients in which two students were supervised by one attending physician, a resident continuity care clinic in which four internal medicine residents at various levels of experience saw the panels of patients assigned to them and were supervised by one attending physician, and a faculty primary care clinic in which clinical services were provided by faculty who did not supervise students or residents. Our hypothesis was that teaching in outpatient clinics-either students or resident...

Research has demonstrated that attitudes toward persons who seek psychological counseling are complex. Both favorable and unfavorable characteristics have been attributed to such individuals. However, generalizability of findings to real world circumstances is limited because conclusions have typically been based on studies using college undergraduates in the role of decision makers. The purpose of our study was to determine the extent to which a history of psychological counseling influenced actual decision makers' perceptions of applicants seeking admission to graduate medical training programs. Five hundred twenty-three training directors in six medical specialties (pediatrics, internal medicine, family medicine, psychiatry, obstetrics and gynecology, and surgery) rated a hypothetical male or female applicant's personal characteristics and indicated whether they would invite the applicant for an interview and accept him or her into the training program. A 2 x 2 x 6 (gender, counseling history, medical specialty) multivariate analysis of variance on 19 dependent variables indicated that residency directors formed a negative stereotype toward applicants with a history of psychological counseling. Subsequent stepwise multiple regression analyses indicated that this stereotype mediated the directors' personnel decisions. Implications of these findings are discussed.

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SUMMARY Left ventricular performance was determined by echocardiography in 44 black children with homozygous sickle cell anaemia and a control group of 28 normal black children of comparable age. Statistically significant differences were observed between the children with sickle cell anaemia and the normal group in left ventricular ejection fraction (sickle cell anaemia group: 0-59 + 0.01 [mean + standard error of the mean] vs. normal group: 0-65 + 0.01), cardiac index (5.3 + 0 3 vs 4-2 + 0 3 1/min per i2), mean circumferential fibre shortening velocity (116 + 0 04 vs 1-31 + 0.03s-1) and the percentage of shortening of left ventricular minor axis dimension (32.5 + 1 vs 36-7 + 0.8). The children with sickle cell anaemia were divided into two groups according to the absence or presence of dyspnoea and/or fatigue on moderate effort; though both groups had the same degree of anaemia, significantly depressed left ventricular performance indices were observed only in the group of symptomatic patients. All asymptomatic children with sickle-cell anaemia had uncompromised left ventricular performance.These findings indicate that left ventricular dysfunction is present in a significantproportionofchildren with sickle cell anaemia. The extent of the left ventricular dysfunction, is not related to the degree of anaemia or the percentage of fetal haemoglobin. Since many of the symptoms, physical signs, and radiological findings of severe anaemia resemble those ofcongestive heart failure, echocardiographic examination of symptomatic children with homozygous sickle cell anaemia is useful in detecting the presence of left ventricular dysfunction.Children and adults with homozygous sickle cell with the tendency of the sickle cells to occlude small anaemia frequently present evidence of cardio-vessels in the systemic, pulmonary (Moser et al., vascular system abnormalities (Klinefelter, 1942;1960), and coronary circulation (Oliveira and