DNA fragments from a locus spanning 29 kilobases within chromosome band 13q14 detected deletions in 3 retinoblastomas out of 37 such tumors examined. Somatically occurring, homozygous deletions spanning at least 25 kilobases were detected in retinoblastomas from two unrelated patients. These deletions are bounded by the esterase D locus proximally. In a third patient, both tumor cells and leukocytes have a deletion of one chromosome 13 homolog, with one end of the deletion localized to a 1.55-kilobase fragment within the cloned region. It is likely that the cloned locus is within a few hundred kilobases of the retinoblastoma gene (i.e., the locus governing predisposition to such tumors) and that the deletions detected also involve the retinoblastoma gene. Further, it may be possible to base a successful approach to the isolation of the retinoblastoma gene on this assumed physical proximity of the two loci.It has been about 80 years since the appearance of published reports of families in which a parent who was cured of retinoblastoma had children afflicted with the same type of tumor (ref. 1, p. 336; ref. 2). There is evidence from more recent studies that the heritability of predisposition to retinoblastoma is governed by a locus within human chromosome band 13q14 (3-8). Furthermore, the locus is representative of a class of such loci in the human genome, called recessive oncogenes (9, 10). The loci are related, since it appears that recessive, mutant alleles at any of the loci tend to be oncogenic and, correspondingly, that the dominant alleles normally present at the loci have a role in preventing tumor formation (11)(12)(13)(14)(15)(16). The evidence supporting this genetic nature of alleles at the retinoblastoma locus has been indirect; i.e., the locus has not been isolated for direct molecular study.A proportion of the recessive mutations at the locus that predispose to tumor formation are deletions (3,4 MATERIALS AND METHODSOrigin of Probes. There are three loci established to be within 13q14: the esterase D locus and the loci detected by probes pH3-8 and pH2-42 (4, 17). Probes pH3-8 and pH2-42 were derived from a phage library enriched for DNA sequences from chromosome 13 by using a fluorescenceactivated chromosome sorter (17). Esterase D is an enzyme, of unknown biologic function, that demonstrates allelic isozymes (18). One other locus, named 7D2, is closely linked to the esterase D locus and is probably within or near 13q14 (19).Other probes that detect loci assigned to chromosome 13 and were used in this study are p7F12, p9D11, plE8, p9A7, pHU10, pHU26, and pHUB8 (20,21). The sublocalization of the loci detected by these probes has been determined by deletion mapping (20,21) and by in situ hybridization (22). Probe p4-A detects an arbitrary autosomal locus not on chromosome 13.Construction of Phage Library. For the purpose of "chromosome walking," a total human phage library was constructed. Normal human lymphoblast DNA was digested partially with Mbo I, with due regard to the calculations ...

We offer a model based on the theory of planned behaviour (TPB), which describes the relationships of attitudes, social norms and perceived behavioural control with behaviour. It has been used to predict a wide range of behaviours, including doctor professional behaviours. Therefore, we propose an educational model that expands the TPB as an organisational framework that can integrate professionalism training into medical education. We conclude with a discussion about the implications of using this model to transform medical school curricula to develop positive professionalism attitudes, alter the professionalism social norms of the medical school and increase students' perceived control over their behaviours.

Objective-The purpose of this research was to examine the content of physicians' colorectal cancer screening recommendations. More specifically, using the framework of informed decision making synthesized by Braddock and colleagues, we conducted a qualitative study of the content of recommendations to describe how physicians are currently presenting this information to patients.Methods-We conducted semi-structured interviews with 65 primary care physicians. We analyzed responses to a question designed to elicit how the physicians typically communicate their recommendation.Results-Almost all of the physicians (98.5%) addressed the "nature of decision" element. A majority of physicians discussed "uncertainties associated with the decision" (67.7%). Fewer physicians covered "the patient's role in decision making" (33.8%), "risks and benefits" (16.9%), "alternatives" (10.8%), "assessment of patient understanding" (6.2%), or "exploration of patient's preferences" (1.5%). Conclusion-Wepropose that the content of the colorectal screening recommendation is a critical determinant to whether a patient undergoes screening. Our examination of physician recommendations yielded mixed results, and the deficiencies identified opportunities for improvement.Practice implications-We suggest primary care physicians clarify that screening is meant for those who are asymptotic, present tangible and intangible benefits and risks, as well as make a primary recommendation, and, if needed, a "compromise" recommendation, in order to increase screening utilization. Keywords

While patient barriers to colorectal cancer (CRC) screening have been identified, how well this knowledge is utilized during the patient-physician interaction is not fully understood. This study aims to assess among primary care physicians the degree of consensus between perceived and actual patients' CRC screening decision-making influential factors. During 2004-2006, 30 patients were interviewed to identify factors influencing screening decisions and 66 physicians were interviewed to understand what factors they thought were important to patients. The factors were categorized using the PRECEDE-PROCEED framework, and perspectives were compared. The researchers found little consensus on CRC screening decision-making influential factors between family practitioners, general internists, and patients. The recommendations to reach consensus are provided on the individual (e.g., updating the contents of a physician's screening recommendation to proactively address patients' decision-making needs) and population (e.g., providing cross-cultural training to medical students enabling them to better understand their patients) levels.

Enhancing the professionalism of graduates is a major objective of most health care education institutions today. Educating conventional health care providers about complementary and alternative medicine (CAM) may directly and indirectly improve trainee professionalism by expanding trainees' knowledge and appreciation of diverse health care beliefs and practices, improving physician-patient communication, enhancing self-care, and increasing sense of competence and job satisfaction. A survey based on professional competencies proposed by the Consortium of Academic Health Centers for Integrative Medicine was administered to the grantees of the National Institutes of Health, National Center for Complementary and Alternative Medicine R-25 CAM education project initiative. The survey's aim was to identify project activities that taught professionalism skills. All projects reported curricular features that enhanced trainee professionalism, with substantial percentages of project effort directed toward professionalism-related activities.