Faculty Bibliography

On Wednesday, the World Health Organization convened a meeting in Geneva of representatives of the drug industry to demand that they speed vaccine production. In the United States, scientists with the federal Centers for Disease Control and Prevention in Atlanta are racing to complete a genetic sequence of the virus from the case. If the virus has acquired any mammalian influenza genetic material, it could make it more transmissible. The U.S. government has also ordered two million doses of experimental vaccine. The United States, like governments in Australia, Japan, New Zealand and a small number of other countries, is also stockpiling the only antiviral medicine that may work against the strain, Tamiflu, but there have been too few human cases to document its effectiveness. The symptoms of human bird flu appear to be indistinguishable from severe cases of conventional flu, with fevers, sneezing, coughing and aches. 'You're dealing with very conservative Swiss bankers to me, they don't see the opportunity yet,' said Arnold Monto, a University of Michigan influenza expert, pointing out that Tamiflu not used for an avian influenza pandemic could be used instead to make human influenza less severe

Clusters of transcription factor binding sites (TFBSs) which direct gene expression constitute cis-regulatory modules (CRMs). We present a novel algorithm, based on Gibbs sampling, which locates, de novo, the cis features of these CRMs, their component TFBSs, and the properties of their spatial distribution. The algorithm finds 69% of experimentally reported TFBSs and 85% of the CRMs in a reference data set of regions upstream of genes differentially expressed in skeletal muscle cells. A discriminant procedure based on the output of the model specifically discriminated regulatory sequences in muscle-specific genes in an independent test set. Application of the method to the analysis of 2710 10-kb fragments upstream of annotated human genes identified 17 novel candidate modules with a false discovery rate </=0.05, demonstrating the applicability of the method to genome-scale data

Historians have debated the degree to which past patients have provided meaningful consent prior to medical interventions. This article, a chart review of 170 patients treated for cancer between 1945 and 1970, adds to this literature by exploring the years when informed consent was being introduced in medical practice. As would be expected in a largely paternalistic era, physicians controlled most of the clinical encounters, even concealing cancer diagnoses. Yet thirty-one (18 percent) of the patients showed some involvement in decision making, either writing restrictions on their consent forms, asking probing questions, or otherwise challenging physicians' orders. Although the overall number of patients studied was small, minority and other ward patients were as likely as white, private patients to speak up. This study concludes that most patients passively assented to treatment, signing consent forms without making any inquiries. But a small group of patients challenged their physicians, leading them to learn more about proposed treatment options and perhaps make more informed decisions. Although motivated in part by the increasing attention to better consent practices, these patients spoke up for other reasons as well, possibly including their basic personalities, prior negative experiences in hospitals, or apprehensiveness regarding specific types of interventions. Further research should explore the factors--beyond the introduction of informed consent--that have historically promoted better dialogue between physicians and patients.

We surveyed primary care physicians about their involvement and perceived skills in palliative care. A survey instrument asked how frequently internal medicine and family practice physicians performed 10 palliative care items. Subjects rated their skills in each area. A majority of physicians always or frequently performed all 10 palliative care items, but fewer than 50% of respondents adequately attended to the spiritual needs and economic problems of patients. Interest in palliative care was associated with an increased frequency in performing palliative care items (P = 0.036), while training in palliative care was associated with better perceived performance (P = 0.05). Only 36% of respondents had received training in palliative care. Internists and family practitioners provide palliative care to patients, but feel their skills are lacking in certain areas. Training may improve care to patients at the end of life

In recent years, there have been substantial investments and improvements in federal and state surveillance systems to track the health effects from pesticide exposure. These surveillance systems help to identify risk factors for occupational exposure to pesticides, patterns in poisonings, clusters of disease, and populations at risk of exposure from pesticide use. Data from pesticide use registries and recent epidemiologic evidence pointing to health risks from urban residential pesticide use make a strong case for understanding better the sale, application, and use of pesticides in cities. In this article, we describe plans for the development of a pesticide tracking system for New York City that will help to elucidate where and why pesticides are used, potential risks to varied populations, and the health consequences of their use. The results of an inventory of data sources are presented along with a description of their relevance to pesticide tracking. We also discuss practical, logistical, and methodologic difficulties of linking multiple secondary data sources with different levels of person, place, and time descriptors.