Faculty Bibliography

The plans must wait until President Bush announces whether he will limit vaccinations to about 500,000 health care workers or offer them to all Americans. No vaccination can occur until Mr. Bush's decision because the government owns all stocks of smallpox vaccine. In the next few days, the centers' smallpox experts will review the plans to determine whether they need revision before any vaccine is released, said Thomas W. Skinner, a spokesman for the centers. The C.D.C. will be reviewing a number of issues: how many health workers the states and cities plan to vaccinate; how many clinics are ready to vaccinate; how many public health and medical response teams have been identified; and how many hospitals in each state will be able to care for smallpox patients if any cases occur. Smallpox vaccine, which is made from a live virus related to the one that causes smallpox, is considered the most dangerous immunization for humans. Before the United States stopped routine smallpox vaccinations in 1972, life-threatening complications occurred at a rate of 15 per million among those who received their first smallpox vaccination, and the number included about one to two deaths

In atrial fibrillation, the heart beats irregularly because the atria fire electrical signals in an uncontrolled and very fast way. When the signals arrive in the ventricles in an erratic pattern, the ventricles pump blood less efficiently to the body. The slower flow of blood promotes formation of clots in the atria. The danger from the blood clots promoted by atrial fibrillation is that pieces of clots will break off to lodge in arteries in the brain, causing strokes, or elsewhere in the body, damaging organs. In the studies, strokes tended to occur among those taking inadequate doses of anticoagulant drugs like warfarin (sold under the brand name Coumadin) or not taking them at all. Anticoagulants showed benefit even if the heart rhythm returned to normal. Among the drugs that have been most commonly used for atrial fibrillation, those to restore a normal rhythm, are amiodarone (sold as Cordarone), sotalol (Betapace), propafenone (Rythmol), procainamide, quinidine, flecainide (Tambocor), disopyramide, moricizine and dofetilide (Tikosyn)

BACKGROUND: There are few data available on how physicians inform patients about bad news. We surveyed internists about how they convey this information. METHODS: We surveyed internists about their activities in giving bad news to patients. One set of questions was about activities for the emotional support of the patient (11 items), and the other was about activities for creating a supportive environment for delivering bad news (9 items). The impact of demographic factors on the performance of emotionally supportive items, environmentally supportive items, and on the number of minutes reportedly spent delivering news was analyzed by analysis of variance and multiple regression analysis. RESULTS: More than half of the internists reported that they always or frequently performed 10 of the 11 emotionally supportive items and 6 of the 9 environmentally supportive items while giving bad news to patients. The average time reportedly spent in giving bad news was 27 minutes. Although training in giving bad news had a significant impact on the number of emotionally supportive items reported (P <.05), only 25% of respondents had any previous training in this area. Being older, a woman, unmarried, and having a history of major illness were also associated with reporting a greater number of emotionally supportive activities. CONCLUSIONS: Internists report that they inform patients of bad news appropriately. Some deficiencies exist, specifically in discussing prognosis and referral of patients to support groups. Physician educational efforts should include discussion of prognosis with patients as well as the availability of support groups

Several human pathogens (e.g., Bacillus anthracis, Yersinia pestis, Bordetella pertussis, Plasmodium falciparum, and Mycobacterium tuberculosis) have very restricted unselected allelic variation in structural genes, which hinders study of the genetic relationships among strains and strain-trait correlations. To address this problem in a representative pathogen, 432 M. tuberculosis complex strains from global sources were genotyped on the basis of 230 synonymous (silent) single nucleotide polymorphisms (sSNPs) identified by comparison of four genome sequences. Eight major clusters of related genotypes were identified in M. tuberculosis sensu stricto, including a single cluster representing organisms responsible for several large outbreaks in the United States and Asia. All M. tuberculosis sensu stricto isolates of previously unknown phylogenetic position could be rapidly and unambiguously assigned to one of the eight major clusters, thus providing a facile strategy for identifying organisms that are clonally related by descent. Common clones of M. tuberculosis sensu stricto and M. bovis are distinct, deeply branching genotypic complexes whose extant members did not emerge directly from one another in the recent past. sSNP genotyping rapidly delineates relationships among closely related strains of pathogenic microbes and allows construction of genetic frameworks for examining the distribution of biomedically relevant traits such as virulence, transmissibility, and host range

Yet for all of Kennedy's suffering, the ailments did not incapacitate him, [Robert Dallek] concluded. In fact, he said, while Kennedy sometimes complained of grogginess, detailed transcripts of tape- recorded conversations during the Cuban missile crisis in 1962 and other times show the president as lucid and in firm command. For many years, Kennedy's back problems were largely attributed to injuries suffered when his Navy patrol boat, PT-109, was sunk in World War II. In fact, he had back pain before that. Dallek said his vertebrae may have begun degenerating as a result of the steroids he may have taken for intestinal problems in the late 1930s. The records show that Kennedy had 'a tremendous proclivity for infections,' [Jeffrey A. Kelman] said, contradicting [Janet G. Travell]'s assertion in 1960 that Kennedy had 'a better than average resistance to infection' and 'astounding vitality.'

The trend has been building for years but has only now been confirmed through more refined statistical methods and improved reporting of infection with HIV, the virus that causes AIDS. The world figures largely reflect the epidemic in sub-Saharan Africa, the world's worst-affected area, where nearly 1 in 11 adults is infected. There, women account for 58 percent of infections. Whether the ratio of women to men will continue to increase depends on unpredictable factors. If the AIDS epidemic explodes in Asia, men can be expected to make up a larger percentage of those infected worldwide, because among infected people there, the male- female ratio ranges from about 2 to 1, in Thailand, to 8 to 1, in China, Dr. Neff Walker, a U.N. epidemiologist, said in a telephone interview from Geneva. Of the 38.6 million adults living with HIV worldwide, 19.2 million are women. Of the 4.2 million adults newly infected this year, 2 million are women. Women accounted for 1.2 million of the world's 2.5 million adult deaths from AIDS this year