Medicine and Health Sciences Commons^™

Regional Differences In Cervical Cancer Incidence Among American Indians And Alaska Natives, 1999–2004, Thomas M. Becker, David K. Espey, Herschel W. Lawson, Mona Saraiya, Melissa A. Jim, Alan G. Waxman

United States Public Health Resources

BACKGROUND. Reports from limited geographic regions indicate higher rates of cervical cancer incidence in American Indian and Alaska Native (AI/AN) women than in women of other races. However, accurate determinations of cervical cancer incidence in AI/AN women have been hampered by racial misclassification in central cancer registries.

METHODS. The authors linked data from cancer registries participating in the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) Program with Indian Health Service (IHS) enrollment records to improve identification of AI/AN race. NPCR and SEER data were combined to estimate annualized age-adjusted rates (expressed …

Lung Cancer Incidence Among American Indians And Alaska Natives In The United States, 1999–2004, Anne Bliss, Nathaniel Cobb, Teshia Solomon, Kym Cravatt, Melissa A. Jim, Latisha Marshall, Janis Campbell

United States Public Health Resources

BACKGROUND. Lung cancer incidence rates among American Indians and Alaska Natives (AI/ANs) in the United States have not been described well, primarily because of race misclassification and, until the 1990s, incomplete coverage of their population by cancer registries. Smoking, the predominant cause of lung cancer, is particularly prevalent among this population.

METHODS. Data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program were combined to estimate age adjusted incidence rates of lung cancer during 1999 through 2004. Cases were linked to Indian Health Service (IHS) registration databases to identify AI/ANs whose race …

Host And Vector Movement Affects Genetic Diversity And Spatial Structure Of Buggy Creek Virus (Togaviridae), Charles R. Brown, Mary Bomberger Brown, Abinash Padhi, Jerome E. Foster, Amy T. Moore, Martin Pfeffer, Nicholas Komar

United States Public Health Resources

Determining the degree of genetic variability and spatial structure of arthropod-borne viruses (arboviruses) may help in identifying where strains that potentially cause epidemics or epizootics occur. Genetic diversity in arboviruses is assumed to reflect relative mobility of their vertebrate hosts (and invertebrate vectors), with highly mobile hosts such as birds leading to genetic similarity of viruses over large areas. There are no empirical studies that have directly related host or vector movement to virus genetic diversity and spatial structure. Using the entire E2 glycoprotein-coding region of 377 Buggy Creek virus isolates taken from cimicid swallow bugs (Oeciacus vicarius), …

Methods For Improving Cancer Surveillance Data In American Indian And Alaska Native Populations, David K. Espey, Charles Wiggins, Melissa A. Jim, Barry A. Miller, Christopher J. Johnson, Tom M. Becker

United States Public Health Resources

BACKGROUND. The misclassification of race decreases the accuracy of cancer incidence data for American Indians and Alaska Natives (AI/ANs) in some central cancer registries. This article describes the data sources and methods that were used to address this misclassification and to produce the cancer statistics used by most of the articles in this supplement.

METHODS. Records from United States cancer registries were linked with Indian Health Service (IHS) records to identify AI/AN cases that were misclassified as non-AI/AN. Data were available from 47 registries that linked their data with IHS, met quality criteria, and agreed to participate. Analyses …

Prostate Cancer Incidence Among American Indian And Alaska Native Men, Us, 1999–2004, Jeffrey A. Henderson, David K. Espey, Melissa Jim, Robert R. German, Kate M. Shaw, Richard M. Hoffman

United States Public Health Resources

BACKGROUND. American Indian and Alaska Native (AI/AN) men experience lower incidence of prostate cancer than other race/ethnic populations in the US, but racial misclassification of AI/AN men threatens the validity of these estimates. To the authors’ knowledge, little is known concerning prostate-specific antigen (PSA) testing in AI/AN men.

METHODS. The authors linked cancer registry data with Indian Health Service enrollment records to improve race classification. Analyses comparing cancer incidence rates and stage at diagnosis for AI/AN and non-Hispanic white (NHW) men for 6 geographic regions focused on counties known to have less race misclassification. The authors also used …

Primary Liver Cancer Incidence Among American Indians And Alaska Natives, Us, 1999–2004, Melissa Jim, David G. Perdue, Lisa C. Richardson, David K. Espey, John T. Redd, Howard J. Martin, Sandy L. Kwong, Janet J. Kelly, Jeffrey A. Henderson, Faruque Ahmed

United States Public Health Resources

BACKGROUND. American Indians and Alaska Natives (AI/AN) experience higher morbidity and mortality from primary liver cancer than other United States (US) populations, but racial misclassification in medical records results in underestimates of disease burden.

METHODS. To reduce misclassification, National Program of Cancer Registries and Surveillance, Epidemiology, and End Results data were linked with Indian Health Service (IHS) enrollment records to compare primary liver cancer incidence and stage at diagnosis between AI/AN and non-Hispanic whites (NHW) living within the regionalized IHS Contract Health Service Delivery Area counties. Incidence rates are expressed per 100,000 persons and age-adjusted by 19 age …

Gallbladder Cancer Incidence Among American Indians And Alaska Natives, Us, 1999–2004, Shannon M. Lemrow, David G. Perdue, Sherri L. Stewart, Lisa C. Richardson, Melissa Jim, Helen T. French, Judith Swan, Brenda K. Edwards, Charles Wiggins, Lois Dickie, David K. Espey

United States Public Health Resources

BACKGROUND. Gallbladder cancer (GBC) is rare; however, it disproportionately affects the American Indian and Alaska Natives (AI/AN) population. The purpose of the study was to characterize GBC among AI/AN in the US population.

METHODS. Cases of GBC diagnosed between 1999 and 2004 and collected by state-based cancer registries were included. Registry records were linked with Indian Health Service (IHS) administration records to decrease race misclassification of AI/AN. GBC rates and/or percent distributions for AI/AN and non-Hispanic whites (NHW) were calculated by sex, IHS region, age, and stage for all US counties and IHS Contract Health Service Delivery Area …

Regional Differences In Colorectal Cancer Incidence, Stage, And Subsite Among American Indians And Alaska Natives, 1999–2004, David G. Perdue, Carin Perkins, Jeannette Jackson-Thompson, Steven S. Coughlin, Faruque Ahmed, Donald S. Haverkamp, Melissa Jim

United States Public Health Resources

BACKGROUND. Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality for American Indians and Alaska Natives (AI/ANs), but misclassification of race causes underestimates of disease burden.

METHODS. The authors compared regional differences in CRC incidence, stage at diagnosis, and anatomic distribution between AI/ANs and non-Hispanic whites (NHWs). To reduce misclassification, data from the National Program of Cancer Registries; the Surveillance, Epidemiology, and End Results Program; and the Indian Health Service (IHS) were linked. The analysis was limited to the 56% of AI/ AN who live in IHS Contract Health Service Delivery Areas.

RESULTS. From …

Trends In Esophageal Cancer Incidence By Histology, United States, 1998–2003, Katrina F. Trivers, Susan A. Sabatino, Sherri L. Stewart

United States Public Health Resources

Esophageal adenocarcinoma rates may be increasing, whereas, squamous cell carcinoma rates appear to be decreasing in the United States. Previous population-based research on esophageal cancer has only covered up to 68% of the country. Additional, updated research on a larger percentage of the country is needed to describe racial, ethnic and regional trends in histologic subtypes of esophageal cancer. Invasive esophageal cancer cases diagnosed between 1998 and 2003 (n = 65,926), collected by the National Program of Cancer Registries or the Surveillance, Epidemiology, and End Results program, were included. These data cover 83% of the US population. Esophageal squamous …

Surveillance For Health Behaviors Of American Indians And Alaska Natives—Findings From The Behavioral Risk Factor Surveillance System, 2000–2006, C. Brooke Steele, Cheryll J. Cardinez, Lisa C. Richardson, Lillian Tom-Orme, Kate M. Shaw

United States Public Health Resources

BACKGROUND. The authors compared estimates for cancer risk factors, use of cancer screening tests, health status indicators, and access to care for American Indians and Alaska Natives (AI/ANs) and non-Hispanic whites (NHWs) in the US and for AI/ANs in 6 Indian Health Service regions.

METHODS. Behavioral Risk Factor Surveillance System data were aggregated from the years 2000 through 2006 and were used to calculate weighted prevalence estimates by gender for key variables except demographic variables.

RESULTS. Compared with NHWs, AI/ANs had lower prevalence estimates for income, educational attainment, insurance coverage, and access to personal healthcare providers. AI/ANs …

Cancer Among American Indians And Alaska Natives In The United States, 1999–2004, Charles Wiggins, David K. Espey, Phyllis A. Wingo, Judith S. Kaur, Robin Taylor Wilson, Judith Swan, Barry A. Miller, Melissa Jim, Janet J. Kelly, Anne P. Lanier

United States Public Health Resources

BACKGROUND. Cancer incidence rates vary among American Indian and Alaska Native (AI/AN) populations and often differ from rates among non-Hispanic whites (NHWs). However, the misclassification of race for AI/AN cancer cases in central cancer registries may have led to underestimates of the AI/AN cancer burden in previous reports.

METHODS. Cases diagnosed during 1999 through 2004 were identified from population- based cancer registries in the United States. Age-adjusted rates were calculated for the 25 most common sites for AI/ANs and NHWs. To minimize the misclassification of race, cancer registry records were linked with patient registration files from the Indian …

Breast Cancer Incidence Among American Indian And Alaska Native Women: Us, 1999–2004, Phyllis A. Wingo, Jessica King, Judith Swan, Steven S. Coughlin, Judith S. Kaur, Julie A. Erb-Alvarez, Jeannette Jackson-Thompson, Teshia G. Arambula Solomon

United States Public Health Resources

BACKGROUND. Breast cancer is a leading cause of cancer morbidity and mortality among American Indian and Alaska Native (AI/AN) women. Although published studies have suggested that breast cancer rates among AI/AN women are lower than those among other racial and ethnic populations, accurate determinations of the breast cancer burden have been hampered by misclassification of AI/AN race.

METHODS. Cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program were combined to estimate age-adjusted rates for the diagnosis years 1999 through 2004. Several steps were taken to reduce the misclassification of …

Bilateral Claudication Results In Alterations In The Gait Biomechanics At The Hip And Ankle Joints, Shing-Jye Chen, Iraklis Pipinos, Jason Johanning, Matija Radovic, Jessie M. Huisinga, Sara A. Myers, Nikolaos Stergiou

United States Public Health Resources

Claudication is the most common symptomatic manifestation of peripheral arterial disease (PAD), producing significant ambulatory compromise. The purpose of this study was to use advanced biomechanical gait analysis to determine the gait alterations occurring in claudicating patients both before and after onset of claudication pain in their legs. Hip, knee, and ankle joint moments were measured in claudicating patients (age: 64.46±8.47 years; body mass: 80.70±12.64 kg; body height: 1.72±0.08 m) and were compared to gender–age–body mass–height-matched healthy controls (age 66.27±9.22 years; body mass: 77.89±10.65 kg; body height: 1.74±0.08 m). The claudicating patients were evaluated both before (pain-free (PF) condition) and …

Alcohol Research: A Lifespan Perspective, National Institute On Alcohol Abuse And Alcoholism

United States Public Health Resources

Contents:
The Embryo and Fetus: Focus on Fetal Alcohol Spectrum Disorder (FASD) and Fetal Alcohol Syndrome (FAS)
Midlife Focus on Detrimental Effects of Drinking and on Treatment Options
Senior Adults and Alcohol: A National Health Issue

Alcohol use and the risk for alcohol-related problems change over the lifespan. College students and young adults, who often drink large quantities of alcohol at one time, are more likely to experience problems such as alcohol poisoning, drunk-driving crashes, and assaults; whereas, older individuals who drink even moderately while taking certain medications run the risk of harmful drug interactions. Additionally, patterns of alcohol use …

First Administration To Humans Of A Monoclonal Antibody Cocktail Against Rabies Virus: Safety, Tolerability, And Neutralizing Activity, A.B.H. Bakker, C. Python, C.J. Kissling, P. Pandya, W.E. Marissen, M.F. Brink, F. Lagerwerf, S. Worst, E. Van Corven, S. Kostense, K. Hartmann, G.J. Weverling, F. Uytdehaag, C. Herzog, D.J. Briggs, C.E. Rupprecht, R. Grimaldi, J. Goudsmit

United States Public Health Resources

Immediate passive immune prophylaxis as part of rabies post-exposure prophylaxis (PEP) often cannot be provided due to limited availability of human or equine rabies immunoglobulin (HRIG and ERIG, respectively). We report first clinical data from two phase I studies evaluating a monoclonal antibody cocktail CL184 against rabies.
The studies included healthy adult subjects in the USA and India and involved two parts. First, subjects received a single intramuscular dose of CL184 or placebo in a double blind, randomized, dose-escalation trial. Second, open-label CL184 (20 IU/kg)was co-administered with rabies vaccine. Safety was the primary objective and rabies virus neutralizing activity (RVNA) …

Toward Vocabulary Control For Chief Complaint, Stephanie W. Haas, Debbie Travers, Judith E. Tintinalli, Daniel Pollock, Anna Waller, Edward Barthell, Catharine Burt, Wendy Chapman, Kevin Coonan, Donald Kamens, James Mcclay

United States Public Health Resources

The chief complaint (CC) is the data element that documents the patient’s reason for visiting the emergency department (ED). The need for a CC vocabulary has been acknowledged at national meetings and in multiple publications, but to our knowledge no groups have specifically focused on the requirements and development plans for a CC vocabulary. The national consensus meeting ‘‘Towards Vocabulary Control for Chief Complaint’’ was convened to identify the potential uses for ED CC and to develop the framework for CC vocabulary control. The 10-point consensus recommendations for action were 1) begin to develop a controlled vocabulary for CC, 2) …

An In Vitro Method Of Alcoholic Liver Injury Using Precision-Cut Liver Slices From Rats, Lynell W. Klassen, Geoffrey M. Thiele, Michael J. Duryee, Courtney S. Schaffert, Amy L. Deveney, Carlos D. Hunter, Peter Olinga, Dean J. Tuma

United States Public Health Resources

Alcohol abuse results in liver injury, but investigations into the mechanism(s) for this injury have been hampered by the lack of appropriate in vitro culture models in which to conduct in depth and specific studies. In order to overcome these shortcomings, we have developed the use of precision-cut liver slices (PCLS) as an in vitro culture model in which to investigate how ethanol causes alcohol-induced liver injury. In these studies, it was shown that the PCLS retained excellent viability as determined by lactate dehydrogenase and adenosine triphosphate (ATP) levels over a 96-h period of incubation. More importantly, the major enzymes …

Populations Receiving Optimally Fluoridated Public Drinking Water— United States, 1992-2006

United States Public Health Resources

Water fluoridation has been identified by CDC as one of 10 great public health achievements of the 20th century. The decline in the prevalence and severity of dental caries (tooth decay) in the United States during the past 60 years has been attributed largely to the increased use of fluoride. Community water fluoridation is an equitable and cost-effective method for delivering fluoride to the community. A Healthy People 2010 objective is to increase to 75% the proportion of the U.S. population served by community water systems who receive optimally fluoridated water. To update and revise previous reports on fluoridation in …

Self-Reported Falls And Fall-Related Injuries Among Persons Aged ≥65 Years–United States, 2006, J.A. Stevens, K.A. Mack, L.J. Paulozzi, M.F. Ballesteros

United States Public Health Resources

Problem: In 2005, 15,802 persons aged ≥65 years died from fall injuries. How many older adults seek outpatient treatment for minor or moderate fall injuries is unknown.
Method: To estimate the percentage of older adults who fell during the preceding three months, the Centers for Disease Control and Prevention (CDC) analyzed data from two questions about falls included in the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey.
Results: Approximately 5.8 million (15.9%) persons aged ≥65 years reported falling at least once during the preceding three months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted …

Animal-Side Serologic Assay For Rapid Detection Of Mycobacterium Bovis Infection In Multiple Species Of Free-Ranging Wildlife, K.P. Lyashchenko, R. Greenwald, J. Esfandiari, M.A. Chambers, J. Vicente, C. Gortazar, N. Santos, M. Correia-Neves, B.M. Buddle, R. Jackson, D.J. O’Brien, S. Schmitt, M. V. Palmer, R.J. Delahay, W.R. Waters

Michigan Bovine Tuberculosis Bibliography and Database

Numerous species of mammals are susceptible to Mycobacterium bovis, the causative agent of bovine tuberculosis (TB). Several wildlife hosts have emerged as reservoirs of M. bovis infection for domestic livestock in different countries. In the present study, blood samples were collected from Eurasian badgers (n = 1532), white-tailed deer (n = 463), brushtail possums (n = 129), and wild boar (n = 177) for evaluation of antibody responses to M. bovis infection by a lateral-flow rapid test (RT) and multiantigen print immunoassay (MAPIA). Magnitude of the antibody responses and antigen recognition patterns varied among the animals as determined by …

A Versatile Assay For The Identification Of Rna Silencing Suppressors Based On Complementation Of Viral Movement, Jason G. Powers, Tim L. Sit, Feng Qu, T. Jack Morris, Kook-Hyung Kim, Steven A. Lommel

Nebraska Center for Virology: Faculty Publications

The cell-to-cell movement of Turnip crinkle virus (TCV) in Nicotiana benthamiana requires the presence of its coat protein (CP), a known suppressor of RNA silencing. RNA transcripts of a TCV construct containing a reporter gene (green fluorescent protein) (TCV-sGFP) in place of the CP open reading frame generated foci of three to five cells. TCV CP delivered in trans by Agrobacterium tumefaciens infiltration potentiated movement of TCV-sGFP and increased foci diameter, on average, by a factor of four. Deletion of the TCV movement proteins in TCV-sGFP (construct TCVΔ92-sGFP) abolished the movement complementation ability of TCV CP. Other known suppressors of …

Using Population-Based Cancer Registry Data To Assess The Burden Of Human Papillomavirus-Associated Cancers In The United States: Overview Of Methods, Meg Watson, Mona Saraiya, Faruque Ahmed, Cheryll J. Cardinez, Marsha E. Reichman, Hannah K. Weir, Thomas B. Richards

United States Public Health Resources

Increased attention to human papillomavirus (HPV)-associated cancers in light of the recent release of an HPV vaccine, as well as increased availability of cancer registry data that now include reporting from a large proportion of the US population, prompted the current assessment of HPV-associated cancers. This article describes methods used to assess the burden of HPV-associated cervical, vulvar, vaginal, penile, anal, and oral cavity/oropharyngeal cancers in the United States during 1998 through 2003 using cancer registry data, and it provides a brief overview of the epidemiology of these cancers.

Persistent infection with the human papillomavirus (HPV) is considered to be …

Michigan Bovine Tuberculosis Eradication Project: 2008 Activities Report

Michigan Bovine Tuberculosis Bibliography and Database

Bovine Tuberculosis (TB) is an infectious disease that is close to being eradicated in the United States, but still poses a significant risk to domestic livestock, wildlife, companion animals, and humans throughout the world. The Michigan Bovine TB Eradication Project involves a multiagency team of experts from the Michigan Departments of Agriculture, Natural Resources and Community Health, Michigan State University, and the US Department of Agriculture.

Managing Bovine Tuberculosis In White-Tailed Deer In Northwestern Minnesota: A 2008 Progress Report, Michelle Carstensen, Erika Butler, Michael Doncarlos, Lou Cornicelli

Michigan Bovine Tuberculosis Bibliography and Database

Bovine tuberculosis (TB), first discovered in 2005, has now been found in 12 cattle operations in northwestern Minnesota. To date, all of the infected cattle herds have been depopulated and the Board of Animal Health (BAH) has continued to test cattle herds in the area. The strain has been identified as one that is consistent with Bovine TB found in cattle in the southwestern United States and Mexico. In response to the disease being detected in cattle, the Minnesota Department of Natural Resources (MNDNR) began surveillance efforts in free-ranging white-tailed deer (Odocoileus virginianus) within a 15-mile radius of …

Risks Associated With The Transmission Of Bovine Tuberculosis From White-Tailed Deer To Cattle In Michigan: Current Research, Are R. Berentsen, Mike R. Dunbar, Regina Ebersole, Robert G. Mclean

Michigan Bovine Tuberculosis Bibliography and Database

Bovine tuberculosis (bTB) is a contagious disease of livestock, wildlife, and humans. Typically, it is transmitted through inhalation of aerosolized bacilli and direct or indirect contact between animals. In northeastern Michigan, bTB is endemic in white-tailed deer, and evidence suggests deer have spread the disease to domestic cattle. Previous research indicates bTB transmission likely occurs through contamination of cattle feeding sources by infected deer and subsequent use by cattle. We are investigating deer movements in relation to farm management practices such as feeding schedules as well as locations of cattle feeding areas, hay storage sites, barns, and water sources. All …

Blood Culture And Stimulation Conditions For The Diagnosis Of Tuberculosis In Cervids By The Cervigam Assay, W. R. Waters, M. V. Palmer, T. C. Thacker, K. Orloski, P. Nol, N. P. Harrington, S. C. Olsen, B. J. Nonnecke

Michigan Bovine Tuberculosis Bibliography and Database

Mitogen- and antigen-induced interferon-γ (IFN-γ) responses of peripheral blood leucocytes from cervids were evaluated by a commercial whole-blood assay. The assay was applied to Mycobacterium bovis-infected white-tailed deer and reindeer, M bovis BCG-vaccinated white-tailed deer and elk, and unvaccinated, uninfected white-tailed deer, fallow deer, elk and reindeer. The responses of the M bovis-infected white-tailed deer to pokeweed mitogen (PWM) varied with time and between individuals. The responses of the M bovis-infected reindeer to PWM and M bovis purified protein derivative (PPD) were positively associated. Samples from tuberculosis-free captive herds in various parts of the USA were also …

Sentinel-Based Surveillance Of Coyotes To Detect Bovine Tuberculosis, Michigan, Kurt C. Vercauteren, Todd C. Atwood, Thomas J. Deliberto, Holly J. Smith, Justin S. Stevenson, Bruce V. Thomsen, Thomas Gidlewski, Janet Payeur

Michigan Bovine Tuberculosis Bibliography and Database

Bovine tuberculosis (TB) is endemic in white-tailed deer (Odocoileus virginianus) in the northeastern portion of Michigan’s Lower Peninsula. Bovine TB in deer and cattle has created immense fi nancial consequences for the livestock industry and hunting public. Surveillance identified coyotes (Canis latrans) as potential bio-accumulators of Mycobacterium bovis, a finding that generated interest in their potential to serve as sentinels for monitoring disease risk. We sampled 175 coyotes in the bovine TB–endemic area. Fifty-eight tested positive, and infection prevalence by county ranged from 19% to 52% (statistical mean 33%, SE 0.07). By contrast, prevalence in …

Eye Malformations In Children With Heavy Alcohol Exposure In Utero, Elizabeth Y. Flanigan, Sora Aros, Maria Ferraz Bueno, Mary Conley, James F. Troendle, Fernando Cassorla, James L. Mills

Uniformed Services University of the Health Sciences

Objective: To determine whether children who do not develop fetal alcohol syndrome (FAS) despite heavy alcohol exposure are at risk for eye abnormalities.
Study design: We screened 9628 pregnant women and identified 101 women who were drinking > 2 oz of absolute alcohol per day and 101 nondrinking control women. We followed 43 exposed and 55 control offspring between age 4 and 9 years, performing masked standardized ophthalomologic examinations.
Results: The groups did not differ in their rates of impaired visual acuity, refractory errors, ptosis, epicanthal folds, or short palpebral fissures. Biomicroscopy examination was normal in all exposed …

Duffy Antigen Receptor For Chemokines Mediates Trans-Infection Of Hiv-1 From Red Blood Cells To Target Cells And Affects Hiv-Aids Susceptibility, Weijing He, Stuart Neil, Hemant Kulkarni, Edward Wright, Brian K. Agan, Vincent C. Marconi, Matthew J. Dolan, Robin A. Weiss, Sunil K. Ahuja

Uniformed Services University of the Health Sciences

Duffy antigen receptor for chemokines (DARC) expressed on red blood cells (RBCs) influences plasma levels of HIV-1-suppressive and proinflammatory chemokines such as CCL5/RANTES. DARC is also the RBC receptor for Plasmodium vivax. Africans with DARC -46C/C genotype, which confers a DARC negative phenotype, are resistant to vivax malaria. Here, we show that HIV-1 attaches to RBCs via DARC, effecting trans-infection of target cells. In African Americans, DARC -46C/C is associated with 40% increase in the odds of acquiring HIV-1. If extrapolated to Africans, ~11% of the HIV-1 burden in Africa may be linked to this genotype. …

Predicting, Preparing For, And Creating The Future: What Will Happen To Internal Medicine?, Paul A. Hemmer, Sheila T. Costa, Deborah M. Demarco, Stuart L. Linas, Don C. Glazier, Barbara L. Schuster

Uniformed Services University of the Health Sciences

It is the year 2025. During the past 20 years, internal medicine as a discipline continued to become less prestigious, less respected, and more fragmented. As fewer medical students chose internal medicine as a career, residency programs began to close. Those that remained open filled with fewer graduates of US medical schools but filled with more US citizens who graduated from international medical schools, more graduates of osteopathic medical schools, and more foreign graduates of international medical schools. Due to lack of adequate remuneration and a shift of primary care provision from generalist physicians to nurse practitioners and physician assistants, …