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Biomedical subjects

D Wear

Publications and source records attributed to D Wear.

At least 19 recordsLinked to original sources
PubMed2001

Ecological forecasts: an emerging imperative.

Planning and decision-making can be improved by access to reliable forecasts of ecosystem state, ecosystem services, and natural capital. Availability of new data sets, together with progress in computation and statistics, will increase our ability to forecast ecosystem change. An agenda that would lead toward a capacity to produce, evaluate, and communicate forecasts of critical ecosystem services requires a process that engages scientists and decision-makers. Interdisciplinary linkages are necessary because of the climate and societal controls on ecosystems, the feedbacks involving social change, and the decision-making relevance of forecasts.

Agriculture↗
PubMed2001

Identification of the target cells of Orientia tsutsugamushi in human cases of scrub typhus.

Orientia tsutsugamushi is the etiologic agent of scrub typhus, a chigger-borne zoonosis that is a highly prevalent, life-threatening illness of greatest public health importance in tropical Asia and the islands of the western Pacific Ocean. The target cell of this bacterium is poorly defined in humans. In this study, O. tsutsugamushi were identified by immunohistochemistry using a rabbit polyclonal antibody raised against O. tsutsugamushi Karp strain in paraffin-embedded archived autopsy tissues of three patients with clinical suspicion of scrub typhus who died during World War II and the Vietnam War. Rickettsiae were located in endothelial cells in all of the organs evaluated, namely heart, lung, brain, kidney, pancreas, and skin, and within cardiac muscle cells and in macrophages located in liver and spleen. Electron microscopy confirmed the location of rickettsiae in endothelium and cardiac myocytes.

Adult↗
PubMed2000

Lack of serological evidence for Mycoplasma fermentans infection in army Gulf War veterans: a large scale case-control study.

Mycoplasma firmentans is suspected in the development of 'Gulf War illness' in veterans of Operation Desert Storm. We conducted a matched case-control study for the prevalence of M. firmentans-specific antibodies before and after the operation, as well as seroconversion rates in veterans with and without complaints of 'Gulf War illness'. Cases consisted of Gulf War veterans, who complained of various illnesses and were enrolled in the second phase of the health evaluation by the Army Comprehensive Clinical Examination Program (CCEP). Controls were selected from Gulf War veterans who did not participate in the registry and did not request a health evaluation by the CCEP. Before operation deployment, 34 out of 718 of the cases (48%) and 116 out of 2233 of the controls (5.2%) tested positive for M. fermentans-specific antibodies. There was no difference in rates of seroconversion between cases and controls (1.1 vs. 1.2%) to M. fermentans during Operation Desert Storm. Thus, there is no serological evidence that suggests infectionby M. fermentans is associated with development of 'Gulf War illness'.

Adolescent↗
PubMed2000

The development of professionalism: curriculum matters.

The authors propose that professionalism, rather than being left to the chance that students will model themselves on ideal physicians or somehow be permeable to other elements of professionalism, is fostered by students' engagement with significant, integrated experiences with certain kinds of content. Like clinical reasoning, which cannot occur in a vacuum but must be built on particular knowledge, methods, and the development of skills, professionalism cannot flourish without its necessary basis of knowledge, methods, and skills. The authors present the need for an intellectual widening of the medical curriculum, so that students acquire not only the necessary tools of scientific and clinical knowledge, methods, and skills but also other relevant tools for professional development that can be provided only by particular knowledge, methods, and skills outside bioscience domains. Medical students have little opportunity to engage any body of knowledge not gained through bioscientific/empirical methods. Yet other bodies of knowledge-philosophy, sociology, literature, spirituality, and aesthetics are often the ones where compassion, communication, and social responsibility are addressed, illuminated, practiced, and learned. To educate broadly educated physicians who develop professionalism throughout their education and their careers requires a full-spectrum curriculum and the processes to support it. The authors sketch the ways in which admission, the curriculum (particularly promoting a sociologic consciousness, interdisciplinary thinking, and understanding of the economic/ political dimensions of health care), and assessment and licensure would function.

Clinical Competence↗
PubMed2000

Physician views on practicing professionalism in the corporate age.

Arnold Relman argues that medical education does not prepare students and residents to practice their profession in today's corporate health care system. Corporate health care administrators agree: Physicians enter the workforce unskilled in contract negotiation, evidence-based medicine, navigating bureaucratic systems, and so forth. What about practicing physicians? Do they agree as well? According to this study, they do. Feeling like decentered double agents and unprepared, physicians find themselves professionally lost, struggling to balance issues of cost and care and expressing lots of negativity toward the cultures of medicine and managed care. However, physicians are resilient. A group of physicians, who may be called proactive, are meeting the professional demands of corporate health care by becoming sophisticated about its bureaucratic organization and the ways in which their professional and personal commitments fit within the system. Following the lead of proactive physicians, the authors support Relman's thesis and education for both students and physicians requires a major overhaul.

Attitude of Health Personnel↗
PubMed2000

Asian/Pacific Islander women in medical education: personal and professional challenges.

PURPOSE: The purpose of this qualitative study was to identify the complex issues facing Asian/Pacific Islander (API) women students at one Midwestern medical school as they subjectively experience their medical training. Of particular interest was how students navigated family influences, career planning, and ethnic and gender stereotypes. SUMMARY: Sixty-five percent of the students reported that their parents exerted various degrees of encouragement or pressure to enter medicine. The remaining students said that the decision was entirely theirs (20%) or that the decision had been made for them (15%). Many reported the larger Asian "community" as a source of influence. A slight majority of students thought they were perceived by faculty as being "quiet," often too quiet. With only 1 exception, all of the students believed that their cultural identity influenced their specialty choice. Stressors reported by students centered on competition, achievement, and formation of intimate relationships (i.e., dating). CONCLUSIONS: Medical educators who provide personal and professional support for API women students should be keenly aware of the career, gender, and family issues that emerge at the intersection of API and Euro-American cultures. Faculty development should include an educational component on issues of concern to API students, men and women. Faculty also need to wrestle with the cultural values of "modesty, respect for authority, public self-consciousness, and other directness" as they intersect with assertion as a primary value found in Euro-American culture in general and in medical education in particular.

Asian↗
PubMed1998

On white coats and professional development: the formal and the hidden curricula.

White coat ceremonies are a recent phenomenon in medical education. Selected as a symbol by the Arnold P. Gold Foundation to impress upon medical students the importance of compassion and humility, the white coat has had a long association with all things medical, scientific, and healing. It is also associated with the attributes of purity and goodness traditionally symbolized by the color white. Thus, its selection as the material focus of the white coat ceremony seems natural. This article situates the white coat ceremony as a curricular event and suggests that, in addition to having the meanings cited above, the white coat has other meanings that fall into the realm of the hidden curriculum--it can symbolize caregiving hierarchies and spheres of practice, the social and economic privilege of physicians, and medicine's well-established practices of determining membership in the profession. Finally, this paper suggests several other ceremonies or rituals that may be better than the white coat ceremony for encouraging compassion and humility in medical students.

Ceremonial Behavior↗
PubMed1997

Professional development of medical students: problems and promises.

Observers and critics of the medical profession, both within and without, urge that more attention be paid to the moral sensibilities, the characters, of medical students. Passing on particular moral values and actions to physicians has always been an essential core of medical training, and this call for renewal is not new in modern medicine. Some of the structures and characteristics of modern medical education, however, often work directly against the professionalism that the education espouses. For example, medical students are socialized into a hierarchy that has broad implications for relations among health care professionals, other health care workers, and patients, and academic medicine has not promoted and taught critical reflection about the values and consequences of this hierarchy. Further, behind the formal curriculum lies the "hidden curriculum" of values that are unconsciously or half-consciously passed on from the faculty and older trainees. Two resources for thinking anew about professional development for medical students are feminist standpoint theory and critical multicultural theory, each of which raises important and fundamental questions about defining the role of medicine in society and the role of the physician in medicine. The author discusses these two theories and their implications for medical education, showing how they can be used to move discussions of professional development into analysis of the widespread social consequences of how a society organizes its health care and into critical reflection on the nature of medical knowledge.

Character↗
PubMed1994

The depiction of medical education in medical school catalogs.

BACKGROUND: Medical educators bear responsibility for the informational materials that their institutions use to communicate with potential applicants. These documents, because they are often the first official correspondence that prospective students receive, may be influential in shaping students' expectations. METHOD: In March 1990 all North American medical schools that awarded MD or DO degrees were requested to send their catalogs and courses of study to the authors. In response came 175 documents, with nearly all the schools represented at least once. The photographs and other visual images in these documents were then analyzed from the perspective of a hypothetical applicant who perused what his or her initial request for information had produced. RESULTS: Nearly 3,400 images were analyzed and categorized according to content and stylistic approach. Two basic stylistic approaches were found: stylized and documentary. Few documents used exclusively one or the other approach, as the approaches represent poles along a continuum. The stylized approach portrays medical education as a product to be sold, whereas the documentary approach candidly tells the story of medical education. CONCLUSION: The authors conclude that the documentary approach is a more morally responsible way for schools to communicate with individuals who are in the beginning stages of building their mental images of medical education and medical care.

Catalogs as Topic↗
PubMed1993

"Your breasts/sliced off": literary images of breast cancer.

This essay explores how breast cancer and mastectomy are portrayed in twentieth-century North American literature. The purpose in doing so is to examine our understandings of how women in contemporary North American culture may experience this potentially fatal disease and disfigurement-understandings that often are narrowly prescribed by the abstract, universalizing language of medicine. The essay is divided into four sections based on the readings of the selected literature: denial and fear; sadness and pain; shame through others' eyes; and transcendence.

Adult↗
PubMed1993

Literary images of menopause.

In contemporary North American cultures, menopause is primarily thought of as a deficiency disease. In literature, however, authors often portray menopause differently. In various literary portrayals, menopause evokes themes of the urgency of remaining life span, the occurrence of a significant life event, and a rite of passage. The use of literature to understand the way women experience life may help deepen and enlarge the perceptions of students and residents regarding the menopause.

Female↗