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PubMed1989

AMA and TMA: partners for better health.

United States Rep Charles W. Stenholm (D-Tex) has warned physicians, "The AMA can be effective only if members of Congress are convinced that this group truly represents their constituents. Until the AMA represents a majority of its self-proclaimed constituency, it won't be as effective as physicians across the country would like it to be." Texas Medical Association is the fourth largest delegation to the American Medical Association, but approximately 40% of the TMA membership does not belong to the national organization. Nationwide, approximately 60% of physicians have chosen not to join the AMA. TMA's House of Delegates recognizes the importance of a strong national organization and supports communication and recruitment activities to assure the state has maximum voluntary participation in the AMA. This article describes the AMA's activities as the physician's and the patient's advocate.

American Medical Association↗

PubMedDate not supplied

Quality of the family physician component of AMA Masterfile.

BACKGROUND: This investigation was undertaken to gain insight into the validity of the American Medical Association (AMA) Masterfile data. METHODS: Allopathic family physicians were chosen as the study population Omissions were picked up from by comparing the AMA list with the 1990 Ohio Academy of Family Physicians Foundation-Ohio Department of Health (OAFPF-ODH) census. Verification of the 1990 specialty and geographic location of allopathic family physicians not common to both files was achieved by sequentially (1) reviewing the AMA names against 1990 deletions from the 1985 OAFPF-ODH census, (2) contacting physicians directly by telephone, (3) verifying 1990 physician status with county medical personnel, and (4) mailing a brief questionnaire to each physician whose 1990 status remained unverified. RESULTS: The status of specialty and geographic location in 1990 was verified in 91 percent of names not common to both lists. Incorrect omissions (undercounts) and incorrect inclusions (overcounts) offset each other for both lists. Two groups of family physicians contribute to counting biases: family physicians who fulfill short-term goals by part-time practice in several locations, and family physicians who restrict their practice to a limited medical content area. CONCLUSIONS: Because of nearly equal offsetting of overcounting (incorrect inclusions) and under counting (incorrect omissions), the 1990 Ohio family physician AMA Masterfile data is adequate for work-force projections and policy studies when the county data are aggregated at the state level. The overcounting and undercounting for smaller areas or categories must still be studied, however. Application of the AMA Masterfile data of other geographic areas requires a knowledge of the components of undercounts and overcounts of the population being studied.

American Medical Association↗

PubMed1995

Biodistribution and radioimmunopharmacokinetics of 131I-Ama monoclonal antibody in atherosclerotic rabbits.

Monoclonal antibodies have been raised against Ama isolated from human and experimental atherosclerotic plaque. 131I-Ama-MoAb in the whole antibody form was injected into normal NZW rabbits and Watanabe hyperlipidemic rabbits. Biodistribution studies showed that atheromatous aortas had a significantly higher (5-7X) uptake of 131I-Ama-MoAb than that of normal aortas. However, 131I-Ama-MoAb was cleared very slowly from atherosclerotic rabbits. As a result, atheromas could not be identified by imaging because of the low target to non-target ratios.

Animals↗

PubMed2001

Polymorphism in the gene encoding the apical membrane antigen-1 (AMA-1) of Plasmodium falciparum. X. Asembo Bay Cohort Project.

We have investigated the genetic diversity of the gene encoding the apical membrane antigen-1 (AMA-1) in natural populations of Plasmodium falciparum from western Kenya and compared it with parasite populations from other geographic regions. A total of 28 complete sequences from Kenya, Thailand, India, and Venezuela field isolates were obtained. The genetic polymorphism is not evenly distributed across the gene, which is in agreement with the pattern reported in earlier studies. The alleles from Kenya exhibit 20 and 30% more polymorphism than that found in Southeast Asia and Venezuelan alleles, respectively. Based on the gene genealogies derived from sequencing data, no evidence for allele families was found. We have found evidence supporting limited gene flow between the parasite populations, specifically, between the Southeast Asian and Venezuelan isolates; however, no alleles could be linked to a specific geographic region. This study reveals that positive natural selection is an important factor in the maintenance of genetic diversity for AMA-1. We did not find conclusive evidence indicating intragenic recombination is important in the generation of the AMA-1 allelic diversity. The study provides information on the genetic diversity of the AMA-1 gene that would be useful in vaccine development and testing, as well as in assessing factors that are involved in the generation and maintenance of the genetic diversity in P. falciparum.

Alleles↗

PubMed2005

In harm's way: AMA physicians and the duty to treat.

In June 2001, the American Medical Association (AMA) issued a revised and expanded version of the Principles of Medical Ethics (last published in 1980). In light of the new and more comprehensive document, the present essay is geared to consideration of a longstanding tension between physician's autonomy rights and societal obligations in the AMA Code. In particular, it will be argued that a duty to treat overrides AMA autonomy rights in social emergencies, even in cases that involve personal risk to physicians (e.g., bioterrorist attack, HIV infection, SARS). The argument will be made by way of the logic and language of the AMA Code through its history, commentaries, and precedents. It also will be shown that there are substantial reasons to believe that the logic of the Code is sound in morally relevant ways. The essay will conclude with some philosophical proposals suggesting a framework for the duty to render aid and the extension of those duties to physicians facing personal risks.

American Medical Association↗

PubMed1990

Splenic contraction during breath-hold diving in the Korean ama.

Major increases of hemoglobin concentration and hematocrit, possibly secondary to splenic contraction, have been noted during diving in the Weddell seal. We sought to learn whether this component of the diving response could be present in professional human breath-hold divers. Splenic size was measured ultrasonically before and after repetitive breath-hold dives to approximately 6-m depth in ten Korean ama (diving women) and in three Japanese male divers who did not routinely practice breath-hold diving. Venous hemoglobin concentration and hematocrit were measured in nine of the ama and all Japanese divers. In the ama, splenic length and width were reduced after diving (P = 0.0007 and 0.0005, respectively) and calculated splenic volume decreased 19.5 +/- 8.7% (mean +/- SD, P = 0.0002). Hemoglobin concentration and hematocrit increased 9.5 +/- 5.9% (P = 0.0009) and 10.5 +/- 4% (P = 0.0001), respectively. In Japanese male divers, splenic size and hematocrit were unaffected by repetitive breath-hold diving and hemoglobin concentration increased only slightly over baseline (3.0 +/- 0.6%, P = 0.0198). Splenic contraction and increased hematocrit occur during breath-hold diving in the Korean ama.

Adult↗

PubMed1984

AMA's drug information data base: program capabilities and opportunities for clinical pharmacy.

The AMA drug information base (AMA-DIB) is reviewed and the impact of computerized drug data bases on the practice of clinical pharmacy is discussed. The AMA-DIB is an on-line data base derived from the fifth edition of AMA Drug Evaluations. Thus, it represents consensus information. The data base consists of individual drug records, pharmacologic class records, and therapeutic class records. It is accessed via commands using keyword searches. Computerized on-line drug data bases will have an impact on the practice of clinical pharmacy. Information resource services will either discontinue or proliferate, depending on the quality of the service and the ability of the directors to adapt to future needs. Patient monitoring services will discover that these data bases allow easier access to more information, but the computer will not be able to transfer the data to direct patient care. Thus, their professional roles will remain intact. Clinical pharmacy researchers, in contrast, will notice little or no impact on their practice.

American Medical Association↗

PubMed1999

On the concepts of amae and the mother-group.

Notwithstanding Freud's (1921) early linkage of psychoanalytic group psychology with patriarchal themes (i.e., father-leader), more recent findings suggest that the regression in group behavior in general, and in group psychotherapy in particular, tends to evoke frequent maternal ideations. In this connection, this article points to a phenomenological relationship between the individual's universal need to be at one with the internalized mother, as exemplified in the Japanese concept of amae and that of the Mother-Group. With amae serving as an explanatory construct for the group members' interpersonal relations (i.e., identifications and transferences), the idea of the Mother-Group ties in with the group entity's simultaneous supportive functions (i.e., "we are all in the same boat") coupled with its role as a collective arena for the reactivation of unconscious wishes for the nurturing mother of early childhood. In linking a Japanese psychological concept with another, which was developed in the West, I am disproving Rudyard Kipling's often quoted assertion that "never the East and the West shall meet." I was encouraged in this task by Takeo Doi's written comment to me that the idea of the Mother-Group "certainly can be linked with that of Amae. For instance, when the group functions as the Mother-Group, you can say that the participants are experiencing Amae in one way or another" (T. Doi, Sept. 17, 1993, personal communication). In an extended sense, one hopes this essay might even serve to revive our interest in the interrupted well-known early collaboration of psychoanalysts and of anthropologists, which had begun to forge a way to connect personality formation with its cultural context (LeVine, 1974). The insufficient attention paid to the influence of cultural factors on attachment behavior was recently decried by Bretherton (1997).

Child↗

PubMed1998

1996 congressional campaign priorities of the AMA: tackling tobacco or limiting malpractice awards?

OBJECTIVES: This study sought to determine whether the political action committee of the American Medical Association (AMA) contributed more to pro- or anti-tobacco members of Congress in the 1995/96 campaign and whether representatives' voting records on malpractice reform could explain the AMA's contribution patterns. METHODS: Campaign contributions to House members were analyzed. RESULTS: The AMA's political action committee contributed averages of $5382 to pro-tobacco representatives and $2103 to anti-tobacco representatives (P < .0005). This contribution pattern can be fully explained by representatives' votes to limit malpractice awards. CONCLUSIONS: In seeking malpractice reform, the AMA contributed significantly more to pro-tobacco representatives, potentially undermining tobacco control legislation.

Adolescent↗

PubMed1991

[The concept of "amae"].

A concept deriving from the Japanese word amae is introduced as that which bridges dependence and attachment, two conceptually different states. The word primarily refers to what an infant feels when it seeks mother, but it can be predicated of an adult to indicate the presence of a similar feeling of being emotionally close to another. Significantly, the feeling of amae is not mediated by words, though it can be acknowledged as such on reflection. Also, when frustrated, it can easily lead to a desire for such a feeling. Two popular stories, one French and the other American, are cited to illustrate the existence of amae, in fact its central importance, even in non-Japanese contexts. The psychology of keeping pets can also be understood in terms of amae. It is thus maintained that though the concept comes from Japanese, it is universally applicable and can shed a new light on the emotional life which has been the main target of psychoanalytic investigation.

Anecdotes as Topic↗

PubMedDate not supplied

Guidelines for medical and health information sites on the internet: principles governing AMA web sites. American Medical Association.

Access to medical information via the Internet has the potential to speed the transformation of the patient-physician relationship from that of physician authority ministering advice and treatment to that of shared decision making between patient and physician. However, barriers impeding this transformation include wide variations in quality of content on the Web, potential for commercial interests to influence online content, and uncertain preservation of personal privacy. To address these issues, the American Medical Association (AMA) has developed principles to guide development and posting of Web site content, govern acquisition and posting of online advertising and sponsorship, ensure site visitors' and patients' rights to privacy and confidentiality, and provide effective and secure means of e-commerce. While these guidelines were developed for the AMA Web sites and visitors to these sites, they also may be useful to other providers and users of medical information on the Web. These principles have been developed with the understanding that they will require frequent revision to keep pace with evolving technology and practices on the Internet. The AMA encourages review and feedback from readers, Web site visitors, policymakers, and all others interested in providing reliable quality information via the Web.

American Medical Association↗

PubMed2000

The Toxoplasma homolog of Plasmodium apical membrane antigen-1 (AMA-1) is a microneme protein secreted in response to elevated intracellular calcium levels.

A monoclonal antibody (MAb) has been generated against a novel 63 kDa surface/apical antigen of Toxoplasma gondii tachyzoites which is identified here as TgAMA-1, the Toxoplasma homolog of Plasmodium apical membrane antigen-1 (AMA-1). Sequence analysis, phase partitioning in Triton X-114, and labeling of TgAMA-1 with iodonaphthalene azide all suggest that TgAMA-1 is a type I transmembrane protein. There is a high degree of sequence similarity between TgAMA-1 and Plasmodium AMA-1, most notably in the position of conserved cysteine residues within the protein's predicted extracellular domain. In contrast to full length Plasmodium AMA-1, which has previously been localized to the rhoptries, it is shown here by immunofluorescence and immunoelectron microscopy that intracellular TgAMA-1 is found in the micronemes. A 53 kDa N-terminal proteolytic fragment of TgAMA-1 is constitutively secreted from the parasite at 37 degrees C. As is the case with other microneme proteins, the proteolytic processing and secretion of TgAMA-1 is dramatically enhanced in response to treatments which increase intracellular calcium levels.

Amino Acid Sequence↗

PubMed2006

Amae in Japan and the United States: an exploration of a "culturally unique" emotion.

The experience of an emotion considered to be culturally unique (i.e., Japanese Amae) was tested in the United States, where there is no word to describe the concept. North American and Japanese participants read scenarios in which a friend made an inappropriate request (Amae), made no request, or made the request to another friend. Both American and Japanese participants felt more positive emotion and perceived the requester as feeling closer to them in the Amae condition than in the other two conditions. However, Americans felt more in control when asked for a favor than when not asked, a pattern that did not emerge among the Japanese. Cultural specificity of hypocognized emotions is discussed.

Adult↗

PubMed1989

Projections of physician supply and demand: a summary of HRSA and AMA studies.

There is concern that the United States may have a surplus of physicians soon. In a continuation of a movement started around 1980 by the Graduate Medical Education National Advisory Committee (GMENAC) to quantify and project supply and demand for physicians, the American Medical Association (AMA) and the Health Resources and Services Administration (HRSA) have recently produced their latest studies on this subject. The HRSA conclusion, published in its 1988 report to the President and Congress on the status of health personnel in the United States, is that a surplus may come as early as 1990 and will probably worsen by the year 2000. The AMA study, also published in 1988, agrees with the HRSA and the GMENAC that supply will probably grow faster than demand, but it disclaims the notion of a surplus or shortage because that would imply judgments about the adequacy of current utilization rates by all segments of the population. The HRSA report cites a 1986 finding by the Robert Wood Johnson Foundation that access to medical care deteriorated between 1982 and 1986 for minorities and lower-income groups. On the supply side, the HRSA's estimates are somewhat higher than the AMA's, mainly because the former assumes faster growth in foreign medical graduates. Both studies use a demand-based approach to projecting the number of physicians required, but there are considerable differences in the assumptions made about future utilization rates.

American Medical Association↗

PubMed1986

Disposition of carumonam (AMA-1080/Ro 17-2301), a new N-sulfonated monocyclic beta-lactam, in rats and dogs.

Rats and dogs were given a single 20-mg/kg dose of [14C]carumonam intramuscularly or intravenously. In rats, the level in plasma of [14C]carumonam administered intramuscularly peaked (29.1 micrograms/ml) 15 min after dosing and then declined with an apparent elimination half-life of 16.2 min. Intramuscular injection of [14C]carumonam to dogs gave a peak level (36.8 micrograms/ml) in plasma at 20 min and an apparent elimination half-life of 51.7 min. After administration of the intravenous dose, apparent elimination half-lives were 13.1 and 52.7 min in rats and dogs, respectively. In both animals, the radioactivity in plasma was made up largely (greater than 80%) of unchanged carumonam, which was protein bound to only a small extent. In rats given [14C]carumonam intramuscularly, radioactivity was distributed widely in tissues, with relatively high concentrations in the kidney and liver. The radioactivity concentration in the rat fetus was relatively low, as was that in milk. In both rats and dogs carumonam did not undergo extensive metabolism; the most prominent metabolite was AMA-1294, the compound resulting from beta-lactam ring hydrolysis. [14C]carumonam and metabolites were mostly eliminated from the bodies within 72 h in rats and 120 h in dogs. In both animals, a large amount of the dosed radioactivity was excreted in the urine largely as unchanged antibiotic. The remainder was eliminated in the feces via bile. AMA-1294 was eliminated from the bodies of rats and dogs at a considerably slower rate than was unchanged carumonam. In rats, [14C]carumonam was eliminated by both glomerular filtration (67%) and tubular secretion (33%); the renal elimination of [14C]AMA-1294 was only by glomerular filtration.

Animals↗

PubMed1992

Nitrogen tensions in brachial vein blood of Korean ama divers.

Intravascular bubble formation and symptoms of decompression sickness have been reported during repetitive deep breath-hold diving. Therefore we examined the pattern of blood N2 kinetics during and after repetitive breath-hold diving. To study muscle N2 uptake and release, we measured brachial venous N2 partial pressure (PN2) in nine professional Korean breath-hold divers (ama) during a 3-h diving shift at approximately 4 m seawater depth and up to 4 h after diving. PN2 was determined with the manometric Van Slyke method. Diving time and depth were recorded using a backpack computer-assisted dive longer that allowed calculating the surface-to-depth time ratio to derive the effective depth. With the assumption that forearm muscle N2 kinetics follow the general Haldanian principles of compression and decompression, i.e., forearm muscle is a single compartment with a uniform tissue PN2 equal to venous PN2, PN2 data were fitted to monoexponential functions of time. In the early phase of the diving shift, PN2 rapidly increased to 640 Torr (half time = 6 min) and then slowly declined to baseline levels (half time = 36 min) after the work shift. Peak PN2 levels approximated the alveolar PN2 derived from the effective depth. We conclude that forearm muscle N2 kinetics are well described by a Haldanian single-compartment model. Decompression sickness is theoretically possible in the ama; it did not occur because the absolute PN2 remained low due to the shallow working depth of the ama we studied.

Diving↗

PubMed1993

Arterial blood gas tensions during breath-hold diving in the Korean ama.

Korean female unassisted divers (cachido ama) breath-hold dive > 100 times to depths of 3-7 m during a work day. We sought to determine the extent of arterial hypoxemia during normal working dives and reasonable time limits for breath-hold diving by measuring radial artery blood gas tensions and pH in five cachido ama who dove to a fixed depth of 4-5 m and then continued to breath hold for various times after their return to the surface. Eighty-two blood samples were withdrawn from indwelling radial artery catheters during 37 ocean dives. We measured compression hyperoxia [arterial PO2 = 141 +/- 24 (SD) Torr] and hypercapnia (arterial PCO2 = 46.6 +/- 2.4 Torr) at depth. Mean arterial PO2 near the end of breath-hold dives lasting 32-95 s (62 +/- 14 s) was decreased (62.6 +/- 13.5 Torr). Mean arterial PCO2 reached 49.9 +/- 5.4 Torr. Complete return of these values to their baseline did not occur until 15-20 s after breathing was resumed. In dives of usual working duration (< 30 s), blood gas tensions remained within normal ranges. Detailed analysis of hemoglobin components and intrinsic oxygenation properties revealed no evidence for adaptive changes that could increase the tolerance of the ama to hypoxic or hypothermic conditions associated with repetitive diving.

2,3-Diphosphoglycerate↗

PubMed1990

The impact of the amended Ontario Mental Health Act (Bill 7) on patients discharging themselves from hospital against medical advice (AMA): a preliminary study.

Bill 7, the most recent amendment to the Ontario Mental Health Act was introduced in December 1986. It has resulted in some major changes to the practice of psychiatry, especially in provincial hospitals. We compared patients who had discharged themselves against medical advice (AMA) during the six months before the Bill was enacted, with those who discharged themselves AMA in the 12 months following. Significantly more patients discharged themselves AMA in the post- than the pre-Bill period. The majority of these were potentially treatable, acutely ill individuals with schizophrenia or affective disorder. We argue that Bill 7 has largely failed in its objective to improve the overall "quality of care" to psychiatric patients, at least in the short term.

Commitment of Persons with Psychiatric Disorders↗