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A review of published data relating to A-bomb survivors has led to the conclusion that since they were based on the mortality experiences of five year survivors estimates of radiation effects should have been controlled for two opposing forces-namely, selective survival of exceptionally fit individuals during the period of heavy acute mortality and residual disabilities. Both effects were dose-related and beyond question, and the disabilities probably included the effects of incomplete repair of bone marrow damage. Therefore, in addition to differences between high and low dose being largely obliterated, there was probably distortion of cancer effects. The two opposing forces are clearly the reason why the change from the high mortality rates of 1945-6 to the low rates of the 1950s was not accompanied by a change from a position to a negative association with dose, and imperviousness to the residual disabilities is probably the reason why sudden deaths of previously healthy individuals (exemplified by suicides) were an exception to this rule. Finally, impairment of bone marrow function probably accounts for the early epidemic of myeloid leukaemia; the apparent absence of other cancers at this time, and the relatively high dose-related death rates for blood diseases other than leukaemia.

This paper describes the procedures used at the Library of the College of Physicians of Philadelphia to divide its ninety-year-old dictionary card catalog. The division was necessitated by overcrowding, obsolete subject headings, and lack of a complete authority list which resulted in like materials being scattered throughout the catalog under several headings. Two catalogs were created: the historical-biographical catalog, representing all works published before 1950 and all works of historical or biographical nature; and the current catalog, containing all works published from 1950 on, excepting historical or biographical materials. The 1950- catalog was further divided into name and subject catalogs, and the subject section was revised according to MeSH. The project was completed in about two years. As a result, searching time has been much reduced, and the library is able to take advantage of the annual revisions of MeSH to update the subject catalog.

A growing body of evidence indicates that physical activity is protective against breast cancer. In 1996–97, we conducted a 15-year follow-up of 5398 college alumnae comprised of former college athletes with their non-athletic classmates. Participants completed a detailed mailed questionnaire on their health history from 1981–82 to the present. Excluding women who had died and non-deliverable questionnaires, 84.7% (n = 3940) of the participants in our earlier study responded to the questionnaire; the response rate for former athletes was 86.6% (n = 1945), for non-athletes, 83.0% (n = 1995). Results confirmed our earlier findings. Based on self-reports, former college athletes had a significantly lower risk of breast cancer than the non-athletes. The OR for the 15-year incidence of breast cancer is 0.605 with 95% confidence interval (CI) (0.438–0.835); the 15-year incident breast cancers were 64 among the athletes and 111 among the non-athletes. Among women under 45 the protective effect of physical activity on the risk of breast cancer is considerably greater; odds ratio (OR) = 0.164, 95% CI (0.042–0.636). Athletic activity during the college and pre-college years is protective against breast cancer throughout the life span, and more markedly among women under 45. These results confirm our earlier findings and the findings of other investigators. © 2000 Cancer Research Campaign

Philadelphia medical libraries embrace the past, the present, and the future. Typifying the expansion in medical communications, area libraries cover the broad spectrum of medical and paramedical fields. Serving workers in these fields are the College of Physicians Library, the five medical school libraries, and a host of hospital and special libraries. Many of these libraries date from the early years of this country. Pharmaceutical firms and governmental institutions in the city, as well as medical libraries in neighboring states, contribute to the area's rich resources. The cooperative efforts and outlook of all these libraries are reflected in the strength of the Regional Group of the Medical Library Association and the plans being made for the future of medical libraries in the Philadelphia area.

The records of all 1591 women with a histologically confirmed primary breast neoplasm who received their primary treatment at the main referral centre in British Columbia and were diagnosed in the years 1945, 1950, 1955, 1960, 1965, 1970, or 1975 were reviewed. The interval from appearance of the first symptom to diagnosis decreased from 1945 to 1960, but no change was seen from 1960 to 1975. An analysis of survival from the date of first symptom showed that long-term survival was greater in patients with a shorter delay between the appearance of symptoms and diagnosis. The demonstration that shorter delay does improve survival, even when assessed from the appearance of the first symptom, yet delay times have not been falling recently, suggests that educational efforts are inefficient.

The Yale School of Medicine began accepting women as candidates for the degree of medicine in the fall of 1916. This decision was consistent with the trend in medical education at the time. While Yale was not the first prestigious Eastern medical school to admit women, joining Johns Hopkins (1893) and the University of Pennsylvania (1914), it was not one of the last. Columbia University College of Physicians and Surgeons admitted women a year later, but Harvard Medical School held out until 1945. The years 1916--1920 saw the number of women enrolled in medical school almost double. Yale's decision to admit women seems to have been made with little resistance from the faculty. The final decision was made through the encouragement and financial help of Henry Farnam, a professor of economics at Yale, who agreed to pay for the women's bathrooms. His daughter, Louise, was in the first class of women. At graduation she was awarded the highest scholastic honors, the Campbell Gold Prize. From Yale she travelled to the Yale-sponsored medical school in Changsha, China, where she became the first female faculty member, a position she held for twelve years. The impressions of Ella Clay Wakeman Calhoun, the only woman to graduate in the second class of women, are presented here. Since 1916 the Yale School of Medicine has undergone extensive physical and philosophical changes, developments in which women have participated.

The hospital health sciences library of today that reaches out to the world knowledge base through electronic networks bears little resemblance to its forebears. Yet to understand the challenges and future directions of the hospital library it is necessary to examine how it began and how it has evolved in more than 200 years. This paper identifies five developmental periods in which major strides were made: the colonial years through the 19th century; World War I to the Great Depression; World War II and the 1950s; the 1960s--the Great Society and the Medical Library Assistance Act; and the 1970s, an era of growth for hospital libraries.

In 2002, a regional consortium was created for schools and colleges of pharmacy in Georgia and Alabama to assist experiential education faculty and staff members in streamlining administrative processes, providing required preceptor development, establishing a professional network, and conducting scholarly endeavors. Five schools and colleges of pharmacy with many shared experiential practice sites formed a consortium to help experiential faculty and staff members identify, discuss, and solve common experience program issues and challenges. During its 5 years in existence, the Southeastern Pharmacy Experiential Education Consortium has coordinated experiential schedules, developed and implemented uniform evaluation tools, coordinated site and preceptor development activities, established a work group for educational research and scholarship, and provided opportunities for networking and professional development. Several consortium members have received national recognition for their individual experiential education accomplishments. Through the activities of a regional consortium, members have successfully developed programs and initiatives that have streamlined administrative processes and have the potential to improve overall quality of experiential education programs. Professionally, consortium activities have resulted in 5 national presentations.

The China Medical Board was created in 1914 to support the development of a medical college in Peking, China. However, its activity had to be discontinued due to the political change in China in late 1950, and the Board's new plans expanded into the whole area of the Far East in 1951. The primary program is to assist financially in the development of medical and nursing education and research; the library is one of the major concerns of the program. The assistance to libraries is categorized as follows: construction and equipment, books and journals, fellowships, and other items. An attempt is made to describe the actual status of medical libraries in the area since World War II from the point of view of the program of the Board.

A follow-up survey was conducted in 1977, five years after a previous survey of head librarians in large biomedical libraries, to assess changes that had occurred in the representation of women in top administrative positions. Results for the 126 libraries that responded are reported in six category groupings, with comparative figures for 1977, 1972, and 1950. Also reported are data on head librarian and associate librarian positions and on the appointment rate of women and men to head librarian posts that became vacant from 1972 to 1977. Despite a large number of vacancies and turnover, which provided an opportunity for change to have occurred, the most striking aspect of the 1977 survey is the similarity of its results to those of the 1972 survey. Women made up over three-fourths of the librarian work force and held considerably less than one-half of the head librarian positions.

Background

Publications are often used as a measure of success of research work. Leishmaniasis is considered endemic in 98 countries, most of which are developing. This article describes a bibliometric review of the literature on leishmaniasis research indexed in PubMed during a 66-year period.

Methods

Medline was used via the PubMed online service of the US National Library of Medicine. The search strategy was Leishmania [MeSH] or leishmaniasis [MeSH] from 1 January 1945 until 31 December 2010. Neither language nor document type restrictions were employed.

Results

A total of 20,780 references were retrieved. The number of publications increased steadily over time, with 3,380 publications from 1945-1980 to 8,267 from 2001-2010. Leishmaniasis documents were published in 1,846 scientific journals, and Transactions of the Royal Society of Tropical Medicine and Hygiene (4.9%) was the top one. The USA was the predominant country by considering the first author’s institutional address (16.8%), followed by Brazil (14.9%), and then India (9.0%), however Brazil leads the scientific output in 2001-2010 period (18.5%), followed by the USA (13.5%) and India (10%). The production ranking changed when the number of publications was normalised by population (Israel and Switzerland), by gross domestic product (Nepal and Tunisia), and by gross national income per capita (India and Ethiopia). For geographical area, Europe led (31.7%), followed by Latin America (24.5%).

Conclusions

We have found an increase in the number of publications in the field of leishmaniasis. The USA and Brazil led scientific production on leishmaniasis research.

The Association of Academic Health Sciences Libraries has made collaboration with other organizations a fundamental success strategy throughout its twenty-five year history. From the beginning its relationships with Association of American Medical Colleges and with the Medical Library Association have shaped its mission and influenced its success at promoting academic health sciences libraries' roles in their institutions. This article describes and evaluates those relationships. It also describes evolving relationships with other organizations including the National Library of Medicine and the Association of Research Libraries.

Context

An effective application of biofeedback for interventions in older adults with balance and mobility disorders may be compromised due to co-morbidity.

Objective

To evaluate the feasibility and the effectiveness of biofeedback-based training of balance and/or mobility in older adults.

Data Sources

PubMed (1950-2009), EMBASE (1988-2009), Web of Science (1945-2009), the Cochrane Controlled Trials Register (1960-2009), CINAHL (1982-2009) and PsycINFO (1840-2009). The search strategy was composed of terms referring to biofeedback, balance or mobility, and older adults. Additional studies were identified by scanning reference lists.

Study Selection

For evaluating effectiveness, 2 reviewers independently screened papers and included controlled studies in older adults (i.e. mean age equal to or greater than 60 years) if they applied biofeedback during repeated practice sessions, and if they used at least one objective outcome measure of a balance or mobility task.

Data Extraction

Rating of study quality, with use of the Physiotherapy Evidence Database rating scale (PEDro scale), was performed independently by the 2 reviewers. Indications for (non)effectiveness were identified if 2 or more similar studies reported a (non)significant effect for the same type of outcome. Effect sizes were calculated.

Results and Conclusions

Although most available studies did not systematically evaluate feasibility aspects, reports of high participation rates, low drop-out rates, absence of adverse events and positive training experiences suggest that biofeedback methods can be applied in older adults. Effectiveness was evaluated based on 21 studies, mostly of moderate quality. An indication for effectiveness of visual feedback-based training of balance in (frail) older adults was identified for postural sway, weight-shifting and reaction time in standing, and for the Berg Balance Scale. Indications for added effectiveness of applying biofeedback during training of balance, gait, or sit-to-stand transfers in older patients post-stroke were identified for training-specific aspects. The same applies for auditory feedback-based training of gait in older patients with lower-limb surgery.

Implications

Further appropriate studies are needed in different populations of older adults to be able to make definitive statements regarding the (long-term) added effectiveness, particularly on measures of functioning.

Rabies first became evident in Canada during the late 18th and early 19th centuries. However, only a few sporadic outbreaks, mainly in domestic animals, were noted before 1945.

Rabies in foxes spread into the Canadian provinces from the Arctic regions during the late 1940s. The disease gradually died out in most areas except Ontario. A second major outbreak, involving skunks, progressed from North Dakota into the Prairie provinces during the late 1950s and 1960s. Today, the major problem areas in Canada with respect to rabies are southern Ontario, which accounts for 85% of the Canadian diagnoses, and the Prairie provinces where rabies is enzootic in skunks.

Rabies is rare in humans in Canada; however more than 40,000 cases have been reported in wild and domestic animals since 1958. Control of rabies is currently being undertaken through vaccination of domestic animals and wildlife, population reduction of wildlife vectors, and human preexposure rabies vaccination.

Question: What are some of the historical societal, medical, and public health trends leading to today's provision of hospital library services to patients?

Data Sources: Literature from the archives of the Bulletin of the Medical Library Association and other library sources, medical journals, primary historical documents, and texts from the history of medicine form the core of this review.

Study Selection: The period of review extends from about 1790 through 1950 and focuses solely on trends in the United States. Of primary concern are explicitly documented examples that appear to illustrate the patient-physician relationship and those between librarians and their patient-patrons during the earliest years of the profession's development.

Data Extraction: An historical timeline was created to allow the identification of major trends that may have affected library services. Multiple literature searches were conducted using library, medical, and health anthropology resources. When possible, primary sources were preferred over reviews.

Main Results: Juxtapositioning historical events allows the reader to obtain an overview of the roots of consumer health services in medical libraries and to consider their potential legacy in today's health care libraries.

Conclusion: This review article highlights early developments in hospital library service to patients. Further research is needed to verify a preliminary conclusion that in some medical library settings, services to the general public are shaped by the broader health care environment as it has evolved.

OBJECTIVES—Three operative techniques have been described to correct thoracolumbar kyphotic deformity (TLKD) resulting from ankylosing spondylitis (AS) at the level of the lumbar spine: opening wedge osteotomy, polysegmental wedge osteotomies, and closing wedge osteotomy. Little knowledge exists on the indication for, and outcome of these corrective lumbar osteotomies.
METHODS—A structured review of the medical literature was performed.
RESULTS—A search of the literature revealed 856 patients reported in 41 articles published between 1945 and 1998. The mean age at time of operation was 41 years, male-female ratio 7.5 to 1. In 451 patients an open wedge osteotomy was performed. Polysegmental wedge osteotomies were performed in 249 patients and a closing wedge osteotomy in 156 patients. Most of the studies primarily focus on the surgical technique. Technical outcome data were poorly reported. Sixteen reports, including 523 patients, met the inclusion criteria of this study, and could be analysed for technical outcome data. The average correction achieved with each surgical techniques ranged from 37 to 40 degrees. Loss of correction was mainly reported in patients treated by open wedge osteotomy and polysegmental wedge osteotomies. Neurological complications were reported in all three techniques. The perioperative mortality was 4%. Pulmonary, cardiac and intestinal problems were found to be the major cause of fatal complications.
CONCLUSION—Lumbar osteotomy for correction of TLKD resulting from AS is a major surgery. The indication for these lumbar osteotomies as well as the degree of correction in the lumbar spine has not yet been established. Furthermore, there is a need for a generally accepted clinical score that encompasses accurate preoperative and postoperative assessment of the spinal deformity. The results of this review suggest that the data from the literature are not suitable for decision making with regard to surgical treatment of TLKD resulting from AS.



The full impact of twentieth century technology upon medical libraries was first felt in the late 1950s and early 1960s with the introduction of electronic automation into library methodology. During those years, often the aura of technology for the sake of technology prevailed, and medical librarians did little to inform themselves of capabilities, potentialities, and limitations in relation to cost-effective library usage of automation. Likewise, currently microforms and audiovisuals are frequently acquired for their own sake instead of for their capacity to transmit messages in the most effective and comprehensive way possible. Controversy has raged and still rages over the pros and cons of applying modern technology to library procedures and over the coexistence of the printed page with electronic media. New systems and methodologies, machine or manual, must realistically be evaluated in terms of increased service output by the library to its clientele. Regardless of technological sophistication, any machine that does not significantly contribute to that specific aim has no place in a library. The tradition of the medical librarian has always been to collect, organize, store, and disseminate information in the most efficient manner that the media of the times have had to offer.

Objectives

This paper documents individual asthma action plan presence and quick relief medication (albuterol) availability for elementary students enrolled in five Alabama school systems.

Patients and Methods

Data were obtained during baseline data collection (fall 2005) of a school-based supervised asthma medication trial. All students attended 1 of 36 participating elementary schools across five school systems in Jefferson County, Alabama. In addition, they had to have physician-diagnosed asthma requiring daily controller medication. Each school system had its own superintendent and elected school board. Asthma action plan presence and albuterol availability was confirmed by study personnel. Asthma action plans had to contain daily and acute asthma management instructions. Predictors of asthma action plan presence and albuterol availability were also investigated. Associations between albuterol availability and self-reported characteristics including health care utilization prior to study enrollment and outcomes during the study baseline period were also investigated.

Results

Enrolled students had a mean (SD) age of 11.0 (2.1) years, 91% were African American, and 79% had moderate persistent asthma. No student had a complete asthma action plan on file and only 14% had albuterol physically available at school. Albuterol availability was not predicted by gender, race, insurance status, second-hand smoke exposure, need for pre-exercise albuterol, asthma severity, or self-reported health care utilization prior to study enrollment. Albuterol availability did not predict school absences, red/yellow peak flow recordings, or medication adherence during the study's baseline period.

Conclusion

Despite policies permitting students to possess albuterol, few elementary students across five independent school systems in Alabama actually had it readily available at school.

Nine hundred and sixty-seven men who were employed in a nickel refinery in South Wales on at least two occasions five or more years apart before 1945 have been followed up, and the mortality rates from different causes related to the date of their first employment. Previous reports suggested that the occupational risks of lung and nasal sinus cancer had been eliminated by 1925. It is now shown that the risk persisted until 1930, which accords better with the temporal changes in the process.

PURPOSE

We examined the association between post-diagnosis statin use (3-hydroxy-3-methylglutaryl-coenzyme A [HMG-CoA] inhibitors) and risk of breast cancer recurrence.

MATERIALS AND METHODS

The study included 1945 early-stage breast cancer survivors participating in the Life After Cancer Epidemiology (LACE) Study. Women who were diagnosed from 1997 to 2000 and identified from the Kaiser Permanente Northern California (KPNC) Cancer Registry entered the cohort on average two years post-diagnosis. Information on statin use was obtained from the KPNC pharmacy database. A total of 210 breast cancer recurrences were reported and verified by medical record review. Cox proportional hazard models were used to estimate rate ratios (RR) and 95% confidence intervals (CI).

RESULTS

The mean duration of statin use in the cohort among those who initiated use post-diagnosis was 1.96 years, and lipophilic statins were mainly used (97.8%). Starting statins after diagnosis was suggestive of a decreased risk of breast cancer recurrence (RR = 0.67; 95% CI: 0.39–1.13). Risk of recurrence decreased with increasing duration of statin use after diagnosis (p linear trend = 0.02).

CONCLUSION

Our findings provide initial support for an inverse association between post-diagnosis, lipophilic statin use and risk of breast cancer recurrence.

Objectives

To examine correlates of analgesic medication prescription and administration in communicative, cognitively impaired nursing home residents. Residents' behaviors were assessed using computer-assisted real-time observations as potential adjunctive indicators of pain.

Design

Cross-sectional study over a 4-week period.

Setting

Five nursing homes in the greater Birmingham, Alabama, area.

Participants

Ninety-two residents (mean age ± standard deviation = 83.86 ± 8.55) with a mean Mini-Mental State Examination (MMSE) score of 13.81 ± 6.34.

Measurements

Data were obtained via chart review, resident assessments, questionnaire completion by certified nursing assistants familiar with residents' care, and direct observation of residents' daily behaviors.

Results

Receipt of analgesic medication was related to self-report of pain (F2,89 = 9.89, P = .0001), MMSE (F2,88 = 3.98, P = .022), and time spent inactive (F2,89 = 3.04, P = .053). Residents who received analgesic medication reported greater intensity of pain than other residents. Residents who received analgesics had higher MMSE scores than those who did not receive analgesics. Residents who received analgesics spent less time being inactive than those not prescribed analgesics. Receipt of higher dosage of opioid analgesic medication was associated with more time spent with others in verbal interaction (r = .22, P = .03).

Conclusion

This study refines the methodology of measuring analgesic medication dosage and its effect on resident behavior. Analgesic prescription and administration patterns are related to time residents spend being inactive. Results suggest that opioid analgesics may hold particular promise in alleviating pain, as indicated by resident behaviors.

Several dengue outbreaks occurred in Japan from 1942 to 1945. Dengue fever emerged in Nagasaki in August 1942 and soon spread to other cities such as Sasebo, Hiroshima, Kobe and Osaka, recurring every summer until 1945 and constituting the greatest outbreak in the temperate zone. Domestic outbreaks have not been reported in Japan since then. However, the number of imported dengue cases has increased year by year: 868 imported cases were reported in Japan between 1999 and 2010 according to the Infectious Diseases Control Law. Moreover, 406 imported cases were confirmed to be dengue virus infection among 768 dengue suspected cases received at NIID from 2003 to 2010. A total of 142 cases (35.6%), 103 cases (25.8%) and 62 cases (15.5%) were noted in the 20–29, 30–39 and 40–49 age groups, respectively. Infecting dengue virus serotypes were determined for 280 of the 406 cases. The number of cases infected with each of the 4 serotypes was 98 (35%) with type 1, 78 (28%) with type 3, 72 (26%) with type 2, and 32 (11%) with type 4. Sixty percent of dengue cases were imported from July to October, the summer vacation season in Japan.

The iliac crest has become an often used site for autogenous bone graft, because of the easy access it affords. One of the less common complications that can occur after removal is a graft-site hernia. It was first reported in 1945 (see the work by Oldfield, 1945). We report a case of iliac crest bone hernia in a 53-year-old male who was admitted for elective resection of a pseudarthrosis and reconstruction of the left femur with iliac crest bone from the right side. One and a half months after initial surgery, the patient presented with increasing abdominal pain and signs of bowel obstruction. A CT scan of the abdominal cavity showed an obstruction of the small bowel caused by the bone defect of the right iliac crest. A laparoscopy showed a herniation of the small bowel. Due to collateral vessels of the peritoneum caused by portal hypertension, an IPOM (intraperitoneal onlay-mesh) occlusion could not be performed. We performed a conventional ventral hernia repair with an onlay mesh. The recovery was uneventful.

Since its establishment in 1945, the Canadian Memorial Chiropractic College (CMCC) has predominately adhered to a Diversified model of chiropractic technique in the core curriculum; however, many students and graduates have voiced a desire for greater exposure to chiropractic techniques other than Diversified at CMCC. A course structure is presented that both exposes students to a plethora of different “Name techniques” and provides students with a forum to appraise them critically. The results of a student survey suggested that both of these learning objectives have been successfully met. In addition, an assignment was designed that enabled students to recommend which, if any, “Name techniques” should be included in the curriculum of the College. The recommendations from these assignments were compiled since the 1996/97 academic year. The results indicated an overwhelming demand for the inclusion of Thompson Terminal Point, Gonstead, Activator Methods, Palmer HIO and Active Release Therapy techniques either as part of the core curriculum or in an elective program. These recommendations parallel the practice activities of Canadian chiropractors.

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Background

Despite the proven benefits conferred by early human immunodeficiency virus (HIV) diagnosis and presentation to care, delays in HIV medical care are common; these delays are not fully understood, especially in the southern United States.

Methods

We evaluated the extent of, and characteristics associated with, delayed presentation to HIV care among 1,209 patients at an HIV/AIDS Outpatient Clinic in Birmingham, Alabama between 1996 and 2005.

Results

Two out of five (41.2%) patients first engaged care only after they had progressed to CDC-defined AIDS. Among these, 53.6% were diagnosed with HIV in the year preceding entry to care. Recent presentation (2002 – 2005), male sex, age ≥25, Medicare or Medicaid insurance coverage, and presentation within six months of HIV diagnosis were independently associated with initiating care after progression to AIDS.

Conclusions

A high proportion of patients entered clinical care after experiencing substantial disease progression. Interventions that effectively improve the timing of HIV diagnosis and presentation to care are needed.