The Yale journal of biology and medicine
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The highly interdisciplinary field of bioinformatics has emerged as a powerful modern science. There has been a great demand for undergraduate- and graduate-level trained bioinformaticists in the industry as well in the academia. ⋯ There are many challenges in developing an undergraduate-level bioinformatics program that needs to be carefully designed as a well-integrated and cohesive interdisciplinary curriculum that prepares the students for a wide variety of career options. This article describes the challenges of establishing a highly interdisciplinary undergraduate major, the development of an undergraduate bioinformatics degree program at Ramapo College of New Jersey, and lessons learned in the last 10 years during its management.
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In 1994, Oregon passed the Oregon Death With Dignity Act, becoming the first state in the nation to allow physician-assisted suicide (PAS). This paper compares the public discussion that occurred in 1994 and during the Act's implementation in 1997 and examines these debates in relation to health care reform under the Obama administration. ⋯ The public debate over PAS in Oregon underscored the conflicts among competing religious, political, and personal interests. More visible and widespread than any other American debate on PAS, the conflict in Oregon marked the beginning of the now nationwide problem of determining if and when a terminally ill person can choose to die.
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Review Historical Article
Guanfacine for the treatment of cognitive disorders: a century of discoveries at Yale.
The prefrontal cortex (PFC) is among the most evolved brain regions, contributing to our highest order cognitive abilities. It regulates behavior, thought, and emotion using working memory. Many cognitive disorders involve impairments of the PFC. ⋯ Recent research has found that the noradrenergic α2A agonist guanfacine can improve PFC function by strengthening PFC network connections via inhibition of cAMP-potassium channel signaling in postsynaptic spines. Guanfacine is now being used to treat a variety of PFC cognitive disorders, including Tourette's Syndrome and Attention Deficit Hyperactivity Disorder (ADHD). This article reviews the history of Yale discoveries on the neurobiology of PFC working memory function and the identification of guanfacine for treating cognitive disorders.
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Vietnam has had a long history of international mission teams that volunteer needed surgical care to underserved populations for various medical problems. As senior medical students, we joined a non-profit organization's surgical mission trip led by a community practice surgeon and staffed by 32 health care professionals to provide cleft lip and palate reconstructions for 75 patients at a local hospital in Nha Trang, Vietnam. As a surgical mission team in a resource-poor country, we intended to fill gaps and unmet areas of need by offering care that patients would otherwise not receive. ⋯ Although the purpose of our mission was to provide a specific service, we felt it is important to examine the service in the context of these broader issues. We considered these concerns from two different perspectives: what a medical mission gives and what it does not. In this article, we present several issues that our medical mission confronted and how they were both addressed and overlooked.
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Medical reversal occurs when a new clinical trial - superior to predecessors by virtue of better controls, design, size, or endpoints - contradicts current clinical practice. In recent years, we have witnessed several instances of medical reversal. Famous examples include the class 1C anti-arrhythmics post-myocardial infarction (contradicted by the CAST trial) or routine stenting for stable coronary disease (contradicted by the COURAGE trial). ⋯ Reversal harms patients who undergo the contradicted therapy during the years it was in favor and those patients who undergo the therapy in the lag time before a change in medical practice. Most importantly, it creates a loss of faith in the medical system by physicians and patients. The solution to reversal is upfront, randomized clinical trials for new clinical practices and a systematic method to evaluate practices already in existence.