RESUMEN
The authors report the results of a Robert Wood Johnson Foundation-funded project that catalyzed New York State medical schools to develop and implement strategic plans for curricular change to enhance palliative care education. The project used the Palliative Education Assessment Tool for curricular mapping of palliative care education throughout each school's four-year curriculum and used site visits to facilitate strategic planning within each institution. Of the 14 New York State medical schools, 13 participated in the project. Ten provided strategic plans for change, with a total of 71 specific goals (median = 5 per school). Of these goals, 67 (94.4%) had been implemented or were in the active-planning process one year after the plans were created. Overall, palliative care content was enhanced in four curricular areas: basic science courses, ethics and humanities courses, clerkship rotations, and faculty development in palliative care. The process of self-assessment, curriculum mapping of a specific thematic area, and strategic planning for change appears to have successfully enhanced the palliative care content in the medical schools' curricula.
Asunto(s)
Curriculum , Educación de Pregrado en Medicina , Cuidados Paliativos , Cuidado Terminal , Humanos , New York , Desarrollo de Programa , Facultades de MedicinaRESUMEN
Hypochromic, microcytic anemias are typically the result of inadequate hemoglobin production because of globin defects or iron deficiency. Here, we describe the phenotypic characteristics and pathogenesis of a new recessive, hypochromic, microcytic anemia mouse mutant, nm1054. Although the mutation nm1054 is pleiotropic, also resulting in sparse hair, male infertility, failure to thrive, and hydrocephaly, the anemia is the focus of this study. Hematologic analysis reveals a moderately severe, congenital, hypochromic, microcytic anemia, with an elevated red cell zinc protoporphyrin, consistent with functional erythroid iron deficiency. However, serum and tissue iron analyses show that nm1054 animals are not systemically iron deficient. From hematopoietic stem cell transplantation and iron uptake studies in nm1054 reticulocytes, we provide evidence that the nm1054 anemia is due to an intrinsic hematopoietic defect resulting in inefficient transferrin-dependent iron uptake by erythroid precursors. Linkage studies demonstrate that nm1054 maps to a genetic locus not previously implicated in microcytic anemia or iron phenotypes.
Asunto(s)
Anemia Hipocrómica/genética , Anemia Hipocrómica/patología , Genes Recesivos/genética , Hematopoyesis/genética , Anemia Hipocrómica/sangre , Animales , Eritrocitos/metabolismo , Insuficiencia de Crecimiento/sangre , Insuficiencia de Crecimiento/genética , Insuficiencia de Crecimiento/patología , Femenino , Ligamiento Genético/genética , Infertilidad Masculina/sangre , Infertilidad Masculina/genética , Infertilidad Masculina/patología , Hierro/sangre , Masculino , Ratones , Ratones Mutantes , Protoporfirinas/metabolismo , Sitios de Carácter Cuantitativo/genéticaRESUMEN
Although research after an episode of terror can provide important information to improve the health and well-being of present and future victims, there are unique ethical challenges that need to be addressed. Man-made disasters have profound effects on victims, rescue workers, and their families and on others in the community; this may impair their ability to provide voluntary and uncoerced decisions about research participation. Because such potential participants in research may be vulnerable and also subject to being overburdened with redundant research, they deserve special consideration. We propose specific recommendations to assist investigators, institutional review boards (IRBs), public health officials, and political leaders to help serve the interests of future participants in terror-related research.