Care Under Fire: United States Army Physician Survey.

United States Army healthcare has faced increasing criticism in recent years from its own active duty physicians. Internal surveys of active duty physicians demonstrate a lack of successful intervention in an annual exodus countered only by ongoing recruiting efforts. Anecdotal experience suggests much more widespread discontent due to numerous factors than has been reported publicly. This cross-sectional survey study of 94 active duty physicians paints a vivid picture of an organization in crisis: a majority of physicians planning to separate at the end of their obligation, leadership out of touch with the needs of physicians, and systematic deterioration of clinical skills. Subgroup analysis offers insight into why reforms are unlikely to come from within the medical corps. Prospective recruits are also provided the most comprehensive view yet of life as an active-duty Army physician with a majority reporting unmet expectations, a willingness to accept a financial debt in exchange for early separation, and a low likelihood to recommend participating in the current Army medical recruitment programs. Reorientation of recruiting efforts to focus on attending physicians is discussed to address core deficiencies with multiple downstream effects.

Phenylcinnamides as novel antimitotic agents.

Compound 8H is a phenylcinnamide that induces G2/M-phase cell cycle arrest and cell death in cancer cell lines. Here we show that 8H exerts its cytotoxic activity through disruption of microtubule dynamics in vitro and in cell culture. A series of cinnamide derivatives were synthesized and evaluated, and several new compounds were identified that improve on the activity of the parent compound, with IC(50) values for induction of cell death ranging from 1 to 10 microM. Notably, these compounds retain potency in the HL-60/VCR leukemia cell line, which is resistant to antimitotic cancer drugs vincrisitine and paclitaxel through up-regulation of P-glycoprotein drug efflux pumps. As P-glycoprotein expression is often responsible for drug resistance in cancer and the exclusion of compounds from the central nervous system, 8H and its derivatives merit further examination as potential antimitotic therapeutics, specifically for brain cancers and cancers that are resistant to standard antimitotic agents.