Distribution of research awards from the National Institutes of Health among medical schools.

BACKGROUND: Previous studies have demonstrated that a small number of the 125 medical schools in the United States receive a disproportionately large share of the research awards granted by the National Institutes of Health (NIH). We assessed whether the distribution of NIH research awards to medical schools changed between 1986 and 1997. METHODS: We used NIH data to rank medical schools in each year from 1986 to 1997 according to the number of awards each school received (as a measure of each school's activity in research, also referred to as research intensity). The proportion of awards received by schools ranked 1 to 10, 11 to 30, 31 to 50, and 51 or lower in research activity was then calculated, and changes over time were examined. We also examined changes in the distribution of awards and changes in award amounts according to the type of department, the type of academic degree held by the principal investigator, and the awarding institute. RESULTS: Between 1986 and 1997, the proportion of research awards granted by the NIH to the 10 most research intensive medical schools increased slightly (from 24.6 percent of all awards to 27.1 percent), whereas the 75 least research intensive medical schools (those ranked 51 or lower) received proportionately fewer awards (declining from 24.3 percent to 21.8 percent). The increased proportion of awards to top-10 schools consisted primarily of increases in awards to clinical departments, awards to physicians, and awards from highly competitive NIH institutes. Basic-science departments received a smaller proportion of awards than clinical departments, both in 1986 and in 1997. CONCLUSIONS: Research funded by the NIH is becoming more concentrated in the medical schools that are most active in research.

Managing information technology in academic medical centers: a "multicultural" experience.

Based on a session at the 1997 conference on Information Resources and Academic Medicine sponsored by the Association of American Medical Colleges, this article illustrates how the beliefs and concerns of academic medicine's diverse professional cultures affect the management of information technology. Two scenarios--one dealing with the standardization of desktop PCs, the other with publication of syllabi on an institutional intranet--form the basis of this exercise. Four prototypical members of a hypothetical medical center community--the chairman of surgery, a senior basic scientist, the chief information officer of an affiliated hospital, and the chief administrative officer--offer their perspectives on each scenario. Their statements illustrate many of the challenges of planning, deploying, and maintaining effective information technology in the "multicultural" environment of academic medical centers.

Gastrointestinal manifestations of cystic fibrosis: radiologic-pathologic correlation.

Cystic fibrosis (CF), the most common lethal autosomal recessive disease in white populations, is characterized by dysfunctional chloride ion transport across epithelial surfaces. Although recurrent pulmonary infections and pulmonary insufficiency are the principal causes of morbidity and death, gastrointestinal symptoms commonly precede the pulmonary findings and may suggest the diagnosis in infants and young children. The protean gastrointestinal manifestations of CF result primarily from abnormally viscous luminal secretions within hollow viscera and the ducts of solid organs. Bowel obstruction may be present at birth due to meconium ileus or meconium plug syndrome. Complications of meconium ileus include volvulus, small bowel atresia, perforation, and meconium peritonitis with abdominal calcifications. Older children with CF may present with bowel obstruction due to distal intestinal obstruction syndrome or colonic stricture, and tenacious intestinal residue may serve as a lead point for intussusception or cause recurrent rectal prolapse. Radiologic studies often demonstrate thickened intestinal mucosal folds in older children and uncommonly show colonic pneumatosis, peptic esophageal stricture due to gastroesophageal reflux, and duodenal ulcer. Appendicitis due to inspissated secretions is uncommon. Obstruction of ducts and ductules produces exocrine pancreatic insufficiency, pancreatitis, cholestasis, cholelithiasis, and cirrhosis with portal hypertension. On imaging studies, the pancreas is commonly small and largely replaced by fat, sometimes displays calcifications, and is rarely replaced by macrocysts. Radiologic features of hepatobiliary disease include an enlarged radiolucent liver from steatosis, gallstones, a shrunken nodular liver, splenomegaly, and portosystemic collateral vessels. With the improved survival of CF patients, an increased risk for developing gastrointestinal carcinomas has been established, many occurring as early as the 3rd decade.

Particle distribution around a copper beam stop for 72 MeV protons.

Results are presented of an experiment to study neutron yields at different production angles from 72 MeV protons stopping in copper. Activation detectors were used to provide data on neutron energies and flux densities. The results of a spectrum unfolding analysis are presented and compared with a Monte Carlo calculation. Some dosimetric data are also included.

Research advances and resource constraints: dilemmas facing medical education.

Public investment in health research is concentrated disproportionately in a limited number of United States medical schools: about 75 per cent of federal health-research expenditures occur in the "Top 40" institutions. The heavy resource demands of advanced research, coupled with constrained public investment in the foreseeable future, will cause a gradual shift of resources toward the already research-rich schools. The various implications of this shift in resources for different categories of medical schools are described under different assumptions for the future: growth, a steady state, and decline. These developments underscore a public-policy dilemma. The further concentration of health-research resources in centers of excellence, which is justifiable in terms of maximizing the potential scientific return on the public's investment, is apt to prove disruptive to medical education in many schools in the middle and lower strata of funded research activity.

Neuronal organization of the rabbit cochlear nucleus: some anatomical and electrophysiological observations.

The cochlear nucleus of the young adult rabbit was studied using both anatomical and electrophysiological techniques. The cytoarchitecture of the cochlear nucleus, as revealed by Nissl-staining and Bodian's Protargol method, was quite similar to that of the cat. The cell types observed by the Golgi-Cox method were very similar to those observed in the cat cochlear nucleus. Bushy and stellate cells were predominant in the anterior ventral cochlear nucleus, and multipolar and globular cells were observed throughout the posterior ventral cochlear nucleus, surrounding a region containing mainly octopus cells. The dorsal cochlear nucleus was revealed as a limited structure with a prominent band of fusiform cells. The polymorphic layers continued varieties of giant neurons similar to those observed in the cat. Units in the cochlear nucleus were classified electrophysiologically, in terms of their discharge pattern, and located histologically. The ventral cochlear nucleus contained mainly "primarylike," "chopper" and "onset" units, but the dorsal cochlear nucleus contained a greater variety of response patterns. "Buildup," "pauser" and "chopper" response patterns were predominant, and the dorsal cochlear nucleus also obtained more inhibitory units than the ventral cochlear nucleus. Both the types of units observed and their location in each nucleus were very similar to those reported for the cat. Both divisions of the ventral cochlear nucleus and the dorsal cochlear nucleus were found to be tonotopically organized in a dorsal (high frequency) to ventral (low frequency) direction. A trend for an organization in a medial to lateral direction was also apparent, particularly in the dorsal cochlear nucleus.

A rationale for continued federal support of medical education.

Changing circumstances and shifting public attitudes are forcing policy makers and educators to reconsider the rationale for a continuing federal role in support of medical education. Federal institutional support programs are criticized as being inappropriate to current and future needs, socially inequitable and subject to abuse by a coercive governmental apparatus. A rationale for federal support can be advanced, but such support must be designed to avoid unwarranted subsidies and to encourage maximum reliance upon private-sector resources, and should be confined to functions for which the federal government in uniquely suited. The appropriate federal role is conceived as being the ultimate guarantor of financial access to the medical-education system by otherwise qualified students, perfecting the market for human-capital investment.

Stress fractures of the calcaneus in women marine recruits.

Stress fractures of the calcaneus constitute about 25% of all stress fractures seen during Marine recruit training, and are often bilateral. The incidence can be correlated with individual physical condition at the onset of training. There was no correlation with age, height, weight, or foot architecture. In 114 women Marine recruits the incidence was 10.5%. The principal factors involved in the occurrence of this fractur are: the types and mechanism of application of forces to the calcaneus, the musculo-skeletal architecture of the foot and ankle, and the initial physiologic condition of the individual.