The Twenty-First Century Physician: Expanding Frontiers
The Era of Genomics
In the spring of 2003, the complete sequencing of the human genome was announced, officially ushering in the genomic era. However, even before this landmark accomplishment, the practice of medicine had been evolving as a result of the insights gained from an understanding of the human genome as well as the genomes of a wide variety of microbes, whose genetic sequences were becoming widely available as a result of the breathtaking advances in sequencing techniques and informatics.
To better understand the contemporary world, the world of innovation and
technology, the science should try to synthesize and assimilate the social science and
humanities in the development of our civilization.
The American Holistic Nurses’ Association
(AHNA) has joined with the authors and
contributors of Holistic Nursing: A Handbook
for Practice, Fourth Edition, to develop further
the knowledge base for holistic nursing
and delineate the essence of contemporary
nursing. The purposes of this book are threefold:
(1) to expand an understanding of healing
and the nurse as an instrument of
healing; (2) to explore the unity and relatedness
of nurses, clients, and others; and (3) to
develop caring-healing interventions to
strengthen the whole person....
This book applies pharmacology to nursing practice, with the overall aim of enhancing
patient care. The main focus of the book is adverse drug reactions, and the implications for
patient monitoring. Adverse drug reactions account for around 4% of UK hospital admissions.
Over 70% of these problems are avoidable (Pirmohamed et al. 2004): the monitoring
of prescribed medications has long been a cause for concern (Royal College of General
Practitioners 1985, DH 2000, Audit Commission 2001, Committee of Public Accounts 2006).
In 1970, Henry L. Nadler and Albert B. Gerbie helped usher in the era of prenatal
genetic diagnosis in their landmark paper ‘‘Role of amniocentesis in the interuterine
detection of genetic disorders’’ (N Engl J Med 1970;282:596-9). Since that time,
advances in genetics and perinatal medicine have occurred at an amazing pace,
allowing physicians to detect and treat genetic disorders in utero with increasing
success. There has also been an escalating demand by the public for translational
medicine where discoveries in the laboratory are rapidly brought to the bedside.
In an era of spectacular medical advances, it is easy to become immune to
the announcement of new “breakthroughs”. This in no way lessens the
remarkable achievements of diagnostic imaging over the last few years in
which the field of Nuclear Medicine has shared. To the outsider the specialty
of Nuclear Medicine can appear confusing and esoteric since it operates
in a world of invisible radioactive emissions, nuclear decay charts and
The availability of extensive genomic information and content has spawned
an era of high-throughput screening that is generating large sets of func-tional genomic data. In particular, the need to understand the biochemical
wiring within a cell has introduced novel approaches to map the intricate
networks of biological interactions arising from the interactions of proteins.
This book considers diagnosis and treatment of abdominal and thoracic aortic
aneurysms. It addresses vascular and cardiothoracic surgeons and interventional
radiologists, but also anyone engaged in vascular medicine. The book focuses amongst
other things on operations in the ascending aorta and the aortic arch. Surgical
procedures in this area have received increasing attention in the last few years and
have been subjected to several modifications.
The era of pharmacology, the science concerned with the understanding of drug action, began only about 150 years
ago when Rudolf Buchheim established the first pharmacological laboratory in Dorpat (now, Tartu, Estonia). Since
then, pharmacology has always been a lively discipline with “open borders”, reaching out not only to other life
sciences such as physiology, biochemistry, cell biology and clinical medicine, but also to chemistry and physics.
Internal Medicine is designed to provide the busy clinician
with precisely the information needed where and when it is
needed. The Associate Editors and contributors are internationally
recognized authorities, and they have organized the
content specifically so as to convey the essentials necessary for
diagnosis, differential diagnosis, management, treatment and
follow-up. Many topics start with a “What To Do First” heading
which brings the collective experience and guidance of top
experts to bear on the “up front” considerations the clinician
To discuss embryological thought in seventeenth-century England is to discuss the main currents in
embryological thought at a time when those currents were both numerous and shifting. Like every other
period, the seventeenth century was one of transition. It was an era of explosive growth in scientific ideas and
techniques, suffused with a creative urge engendered by new philosophical insights and the excitement of
The past several decades have seen dramatic advances in understanding the
etiopathogenesis of glomerulonephritis. The science of renal disease has progressed
steadily from a discipline focused largely on whole organ physiology, through
successive eras of cell and molecular biology, several omics (proteomics, genomics)
and now into molecular mapping and personalized medicine.
Estrogen is known to influence glucose homeostasis but the role
of estrogen receptors in muscle glucose metabolism is unknown.
Therefore, we investigated the expression of the two estrogen
receptors, ERa and ERb and their influence on regulation of
GLUT4, and its associated structural protein, caveolin-1, in
mouse muscle. ERaand ERbare co-expressed in the nuclei of
most muscle cells and their levels were not affected by absence of
estradiol (in aromatase knockout, ArKO, mice).
The modern era in sexual medicine started in the
1970s when a few devoted pioneers and visionaries
began to revolutionize our thinking and understanding
in this field.
Prior to that time, sexual dysfunctions in men,
particularly erectile disorders, were thought to be
purely psychogenic or in rare cases caused by testosterone
deficiency. Treatment of sexual disorders was
considered to be predominantly the business of sextherapists
or rarely of endocrinologists.
The escalating prevalence of obesity is one of the most pressing health
concerns of the modern era, yet existing medicines to combat this global
pandemic are disappointingly limited in terms of safety and effectiveness.
The inadequacy of currently available therapies for obesity has made new
drug development crucial.
As new species emerged and evolved into disparate new forms, other species
became extinct. And just as the origin of species and disparity form large-scale
patterns, extinctions have formed patterns of their own. One of those patterns is
illustrated in . It shows how the extinction rate has gone up and
down over the past 540 million years. A few pulses of extinctions stand out
above the others. These mass extinctions were truly tremendous cataclysms.
The biggest of all, which occurred 250 million years ago, claimed 55% of all gen-
In the postgenomic era it is essential that protein sequences
are annotated correctly in order to help in the assignment of
their putative functions. Over 1300 proteins in current pro-tein sequence databases are predicted to contain a PAS
domainbaseduponaminoacid sequence alignments.Oneof
theproblemswith the current annotationof thePASdomain
is that this domain exhibits limited similarity at the amino
acid sequence level.
We have defined thein vivo andin vitro metabolic fate of internalized chol-era toxin (CT) in the endosomal apparatus of rat liver. In vivo, CT was
internalized and accumulated in endosomes where it underwent degrada-tion in a pH-dependent manner. In vitro proteolysis of CT using an endo-somal lysate required an acidic pH and was sensitive to pepstatin A, an
inhibitor of aspartic acid proteases.
Era is a highly conserved GTPase essential for bacterial
growth. The N-terminal part of Era contains a conserved
GTPase domain, whereas the C-terminal part of the protein
contains anRNA- andmembrane-binding domain, theKH
domain. To investigate whether the binding of Era to 16S
rRNA and membrane requires its GTPase activity and
whether the GTPase domain is essential for these acti-vities, the N- and C-terminal parts of the Streptococ-cus pneumoniaeEra –Era-N(aminoacids 1–185) andEra-C
(amino acids 141–299), respectively – were expressed and
Now, under homogeneity these expectations of others’ expectations collapsed into single, shared,
objectively determined expectations. Under heterogeneity, however, not only is there no objective means
by which others’ dividend expectations can be known, but attempts to eliminate the other unknowns, the
price expectations, merely lead to the repeated iteration of subjective expectations of subjective
expectations (or equivalently, subjective priors on others’ subjective priors)—an infinite regress in