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Biomedical subjects

A M Singer

Publications and source records attributed to A M Singer.

15 recordsLinked to original sources
PubMed2001

The ups and downs of medical school applicants.

The number of students applying to medical schools is shrinking after rising steadily during the 1990s. The decline is the latest turn in the behavior of the applicant pool, which historically has gone through many cycles. Although government policies have strongly influenced the past behavior of the applicant pool, the more recent cycles appear to be related to changes in the Medical College Admission Test (MCAT) and labor market conditions. This article first reviews the cyclical nature of the pool and outlines some of the important factors that have influenced its patterns. Then it focuses on more recent data covering 1990-2000, showing how changes made in 1991 to the MCAT have affected the applicant pool. Data are presented to document the close relationship between the number of students taking the MCAT and the number of medical school applicants in subsequent years. Using this relationship, a projection model has been developed for making projections of the number of applicants for the entering class in osteopathic medical schools in future years. Actual data are compared to the model's projections.

Educational Measurement↗
PubMed1996

Determinants of specialty choice of physician assistants.

PURPOSE: Although physician assistants (PAs) became part of the U.S. health scene in 1967 and have made important contributions to primary care, available information about the factors that may influence the career choices of this rapidly-growing group of health care providers is sparse. The intent of this analysis was to identify the main factors underlying the specialty-choice decisions of PAs in the first practice year after completing PA training and the reasons for their selections. METHOD: Data were collected from a 1994 survey of 4,416 PAs who had graduated in 1991-1993. Usable responses were obtained from 1,472 PAs (33%). Each PA was asked to state the specialty he or she had entered in the first practice year and also to rate each of 33 possible reasons for this decision. Primary care specialties were defined as family medicine, general internal medicine, and general pediatrics. The ratings were subjected to a factor analysis. RESULTS: The 33 original variables were reduced to nine basic factors influencing the specialty-choice decisions of the PAs, accounting for 47.3% of the variance. The two most important factors were intellectual content of the specialty and a technical orientation. Then factor scores were computed for each PA and subjected to further examination, in which the PAs were divided into two groups: 776 who had entered primary care specialties, and 646 who had entered non-primary-care specialties (50 did not specify their specialties). For the PAs in non-primary-care specialties, the most influential factors were technical orientation and income/employment. For the PAs in primary care, the most influential factors were prevention, academic environment, debt/scholarship, intellectual content, and peer influence. CONCLUSION: For this recently graduated group of PAs, factors representing the kinds of activities they would be engaged in as health care providers were among the most influential, but the relative importances of the factors varied according to whether the PAs were in primary care or non-primary-care specialties, with the latter group being more strongly influenced by marker forces such as income and employment opportunities.

Career Choice↗
PubMed1996

In pursuit of generalism: basic factors influencing the specialty decisions of osteopathic medical school seniors in 1995.

An analysis of survey responses of seniors graduating from osteopathic medical school in 1995 shows that the selection of the medical specialty they planned to pursue in their postgraduate training was considerably influenced by 10 common factors. These factors ranged from the students' orientation to people or techniques, to prestige and income associated with the specialty. The People orientation factor exerted a strong influence on students planning to pursue primary care specialties (defined as Family Practice, General Internal Medicine, and General Pediatrics) Similarly, for students planning to pursue a nonprimary care specialty, the Prestige/income, the Intellectual Content factor, and the Research Factor, with its absence of stress and opportunity for research in other nonprimary care fields, swayed their decision. These findings have implications for the medical school admissions process. If that process can be used to identify students who relate well to people and are more oriented to dealing with preventive medicine and the broad spectrum of health problems presented by individual patients, then it could become an even greater force in the movement toward generalism in medicine.

Career Choice↗
PubMed1989

Projections of physician supply and demand: a summary of HRSA and AMA studies.

There is concern that the United States may have a surplus of physicians soon. In a continuation of a movement started around 1980 by the Graduate Medical Education National Advisory Committee (GMENAC) to quantify and project supply and demand for physicians, the American Medical Association (AMA) and the Health Resources and Services Administration (HRSA) have recently produced their latest studies on this subject. The HRSA conclusion, published in its 1988 report to the President and Congress on the status of health personnel in the United States, is that a surplus may come as early as 1990 and will probably worsen by the year 2000. The AMA study, also published in 1988, agrees with the HRSA and the GMENAC that supply will probably grow faster than demand, but it disclaims the notion of a surplus or shortage because that would imply judgments about the adequacy of current utilization rates by all segments of the population. The HRSA report cites a 1986 finding by the Robert Wood Johnson Foundation that access to medical care deteriorated between 1982 and 1986 for minorities and lower-income groups. On the supply side, the HRSA's estimates are somewhat higher than the AMA's, mainly because the former assumes faster growth in foreign medical graduates. Both studies use a demand-based approach to projecting the number of physicians required, but there are considerable differences in the assumptions made about future utilization rates.

American Medical Association↗
PubMed1985

Comparison of overhead and cross-table lateral views for detection of knee-joint effusion.

Prompted by the failure to detect a clinically evident knee-joint effusion on the cross-table lateral view of an injured patient, a prospective study was carried out to compare the routine overhead and cross-table lateral knee views for detection of joint effusion in 18 patients with acute knee trauma. In every case, the size of the effusion as determined by the "fat-pad separation sign" was greater on the overhead view (p less than 0.001). In three patients the effusion would have been missed radiologically had the vertical-beam projection been omitted. The authors conclude that the cross-table lateral view is less sensitive than the routine overhead lateral view in the detection of knee-joint effusions because of fluid shift into the lateral recesses of the suprapatellar bursa with the patient in the supine position. This phenomenon is demonstrated by arthrography and computed tomography in one patient.

Adult↗
PubMed1979

Congenital megaureter.

Megaureter is the descriptive term applied to the large, wide, dilated and often tortuous ureter, which is usually congenital. Megaureter may result from a number of causes and an accurate diagnostic classification, such as refluxing, obstructed or non-refluxing, non-obstructed, is essential for appropriate management. The 52 consecutive patients with the various forms of megaureter presented typify the various causes of the entity. Surgical intervention virtually is universal and factors bearing upon recoverability and prognosis have been analyzed.

Classification↗
PubMed1977

The adynamic terminal ureteral segment.

Recently, we observed hydroureteronephrosis owing to an adynamic transmural distal ureteral segment associated with a thickened bladder, consequent to bladder outlet obstruction. Histological examination disclosed a loss of intrinsic musculature of the terminal ureteral segment with fibrosis. The importance of this entity is in the fact that upper tract dilatation and deterioration may progress, despite apparently successful correction of the bladder outlet uropathy.

Child↗
PubMed1976

The suppressive effect of immunization on the proliferative responses of rat T cells in vitro. II. Abrogation of antigen-induced suppression by selective cytotoxic agents.

Rats given large i.v. doses of ovalbumin or sheep erythrocytes manifest suppressed spleen cell responses (3H-thymidine incorporation) to PHA within hours. Removal of glass wool-adherent cells totally restores responsiveness to that of normal nonadherent spleen cell cultures. Carrageenan, selectively toxic for macrophages, partially restores responses of antigen-suppressed spleen cells in culture, suggesting a supportive role for macrophages in the suppression phenomenon. Treatment of donors with low doses of cyclophosphamide (20 to 50 mg/kg) at the time of antigen injection abrogates the ability of their spleen cells to suppress the responses of normal cells to PHA. The low dose of cyclophosphamide required indicates a target other than the B cell or macrophage and suggests the possibility that cyclophosphamide eliminates the suppressor T cell component of the macrophage-T cell complex.

Animals↗
PubMed1975

Measurement of the immune response to an allograft: amino acid incorporation by peripheral white blood cells in man.

The uptake in vitro of 3H-thymidine and of 3H-uridine by white blood cells freshly taken from the recipients of renal transplants has been followed at regular intervals during the period of the patients' hospitalization. In addition, groups of subjects without renal failure undergoing operation and of patients on chronic dialysis have been studied. Of 33 patients undergoing rejection of their kidney, 28 showed a marked rise in the incorporation of thymidine over the period of rejection. However, a similar rise appears to accompany episodes of inter-current infection.

Graft Rejection↗
PubMed1973

Blood and urinary changes in patients with ileostomies and ileorectal anastomoses.

Biochemical investigations done on the blood and urine of currently healthy, uncomplicated patients previously treated by either proctocolectomy and ileostomy or colectomy and ileorectal anastomosis for ulcerative colitis were compared with estimations on matched controls. The most striking finding was the reduced urine volume, and to a lesser extent its sodium content, in patients with ileostomies. The urinary pH indicated persistent acidity in postoperative patients but this was also a remarkably constant feature in control subjects. These findings are in agreement with other studies related to the occurrence of urinary calculi after colectomy and ileostomy, and are consistent with the contention that there is a lower incidence of calculi after ileorectal anastomosis.

Adult↗