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Education and health are two of the most valued goods of human existence. The wellbeing of society is largely determined by the content and quality of health and education passed from one generation to the next. Upon the education of present and future osteopaths the fate of osteopathy and osteopathic medicine depends. We are asking you to share your ideas about education in the pages of the International Journal of Osteopathic Medicine. Osteopathy exists in its practitioners. The culture that we have and outwardly express publicly defines us. Osteopathic education and the institutions are where that dynamic culture exists and are at the heart of the osteopathic profession. These institutions have a fundamental

Hospitals that provide post-graduate medical education have a unique role in the American healthcare system. These hospitals provide a large portion of healthcare for populations that are poor and chronically ill. With few exceptions, these institutions are responsible for training all physicians who practice in the United States. Teaching hospitals receive funding for providing graduate medical education through the Medicare program, Medicaid program, Health and Human Services, the Veterans Administration, Department of Defense, and private funding from individual hospitals. Payment for training of postgraduate physicians consists of direct costs for maintaining residency training programs and indirect medical expenses related to the increased costs associated with having residency training programs in a hospital. Funding for individual residency training programs is determined by complex formulas which are reviewed.

The release of biological agents, including those which could be used in biowarfare or bioterrorism in large urban areas, has been a concern for governments for nearly three decades. Previous incidents from Sverdlosk and the postal anthrax attack of 2001 have raised questions on the mechanism of spread of Bacillus anthracis spores as an aerosol or contaminant. Prior studies have demonstrated that Bacillus atrophaeus is easily transferred through simulated mail handing, but no reports have demonstrated this ability with Bacillus anthracis spores, which have morphological differences that may affect adhesion properties between spore and formite. In this study, equipment developed to simulate interactions across three generations of envelopes subjected to tumbling and mixing was used to evaluate the potential for cross-contamination of B. anthracis spores in simulated mail handling. In these experiments, we found that the potential for cross-contamination through letter tumbling from one generation to the next varied between generations while the presence of a fluidizer had no statistical impact on the transfer of material. Likewise, the presence or absence of a fluidizer had no statistically significant impact on cross-contamination levels or reaerosolization from letter opening.

The assessment for pulmonary emboli is still Stone Age. History and physical findings are not sensitive or specific making it difficult to establish the diagnosis. PE is still potentially fatal. Death most often results from the severity of the clot, although delay in treatment may play a role. Clots, including deep venous thrombosis and pulmonary emboli, are the first disease that falls clearly under the Hospitalist specialty. An argument over what imaging is ideal continues to rage on, without any clear leader at this point. The CT scan and Ventilation/Perfusion scan are the two modalities being used most often. However without the use of a pretest probability the sensitivity and specificity can go down to less than 80%. The many new anticoagulants and oral therapies have widened the armamentarium, without increasing the success of therapy.

The Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) assesses the competence of osteopathic physicians in training. It is designed to protect the public by setting minimum competence standards. All osteopathic medical students must pass COMLEX-USA Level 1, Level 2-Cognitive Evaluation, and Level 2-Performance Evaluation before being allowed to graduate from an osteopathic medical school. Residency training programs use COMLEX-USA scores as a major factor in deciding whom they will interview and admit into their programs. In addition, colleges of osteopathic medicine use student COMLEX-USA scores as an external assessment of their success in educating students. Because COMLEX-USA is a high-stakes examination series, it is important to understand predictive factors for performance. The authors review the literature on the relationship between COMLEX-USA scores and correlated student variables. Results from the Council on Osteopathic Student Government Presidents' survey on students' preparation methods and performance are also provided. J Am Osteopath Assoc. 2015;115(4):232-235 doi:10.7556/jaoa.2015.046

In people with cancer, pain often occurs from the malignancy, from procedures done to diagnose, stage, and treat the malignancy, and from the toxicities of therapy used in treating the cancer. Of people with cancer, 75% complain of some sort of pain. Determining whether the pain is from tissue damage or nerve structures will guide therapy. Assessment of the severity of the pain by location, oncological type, as well as psychosocial and environmental factors are necessary to understand and treat the pain that accompanies cancer. Medical interventions include non-opioid analgesics, opioids, and multiple different combinations of medications. Adjuvant medication like anticonvulsants and steroids are being used frequently to help people feel more comfortable.

Genital human papilloma virus (HPV), the most common sexually transmitted disease in the United States, is associated with cervical cancer in women, and penile cancers in men. The infection is asymptomatic until a malignancy develops. Of the more than 90 subtypes, only a small number are associated with malignancies. Vaccines made with recombinant HPV proteins have been shown effective in preventing infection with the more virulent strains of the virus.

It is often assumed that cardiovascular disease is due to issues related to lifestyle. While lifestyle does contribute to the expression of cardiovascular issues, a genetic etiology to Marfan's syndrome, hypertrophic cardiomyopathy and long QT syndrome have been shown. It is unclear as to what role genetics plays in hypertension and hyperlipidemia, although it is felt that genetics contributes to these pathologies as well.

Successful management of transplant patients requires an informed primary care provider with a good working relationship with the patient's medical home. Primary care physicians who are aware of the policies and criteria that regulate transplants will help their patients obtain the organs as treatment of end organ damage.

Anti-Hu antibodies, also known as ANNA-1, are well characterized in paraneoplastic neuropathies. We present here the first known case of anti-Hu seropositivity, cerebellar ataxia, and sensory neuropathy in association with cervical cancer.

The co-existence of rare clinical findings in a patient with a genetic abnormality has often led to the characterization of new syndromes. Although these genetic syndromes are generally rare, the pathophysiology of these disorders has broadened our understanding of common medical conditions. The variety of disorders that map to chromosome 21 provide insight into the effects of lifelong low pO2 and poor perfusion on various organs. In discovering the different disorders that map specifically to chromosome 21, we can characterized, treat and even prevent some medical conditions. We present the case of a man whose incidental finding of hypoxemia lead to the discovery of many unusual disorders that appear to be related to abnormalities in chromosome 21.

When people overuse their legs they develop an uncomfortable awareness of these limbs manifested as a dull burning or aching. The cause is often clear to the person with the problem as a result of the often obvious relationship to overdoing an exercise or activity and the pain. "Shin splints" is the lay term; physicians use the term medial tibial stress syndrome. The pathophysiology that leads to this pain is unclear, although there are a number of competing theories. Differential diagnosis includes stress fractures and compartment syndromes. Bone tumors or lipomas can also cause similar pain to shin splints. Diagnosis can be made by history alone in a majority of cases, but if the diagnosis is unclear, an X-ray and magnetic resonance imaging should be considered. Treatment is still mostly supportive and symptom related. Rest is the most important aspect of treatment. Locally applied cold and anti-inflammatory medication have also been felt to be beneficial.

The potential damage from an avian flu epidemic is huge, but unlikely. Currently, the virus affects birds and humans who handle dead birds. Only one case of suspected human-to-human transmission exists. If human-to-human transmission can occur with a new strain of the virus, we are susceptible to a pandemic. The many subtypes of influenza act and develop differently. The inflammatory response generated by the virus accounts for the illness. Vaccines are being developed, but the difficulties are real, and the time to success cannot be confidently stated. Lymphopenia, thrombocytopenia, and elevated liver enzymes are common. Treatment has to take into account societal issues as well as the individual health of every patient.

The majority of our diet consists of carbohydrates. Carbohydrates may be glycemic, which can be broken down and turned into simple glucose molecules quickly, or non-glycemic, which are not turned into sugar until they reach the large intestine. The glycemic index tells us how quickly the food we eat is turned into sugar and the glycemic load will give us absolute amounts of sugar introduced into the body by a food. Processing of foods and addition of fructose to the diet are major changes that correlate with weight gain in individuals. Decreasing carbohydrates in the diet goes along with a decrease in total calories in the diet.

Disaster victims present in waves. The initial presenting group is traditionally suffering from mild physical injuries, and the second wave, usually following 6 h later, typically has more serious trauma. Medical problems typically are not adequately treated when a person has psychological reasons to worry about survival. The third wave of victims from untreated medical problems occurs 6 d after the initial disaster. Triage of the initial waves is important to prevent the system from becoming overwhelmed and to begin looking for those who will suffer long-term psychological sequelae. Early intervention in those at greatest risk for long-term issues is important and can be accomplished.