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October 27, 2005  Vol. 353 No. 17

Perspective
1761-1763
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The shortage of nurses in the United States is a serious and growing problem. However, Dr. Sreekanth Chaguturu and Snigdha Vallabhaneni write that entire public health systems are at risk of collapse because of the shortage of nurses in the developing ...

1764-1766

This summer, the Defense Base Reallocation and Closure Commission decided unanimously to close the venerable Walter Reed Army Medical Center in Washington, D.C. For almost a century, countless stories of crisis, caring, triumph, and tragedy have unfolded ...

1766-1768

Elizabeth Phimister describes the HapMap, a welcome tool that affords a fascinating glimpse of the human genome. A critical question, she writes, is how useful the HapMap will be in analyzing populations other than those from which it was derived.

1768-1771

The struggle to combat cancer — including the discovery of oncogenes, tumor suppressors, telomerase, and cancer stem cells — has revealed the complex nature of cancer in humans. Chang-Zheng Chen asks are microRNAs the magic cure for the diagnosis and ...

Original Articles
1773-1783

In this study of 42,760 asymptomatic women, the overall diagnostic accuracy of digital and film mammography as a means of screening for breast cancer was similar, but the former method was better among women under the age of 50 years, women with radiographically dense breasts, and premenopausal or perimenopausal women.

1784-1792

Seven statistical models were independently developed to investigate the reasons for the reduction in the rate of death from breast cancer from 1975 to 2000. All models led to the conclusion that both mammographic screening and adjuvant treatment have contributed to the decrease in mortality.

1793-1801

A microRNA signature consisting of 13 genes was associated with factors that predict disease progression in patients with chronic lymphocytic leukemia.

1802-1809
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Low birth weight is a risk factor for the subsequent development of coronary disease. The effect of childhood growth on coronary risk was evaluated in a cohort of persons born in Finland between 1934 and 1944. On average, children who had a coronary event as adults were small at birth but grew rapidly from 2 to 11 years of age. This growth pattern was also associated with elevated fasting insulin concentrations.

Special Article
1810-1818
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This study found that about a quarter of the physicians working in the United States, the United Kingdom, Canada, and Australia are immigrants who were educated in other countries. Many of these physicians come from lower-income countries, which may cause physician shortages in resource-poor nations.

Review Article
1819-1834

Major depression, which affects 5 to 13 percent of medical outpatients, is often undiagnosed and untreated. Treatment with antidepressant and adjunctive medications and prevention of future episodes are discussed in this article.

Images in Clinical Medicine
1835
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A 42-year-old woman presented to the breast clinic with a mass posterior to an accessory nipple (arrow) that had been progressively enlarging over the past year. On physical examination, the patient had an irregular, hard mass, 3 cm by 4 cm, overlying the ...

e15
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This woman reported feeling as if something were stuck in her throat. She had a hoarse, raspy voice but no respiratory symptoms.

Case Records of the Massachusetts General Hospital
1836-1844

    A 43-year-old man was admitted to the hospital because of acute rectal bleeding. He had had episodes of rectal bleeding intermittently since childhood, and numerous polyps had been resected from the colon, stomach, and duodenum. He also had frequent epistaxis, and vascular malformations had been detected in the nose and lungs. His mother had a similar history. Diagnostic tests were performed.

    Editorials
    1846-1847

    The report by Pisano et al.1 of the results of the Digital Mammographic Imaging Screening Trial (DMIST) in this issue of the Journal adds important information that physicians will use to assess the value of a new technique in mammographic screening: ...

    1848-1850

    At first glance, it may seem implausible that your mother's exposure to stress or toxins while she was pregnant with you, how she fed you when you were an infant, or how fast you grew during childhood can determine your risk for chronic disease as an ...

    1850-1852
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    The movement of physicians from poor to rich countries is a growing obstacle to global health. Ghana, with 0.09 physician per thousand population, sends doctors to the United Kingdom, which has 18 times as many physicians per capita. The United States, ...

    Clinical Implications of Basic Research
    1853-1855

    Findings in a mouse model of frontotemporal dementia suggest that neurofibrillary tangles do not cause dementia.

    Correspondence
    1856-1858

    To the Editor: The article on the risk of cancer in patients with benign breast disease by Hartmann et al. (July 21 issue)1 contains some questionable assumptions. “Atypical ductal hyperplasia” and “lobular hyperplasia,” shown in Figure 1E and Figure 1F ...

    1858-1860

    To the Editor: Wanner et al. (July 21 issue)1 report a lack of benefit from therapy with 20 mg of atorvastatin among patients with type 2 diabetes mellitus who were receiving hemodialysis, despite a high rate of cardiovascular events. In their discussion,...

    1860-1861

    To the Editor: Williams et al.1 and Jha et al.2 (July 21 issue) report improvement but variation among hospitals in a study mandated by the Joint Commission on Accreditation of Healthcare Organizations of measures of the quality of care for acute ...

    1862

    To the Editor: In her review article (Aug. 4 issue), Bain highlighted the usefulness of examining a blood smear in certain clinical settings.1 We would like to add information on the differential diagnosis of leukocytosis in patients with solid tumors ...

    1862-1863

    To the Editor: Case 22-2005 (July 21 issue)1 describes an 81-year-old man with a six-year history of chronic lymphocytic leukemia (CLL) who was admitted to the hospital with cough, purulent sputum production, altered mental status, and fever (39.6°C). ...

    1863-1865

    To the Editor: Buprenorphine was approved by the Food and Drug Administration (FDA) in 2002 for the treatment of opioid addiction in certified physicians' offices. However, the FDA and the Drug Enforcement Administration (DEA) expressed concern that the ...

    1865

    To the Editor: A 73-year-old woman presented on March 22, 2005, for routine evaluation of her VVIR (ventricular pacing, ventricular sensing, inhibition response, rate-adaptive) cardiac pacemaker. The unit had been implanted in the right pectoral region ...

    Book Reviews
    1866-1867

    When we see a family grieving over the illness of a child and know that nothing can be done, we are disheartened and think, “Life can be unfair.” We can be heartened, however, whenever recognized institutions take up the cause of unfair circumstances that ...

    1867-1868

    There is something for everyone interested in public health in The Politics of Public Health in the United States. Students will benefit from the history of public health; the chronology of the more important laws and events in public health policy is ...

    1868-1869

    What can the performance of a clinic in rural Wisconsin tell us about the successes and failures of the U.S. health care system? Although it is not evident in the title, The Rise and Fall of HMOs is the story of how the Marshfield Clinic initiated and ...

    Corrections
    1869

    A Role for Oxidized Phospholipids in Atherosclerosis Perspective, N Engl J Med 2005:353;9-11.. In the figure on page 10, the text in Panel D should have read, “Oxidized phospholipids modulate the thrombotic burden by decreasing thrombomodulin, increasing ...

    1869

    Infection-Control Report Cards — Securing Patient Safety Perspective, N Engl J Med 2005:353;225-227.. On page 226, in the map showing the status of legislation requiring public disclosure of rates of nosocomial infection, Indiana, Louisiana, Texas, and ...

    1869

    Amiodarone versus Sotalol for Atrial Fibrillation Correspondence, N Engl J Med 2005:353;627-630.. On page 628, in the letter by Schlegel, lines 14 and 15 should have read, “Radio-ablation is not an option . . .,” rather than “Radiofrequency ablation is ...

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