Career changes are becoming common among professionals in recent years. Many physicians may want to change direction, but often do not know whether it is the right thing to do or if pursuing a career outside of clinical practice would achieve their professional goals. Doctors have the training and education to contribute to society in many beneficial ways in addition to traditional clinical practice. Yet, there is no formal mapped-out route for doctors who want to pursue alternative careers, which is where Careers Beyond Clinical Medicine comes in.
Doctors at any stage, from early in training to mid-career, to nearing retirement, can use Careers Beyond Clinical Medicine to clearly evaluate the issues involved when considering a career change. This book shows physicians how they can serve society and patients in innovative ways, and make a notable impact on health care delivery, policy and quality when they use their medical background in a non-traditional career pursuit. The numerous unadvertised opportunities for physicians are explored and a step-by-step route with practical advice for finding the best career is described.
Recent advances in healthcare technology, medical science, patient education require physicians to play new roles that have not traditionally been well-defined. Doctors can innovate and have a long-term productive impact on healthcare in the United States and throughout the world if they learn to seize the non-traditional career opportunities available to physicians, or even create a new way to fill a void in health care. Careers Beyond Clinical Medicine helps illuminate that path.

The Second Meeting of the International Society for Trace Element Research in Humans (ISTERH) was held in Tokyo from August 28 through September 1,1989. On August 27, the day preceding the opening of the meeting, a typhoon made a direct attack on Tokyo, welcoming guests from all over the world in a rather violent way. To our great relief, the weather during the week of the meeting turned out to be exceptionally agreeable for that time of year in Tokyo. We were also pleased to see the entire scheduled course of the meeting, including the social activities, carried out smoothly and the contents of the program favorably appraised. The meeting was attended by 518 scientists from 30 countries. Recent unrest following steps toward democratization in the Communist bloc gave rise to some apprehension; therefore, we were particularly pleased to see attendants from China, Eastern Europe, and the Soviet Union. No one could possibly have predicted the drastic change in Eastern Europe that followed, but again, we were relieved to learn (by a subsequent letter) of the safety of an attendant from Rumania, who had been our greatest concern. A total of 384 papers were contributed to the meeting. The abstracts for all have been published in the Journal of Trace Elements in Experimental Medicine, vol 2, No. 2/3 (1989). This proceedings carries 64 subjects introduced in the Special Session.

Genital Papillomavirus Infections provides a state of the art survey on the clinical aspects, diagnosis, treatment, and prevention of genital papillomavirus infections, written by experts in the respective fields. Two introductory sections on epidemiology and molecular biology are followed by chapters on new techniques for the detection of genital papillomaviruses and their presence in genital carcinomas. Contributions on the clinical aspects cover infections of the cervix, male and female external genitalia, urethra, and oral cavity. A discussion of the immunobiology of papillomaviruses ends in an evaluation of the prospects for vaccination, and the application of podophyllotoxin, cryosurgery, laser therapy, and interferon treatment are described in detail. This book is unique in placing a strong emphasis on clinical aspects of genital papillomavirus infections. Mainly addressed to clinicians, it provides practical guidelines on methods for their diagnosis and treatment.

The aging process involves changes in neurotransmission at different levels. The purpose of this book is to help define the state-of-the-art of the field and to give directives for future research on the aging brain. Following topics are presented: the comparison of normal and pathological aging at the anatomical and neurochemical level; the knowledge of the responses of the aging brain to drug treatment or environmental stress; the neuro/immune and neuro/endocrine setting during aging; and the definition of therapeutical approaches in normal aging. This book will interest physicians and pathologists as well as neurophysiologists.

nd This book stems from the 2 Parkinson's Disease Symposium on "Neurotoxic Factors in Parkinsons disease and related disorders", held on August 6-7,1999 at the University ofUlm Medical School in Ulm at the Danube, Germany. The symposium wasalso asatellite ofthejointmeetingofthe InternationalSocietyfor Neurochemistry (ISN) and the European Society for Neurochemistry (ESN) that followed immediately afterwards in Berlin. The specific topic, neurotoxic factors in Parkinson's disease (PD), was chosen in light of accumulating neurobiological and epidemiological evidence indicating that the causes of this second most common neurodegenerative disorder, and possibly of related conditions such as multiple systems atrophy, in some manner involve environ- mental (xenobiotic) and even endogenous toxic agents. This volume brings together much of that neurobiological evidence; and in epidemiology, several recent major studies ofPD - for example, a study of20,000 twins published in the Journal of the American Medical Association in 1999 - conclude that environmental and life style than genetics, appear to be critical in the idiopathic disease. However, factors, rather the precise roles of neurotoxic factors in the pathogenesis of PD and related basal ganglia disorders remain uncertain, despite the cascade of research resulting from the discovery of the prototype MPTP in the early 1980's, and frankly, we have been surprised by the paucity of concentrated attention on specific environmental agents other than MPTP.

International experts examine the role of nitric oxide in various metabolic events such as septic shock, cardiovascular dysfunction, and trauma and hemorrhagic shock. The nitric oxide pathway and nitric oxide synthesis regulation are also discussed.

5t The 1 International Moxifloxacin symposium took place in Berlin Germany February 18 - 20,1999. The purpose of this meeting was to introduce the medical and scientific communities to this exciting new fluoroquinolone and to define its role in the management of respiratory tract infections. The fluoroquinolones as a class are an important part of our therapeutic armamentarium and moxi floxacin is a unique addition to this class of compounds. This symposium brought together physician/scientists from around the world to present and discuss the moxifloxacin data. The information from this important meeting are presented in these proceedings and are organized under the following headings: Part I Antimicrobial chemotherapy Part II Pre-clinical microbiology Part III Pharmacology Part IV Clinical needs in the millennium Part V Round table discussion The modifications to the basic quinolone structure resulting in moxifloxacin have produced a drug with unique in vitro, and pharmacokinetic/pharmaco dynamic properties. The drug has a very broad spectrum of antimicrobial activity, is well absorbed and can be taken only once daily. Its profile makes it an excellent therapeutic option for many types of respiratory tract infections. It is hoped that our clinical and laboratory colleagues will be as excited by this data as we are and we look forward to further work with this unique and interesting compound."

Der ausserordentlich grosse Zuwachs an Wissen seit der ersten Auflage dieses Handbuches vor rund 70 Jahren dokumentiert sich in den hier vorliegenden bei den Banden, die das Gebiet der klinischen Osteologie in reprasentativer Form zur Darstellung bringen. Die Gliederung in einen mehr theoretischen und in einen mehr klinischen Teil erschien aus zwei Grunden notig: Erstens sind fur das Verstandnis der Pathophysiologie der einzelnen Krankheitsbilder heute breite Kenntnisse der physiologischen Grundlagen erforderlich. So schien es ratsam auf den aktuellen Stand der diesbezuglichen endokrinologischen Forschung in Schwerpunktform einzugehen und die modernen Vorstellungen vom Knochenumbau und Kalzium- phosphatstoffwechsel darzustellen. Zweitens gibt es inzwischen eine grosse Zahl osteologischer Untersuchungsmethoden, die - um Wiederholungen bei der Ab- handlung der einzelnen Krankheitsbilder zu vermeiden - ebenfalls der Klinik vorangestellt wurden. Mit diesen Untersuchungen haben eine Reihe neuer quan- titativer Verfahren Eingang in die moderne Osteologie gefunden, die erst in neuerer Zeit eine Objektivierung von Skelettprozessen in diagnostischer und therapeutischer Hinsicht ermoglichen.

Today we are on the brink of a much-needed transformative moment for health care. The U.S. health care system is designed to be reactive instead of preventive. The result is diagnoses that are too late and outcomes that are far worse than our level of spending should deliver. In recent years, U.S. life expectancy has been declining. Fundamental to realizing better health, and a more effective health care system, is advancing the disruptive thinking that has spawned innovation in Silicon Valley and throughout the world. That's exactly what Stanford Medicine has done by proposing a new vision for health and health care. In Discovering Precision Health, Lloyd Minor and Matthew Rees describe a holistic approach that will set health care on the right track: keep people healthy by preventing disease before it starts and personalize the treatment of individuals precisely, based on their specific profile. With descriptions of the pioneering work undertaken at Stanford Medicine, complemented by fascinating case studies of innovations from entities including the Chan Zuckerberg Biohub, GRAIL, and Impossible Foods, Minor and Rees present a dynamic vision for the future of individual health and health care. You ll see how tools from smartphone technology to genome sequencing to routine blood tests are helping avert illness and promote health. And you'll learn about the promising progress already underway in bringing greater precision to the process of predicting, preventing, and treating a range of conditions, including allergies, mental illness, preterm birth, cancer, stroke, and autism. The book highlights how biomedical advances are dramatically improving our ability to treat and cure complex diseases, while emphasizing the need to devote more attention to social, behavioral, and environmental factors that are often the primary determinants of health. The authors explore thought-provoking topics including: The unlikely role of Google Glass in treating autism How gene editing can advance precision in treating disease What medicine can learn from aviation Discovering Precision Health showcases entirely new ways of thinking about health and health care and can help empower us to lead healthier lives.

The clinical biochemistry ofhepatobiliary diseases is very widely studied, and publica tions abound on this topic. However, there is no recent publication that provides a comprehensive collection of the various leading aspects that go to make up this complex theme. Therefore, we thought it useful to gather together a few scientists whose work has focused on the various clinical biochemistry-aspects of these disorders in order that they might discuss their experience and expertise. The aim of the International Satellite Symposium on Clinical Biochemistry in Hepatobiliary Disease, in addition to reviewing the individual aspects, was to describe the state-of-the-art so as to provide useful data for laboratory scientists and also for physicians working in the field of hepatobiliary diseases, and these two aims are clearly reflected in the chapters of this volume. The volume opens with an introductory chapter that gives a general overview of the various aspects of the clinical biochemistry of these disorders, while the closing chapter deals with an important aspect that deserves to be increasingly emphasized in laboratory medicine, i.e., strategies to integrate information coming from the laboratory to make them more useful for clinical diagnosis.

New findings involving the brain in traumatic and septic shock and after brain injury are reported in this book, including pathophysiological and pathohistological results. An experimental and clinical approach to treatment is presented together with specific results obtained from the encephalogram and from histopathological study with regard to the immunohistochemistry of toxic lipid peroxidant products. The latest results of clinical and experimental pathophysiology in inflammatory processes after traumatic brain injury and the therapeutic effects of hypertonic fluid therapy are also discussed.

Seit der Charakterisierung der genetischen Marker des familiAren medullAren SchilddrA1/4senkarzinoms bzw. der multiplen endokrinen Neoplasie Typ 2 bestehen verbesserte MAglichkeiten zur FrA1/4herkennung und kurativen Behandlung der hereditAren Formen dieser Tumoren. Durch Nachweis eines erhAhten Calcitonins als sensitiven und prAdiktiven Marker fA1/4r medullAre SchilddrA1/4senkarzinome kAnnen prinzipiell auch die sporadischen Formen frA1/4hzeitig erkannt und therapiert werden. Eine konsequente Anwendung der exzellenten diagnostischen Methoden sollte in Zukunft zu einer verbesserten Langzeitprognose dieser Karzinome beitragen. In der Praxis werden medullAre SchilddrA1/4senkarzinome jedoch hAufig erst im fortgeschrittenen Tumorstadium klinisch auffAllig. Um auch fA1/4r diese Patienten eine optimale Heilungschance zu erzielen, mA1/4ssen die bisherigen Diagnostik- und Therapieprotokolle optimiert und durch innovative Verfahren ergAnzt oder ersetzt werden. In dieser bisher einmaligen Zusammenstellung werden neue Aspekte der Genanalyse zur Diagnostik der hereditAren Karzinome, vielversprechende Methoden zur Lokalisationsdiagnostik von Metastasen sowie etablierte und experimentelle AnsAtze zur Therapie dieser TumorentitAt beleuchtet.

The differentiation between the muscarinic and the nicotinic ef- fects of acetylcholine led to the subdivision of the cholinergic ner- vous system into two categories. Further studies showed that stimu- lating and inhibiting muscarinic effects could be demonstrated in different organs. For instance, gastric secretion and gastrointestinal motility are stimulated, while heart rate and the vascular muscula- ture are inhibited. For decades, it could not be determined whether the various ef- fects were mediated by different subgroups of muscarinic receptors, but eventually, with the availability of agonists and antagonists to muscarinic receptors, and using various techniques, the existence of at least two such subgroups could be ascertained . . Mt receptors are defined by their high affinity for the antagonist pirenzipine in comparison to M2 receptors. This subdivision of muscarinic receptors has since been proved beyond doubt by experi- ments in vivo and in vitro, by receptor binding studies, by histoauto- radiography, and by electrophysiological studies. However, these different classes of muscarinic receptors have not been found to relate to different types of effects; instead both excit- atory and inhibitory effects appear to be linked to each class. For ex- ample, excitation of gut motility and inhibition of cardiac contrac- tile activities both appear to be mediated by M2 receptors, while ex- citation of some nerves in sympathetic ganglia and inhibition of some myenteric nerves may be mediated by M receptors.

H. Hafner, G. Moschel, N. Sartorius The size of the world's population aged over 65 was estimated at about 250 million in 1980; by the year 2025 it is expected to grow to about 760 million (see Hauser, this volume). This sharp increase in life expectancy at birth, in some countries amounting to almost 100% in only a hundred years, has resulted from better nutrition and improved living conditions, hygiene and medical care. Not only life expectancy at birth, but also further life expectancy in advanced age has shown a clear, though more moderate increase. This increased life expectancy, together with a simultaneous fall in birth rates, has caused the mean age of the world population and, especially, the average age of the population of industrial nations to climb substantially in recent times, a development which will reach its peak only some decades from now. For these demographic reasons alone, health care authorities will have to devote more attention to the health problems of the elderly. The main task of medical research is to develop improved methods of disease prevention and treatment. Yet, because the full benefits of such research are only realized after many years of work, researchers have already begun to respond to demographic pressures by focussing part of their efforts on the study of illnesses characteristic of old age.

Immunology, in all its facets of immunochemistry, humoral immunity, cellular immunity, immunodiagnosis, and immunotherapy, is currently the most rapidly advancing discipline of clinical and experimental oncology. But as in most developing subjects, it is continually beset with problems of methodology and nomenclature, both of which are often intertwined. Indicative of this problem are our circular definitions of antigen and antibody. Another fre quent problem is the use of the words "specific" and "associated" when characterizing re actions to tumors or the antigenic properties of neoplasms. When applied to cancer, these terms are obviously very dependent upon the methods used to demonstrate these qualities. Indeed, the very diverse nature and multitude of types of cancer preclude our making gen eralizations or categorical statements regarding tumor "specificity. " Similar problems arise when one considers that many antigens found in malignant tumors share certain properties with embryonic or fetal tissues. First, these observations emphasize a lack of true tumor specificity, for which reason the category of oncofetal antigens has been established. Second, whether or not such antigens are truly oncofetal depends upon the method of detection used, and it has been found that here too specificity decreases as the antigen assay increases in sen sitivity. Thus, whether substances can be truly oncofetal in nature still remains a matter of debate, and such terms must therefore be used in an operational sense.

The acute abdomen is one of the most frequent, most dangerous and most difficult problems that the diagnostic radiologist has to deal with. This comprehensive manual presents a clinico-radiologic approach to the use of diagnostic imaging techniques for acute abdominal conditions. Imaging techniques, radiologic symptoms and clinical conditions are treated separately. This lucid format, together with a detailed subject index, offer the reader a quick and reliable reference aid in daily practice. The text is clearly structured and concise in style, and provides helpful practical hints, including discussion of diagnostic pitfalls. It is supported by a wealth of illustrations covering native diagnosis, ultrasonography, computer tomography and angiography.

"De Motu animalium" is sometimes referred to in the medical literature. But who has read it? The book, originally published in Latin, seemingly constitutes the very first treatise on biomechanics. The author, Giovanni Alfonso Borelli (1608 - 1679), was professor of mathematics and physics in Pisa where he worked with Malpighi, who was professor of theoretical medicine and focused Borelli's interest on the movements of living creatures. This was the time of Galileo, Descartes, Newton and many others, when sciences exploded, sometimes leading to conflicts with religious authorities. "De Motu animalium," Borelli's life work, has two parts. In the first part, he analyses the action of the muscles, the movements of the limbs and motions of man and animals, including skating, running, jumping, swimming and flying. The second part deals with what is now called physiology, considered from the point of view of a mechanist: heart beat, blood circulation, breathing, separation of urine from the blood in the kidneys, liver function, reproduction, fatigue, thirst, hunger, fever, and so on. This work shows Borelli to be a genial precursor. He expresses his opinion as a mathematician on problems which afterwards further stimulated the curiosity and endeavours of many generations of researchers. This book will be welcomed by anybody who is interested in the working of living bodies and in the history of human knowledge.

Surgery as a medical discipline has from its beginnings appealed to the imagination of many. It is therefore not surprising to find that its colourful past has induced quite a few authors to take up their pens. The truth of this in the Netherlands is witnessed by a number of dissertations and monographs and especially by the numerous articles related to the history of surgery which have appeared in the medical weekly Nederlands Tijdschrift voor Geneeskunde, particularly during the two decades preceding the Second World War. The memorial volume, published in 1977 by the 'Nederlandse Vereniging voor Heelkunde' (Association of Surgeons of the Netherlands) has thoroughly covered the history of Dutch surgery since the tum of the century, but a chronological survey of the earlier events which led to these modem achievements is still wanting. This book has been written with a view to meeting this need. In it, Dutch surgery has by no means been taken as an isolated phenomenon, but considered in its context with European surgery as a whole. Foreign influences on the on surgery abroad are discussed Netherlands and, conversely, Dutch influences whilst contemporary medical thinking is set against a cultural and political back ground. It is hoped that this approach will allow the book to exceed the narrow boundaries of'campanilismo' and make it of interest to non-Dutch readers as well."

The application of immobilized enzymes in medicine is the main objective of this book. The author reviews natural and synthetic carriers for enzyme immobilization, chemistry of enzyme binding, and in-vitro and in-vivo properties of immobilized enzymes. Four chapters are dedicated to clinical use of immobilized enzymes.

This book is designed to be a physician's guide for those interested in diving and hyperbaric environments. It is not a detailed document for the erudite researcher; rather, it is a source of information for the scuba-diving physician who is searching for answers put to him by his fellow nonmedical divers. Following the publication of The Underwater Handbook: A Guide to Physiology and Performance for the Engineer there were frequent requests for a companion volume for the physician. This book is designed to fill the void. Production of the book has been supported by the Office of Naval Research and by the Bureau of Medicine and Surgery, Research and Development Command, under Navy Contract No. NOOOOI4-78-C-0604. Our heartfelt thanks go to the many authors without whose contributions the book could not have been produced. These articles are signed by the responsible authors, and the names a e also listed alphabetically in these preliminary pages. Every chapter was officially reviewed by at least one expert in the field covered and these reviewers are also listed on these pages. Our thanks go to them for their valuable assistance. We are grateful to Marthe Beckett Kent for editing Chapter III. Our thanks also go to Mrs. Carolyn Paddon for typing and retyping the manuscripts, and to Mrs. Catherine Coppola, who so expertly handled the many fiscal affairs.

This volume is intended to cover research in the field of muscle morphology since publication of the previous edition by Haggquist in 1956. The development of new techniques, coupled with an intensified interest in muscle, has resulted in a vast literature which no single person could review, especially within the limitations of one volume. When I accepted the flattering offer to write a new edition, I quickly abandoned any hope of a comprehensive review. Instead, I tried to consider, within my limits, those lines of research which I believe to be important for the understanding of mammalian and ultimately human muscles under normal, experimental, and pathological conditions. It would be naive to suggest that muscle can be adequately described in purely morphologi cal aspects; I would characterize the results of my effort as "muscle as seen with the eyes of a morphologist." It gives me pleasure to acknowledge the help of several colleagues who read and commented on drafts of individual chapters: Dr. Brenda Eisenberg, Chicago; Dr. Else Nygaard, Copenhagen; Dr. Stefano Schiaffino, Padova; Dr. Michael Sjostrom, Umea; Dr. Lars Erik Thornell, Umea. None of these individ uals can be held responsible for any error or obscurity that persists. Indeed, without their assistance there would have been more. I also thank those col leagues who allowed me to include their published and unpublished material; their names, and also those of the publishers who kindly granted copyright permission, are given in the individual figure captions."

At the beginning of the century the average life span in developed societies was less than 50 years. It is now more than 70 years and will continue to increase in the near future. Aging is a challenge to science and society. There are several theories of aging. The programmed aging hypothesis suggests that aging cannot be altered by any external influence, that aging is programmed from the beginning of life until the end of senescence. Another theory is based on genetic instability, with repair processes correcting errors in the cells that cause aging. Aging processes manifest themselves at the molecular and cellular level, in different organs, and in the whole organism. Most older persons acquire multiple diseases, primarily chronic ones. The multimorbidity of the elderly raises many questions as to nutrition, metabolism, immunity, drug therapy, and rehabilitation. Nutrition may be able to intervene in the aging process. Aging is associated with dec lining immunity and reduced resistance to many diseases, and it is pos sible that nutritional changes in old age contribute to the declining immunity in the elderly. The elderly take 40% of the prescription drugs in Germany and adverse drug reactions are more frequent in geriatric patients. There are not only problems in drug therapy for elderly pa tients, but also in their rehabilitation. The aim of rehabilitation is the restoration of geriatric patients to their former functional and environ mental status."

Man has always been curious about himself, a curiosity that began centuries ago with an examination of the soul, and that extended in the period of the Renaissance to his anatomy and certain functions such as the circulation of the blood. Chemical science entered the scene in the 18th century, and burst into prominence in the 19th century. As the various chemical elements were discovered, many were found to be present in body fluids and tissues. Organic compounds were recognized; it became known that body heat was produced by the combustion of food; chemical transformations such as the production of fat from carbohydrate were recognized; and in the 1850s it was determined that young animals differed from adults in certain aspects of body composition. As methods for chemical analysis evolved, they were applied to samples of body fluids and tissues, and it became apparent that life depended on chemical normality; and most importantly it was realized that given the necessary amount of food and water the body had the ability to maintain a degree of constancy of what Claude Bernard called the milieu interieur, in other words its interior chemical en vironment."