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(1992). Eating Right With Type II Diabetes. The Physician and Sportsmedicine: Vol. 20, No. 9, pp. 17-18.

But in the transition from a high-protein to high-carb diet, many athletes have eliminated meat— and have also overlooked the importance of protein. Some have taken the public health recommendations to eat less saturated fat to the extreme and are surviving on fat-free bagels and pasta. This type of diet may seem ideal, but in addition to being low in protein, it lacks important nutrients such as iron (needed to carry oxygen to working muscles) and zinc (needed for healing).

(1994). What's Brewing With Caffeine? The Physician and Sportsmedicine: Vol. 22, No. 9, pp. 15-16.

An aircraft seat manufacturing company requested a NIOSH health hazard evaluation to help identify a strong odor that had persisted throughout the facility for over a year. Employees reported experiencing health effects thought to be related to the odor. We collected and analyzed area air samples for volatile organic compounds, endotoxin, bacterial and fungal metagenome, and metalworking fluid aerosol. Bulk metalworking fluid samples were analyzed for endotoxin, bacterial and fungal metagenome, and viable bacteria and fungus. We also evaluated the building ventilation systems and water diversion systems. Employees underwent confidential medical interviews about work practices, medical history, and health concerns. Based on our analyses, the odor was likely 2-methoxy-3,5-dimethylpyrazine. This pyrazine was found in air samples across the facility and originated from bacteria in the metalworking fluid. We did not identify bacteria known to produce the compound but bacteria from the same Proteobacteria order were found as well as bacteria from orders known to produce other pyrazines. Chemical and biological contaminants and odors could have contributed to health symptoms reported by employees, but it is likely that the symptoms were caused by several factors. We provided several recommendations to eliminate the odor including washing and disinfecting the metalworking machines and metalworking fluid recycling equipment, discarding all used metalworking fluid, instituting a metalworking fluid maintenance program at the site, and physically isolating the metalworking department from other departments.

Milk is fattening. Milk is mucus-forming. Milk is hard to digest. Milk is bad for the heart. Milk is for kids.

In brief: With the recent plethora of research indicating that food affects performance, athletes are eager to learn how to eat to win. They recognize that sound nutrition practices are an integral part of their training program. Hence, sports-active people of all ages and athletic abilities are increasingly receptive to professional nutrition advice. This article presents two case reports of athletes who consulted the author for advice regarding diverse problems: One wanted to stabilize her blood sugar and lose weight; the other wished to gain weight. Both wanted to enhance their athletic performance.

New York City's South Asian children and pregnant women have a disproportionate burden of elevated blood lead levels. This study is the first to investigate blood lead levels and risk factors for lead exposures among South Asian New Yorkers. A survey and a finger-stick blood lead test using a portable analyzer were administered to 230 South Asian adults and children. Blood lead levels of 5 µg/dL or higher were found in 20 % of the adults and 15 % of the children, as compared to 5 % of adults and 2.5 % of children citywide. Factors associated with elevated blood lead levels were recent repair work at home, not speaking English, Bangladeshi or Indian ethnicity, and occupational risk factors. Public health professional should be aware that South Asians may be at an increased risk for elevated blood lead levels.

— This article argues that executive function (EF) capacity plays a critical role in preschoolers’ ability to test and revise hypotheses and, furthermore, that young children can engage in the process of testing hypotheses before they are able to revise or confirm them. Research supports the view that this ability depends on their EF capacity to represent, and reflect on, hierarchical rules relating actions to predicted or observed outcomes (i.e., differences between what they predicted and what they observed). The article concludes by discussing the ramifications of this perspective for early science education.

Multidisciplinary management of the female athlete triad (disordered eating, amenorrhea, and osteoporosis) is optimal, but what exactly does it entail? With the primary care physician as the point person, the healthcare team addresses the underlying causes of disordered eating through such measures as drawing up a contract for returning to play, resolving nutrition issues, exploring psychotherapy options, and, sometimes, prescribing antidepressants. Hormone replacement therapy and conservative or orthopedic intervention for stress fractures may also be required. Communication among the members of the treatment team is crucial, and athletic trainers especially can provide valuable input. Prevention strategies need to involve education of coaches, teachers, trainers, parents, and others who work closely with female athletes.

The female athlete triad of disordered eating, amenorrhea, and osteoporosis affects many active women and girls, especially those in sports that emphasize appearance or leanness. Because of the athlete's psychological defense mechanisms and the stigma surrounding disordered eating, physicians may need to ask targeted questions about nutrition habits when assessing a patient who has a stress fracture or amenorrhea, or during preparticipation exams. Carefully worded questions can help. Physical signs and symptoms include unexplained recurrent or stress fracture, dry hair, low body temperature, lanugo, and fatigue. Targeted lab tests to assess nutritional and hormonal status are essential in making a diagnosis that will steer treatment, as are optimal radiologic tests like dual-energy x-ray absorptiometry for assessing bone density.

In Pennsylvania on February 16, 2006, a New York City resident collapsed with rigors and was hospitalized. On February 21, the Centers for Disease Control and Prevention and the New York City Department of Health and Mental Hygiene were notified that Bacillus anthracis had been identified in the patient's blood. Although the patient's history of working with dried animal hides to make African drums indicated the likelihood of a natural exposure to aerosolized anthrax spores, bioterrorism had to be ruled out first. Ultimately, this case proved to be the first case of naturally occurring inhalational anthrax in 30 years. This article describes the epidemiologic and environmental investigation to identify other cases and persons at risk and to determine the source of exposure and scope of contamination. Because stricter regulation of the importation of animal hides from areas where anthrax is enzootic is difficult, public healthcare officials should consider the possibility of future naturally occurring anthrax cases caused by contaminated hides. Federal protocols are needed to assist in the local response, which should be tempered by our growing understanding of the epidemiology of naturally acquired anthrax. These protocols should include recommended methods for reliable and efficient environmental sample collection and laboratory testing, and environmental risk assessments and remediation.

Background Mercury is a toxic metal that has been used for centuries as a constituent of medicines and other items. Objective We assessed exposure to inorganic mercury in the adult population of New York City (NYC). Methods We measured mercury concentrations in spot urine specimens from a representative sample of 1,840 adult New Yorkers in the 2004 NYC Health and Nutrition Examination Survey. Cases with urine concentrations ≥ 20 μg/L were followed up with a telephone or in-person interview that asked about potential sources of exposure, including ritualistic/cultural practices, skin care products, mercury spills, herbal medicine products, and fish. Results Geometric mean urine mercury concentration in NYC was higher for Caribbean-born blacks [1.39 μg/L; 95% confidence interval (CI), 1.14–1.70] and Dominicans (1.04 μg/L; 95% CI, 0.82–1.33) than for non-Hispanic whites (0.67 μg/L; 95% CI, 0.60–0.75) or other racial/ethnic groups. It was also higher among those who reported at least 20 fish meals in the past 30 days (1.02 μg/L; 95% CI, 0.83–1.25) than among those who reported no fish meals (0.50 μg/L; 95% CI, 0.41–0.61). We observed the highest 95th percentile of exposure (21.18 μg/L; 95% CI, 7.25–51.29) among Dominican women. Mercury-containing skin-lightening creams were a source of exposure among those most highly exposed, and we subsequently identified 12 imported products containing illegal levels of mercury in NYC stores. Conclusion Population-based biomonitoring identified a previously unrecognized source of exposure to inorganic mercury among NYC residents. In response, the NYC Health Department embargoed products and notified store owners and the public that skin-lightening creams and other skin care products that contain mercury are dangerous and illegal. Although exposure to inorganic mercury is not a widespread problem in NYC, users of these products may be at risk of health effects from exposure.

Traditional and modern techniques for bioaerosol enumeration were used to evaluate the relative efficiency of gaseous chlorine dioxide (ClO2) in reducing the indoor microbial contamination under field and laboratory conditions. The field study was performed in a highly microbially contaminated house, which had had an undetected roof leak for an extended period of time and exhibited large areas of visible microbial growth. Air concentrations of culturable fungi and bacteria, total fungi determined by microscopic count and polymerase chain reaction (PCR) assays, endotoxin, and (1 --> 3)-beta-D-glucan were determined before and after the house was tented and treated with ClO2. The laboratory study was designed to evaluate the efficiency of ClO2 treatment against known concentrations of spores of Aspergillus versicolor and Stachybotrys chartarum on filter paper (surrogate for surface treatment). These species are commonly found in damp indoor environments and were detected in the field study. Upon analysis of the environmental data from the treated house, it was found that the culturable bacteria and fungi as well as total count of fungi (as determined by microscopic count and PCR) were decreased at least 85% after the ClO2 application. However, microscopic analyses of tape samples collected from surfaces after treatment showed that the fungal structures were still present on surfaces. There was no statistically significant change in airborne endotoxin and (1 --> 3)-beta-D-glucan concentration in the field study. The laboratory study supported these results and showed a nonsignificant increase in the concentration of (1 --> 3)-beta-D-glucan after ClO2 treatment.

Learning Objective To discuss the merits of diet, exercise, or both for achieving and maintaining a healthy body weight.

This study explores light as a design element in the composition of interior spaces. An analysis of two graduate–student projects demonstrates the potential in considering light from an aesthetic perspective. Further, the projects demonstrate the gap between the language used in the composition of interior space and the language of light.

This study investigated the phonological awareness of low-income Spanish–English bilingual children, because phonological awareness has been found to be an important prerequisite for literacy acquisition and because such children have been identified as at risk for successful literacy acquisition. Our sample included 123 Spanish–English bilingual preschool children (M=49.1 months) attending Head Start programs. Children's receptive vocabulary was assessed using the Peabody Picture Vocabulary Test—3rd Edition and the Test de Vocabulario en Imagines Peabody. We assessed phonological awareness using English and Spanish versions of the Early Phonological Awareness Profile, which includes deletion detection and rhyming tasks. Emergent literacy was assessed in the child's stronger language using the Emergent Literacy Profile, which includes tests of environmental print knowledge, printed word awareness, alphabet knowledge, and early writing. Spring levels of phonological awareness in each language were most strongly related to development of phonological awareness in the other language. Final models accounted for 68% of the variance in spring English and Spanish phonological awareness. Educational implications are discussed.

Every 4 years, rowers from around the world compete in a 50- to 60-day transAtlantic rowing challenge. These ultra-distance rowers require a diet that provides adequate calories, protein, vitamins, minerals, and fluids so they can perform well day after day, minimize fatigue, and stay healthy. Yet, the rowers are confronted with menu planning challenges. The food needs to be lightweight, compact, sturdy, non-spoiling in tropical temperatures, calorie dense, easy to prepare, quick to cook, and good tasting. Financial concerns commonly add another menu planning challenge. The purpose of this case study is to summarize the rowers’ food experiences and to provide guidance for sports nutrition professionals who work with ultra-endurance athletes embarking on a physical challenge with similar food requirements. The article provides food and nutrition recommendations as well as practical considerations for ultra-distance athletes. We describe an 8,000 calorie per day menu planning model that uses food exchanges based on familiar, tasty, and reasonably priced supermarket foods that provide the required nutrients and help contain financial costs.

Over a three-year period, Education Development Center, Inc. selected and studied three urban middle schools that intentionally set out to serve all of their students, including those with identified disabilities, those acquiring English proficiency, and those recently immigrated to the United States. The three schools share the philosophy that all students are academically competent when they are given the tools for constructing knowledge. All three schools have strong records of progress on various measures of academic learning, including standards-based, statewide tests. Although these schools have developed different cultures around academic excellence, they share a number of common features. This paper discusses seven features of the cultures of excellence and belonging that characterize these schools, drawing on a case study of one of the schools to illustrate how the features interact and mutually support one another.

Lead-based paint and occupational lead hazards remain the primary exposure sources of lead in New York City (NYC) children and men, respectively. Lead poisoning has also been associated with the use of certain consumer products in NYC. The NYC Department of Health and Mental Hygiene developed the Intervention Model for Contaminated Consumer Products, a comprehensive approach to identify and reduce exposure to lead and other hazards in consumer products. The model identifies hazardous consumer products, determines their availability in NYC, enforces on these products, and provides risk communication and public education. Implementation of the model has resulted in removal of thousands of contaminated products from local businesses and continues to raise awareness of these hazardous products.

State frameworks emphasize literacy goals such as understanding literary concepts and understanding how to read and compose texts with varied purposes. Students with learning disabilities need to engage in instruction that addresses these goals and takes into account the special literacy challenges these students face. This article describes a study of how middle-school teachers in general education classrooms implemented a Supported Literacy approach and how students with disabilities performed in relation to their peers. Supported Literacy engages students in integrated thematic units in which they read, discuss, and write about a shared, age-appropriate text. Findings indicate that teachers provided students with disabilities access to the full range of challenging reading and writing activities in the unit. Students with disabilities performed similarly to normally achieving and honors students in one of the most challenging comprehension and writing activities, writing persuasively about their interpretation of a text. Results also indicate that all students need a fuller understanding of the process of developing a persuasive argument and that teachers need more skill in assessing students' work to determine and respond to students' levels of understanding. The article discusses implications of these findings for studying complex literacy interventions.

The purpose of a respirator is to prevent the inhalation of harmful airborne substances or to provide a source of respirable air when breathing in oxygen-deficient atmospheres. For a physician to recommend the use of respirator, general background information on respiratory-protective devices is required. The first part of this clinical practice review describes the general aspects of industrial hygiene, respirators and a respirator-certification program. The second part addresses matters related to medical certification for respirator use. Medical certification for respirators is an important part of the activities of the occupational physician. To determine whether a worker is able to tolerate the added strain of a respiratory protective device is a complex process in which factors such as fitness for work, health of the individual, characteristics of the work itself, and the properties, type, and requirements of the respiratory protective device, have to be considered. Medical certification is of utmost importance for respirator use, and it should be viewed as an element in a comprehensive respiratory protection program. A comprehensive program is the key element in affording the workers' effective respiratory protection once the initial steps of the hierarchy of methods of hazard control have proved insufficient or infeasible. As a result, the need for the industrial hygiene/safety officer, the worker, the employer and the medical professional to work as a team is much more than in any other field of occupational medicine--a necessary requirement for making the right decision.

To contrast prevailing behaviors and attitudes relative to prJgiary care education and practice in osteopathic and allopathic medical schools.Descriptive study using confidential telephone interviews conducted in 1993-94. Analyses compared responses of osteopaths and allopaths, controlling for prJgiary care orientation.United States academic health centers.National stratified probability samples of first-year and fourth-year medical students, postgraduate year 2 residents, and clinical faculty in osteopathic and allopathic medical schools, a sample of allopathic deans, and a census of deans of osteopathic schools (n = 457 osteopaths; n = 2,045 allopaths).Survey items assessed personal characteristics, students' reasons for entering medicine, learners' prJgiary care educational experiences, community support for prJgiary care, and attitudes toward the clinical and academic competence of prJgiary care physicians.PrJgiary care physicians composed a larger fraction of the faculty in osteopathic schools than in allopathic schools. Members of the osteopathic community were significantly more likely than their allopathic peers to describe themselves as socioemotionally oriented rather than technoscientifically oriented. Osteopathic learners were more likely than allopathic learners to have educational experiences in prJgiary care venues and with prJgiary care faculty, and to receive encouragement from faculty, including specialists, to enter prJgiary care. Attitudes toward the clinical and academic competence of prJgiary care physicians were consistently negative in both communities. Differences between communities were sustained after controlling for prJgiary care orientation.In comparison with allopathic schools, the cultural practices and educational structures in osteopathic medical schools better support the production of prJgiary care physicians. However, there is a lack of alignment between attitudes and practices in the osteopathic community.

Background: Clinical education increasingly occurs in ambulatory and primary-care practices. Physicians face increased demands for clinical productivity. Purpose: To explore whether community-based family physicians' perceptions of problems in primary-care practice affect their attitudes toward teaching. Methods: Using the national databases of the American Academy of Family Physicians, we identified a sample of family physicians who teach but are not based at academic health centers. These 80 family physicians were surveyed by telephone about their careers and their teaching. Results: The response rate was 61%. Respondents identified several problematic aspects of medical practice that may have a negative impact on teaching: administrative demands, decreasing autonomy, diminished control over conditions of practice, concern about future income, and increased productivity demands. Over three fourths of the respondents (77.5%) were concerned that increasing the amount of teaching they do would decrease the...

Background and Methods Views of managed care among academic physicians and medical students in the United States are not well known. In 1997, we conducted a telephone survey of a national sample of medical students (506 respondents), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percent. Results Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as “as negative as possible” and 10 as “as positive as possible.” The expressed attitudes toward managed care were negative, ranging from a low mean (±SD) score of 3.9±1.7 for residents to a high of 5.0±1.3 for deans. When asked about specific aspects of care, fee-for-service medicine was rated better than managed care in terms of access (by 80.2 percent of respondents), minimizing ethical c...

After graduating from college and entering the work force, young adult athletes often struggle with the task of fueling themselves optimally for top performance and weight control. The stresses and time constraints of work, family, and social responsibilities often result in eating fast foods on the run. These young adults can benefit from nutrition education programs at the worksite, at health clubs, in the community, and via the media. Dietitians who specialize in sport nutrition have particular appeal to these athletes, who are struggling to eat well, exercise well, and stay lean yet put little time or effort into their food program. This article includes two case studies of young adults and the dietary recommendations that taught them how to make wise food choices, fuel themselves well for high energy, and control their weight.

Although abdominal aortic aneurysm (AAA) is a common problem in elderly patients, AAA is rare in children. Despite its rarity, early diagnosis is imperative to prevent limb-threatening or fatal complications. The treatment may be complicated, because it must allow for the growth of the child. A saccular AAA in an 11-year-old boy, complicated by three repeated embolizations to the lower extremities and treated by aneurysmorrhaphy 25 years ago, was studied. In addition, the long-term function of a vein interposition graft in the common femoral artery was identified. (J Vasc Surg 1998;28:715-8.)