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The Family Factors Field Study of Operation Desert Shield/Storm (ODS) was designed to collect data on the impact of the Persian Gulf deployment on soldier/family well-being, and the effectiveness of Army and community resources in assisting and supporting families of deployed soldiers. In October 1990, a task force was assembled, and multi-agency research teams visited several Army installations. Informal individual and group interviews were conducted with spouses, unit family support leaders, unit rear detachment personnel, garrison leaders, and local Army program/service providers. The questions were aimed at identifying key stressors which spouses and children experienced in relation to the sudden deployment, as well a stress mediators such as social supports and personal coping skills. Anecdotal information collected during the site visits, combined with findings from previous research on Army families, was used to develop a questionnaire designed to quantify those variables which emerged as relevant to a study of stressors and stress mediators in the context of the ODS deployment.

Psychological symptom profiles were obtained on 1,601 children of soldiers deployed during Operation Desert Storm (ODS). The profiles were obtained from reports of the parents who stayed at home with the children. Certain symptoms such as sadness were common, but very few parents considered their children's problems serious enough to require counseling. The strongest predictor of children's receiving counseling during ODS was a previous history of being in counseling for emotional problems.

Purpose To review the background for developing the surgical modification of glass bead implantation in the scleral cavity during evisceration, to demonstrate the technique, and to highlight its indications, advantages and complications. Methods Personal experience is used to demonstrate the technique, its indications, advantages and complications. This includes the follow-up data of 17 patients who underwent evisceration with glass bead implantation during 1993-1996 and our experience from 164 eviscerations performed in our eye institute during the last 14 years. Results All patients achieved good cosmetic results with relatively good motility of the prosthesis. Complications included transient chemosis at the early postoperative period; three patients had local dehiscence of the wound, two patients developed a cyst in the socket and one patient was afflicted with thinning of the conjunctiva over the surgical wound. Conclusion The use of glass beads to fill the scleral cavity during evisceration has the advantage of an excellent fit in accordance with the scleral cavity volume, as well as ease of treatment in case of extrusion. The prosthesis movement is good because of its engagement with the scleral bulges caused by the glass beads.

Purpose The aim of this course is to share our experience with transconjunctival or transcutaneous anterior orbitotomy using surgical microscope and cryoextraction approach for surgery of retroocular orbital tumors. Methods Data regarding the used of this anterior surgical approach to retro-ocular orbital tumors was collected from our case series of 103 patients who, over 16 years, were operated on for retroocular orbital tumors and from a newer case series of 24 patients who, over the last 5 years were operated on for orbital cavernous hemangioma. Results A cryo-assisted, minimally invasive, anterior approach was employed in most patients. During more than 20 years lateral orbitotomy was needed only in 3 patients. The operations with anterior approach lasted 57.9 + 15.0 minutes. In none there was need for transformation into lateral orbitotomy and there were no intra-operative complications. No post operative deterioration of visual acuity was evident. Conclusion In contrast to other reports on treatment of orbital lesions, in our experience, surgery of most solid tumors and of many other cystic or infiltrative lesions can be achieved via an anterior, cryo-assisted approach, and thus with minimal trauma to the orbit. This approach warrants more favorable consideration as it can yield successful results even in cases with large or deeply located tumors. In most cases it obviates the need for extra-ocular muscle disinsersion and lateral or transcranial orbitotomies with bone flaps.

An actinic keratosis (AK) is a pre-malignant cutaneous lesion that frequently manifests in sun-exposed areas of the skin as a small, rough, scaly erythematous papule. They are one of the most common presenting complaints for dermatologists. AKs should be treated due to their potential to progress into a squamous cell carcinoma (SCC). There are numerous treatments available for managing AKs including those broadly categorized as destructive, topical field, and procedural field therapies. The topical field therapies include 5-fluorouracil, imiquimod, and diclofenac gel. Recently, imiquimod 3.75% (Zyclara TM) has been approved for the treatment AKs on the face and scalp. It is a reasonable alternative to imiquimod 5%, as the approved indication includes a larger surface area for treatment, shorter duration course, and the potential for less severe local skin reactions. There is no widely accepted algorithm for the treatment of AKs, as comparative data is unavailable between all approaches. Therapy choices are guided by efficacy, adverse effects, cosmetic results, and patient compliance.

Absorption of 6328-A radiation by Cr(+3) ions in the (2)E level is used to determine the population density of this level in a ruby crystal under optical pumping. This method allows a much more accurate and simple determination of the excited state population than has been available previously.

To describe the changes in calcium and calcitriol requirements during pregnancy and lactation in a patient with hypoparathyroidism due to autosomal dominant hypocalcemia.We summarize the clinical presentation and treatment of the patient and review the pertinent literature.Calcitriol requirements disappeared during pregnancy in a 34-year-old woman with autosomal dominant hypoparathyroidism secondary to an activating mutation in the calcium-sensing receptor gene. Within hours after delivery, her serum calcium concentration dropped to 4.7 mg/dL (albumin, 3.2 g/dL), and she required intravenous calcium and reinstitution of calcitriol. When lactation began a few days later, her calcitriol requirement again disappeared. As has occasionally been described in the literature, this patient with hypoparathyroidism required no calcitriol during late pregnancy and lactation to maintain a normal serum calcium level.To our knowledge, this is the first reported case documenting a period of time between pregnancy and lactation when calcitriol requirements reappeared, likely due to a parathyroid hormone-related protein "window" between delivery, when placental production of parathyroid hormone-related protein stops, and lactation, when mammary gland production begins.

Taking into account the gravitational energy, one finds that for an isolated body the inertial mass, active gravitational mass and passive gravitational mass are all equal, so that there is only one mass.

The most common form of hereditary systemic amyloidosis is familial amyloidotic polyneuropathy associated with single amino acid changes in the plasma protein, transthyretin. In addition, there are two variants of transthyretin (Ser6 and Thr109) not associated with familial amyloidotic polyneuropathy but with familial euthyroid hyperthyroxinemia, also an autosomal dominant disorder. In these autosomal dominant diseases, most affected individuals are heterozygous and therefore have hybrid forms of the tetrameric plasma transthyretin. In order to study the structure/function relationships of homozygous variant transthyretins, normal human transthyretin and five variant transthyretins (Gly6----Ser, Leu58----His, Thr60----Ala, Ile84----Ser, and Ala109----Thr) were produced in Escherichia coli using the expression vector, pCZ11, and site-directed mutagenesis. These recombinant transthyretin (r-TTR) proteins showed the correct size (14 kilodaltons) on sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western analysis and self-associated into tetramers as determined by size exclusion chromatography. Recombinant normal, Ser6, and Ala60 r-TTRs had an affinity for thyroxine indistinguishable from normal human TTR purified from plasma, whereas His58 and Ser84 r-TTRs had significantly reduced affinity. On the other hand, Thr109 r-TTR had a much higher affinity, probably due to its position within the thyroxine-binding pocket. Expression of mutant transthyretins in E. coli provides the opportunity to study structure/function relationships and amyloid-forming capabilities induced by single amino acid substitutions in the transthyretin molecule.

Incidentally discovered adrenal tumors (incidentalomas) are fairly common since the advent of noninvasive methods of imaging the abdomen. Patients with incidentaloma usually undergo screening for overproduction of glucocorticoids by measurement of basal steroid excretion. We describe an asymptomatic patient with an incidentaloma with normal basal steroid excretion whose only manifestation of subtle steroid overproduction was the failure of steroid excretion to be suppressed normally with dexamethasone. It appears that the more careful the search for subtle evidence of steroid overproduction in patients with incidentaloma, the more common the finding; perhaps up to 50% of patients with incidentaloma have some subtle steroid overproduction. We review the literature on this subject, and evaluate the various possible approaches of how intensively to study steroid dynamics in patients with incidentaloma.

To evaluate whether introduction of a densitometry workflow, data-storage, and reporting software system would result in streamlined workflow with fewer expenses and quicker result turnaround time.BoneStation was implemented March 30, 2009, in a large, urban, tertiary referral center performing more than 6000 bone mineral density studies annually at 3 different geographic sites. The times of scan acquisition, report preparation, and final signature in the online medical record were recorded, and the delays from scan to report and from scan to final signature in the online medical record were calculated for each patient during 2 representative weeks before (n = 274) and 2 weeks after (n = 235) implementation of BoneStation.Use of BoneStation reduced time from scan to report from 2.11 +/- 0.16 days to 0.46 +/- 0.05 days (P.001). BoneStation saved our practice $8.94 per scan, while costing only $3 per scan, resulting in net savings. Considering that the total reimbursement from Medicare in 2010 for dual-energy x-ray absorptiometry is projected to be $55.44, this constitutes cost savings of 10.7% of the total reimbursement.The introduction of a specialized electronic medical system for data storage and reporting reduced costs and improved result turnaround time in a densitometry practice.

Psychological and behavioral therapies are being increasingly used for symptom management in patients with irritable bowel syndrome (IBS). The aims of this study were to compare two delivery modes for a comprehensive self-management (CSM) intervention, primarily by telephone vs. entirely in person, and to compare each with usual care (UC).Adults with IBS were recruited through community advertisement. Subjects (N=188) were randomly assigned to three groups: one in which all nine weekly CSM sessions were delivered in person, one in which six of the nine sessions were conducted over telephone, and one in which subjects received UC. Primary outcome measures were a gastrointestinal (GI) symptom score based on six symptoms from a daily diary and disease-specific quality of life (QOL). These and other outcomes were assessed at baseline and at 3, 6, and 12 months after randomization. Mixed model analyses tested for differences between the three groups in each outcome variable at the three follow-up occasions, controlling for the baseline level of each outcome.Both GI symptom score and QOL showed significantly greater improvement in the two CSM groups than in the UC group (P0.001), with the magnitude of this difference being quite similar for the three follow-up time points. The two CSM groups experienced a very similar degree of improvement, and there were no statistically significant differences between the two.A CSM program is efficacious whether delivered primarily by telephone or totally in person, and there is no evidence that replacing six of the in-person sessions by telephone sessions reduces the efficacy of the intervention.

Our aim was to measure the relative risks of Barrett's esophagus (BE) associated with demographic factors, measures of adiposity, and smoking among patients with gastroesophageal reflux disease (GERD).Patients newly diagnosed with specialized intestinal metaplasia (SIM) (n=197) were compared with patients with GERD (n=418) in a community clinic-based case-control study. Case subgroups included those with any visible columnar epithelium (VBE) (n=97), and those with a long segment (or=2 cm) of columnar epithelium (LSBE) (n=54).Risks increased with older age (adjusted odds ratio (aOR) per decade for SIM=1.3, 95% confidence interval (CI)=1.1-1.5; VBE aOR=1.4, CI=1.1-1.6; LSBE aOR=1.5, CI=1.2-1.9), male gender (SIM aOR=1.5, CI=1.1-2.2; VBE aOR=2.7, CI=1.6-4.5; LSBE aOR=3.9, CI=1.9-8.1), and possibly Asian race. Increased risk of BE was observed with high waist-to-hip ratio (WHR, male high:or=0.9, female high:or=0.8) (SIM aOR=1.3, CI=0.9-2.1; VBE aOR=1.9, CI=1.0-3.5; LSBE aOR=4.1, CI=1.5-11.4). These associations were independent of body mass index (BMI) for the VBE and LSBE case groups but not for SIM, which was the only case group in which BMI was a significant risk factor. Ever having smoked cigarettes increased risk similarly for all case groups (SIM aOR=1.8, CI=1.2-2.6; VBE aOR=1.6, CI=1.0-2.6; LSBE aOR=2.6, CI=1.3-4.9), although a dose-response relationship was not detected for duration or intensity of smoking.Older age, male gender, and history of smoking increased risk of SIM and BE among GERD patients independent of other risk factors for BE. Central adiposity was most strongly related to risk of VBE and LSBE. These results may be useful in the development of risk profiles for screening GERD patients.

One of the advantages of studying zebrafish is the ease and speed of manipulating protein levels in the embryo. Morpholinos, which are synthetic oligonucleotides with antisense complementarity to target RNAs, can be added to the embryo to reduce the expression of a particular gene product. Conversely, processed mRNA can be added to the embryo to increase levels of a gene product. The vehicle for adding either mRNA or morpholino to an embryo is microinjection. Microinjection is efficient and rapid, allowing for the injection of hundreds of embryos per hour. This video shows all the steps involved in microinjection. Briefly, eggs are collected immediately after being laid and lined up against a microscope slide in a Petri dish. Next, a fine-tipped needle loaded with injection material is connected to a microinjector and an air source, and the microinjector controls are adjusted to produce a desirable injection volume. Finally, the needle is plunged into the embryo's yolk and the morpholino or mRNA is expelled.

An important dimension of the ongoing demand for greater corporate social responsibility is the emergence of the socially responsible investor (SRI). The SRI invests in companies whose actions support social objectives deemed desirable by the investor, e.g., reducing environmental pollution. There are two broad groups of SRIs: individuals and institutions such as public and private pension funds, trusts, and endowed institutions (e.g., universities or religious orders). While a couple of studies have examined the socially responsible investment criteria used by institutions such as pension funds (Gasper and Schweig 1985) and religious groups (Wokutch 1984), no studies have measured the identity, objectives, expectations, and social screens used by individuals in their investment decisions. As a result, the SRI is unknown except through anecdotal evidence (Schonbak 1984). Nevertheless, improving knowledge of the SRI is important for several reasons. First, the SRI is important to business given the growing volume of investor funds subjects to social screens and the need to anticipate challenges to corporate actions from a key stakeholder group. Second, the financial power of this group is substantial. For example, SRIs have invested hundreds of millions of dollars with mutual funds which incorporate a social screen in their investment decisions such as the Calvert Social Investment Fund, Pax World, and Dreyfus Third Century. To attract investment from SRIs, understanding what issues are salient to this group is critical. Finally, a database on the SRI establishes a baseline from which to track future developments and shifts in the importance of different social issues. This paper presents results of a study designed to answer some important questions about the individual SRI. First, who are SRIs? How do they differ from other investors? How homogeneous is the group of SRIs? Second, what issues are salient for this group as determinants of socially responsible corporate behavior? What do they expect from companies they invest in? BACKGROUND As with many contemporary social trends, the socially responsible investment movement emerged in the late 1960s as part of a broad challenge to business to conduct its affairs in a more socially responsible manner. In his "new social contract," Steiner suggests that "it is the duty of business today to anticipate potentially serious impacts of its action on individuals and prevent undesirable results" (1972, 22). Rather than wait for managers to recognize their social responsibilities, individuals and institutions seek to induce socially responsible behavior by becoming activist stakeholders in the task environment of corporations and by using financial investments to either punish or reward firm behavior (Freeman 1984). Increasingly, such behavior is becoming institutionalized. A good example is the move toward legislating forced divestiture by public pension funds of stocks of companies doing business in South Africa (Apcar 1984). However, these laws do not govern individual private investors. Their identities, attitudes, and behaviors must be studied to gauge what role social criteria play in their investment decisions. Some suggestions about the identity of the individual SRI can be drawn from research on socially responsible consumers such as those who reduce energy consumption (Ritchie, McDougall, and Claxton 1981), use nonpolluting household products (Brooker 1976; Henion, Gregory, and Clee 1980), or recycle (Anderson, Henion, and Cox 1975). Murphy summarizes the literature as indicating that socially concerned consumers are "younger, better educated and more affluent than the general populace" (1978, 316). Socially responsible consumption is presumably relevant and important to SRIs. However, a list of issues important to SRIs would not be identical to a list of socially responsible consumption behaviors. Many of the former fall beyond the scope of consumer behavior, such as providing equal employment opportunities. …

Predictors of general well being were examined in a sample of Army wives who participated in the second and third iterations of the Unit Manning System Family Health Study. Nine variables measured at time 1 (including social supports, personality, domains of life satisfaction, and military life stress) and two aspects of husbands' duty schedule measured at time 2 were regressed on general well being (GWB) measured at time 2. Significant predictors of GWB at time 2 included GWB at time 1, personality, and predictability of husband's schedule at time 2. When GWB at time 1 was excluded from the model, other significant predictors emerged, including financial satisfaction, marital satisfaction, and number of days in the past 6 months that husband was away in the field.

Orangutan populations are particularly susceptible to local extinction due to hunting, habitat loss, and fragmentation because they live at low population densities, grow slowly, and reproduce rarely. This chapter uses Population Viability Analysis (PVA) to consider the conservation implications of orangutan life history and population biology. First, a baseline model that incorporates the best available orangutan life-history data is presented. This model is then used to examine how plausible variation in model parameters, changes in the intensity of human-induced threats, and different conservation and management interventions would affect the probability of orangutan population persistence. The effects of existing threats on the extinction risk of specific orangutan populations on Borneo and Sumatra are also modelled. Finally, the conservation and management implications of this modeling exercise are considered.

The stress-buffering effects of four types of social support on the general well-being of military wives were examined. The stressor was defined as the total number of days in the past 6 months that husbands had been away from home overnight. The four types of support examined were: (a) perceived support from other wives in the husband's unit; (b) perceived support from parents, siblings, and other relatives; (c) perceived support from military wives outside the husband's unit; and (d) perceived support from friends outside the military. Perceived support from other unit wives was the only type of support that emerged as a significant buffer against the stressor of a husband's absence.

A path analytic model was used to examine the impact of three domains of life satisfaction and three employment-related variables on general well-being in a sample of 1,145 Army wives. The life domains included marital, financial, and role satisfaction. The employment-related variables included: (a) time spent employed (none, part, or full); (b) role fit; and (c) satisfaction with overall career development prospects. The employment-related variables were hypothesized to impact on general well-being both directly and indirectly through their relationship to role satisfaction. Time spent employed and role fit were found to be significantly related to role satisfaction, which in turn, was significantly related to general well-being. One variable—satisfaction with overall career development prospects—had a significant direct impact on general well-being.

The Seasonal Pattern Assessment Questionnaire (SPAQ) was mailed to a sample population balanced for sex and randomly selected from local telephone directories in four areas: Nashua, NH, New York, NY, Montgomery County, MD, and Sarasota, FL. On the basis of responses to this questionnaire, prevalence rates of winter seasonal affective disorder (winter SAD), summer seasonal affective disorder (summer SAD), and subsyndromal winter SAD were estimated for the four areas. Rates of winter SAD and subsyndromal SAD were found to be significantly higher at the more northern latitudes, while no correlation was found between latitude and summer SAD. The positive correlation between latitude and prevalence of winter SAD applied predomi- nantly to the age groups over 35.

Soft tissue infections in compromised patients are frequently caused by Gram-negative organisms and particularly by Pseudomonas aeruginosa. These pathogens are effectively eradicated by pefloxacin as well as by ceftazidime. The effectiveness and safety of these two agents were compared in a prospective randomized study in 67 patients with soft tissue infections. Underlying conditions included malignant diseases, diabetes mellitus and chronic renal failure. The infections included: post operative infection, septic foot, soft tissue abscess and cellulitis. Thirty-three patients were treated with intravenous ceftazidime for a mean duration of ten days. More than half the 34 patients given pefloxacin were treated only orally for a mean period of 13 days. The clinical and bacteriological outcomes were similar in both groups. There was clinical cure or improvement in 26 pefloxacin cases and in 23 ceftazidime cases, failure in six pefloxacin cases and in seven ceftazidime and relapse in two pefloxacin and in three ceftazidime patients. The bacteriological responses were eradication in 23 pefloxacin cases and in 22 ceftazidime cases, persistence in five pefloxacin cases and in six ceftazidime cases, relapse in one pefloxacin case and in none of the ceftazidime group, reinfection in four pefloxacin cases and in three ceftazidime cases and there was one unassessed patient in the pefloxacin group and two in the ceftazidime group. Nausea and vomiting occurred in three patients and elevation of liver enzymes in another patient; all side effects were observed only in the pefloxacin treated patients. These results suggest that oral pefloxacin could offer an alternative to intravenous ceftazidime in half the compromised patients with tissue infections. However, adverse reactions due to pefloxacin administration should be watched for during such therapy.

Injuries are the leading cause of death for children. This review integrates the epidemiological literature on children's injury rates and the behavioral correlates of children's injuries with the psychological literature on gender based behavioral differences in children and parenting differences based on child gender. Boys are more likely to experience most kinds of injuries and are more likely to be involved in behaviors that are highly correlated with injury. Common parenting strategies may also be associated with an increase in boys' injury risk. Understanding the mechanism of boys' increased risk is a vital task that may ultimately prevent injuries in both boys and girls.

This study involves a test of the cultural spillover hypothesis through a state-level analysis of the relationship between rape rates and the proportion of military personnel in the population. A statistically significant correlation not predicted by this hypothesis was found between rape rates and the proportion of Air Force personnel in the population. Further exploration revealed that this was largely because of the high correlation between the Air Force and the Indian population. Multivariate analyses revealed that the proportion of Indian women in the population was the main predictor of rape rates. Per capita alcohol consumption was also found to be positively correlated with both rape rates and Air Force personnel but was not significantly related to rape in the multivariate analysis.

There are many different treatment options for osteoporosis available to physicians. Most of these are designed to prevent and treat osteoporosis by inhibiting bone resorption and/or increasing bone formation. One group of patients with very specific needs is those with vertebral compression fractures especially in those whom the most commonly used treatment, bisphosphonate, is not well tolerated. Under these circumstances salmon calcitonin, a treatment that has known efficacy in reducing further vertebral fracture, an analgesic effect, and is known to be safe and well tolerated in older individuals, could be the answer.Salmon calcitonin is the most widely used of the calcitonins effective in humans. It has 40 times the affinity for osteoclasts as human calcitonin and is very effective at inhibiting bone resorption.1,2

This paper describes the ongoing oil spill removal action conducted by EPA Region IV in Glasgow, Kentucky. The discharge source is an improperly abandoned oil well that is leaking crude oil through fractures in the limestone bedrock. The discharge is carried to the surface in a spring, which then flows directly into Boyd's Creek and Barren River Lake, a recreational use lake managed by the U.S. Army Corps of Engineers. Some of the unique technical and policy issues of this removal action include the appropriateness of using Oil Spill Liability Trust Fund (OSLTF) monies on this nontraditional “oil spill;” difficulties recovering the product from the karst features; cost recovery and responsible party (RP) identification; and concerns over Emergency Response Program involvement in the long-term operation and maintenance of the system.

An 8-inch oil pipeline ruptured on Lookout Mountain in Chattanooga, Tennessee, in February 1996. The resulting response was complicated by the unusual geology at the spill site as well as by the proximity of surface waters and sensitive natural resources. Lookout Mountain contains extensive karst cave systems featuring nationally renowned tourist and spelunking destinations. The caves are also a natural resource managed by the National Park Service. A discharge of approximately 65,000 gallons of kerosene-fuel oil mix sprayed into a small ravine that drains toward the nearby Tennessee River. Responders arrived on scene promptly but found little product at the rupture site and so focused their preliminary efforts on containment and cleanup of free product in the ravine. As surface cleanup progressed, it became apparent that most of the discharge was unaccounted for. Responders quickly associated site geology with the “missing” product and feared that oil had entered the cave systems beneath the discharge zone. This paper discusses the strategies used and the problems encountered in attempting to track and clean up the discharge as well as some of the issues surrounding the impact on natural resources.

Leptin, a 16-kDa adipocyte-derived protein whose circulating levels reflect energy stores, increases the resting metabolic rate and thermogenesis in rodents. Thyroid hormones also increase the basal metabolic rate, but nothing is known about possible interactions between leptin and thyroid hormone. Activation of β-adrenergic receptors decreases leptin levels in rodents. To test the hypothesis that thyroid hormones, by causing a “functional hyperadrenergic” state, result in decreased leptin concentrations in humans, we studied 22 normal healthy men before and after the administration of T3 for 1 week to induce moderate hyperthyroidism. Short term thyroid hormone excess does not alter circulating leptin concentrations despite a demonstrated effect on heart rate, systolic blood pressure, cholesterol levels, and metabolic indexes of bone turnover. Elucidation of the apparently separate pathways by which thyroid hormones, β-agonists, and leptin regulate energy expenditure and food intake may have important imp...