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Study Objective: Based on updated guidelines and expressed patient needs, we created a multidisciplinary clinic including endocrinology, gynecology/adolescent medicine, dermatology, psychology, and nutrition to provide comprehensive care to adolescent girls with polycystic ovary syndrome (PCOS). We describe the patient population presenting to this clinic, and prescribing patterns when a multidisciplinary approach is used. Design: Retrospective chart review. Setting: Tertiary care hospital. Participants: Female patients, aged 11-24 years, presenting for initial assessment in a multidisciplinary PCOS clinic. Interventions: None. Main Outcome Measures: Medical history, physical examination findings, laboratory measurements and prescribed therapies. Results: A total of 92 patients seen from 2014 to 2018 are described (age 15.9 years, range 11-24 years, body mass index 35.6 kg/m2, range 19.9-53.5). Metabolic syndrome features were common: 26% had a prediabetes hemoglobin A1c (>5.6%), 83% had a high-density lipoprotein (HDL) 120 mm Hg, and 43% had an alanine aminotransferase level of >30 U/L. Dermatologic findings included acne 93%, hirsutism 38%, acanthosis nigricans 85%, hidradenitis suppurativa 16%, and androgenic alopecia 2%. Of the patients, 33% had a diagnosis of depression or anxiety, 16% of patients had a diagnosis of obstructive sleep apnea, and an additional 59% had symptoms warranting a sleep study The most commonly prescribed medications were topical acne preparations (62%), followed by estrogen-containing hormonal therapy (56%) and metformin (40%). Conclusion: In adolescents with PCOS and obesity, metabolic, dermatologic, and psychologic co-morbidities are common. The use of a multidisciplinary clinic model including dermatology in addition to endocrinology, gynecology, psychology, and lifestyle experts provides care for most aspects of PCOS.

OBJECTIVE: The Diabetes Prevention Program (DPP) is a 27-center randomized clinical trial designed to evaluate the safety and efficacy of interventions that may delay or prevent development of diabetes in people at increased risk for type 2 diabetes. RESEARCH DESIGN AND METHODS: Eligibility requirements were age > or = 25 years, BMI > or = 24 kg/m2 (> or = 22 kg/m2 for Asian-Americans), and impaired glucose tolerance plus a fasting plasma glucose of 5.3-6.9 mmol/l (or < or = 6.9 mmol for American Indians). Randomization of participants into the DPP over 2.7 years ended in June 1999. Baseline data for the three treatment groups--intensive lifestyle modification, standard care plus metformin, and standard care plus placebo--are presented for the 3,234 participants who have been randomized. RESULTS: Of all participants, 55% were Caucasian, 20% were African-American, 16% were Hispanic, 5% were American Indian, and 4% were Asian-American. Their average age at entry was 51 +/- 10.7 years (mean +/- SD), and 67.7% were women. Moreover, 16% were < 40 years of age, and 20% were > or = 60 years of age. Of the women, 48% were postmenopausal. Men and women had similar frequencies of history of hypercholesterolemia (37 and 33%, respectively) or hypertension (29 and 26%, respectively). On the basis of fasting lipid determinations, 54% of men and 40% of women fit National Cholesterol Education Program criteria for abnormal lipid profiles. More men than women were current or former cigarette smokers or had a history of coronary heart disease. Furthermore, 66% of men and 71% of women had a first-degree relative with diabetes. Overall, BMI averaged 34.0 +/- 6.7 kg/m2 at baseline with 57% of the men and 73% of women having a BMI > or = 30 kg/m2. Average fasting plasma glucose (6.0 +/- 0.5 mmol/l) and HbA1c (5.9 +/- 0.5%) in men were comparable with values in women (5.9 +/- 0.4 mmol/l and 5.9 +/- 0.5%, respectively). CONCLUSIONS: The DPP has successfully randomized a large cohort of participants with a wide distribution of age, obesity, and ethnic and racial backgrounds who are at high risk for developing type 2 diabetes. The study will examine the effects of interventions on the development of diabetes.

Since compulsive eating occurs in approximately 30% of obese females and is associated with earlier relapse following weight loss, we compared daily energy intake, dietary composition and energy expenditure among obese binge eaters and obese non-bingers. Nine obese bingers (33 +/- 4 yrs, 95 +/- 6 kg, 39 +/- 1% fat) and nine obese non-bingers (47 +/- 3 yrs, 93 +/- 5 kg, 40 +/- 1% fat) were admitted for 12 days to a metabolic unit. Binge eaters were defined as scoring25 on the binge eating scale (BES). During the initial 8 days, subjects ate ad libitum from two computerized vending machines offering a variety of foods and beverages. A weight maintenance diet was then provided for the next 4 days. Twenty-four hour energy expenditure (24EE) and respiratory quotient (24Q) were measured on the last day of both feeding periods in a respiratory chamber. Obese bingers showed a wider range of energy intake compared to non-bingers, but the mean daily energy intake was similar between the two groups (2587 +/- 454 vs 2386 +/- 201 kcal/d) during 8 days of ad libitum intake. 24EE was not different between bingers and non-bingers after 8 days of ad libitum intake (2298 +/- 147 vs 2109 +/- 97 kcal/d, P = 0.3) or 4 days of weight maintenance diet, even more so after adjustment for differences in fat-free mass, fat mass and age. Resting metabolic rate, sleeping metabolic rate, and macronutrient intake and oxidation were also similar between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Measuring food intake in a laboratory usually involves limited food choices. An automated food-selection system with two vending machines containing a large variety of foods was used to measure food intake in 10 male volunteers (31 +/- 6 y, 69.2 +/- 7.1 kg, 18 +/- 7% fat, mean +/- SD) on a metabolic ward. The effect of carbohydrate, fat, and protein intakes on 24-h energy expenditure (24EE) and substrate oxidations was measured in a respiratory chamber during day 4 of weight maintenance and day 7 of ad libitum intake. Ad libitum intake resulted in a 7-d overfeeding of 6468 +/- 3824 kJ/d above weight-maintenance requirements, leading to a 2.3 +/- 1.2-kg gain. The 10,975 +/- 3774 kJ excess energy intake on day 7 of ad libitum intake caused a 1205 +/- 920 kJ/d increase in 24EE (delta 24EE = 0.17 x delta intake - 695; r = 0.71, P less than 0.02). Of the excess carbohydrate intake, 74% was oxidized (r = 0.86, P less than 0.001), whereas excess fat intake was not. Carbohydrate and protein stores are regulated whereas excess fat intake is channeled to fat stores.

Since 1972, 10 benthic surveys and 9 static fish bioassays have been conducted to assess the impact of AVTEX Fibers, Inc. effluent on the lower South Fork of the Shenandoah River. AVTEX (formerly FMC Corp.) is a rayon and polyester fibers plant located in Front Royal, Virginia. Benthic samples were taken at four stations, one above and three below the plant discharges. Single surveys in 1972 and 1973 indicated a severe impact on the benthic community along the right side of the river, below the plant, as a result of the channelized effluent. Diversity values (¯d) were low (0–2.42) and numbers of taxa and organisms were reduced. A fish bioassay in 1973 indicated the effluent to be acutely toxic at the 34.5% level (mixture of effluent and river water). In early 1974, FMC Corp. constructed an activated sludge treatment system to reduce BOD and supplement the neutralization and chemical precipitation (zinc hydroxide and liquid-solid separation) facilities that had been used to treat waste waters since 1948. After the new equipment was placed in operation, the previously stressed area became more stable. In 1975 and 1976 the stressed area exhibited greater ¯d values (1.19–3.39) and an increased number of taxa and organisms. Bioassays showed the effluent to be acutely toxic to fish only once since 1973. The major improvements in the effluent were a 70% reduction in BOD5 and a 60% reduction in the amount of zinc entering the river. Community conditions in 1977 indicated a partial remission of improvement, probably due to drought conditions. The rehabilitation of damaged ecosystems is a process important to all biologists. An important factor in encouraging industry to participate in this activity is evidence that improved waste treatment will often have demonstrable biological benefits rather soon. As data accumulate on the recovery process it may be possible to predict the degree of rehabilitation and time required more precisely.

Both larva and adult of three riffle beetle species (Elmidae), Stenelmis crenata, S. mera, and Optioservus trivittatus, fed primarily on detritus (≥ 68.3%), while green algae and diatoms constituted the remaining major dietary components. Minor differences in dietary components were noted, but these differences do not appear to contribute significantly to resource partitioning among elmid adults or larvae of different species, or between adults and larvae of conspecifics. Riffle beetles have generally been described as herbivores but evidence suggests that "detritivore-herbivores" would be a more appropriate classification.

Ponar, artificial substrate, and draft samples were collected to define benthic invertebrate community composition in Pool 26 at the confluence of the Mississippi and Illinois rivers. Illinois River Ponar samples produced primarily Chironomidae and Oligochaeta; Mississippi River Ponar samples were dominated by Chironomidae and Ephemeroptera. Mississippi River artifical substrates were dominated by Potamyia flava, Hydropsyche orris, and Chironomidae. Illinois River artificial substrates were dominated by Cyrnellus fraternus, Chironomidae, and Oligochaeta. Artificial substrates in the Mississippi River were colonized by twice as many taxa and 23 times more organisms than those in the Illinois River. Siltation appeared to be a major factor limiting artificial substrate colonization in the Illinois River. Composition of the drift was depth dependent and greatest numbers of organisms and taxa were collected in the two upper strata (0.3 m and 3 m). Mississippi River diel drift samples were dominated by...

A total of 27,457 dryopoids representing 3 families and 7 species was collected at light traps from June to Sept. in the South Fork of the Shenandoah Basin, VA. The elmid Stenelmis mera Sanderson was abundant, making up 97% of the dryopoids collected. S. markeli Motschulsky, S. crenata (Say), and the limnichid Lutrochus laticeps Casey were collected in moderate numbers. S. musgravei Sanderson, S. sandersoni Musgrave, and the dryopid Helichus lithophilus (Germar) were rare. Flight periods occurred from June through Sept., but most specimens were collected in July and Sept. S. mera, S. markeli, and S. crenata exhibited multi-modal flight periodicities through the summer, and distinct peaks were noted in late June, early and mid-July, and early Sept. Total elmids captured per sampling period were compared with changes in stream discharge, and, in most cases, large numbers of elmids were collected ca. 12 days after a spate. In collections with few or no elmids, discharge either had been stable or increasing 12 days before. These data support the hypothesis that high water during a spate leaves larvae on shore for their 11-to-12-day pupal period and subsequent emergence, and it appears that, unlike most aquatic insects, emergence in riffle inhabiting elmids is controlled by fluctuations in stream flow.

Brarbidrilus paucisetus Loden and Locy (Oligochaeta: Enchytraeidae) was found in the Mississippi River, thus extending its range from the eastern United States to the Midwest. The species was found in substrates composed primarily of medium (1φ) and coarser (2φ) sand with 5% silt and clay.

Fifteen dryopoid species in five families were collected from the Clinch and North Fork Holston river basins in southwestern Virginia. Eleven of the species were in the family Elmidae. Stenelmis crenata and Psephenus herricki were the most widely distributed species occurring in 11 of 13 streams. Highest dryopoid densities occurred in September and December, and overall mean dryopoid densities for Brumley Creek and the North Fork Holston River were 186 and 2545 m2, respectively. Stenelmis crenata, Optioservus trivittatus, P. herricki and Dubiraphia sp. were the most abundant species with overall mean densities of 1204, 903, 247 and 122 m2, respectively. Oulimnius latiusculus and Promoresia tardella were dominant in the headwaters of Brumley Creek and S. crenata, Optioservus trivittatus, P. herricki and Dubiraphia sp. were most prevalent in the lower reaches of Brumley Creek and the North Folk Holston River. Microcylloepus pusillus aptus occurred almost exclusively in the North Fork Holston River. Number of dryopoid species among streams was correlated with highest alkalinity, hardness and conductivity (r2 0.76; p

1967. The life and demography of the sideblotched lizard, Uta stansburiana. Misc. Pub. Mus. Zool. Univ. Mich. 132. , AND R. E. BALLINGER. 1972. Sceloporus undulatus: a study of the intraspecific comparative demography of a lizard. Ecology 53:570-584. ,, AND N. F. HADLEY. 1973. Reproductive effort and winter activity in the viviparous montane lizard Sceloporus jarrovi. Copeia 1973:272-277. S , AND . 1975. Lizard reproductive effort: caloric estimates and comments on its evolu