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Background: The experiences that marginalized breast cancer populations have in common are rarely considered.Methods: The authors look across 3 qualitative studies to explore the experiences of older, lower-income, and Aboriginal women diagnosed with cancer and treated by the cancer care system in Ontario, Canada.Results: The research examines critical moments in participants' narratives that parallel one another and are categorized within 2 themes: Not Getting Cancer Care and Not Getting Supportive Care.Conclusions: Although exploratory, the findings merit attention both for what they tell us about women's experiences, and because they suggest disparities in access to treatment and psychosocial support. [ABSTRACT FROM AUTHOR]

Background: The Aboriginal Women's Cancer Care Project used a participatory research model guided by an Aboriginal advisory group. Methods: The researchers attempted to conduct cancer research with 5 culturally and geographically different communities in North America. Results: We discuss the challenges of conducting ethical research in keeping with the emergent research principles of community ownership and control of the research process and products. Conclusions: Although there are many perils for researchers and communities in conducting participatory research, clearer practice guidelines will ensure that research in Aboriginal communities will increasingly prioritize community- versus career-building outcomes. [ABSTRACT FROM AUTHOR]

Background: Prospective study examining the relationship between cardiorespiratory fitness level and incidence of medical treatments during a 1-yr period before each of two examinations. A subset was also evaluated to assess whether improvement in fitness affected incidence of treatments. METHODS AND RESULTS: Part I: Six thousand six hundred seventy-nine healthy male subjects underwent medical examinations on two occasions, including a maximal exercise test. Division of subjects by fitness into quartiles (Q1 = low fitness through Q4 = high fitness) revealed an inverse relationship between fitness and outcome measures. Men in the low-fitness group had more office visits and overnight hospital stays than men in the high-fitness group (3.5% (Q1) vs 1.6% (Q4) men had 10+ office visits, and 10% (Q1) vs 5.0% (Q4) men had overnight hospital stays, P < 0.0001). These differences held after adjustment for potential confounding variables (age, follow-up yr, blood pressure, cholesterol, and smoking). Part II: Subjects in this subset (N = 2974) were evaluated to compare overnight hospital stays between low-fit men who remained low fit at the second examination, and low-fit men who became fit by the second examination. This cohort was divided into fitness tertiles (T1 = low fitness through T3 = high fitness). Those who improved their fitness by the time of the second examination had a decreased number of overnight hospital stays, compared with those who remained unfit at the time of the second examination (10.2% (T1 at second visit) vs 5.9% (T3 at second visit) had overnight hospital stays, P < 0.03). CONCLUSIONS: Men who maintain or become fit are less likely to have physician visits or overnight hospital stays, compared with men who are unfit. [ABSTRACT FROM AUTHOR]

On September 2nd, 1998 Swissair Flight 111 crashed in Saint Margaret's Bay, Nova Scotia. Surrounding coastal communities were immediately transformed into disaster response sites. Sixteen community health professionals were interviewed that identified several types of individual and community exposure, including exposure to human remains. The interviews revealed that the coastal communities have responded with silence and stoicism. This silence has been viewed by some health professionals as resilience. The interface of a major disaster, community silence, low help-seeking behaviours, and limited disaster health responses raises the critical question whether this is a profile of resilience or a community silently enduring. [ABSTRACT FROM AUTHOR]

Exercise testing in asymptomatic persons has been criticized for failing to accurately predict those at risk for coronary heart disease (CHD). Previous studies on asymptomatic subjects, however, may not have been large enough or long enough to provide reliable outcome measures. This study examines the ability of a maximal exercise test to predict death from CHD and death from any cause in a population of asymptomatic men. This is a prospective longitudinal study performed between 1970 and 1989, with an average follow-up of 8.4 years. The subjects are 25,927 healthy men, 20 to 82 years of age at baseline (mean 42.9 years) who were free of cardiovascular disease and who were evaluated in a preventive medicine clinic. The main outcome measures are CHD mortality and all-cause mortality. During follow-up there were 612 deaths from all causes and 158 deaths from CHD. The sensitivity of an abnormal exercise test to predict coronary death was 61%. The age-adjusted relative risk of an abnormal exercise test for CHD death was 21 (6.9 to 63.3) in those with no risk factors, 27 (10.7 to 68.8) in those with 1 risk factor, 54 (21.5 to 133.7) in those with 2 risk factors, and 80 (30.0 to 212. 5) in those with >/=3 factors. A maximal exercise test performed in asymptomatic men free of cardiovascular disease does appear to be a worthwhile tool in predicting future risk of CHD death. An abnormal exercise test is a more powerful predictor of risk in those with than without conventional risk factors. [ABSTRACT FROM AUTHOR]

Drug treatment for abnormal blood lipids includes bile acid sequestrants, fibric acid derivatives, statins, and niacin. Statins generally offer the best combination of safety and effectiveness. Hormone replacement therapy reduces the risk of coronary artery disease in postmenopausal women. The National Cholesterol Education Program offers clear guidelines as to what levels of low-density lipoprotein cholesterol (LDL-C) should trigger consideration of drug treatment, and the authors suggest what levels of high-density lipoprotein cholesterol should prompt treatment. Measurements of small dense LDL-C and lipoprotein(a) may also be helpful in decisions about drug treatment for selected patients. [ABSTRACT FROM AUTHOR]

Dietary measures that can improve blood lipids include limiting consumption of saturated fats, trans fatty acids, simple sugars, and stearic acid and consuming adequate amounts of vitamins C and E and beta-carotene. Eating certain fish once a week may significantly lower the risk of sudden cardiac death. Aerobic exercise three times per week for 20 to 30 minutes at 60% to 80% of the age-predicted maximum heart rate may also improve lipid levels. Research indicates that modest fitness reduces overall mortality, and higher levels benefit those who have abnormally high cholesterol. Moderate alcohol consumption may influence a person's lipid profile favorably but is not recommended for nondrinkers. [ABSTRACT FROM AUTHOR]

Background: Hospital-acquired, perioperative venous thromboembolism is a recognized patient safety indicator in the adult trauma patient population. Mechanical prophylaxis has been identified as a standard intervention to reduce the incidence of venous thromboembolism when prescribed along with anticoagulation or if anticoagulation is contraindicated in the surgical population. Adherence to consistent mechanical prophylaxis remains a nursing issue impacted by numerous factors in patient care., Objective: The purpose of this quality improvement project was to improve the compliance of sequential compression device utilization to decrease the hospital-acquired, perioperative venous thromboembolism rate in the adult hospitalized trauma patient population., Methods: A pre- and postintervention quality improvement approach utilized a nurse-led strategy to engage multidisciplinary team members to increase the consistency of sequential compression device utilization on patients within trauma units. The patient safety indicator rate per 1,000 for hospital-acquired, perioperative venous thromboembolism was monitored for improvement., Results: The patient safety indicator rate per 1,000 for hospital-acquired, perioperative venous thromboembolism demonstrated a decline from 10.60 to 4.95 rate per 1,000 over 12 months. In the trauma units, sequential compression device compliance increased from an initial direct observation audit of only 12% to an average of 65% compliance rate during the last 16-week audits., Conclusion: We found that a multidisciplinary, nurse-driven approach in the trauma units was effective in improving the compliance of sequential compression device utilization and impacted the hospital acquired, perioperative venous thromboembolism rate in the adult trauma patient population., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Society of Trauma Nurses.)

The Wnt signaling pathway is intricately connected with bone mass regulation in humans and rodent models. We designed an antibody-based platform that generates potent and selective Wnt mimetics. Using this platform, we engineer bi-specific Wnt mimetics that target Frizzled and low-density lipoprotein receptor-related proteins and evaluate their effects on bone accrual in murine models. These synthetic Wnt agonists induce rapid and robust bone building effects, and correct bone mass deficiency and bone defects in various disease models, including osteoporosis, aging, and long bone fracture. Furthermore, when these Wnt agonists are combined with antiresorptive bisphosphonates or anti-sclerostin antibody therapies, additional bone accrual/maintenance effects are observed compared to monotherapy, which could benefit individuals with severe and/or acute bone-building deficiencies. Our data support the continued development of Wnt mimetics for the treatment of diseases of low bone mineral density, including osteoporosis.

Sexual violence, including rape, is a pervasive problem on college campuses in the United States. Although men perpetrate the majority of sexual violence, men's attitudes, experiences, and perspectives are not typically included in research on rape and sexual violence. We addressed this empirical gap through our mixed-methods analysis of 365 college-aged men's definitions of the term "rape." Our analysis via consensual qualitative research revealed that men's definitions fit into nine primary domains: lack of consent, taken advantage of, sex, sexual activity, unwanted, gender/sex-specific, harm to victim, relationship, and emotional response, as well as a miscellaneous domain. Further, using chi-square tests of independence, we compared responses from men with and without histories of sexual violence perpetration. Findings showed that the definitions generated by men with a history of perpetration were less likely to include nonpenetrative sexual violence and were more likely to use gender/sex-specific language. We conclude that most young men have a generally accurate understanding of rape, though perpetrators' understandings may be somewhat narrower and more limited than those without a history of perpetration. We end with recommendations for refocusing sexual education curricula to better aid in the prevention of sexual violence perpetration. Specifically, given that (most) men know what rape is, educators should emphasize the cultural and situational factors that make rape more likely so all people can reduce the risk of sexual violence and take proactive precautions to prevent it.

The purpose of the 'First Regional Healthy Aging and Dementia Research Symposium' was to discuss the latest research in healthy aging and dementia research, public health trends related to neurodegenerative diseases of aging, and community-based programs and research studying health, nutrition, and cognition. This symposium was organized by the Garrison Institute on Aging (GIA) of the Texas Tech University Health Sciences Center (TTUHSC), and was held in Lubbock, Texas, October 24-25, 2018. The Symposium joined experts from educational and research institutions across the United States. The two-day Symposium included all GIA staff and researchers. Students, postdoctoral fellows, and faculty members involved in dementia research presented at the Symposium. Healthcare professionals, from geriatricians to social workers working with patients with neurodegenerative diseases, also presented. In addition, experts traveled from across the United States to participate. This event was comprised of multiple sessions, each with several oral presentations, followed by questions and answers, and discussion.

In this paper we discuss the ongoing colonial relationship between Indigenous and non-Indigenous peoples in Canada with a consideration of how to align the principles and core values of community psychology in relation to Indigenous rights, decolonization, and social justice. In working with Community Psychology values to address issues of social justice it is necessary to recognize that empowerment alone is only one half of the solution. While our discipline focuses on oppression and the empowerment of vulnerable and disenfranchised populations we generally fail to consider the relational aspects of power and justice. Specifically, in recognizing power inequities the focus is often placed on empowerment among vulnerable or subjugated communities while neglecting the requisite counterbalance of consciousness-raising and de-powerment of dominant populations. The authors provide three personal accounts from a non-Indigenous faculty member, an Indigenous doctoral student, and a recently graduated non-Indigenous Masters student. We share our experiences of conscientization and decolonization within the post-secondary and graduate education systems. We describe an educational context, a pedagogical praxis, and our efforts to bridge the theories of Settler colonialism and community psychology. From our individual and collective reflections of engagement with decolonization in the education system we present an emergent framework that highlights four principles for decolonization. In implementing these principles we discuss the co-creation of safe(r), decolonized spaces within post-secondary institutions through deconstructing dominant narratives and illuminating Indigenous narratives of self-determination with attention to the de-powerment of non-Indigenous faculty and students., (© 2018 Society for Community Research and Action.)

Each year, 33% of US citizens suffer from a musculoskeletal condition that requires medical intervention, with direct medical costs approaching $1 trillion USD per year. Despite the ubiquity of skeletal dysfunction, there are currently limited safe and efficacious bone growth factors in clinical use. Notch is a cell-cell communication pathway that regulates self-renewal and differentiation within the mesenchymal/osteoblast lineage. The principal Notch ligand in bone, Jagged-1, is a potent osteoinductive protein that positively regulates post-traumatic bone healing in animals. This report describes the temporal regulation of Notch during intramembranous bone formation using marrow ablation as a model system and demonstrates decreased bone formation following disruption of Jagged-1 in mesenchymal progenitor cells. Notch gain-of-function using recombinant Jagged-1 protein on collagen scaffolds promotes healing of craniofacial (calvarial) and appendicular (femoral) surgical defects in both mice and rats. Localized delivery of Jagged-1 promotes bone apposition and defect healing, while avoiding the diffuse bone hypertrophy characteristic of the clinically problematic bone morphogenetic proteins. It is concluded that Jagged-1 is a bone-anabolic agent with therapeutic potential for regenerating traumatic or congenital bone defects., Competing Interests: K.D.H. is the co-founder of Skelegen, LLC and holds US patent application 14/760,371. Other authors declare no competing financial interests.

Participatory health research involves a wide spectrum of participation from the population of study. We describe the participatory research processes of a large mixed method study on the psychosocial impact of dragon boating in individuals with breast cancer. In particular, we discuss the involvement of a Community Advisory Group (consisting of five breast cancer patients/survivors) in the development of the research study, data collection and analysis, and dissemination of the study results. We also outline the elements of a research workshop, in which 13 breast cancer patients/survivors were involved in the development of a provincial survey for the study. The purpose of this article is to share our experience of engaging cancer patients/survivors in a participatory research study. We discuss the value-based elements of participatory research (power sharing, voice and respect, reciprocity, and mutual benefit), and provide a case-based example of how these participatory elements were employed to potentially increase the validity of the survey instrument, to enhance the ethics of working with a cancer population, and ultimately contributed to a high survey response rate.

Purpose: Anatomic considerations are often critical in multidisciplinary cancer care. We developed an anatomy-focused educational program for radiation oncology residents integrating cadaver dissection into the didactic review of diagnostic, surgical, radiologic, and treatment planning, and herein assess its efficacy., Methods and Materials: Monthly, anatomic-site based educational modules were designed and implemented during the 2008-2009 academic year at Duke University Medical Center. Ten radiation oncology residents participated in these modules consisting of a 1-hour didactic introduction followed by a 1-hour session in the gross anatomy lab with cadavers prepared by trained anatomists. Pretests and posttests were given for six modules, and post-module feedback surveys were distributed. Additional review questions testing knowledge from prior sessions were integrated into the later testing to evaluate knowledge retention. Paired analyses of pretests and postests were performed by Wilcoxon signed-rank test., Results: Ninety tests were collected and scored with 35 evaluable pretest and posttest pairs for six site-specific sessions. Posttests had significantly higher scores (median percentage correct 66% vs. 85%, p<0.001). Of 47 evaluable paired pretest and review questions given 1-3 months after the intervention, correct responses rates were significantly higher for the later (59% vs. 86%, p=0.008). Resident course satisfaction was high, with a median rating of 9 of 10 (IQR 8-9); with 1 being "less effective than most educational interventions" and 10 being "more effective than most educational interventions.", Conclusions: An integrated oncoanatomy course is associated with improved scores on post-intervention tests, sustained knowledge retention, and high resident satisfaction., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Much research has shown the benefits of additional anatomical learning and dissection beyond the first year of medical school human gross anatomy, all the way through postgraduate medical training. We have developed an interactive method for teaching eye and orbit anatomy to medical students in their ophthalmology rotation at Duke University School of Medicine. We provide review lectures on the detailed anatomy of the adult human eye and orbit as well as the developmental anatomy of the eye. These lectures are followed by a demonstration of the anatomy of the orbit using conventional frontal and superior exposures on a prosected human cadaver. The anatomy is projected onto a large LCD screen using a mounted overhead camera. Following a brief lecture on clinically relevant anatomy, each student then dissects a fresh porcine (pig) eye under low magnification using a dissecting microscope. These dissections serve to identify structures extrinsic to the eyeball, including extraocular muscle attachments, small vessels, optic nerve stalk, and fascial sheath of the eyeball (Tenon's fascia). Dissection then shifts to the internal anatomy of the eyeball. The size and anatomy of the porcine eye is comparable with that of the human and the dissection provides students with a valuable hands-on learning opportunity that is otherwise not available in embalmed human cadavers. Students and clinical faculty feedback reveal high levels of satisfaction with the presentation of anatomy and its scheduling early during the ophthalmology clerkship., (2009 American Association of Anatomists)

Longer and more intensive postinduction intensification (PII) improved the outcome of children and adolescents with "higher risk" acute lymphoblastic leukemia (ALL) and a slow marrow response to induction therapy. In the Children's Cancer Group study (CCG-1961), we tested longer versus more intensive PII, using a 2 x 2 factorial design for children with higher risk ALL and a rapid marrow response to induction therapy. Between November 1996 and May 2002, 2078 children and adolescents with newly diagnosed ALL (1 to 9 years old with white blood count 50 000/mm3 or more, or 10 years of age or older with any white blood count) were enrolled. After induction, 1299 patients with marrow blasts less than or equal to 25% on day 7 of induction (rapid early responders) were randomized to standard or longer duration (n = 651 + 648) and standard or increased intensity (n = 649 + 650) PII. Stronger intensity PII improved event-free survival (81% vs 72%, P < .001) and survival (89% vs 83%, P = .003) at 5 years. Differences were most apparent after 2 years from diagnosis. Longer duration PII provided no benefit. Stronger intensity but not prolonged duration PII improved outcome for patients with higher-risk ALL. This study is registered at http://clinicaltrials.gov as NCT00002812.

The authors investigated the psychosocial impact of dragon boat participation on women who have been treated for breast cancer. Open-ended qualitative interviews were completed by 10 new members recruited from two breast cancer survivor dragon boat teams. Our findings indicate that the women's experience of survivor dragon boating surpassed their expectations and offered them hope and increased strength and the ability to regain control of their lives. Key themes emerging from the in-depth interviews that encapsulate the experiences of women in their first season of dragon boating follow: awakening of the self, common bond, regaining control, being uplifted, and transcending the fear of death. The interview data support the emerging hypothesis that dragon boating is a vehicle for improving women's wellness and post-treatment quality of life.

Under the Americans with Disabilities Act (ADA), employers must provide employees with disabilities reasonable accommodations that will enable them to perform job duties, as long as the accommodations do not financially burden the organization. Two studies were conducted to investigate whether disability origin and/or prior work history impermissibly influence the granting of reasonable accommodations under the ADA. In both studies, participants granted more accommodations for employees whose disability was caused by some external factor than for those whose disability was caused by the employee's own behavior. In Study Two, participants also granted more and costlier accommodations for an employee with an excellent work history than for an employee with an average work history. Implications of the use of extralegal factors in accommodation decisions are discussed.

Common wisdom seems to suggest that racial bias, defined as disparate treatment of minority defendants, exists in jury decision-making, with Black defendants being treated more harshly by jurors than White defendants. The empirical research, however, is inconsistent--some studies show racial bias while others do not. Two previous meta-analyses have found conflicting results regarding the existence of racial bias in juror decision-making (Mazzella & Feingold, 1994, Journal of Applied Social Psychology, 24, 1315-1344; Sweeney & Haney, 1992, Behavioral Sciences and the Law, 10, 179-195). This research takes a meta-analytic approach to further investigate the inconsistencies within the empirical literature on racial bias in juror decision-making by defining racial bias as disparate treatment of racial out-groups (rather than focusing upon the minority group alone). Our results suggest that a small, yet significant, effect of racial bias in decision-making is present across studies, but that the effect becomes more pronounced when certain moderators are considered. The state of the research will be discussed in light of these findings.

We recently described a novel thiotepa plus etoposide high-dose therapy (HDT) conditioning regimen for aggressive histology non-Hodgkin's lymphoma (NHL) that had low regimen-related toxicity (RRT) and an efficacy rate comparable to other NHL HDT regimens. In this report, we describe the UW experience with the addition of total body irradiation (TBI) and pre-transplant involved-field radiation (IFRT) to the thiotepa + etoposide HDT regimen. Between 1992 and 1999, 28 patients with indolent or mantle cell lymphoma were treated on this protocol. With a median follow-up of 64 mo, the median event-free survival (EFS) was 24 months, and the median overall survival (OS) had not been reached. The median number of grade 3 - 4 non-hematologic toxicities was five. There were five deaths (18%) in the first three months after HDT due to RRT. In contrast, the thiotepa + etoposide conditioning regimen (without TBI or IFRT) given to 65 intermediate grade NHL patients resulted in only one treatment-related death and considerably fewer grade 3 - 4 toxicities. Given the relatively short EFS in this cohort of indolent NHL patients, we conclude that the combination of IFRT and TBI plus thiotepa and etoposide resulted in a HDT regimen with excessive toxicity and this protocol was closed at our institution.

The American Dental Education Association recently reported that the growing shortage of qualified faculty in dental hygiene education programs has reached a crisis situation. The authors hypothesized that Canadian dental hygiene programs will face a similar shortage. However, a review of the literature identified no studies that investigated Canadian dental hygiene faculty shortages. To address this gap in knowledge, a twenty-three-item descriptive survey and cover letter were mailed to the director of each Canadian school of dental hygiene (N=31) in spring 2003. The survey and letter were translated into French for francophone (French-speaking) schools. Follow-up telephone calls were made to nonrespondent programs. Survey results were analyzed using descriptive statistical methods. The response rate was 84 percent. Results revealed that 20 percent of schools had sought to fill empty faculty positions within the year and 47 percent of full-time faculty were forty-nine years or older. Within the next two years, 24 percent of dental hygiene programs in Canada will have full-time faculty positions available, growing to 40 percent within the next five years. Respondents indicated that they preferred faculty to hold a credential above the diploma whether teaching full-time (92 percent) or part-time (88 percent). Other required qualifications included previous teaching experience, current clinical experience, and eligibility for licensure in the province for teaching in Canadian dental hygiene programs.

In collaboration with a Community Advisory Group we examined the impact of the 1998 Swissair Flight 111 disaster on volunteer responders and surrounding communities. We conducted qualitative interviews and administered a set of structured questionnaires to 13 volunteer disaster workers and conducted a focus group with community leaders. Community silence and limited help-seeking behaviour were typical reactions to the SA 111 disaster. The nature and duration of the disaster response efforts contributed to a probable 46 per cent PTSD rate in the community volunteers. Community-based, culturally appropriate followup, as well as the development of volunteer protocols for future disaster response efforts, are necessary to minimize long-term health impacts and to promote resilience among community residents and volunteers exposed to a major disaster.

We investigated the effects of the 1998 Swissair Flight 111 (SA 111) disaster on a variety of indices of alcohol use among volunteer responders. We retrospectively administered standardized questionnaires and a semi-structured interview to 13 volunteer disaster workers recruited from the community. According to the interview, 54% of the volunteers were exposed to human remains. According to Modified Post-Traumatic Stress Disorder (PTSD) Symptoms Scale responses, 46% met DSM-IV criteria for PTSD. Frequency and severity of PTSD symptoms, but not human remains exposure, per se, were positively correlated with coping-motivated drinking (but not social or mood enhancement drinking) and with alcohol use to forget. The re-experiencing and hyper-arousal PTSD symptom dimensions showed the strongest and most consistent correlations with the alcohol use indices. We discuss ways in which the information gleaned from this sample can be used to improve disaster response planning to minimize the probability of maladaptive coping drinking among volunteers.

Hepatoblastoma is the most common liver tumor diagnosed in children. Children with persistently unresectable disease, metastatic disease at presentation, recurrent disease, or slowly declining alpha-fetoprotein levels are at high risk for recurrence, exhibit an extremely poor prognosis, and are in desperate need of novel therapeutic agents and strategies. Four high-risk patients were treated. One patient with a local recurrence was treated with irinotecan followed by orthotopic liver transplant. Three patients were treated with tandem high-dose chemotherapy (HDT) with autologous stem cell rescue (two with primary metastatic disease and one with recurrent disease). All three of the patients treated with HDT had relapse (two of them subsequently received irinotecan); the remaining patient underwent surgical resection of a solitary recurrent pulmonary metastasis. Irinotecan demonstrated significant antitumor effects in all three treated patients and was well tolerated. None of the three patients treated with HDT remained disease-free, although the patient who underwent surgical resection of a solitary recurrent pulmonary metastasis remains disease-free 6 years from diagnosis. Further exploration of the use of irinotecan is warranted in high-risk patients with hepatoblastoma.

Objectives: Multivitamin supplements are often sold to consumers with the claim that supplements modify risk factors associated with disease. Because few products are validated scientifically, we examined the effects of a 24-ingredient multivitamin formula in an open-label pilot investigation., Methods: We examined 150 subjects for specific endpoints including blood concentrations of selected vitamins, homocysteine, lipids, and low-density lipoprotein (LDL) oxidation indices at baseline and at 12 and 24 wk., Results: One hundred forty-one subjects were successfully assayed for and showed significant time effects for homocysteine and vitamin B6 (as pyridoxal-5'-phosphate), B12, and folic acid concentrations during treatment (P < 0.0001). Vitamin B6, B12, and folic acid concentrations were significantly elevated at weeks 12 and 24 (P < 0.05). Homocysteine concentration decreased significantly during the same periods (7.9 +/- 2.4 versus 6.7 +/- 1.7 versus 6.7 +/- 1.9 mM/mL; P < 0.05). There were correlations relating homocysteine to vitamins B6 (P = 0.001, r(2) = 0.03), B12 (P < 0.001, r(2) = 0.09), and folic acid (P = 0.001, r(2) = 0.10). Significant time effects were noted for 121 subjects successfully assayed for vitamin C, E, beta-carotene, LDL oxidation rate, and LDL lag time (P < 0.0001). Post hoc assessment showed elevations in vitamin C, E, and beta-carotene concentrations at 12 and 24 wk (P < 0.05). LDL oxidation lag time at baseline (57.5 +/- 13.9 min) increased by 12 wk (63.5 +/- 19.0 min; P < 0.05) and 24 wk (63.8 +/- 16.3 min; P < 0.05). LDL oxidation rate at baseline (9.7 +/- 3.0 microM x min(-1). g(-1)) was reduced at 12 wk (7.1 +/- 2.5 microM x min(-1) x g(-1); P < 0.05) and 24 wk (6.0 +/- 2.0 microM x min(-1) x g(-1); P < 0.05). Only vitamin C was significantly correlated with LDL oxidation rate (P = 0.05, r(2) = 0.003)., Conclusions: A multi-ingredient vitamin formula with antioxidant properties has measurable effects on homocysteine and LDL oxidation indices.

A unique family of ribonucleases was identified by exhaustive screening of genomic and cDNA libraries using a probe derived from a gene encoding a ribonuclease stored in the mouse eosinophil secondary granule. This family contains at least 13 genes, which encode ribonucleases, and two potential pseudogenes. The conserved sequence identity among these genes (approximately 70%), as well as the isolation/purification of these ribonucleases from eosinophil secondary granules, has led us to conclude that these genes form a unique clade in the mouse that we have identified as the Ear (Eosinophil-associated ribonuclease) gene family. Analyses of the nucleotide substitutions that have occurred among these ribonuclease genes reveal that duplication events within this family have been episodic, occurring within three unique periods during the past 18 x 10(6) years. Moreover, comparisons of non-synonymous (K(a)) vs. synonymous (K(s)) rates of nucleotide substitution show that although these genes conserve residues necessary for RNase activity, selective evolutionary pressure(s) exist such that acquired amino acid changes appear to be advantageous. The selective advantage of these amino acid changes is currently unclear, but the occurrence of this phenomenon in both the mouse and the human highlights the importance of these changes for Ear and, therefore, eosinophil effector function(s).

We present data for 18,785 patients undergoing electron beam computed tomography, dividing them by sex and age (using 5-year age increments) to determine coronary artery calcium scores representing the 50th and 75th percentiles for each group. Because risk stratification is an integral part of determining therapies for coronary artery disease, age- and sex-based scores may be more clinically useful than total coronary artery calcium scores alone.

Purpose: The purpose of this work was to describe the positive predictive value of electron beam CT (EBCT) for diagnosis of solid renal tumors., Method: Among 11,932 consecutive patients undergoing screening EBCT, 27 cases met EBCT criteria for solid renal tumors. Twenty-six of 27 patients underwent surgery., Results: Surgical pathology identified 25 solid renal tumors and 1 adrenal hemorrhage with thrombus. Twenty tumors were classified as T1N0M0, one was T2N0M0, and one was T3aN0M0. All tumor patients are clinically well at 1-41 months (mean 17 months) postoperatively. None of the patients had clinical signs or symptoms characteristic of renal malignancy., Conclusion: EBCT is an effective tool for detection of solid renal tumors in a healthy outpatient population (positive predictive value 0.96). The detection rate is low [0.2% (26/11,932) at our facility] in patients undergoing EBCT for other indications. The cost-effectiveness and sensitivity of this technique for solid renal tumor detection among various populations remain to be determined.

Background: Although medical textbooks usually classify fasting plasma glucose <70 or 80 mg/dL (<3.89 or 4.44 mmol/L) as abnormal, the prognosis for patients with low fasting plasma glucose is unclear., Methods and Results: We conducted prospective cohort studies among 40 069 men and women to investigate the association between fasting plasma glucose levels and cardiovascular disease and all-cause mortality. We documented a U-shaped relation between fasting plasma glucose and mortality. In addition to diabetes and impaired fasting glucose levels, low fasting plasma glucose levels were also associated with high mortality. After multivariate adjustment for age, sex, study population, ethnicity, current smoking status, high blood pressure, total cholesterol, body mass index, triglycerides, history of cardiovascular disease and cancer, and a family history of cardiovascular disease, patients with fasting plasma glucose <70 mg/dL (<3.89 mmol/L) had a 3.3-fold increased risk of cardiovascular disease mortality, and patients with fasting plasma glucose 70 to 79 mg/dL (3.89 to 4.43 mmol/L) had a 2.4-fold increased risk compared with the risk in patients with fasting plasma glucose 80 to 109 mg/dL (4.44 to 6.05 mmol/L) (tests for trend P<0.0001). Participants with low fasting plasma glucose levels also had increased risk of all-cause mortality (test for trend P<0.0001)., Conclusions: Participants with low fasting plasma glucose levels had a high risk of cardiovascular disease and all-cause mortality.

Objective: To evaluate the relation between alcohol intake and incidence of type 2 diabetes., Research Design and Methods: This prospective study included 8,663 men with fasting plasma glucose measurements from at least two medical examinations. Alcohol intake was classified into five groups: nondrinkers and four quartiles (Qs) of drinkers according to the amount of alcohol intake. Type 2 diabetes was diagnosed by 1997 American Diabetes Association criteria., Results: There were 149 incident cases of type 2 diabetes during 52,588 person-years of follow-up. There was a U-shaped association between alcohol intake and diabetes, with the lowest incidence of diabetes at Q2 (61.9-122.7 g/week). As compared with Q2, men in Q3 and Q4 had a 2.2- (95% CI 1.2-3.9, P = 0.01) and 2.4-fold (1.4-4.4, P<0.01) risk of developing diabetes, while nondrinkers and men in Q1 had 1.8- (1.0-3.3, P<0.05) and 1.4-fold (0.7-2.6, P = 0.34) higher risk of diabetes, respectively. These associations persisted after adjustment for age, fasting plasma glucose, smoking, BMI, blood pressure, serum triglyceride concentration, cardiorespiratory fitness, HDL cholesterol, waist circumference, and parental diabetes., Conclusions: We observed an elevated risk of developing type 2 diabetes in nondrinkers and men with high alcohol intakes, when compared with men who reported moderate alcohol intake. Men with a high alcohol intake may be able to reduce their risk of developing type 2 diabetes if they drink less.

Background: Several studies show an inverse association between self-reported physical activity and type 2 diabetes. It is not known whether physical activity or cardiorespiratory fitness is associated with the onset of objectively determined impaired fasting glucose and type 2 diabetes., Objective: To determine whether cardiorespiratory fitness, an objective marker of physical activity, is associated with risk for impaired fasting glucose and type 2 diabetes., Design: Population-based prospective study., Setting: Preventive medicine clinic., Patients: 8633 nondiabetic men (of whom 7511 did not have impaired fasting glucose) who were examined at least twice., Measurements: Cardiorespiratory fitness (determined by a maximal exercise test on a treadmill), fasting plasma glucose level, and other clinical and personal characteristics and incidence of impaired fasting glucose and type 2 diabetes., Results: During an average follow-up of 6 years, 149 patients developed type 2 diabetes and 593 patients developed impaired fasting glucose. After age, cigarette smoking, alcohol consumption, and parental diabetes were considered, men in the low-fitness group (the least fit 20% of the cohort) at baseline had a 1.9-fold risk (95% CI, 1.5- to 2.4-fold) for impaired fasting glucose and a 3.7-fold risk (CI, 2.4- to 5.8-fold) for diabetes compared with those in the high-fitness group (the most fit 40% of the cohort). The risk for impaired fasting glucose was elevated in older men and those with a higher body mass index. Age, body mass index, blood pressure, triglyceride level, and a history of parental diabetes were also directly related to risk for type 2 diabetes., Conclusions: Low cardiorespiratory fitness was associated with increased risk for impaired fasting glucose and type 2 diabetes. A sedentary lifestyle may contribute to the progression from normal fasting glucose to impaired fasting glucose and diabetes. Risk for type 2 diabetes was elevated in older persons and those with higher body mass index, blood pressure, and triglyceride levels and a parental history of diabetes.

1. A randomized, double-blind, placebo-controlled trial utilizing creatine as a potential lipid-lowering agent was conducted to determine plasma lipid, lipoprotein, glucose, urea nitrogen and creatinine profiles in men and women ranging in age from 32 to 70 years. 2. Thirty-four subjects (18 men and 16 women) with total cholesterol concentrations exceeding 200 mg/dl received either a creatine supplement (5 g of creatine plus 1 g of glucose) or a glucose placebo (6 g of glucose) for 56 days. Creatine and placebo were taken orally four times a day for 5 days and then twice a day for 51 days. Plasma analyses were measured at baseline, 4 and 8 weeks of treatment, and at 4 weeks after cessation of treatment (week 12). 3. Significant reductions in plasma total cholesterol, triacylglycerols and very-low-density lipoprotein-C occurred within the creatine monohydrate group. Minor reductions in plasma total cholesterol from baseline (233 +/- 9 mg/dl) of 6% and 5% occurred at weeks 4 and 8, respectively, before returning to baseline at week 12. Baseline triacylglycerols (194 +/- 21 mg/dl) and very-low-density lipoprotein-C (39 +/- 4 mg/dl) were reduced by 23% and 22% at weeks 4 and 8, respectively, and remained attenuated by 26% at week 12. These results remained consistent when data were separated and analysed by gender. Finally, a small, but statistically significant increase in urea nitrogen was observed in women between baseline (11.8 +/- 0.7 mg/dl) and week 8 (13.8 +/- 0.7 mg/dl, P < 0.05). No significant differences were noted for low-density lipoprotein-C, high-density lipoprotein-C, total cholesterol/high-density lipoprotein ratio, glucose, creatinine, body mass, body mass index or physical activity within or between the experimental and placebo groups. However, a trend towards reduced blood glucose levels was present in males given creatine monohydrate (P = 0.051). 4. These preliminary data suggest that creatine monohydrate may modulate lipid metabolism in certain individuals. These observations may demonstrate practical efficacy to the hyperlipidaemic patient as well as providing possible new mechanistic insights into the cellular regulation of blood lipid concentrations.

The research relationship within qualitative research methods, that is, the relationship between researcher and research participant, is reexamined in this paper. We draw upon our own research experiences of working with high-risk individuals and vulnerable communities in reframing a discussion of the interview process. We illustrate the emotionally provocative and volatile nature of the research relationship and argue for the necessity of social research protocols which extend beyond a utilitarian research framework, the expansion of the researcher's role to include skillful navigation of the intersubjective aspects of research interviewing, and participant advocacy.

Although exercise testing is a safe activity for the vast majority of individuals being tested, complications during or soon after testing do occur, and safety is an extremely important consideration. In reviewing published rates of complications, it appears that complication rates around 5 per 10,000 tests and death rates around 0.5 per 10,000 tests might be expected. The rate of complications and deaths in our clinic is much lower than these published rates, but our population is, in general, a healthier population than those reported on in other studies. It is instructive to review the details of exercise tests in which complications have occurred, although sometimes it is impossible to predict that an untoward occurrence is imminent. Exercise testing soon after myocardial infarction or angioplasty can generally be conducted safely by knowledgeable professionals, although submaximal testing is recommended under these circumstances. Following accepted contraindications to testing and accepted indications for terminating an exercise test is still very important to ensure the safety of testing. If one desires to step outside these recognized guidelines, the anticipated benefits of testing must clearly outweigh the inherent risks. Any testing facility must have appropriate safety equipment, including a defibrillator, and personnel must be regularly drilled in responding to emergencies. In reviewing our experience at the Cooper Clinic, practical suggestions have been offered that should make exercise testing, which is already a very safe activity, even safer.

Study Objective: To determine the usefulness of screening reviews of the cardiopulmonary and gastrointestinal systems during medical admissions., Design: Case series., Setting: General internal medicine ward of a university hospital., Patients: 550 consecutive medical patients were initially screened at admission. The authors excluded 265 patients with life-limiting medical conditions, and they studied 98 patients with no known cardiopulmonary disease and 207 patients with no known gastrointestinal disease., Interventions: Positive responses to screening systems review questions were evaluated using a standardized testing algorithm., Main Outcome Measures: Numbers of new diagnoses; potential for patient benefit., Main Results: The authors made 26 new diagnoses for 25 patients (95% confidence limits, 16 to 37 patients), two of whom may have gained years of life as a result., Conclusions: The absolute yield of the screening cardiopulmonary and gastrointestinal reviews of systems of 550 patients admitted to an internal medicine service of a university hospital was a new diagnosis in about 5% of patients. An estimate of the cost-effectiveness compares favorably with those of other accepted screening practices.