Protecting your healthcare organization from liability for sexual harassment by employees and non-employees.
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Delivery of Health Care↗
Biomedical subjects
R Whitehead
Publications and source records attributed to R Whitehead.
Families with autosomal dominant brachydactyly type E, short stature, and severe hypertension.
BACKGROUND: Rare, monogenic forms of hypertension may give insight into novel mechanisms relevant to essential hypertension. Autosomal dominant hypertension with brachydactyly has been documented in a single Turkish kindred; the gene was mapped to chromosome 12p. OBJECTIVE: To describe the molecular genetics of additional families with autosomal dominant hypertension and brachydactyly. DESIGN: Case series. SETTING: Tertiary care medical centers. PATIENTS: An 11-member Canadian family and a 7-member U.S. family, neither of Turkish background, with autosomal dominant hypertension and type E brachydactyly. MEASUREMENTS: Clinical evaluation, genotyping, and haplotype analyses. RESULTS: The mode of inheritance, the type E brachydactyly, and the propensity for stroke were consistent with autosomal dominant hypertension with brachydactyly. The same markers on chromosome 12p cosegregated with the phenotype in the families. A haplotype analysis strongly supported the conclusion that these families have a molecular defect in the same gene. CONCLUSIONS: The syndrome of autosomal dominant hypertension and brachydactyly is not confined to patients of Turkish origin. All persons with brachydactyly should have their blood pressure measured, and the syndrome should be considered if hypertension is found.
Chromosomes, Human, Pair 12↗
Musculoskeletal injuries in adolescents.
This article reviews the anatomy of the physis and the most common classification of injuries or fractures through the physis. The common apophyseal injuries of Osgood-Schlatter, Severs disease and iliac apophysitis, are reviewed in addition to a review of the most common osteochondritides, including Panner's disease and Osteochondritis Dessicans of the femur and talus. An understanding of these is key to diagnosis and treatment of adolescent musculoskeletal injuries. This article also reviews slipped capital femoral epiphysis, little leaguer's elbow, anterior cruciate and collateral ligament injuries, patella problems, ankle sprains and several common fractures in children.
Adolescent↗
Recommendations on folate intake.
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Female↗
Effects of cue validity upon performance in the attention cueing paradigm.
Two experiments were run wherein normal subjects made choice reactions to targets preceded by location cues. Systematic manipulation of the predictive validity of the cue produced consistent advantages for subjects in the low as opposed to the high predictive validity condition. Performance advantages were observed in both response time and accuracy measures. The results are discussed with respect to models of visual orienting and controlled versus automatic processing.
Adult↗
IRS eases rules for physician representation on governing boards.
In September 1996, the IRS eased its policy prohibiting extensive physician representation on governing boards of tax-exempt integrated delivery systems (IDSs). The IRS now allows increased physician participation on governing boards if the organizations institute conflict-of-interest safeguards that prohibit physicians from obtaining private inurements. A section of the Internal Revenue Code, enacted in 1996 by the Taxpayer Bill of Rights 2, strengthens the IRS's enforcement policy by providing targeted sanctions against individual violators of the private inurement rule rather than penalizing entire IDSs and the communities they serve by revoking their tax-exempt status.
Conflict of Interest↗
Avoiding state intervention in not-for-profit/for-profit affiliations.
States attorneys general recently have intervened in transactions involving not-for-profit organizations that wish to convert to or transfer assets to for-profit status. These interventions are significant for two reasons: first, they reflect a tendency amount state attorneys general to involve states in the governance of not-for-profit healthcare organizations, and second, they demonstrate that attorneys general are paying renewed attention to the legal obligation of such organizations to provide a community health benefit, which imposes a charitable trust on not-for-profit healthcare organizations and the fiduciary duties of care and loyalty to that charitable trust on the organizations' officers and directors. To avoid state intervention in such transactions, officers and directors of not-for-profit organizations need to understand the circumstances under which attorneys general justify such intervention, which include the undervaluation of the organization's charitable assets; lack of a private letter ruling from the IRS; failure to adequately consider alternatives to the transaction; conflicts with the best interest of the organization; and inadequate responses to the attorney general's requests for information.
California↗
The implementation and use of automated group and screen procedures in a hospital transfusion laboratory.
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Anticoagulants↗
Stress and performance: an application of Gray's three-factor arousal theory to basketball free-throw shooting.
The suitability of Gray's (1975) three-factor arousal theory as a model of human performance under stress was investigated in a study of basketball free-throw shooting. Free-throw attempts, made by members of an NCAA Division I men's varsity team, were videotaped during one full season. On the basis of Gray's theory, we predicted that increased stress (assumed to be present in games as opposed to practices) would be associated with longer pre-shot preparations and a greater incidence of overthrow shots. The prediction was confirmed by the results. Moreover, we found that free-throws were more frequently overthrown when attempted during crucial rather than non-crucial game situations. Further tests of the utility of Gray's theory are suggested.
Arousal↗
Resistance training-induced increases in muscle mass and performance in ponies.
The purpose of this study was to determine whether 8 wk of progressive resistance exercise training would produce increases in strength and changes in foreleg muscle characteristics indicative of hypertrophy in ponies. Two mature 3- to 6-yr-old, male ponies (188 +/- 16 kg) were taught to carry sheets of lead over their saddle region (wither) while walking on a level treadmill at 1.9 m.s-1. This initial familiarization period was followed by 8 wk of training (3 d per wk), in which the ponies performed a series of progressive sets of weight carrying to fatigue. Each workout started with a 2-min walk at 1.9 m.s-1 followed by sets of weight carrying. The ponies carried 44.5 kg for the first set with increases of 22.3 kg per set until fatigue. Weights were applied and then removed for 60-90 s between sets using a chain hoist and sling apparatus. Measurements of forelimb girth, body weight, and total weight carried were recorded at each workout session. Ultrasound measurement of the diameters of the superdigital flexor muscles and muscle biopsies were performed before and after the 8-wk training period. Eight weeks of resistance training resulted in significant increases in peak weight carried (260%, P < 0.05) and total weight carried (1525%, P < 0.05) during each workout. Forelimb girth increased 12 +/- 1% (P < 0.05) with a corresponding 19 +/- 3% (P < 0.05) increase in muscle cross-sectional diameter. There were no changes (P > 0.05) in Type I muscle fiber area; however, there was a nonsignificant 26% increase in Type IIA+IIB fiber area. These data suggest that 8 wk of progressive resistance exercise training increase strength and cause changes in muscle size and characteristics consistent with hypertrophy.
Animals↗
Obstructive colitis: an analysis of 50 cases and a review of the literature.
Obstructive colitis is an ulcero-inflammatory and necrotizing condition that occurs in the colon proximal to benign or malignant stenosing lesions. it is the result of ischemia due to impairment of blood supply secondary to elevation of the endoluminal pressure, distension of the colonic wall and other factors which impair adequate perfusion. The incidence among patients with colonic obstruction is reported at between 1 and 7%. Of 50 patients with this condition in this series, 30 female and 20 male, 2/3rds were well over 70 yrs of age. Obstruction was most common in the rectosigmoid. In half the patients this was due to adenocarcinoma, 24 were due to benign obstruction and 15 were caused by diverticular disease. Type, extent and depth of ischemic lesions were highly variable and comprised early mucosal hemorrhage and edema, ulcero-hemorrhagic lesions and transmural necrosis. There was always an abrupt transition between affected and normal bowel. A segment of preserved mucosa was usually present on the proximal side of the stenosis. In 16 patients massive dilatation with stretching and thinning of the bowel wall, associated with a blow-out type of perforation or with transmural necrosis, was observed and was considered to have resulted from a rapid rise of endoluminal pressure to high levels. The microscopic and macroscopic features are described in detail and histological factors discussed in relation to the pathological lesions encountered. Emphasis is placed upon the range of appearances and similarities are shared with other inflammatory colonic diseases, particularly idiopathic inflammatory bowel disease. The importance of recognition of this disease entity, not only by pathologists but by surgeons dealing with the disease at operation, is stressed.
Aged↗
The classification of chronic gastritis: current status.
The importance of classifying chronic gastritis is the causal relationship of some cases to pernicious anemia, peptic ulcer, and gastric adenocarcinoma. The morphology and topographic distribution of chronic gastritis form the basis for the current recognition of five subtypes. These are: Type A or diffuse atrophic corporal; Type B or diffuse antral; Type AB or multifocal atrophic; and Type C chemical, reactive, and lymphocytic. The etiology includes autoimmunity, bacterial infection, bile reflux, the effects of nonsteroidal anti-inflammatory drugs, and diet. There are, however, discrepancies in the evidence that these subtypes are entirely distinct. A multifactorial etiology for individual cases and groups of cases is argued as the cause of difficulty in assigning cases to a specific type. The challenge still posed by chronic gastritis is stressed.
Chronic Disease↗
Recommendations on nutrient and energy intake in the UK.
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Energy Intake↗
Video image analysis of AgNOR distribution in the normal and adenomatous colorectum.
The nucleolar organizer regions (AgNORs) have been studied by video image analysis in the normal colorectum and in adenomas arising there. Total AgNOR area was measured in conjunction with the total area of nuclei and expressed as a ratio. AgNORs are found to predominate in the proliferative regions of the normal mucosal crypt, and the ratio of AgNOR to nuclear area proved significantly greater in the normal colon than in the rectum and far greater in colorectal adenomas. Further, there is a significant difference between the ratio in tubular as opposed to villous patterns of adenomatous growth in the colon but not in the rectum. When classified according to their degree of dysplasia, adenomas in the rectum exhibit a significantly higher ratio of AgNOR to nuclear area as the degree of dysplasia increases in severity. This correlation is not shown in the colon.
Adenoma↗
Whole body protein metabolism and resting energy expenditure in pregnant Gambian women.
Whole body protein metabolism and resting energy expenditure (REE) were measured at 11, 23, and 33 wk of pregnancy in nine pregnant (not malnourished) Gambian women and in eight matched nonpregnant nonlactating (NPNL) matched controls. Rates of whole body nitrogen flux, protein synthesis, and protein breakdown were determined in the fed state from the level of isotope enrichment of urinary urea and ammonia during a period of 9 h after a single oral dose of [15N]glycine. At regular intervals, REE was measured by indirect calorimetry (hood system). Based on the arithmetic end-product average of values obtained with urea and ammonia, a significant increase in whole body protein synthesis was observed during the second trimester (5.8 +/- 0.4 g.kg-1.day-1) relative to values obtained both for the NPNL controls (4.5 +/- 0.3 g.kg-1.day-1) and those during the first trimester (4.7 +/- 0.3 g.kg-1.day-1). There was a significant rise in REE during the third trimester both in the preprandial and postprandial states. No correlation was found between REE after meal ingestion and the rate of whole body protein synthesis.
Adult↗
Effect of malaria and fever on energy metabolism in Gambian children.
The aim of the present study was to measure the changes in resting energy expenditure (REE) induced by malaria and to assess to what extent they are related to fever and nutritional status. The REE of 19 Gambian children (mean age +/- SEM, 9 +/- 1 y; weight, 24 +/- 2 kg; expected weight for height 86 +/- 1%) were measured with a hood system at repeated intervals at the onset of malaria crisis (test A), 3 to 4 d after therapy (test B), and 14 to 21 d later (test C). Axillary temperature averaged 39.2 +/- 0.1, 36.6 +/- 0.1, and 36.7 +/- 0.1 degrees C in the tests A, B, and C, respectively. REE in test A was significantly higher than REE in test B (223 +/- 10 versus 174 +/- 8 kJ/kg.d, p less than 0.0001), but in test C (169 +/- 8 kJ/kg.d), it did not differ from that observed in test B. The percentage of increase in REE was significantly correlated with the difference in axillary temperature (r = 0.46, p less than 0.05); the slope of the regression line indicated an increase of 6.9% in REE/degree C of fever. Furthermore, the individual increase in REE/degree C was correlated to the percentage of weight for height of the children (r = 0.54, p less than 0.05), indicating that the child's nutritional status influences the magnitude of the hypermetabolism due to fever. We concluded that Gambian children suffering from an acute episode of malaria have an increase in REE averaging 30%; however, REE promptly returns to baseline value a few days after the beginning of therapy.
Adolescent↗
Anabolic steroid use among adolescents in a rural state.
BACKGROUND: Anabolic-androgenic steroid use is an increasing problem among high school students. Previous reports have been mainly from metropolitan areas. METHODS: We report the first study of anabolic-androgenic steroid use to concentrate on rural communities. The study was conducted using an anonymous survey of a random sample of male high school students (N = 3900) in grades 10 through 12 encompassing 31 high schools in a predominantly rural state. RESULTS: Two-hundred five (5.3%) students reported using steroids. The prevalence of illicit drug use was significantly higher (P < .05) in steroid users (74%) than in nonusers (31%) (P < .001). The association was between anabolic-androgenic steroid use and illicit drug use rather than between sports participation of any type and illicit drug use (P > .2). Comparison of the prevalence of illicit drug use among athletic (63.2%) and nonathletic (36.8%) steroid users found no significant difference. Findings were similar with cigarette use. There was no difference in the rate of steroid use by school enrollment (69 to 1495) or by city population size (< 200 to 64,000). The predominant reason for steroid use was to improve appearance (43%). CONCLUSIONS: This study found the prevalence of steroid use throughout a predominantly rural state to be similar to that found by previous studies conducted in metropolitan areas; prevalence was not affected by city or school size. Steroid use was closely associated with illicit drug and cigarette use, a new finding that deserves further examination.
Adolescent↗
Postprandial thermogenesis in lactating and non-lactating women from The Gambia.
Postprandial thermogenesis was assessed by indirect calorimetry in 32 Gambian women classified into three groups as follows: 12 non-pregnant non-lactating and 10 lactating women studied during the dry season and 10 lactating women studied during the rainy season. The test meal consisted of a typical Gambian breakfast and its energy content corresponded to 30% of the individual's resting metabolic rate (RMR)/24 h. During the dry season, the postprandial thermogenesis of the lactating women averaged 6.0 +/- 0.4% of the test meal energy content and was similar to that observed in the non-pregnant non-lactating women studied during the same season (5.8 +/- 0.3%). In contrast, the postprandial thermogenesis of lactating women studied during the rainy, nutritionally unfavourable season was found to be significantly lower (4.9 +/- 0.5%). There was no significant difference in the pre- and postprandial respiratory quotients among groups. This leads to the conclusion that lactation does not alter the thermogenic response to food and that the reduction in postprandial thermogenesis observed in lactating women during the wet season constitutes an adaptive response to energy deficit allowing a saving of energy in periods of food restriction.
Adolescent↗