Balancing smokers, nonsmokers and health concerns.
Delaware and California have banned all public smoking. Other states are looking at requiring separate, well-vented rooms. The problem is no one knows how much ventilation is enough.
Humans↗
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Prognostic factors in mortality and morbidity in patients with differentiated thyroid cancer.
We attempted to determine if women younger than 45 years of age who have isolated papillary thyroid cancer and whose tumors are smaller than 4 cm (T2N0M0) are at low risk for mortality and morbidity following thyroid lobectomy. To this end, we analyzed information on both women and men obtained from our review of the literature, and we integrated it with data compiled in the Delaware Cancer Registry. We performed a secondary analysis to determine if the risk of death and recurrence can be predicted on the basis of age, tumor size, sex, histology, and the type of operation. We found that among patients who had undergone either thyroid lobectomy or total thyroidectomy, mortality rates were 1.3% for those younger than 45 years of age and 15.6% for those 45 years and older (p < 0.0001). With respect to tumor size, patients whose masses were smaller than 4 cm had significantly lower mortality (3.0%) and recurrence (11.1%) rates than did those whose tumors were 4 cm or larger (16.8 and 33.3%, respectively; p < 0.0001). Other significant risk factors for death were male sex and the presence of follicular thyroid cancer (as opposed to papillary thyroid cancer). The risk of permanent hypocalcemia was significant among patients who had undergone total thyroidectomy, but not among those who had been treated with lobectomy. The subgroup of patients who had the lowest risk of mortality and morbidity was made up of women younger than 45 years years who had a papillary thyroid tumor smaller than 4 cm that was limited to one lobe and who had undergone lobectomy. On the other hand, we found that lobectomy might carry a higher risk of recurrence (from a micrometastasis in the cervical lymph node) than does total thyroidectomy. Experienced surgeons whose rates of hypocalcemia and recurrent laryngeal nerve paralysis following total thyroidectomy are low offer their patients the unambiguous advantage of superior follow-up with thyroglobulin and radioactive iodine.
Carcinoma, Papillary↗
N-nitroso compounds: detection in ambient air.
By use of a new, highly selective detection technique for N-nitroso compounds, which is sensitive to picogram quantities and which is based on the catalytic cleavage of the N-NO bond and the subsequent detection of the nitrosyl radical, dimethylnitrosamine has been found in concentrations of 0.02 to 0.96 part per billion in three out of five air samples from Baltimore, Maryland, and 0.014 to 0.051 part per billion in five out of six air samples from Belle, West Virginia. The sensitivity of the analytical procedures used was 1 part in 10(12). The presence of dimethylnitrosamine has been confirmed by using the new detector in conjunction with both a gas-liquid chromatograph and a high-performance liquid chromatograph. In addition, between one and three as yet unidentified N-nitroso compounds were detected in both cities. N-Nitroso compounds were not found in air samples from Philadelphia, Pennsylvania; Wilmington, Delaware; and Waltham, Massachusetts.
Air Pollutants↗
[Ventricular tachycardia "in salvoes"].
The term of ventricular tachycardia "in salvoes" describes electrophysiographic appearances of several consecutive ectopic ventricular beats without interposition of sinus rhythm. This is an intermediate arrhythmic state between isolated ventricular extrasystoles and sustained ventricular tachycardia. The generally accepted definition of the term "sustained" implies a duration of over 30 seconds or poor haemodynamic tolerance. Strictly speaking, the term "salvoe" has no precise definition in cardiology. In the 1996 edition of the Petit Robert French dictionary, the term is defined as the simultaneous discharge of guns or successive blasts of canons. The Delaware medical dictionary does not provide a French definition of the term "salvoe". In practice, we use the term tachycardia in salvoes in the same meaning as ventricular tachycardia. Schematically, in clinical practice, two situations may be encountered. In the first case, salvoes of VT are recorded in apparently normal hearts; they are not life-threatening and, though often nearly asymptomatic, they may pose therapeutic problems. In the second case, the arrhythmia occurs in a diseased heart, with a low ejection fraction, in which the essential problem is the vital prognosis.
Electrocardiography↗
Data-Based Interval Throwing Programs for Collegiate Softball Players.
OBJECTIVE: To construct interval throwing programs followed by a simulated game for collegiate softball players at all positions. The programs are intended to be used as functional progressions within a comprehensive rehabilitation program for an injured athlete or to augment off-season conditioning workouts. DESIGN AND SETTING: We collected data over a single season of National Collegiate Athletic Association softball at the University of Delaware and Goldey Beacom College. We observed 220 half-innings of play and 2785 pitches during data collection. SUBJECTS: The subjects were collegiate-level softball players at all positions of play. MEASUREMENTS: We recorded the number of pitches for pitchers. For catchers, we recorded the number of sprints to back up a play, time in the squat stance, throws back to the pitcher, and the perceived effort and distance of all other throws. We also collected the perceived effort and distance of all throws for infielders and outfielders. RESULTS: Pitchers threw an average of 89.61 pitches per game; catchers were in the squat stance 14.13 minutes per game; infielders threw the ball between 4.28 times per game and 6.30 times per game; and outfielders threw distances of up to 175 feet. CONCLUSIONS: We devised the interval throwing programs from the data collected, field dimensions, the types of injuries found to occur in softball, and a general understanding of tissue healing. We designed programs that allow a safe and efficient progressive return to sport.
Journal Article↗
[Education needs for the development of binational programs of health care].
The purpose of this article is to describe a research project carried out in Virginia, Maryland, Delaware and Pennsylvania. The main objective was to find out the continuing education needs of the staff implementing Primary Health Care (phc) programs developed with Mexican migrant workers. The methodology was based on applied research techniques. It was divided into two stages. The first stage was an interview which was applied to the coordinators of three programs: medical care, health education and sexually transmitted diseases. The second part of the methodology was to design a continuing education course with the input of the first stage. The course was implemented in the School of Public Health of Mexico in 1990. It had three main components: sociology and health in Mexico; health programmes in Mexico, and traditional medicine. The course also included a set of visits to clinics, hospitals and curanderos. The course has generated a group of scholars who are planning projects in this field to define the health needs of the migrant Mexican population in that area and the impact in Mexico. The course is also part of the regular Continuing Education Programme of the School of Public Health of Mexico now.
Delivery of Health Care↗
Journal reading habits of dietitians.
Professional journals are an important resource for continuing education. To explore the journal reading habits of registered dietitians (RDs), we mailed a questionnaire to all RDs in the state of Delaware. Responses were received from 71 RDs (47%) who identified 44 professional journals they rely on for current, practical information. RDs who have journals available at work tend to devote more time to reading at work than at home. The Journal of The American Dietetic Association was clearly the professional journal read with most regularity by respondents. Articles of practical interest, followed by abstracts and book reviews, were sections most widely read. Lack of time was the primary reason RDs identified for not devoting adequate time to reading. Many attempted to resolve this problem through reliance on newsletters and less involvement with journal articles. Suggestions for improving and maximizing journal reading habits are offered.
Adult↗
Rabies surveillance in the United States during 1991.
In 1991, 49 states, the District of Columbia, and Puerto Rico reported 6,972 cases of rabies in nonhuman animals and 3 cases in human beings to the Centers for Disease Control. Ninety-one percent (6,354 cases) were wild animals, whereas 8.9% (618 cases) were domestic species. The total number of reported cases of rabies increased 42.9% over that of 1990 (4,881 cases), with most of the increase resulting from continued spread of the epizootic of rabies in raccoons in the mid-Atlantic and northeastern states. Large increases in cases of rabies in animals were reported from Connecticut (200 cases in 1991, compared with 3 in 1990, an increase of 6,567%), Delaware (197 cases in 1991, compared with 44 in 1990, an increase of 348%), New York (1,303 cases in 1991, compared with 242 in 1990, an increase of 326%), and New Jersey (994 cases in 1991, compared with 469 in 1990, an increase of 112%). Other noteworthy increases were reported by Wyoming (96.4%), Texas (69.7%), California (41.3%), Oklahoma (33.1%), Minnesota (31.4%), Georgia (26.7%), and Maryland (23.7%). Hawaii reported 1 imported case of rabies in a bat. Only 16 states reported decreases in rabies in animals in 1991, compared with 30 in 1990. Pennsylvania and Iowa reported decreases of 40.6% and 27.4%, respectively. Rhode Island was the only state that did not report a case of rabies in 1991.
Adult↗
Impact of a smoking ban on restaurant and bar revenues--El Paso, Texas, 2002.
Smoke-free indoor air ordinances protect employees and customers from secondhand smoke exposure, which is associated with increased risks for heart disease and lung cancer in adults and respiratory disease in children. As of January 2004, five states (California, Connecticut, Delaware, Maine, and New York) and 72 municipalities in the United States had passed laws that prohibit smoking in almost all workplaces, restaurants, and bars. On January 2, 2002, El Paso, Texas (2000 population: 563,662), implemented an ordinance banning smoking in all public places and workplaces, including restaurants and bars. The El Paso smoking ban is the strongest smoke-free indoor air ordinance in Texas and includes stipulations for enforcement of the ban by firefighting and law enforcement agencies, with fines of up to $500 for ordinance violations. To assess whether the El Paso smoking ban affected restaurant and bar revenues, the Texas Department of Health (TDH) and CDC analyzed sales tax and mixed-beverage tax data during the 12 years preceding and 1 year after the smoking ban was implemented. This report summarizes the results of that analysis, which determined that no statistically significant changes in restaurant and bar revenues occurred after the smoking ban took effect. These findings are consistent with those from studies of smoking bans in other U.S. cities. Local public health officials can use these data to support implementation of smokefree environments as recommended by the Task Force on Community Preventive Services.
Humans↗
Teaching an online course.
An online pharmacology course was developed for nursing students in the associate degree program at Delaware County Community College, Media, PA. The course was a response to an expressed need from students for more pharmacology content in their curriculum and as part of an articulation agreement with Widener University School of Nursing, Chester, PA, registered nurse to a masters of science in nursing program. Course design was a team effort among faculty and instructional technology specialists. Faculty developed a list of features the course needed to deliver the content as well as instructional activities designed to help learning to occur. Instructional technology specialists designed the course layout, chose the appropriate software needed to support the course design, and developed original programming as necessary. These elements were woven into a course that is tailored to our instructional design. In the years since the course was first offered, changes have been made to increase interaction between students and to provide all aspects of the course online, including testing. Teaching online challenges faculty to learn new technical skills as well as to think about new ways of teaching.
Attitude of Health Personnel↗
The registered nurse as a first assistant: the "downunder" experience.
In 1996, Bernadette Brennan, RN, was awarded a fellowship from the Australian Confederation of Operating Room Nurses (now known as the Australian College of Operating Room Nurses Ltd.) to travel to the United States to study the role of the Advanced Nurse Practitioner, with an emphasis on the role of the registered nurse first assistant (RNFA). As part of this study, she undertook an RNFA course at Delaware County Community College. This article provides a description of her work to develop an educational program for RNFAs in Australia. Because of the size of the country and the many rural areas needing to be served, her challenge was to devise an accessible program that was also academically rigorous. Her trials as well as her triumphs are presented here.
Certification↗
Medicare, physicians, and patients.
There are many other provisions to the MMA. It is important to remind our patients that these changes are voluntary. If patients are satisfied with their current Medicare benefits and plan, they need not change to these new plans. However, as physicians we should familiarize ourselves with these new Medicare options so as to better advise our patients. For more information, visit www.ama-assn.org. The Medical Society of Delaware will strive to keep you informed as these new changes are implemented.
Aged↗
The Asian Tobacco Education, Cancer Awareness and Research's role in tobacco and cancer control efforts in Asian American communities.
PURPOSE: This article identifies the urgent needs for tobacco and cancer control in Asian American communities and the barriers that have historically prevented the development and implementation of tobacco and cancer prevention and intervention research programs among Asian Americans residing in Delaware Valley region of Pennsylvania and New Jersey. This article also presents ATECAR, the first long-term federal effort in tobacco and cancer control targeting the multi-ethnic Asian American communities in this area. METHODS: ATECAR uses a three-pronged approach: the development of community and university infrastructure, the development of training programs for minority and underserved students so that they will pursue cancer research careers, and community-based intervention research projects. PRINCIPAL FINDINGS: ATECAR's pioneering work redefined our understanding of Asian Americans' smoking habits and the important role of smoking, especially in newly immigrated communities. CONCLUSION: The advent of ATECAR marks the building of a viable infrastructure that can ensure sustainability of current and future efforts in tobacco control and use.
Adolescent↗
Rabies surveillance in the United States during 1990.
In 1990, the United States and its territories reported 4,881 cases of rabies in animals to the Centers for Disease Control, a 1.5% increase from 1989. Of these, 553 were domestic animals, 4,327 were wild animals, and one was a human being. Pennsylvania reported the highest number (611) of rabies cases in animals in 1990. For the first time since surveillance of rabies in wild animals was begun in the 1950s, the number of cases of rabies in raccoons exceeded that in skunks. Particularly large increases of cases of rabies in wild and domestic animals were reported in New Jersey (469 cases in 1990 compared with 50 cases in 1989, an increase of 838% from 1989) and New York (242 cases in 1990 compared with 54 cases in 1989, an increase of 348%). The 1,821 cases of rabies in raccoons represented a 17.9% increase over those reported in 1989 and 24.5% over those in 1988. This increase was largely attributable to the larger number of rabid raccoons in New Jersey and New York. Other states that reported an increased number of rabies cases in animals in 1990 included Utah (77.8%), Louisiana (64.7%), North Dakota (60.3%), Arizona (28.6%), Oklahoma (27.5%), Delaware (22.2%), and Maryland (20.6%). Thirty states reported a decrease in the number of cases of rabies in animals.
Adult↗
Applying science to conservation and restoration of the world's wetlands.
The world has an estimated 7 to 9 million km2 of wetlands which can be defined through their hydrology, physiochemical environment, and biota. Many human cultures have lived in harmony with wetland environments for centuries. Many others have not, resulting in drainage or severe impact of wetlands throughout the world. Conservation of wetlands needs to be a priority for the cultural and ecological values they provide. But a more optimistic note is that large-scale restoration and re-creation of wetlands and riverine systems is beginning to happen throughout the world through ecological engineering. Examples of large-scale wetland restoration projects are presented for Delaware Bay, the Skjern River (Denmark), Florida Everglades, Louisiana Delta, the Mississippi River Basin, and the Mesopotamian Marshlands of Iraq.
Conservation of Natural Resources↗
Effects of large-scale poultry farms on aquatic microbial communities: a molecular investigation.
The effects of large-scale poultry production operations on water quality and human health are largely unknown. Poultry litter is frequently applied as fertilizer to agricultural lands adjacent to large poultry farms. Run-off from the land introduces a variety of stressors into the surface waters including nutrients, antimicrobials and pathogenic bacteria. The Delaware, Maryland and Virginia (Delmarva) Peninsula has the highest concentration of broiler chickens per farm acre in the United States and provides an ideal location for studying the effects of stressors from poultry farms. We investigated potential effects by characterizing shifts in the structure of aquatic bacterial communities. DNA was isolated from microorganisms in water samples from streams and rivers at varying distances from, or having different frequencies of, litter applications. Fingerprints of 16S rDNA amplicons from bacteria in water samples collected during late summer 2001 to late spring 2002 were produced by denaturing gradient gel electrophoresis (DGGE). A statistical analysis of multiple fingerprints from each sampling location demonstrated that each site harboured a bacterial community significantly different from the communities at other sites. Similarly, the bacterial communities from each sampling time differed significantly from communities at other sampling times. Most importantly, a competitive, library-based analysis showed time of sampling (month) had a greater effect on community structure than did location.
Agriculture↗
Science, politics, and society: a brief history of environmental tobacco smoke.
This article is the second in a series of four providing current, state-of-the-art information about the tobacco problem and how physicians can effectively intervene. It provides an historical perspective of the issues surrounding environmental tobacco smoke in the United States. The remaining three manuscripts in this series offer free continuing medical education credits for physicians via www.pedseducation.org. Please refer to the first article in the April edition of the Delaware Medical Journal and upcoming articles in the June and July issues for further information.
Empirical Research↗
Analysis of human exposure to benzo(a)pyrene via inhalation and food ingestion in the Total Human Environmental Exposure Study (THEES).
The Total Human Environmental Exposure Study (THEES) focuses on benzo(a)pyrene (BaP) as an example of a combustion-generated polycyclic aromatic hydrocarbon (PAH) compound. Primary pathways for environmental exposures to BaP are inhalation and ingestion. This program of field studies was conducted in Phillipsburg, New Jersey, a small, industrial city in the Delaware River valley. The study protocols included direct monitoring of BaP exposures via inhalation and ingestion pathways during three separate periods, each lasting 14 days. BaP concentrations in air were sampled at outdoor and in-home locations, with personal air sampling added during the latter two phases. Cooked food samples from each household were acquired, using a constant portion "second plate" of each meal prepared at home. Ambient levels were 4-10 times higher during the cold months compared with the late summer study period. Space heating and regional aerosol were major contributors to community levels of BaP in the air during the wintertime. Penetration of outdoor air, cooking activities, combustion appliances, and cigarette smoke were important sources of indoor air exposures. Cooking activities, besides releasing BaP-enriched particles indoors, produced food imbued with BaP and added substantially to exposure via the ingestion route. Among the study subjects, the range and magnitude of dietary exposures (2 to 500 ng/d) were much greater than for inhalation (10 to 50 ng/d). Nevertheless, there were ample individual cases where inhalation of BaP was the predominant exposure route. Indoor air BaP levels were closely correlated with ambient levels in most of the homes. For some individuals, measured personal air BaP exposures were adequately predicted by time-weighting of microenvironmental (i.e., outdoor and in-home) concentrations. However, enormously high exposures for ingestion or inhalation were detected only by direct observation, not from microenvironmental data.
Administration, Inhalation↗