Cultural considerations for treatment of childhood obesity.

Childhood obesity has become one of the most common health problems facing children in America. Results from the Third National Health and Nutrition Examination Survey reveal that ethnic minority children in the United States are at particular risk for development of cardiovascular disease due to their disproportionate levels of obesity. In treating childhood obesity among ethnic minorities, practitioners need to be mindful of the cultural norms surrounding body size. Additional concerns that must be addressed include the effects of target marketing of unhealthy foods toward ethnic minorities and environmental deterrents to outside physical activities, to name a few. Strategies given to address the problem of childhood obesity among ethnic minorities include, increasing the child's physical activity, reducing television viewing and the adoption and maintenance of healthy lifestyle practices for the entire family.

Magnetic resonance navigation for head and neck lesions.

OBJECTIVE: Review applications of interventional magnetic resonance imaging and describe methods, procedures, and additional instrumentation for the magnetic resonance "operating theater." Describe advantages of magnetic resonance navigation for biopsies of head and neck tumors. STUDY DESIGN: Patients with palpable and nonpalpable head and neck and cranial base tumors were recruited into the study. Patients underwent magnetic resonance-guided biopsy. Retrospective analysis of 21 patients was conducted. METHODS: 0.5 Tesla superconducting open magnetic resonance imaging was used for navigation of the biopsy needle. Patient records and magnetic resonance images were reviewed. The type, size, and location of the lesions were tabulated. Type of anesthesia and monitoring method were analyzed. The histopathologic correlation was conducted in patients who required further surgeries or open surgical biopsies. RESULTS: Twenty-two biopsies were carried out in the magnetic resonance suite. One patient required general anesthesia and the other biopsies were conducted under intravenous sedation. There was only one case of nonconcurrence in a patient with Wegener's granulomatosis of the posterior orbit. Overall, a 92% concurrence rate between image-directed fine-needle aspiration, open biopsy, and surgical therapy was encountered. No complications occurred. CONCLUSIONS: The use of interventional magnetic resonance imaging to assist with fine-needle aspiration core biopsy has made the biopsy procedure safer and more accurate. Potentially morbid and disfiguring surgeries have been avoided in some patients. Deeper lesions have been more easily approached, as the needle for biopsy is under constant magnetic resonance guidance. Improved visualization for critical structures allows safer performance of biopsies. The primary difficulties of open magnetic resonance imaging relate to the need for nonferromagnetic instrumentation and equipment and their high costs. An inverse relationship exists between the imaging quality and the "dead time" required to acquire images.

Experiences of ethnic minority faculty employed in predominantly white schools of nursing.

This qualitative study describes the bicultural experience of ten ethnic minority faculty employed in predominately white baccalaureate and higher degree nursing programs in the Southeastern section of the United States. Seven themes emerged from the data: (a) appraising, (b) proving, (c) fitting-in, (d) defending, (e) distancing, (f) being invisible, and (g) mentoring to describe their experience. Results also provided support for the authors' generated Bicultural Systems Model which evaluates why and to what extent a particular transaction or series of transactions between the person and the environment is perceived as stressful. The general perception among participants was that they were not fully accepted in the academic setting of predominately white nursing programs. As a result, some faculty were expending energy trying to convince others of their legitimacy; while others were choosing to distance themselves from the academic setting and white colleagues. This study indicates a need for dialogue between white and ethnic minority faculty to facilitate adoption of strategies that reduce the negative effects of the bicultural phenomenon.

Chattanooga and Cape Town: a cross continental medical/nursing partnership.

The author discusses her recent four-week visit to Cape Town. South Africa as a part of a multi-disciplinary, multi-racial, medical/evangelistic team to provide health related services to people in nine different sites. She also discusses her impressions of the country and the people from an African American perspective.

High-resolution Fourier spectrometry of N(2)(+).

A new perturbation analysis of the first negative system B(2)Σ(u)(+) ? X(2)Σ(g)(+) of the (14)N(2)(+) ion is performed based on spectra excited both at low and high temperatures by the use of either a hollow-cathode or a Pointolite lamp. Preliminary results are given for a deperturbation of the B(2)Σ(u)(+) (ν = 0, ν = 1) levels. Deperturbed molecular constants and parameters that describe the B(2)Σ(u)(+) ~ A(2)∏(u) interaction are derived.

Fourier transform spectroscopy of LaS in the infrared.

We recorded the emission spectrum of diatomic lanthanum sulfide on the Los Alamos Fourier transform spectrometer. In the region 7500-16,000 cm(-1), we identified over 120 bands and assigned them to the A(2)∏(r)-X(2)Σ(+) and B(2)Σ(+)-X(2)Σ(+) transitions. Each of these bands is four headed.

Critical social theory and the domination of African American Women.

This historical reconstruction of the experiences of African American women in America from slavery to the present exposes the prevailing and enduring system of White male domination. From White men having control of their reproductive choices, to conspiracy to withhold the right to vote, African American women were victims of both sexism and racism. Later, as a result of the myth conceived by White sociologists of the super African American woman, further divisiveness became apparent in the African American home. As African American women took advantage of educational opportunities only to find that there was a dearth of similarly educated African American males to marry, increasing numbers of African American men were reported as parties to violent acts, drugs or illness. All of these variables are conjectured as impacting on the African American woman's experience. Lastly, data were presented depicting the increasing trend of African American women marrying White men, and the emergence of a more diverse workforce. It was concluded that economics serve as a catalyst for this change in human relations.

Demographic portrayal and outcome analysis of head and neck cancer surgery in the elderly.

OBJECTIVE: To analyze the outcome and risk factors for 217 elderly patients who have undergone surgery for head and neck cancer, with or without radiation therapy. DESIGN: The risk factors that were reviewed included the primary tumor size, TNM staging, disease stage, preoperative health status, and type of surgical procedure. SETTING: Head and neck oncology clinic at North Carolina Baptist Hospital, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem. RESULTS: The disease stage was directly related to prognosis, while advanced age and concomitant medical conditions were not. Complications were more prevalent with increased patient age, and the 57 patients who were older than 81 years had a slightly lower 3- and 5-year survival than those who were 65 to 80 years old. Sixty-six percent of all patients were discharged at 2 weeks, and 5% remained hospitalized for longer than 1 month. At the latest follow-up, 46% of the patients were alive without recurrence or had died of other causes. CONCLUSIONS: Appropriate surgical therapy of head and neck cancer can be as effective in elderly patients as in younger patients without a significant increase in complications.

A challenge to develop a new paradigm shift in nursing education.

The failure of American society to integrate all segments of its population is discussed in this paper as well as how the profession of nursing has followed national patterns, what these patterns of exclusion mean to the health care of ethnic communities as well as to the nation. Recommendations are made for positive change.

Africanity theory and the new student in nursing.

Recognition and acceptance of Africanity theory in schools of nursing curricular has been presented as one strategy to address the needs of the new student in general and the ethnic minority student in particular. It was postulated that acceptance of the legitimacy of African-American culture would facilitate the recognition of the unique attributes of other "sub" cultures. Factors such as the (a) prevailing nursing shortage and (b) the changing applicant pool demand that nursing develop and incorporate innovative approaches to attract and retain the new student in nursing. Are we as a profession ready for the "new" students? It's either now or ...

Suture calcification mimicking recurrence in the irradiated breast: a potential pitfall in mammographic evaluation.

Development of microcalcifications at the primary excision site of the irradiated breast is a common manifestation of local tumor recurrence. The authors describe the mammographic appearances of benign suture calcifications, which, in some cases, can mimic recurrence on routine follow-up mammograms and include (a) a typical, knotted configuration, (b) a smooth, linear type, or (c) an apparent indeterminate cluster, which, when imaged with magnification technique, exhibits a more typical appearance. Pathologic examination demonstrates calcifications in the dead collagen that makes up catgut suture. Knowledge of these appearances and use of magnification technique in the evaluation of microcalcifications at the primary excision site may prevent unnecessary biopsy.

Clinically occult, noncalcified breast cancer: serial radiologic-pathologic correlation in 27 cases.

A serial radiographic-pathologic correlation based on specimen radiography was performed on 27 consecutive, clinically occult, noncalcified breast cancers to determine the frequency of and correlation between appearances at mammography, pathologic diagnoses, and the features of the histologic margins. Twenty (74%) of the lesions were infiltrating ductal cancers, five (19%) were intraductal cancers, and two (7%) were medullary cancers. Forty-one percent of these malignancies contained microscopic calcifications. Lesions demonstrated at mammography in these 27 cases consisted of a well-defined round mass (n = 1); well-defined lobulated masses (n = 2); indistinct round, oval, or lobulated masses (n = 7); irregular or mixed lesions (n = 7); spiculated masses (n = 9); and architectural distortion (n = 1). Histologic margins of infiltrating and intraductal cancers, created by several types of tumor-fat interfaces and surrounding reactive fibrosis, correlated with these radiographic appearances. Serial specimen radiographic-pathologic correlation can improve our understanding of the appearance of early breast cancer at mammography.

Efficacy of specimen radiography of clinically occult noncalcified breast lesions.

Breast biopsy specimen radiography is required to ensure the accurate removal of clinically occult lesions discovered by mammography. Although used routinely for calcified lesions, it has not been widely accepted for those abnormalities that do not contain calcium. To determine the efficacy of film-screen specimen radiography for confirming the presence of clinically occult, noncalcified lesions, we undertook a prospective study of 104 specimen radiographs obtained after mammographically guided hookwire localization and planned excision of these lesions. Ninety-seven (93%) of the excised abnormalities were visualized on specimen mammograms. Malignancy was found in 22 (21%) of them. Thirty-five percent of the specimen radiographs showed better anatomic detail of the lesion, 48% showed the same detail, and 16% showed less detail than the original mammograms. Specimen radiographs failed to show the lesion in only seven cases. Five of the seven were true-negative specimen radiographs, making the efficacy rate 98%. Film-screen specimen radiography of clinically occult, noncalcified lesions is a highly effective procedure for correctly identifying the presence of a mammographic abnormality.

Maximizing the benefits of type and screen by continued surveillance of transfusion practice.

The use of type and screen (T&S) has reduced our overall crossmatch:transfusion (C:T) ratio from 2.5:1 prior to T&S to 1.9:1. Review of our progress, however, demonstrated only a partial reduction of C:T for elective cholecystectomy from 103:1 to 18:1, with only 39% T&S utilization. In addition, units crossmatched in excess of the surgical schedule for 174 high-risk patients had a C:T ratio of 18.6:1. Routine questioning of all excess orders proved unacceptable to blood bank staff and surgeons. An inflexible schedule was also deemed unacceptable. We therefore began monthly written summary reports to each surgical division listing each case in which extra crossmatching was reported and whether the units requested were transfused. These reports enabled the surgical directors to help monitor crossmatch utilization. In addition, we have reduced our C:T ratio of extra units for 405 high-risk patients to 4.0:1. T&S utilization for elective cholecystectomy has increased to 64%, and C:T has fallen to 9:1. These results demonstrate that establishing T&S can reduce the C:T ratio and patient costs; but continued attention is required to maximize the benefits of this procedure.

Effects of 4-hydroxy-4-androstene-3, 17-dione and 10-propargylestr-4-ene-3, 17-dione on the metabolism of androstenedione in human breast carcinoma and breast adipose tissues.

The effects of 4-hydroxy-4-androstene-3, 17-dione (4-OH-A) and 10-propargylestr-4-ene-3, 17-dione (PED) on the aromatization of androstenedione (A) and the conversion of A to testosterone (T) were studied in incubations with breast carcinoma and breast adipose tissues. Parallel studies were carried out to determine the effects of 4-OH-A and PED on A metabolism in tissue from 5 patients with breast carcinoma. At 11 micro M, both compounds fully inhibited aromatization, whereas the conversion of A to T was decreased in only 2 incubations. Studies with varying concentrations of 4-OH-A and PED demonstrated that both compounds inhibited estrone (E1) formation by 80% at a concentration of 0.085 micro M, with maximum effect at 0.34 micro M. 90% inhibition of estradiol (E2) formation was observed at inhibitor concentrations of 0.17 micro M or greater. T formation was slightly affected at 0.67 microM, but was progressively inhibited with increasing 4-OH-A or PED concentrations, reaching 70% at 11 micro M. Similar experiments with 4-OH-A in breast adipose tissue homogenates showed that a concentration of 0.1 micro M was sufficient to inhibit aromatization while T inhibition required 11 micro M. 4-OH-A and PED are selective inhibitors of aromatization in human breast tissues and may provide a mechanism for controlling estrogen responsive processes.