Medical Subspecialty Textbooks in the 21st Century. Essential or Headed for Extinction?

In recent years, the role of medical subspecialty textbooks as sources of information for students, trainees, and practicing clinicians has been challenged. Although the structure of textbooks continues to evolve from standard, printed versions to digital formats, including e-books and online texts, we maintain that the authoritative compilation of clinical and scientific material by experts in the field (i.e., a modern-day textbook) remains central to the education, training, and practice of subspecialists. Regardless of format, an effective medical subspecialty textbook is authoritative, comprehensive, and integrated in its coverage of the subject. Textbook content represents a unique synthesis of clinical and scientific material of real educational and clinical value. Incorporation of illustrations, including figures, tables, videos, and audios, bolsters the presentation and further solidifies the reader's understanding of the subject. The textbook, both printed and digital, reinforces the many widely available online resources and serves as a platform from which to evaluate other sources of information and to launch additional scientific and clinical inquiry.

Estudio mediante una técnica no lesiva, basada en la luz estructurada, de la topografia de la espalda de futbolistas / Study of back topography of football players by a nonlesive method based on structured light

Se presenta un método no lesivo basado en la proyección de luz estructurada con código de color para la obtención de la topografía de la superficie de la espalda en deportistas. El método permite la visualización de las asimetrías existentes en las distintas zonas de la espalda, cervical, dorsal y lumbar, tomando como referencia la posición de las cervicales y de los glúteos. La determinación en estas topografías de variables cuantificadoras para caracterizar la deformidad, tanto en el plano frontal como transversal, permite realizar un diagnóstico precoz de la existencia de patologías asociadas con desviación de la columna en los deportistas integrantes de los clubs deportivos, sobre todo en las edades infantiles y juveniles, donde la prevalencia de la escoliosis es mayor. En este trabajo se ha introducido una nueva variable, el gradiente lumbar, que permite identificar la elevación de los glúteos respecto de la cintura, para cuantificar el desarrollo de los glúteos asociado a la práctica deportiva, así como la asimetría de la zona lumbar. Estas variables topográficas han resultado independientes de la altura y edad de los sujetos del estudio y, por tanto, pueden resultar de interés para valorar el efecto del entrenamiento deportivo en la musculatura, tanto a nivel dorsal como lumbar, a lo largo de la evolución del deportista en estudios longitudinales, así como para realizar las oportunas comparaciones entre las distintas actividades deportivas. En nuestro estudio, aplicado aun equipo de fútbol, se ha podido comprobar el mayor número de valores elevados de la variable que mide la deformidad en el plano horizontal en el grupo de edad de los 14 a los 15 años y una ligera variación en función de la posición que ocupan en el campo (AU)

We present a noninvasive method based on structured light projection with color code to obtain the topography of the back surface in athletes. The method allows the display of the asymmetries in the areas of the back, cervical, dorsal and lumbar, with reference to the position of the neck and buttocks. The determination of quantifier variables in these topographies to characterize the deformity in both the frontal and transverse plane allows an early diagnosis of the existence of pathologies associated with curvature of the spine in athletes members of sports clubs, especially in children and youth ages where the prevalence of scoliosis is greater. In this paper we have introduced a new variable, the lumbar gradient, which identifies the elevation of the buttocks on the waist, to quantify the development of the buttocks associated with the sport, and the asymmetry of the lumbar area. These topographic variables were independent of height and age of athletes and therefore may be of interest to assess the effect of sport training in the musculature, both dorsal and lumbar, along of the evolution the athlete and to make appropriate comparisons between different sport activities. In our study, applied to a football team, it has been found the most elevated values of the variable that measures the deformity in the horizontal plane in the age group of 14 to 15 years and a slight variation depending on the playing position (AU)

Topografía médica de Lanjarón en la Real Academia de Medicina y Cirugía de Cádiz / Medical topography in Lanjaron in Royal Academy of Medicine and Surgery of Cadiz

La Real Academia de Medicina y Cirugía de Cádiz tiene su origen en la Sociedad Médica de Cádiz. El 30 de Septiembre de 1815 fue aprobado el Reglamento, sus Socios Fundadores fueron unos profesores del Real Colegio de Cirugía de la Armada. El estudio de las “Topografías médicas”, es un uso habitual en las Reales Academias de Medicina de España, desde que el “Reglamento general para el Régimen literario e interior de las Reales Academias de Medicina y Cirugía del Reino de 1830” lo impuso. Los Socios corresponsales de la Real Academia de Medicina y Cirugía de Cádiz tuvieron una destacada responsabilidad en las descripciones de las Topografías Médicas. El objetivo es el estudio de una memoria de la Real Academia de Medicina y Cirugía de Cádiz sobre una noticia topográfica de Lanjarón. El autor de la memoria hace una descripción de la situación topográfica de Lanjarón, de su clima en las distintas estaciones, del terreno, de las calles, del estado de salud y de las fuentes de aguas minerales medicinales destinadas al consumo oral y a los baños. Eduardo Mª González, académico corresponsal de la Real Academia de Medicina y Cirugía de Cádiz en Lanjarón cumple así con sus deberes de realizar la topografía médica de su país de residencia(AU)

The Royal Academy of Medicine and Surgery of Cadiz has its origin in the Medical Society of Cadiz. On September 30, 1815 was approved the Regulation, its founders were some teachers of the Royal College of Surgeons of the Navy. The study of "medical topographies" is a commonly used in the Royal Academy of Medicine in Spain, since the "General Regulations for the literary and internal arrangements of the Royal Schools ofMedicine and Surgery of the Kingdom of 1830" was imposed. Partners correspondents of the Royal Academy of Medicine and Surgery of Cadiz had a major responsibility in the descriptions of the Medical Topography. The aim is to study a report of the Royal Academy of Medicine and Surgery of Cadiz on a topographic Lanjarón news. The author of the report a description of the topographical situation of Lanjaron, its climate indifferent seasons, terrain, streets, health status and sources of medicinal mineral water intended fororal consumption and bathrooms. Eduardo M ª González, academic correspondent of the Royal Academy of Medicine and Surgery of Cadiz in Lanjarón thus fulfilling their duties to conduct the medical topography of their country of residence(AU)

Quantifying geocode location error using GIS methods.

BACKGROUND: The Metropolitan Atlanta Congenital Defects Program (MACDP) collects maternal address information at the time of delivery for infants and fetuses with birth defects. These addresses have been geocoded by two independent agencies: (1) the Georgia Division of Public Health Office of Health Information and Policy (OHIP) and (2) a commercial vendor. Geographic information system (GIS) methods were used to quantify uncertainty in the two sets of geocodes using orthoimagery and tax parcel datasets. METHODS: We sampled 599 infants and fetuses with birth defects delivered during 1994-2002 with maternal residence in either Fulton or Gwinnett County. Tax parcel datasets were obtained from the tax assessor's offices of Fulton and Gwinnett County. High-resolution orthoimagery for these counties was acquired from the U.S. Geological Survey. For each of the 599 addresses we attempted to locate the tax parcel corresponding to the maternal address. If the tax parcel was identified the distance and the angle between the geocode and the residence were calculated. We used simulated data to characterize the impact of geocode location error. In each county 5,000 geocodes were generated and assigned their corresponding Census 2000 tract. Each geocode was then displaced at a random angle by a random distance drawn from the distribution of observed geocode location errors. The census tract of the displaced geocode was determined. We repeated this process 5,000 times and report the percentage of geocodes that resolved into incorrect census tracts. RESULTS: Median location error was less than 100 meters for both OHIP and commercial vendor geocodes; the distribution of angles appeared uniform. Median location error was approximately 35% larger in Gwinnett (a suburban county) relative to Fulton (a county with urban and suburban areas). Location error occasionally caused the simulated geocodes to be displaced into incorrect census tracts; the median percentage of geocodes resolving into incorrect census tracts ranged between 4.5% and 5.3%, depending upon the county and geocoding agency. CONCLUSION: Geocode location uncertainty can be estimated using tax parcel databases in a GIS. This approach is a viable alternative to global positioning system field validation of geocodes.

Comparing a single-stage geocoding method to a multi-stage geocoding method: how much and where do they disagree?

BACKGROUND: Geocoding methods vary among spatial epidemiology studies. Errors in the geocoding process and differential match rates may reduce study validity. We compared two geocoding methods using 8,157 Washington State addresses. The multi-stage geocoding method implemented by the state health department used a sequence of local and national reference files. The single-stage method used a single national reference file. For each address geocoded by both methods, we measured the distance between the locations assigned by each method. Area-level characteristics were collected from census data, and modeled as predictors of the discordance between geocoded address coordinates. RESULTS: The multi-stage method had a higher match rate than the single-stage method: 99% versus 95%. Of 7,686 addresses were geocoded by both methods, 96% were geocoded to the same census tract by both methods and 98% were geocoded to locations within 1 km of each other by the two methods. The distance between geocoded coordinates for the same address was higher in sparsely populated and low poverty areas, and counties with local reference files. CONCLUSION: The multi-stage geocoding method had a higher match rate than the single-stage method. An examination of differences in the location assigned to the same address suggested that study results may be most sensitive to the choice of geocoding method in sparsely populated or low-poverty areas.

The accuracy of human population maps for public health application.

OBJECTIVES: Human population totals are used for generating burden of disease estimates at global, continental and national scales to help guide priority setting in international health financing. These exercises should be aware of the accuracy of the demographic information used. METHODS: The analysis presented in this paper tests the accuracy of five large-area, public-domain human population distribution data maps against high spatial resolution population census data enumerated in Kenya in 1999. We illustrate the epidemiological significance, by assessing the impact of using these different human population surfaces in determining populations at risk of various levels of climate suitability for malaria transmission. We also describe how areal weighting, pycnophylactic interpolation and accessibility potential interpolation techniques can be used to generate novel human population distribution surfaces from local census information and evaluate to what accuracy this can be achieved. RESULTS: We demonstrate which human population distribution surface performed best and which population interpolation techniques generated the most accurate bespoke distributions. Despite various levels of modelling complexity, the accuracy achieved by the different surfaces was primarily determined by the spatial resolution of the input population data. The simplest technique of areal weighting performed best. CONCLUSIONS: Differences in estimates of populations at risk of malaria in Kenya of over 1 million persons can be generated by the choice of surface, highlighting the importance of these considerations in deriving per capita health metrics in public health. Despite focussing on Kenya the results of these analyses have general application and are discussed in this wider context.

Quality assurance and quality control methodologies used within the Austrian UV monitoring network.

The Austrian UVB monitoring network is operational since 1997. Nine detectors for measuring erythemally weighted solar UV irradiance are distributed over Austria in order to cover the main populated areas as well as different levels of altitude. The detectors are calibrated to indicate the UV-Index, the internationally agreed unit for erythemally weighted solar UV irradiance. Calibration is carried out in the laboratory for determination of spectral sensitivity of each detector, and under the sun for absolute comparison with a well-calibrated, double-monochromator spectroradiometer. For the conversion from detector-weighted units to erythemally weighted units a lookup table is used, which is calculated using a radiative transfer model and which reflects the dependence of the conversion on the solar zenith angle and total ozone content of the atmosphere. The uncertainty of the calibration is about +/-7%, dominated by the uncertainty of the calibration lamp for the spectroradiometer (+/-4%). The long-term stability of this type of detectors has been found to be not satisfactory. Therefore, routinely every year all detectors are completely recalibrated. Variations of the calibration factors up to +/-10% are found. Thus, during routine operation, several measures take place for quality control. The measured data are compared to results of model calculations with a radiative transfer model, where clear sky and an aerosol-free atmosphere are assumed. At each site, the UV data are also compared with data from a co-located pyranometer measuring total solar irradiance. These two radiation quantities are well correlated, especially on clear days and when the ozone content is taken into account. If suspicious measurements are found for one detector in the network, a well-calibrated travelling reference detector of the same type is set up side-by-side, allowing the identification of relative differences of approximately 3%. If necessary, a recalibration is carried out. As the main aim for the Austrian UV monitoring network is the information of the public about the actual levels of UVB irradiance, the measurement results are published on-line in the Internet (http://www.uibk.ac.at/projects/uv-index). For the previous day and backwards approximately 2 years, the distribution of maximal UVB levels over Austria is shown on a regional map. Additionally, near real-time data of most of the measurement stations are presented with a delay of usually less than half-an-hour. Together with these actually measured data there is also shown the diurnal variation of the maximal expected value of the UV-Index under ideal clear conditions.

A re-evaluation of the occupancy factors for effective dose estimate in tropical environment.

In the estimation of the effective dose to the public, outdoor and indoor occupancy factors have been an important parameter. These factors vary, depending on the prevailing environmental condition in a particular location. The factors have been estimated for the rural and urban areas in Nigeria. An outdoor factor of 0.3 and 0.22 have been estimated for rural and urban dwellers, respectively. The rural outdoor factor is 50% above the value recommended as the world average by the UNSCEAR. The urban outdoor factor is 10% higher than this value. The total outdoor gamma dose rate in the air due to (40)K, (238)U and (232)Th in the soil for some rural population in the southern part of Nigeria is 29.50 +/- 3.80 nGy h(-1) and the average outdoor effective dose has been estimated to be 54.28 +/- 6.95 microSv y(-1) using the present occupancy factor.

[A cancer mortality atlas on a small geographic scale: procedure, validity and possibilities for its use]. / Erstellung eines kleinräumigen Krebsatlanten: Vorgehensweise, Validität und Nutzungsmöglichkeiten.

Cancer mortality in two counties (Dithmarschen and Nordfriesland) of the Federal State of Schleswig-Holstein (Germany) was assessed by analysing the death certificates for the period from 1980 to 1991. Age-adjusted cancer mortality rates were calculated for the more common cancers for counties as well as for smaller sub-scales. The procedure in respect of data base, data protection, data flow, calculation of rates and mapping of cancer mortality rates on small geographic scales is described and discussed. The data collected by us was compared with the data provided by the offices of statistic affairs on a county scale (only for the more common cancers). The comparison was done for each gender and each county, respectively. The agreement was high (> 95%) for 16 of 22 compared items, and below 90% for two items only. The validity of the data, therefore, was considered sufficient for epidemiological studies. As an example, results regarding female breast cancer rates are shown. The possibilities for the utilization of cancer registries on small geographic scales are discussed: Depending on the incidence of the occurrence of different cancers, cancer registries should provide data on multiple regional scales. A more flexible use of the possibilities of the assessment of regional cancer rates is imperative to utilise the very expensive and time-consuming instruments of analytical epidemiological studies of the causes of cancer more effectively.