Celiac disease is not increased in women with hip fractures and low vitamin D levels.

OBJECTIVE: Celiac disease is associated with decreased bone density; however, the risk of fractures in celiac disease patients is unclear. We compared the prevalence of celiac disease between a group of women with hip fractures and a group of women undergoing elective joint replacement surgery and the association between celiac disease and vitamin D levels. METHODS: Two hundred eight community dwelling and postmenopausal women were recruited from Boston, MA (n=81) and Baltimore, MD (n=127). We measured tissue transglutaminase IgA by ELISA to diagnose celiac disease and 25-hydroxyvitamin D (25(OH)D) levels by radioimmunoassay in both women with hip fractures (n=157) and a control group (n=51) of total hip replacement subjects from Boston. Subjects were excluded if they took any medications or had medical conditions that might affect bone. RESULTS: Median serum 25(OH)D levels were significantly lower (p< 0.0001) in the hip fracture cohorts compared to the elective joint replacement cohort (14.1 ng/ml vs. 21.3 ng/ml, respectively). There were no differences in the percentage of subjects with a positive tissue transglutaminase in the women with hip fractures versus the control group (1.91% vs. 1.96%, respectively). CONCLUSION: Vitamin D levels are markedly reduced in women with hip fractures, however hip fracture patients did not show a higher percentage of positive tissue transglutaminase levels compared with controls. These data suggest that routine testing for celiac disease among hip fracture patients may not be necessary in the absence of clinical signs and symptoms, although data from larger studies among hip fracture subjects are needed.

Three Michaelis-Menten pharmacokinetic dosing methods compared with physician dosing of phenytoin in an outpatient neurology practice.

We compared predicted phenytoin serum concentrations using three Michaelis-Menten pharmacokinetic dosing methods with actual concentrations obtained from physician dosing in an outpatient neurology practice. Method 1 used population estimates for the Michaelis-Menten constant (Km) and maximum velocity (Vmax), method 2 used one dose and serum concentration pair to determine Vmax, and method 3 used two dose-concentration pairs to determine both Km and Vmax. In addition, physician doses were compared with pharmacokinetically calculated doses. Records of patients who received at least two phenytoin doses followed by two serum concentration determinations were reviewed. Data on age, gender, weight, physician doses, and resultant serum concentrations were collected. Pearson's correlation coefficient was used to compare physician maintenance doses with pharmacokinetically calculated predicted doses, whereas actual and predicted serum concentration data were used to determine precision and bias associated with each of the three methods. Actual serum concentrations fell into therapeutic range more frequently than predicted values in all but one comparison (method 3). Predicted and actual phenytoin doses were significantly correlated only with method 2. Only one of the three Michaelis-Menten pharmacokinetic dosing methods evaluated (method 3) was more predictive than physician phenytoin dosing.

Collaborative teacher roles: special and general educators.

The purpose of this study was to analyze and compare the perceptions of a national sample of elementary-level learning disabilities resource teachers (n = 83) and elementary general education teachers (n = 64) in regard to actual and ideal performance of collaborative roles. Resource teacher perceptions of constraints on their performance of collaborative roles also were examined. Results indicated significant differences between teacher perceptions of actual and ideal performance of collaborative roles. Constraints on resource teachers' collaborative role performance were identified.

Processing distinctions between stems and affixes: evidence from a non-fluent aphasic patient.

In this paper, we study the ability of a non-fluent aphasic patient, BN, to comprehend morphologically complex words when they appear in utterance contexts. We first establish that he is insensitive to the contextual appropriateness of both derived and inflected words. In a further experiment we show that he has no difficulty processing the stems of complex words and conclude that his problem is with the bound morphemes themselves. We then ask whether this problem is due to his inability to access either the phonological form of a morphologically complex word or its semantic and/or syntactic content. We find that only the access of semantic and syntactic content is impaired. We conclude from these six studies that: (a) BN presents a counter-example to the claim that non-fluent patients have particular difficulty with those aspects of morphology which have a syntactic function; (b) BN processes both derived and inflected words by mapping the sensory input onto the entire full-form of a complex word, but the semantic and syntactic content of the stem alone is accessed and integrated into the context. The semantic and syntactic implications of the suffix are never evaluated. This implies separate representation of the stems and suffixes of some types of morphologically complex words.

Computer applications in veterinary medical education.

This is a review of the various computer applications used in veterinary medical education. The various applications include drill-and-practice, tutorial, problem-solving, testing, educational management programs, educational games, word processing, educational utilities, authoring programs, and simulations.

Dagga (cannabis) usage among medical students in Johannesburg.

Of 1 020 undergraduate medical students at the University of the Witwatersrand surveyed in 1981 as regards attitudes to and patterns of illicit drug use 868 completed the questionnaire; 32,4% had tried dagga (cannabis) and 16,4% were still using the drug. There was a large increase in the number of students using the drug as they advanced through their studies (6% of the 1st-year class as against 24% of the 5th-year class). The timing of dagga use and previous experimentation with habit-forming drugs are mentioned, and reasons for non-experimentation and attitudes towards legalization of dagga are analysed.