Increasing a Dermatologist's Footprint on Instagram: An Analysis of Top Influencers Performing Nonsurgical Cosmetic Procedures

BACKGROUND

Patients use social media to find information about cosmetic procedures, yet dermatologists historically lack a social media presence. Misleading information from nonexperts is potentially harmful.

OBJECTIVE

To identify the top influencers posting about nonsurgical cosmetic procedures on Instagram, verify their credentials, and analyze their content to empower dermatologists to effectively join the online conversation, combat harmful misinformation, and preserve the expertise and influence of board-certified dermatologists.

METHODS AND MATERIALS

Using the Klear marketing platform, Instagram influencers with more than 50,000 followers were identified. Influence rating, top posts, and other metrics were extracted using proprietary algorithms.

RESULTS

Ninety nine influencers were identified. Of the top 10, 70% were board-certified plastic surgeons. Physicians not board-certified in a core cosmetic specialty had the highest influencer rating and number of followers. The most popular posts were of before and after photographs and personal posts.

CONCLUSION

Dermatologists may be able to increase their Instagram footprint by posting frequently, especially of before and after and personal photographs, using hashtags, Instagram live and Instagram television, and Instagram stories. It is important for the dermatology community to find a way to ethically navigate social media to have a seat at the table and meet patients where they are.

Analysis of lesional color to differentiate infantile hemangiomas from port-wine birthmarks in infants less than 3 months old: A pilot study

BACKGROUND

In their early phase, infantile hemangiomas (IH) can sometimes be difficult to differentiate from port-wine birthmarks (PWB). Until recently, inexpensive diagnostic tools have not been readily available.

OBJECTIVE

To determine the diagnostic utility of widely available colorimetric technology when differentiating PWB from IH in photographs of infants less than 3 months old.

METHODS

Multi-center, retrospective analysis of RGB (red, green, and blue) and HSL (hue, saturation, lightness) values collected using electronic colorimeters from images of clinically confirmed untreated IH or PWB. Subgroup analysis of flat vascular birthmarks was subsequently performed.

RESULTS

Images of 119 IH (specifically, 45 flat IH) and 59 PWB were identified. PWB had significantly (P < .001) higher RGB values of all primary colors, most notably for blue and green (mean difference: >50), irrespective of thickness. RGB or RGB with HSL values had an excellent accuracy (90%), sensitivity (92%), specificity (98%), and positive predictive value (98%) when discriminating PWB from flat IH. IH could be distinctly clustered from PWB when combining their RGB with HSL values.

CONCLUSION

Electronic colorimeters with emphasis on blue and green values, are able to differentiate PWB from IH, irrespective of thickness, with a high degree of accuracy. A larger scale evaluation is now required.

Laser Treatment of Darier Disease: Report of Two Cases and Systematic Review of the Literature

Introduction: Darier disease (DD) is a chronic disease with high morbidity and limited treatment options. Laser efficacy in the treatment of DD remains understudied. Methods: A literature search conducted between 07/21/2017 and 05/05/2018 identified all original cases of DD treated with laser therapy. Results: Outcomes from 24 patients were reviewed, 22 patients were identified in the literature and 2 cases are included from our institution. Five types of lasers were identified [CO₂ laser, Er:YAG laser, pulse dye laser [PDL], diode laser, erbium-doped fiber laser], with CO₂ (46%) and PDL (42%) being the most common. Seventy-nine percent of patients were treated with more than one procedure (average, 3 procedures). The estimated body surface treated with each session ranged from 5%-50%. The most common adverse events came from CO₂ and Er:YAG lasers and included dyspigmentation, pain, and post-laser erythema and edema. The time to response (mode, 1 month) was only reported in half of the studies. Conclusion: Laser treatments appear to be a promising alternative to standardized therapies in DD.

Vulvovaginal manifestations in Stevens-Johnson syndrome and toxic epidermal necrolysis: Prevention and treatment

The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis can be as high as 70%; up to 28% of female patients will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecologic sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae, including erosions, scar formation, chronic skin changes, urethral complications, adenosis, malignant transformation, vulvodynia, and dyspareunia. We provide comprehensive recommendations for acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Treatment should include an ultrapotent topical steroid, followed by a nonirritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults (but should be avoided in prepubertal adolescents) with vaginal involvement. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Last, referrals for pelvic floor physical therapy and to surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients.

Idiopathic toxic epidermal necrolysis in an adolescent

A 10-year-old girl, suspected 2 days prior to have streptococcal pharyngitis, presented with diffuse erythema, tense bullae, Nikolsky-positive desquamation, as well as ulcerations of her oral and genital mucosa. She denied recent travel, sick contacts, or preceding and concurrent use of medications, including over-the-counter and herbal supplements. A comprehensive viral polymerase chain reaction (PCR) panel, Mycoplasma pneumoniae PCR and IgM, streptococcal molecular antigen test, urine culture, blood culture, and rheumatologic serologies were negative. Based on the patient's clinical presentation and biopsy results, she was diagnosed with idiopathic toxic epidermal necrolysis.

Exogenous Cushing syndrome from an unexpected source of systemic steroids

A 12-year-old Hispanic boy with chronic atopic dermatitis and cushingoid features presented to our institution. He was being treated with an unknown quantity of oral prednisolone 15 mg/5 mL, equivalent to 70 mg/m² /d of oral prednisone, purchased over the counter in El Salvador. Systemic corticosteroids are not recommended for chronic therapy of atopic dermatitis because of their significant adverse effects. Foreign-sourced pharmaceuticals account for almost half of the drugs consumed in the United States, which means that, to protect our patients, medical providers must inquire about and report unsafe medications deemed legal outside the United States to the Food and Drug Administration.

The dystrophin associated protein complex in zebrafish

Many cases of muscular dystrophy in humans are caused by mutations in members of the dystrophin associated protein complex (DAPC). Zebrafish are small vertebrates whose bodies are composed predominantly of skeletal muscle, making them attractive models for studying mammalian muscle disorders. Potential orthologs to most of the human DAPC proteins have been found in zebrafish by database screening. Expression of the sarcoglycans, dystroglycan and dystrophin has been confirmed by western blotting. Immunohistochemical and biochemical techniques localize these proteins to the muscle cell membrane in adult zebrafish. Morpholino (MO) experiments designed to inhibit the translation of dystrophin mRNA produce juvenile zebrafish that are less active than zebrafish injected with control morpholinos. Western blot analysis of the dystrophin morpholino-injected zebrafish shows concurrent reduction of dystrophin and the sarcoglycans, suggesting that these proteins, like those in mammals, are part of a complex whose integrity is dependent on dystrophin expression. These results indicate that the zebrafish is an excellent animal model in which to approach the study of dystrophin and its associated proteins.

Dystrophin and muscular dystrophy: past, present, and future

Duchenne muscular dystrophy was described in the medical literature in the early 1850s but the molecular basis of the disease was not determined until the late 1980s. The cloning of dystrophin led to the identification of a large complex of proteins that plays an important, although not yet well understood, role in muscle biology. Concomitant with the elucidation of the function of dystrophin and its associated proteins has been the pursuit of therapeutic options for muscular dystrophy. Although there is still no cure for this disorder, great advances are being made in the areas of gene introduction and cell transplant therapy.

Micronuclei in lymphocytes of prostate cancer patients undergoing radiation therapy

To further verify the applicability of the micronucleus (MN) assay in biodosimetry, we measured the MN yield in cytokinesis-blocked (CB) peripheral blood lymphocytes (PBL) of eight prostate cancer (PC) patients. These patients had no previous chemotherapy or radiotherapy (xRT). They were treated with standardized schemes of fractionated pelvic xRT. Before xRT, and at one random time-point during the course of xRT, blood samples were collected from each patient for the following purposes: (1) to verify the relationship between the MN yield in PBL and the estimated equivalent (EQ) total-body absorbed dose; and (2) to evaluate the individual differences of ex vivo radiation dose-response (1-4 Gy) relationship of MN yield in PBL before xRT. The number of xRT fractions, cumulative tumor dose, and EQ total-body absorbed doses of these patients represented a wide range. We found in PBL of these patients that (1) MN yield (Y) increased linearly with the estimated EQ total-body absorbed dose as Y=14.6+9.2D (R(2)=0.7, p=0.007); the distributions of MN yield were overdispersed; the ratio of relative increment of MN yield per 1000 binucleated (BN) PBL ranged from 0.9 to 8.2 (median: 4.1) folds above that of the respective baseline levels; and (2) before xRT, the MN yields also increased linearly with the ex vivo radiation dose; at each radiation dose level, the distributions of MN yield were overdispersed in most patients. In two of the three patients with xRT-induced early side effects (cystitis, diarrhea), the MN yield in PBL induced by ex vivo irradiation before xRT was significantly higher than in the other patients without xRT-induced side effects. These findings suggest that MN yields in CB PBL can be used as an in vivo biodosimeter. Since the differences in individual ex vivo radiation dose-response relationship of MN yield in PBL before xRT appeared to be significant, our preliminary results also suggest that it may be possible to identify individual intrinsic radiosensitivity before the start of xRT.

Recent mortality patterns in California

Mortality among people with developmental disabilities was reviewed using recent data obtained from the California Department of Developmental Services. The time interval for this report was 1991-1995. We defined two study cohorts: one beginning in January 1991 and a second in April 1993. The latter period represented the years of implementation of the Coffelt settlement. Our primary interest was in the Coffelt period cohort. Statistically significant association with increased rates of mortality was found for community residence. A trend of declining mortality was noted for the community facilities from 1991-1995, but not for the developmental centers.

beta-dystrobrevin, a new member of the dystrophin family. Identification, cloning, and protein associations

Dystrophin, the protein disrupted in Duchenne muscular dystrophy, is one of several related proteins that are key components of the submembrane cytoskeleton. Three dystrophin-related proteins (utrophin, dystrophin-related protein-2 (DRP2), and dystrobrevin) have been described. Here, we identify a human gene on chromosome 2p22-23 that encodes a novel protein, beta-dystrobrevin, with significant homology to the other known dystrobrevin (now termed alpha-dystrobrevin). Sequence alignments including this second dystrobrevin strongly support the concept that two distinct subfamilies exist within the dystrophin family, one composed of dystrophin, utrophin, and DRP2 and the other composed of alpha- and beta-dystrobrevin. The possibility that members of each subfamily form distinct protein complexes was examined by immunopurifying dystrobrevins and dystrophin. A beta-dystrobrevin antibody recognized a protein of the predicted size (71 kDa) that copurified with the dystrophin short form, Dp71. Thus, like alpha-dystrobrevin, beta-dystrobrevin is likely to associate directly with dystrophin. alpha- and beta-dystrobrevins failed to copurify with each other, however. These results suggest that members of the dystrobrevin subfamily form heterotypic associations with dystrophin and raise the possibility that pairing of a particular dystrobrevin with dystrophin may be regulated, thereby providing a mechanism for assembly of distinct submembrane protein complexes.

Reliability of finger stick capillary blood for the lymphocyte micronucleus assay

Compared with peripheral blood sampling, capillary blood collecting by finger stick is less traumatic and more convenient. To assess the sensitivity and reliability of capillary blood for the lymphocyte micronucleus (MN) assay, this study was performed in three sample groups, i.e. healthy donors (n = 3), cancer patients before treatment (n = 7), and cancer patients who were undergoing fractionated partial-body radiotherapy (n = 9). For each group, we measured three intra-individual variables, i.e. micronucleus (MN) frequency, binucleate (BN) index, and micronucleated BN index of lymphocytes obtained from capillary blood and the corresponding peripheral blood. Our results indicated that in all three sample groups, the differences in these variables between capillary blood and peripheral blood either before or after ex vivo 137Cs irradiation (2 Gy) were insignificant. Since capillary blood is more accessible than peripheral blood, we believe that it is a reliable source for the lymphocyte MN assay especially when venipuncture is not convenient.

Concerning the analysis of 2 x 2 tables

Recent papers (R. M. Engeman and G. D. Swanson, 1991, Comput. Biomed. Res. 24, 509; M. R. Massai and P. Barbini, 1993, Comput. Biomed Res. 26, 98) have expressed concern regarding differences in results among statistical methods of hypothesis testing for 2 x 2 contingency tables. These papers did not present current statistical thought on this topic, and they did not discuss measures of effect for such analyses. In this paper statistical literature on the 2 x 2 contingency table is presented and philosophical issues underlying the methods discussed. Measures of effect appropriate for several data origins or designs which result in 2 x 2 arrays are also presented. The paper presents an empirical adjustment to the Fisher's exact test known as the mid-P approach. The information should help provide the user of statistics a better understanding of the analysis of 2 x 2 tables. An example using data from Engeman and Swanson (1991) is provided, and some recommendations for the analysis of 2 x 2 tables are given.

Gender differences in laterality patterns for speaking and singing

This study examined behaviors reflecting cerebral organization of speaking and singing in normal college students. The investigation focused on whether differences existed in the laterality patterns of two singing tasks and one speaking task in males and females. Performance was measured on a verbal/manual time-sharing paradigm, coupling finger tapping with three vocal tasks (speaking, singing a rote song, singing up and down a diatonic five note scale). Females exhibited less variation than males in mean tapping rates and laterality scores across all three vocal tasks, thus indicating that gender most likely influences lateralization of vocal tasks. Bilateral integration was indicated for both males and females during singing up/down the aforementioned scale. These findings suggest differential involvement of both hemispheres in processing musical functions.

Sensitivity and specificity of the Quetelet index to assess obesity in men and women

OBJECTIVE AND METHODS

In a cross-sectional design, the sensitivity and specificity of the Quetelet Index (QI) was determined in relation to percent body fat standards. Subjects were 1280 men and 365 women asymptomatic for coronary heart disease. Contingency tables by QI quartiles were created using two sets of criteria of obesity: body fat > or = 25% and QI > or = 28 kg.m-2 for men and 30% and 27 kg.m-2 for women. Percent body fat was determined with hydrodensitometry in all subjects.

RESULTS

In men, sensitivity, positive, and negative predictive value of QI in relation to percent body fat was 54.5%, 91.8%, 82.7% and 73.8%, respectively. The corresponding values for women were 26.9%, 98.2%, 90.7% and 67.1%. Sensitivity of QI was 2.03 times greater for men than for women (P < 0.001). Receiver operator characteristic (ROC) curve analysis suggested that an acceptable trade-off between sensitivity (91%) and specificity (47%) occurred at a QI of 24.5 kg.m-2 for men and at a QI of 22 kg.m-2 for women.

CONCLUSIONS

The data suggest that in an asymptomatic population, percent body fat-based QI cut-off values may misclassify the obese. A fat mass-based reference system could perhaps lead to an improved classification outcome.

Comparison of four methods to assess body composition in women

The purpose of this study was to compare the accuracy of four methods to assess body composition of women. Seventy-seven Caucasian women [mean (+/- SD) age: 31.8 +/- 8.6 years; mass: 59.5 +/- 9.1 kg; stature: 162.4 +/- 6.9 cm; Quetelet Index: 22.5 +/- 3.1 kg/m2] were tested for percent body fat (%BF) with hydrostatic weighing (HW), near-infrared spectrophotometry (NIR), bioelectrical impedance analysis (BIA), and seven-site skinfolds (7-SFs). Compared to %BF with HW (24.9 +/- 6.5%), an analysis of variance revealed no mean differences (P > or = 0.05) among %BF with NIR (26.0 +/- 5.5%), BIA (25.7 +/- 5.8%) and 7-SFs (24.0 +/- 6.0%). The correlations between %BF with HW and NIR, BIA and 7-SF were r = 0.47, r = 0.77, and r = 0.79, respectively (P < or = 0.05), and prediction errors (SEE) were 5.8%, 4.2%, and 4.1%. Comparisons of %BF obtained from machine readings versus those computed from the manufacturer's equation indicated significant differences for the BIA (machine 25.7%, equation 27.8%) and NIR (machine 26.0%, equation 21.5%) methods. We concluded that although the mean %BF differences were small among the four methods, the large SEE values may allow the use of BIA and 7-SFs but not NIR. Inaccuracies of machine readings versus equation-computed %BF indicate that BIA and NIR variables and/or constants in the equations supplied are not identical to those used in machine-generated calculations.

Role of industry representatives in providing assistance to certified diabetes educators

OBJECTIVE

As diabetes educators have become more frequently involved in decisions regarding medications, equipment, and supplies, industry representatives have increasingly provided various types of assistance. The major objectives of this survey were to determine 1) the types of assistance being provided to certified diabetes educators (CDEs) by industry representatives, 2) whether product recommendations are based on assistance provided, and 3) the types of assistance that CDEs consider appropriate.

RESEARCH DESIGN AND METHODS

We developed the survey instrument and it was mailed to every fifth person listed in the 1989 directory of CDEs. Three hundred twenty-five (51%) of the active surveys were returned.

RESULTS

Those responding indicated that 1) the types of support provided most frequently by industry representatives include instructional materials, samples, supplies, and equipment for patient care and education; 2) the number of types of support provided is directly related to the number of industry representatives seen on a regular basis and the frequency of interaction; 3) 22% of the educators state that they make product recommendations based on support provided; and 4) the role of the industry reps should be to continue support for patient care and education, to provide more support for public and professional education, and to minimize support for personal items, e.g., gifts or meals.

CONCLUSIONS

The survey indicates that CDEs are receiving many types of assistance from industry representatives and that they prefer that such assistance be targeted toward patient and professional education.

Comparison of four methods to assess body composition in black and white athletes

Four methods of assessing body composition were compared in 55 black and 35 white, Division I, American football players. Percent body fat (%BF) was estimated with hydrostatic weighing at residual volume, corrected for race; seven-site skinfolds (7 SF), corrected for race; bioelectrical impedance analysis (BIA); and near-infrared spectrophotometry (NIR). Percent body fat with HW in blacks (mean = 14.7%) and whites (19.7%) did not differ (P > .05) from %BF with 7 SF (blacks, 14.7%; whites, 19.0%). In relation to HW, BIA significantly (P < .05) overpredicted (blacks: 20.1%, SEE = 3.2%; whites: 22.3%, SEE = 4.3%) and NIR underpredicted %BF (blacks: 12.6%, SEE = 3.9%; whites: 17.7%, SEE = 3.6%). The contribution of BIA variables (resistance, phase angle, conductance) and NIR optical density to predict %BF was trivial compared to body mass index. It appears that race may not substantially influence %BF prediction by NIR and BIA. It was concluded that when considering the cost and expertise required with NIR and BIA, SF measurements appear to be a superior alternative for rapid and accurate body composition assessment of athletes, independent of race.

Comparison of body composition assessment by hydrodensitometry, skinfolds, and multiple site near-infrared spectrophotometry

Percent body fat (%BF) was assessed in 171 men with underwater weighing (UWW), seven-site skinfolds (7 SF), and near-infrared spectrophotometry (NIR). NIR was determined at eight sites, including biceps, triceps, axilla, chest, abdomen, suprailium, subscapula and thigh. Analysis of variance and Dunnett's post-hoc procedure revealed that NIR significantly (P less than 0.05) underpredicted %BF when using the biceps (12.9%), chest (11.3%), abdomen (10.2%), subscapula (11.3%) and thigh (9.9%) sites compared to the criterion %BF measured with UWW (13.4% +/- SD = 6.49). %BF with 7 SF was only 0.3% higher than %BF with UWW (r = 0.94, standard error of estimate = 2.9%). Correlation coefficients between SF thickness and NIR optical density readings at 940 nm (OD1) and 950 nm (OD2) wavelengths ranged from r = -0.30 (subscapula) to r = -0.67 (biceps) for OD1 and r = -0.39 (axilla) to r = -0.68 (biceps) for OD2. Multiple linear regression showed that the OD readings were not significant predictors of UWW %BF when using body mass, stature, activity level, and frame size as predictors, except for the OD2 reading at the biceps site. Stepwise regression revealed that NIR OD readings did not predict additional variance in %BF beyond mass, stature, activity level, frame size, or 7 SF. It was concluded that 7 SF are better predictors of %BF than NIR, and that NIR at multiple sites is inconsistent in assessing body composition.

Peak running velocity, submaximal energy expenditure, VO2max, and 8 km distance running performance

The purposes of this study were to examine (1) if the peak running velocity achieved during maximal treadmill testing is related to 8 km distance running performance (DRP) and (2) if the relationship between selected physiological determinants are consistant for two 8 km races within a competitive season. Seven members of a University cross-country team (mean +/- SE) (age, 19.4 +/- 0.5 years, VO2max 67.0 +/- 1.0 ml/kg/min were tested 2-3 days following a mid-season race (Race M) and the season-ending conference championship (Race C). Despite similar weather and terrain, Race C (29:22 +/- 1:22 min:sec) was significantly (p less than 0.05) slower than Race M (28:31 +/- 0:58 min:sec). However, no significant differences (p greater than 0.05) were observed between testing sessions for calculated energy expenditure heart rate oxygen consumption and RER during submaximal running (248 and 268 m/min), postsubmaximal run lactate, peak running velocity, and VO2max. A significant correlation (p less than 0.05) was observed for Race M with with calculated energy expenditure during submaximal running at both speeds (r = 0.85) and with peak running velocity (r = -0.76). Regression analysis revealed that 92% of the total variance for Race M was accounted for by calculated energy expenditure during submaximal running and VO2max. No significant correlation or regression relationship was observed for any variables with Race C. These results suggest that peak running velocity, calculated energy expenditure during submaximal running, and VO2max can be associated with 8 km running performance. However, the relationship between 8 km DRP and the variables measured can differ for two races over a competitive season.

Mortality in a large southeastern facility for persons with mental retardation

Mortality rates for institutionalized persons with mental retardation were presented. Rates were provided for two time intervals, 1974 through 1979 and 1980 through 1985, and by age, race, and gender. Consistent differences between black and white residents or by gender were not indicated. However, significant improvement in mortality did occur between the two time periods. Persons with profound retardation were found to have higher mortality than those whose retardation was mild to severe. Respiratory disease was the most prevalent cause of death among the individuals with profound mental retardation, whereas heart disease and cancer were the most common causes of death among persons with mild, moderate, or severe retardation. Aging of the population was noted over the period of the study, indicative of the increasing frailty of the institutionalized population.

Trend analysis for repeated measures designs

This paper outlines a method of analysis that is well-suited to repeated measures designs. This method uses polynomial functions of time to characterize an outcome variable measured at several distinct time points on the same subjects. Profiles for different treatment groups may be compared using the appropriate interaction terms in an analysis of variance table. The method is illustrated with data from two recent studies.

Liver pathology in morbidly obese patients with and without diabetes

The contribution of obesity and/or diabetes to liver pathology in the morbidly obese patient is controversial. We studied the liver biopsies of 100 consecutive patients undergoing gastric bypass surgery for morbid obesity. Multiple morphologic parameters were analyzed and graded independently, without knowledge of the clinical history, liver function tests, and oral glucose tolerance results of the patients. Six percent of the entire group demonstrated no fat, 42% mild fat, 20% moderate fat, and 24% severe fatty metamorphosis of the liver. Twenty-three percent of the patients had central vein fibrosis, 23% sinusoidal fibrosis, 19% bridging fibrosis, and 4% cirrhosis. Thirty-six percent of the patients had some degree of steatohepatitis, 66% possessed so-called glycogen nuclei of hepatocytes, 6% had PAS-positive thickening of blood vessels in the portal tracts, and 1% had lipogranulomas. The degree of fatty metamorphosis and fibrosis was analyzed in three separate groups, categorized by the glycemic status of the patient: 46 patients with normal glucose tolerance (NGT), 23 patients with impaired glucose tolerance (IGT), and 31 patients with non-insulin-dependent diabetes mellitus (NIDDM). Increasing severity of fatty metamorphosis from the normoglycemic obese to the diabetic obese patients was found, which was statistically significant by chi 2 analysis. Four of the six patients showing no fatty metamorphosis were normoglycemic. Glycogen nuclei and PAS-positive blood vessels were significantly more prevalent in the diabetic obese than in the normal obese. In conclusion, the distribution of significant liver histopathology in the morbidly obese patient correlates in severity with the degree of impaired glycemic status.

Comparison between two methods of hydrostatic weighing without head submersion in morbidly obese females

This study compared two methods of hydrostatic weighing without head submersion to conventional hydrostatic weighting in morbidly obese females. We concluded that hydrostatic weighing without head submersion is a valid alternative to conventional hydrostatic weighing especially when subjects are apprehensive in the water. The use of anthropometric head measures (HWNS-A) did not significantly improve the accuracy of the body composition assessment; therefore, elimination of these time consuming measurements in favor of the direct correction of head above Db is recommended.

Sensitivity and specificity of current methods for classifying morbid obesity

This study examined the sensitivity and specificity of current methods for classifying morbid obesity in females. Results suggest that current methods for classifying morbid obesity (greater than or equal to 45.5 kg over ideal weight or BMI greater than or equal to 45) do not provide acceptable specificity and sensitivity, respectively. We suggest that additional measurements such as total body fatness determined by hydrodensitometry be used to classify morbid obesity and determine eligibility for aggressive therapeutic interventions for weight loss.

Diagnostic accuracy and role of immediate interpretation of fine needle aspiration biopsy specimens from various sites

A statistical analysis of the accuracy of the immediate interpretation of 425 fine needle aspiration (FNA) biopsies from various sites was performed. Preliminary interpretation of Diff-Quik-stained smears was rendered within a few minutes after performing the FNA biopsy, using diagnostic terminology similar to that of a surgical pathology report. The immediate assessment was documented in the formal cytology report and compared to the final diagnosis. For the entire series, the immediate interpretation had a sensitivity of 96%, a specificity of 97%, a positive predictive value (PV) of 98%, a negative PV of 95% and an efficiency of the test of 96%. There were 14 false-negative or falsely insufficient immediate interpretations and one false-positive immediate diagnosis. The diagnostic accuracy of the immediate interpretation of FNA biopsies from specific sites was also calculated; FNA biopsies of the pancreas were the least accurate procedure, having a sensitivity of 60% but a specificity of 100%. The role of the immediate interpretation of FNA biopsies is similar to the use of frozen sections in surgical pathology. An immediate assessment can (1) determine whether an adequate specimen is present, (2) render a specific preliminary diagnosis, (3) guide further clinical investigations or treatment, and (4) determine whether ancillary studies are needed to make a more accurate or specific diagnosis from the FNA specimen. Our results indicate that the immediate interpretation of FNA biopsies is an accurate procedure that should be routinely employed.

Hydrostatic weighing without head submersion in morbidly obese females

This study tests the validity of hydrostatic weighing without head submersion (HWNS) for determining the body density (Db) of morbidly obese (MO) females. Eighty MO females who were able to perform traditional hydrostatic weighing at residual volume (HW) underwent four counterbalanced trials for each procedure (HW and HWNS) to determine Db. Residual volume was determined by oxygen dilution. Twenty subjects were randomly excluded from the experimental group (EG) and assigned to a cross-validation group (CV). Simple linear regression was performed on EG data (n = 60, means = 36.8 y, means % fat = 50.1) to predict Db from HWNS (Db = 0.569563 [Db HWNS] + 0.408621, SEE = 0.0066). Comparison of the predicted and actual Db for CV group yielded r = 0.69, SEE = 0.0066, E statistic = 0.0067, mean difference = 0.0013 kg/L. The SEE and E statistic for body fat were 3.31 and 3.39, respectively. Mean difference for percent fat was 0.66%. Results indicate that HWNS is a valid technique for assessing body composition in MO females.

White blood cell response to uphill walking and downhill jogging at similar metabolic loads

The object of this study was to determine whether leukocytosis would occur in response to eccentric exercise, to concentric exercise, and/or to possible increases in serum cortisol levels. Eight men performed 2 bouts of exercise at 46% VO2max for 40 min. Subjects initially walked up a 10% grade (UW); 2 weeks later they jogged down a 10% grade (DJ), a form of eccentric exercise known to induce delayed onset muscle soreness (DOMS). Venous blood samples were drawn before and after each exercise bout (0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, and 5 h). Total and differential WBCc and serum cortisol levels were assessed. Results were analyzed using repeated measures ANOVA (2 x 11). Subjects experienced severe DOMS after DJ. There was a significant difference in TWBCc (p less than 0.0001) between UW and DJ. Post-hoc testing revealed no significant increase over baseline values for UW; after DJ there was a 46% increase over baseline values (p less than 0.05) initially seen at 1.0 h. These increases in TWBCc were predominantly a reflection of increases in neutrophils which were significant (p less than 0.0001) when compared to baseline values at 1.0, 1.5 and 2.0 h (approximately 60%). No significant neutrophil increases were seen after UW. Cortisol levels were similar for both groups pre-exercise (UW = 367.1 +/- 38.6, DJ = 320.2 +/- 44.16 nmol.L-1 means +/- SE) and decreased similarly for both groups after exercise, and thus were not related to the post-exercise neutrophilia.(ABSTRACT TRUNCATED AT 250 WORDS)

Hydrostatic weighing without head submersion: description of a method

Hydrostatic weighing (HW) was performed at residual volume (RV) and total lung capacity without head submersion (TLCNS). Ninety-five males (25.6 +/- 4.9 yr) and 87 females (22.6 +/- 5.2 yr) were studied at two laboratory sites using identical protocols. Twenty males and 20 females were separated from the original group and randomly assigned to cross-validation groups. RVs were determined by the oxygen dilution method. Vital capacity was determined with the subject submerged in water to the shoulders. Underwater weight was determined using 10 trials at RV and 5 trials at TLCNS, with the order of methods randomly assigned. Regression analysis provided an equation to predict body density (pDb) at RV from body density (Db) at TLCNS. The equation for males was pDb (HW at RV) = 0.5829 (DbHW at TLCNS) + 0.4059, r = 0.88, SEE = 0.0067. The equation for females was pDb (HW at RV) = 0.4745 (DbHW at TLCNS) + 0.5173, r = 0.85, SEE = 0.0061. Cross-validation showed no significant differences using Db from HW at RV (males = 1.0626 g.ml-1, females = 1.0493 g.ml-1 and pDb from HW at TLCNS (males = 1.0625 g.ml-1, females = 1.0479 g.ml-1). The correlation coefficient SEE and total error for males were r = 0.95, 0.0043, and 0.0041, respectively and for females r = 0.82, 0.0084, and 0.0085, respectively. Mean percent fat for RV and TLCNS was identical for males and differed by 0.7% for females. Test-re-test data indicated the TLCNS procedure was reliable (r = 0.98).(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of exercise on lipogenic enzyme activity and glyceride synthesis by liver homogenates of diabetic rats

The purpose of this study was to determine if exercise ameliorates the elevated levels of triglycerides in diabetic rats and also to determine if the capacity of liver to synthesize glycerides correlates with changes in plasma triglyceride levels. Forty female rats were divided into four groups: sedentary control, sedentary diabetic, exercised control, and exercised diabetic. Diabetes was induced by intravenous injection of alloxan (40 mg/kg), and control rats were sham-dosed with physiologic saline. All rats remained sedentary in their cages for the first week after the injections. The exercised groups were exercised for seven consecutive days for 2 h/d at 20 m/min (0 grade). All rats were killed 24 hours after the last exercise bout. Blood glucose levels were significantly higher in the diabetic group than the nondiabetic counterparts, but exercise did not affect glucose levels in either the diabetic or nondiabetic groups. Exercise, however, significantly lowered plasma triglyceride and free fatty acid levels in both diabetic and nondiabetic rats. The activities of the five enzymes involved in fatty acid synthesis were all depressed in the diabetic rats compared to controls, and exercise had no effect on the activities of the enzymes. The capacity of liver to synthesize total lipids, diglycerides, or triglycerides was not different in the diabetic rats from that of nondiabetic rats, and exercise did not change that. Only phospholipid synthesis from glycerol-3-phosphate was affected by diabetes. It is concluded that exercise ameliorates the elevations in plasma triglyceride levels that result from diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Faculty input in book selection: a comparison of alternative methods

In an era of tight funding, academic medical center libraries need to determine their users' needs in order to provide cost-effective resource collections. Although faculty input is valuable, it is impractical to impose such ongoing responsibility on faculty members. This study tested an alternative method by comparing faculty preferences in discipline-specific subjects with faculty choices on corresponding discipline-specific, new-book approval slips from a vendor. Collection development librarian selections, based on formal selection criteria, were evaluated against both measures of faculty preferences. It was found that faculty members' subject ratings did not accurately predict their book choices. Implications of this and the other findings are discussed.

Acute posttraumatic stress disorder in victims of a natural disaster

Five months after a tornado devastated a rural community in eastern North Carolina, the authors surveyed the mental health status of 116 disaster victims, using the Hopkins Symptom Checklist (HSCL) expanded to include most of DSM-III criteria for posttraumatic stress disorder (PTSD). A total of 69 (59%) victims met the criteria for acute PTSD, 19 of whom had a severe form. Although an inadequate degree of social support was more often noted in victims with severe PTSD, other demographic factors and degree of injury or property damage did not appear to be related to the presence of PTSD. Severity or presence of PTSD was supported by high scores on all HSCL subscale factors. These findings suggest a high incidence of acute PTSD in victims of natural disasters and the potential value of HSCL in screening for PTSD in large populations.

Note on the choice of statistic for testing hypotheses regarding seasonality

The Kolmogorov-Smirnov one-sample test and the Pearson chi-square test are discussed regarding their application for testing hypotheses of seasonality in births. This paper addresses some points mentioned in an earlier paper by McCullough and argues that the chi-square procedure may be the better test.

Foundation care: a treatment model for nonambulatory profoundly mentally retarded persons

Two treatment models, Intermediate Care Facilities for the Mentally Retarded (ICF/MR) and Foundation Care, were compared with respect to their use in the institutional treatment of nonambulatory profoundly mentally retarded persons. Foundation Care is focused on physical and social environmental components of caregiving through emphases on health, nourishment, nurturance, stimulation, and play, with the goal of habilitation. Subjects were randomly assigned to the treatment models. We hypothesized that when compared to ICF/MR, the Foundation Care unit would use more resident-oriented management practices, have different caregiver resident interaction, and have residents who would exhibit more behavioral complexity. Baseline, 6-month, and 1-year measurements were made. Results supported the first and third hypotheses. Caregiver resident interaction was similar for both groups; however, Foundation Care staff used more tactile modalities and contingent interaction. We conclude that Foundation Care may be an appropriate alternative level of care for the nonambulatory profoundly retarded person.