bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing the ACGME General Competencies: General Considerations and Assessment Methods
Authors: Swing Susan R.
Published: November 2002

The Accreditation Council for Graduate Medical Education's (ACGME's) general competency and outcome assessment initiative (i.e., the ACGME Outcome Project) is an effort to enhance residency education and accreditation effectiveness by increasing emphasis on educational outcomes. The Project is also a response to concerns about new graduates' ability to meet the demands of today's practice environment. The competencies emphasize learning in new domains (e.g., Practice‐Based Learning and Improvement and Systems‐Based Practice) and more traditional ones (e.g., Patient Care and Medical Knowledge). Outcome assessment will provide evidence of residency program educational effectiveness and information to guide improvement. This paper discusses the development and implementations of assessment methods appropriate to evaluate the performance of residents in each of the core competencies.
Clinical Assessment in Emergency Medicine
Authors: Jouriles Nicholas , Burdick William , Hobgood Cherri
Published: November 2002

The Accreditation Council for Graduate Medical Education (ACGME) has challenged all residencies with a new paradigm—to teach and evaluate residents based on six core competencies. One of these core competencies is clinical assessment. Standardized patients and direct observation are the most promising for emergency medicine educators to use to assess this competency. There is much room for research and national standardization of methods.
The Use of Simulation for Emergency Medicine Resident Assessment
Authors: Bond William F. , Spillane Linda ,   The CORD Core Competencies Simulation Group
Published: November 2002

Simulations are exercises designed to mimic real‐life situations in which learners are given the opportunity to reason through a clinical problem and make critical decisions without the potential of harming actual patients. Simulation, using a variety of formats, is useful for assessing the core competencies—particularly patient care (decision making, prioritizing, procedural skills), interpersonal skills (team leadership, communication), and systems‐based practice (team structure and utilization, resource use). High‐fidelity computerized human simulators are a relatively new tool for use in medical simulation. These realistic mannequins mimic physical findings including respiratory rate, breath sounds, central and peripheral pulses, murmurs, and pupil reactivity. They generate an electrocardiographic (ECG) waveform, cardiac indices, and oxygen saturation that can be viewed on standard cardiac monitoring equipment and can be programmed to respond physiologically to medications and invasive procedures. The use of human simulators to reproduce life‐threatening situations will be especially useful in assessing the clinical competence of emergency medicine physicians. Operational definitions of competence and tools with which to evaluate performance must first be developed. Standardization of scenarios and evaluation tools will permit assessment of the reproducibility of scenarios and the reliability and validity of the tools used to measure competence.
360‐degree Feedback: Possibilities for Assessment of the ACGME Core Competencies for Emergency Medicine Residents
Authors: Rodgers Kevin G. , Manifold Craig
Published: November 2002

The Accreditation Council for Graduate Medical Education (ACGME) has challenged residency programs to provide documentation via outcomes assessment that all residents have successfully mastered the six core competencies. A variety of assessment “tools” has been identified by the ACGME for outcomes assessment determination. Although rarely cited in the medical literature, 360‐degree feedback is currently in widespread use in the business sector. This tool provides timely, consolidated feedback from sources in the resident's sphere of influence (emergency medicine faculty, emergency medicine residents, off‐service residents and faculty, nurses, ancillary personnel, patients, out‐of‐hospital care providers, and a self‐assessment). This is a significant deviation from both the peer review process and the resident review process that almost exclusively use physicians as raters. Because of its relative lack of development, utilization, and validation as a method of resident assessment in graduate medical education, a great opportunity exists to develop the 360‐degree feedback tool for resident assessment.
Portfolios: Possibilities for Addressing Emergency Medicine Resident Competencies
Authors: O'Sullivan Patricia , Greene Constance
Published: November 2002

Portfolios are an innovative approach to evaluate the competency of emergency medicine residents. Three key characteristics add to their attractiveness. First, portfolios draw from the resident's actual work. Second, they require self‐reflection on the part of the resident. Third, they are inherently practice‐based learning since residents must review and consider their practice in order to begin the portfolio. This paper illustrates five different applications of portfolios. First, portfolios are applied to evaluating specific competencies as part of the training of emergency physicians. While evaluating specific competencies, the portfolio captures aspects of the general competencies. Second, the article illustrates using portfolios as a way to address a specific residency review committee (RRC) requirement such as follow‐ups. Third is a description of how portfolios can be used to evaluate resident conferences capturing the competency of practice‐based learning and possibly other competencies such as medical knowledge and patient care. Fourth, the authors of the article designed a portfolio as a way to demonstrate clinical competence. Fifth, they elaborate as to how a continuous quality improvement project could be cast within the portfolio framework. They provide some guidance concerning issues to address when designing the portfolios. Portfolios are carefully structured and not haphazard collections of materials. Following criteria is important in maintaining the validity of the portfolio as well as contributing to reliability. The portfolios can enhance the relationship between faculty and residents since faculty will suggest cases, discuss anomalies, and interact with the residents around the portfolio. The authors believe that in general portfolios can cover many of the general competencies specified by the ACGME while still focusing on issues important to emergency medicine. The authors believe that portfolios provide an approach to evaluation commensurate with the self‐evaluation skills they would like to develop in their residents.
Human Simulation in Emergency Medicine Training: A Model Curriculum
Authors: McLaughlin Steven A. , Doezema David , Sklar David P.
Published: November 2002

The authors propose a three‐year curriculum for emergency medicine residents using human simulation both to teach and to assess the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Human simulation refers to a variety of technologies that allow residents to work through realistic patient problems so as to allow them to make mistakes, learn, and be evaluated without exposing a real patient to risk. This curriculum incorporates 15 simulated patient encounters with gradually increasing difficulty, complexity, and realism into a three‐year emergency medicine residency. The core competencies are incorporated into each case, focusing on the areas of patient care, interpersonal skills and communication, professionalism, and practice based learning and improvement. Because of the limitations of current assessment tools, the demonstration of resident competence is used only for formative evaluations. Limitations of this proposal and difficulties in implementation are discussed, along with a description of the organization and initiation of the simulation program.
Evaluation of the Educational Effectiveness of a Virtual Reality Intravenous Insertion Simulator
Authors: Reznek Martin A. , Rawn Chantal L. , Krummel Thomas M.
Published: November 2002

Objective: To evaluate construct and content validity as well as learners' perceptions of CathSim, a virtual reality intravenous (IV) insertion simulator. Methods: A prospective cohort study design was employed to determine construct validity, and a participant survey was used to ascertain content validity as well as user perceptions of CathSim. Forty‐one attendings, residents, and medical students in emergency medicine and anesthesia attempted five simulated IV insertions on CathSim. Subject performances were scored by the computer, and subject perceptions of the simulator were measured using a Likert scale questionnaire (1 = worst rating; 5 = best rating). The subjects were divided into three groups (novices, intermediates, and experts) based on previous IV experience. To determine construct validity, performances of the three groups were compared using one‐way analysis of variance (ANOVA). To determine content validity, the experts' perceptions of the simulator's realism and usefulness were assessed. Study subjects' perceptions of the simulator's ease of use and overall appeal were analyzed. Results: The experts scored better than the others in five of nine scoring parameters (p < 0.05). The experts rated the realism of CathSim's four major simulation components at 3.85, 3.46, 3.69, and 3.46; the overall realism of CathSim at 2.93; and its utility for medical student training at 4.57. The simulator's ease of use was rated at 2.34 by all subjects. Novices reported a score of 4.59 regarding their likelihood to use the simulator. Conclusions: CathSim demonstrated construct validity in five of nine internal scoring parameters and was judged to be adequately realistic and highly useful for medical student training. Despite being difficult to learn to use, it remained appealing to the users, especially the novices.
Using Standardized Oral Examinations to Evaluate General Competencies
Authors: Hayes Oliver W. , Reisdorff Earl J. , Walker Gregory L. , Carlson Dale J. , Reinoehl Bruce
Published: November 2002

Emergency medicine residency programs are required by the Accreditation Council for Graduate Medical Education (ACGME) to formally evaluate each resident with oral and written examinations. The Michigan State University Emergency Medicine Residency Program in Lansing conducts monthly standardized oral examinations (SOEs) as part of each resident's evaluation. Recently, the ACGME has advanced six areas, termed “general competencies,” that should be acquired during graduate medical education. According to the ACGME, these competencies should be included in the educational process of all residency programs. In promulgating these competencies, the ACGME did not provide examples of core content, strategies for implementation, or methods of evaluation; rather, individual residency programs are required to develop their own methods. The authors describe a modification of an existing SOE strategy that assesses residents' knowledge, skills, experiences, and attitudes as reflected in the general competencies.
Direct Observation for Assessing Emergency Medicine Core Competencies: Interpersonal Skills
Authors: Jouriles Nicholas J. , Emerman Charles L. , Cydulka Rita K.
Published: November 2002

The American Board of Medical Specialties described six core competencies considered essential elements of medical practice: patient care, medical knowledge, practice‐based learning and improvement, interpersonal and communication skills, professionalism, and systems‐based practice. In response, the Accreditation Council for Graduate Medical Education (ACGME) mandated that all residency programs assess trainees for the newly defined core competencies. Despite the mandate for including these six competencies in residency training, neither a specific curriculum nor a method to assess the outlined objectives has been developed by the ACGME. Instead, it is up to individual residency programs to document how they plan to incorporate and assess the core competencies in their programs. This article describes the potential use of direct observation to assess resident performance in the interpersonal skills core competency.
Protected Clinical Teaching Time and a Bedside Clinical Evaluation Instrument in an Emergency Medicine Training Program
Authors: Shayne Philip , Heilpern Katherine , Ander Douglas , Palmer‐Smith Victoria ,   The Emory University Department of Emergency Medicine Education Committee
Published: November 2002

In a process that has evolved over the last four years, the Emory University Emergency Medicine Education Committee has developed an “academic attending” teaching shift incorporating a formatted lecture series with a clinical evaluation exercise (CEE). The program structures the approach to clinical teaching at the bedside, provides an objective clinical evaluation tool specific to emergency medicine residents, and provides targeted learning for medical students and residents rotating in the emergency department (ED). The CEE instrument was designed to be quick and efficient, satisfy requirements of assessment of the Accreditation Council for Graduate Medical Education (ACGME) general competencies, and incorporate the language of the “Model of the Clinical Practice of Emergency Medicine.” The original program called for unstructured bedside teaching three days a week, by faculty freed from clinical duties, combined with a limited series of introductory emergency medicine lectures. The program proved more successful when concentrated in a once weekly structured educational program. The prepared, repeating lecture series has been expanded to include many of the most common ED presenting chief complaints and has significantly advanced a curriculum for medical students and visiting interns. A CEE was developed to evaluate and provide immediate feedback to residents on many of the core ACGME competencies. The CEE has been successfully used to structure the bedside educational encounter. This dedicated non‐clinical “teaching” shift appears effective in meeting the educational goals of the authors' academic ED. This is a description of the program and its evolution; the program has not been formally evaluated.
Evaluating Systems‐based Practice in Emergency Medicine
Authors: Reisdorff Earl J. , Hayes Oliver W. , Walker Gregory L. , Carlson Dale J.
Published: November 2002

The Accreditation Council for Graduate Medical Education has required that training programs initiate an evaluation process to assess resident acquisition of the newly promulgated general competencies (GCs). Certain GCs (e.g., systems‐based practice, problem‐based learning and improvement) are somewhat more challenging to define and measure than others. Systems‐based practice essentially captures the interactions of the emergency medicine resident that expand beyond isolated contact with the patient. Evaluating these various interactions is readily accomplished using a detailed ordinal evaluation form that measures commonly occurring easily identified actions. Examples of measurable items and the method by which they can be integrated into an evaluation device are presented.
An Approach to Fulfilling the Systems‐based Practice Competency Requirement
Authors: Doezema David , McLaughlin Steve , Sklar David P.
Published: November 2002

The Accreditation Council for Graduate Medical Education (ACGME)‐identified core competency of systems‐based practice requires the demonstration of an awareness of the larger context and system of health care, and the ability to call on system resources to provide optimum care. This article describes an approach to teaching and fulfilling the requirement of this core competency in an emergency medicine residency. Beginning residents are oriented to community resources that are important to the larger context of care outside the emergency department. Each resident completes a community project during his or her residency. Readings and discussions concerning community‐oriented medical care and the literature of research and injury prevention in emergency medicine precede the project development. Several projects are described in detail. Such projects help to teach not only awareness of the community resources of the greater context of medical practice outside the emergency department, but also how to use those resources. Projects could be a main component of a resident portfolio. This approach to teaching the core competency of systems‐based practice is proposed as an innovative and substantial contribution toward satisfying the requirement of the core competency.
Teaching Communications and Professionalism through Writing and Humanities: Reflections of Ten Years of Experience
Authors: Sklar David P. , Doezema David , McLaughlin Steve , Helitzer Deborah
Published: November 2002

Both professionalism and interpersonal communication are core competencies for emergency medicine residents as well as residents from other specialties. The authors describe a weekly, small‐group seminar lasting one year for emergency medicine residents that incorporates didactic materials, case studies, narrative expression (stories and poems), and small‐group discussion. Examples of cases and narrative expressions are provided and a rationale for utilizing the format is explained. A theoretical model for evaluation measures is also included.
Acute Growth Hormone Administration Causes Exaggerated Increases in Plasma Lactate and Glycerol during Moderate to High Intensity Bicycling in Trained Young Men
Authors: Lange Kai Henrik Wiborg , Larsson Benny , Flyvbjerg Allan , Dall Rolf , Bennekou Morten , Rasmussen Michael Højby , Ørskov Hans , Kjær Michael
Published: November 2002

We studied the acute effects of a single, sc GH dose on exercise performance and metabolism during bicycling. Seven highly trained men [age, 26 ± 1 yr (mean ± sem); weight, 77 ± 3 kg; maximal oxygen uptake, 65 ± 1 ml O2·min−1·kg−1] performed 90 min of bicycling 4 h after receiving 7.5 IU (2.5 mg) GH or placebo in a randomized, double-blinded, cross-over design trial. A standardized pre-exercise meal was given 2 h before exercise. Blood was sampled at rest and during exercise and analyzed for GH, IGF-I, glucose, lactate, insulin, glycerol, and nonesterified fatty acids (NEFA). In the placebo trial, all subjects completed the exercise protocol without any difficulties. In contrast, two subjects were not able to complete the exercise protocol in the GH trial, and one subject barely managed to complete the protocol. In addition, GH administration resulted in exaggerated increases in plasma lactate concentrations during exercise (P < 0.0001). The combined lipolytic effect of GH and exercise, evidenced by increased plasma glycerol and serum NEFA concentrations, was 3-fold greater than the effect of exercise alone (P < 0.0001), but this increased substrate availability did not result in increased whole body fat oxidation (indirect calorimetry). Plasma glucose was, on average, 9% higher during exercise after GH administration compared with placebo (P < 0.0001).

We conclude that a single, relevant GH dose causes exaggerated increases in plasma lactate and glycerol as well as serum NEFA during 90 min of subsequent bicycling at moderate to high intensity. The exaggerated increase in plasma lactate may be associated with substantially decreased exercise performance.
Thyroid Hormone Action Is Disrupted by Bisphenol A as an Antagonist
Authors: Moriyama Kenji , Tagami Tetsuya , Akamizu Takashi , Usui Takeshi , Saijo Misa , Kanamoto Naotetsu , Hataya Yuji , Shimatsu Akira , Kuzuya Hideshi , Nakao Kazuwa
Published: November 2002

Bisphenol A (BPA), a monomer of polycarbonate plastics, has been shown to possess estrogenic properties and act as an agonist for the estrogen receptors. Although an epidemiologically based investigation has suggested that some chemicals could disrupt thyroid function in animals, the effects on thyroid hormone receptors (TRs) are unknown. We show here that BPA inhibits TR-mediated transcription by acting as an antagonist. In the transient gene expression experiments, BPA suppressed transcriptional activity that is stimulated by thyroid hormone (T3) in a dose-dependent manner. The inhibitory effects were observed in the presence of physiological concentrations of T3. In contrast, in the case of negatively regulated TSHα promoter, BPA activated the gene transcription that is suppressed by T3. To elucidate possible mechanisms of the antagonistic action of BPA, the effects on T3 binding and cofactor interaction with TR were examined. The Ki value for BPA was 200 μm when assessed by inhibition of [125I]T3 binding to rat hepatic nuclear TRs. In a mammalian two-hybrid assay, BPA recruited the nuclear corepressor to the TR. These results suggest that BPA could displace T3 from the TR and recruit a transcriptional repressor, resulting in gene suppression. This is the first report that BPA can antagonize T3 action at the transcriptional level. BPA may disrupt the function of various types of nuclear hormone receptors and their cofactors to disturb our internal hormonal environment.
Human Chorionic Gonadotropin (HCG) Activates Monocytes to Produce Interleukin-8 via a Different Pathway from Luteinizing Hormone/HCG Receptor System
Authors: Kosaka Kenzo , Fujiwara Hiroshi , Tatsumi Keiji , Yoshioka Shinya , Sato Yukiyasu , Egawa Haruto , Higuchi Toshihiro , Nakayama Takahiro , Ueda Masamichi , Maeda Michiyuki , Fujii Shingo
Published: November 2002

To investigate immune-endocrine interactions between the embryo and the mother early in pregnancy, we examined the effects of human chorionic gonadotropin (HCG) on IL-8 production by peripheral blood mononuclear cells (PBMC). Recombinant HCG promoted IL-8 secretion by PBMC derived from nonpregnant women. The induction of IL-8 mRNA expression was observed after 30 min of HCG stimulation. Adsorption of the HCG with anti-HCG antibodies confirmed the specificity of this effect. The translocation of nuclear factor κB into the nucleus and subsequent IL-8 production were observed mainly in monocytes, and IL-8 production was reduced when a proteasome inhibitor was added to inactivate nuclear factor κB. Although fluorescein isothiocyanate-labeled HCG was bound to the majority of monocytes, cell surface expression of HCG receptor was hardly detected. IL-8 production by HCG was not affected by inhibitors of protein kinases A and C. In contrast, this stimulation was attenuated by d-mannose, which inhibits binding to C-type lectins. The basal IL-8 production by PBMC from women early in pregnancy was significantly elevated, compared with that from nonpregnant women.

This study showed that human monocytes respond to HCG and secrete IL-8 through a pathway different from the HCG receptor system, suggesting that this glycoprotein hormone can react with not only endocrine cells but also immune cells early in pregnancy, probably via primitive systems such as C-type lectins.
Mifepristone-Induced Vaginal Bleeding Is Associated with Increased Immunostaining for Cyclooxygenase-2 and Decrease in Prostaglandin Dehydrogenase in Luteal Phase Endometrium
Authors: Hapangama Dharani K. , Critchley Hilary O. D. , Henderson Teresa A. , Baird David T.
Published: November 2002

The mechanism of mifepristone-induced vaginal bleeding and endometrial shedding was investigated in 13 women who took 200 mg mifepristone in the midluteal phase on d 8 after the onset of the urinary LH surge (LH+8). Endometrial biopsies were collected, 6–24 h after mifepristone (group 1, n = 7) or 36–48 h after mifepristone (group 2, n = 6), and compared with those from a control group in the midluteal phase (n = 7). All women reported vaginal bleeding commencing 36–48 h after taking mifepristone. Treatment with mifepristone significantly reduced serum progesterone levels in all women, when compared with the controls (13.2 nmvs. 34.8 nm, P = 0.001). After mifepristone, a significant increase in cyclooxygenase-2 immunoreactivity was apparent at 36–48 h (P = 0.0018), whereas prostaglandin 15 dehydrogenase enzyme-positive immunostaining declined, to be virtually absent by 36–48 h in both glands and in stroma (P < 0.05). There was no change in intensity or distribution of staining for steroid receptors after mifepristone. The changes in immunostaining for cyclooxygenase-2 and prostaglandin 15 dehydrogenase strongly support the hypothesis that an increase in the local concentration of prostaglandins in the endometrium is involved in the mechanism of bleeding induced by mifepristone in the luteal phase.
Vascular Reactivity in Hypogonadal Men Is Reduced by Androgen Substitution
Authors: Zitzmann Michael , Brune Maik , Nieschlag Eberhard
Published: November 2002

The effect of testosterone (T) substitution therapy on blood vessel functions in relation to cardiovascular disease has not been fully elucidated. In 36 newly diagnosed nonsmoking hypogonadal men (37.5 ± 12.7 yr) endothelium-dependent flow-mediated vasodilatation (FMD; decreased in atherosclerosis) of the brachial artery was assessed before treatment and after 3 months of T substitution therapy (250 mg testosterone enanthate im every 2 wk in 19 men, human chorionic gonadotropin sc twice per week in 17 men). Twenty nonsmoking controls matched for age, low-density lipoprotein cholesterol (LDL-C), body height, and baseline diameter of the artery were selected for repeated measurements from a larger eugonadal control group (n = 113). In hypogonadal men, basal FMD (17.9 ± 4.5%) was significantly higher than in the large (11.9 ± 6.4%) and matched control (11.8 ± 7.1%, both P < 0.001) groups. Grouped multiple linear regression analysis revealed a significant negative association of T levels with FMD within the hypogonadal range, but no significant association was seen within the eugonadal range. During substitution therapy, T levels increased from 5.8 ± 2.3 to 17.2 ± 5.1 nmol/liter and FMD decreased significantly to 8.6 ± 3.1% (P < 0.001, analysis for covariance for repeated measurements including matched controls). LDL-C and advanced age contributed significantly to decrease FMD (P = 0.01, P = 0.04, respectively). Because T substitution adversely affects this important predictor of atherosclerosis, other contributing factors (such as smoking, high blood glucose, and LDL-C) should be eliminated or strictly controlled during treatment of hypogonadal men.
Diurnal Leptin Secretion Is Intact in Male Hypogonadotropic Hypogonadism and Is Not Influenced by Exogenous Gonadotropins
Authors: Kilciler Guldem , Ozata Metin , Oktenli Cagatay , Sanisoglu S.Yavuz , Bolu Erol , Bingol Necati , Kilciler Mete , Ozdemir I. Caglayan , Kutlu Mustafa
Published: November 2002

Circulating leptin shows a pulsatile secretory pattern along with a nocturnal rise. We have previously shown that circulating leptin concentrations are high in males with untreated idiopathic hypogonadotropic hypogonadism (IHH). However, circadian leptin secretion in IHH before and after gonadotropin treatment is not known. Thus, we studied 14 adult males with IHH who had no history of previous hormonal therapy, and 12 age- and body mass index-matched healthy men. Plasma leptin concentrations were measured with 1-h intervals for 24 h before and 6 months after gonadotropin treatment. The 24-h mean leptin concentration showed a significant decrease, from 11.78 ± 1.908 μg/liter at baseline to 10.85 ± 1.939 μg/liter after 6 months of therapy (z = 3.107; P = 0.002). Before and after treatment, 24-h mean leptin concentrations were also significantly higher in the patient group when compared with controls (4.275 ± 0.711 μg/liter) (z = 5.938; P = 0.0001). Hourly leptin levels demonstrated a diurnal pattern in hypogonadal patients, a surge in the midday, and a peak just after midnight, and this pattern did not differ before and after treatment. We observed a similar diurnal pattern in the control subjects too. Leptin levels were negatively and significantly correlated with free testosterone and total testosterone levels both before (r = −0.656, P = 0.011; and r = −0.639, P = 0.014, respectively) and after (r = −0.537, P = 0.048; and r = −0.563, P = 0.036, respectively) gonadotropin administration.

Our observations suggest that the diurnal rhythm of leptin is intact in males with IHH, and short-term gonadotropin treatment does not effect its diurnal rhythm. Moreover, testosterone produced under the influence of the gonadotropin treatment led to decreases in the leptin levels.
Pubertal and Gender-Related Changes in the Sympathoadrenal System in Healthy Children
Authors: Weise Martina , Eisenhofer Graeme , Merke Deborah P.
Published: November 2002

A critical amount of body fat is necessary for the initiation of puberty, and leptin, an adipocyte-derived hormone, is necessary for pubertal development. The sympathoadrenal system modulates body fat stores and leptin secretion and interacts with adrenocortical androgen production, suggesting a possible role in sexual maturation. We studied sympathetic nerve and adrenomedullary activity at rest in 80 healthy children (ages, 5–17 yr; 37 boys and 43 girls) in relation to age, pubertal stage, gender, physical activity, body mass index, and serum levels of sex steroids, dehydroepiandrosterone sulfate, cortisol, leptin, and insulin.

Plasma concentrations of the adrenomedullary hormone, epinephrine (E), and its metabolite metanephrine (MN), decreased significantly with advancing puberty and were higher in boys than in girls. E and MN correlated significantly and inversely with dehydroepiandrosterone sulfate, estradiol, testosterone, leptin, and insulin. Plasma norepinephrine, which is primarily derived from sympathetic nerve endings, increased significantly with advancing puberty and increasing testosterone levels in boys. Stepwise multiple regression analysis revealed that E was best predicted by pubertal stage and leptin, and MN by estradiol and leptin.

Our data suggest that sympathoadrenal hormones may play a role in the complex process of sexual maturation. Further studies are needed to investigate a possible modulatory role of the adrenal medulla in the body weight-related timing of adrenarche and/or gonadarche.
Effects of Above Average Summer Sun Exposure on Serum 25-Hydroxyvitamin D and Calcium Absorption
Authors: Barger-Lux M. Janet , Heaney Robert P.
Published: November 2002

The purpose of this study was to examine the effects of summer sun exposure on serum 25-hydroxyvitamin D [25(OH)D], calcium absorption fraction, and urinary calcium excretion. Subjects were 30 healthy men who had just completed a summer season of extended outdoor activity (e.g. landscaping, construction work, farming, or recreation). Twenty-six subjects completed both visits: after summer sun exposure and again approximately 175 d later, after winter sun deprivation. We characterized each subject’s sun exposure by locale, schedule, and usual attire. At both visits we measured serum 25(OH)D, fasting urinary calcium to creatinine ratio, and calcium absorption fraction. Median serum 25(OH)D decreased from 122 nmol/liter in late summer to 74 nmol/liter in late winter. The median seasonal difference of 49 nmol/liter (interquartile range, 29–67) was highly significant (P < 0.0001). However, we found only a trivial, nonsignificant seasonal difference in calcium absorption fraction and no change in fasting urinary calcium to creatinine ratio. Findings from earlier work indicate that our subjects’ sun exposure was equivalent in 25(OH)D production to extended oral dosing with 70 μg/d vitamin D3 (interquartile range, 41–96) or, equivalently, 2800 IU/d (interquartile range, 1640–3840). Despite this input, at the late winter visit, 25(OH)D was less than 50 nmol/liter in 3 subjects and less than 75 nmol/liter in 15 subjects.
A Mutation in the KCNE3 Potassium Channel Gene Is Associated with Susceptibility to Thyrotoxic Hypokalemic Periodic Paralysis
Authors: Dias Da Silva Magnus R. , Cerutti Janete M. , Arnaldi Liliane A. T. , Maciel Rui M. B.
Published: November 2002

Hypokalemic Periodic Paralyses comprise diverse diseases characterized by acute and reversible attacks of severe muscle weakness, associated with low serum potassium. The most common causes are Familial Hypokalemic Periodic Paralysis (FHypoKPP), an autosomal dominant disease, and Thyrotoxic Hypokalemic Periodic Paralysis (THypoKPP), secondary to thyrotoxicosis. Symptoms of paralysis are similar in both diseases, distinguished by thyrotoxicosis present in THypoKPP. FHypoKPP is caused by mutations in ionic channel genes calcium (CACN1AS), sodium (SCN4A) and potassium (KCNE3). Since both diseases are similar, we tested the hypothesis that THypoKPP could carry the same mutations described in FHypoKPP, being the paralysis a genetically conditioned complication of thyrotoxicosis. In 15 patients with THypoKPP, using target-exon PCR, CSGE screening, and direct sequencing, we excluded known mutations in CACN1AS and SCN4A genes. On the other hand, we were able to identify the R83H mutation in the KCNE3 gene in one sporadic case of THypoKPP, a man who had been asymptomatic until developing thyrotoxicosis caused by Graves’ disease; we confirmed the disease-causing mutation in 2 of 3 descendants. R83H was recently found in two FHypoKPP unrelated families, in which the mutant decreased outward potassium flux, resulting in a more positive resting membrane potential. We, therefore, identified the first genetic defect in THypoKPP, a mutation in the KCNE3 gene.
Assessment of Nondiagnostic Ultrasound-Guided Fine Needle Aspirations of Thyroid Nodules
Authors: Alexander Erik K. , Heering Jenny P. , Benson Carol B. , Frates Mary C. , Doubilet Peter M. , Cibas Edmund S. , Marqusee Ellen
Published: November 2002

Thyroid nodules are common. Evaluation of patients with thyroid nodules typically includes fine needle aspiration biopsy (FNA), an approach that has proven to be accurate for the detection of thyroid cancer. Although the majority of biopsies are adequate for a cytological diagnosis, up to 20% will be insufficient or nondiagnostic. Current opinion suggests that such aspirates should be repeated, although no systematic study has investigated the usefulness of this approach, especially when ultrasound guidance is used to direct the initial FNA. We sought to define the predictors and optimal follow-up strategy for initial nondiagnostic ultrasound-guided FNAs of thyroid nodules.

Data were collected for all patients at the Brigham and Women’s Hospital Thyroid Nodule Clinic between 1995–2000 who underwent ultrasound-guided FNA of a thyroid nodule. All patients with nondiagnostic cytology were advised to return for a repeat ultrasound-guided FNA. Patient age, gender, nodule size, cystic content, solitary vs. multinodular thyroid, and nodule location were documented and evaluated as possible predictors of a nondiagnostic biopsy in a multivariable model. The rate of diagnostic cytology obtained on repeat ultrasound-guided FNA was calculated.

A total of 1128 patients with 1458 nodules were biopsied over a 6-yr period. A total of 1269 aspirations (950 patients) were diagnostic, and 189 (178 patients) were nondiagnostic. The cystic content of each nodule was the only significant independent predictor of nondiagnostic cytology (P < 0.001). The fraction of specimens with initial nondiagnostic cytology increased with greater cystic content (P < 0.001 for trend). A diagnostic ultrasound-guided FNA was obtained on the first repeat biopsy in 63% of nodules and was inversely related to increasing cystic content of each nodule (P = 0.03). One hundred and nineteen patients with 127 nodules returned for follow-up as advised, and malignancy was documented in 5%.

Despite ultrasound-guided FNA, there remains a significant risk of initial nondiagnostic cytology, largely predicted by the cystic content of each nodule. Repeat aspiration is often successful and should be the standard approach to such nodules, given their risk of malignancy.
Transcriptionally Targeted Retroviral Vector for Combined Suicide and Immunomodulating Gene Therapy of Thyroid Cancer
Authors: Barzon Luisa , Bonaguro Roberta , Castagliuolo Ignazio , Chilosi Marco , Gnatta Elisa , Parolin Cristina , Boscaro Marco , Palù Giorgio
Published: November 2002

Gene therapy may be an effective approach to thyroid carcinoma refractory to conventional treatment. A transcriptionally targeted retroviral vector for gene therapy of thyroid carcinomas was generated replacing the viral enhancer with the enhancer sequence of the human thyroglobulin (TG) gene, yielding a chimeric long-terminal repeat. The TG enhancer was used to drive the expression of either a reporter gene (β-galactosidase) or two therapeutic genes, i.e. the prodrug-activating enzyme thymidine kinase of herpes simplex virus (HSV-TK) and human IL-2, separated by an internal ribosome entry site. The corresponding vector having an unmodified long-terminal repeat was used as control. The targeted vector allowed selective transgene expression and cell killing in differentiated thyroid tumor cells but not in anaplastic thyroid carcinoma cells and nonthyroid cells, as demonstrated by quantitative RT-PCR and cytotoxicity assays. Nude mice injected with tumor cells underwent near complete or complete regression of tumors transduced with the control vector after ganciclovir treatment. On the other hand, infection with the thyroid-specific vector led to regression only of TG-expressing tumors. In addition, tumors expressing human IL-2 showed significant growth retardation, compared with nontransduced tumors while exhibiting signs of necrosis and presence of an inflammatory infiltrate. However, HSV-TK/IL-2 plus ganciclovir was significantly more efficient than HSV-TK/IL-2 alone in eradicating tumor masses. Our results indicate that replacement of viral enhancer with TG enhancer confers selectivity of transgene expression in thyroid cells. Thus, the combined thyroid-specific expression of two therapeutic genes (cytokine and suicide genes), although a safe tumor-targeted treatment, would allow an increased anticancer effect.
Analysis and design using the allowable eigenvector subspace
Authors: Ensor J , Clarke T
Published: November 2002

Eigenstructure assignment has enjoyed considerable success in applications where both the modal response and mode distribution are important. However, a significant constraint on eigenvector selection is defined by an allowable subspace, the range of which varies both with model parameters and desired eigenvalue. This paper presents a technique that explores this constraint, from which analysis and design methods result. A four-input, eighth-order helicopter model is presented. The application of the novel method reveals the achievable response rates in the helicopter states, and provides information on how parameter variations affect the system dynamics. A revised eigenstructure is developed, and the resulting closed-loop system is shown to comply with handling qualities specifications while reducing cross-coupling between modes.
A lighter enclosure for electronics for space applications
Authors: Aglietti G S
Published: November 2002

In this paper, the conventional design of an enclosure for electronic equipment for space application is reviewed and an alternative type of construction is proposed. The alternative design is based on the use of carbon fibre reinforced plastic (CFRP) sandwich panels for the construction of the enclosure, and the substitution of the printed circuit board (PCB) antivibration frames (AVFs) with antivibration rods (AVRs). To put this work into context, the requirements applicable to the structural design of this type of unit are briefly reviewed. Standard structural analyses have been performed on the conventional enclosure and then repeated for the proposed configuration, in order to demonstrate its compliance with the fundamental mechanical requirements. The issues concerning the radiation protection offered by the enclosure are discussed, and some solutions to this potential problem are briefly presented. The work demonstrates the possibility of achieving a saving of about 20 per cent on the overall mass of the unit. Finally, the cost of the proposed enclosure is assessed and compared with the conventional design for various missions.
Verification of various modelling techniques for simply-supported piezoelectric actuated thin panels
Authors: Aglietti G S , Cunningham P R , Langley R S
Published: November 2002

In this work, three techniques for the mathematical modelling of a piezoelectric actuated thin panel, namely the finite element method, a Lagrange Rayleigh—Ritz method, and a mechanical impedance-based method, are briefly presented. An accurate experimental implementation of a piezoelectric actuated simply-supported panel, whose dynamics have been simulated using the mathematical models, is described in detail. Since the differences between the results produced by the various mathematical models are very small, the accuracy of the experimental set-up is crucial. The results obtained via the numerical simulations are then compared with test results in order to assess the accuracy of the various modelling techniques.
Enlarging SCADA to Include Climate and Hence Wind Power Prediction Forecasts
Authors: Kiehling Jennifer , Cohn Kenneth E.
Published: November 2002

Traditionally, SCADA (supervisory control and data acquisition) relates to isolated machine systems, e.g. a windfarm of utility scale wind turbine generators connected to a central supervisory computer. The central computer collects performance information about the turbines and sends them commands. However, the method can be enlarged to include cooperative systems such as the combination of a windfarm's performance and the site's wind climate seen as one system. This conceptual change is commercially important, because windfarm operators and wind-electricity suppliers are often required to submit short-term forecasts of the wind energy production before the energy can be sold. Penalties may be levied for over- or under-production as compared with the contracted forecast. Methods to fulfil this enlarged concept are described for commercially available wind energy SCADA systems. The windfarm SCADA system can automate the process of transmitting site performance data to the scheduling entity, to the forecaster, or both. Machine performance information can improve near-term forecasts.
Active Pitch Control in Larger Scale Fixed Speed Horizontal Axis Wind Turbine Systems Part II: Non-Linear Controller Design
Authors: Bao Nengsheng , Ye Zhiquan
Published: November 2002

This paper considers non-linear control of fixed speed wind turbines in above rated wind speed, using blade pitch angle control and with special emphasis on differential geometric theory. A non-linear system can be described as a linear system with the co-ordinates transformations in differential geometry theory. Firstly, a non-linear theoretical model of the fixed speed wind turbine was built according to the physical characteristics. Then, the non-linear model was linearised globally with differential geometry transmission and a new linear model was prepared. Finally, a non-linear controller has been designed relying on the linear quadratic optimal algorithm of the new linear system.
Experimental Determination of Optimum Design Configuration for Micro Wind Turbines at Low Wind Speeds
Authors: Tokuyama Hideki , Ushiyama Izumi , Seki Kazuichi
Published: November 2002

This paper reports experiments and theory on some small wind turbines of rotor diameter 100 cm and less. Discrepancies in power performance have been found from predictions of blade element theory. Wind tunnel experiments showed that performance depends on the solidity of the fixed diameter rotor due to the dependence of Reynolds number on chord length. In particular, power output is lower than theory predicts on wind speed less than about 10m/s. For turbine rotors of constant diameter, output depends on solidity. In general, at low wind speeds, rotors with greater solidity give a higher output than with less solidity. This is due to the difference in Reynolds number, which itself is associated with chord length. The optimum value of Reynolds number for such small turbines is 100,000.
Pharmacopoeia – A Collaboration between the Textile Artist Susie Freeman and the General Practitioner Liz Lee
Authors: Lee Liz
Published: November 2002

In this article I describe the development of my collaboration with the textile artist Susie Freeman in the production of the visual arts project Pharmacopoeia. Over the last 3 years we have created a body of work that aims to provide information about common medical treatments in a way that engages the public imagination. The work is dominated by the use of active pharmaceuticals, both pills and capsules, which are incorporated into dramatic fabrics by a process known as pocket knitting. These fabrics are then made into clothing and accessories, making their individual messages easier to ‘read’. The work aims to encourage people to think about their own medical and pharmacological history, and to reflect on their relationship with commonly prescribed drugs. It also reveals how dependent our society is on pharmaceuticals, how ambivalent we feel about them and yet how casually we use them.
From Dogs’ Testicles to Mares’ Urine: The Origins and Contemporary use of Hormonal Therapy for the Menopause
Authors: Banks Emily
Published: November 2002

Contemporary hormonal therapy for the menopause has its conceptual origins in the ancient tradition of organotherapy. The popular but pharmacologically inactive precursors of hormonal therapy were developed as part of a resurgence of interest in organotherapy in the 19th century, which coincided with increasing medicalization of the menopause and the view that the ovaries were responsible for the ‘feminine’ identity and wellbeing of women. The subsequent chemical identification of oestrogens allowed the development of pharmacologically active hormonal therapy for the menopause, which was probably first used clinically in the late 1920s. Around this time, emphasis shifted from the ovaries to oestrogen as being responsible for femininity and health, with the menopause and ageing increasingly defined as oestrogen deficiency diseases. Hormonal therapy for the menopause was first used predominantly for women who had a premature menopause. In the 1960s, universal prescription was increasingly promoted as a way of preventing diseases of later life and the perceived ‘defeminization’ of women by menopause. Scientific evidence regarding the risks and benefits of hormonal therapy for the menopause has been accruing over the last 70 years; its interpretation has been affected by background beliefs regarding the effects of oestrogen and the menopause on women.
Photoacoustic study of KrF laser heating of Si: Implications for laser particle removal
Authors: Kudryashov Sergey I. , Allen Susan D.
Published: November 2002

A photoacoustic study of KrF laser heating of Si has revealed that the dominant mechanism of acoustic generation is thermoacoustic with a considerable contribution from the concentration–deformation mechanism at laser fluences below the Si melting threshold of 0.5 J/cm2. Upon Si melting the contraction of the molten material contributes significantly to acoustic generation. At fluences above 1.4 J/cm2 laser ablation of the molten layer enhances the amplitude of the compression pulse and diminishes that of the rarefaction pulse. The results of photoacoustic measurements allow optimization of experimental conditions for dry laser particle removal.