Recruitment and training of minority health care managers: a case study

This paper describes a cooperative learning model that uses six critical points of intervention at which learning can be facilitated for minority students. These six points were identified in the Health Career Opportunity Program (HCOP). The HCOP initiative model is used because it has been demonstrated that this strategy has been successful in increasing the number of minority health care professionals. The paper is presented in two parts. The first part gives an overview of the six critical points of intervention. The recommendations presented will focus on incorporating mechanisms that can facilitate the learning and achievement of minority students once they have been identified and admitted. The second part presents a case study of how these intervention strategies were implemented in the Health Services Administration Program at Meharry Medical College between the years of 1989 through 1993.     

上海市崇明地区成年人鼻阻力和鼻声反射的初步研究

目的 通过对上海市崇明地区健康成年人鼻通气功能的客观测定,建立崇明地区健康成年人鼻阻力(RM)、鼻声反射(AR)等参数的正常参考值范围,并初步分析两者相关性.方法 采用NR6鼻阻力计采集受试者经鼻压差为150Pa下前端测量的单侧鼻腔吸气阻力(Ri)、呼气阻力(Re)等数据,通过计算机软件计算后得出单侧总阻力(RI)、双...     

Subtle appearance of pelvic endometriosis

This retrospective study demonstrates an increased documentation of subtle appearances of endometriosis. This documentation was associated with an increased emphasis on excising these lesions for histologic examination. Endometriosis was documented in pink, clear, red, white, and puckered black lesions in 106 (97%) of 109 patients. This included 22 (100%) of 22 patients undergoing laparotomy and 84 (97%) of 87 patients undergoing laparoscopy. Subtle lesions were documented at laparoscopy in 32% of patients in the first 5 months and in 72% of patients in the last 5 months of the study. The increased documentation of these subtle lesions appeared to be related to an increased awareness and anticipation of subtle lesions. The ability to detect such lesions increased with experience and was reinforced by histologic confirmation.     

Single motherhood and neonatal survival of twins among blacks and whites

OBJECTIVE: We investigated whether an association existed between single motherhood and neonatal mortality among twins and whether such a linkage varied by race. STUDY DESIGN: Retrospective cohort analysis on 446,570 twin live births (between 24-44 gestational weeks inclusive) in the United States from 1995 through 1998. Neonatal survival was compared between twins of single and those of married mothers for blacks and whites separately using Cox proportional hazards regression that adjusted for the confounding effects of education, parity, adequacy of prenatal care and maternal smoking during pregnancy. The Robust Sandwich Estimator was employed to adjust for intracluster correlation. RESULTS: The rates for neonatal mortality among blacks were 34.9 per 1,000 among married and 43.4 per 1,000 among single mothers. Among whites, the rates were 20.6 per 1,000 for married and 28.9 per 1,000 for unmarried mothers. Neonatal mortality was significantly elevated among white twins of single mothers (Hazard Ratio (HR) = 1.23; 95% Confidence Interval (CI) = 1.14-1.31) and among black twins of single mothers (HR = 1.12; 95% CI = 1.01-1.25). However, when gestational age was adjusted for, the association between single motherhood and neonatal mortality disappeared. CONCLUSION: Single motherhood was a risk factor for neonatal mortality among twins, and the disparity in survival was more accentuated among whites. The association between single motherhood and neonatal mortality was explained by the preponderance of preterm births among twins of unmarried gravidas. Our findings reinforce the importance of future research to develop and test interventions that will decrease the incidence of preterm birth.     

mda-7/IL-24, novel anticancer cytokine: focus on bystander antitumor, radiosensitization and antiangiogenic properties and overview of the phase I clinical experience (Review)

Subtraction hybridization applied to a 'differentiation therapy' model of cancer employing human melanoma cells resulted in the cloning of melanoma differentiation associated gene-7/interleukin-24 (mda-7/IL-24). Initial studies confirm an inverse correlation between mda-7 expression and melanoma development and progression. Forced expression of mda-7 by means of a plasmid or via a replication incompetent adenovirus (Ad.mda-7) promotes growth suppression and induces apoptosis in a broad array of human cancers. In contrast, mda-7 does not induce growth suppressive or toxic effects in normal cells. Based on structure (containing an IL-10 signature motif), secretion by cells (including subsets of T-cells) and location on chromosome 1q (in an area containing IL-10-family genes), mda-7 has now been renamed mda-7/IL-24. Studies by several laboratories have uncovered many of mda-7/IL-24's unique properties, including cancer-specific apoptosis-induction, cell cycle regulation, an ability to inhibit angiogenesis, potent 'bystander antitumor activity' and a capacity to enhance the sensitivity of tumor cells to radiation, chemotherapy and monoclonal antibody therapy. Moreover, based on its profound cancer tropism, substantiated by in vivo human xenograft studies in nude mice, mda-7/IL-24 (administered as Ad.mda-7) was evaluated in a phase I clinical trial in patients with melanomas and solid cancers. These studies document that mda-7/IL-24 is well tolerated and demonstrates evidence of significant clinical activity. In these contexts, mda-7/IL-24 represents a unique cytokine gene with potential for therapy of human cancers. The present review focuses on three unique properties of mda-7/IL-24, namely its potent 'bystander antitumor activity', ability to sensitize tumor cells to radiation, and its antiangiogenesis properties. Additionally, an overview of the phase I clinical trial is provided. These studies affirm that mda-7/IL-24 has promise for the management of diverse cancers.     

Pelvic peritoneal defects and endometriosis: further observations

Congenital or acquired defects in the mesentery are rare, and defects of the supporting structures and in the peritoneum of the pelvis are even more uncommon. Such pelvic peritoneal defects have been associated with endometriosis; however, the extent of this association has been unclear. In the present study, 309 patients had a diagnostic laparoscopy performed for pelvic pain in a prospective manner over a 2-year period. A total of 53 patients were found to have pelvic peritoneal defects. Seventy-nine percent of this group with peritoneal defects had associated endometriosis. Of the 309 patients undergoing laparoscopy, 148 patients were diagnosed as having endometriosis. Twenty-eight percent of this group with endometriosis had pelvic peritoneal defects. We conclude that when such defects are found at laparoscopy, the presence of endometriosis should be investigated thoroughly.     

Hyperparathyroidism in black patients: an update.

Cervical exploration with removal of the pathologic gland or glands is effective treatment for parathyroid adenomas and hyperplasia. This article reports the results of a retrospective study of 41 patients who underwent elective cervical exploration for primary hyperparathyroidism at Howard University Hospital between 1974 and 1989. Preoperative localization studies for primary neck exploration consisted of an ultrasound of the neck. Removing the diseased gland/glands resulted in the resolution of the patients' symptoms and the return of calcium levels to normal. Complications included transient hypocalcemia, a wound hematoma, and a postoperative death.     

Endometriosis in the black woman.

Endometriosis has heretofore been considered rare in black women. Laparoscopy in 190 black women, in many of whom pelvic inflammatory disease was previously diagnosed clinically and treated, revealed endometriosis to be present in 21 per cent. The importance of this finding for clinical practice is discussed.     

Use of sulphopropyl-sephadex chromatography and disc gel electrophoresis for the fractionation and identification of elapid venoms

The cation exchange resin Sulphopropyl (SP)-Sephadex has been used for the preparative isolation of both neurotoxins and cytotoxins from various Elapid venoms. The chromatographic system described affords high resolution of venom components upon elution with simple linear salt gradients. Cytotoxins from the venom of Naja naja naja (India) and neurotoxins from Naja naja atra (Formosa), Naja naja siamensis and Bungarus multicinctus have been isolated in high yield as pure, physiologically-active materials.The resin has also been applied, together with two different discontinuous gel electrophoresis systems, to the characterization of venoms from ten Asian Naja naja subspecies. All of the venoms studied could be identified by their disc gel acidic and basic protein patterns alone, or by a combination of their SP-Sephadex protein elution profiles and the disc gel patterns of their acidic proteins. These studies indicate that the systems reported could be used not only for the identification of specific venoms but could also serve as a basis for a classification system for snake venoms.     

Inhibition of NMU-induced mammary tumorigenesis by dietary soy

We previously demonstrated that female Sprague-Dawley rats fed AIN-93G diets containing soy protein isolate (SPI+) had lower DMBA-induced mammary tumor incidence than those fed diets containing casein (CAS), due partly to altered Phase I metabolism with soy. Here, we evaluated the tumor protective effects of these same diets to the direct-acting carcinogen N-methyl-nitrosourea (NMU). Tumor incidence was reduced and tumor latency was enhanced, in NMU-administered female rats lifetime exposed to SPI+, relative to the CAS group. Tumor multiplicity did not differ with diet, while tumor grade tended to be more advanced with SPI+. Normal mammary glands of CAS and SPI+ tumor-bearing rats had comparable proliferative and apoptotic status. However, mammary expression of HER-2/neu and progesterone receptor (PR) genes was higher for SPI+ rats. Moreover, tumored SPI+ rats had lower serum progesterone levels than those fed CAS, while serum estrogen did not differ. Serum from tumored SPI+ rats had higher apoptotic activity towards mammary epithelial MCF-7 cells, than CAS serum. Thus, dietary soy protects against mammary tumorigenesis induced by a direct-acting carcinogen and alters signaling pathways involving PR and HER-2/neu.