Malpractice litigation against child and adolescent psychiatry residency programs, 1981-1991

A national survey was conducted to investigate malpractice litigation at United States child and adolescent psychiatry residency programs between 1981 and 1991. Fourteen percent of the directors of child and adolescent psychiatry reported at least one malpractice claim during this period. The highest percentage of lawsuits reported was in the northeast. Suicide and sexual abuse of latency age patients by other patients accounted for the most litigation. The mean monetary award was $167,000, and the largest award was $500,000 for discharge of a patient who killed his mother. There has been an increase in malpractice litigation during the past 10 years. Risk management strategies should be implemented to address areas of liability in child and adolescent psychiatry training programs.     

Abortion incidence and services in the United States, 1995-1996

CONTEXT: In the 1980s, the number of abortion providers in the United States began to decline, and more recently, so has the number of abortions performed. Whether the decline in service providers, which was last documented in 1992, is continuing and whether this influences the availability and number of abortions is of public interest. METHODS: In 1997, the Alan Guttmacher Institute conducted its 12th survey of all known abortion providers in the United States. The number and location of abortion providers and abortions were tabulated for 1995 and 1996, and trends were calculated by comparing these data with those from earlier surveys. Limited data were also gathered on types of abortion procedures. RESULTS: Between 1992 and 1996, the number of abortions fell from 1,529,000 to 1,366,000, and the abortion rate decreased from 26 to 23 per 1,000 women aged 15-44. The number of providers fell 14%, to 2,042, with the greatest decline among hospitals and physicians' offices rather than clinics. Eighty-six percent of counties had no known abortion provider, and 32% of women aged 15-44 lived in these counties. Of the country's 320 metropolitan areas, 89 had no known abortion provider, and for an additional 12, fewer than 50 abortions each were reported. Seventy percent of abortions were performed in specialized clinics and only 7% in hospitals. In the first half of 1997, early medical abortions were being offered in about 160 facilities, virtually all of which were also providers of surgical abortions. CONCLUSIONS: While abortion services in some areas of the country have declined since 1992 and many women continue to have limited access to providers, other factors have probably had more influence on the level of abortions performed. Early medical abortion methods are too new to be a measurable factor in abortion access.     

Basic characteristics of radiology groups in the United States: results of a 1991-1992 census

OBJECTIVE: The American College of Radiology (ACR), the principal professional organization of United States radiologists, receives numerous requests for information on the characteristics of radiology groups. This report describes the basic characteristics of radiology groups in the United States. We defined radiology groups as any practice with two or more radiologists or radiation oncologists, including academic departments, units in multispecialty groups, and staff of government facilities. MATERIALS AND METHODS: To collect basic information on radiology groups, the ACR conducted a mail census of all identified radiology groups in the United States during late 1991 and early 1992. Follow-up was conducted by mail and telephone. To make the responses accurately representative of all radiology groups, we weighted the approximately 2000 responses to correspond to known control totals for the number of groups of each of seven size categories in each of the four census regions (Northeast, Midwest, South, and West). These control totals were obtained from the ACR's 1990 Manpower Survey, which showed a total of approximately 3200 radiology groups. RESULTS: Approximately one fourth of all groups have two radiologists, one fourth have three or four radiologists, one fourth have five to seven radiologists, and one fourth have eight or more radiologists. Academic groups were relatively large; almost 50% had 11 or more radiologists. Nonmetropolitan areas had very few large groups, and metropolitan center cities had relatively few small groups. Ninety-two percent of all groups practiced at hospitals, and 73% of all groups practiced at nonhospital offices or centers. The median number of practice sites for all groups was three, including both hospital and nonhospital sites. Eighty-eight percent of all groups provided diagnostic radiology services, 23% provided radiation oncology, 12% offered both, and 11% were oncology-only groups. Relatively many academic groups (25%) were oncology-only groups; very few radiology groups (2%) in multispecialty practices were oncology-only groups. The diagnostic radiology techniques available from the largest percentages of groups were general radiography (plain film), sonography, mammography, and CT. One eighth of academic groups that provided diagnostic services did not report providing mammography, compared with only a few percent of all groups in the United States that provided diagnostic services. CONCLUSION: Half of all groups have two to four radiologists, and this has not changed since at least 1986. A substantial percentage of groups that perform diagnostic radiology do not provide MR, interventional, or nuclear medicine services. This is particularly true of relatively small groups. These characteristics may become the source of some problems as managed care becomes more prominent and larger groups, offering a full range of services and practicing at several sites, are favored by managed care organizations that seek to contract with one group for all their radiology services.     

Comparison of cardiology training programs in Canada and the United States

To compare the composition of cardiology training programs in Canada and the USA, we surveyed the directors of all Canadian and American training programs. We found that Canadian trainees performed significantly fewer procedures than USA trainees and that the chief determinants of numbers of procedures performed are duration of time spent in a rotation and the type of hospital where the program is based.     

Radionuclides in domestic and imported foods in the United States, 1987-1992

Findings from the U.S. Food and Drug Administration's Radionuclides in Foods program are summarized for foods collected between October 1, 1986, and September 30, 1992. Concentrations of radionuclide activity in the Total Diet Study and reactor-survey foods were in Range 1 or low in Range II of the surveillance and control recommendations of the Federal Radiation Council; no control actions were suggested. Dietary intake of 90Sr continued the general decline observed since 1961. Approximately 2600 test portions of imported foods were analyzed for contamination associated with the Chernobyl nuclear accident. Concentrations of radionuclide activity were below limits of detection for the vast majority of the imported food test portions but were above the levels of concern for 23 portions. Since 1986, the fraction of imported food test portions having measurable amounts of contamination has steadily declined, as have the average concentrations of radionuclide activity; however, contamination is still occasionally found. Continued monitoring of both domestic and imported foods is planned.     

Traumatic occupational fatalities in the retail industry, United States 1992-1996

BACKGROUND: Retail is a growing economic sector and employs an increasing number of the overall workforce, yet little is known about the incidence and characteristics of work-related deaths in the retail industry. METHODS: Workplace deaths were examined using the Census of Fatal Occupational Injuries from 1992 through 1996. Occupational fatality rates were calculated by age, gender, and type of establishment, and characteristics of occupational deaths in the retail industry were compared to other industries. RESULTS: Liquor stores had the highest work-related fatality rates in the retail industry. The two leading causes of death in the retail industry were violence (69.5%) and motor vehicle crashes (19.3%). Females, younger, minority, and foreign-born workers were more likely to be killed in retail than other industries. Deaths in the retail industry were more likely to be in small businesses, after normal business hours, and in urban settings. DISCUSSION: Workers in the retail industry were at lower risk of most types of workplace deaths but had a markedly increased risk of violent death than workers in other industries.     

Medical informatics training in pathology residency programs

An iron-mediated oxidative stress caused by an increase of the intracellular pool of low molecular weight complex of iron (LMWC) can be observed with iron overloading or ethanol metabolism. The aim of this study was to determine whether nitric oxide (NO) behaved as a pro-oxidant or an antioxidant in such an iron-mediated oxidative stress in rat hepatocytes. The cells were set up in primary cultures and incubated with lipopolysaccharide (LPS) and gamma-interferon (IFN) for 18 hours to induce NO synthase and to trigger NO production. Then 20 micromol/L iron or 50 mmol/L ethanol were added. Oxidative stress was evaluated by measuring lipoperoxidation using two markers: malondialdehyde (MDA) and conjugated dienes. Simultaneously, NO production was followed by the quantitation of nitrites in the culture medium, dinitrosyl iron complexes (DNICs) and mononitrosyl iron complexes (MNICs) in intact hepatocytes. DNIC and MNIC, evaluated by electron paramagnetic resonance (EPR), corresponded to NO bound to iron-containing molecules and to free NO, respectively. In cultures preincubated with LPS and IFN before iron or ethanol addition, a net decrease of lipid peroxidation induced by either NO, iron, or ethanol was noted. Moreover, an elevation of iron-bound NO and a decrease of free NO were observed in these cultures compared with the cultures incubated with only LPS and IFN. These data support the idea that there is a relationship between the changes of NO pool and the inhibition of oxidative stress. In addition, using N(G)-monomethyl-L-arginine (L-NMMA), a NO synthase inhibitor, NO was shown to be involved in the inhibition of oxidative stress induced by iron or ethanol. Addition of the chelator of LMWC iron, deferiprone, was followed by the inhibition of the increase of iron-bound NO and the reincrease of lipid peroxidation extent, which was as high as in cultures incubated only with LPS and IFN. Thus LMWC iron appeared to be involved also in the inhibition of oxidative stress induced by NO. All the results favor the conclusion that NO acts as an antioxidant in iron-mediated oxidative stress in rat hepatocytes. NO reacted with LMWC iron to form inactive iron complexes unable to induce oxidative stress in rat hepatocytes. Thus NO played a critical role in protecting the liver from oxidative stress.     

Foreign residency: specialist candidate in the United States

OBJECTIVE: Endotoxin as the inciting agent of cytokines and other mediators, whose high level expression correlates with the septic shock and MOF, has been the one of leading causes of death in ICU. METHODS: For treating sepsis and MOF caused by endotoxin, the anti-lipid A of LPS antibody was used, 19 burned patients whose TBSA varied from 50% to 100% were divided into anti-LPS treatment group and nontreated group. RESULTS: The levels of serum endotoxin, IL-6, IL-8, TNF and soluble IL-2R were lower obviously in patients of anti-LPS group than those of nontreated group (P < 0.05). CONCLUSION: Clinical study surggests that anti-lipid A of LPS antibody can act as an therapeutic agent against gram-negative bacterin infection in burned patients.     

Exercise stress test training in family practice residency programs

EST is a commonly indicated procedure in primary care medicine and as such is well suited for use by family physicians. At present there are few family physicians performing this procedure in their offices. Our survey of US family practice residency directors has shown an interest well above what would be expected for the level of current practice in the community; however, there remains an ambivalence on the need to provide EST training in the curriculum.     

The fall after the rise: Tuberculosis in the United States, 1991 through 1994

A thrombin-like enzyme, balterobin, was purified from the venom of Bothrops alternatus. The purification steps included Sephadex G-75, heparin-sepharose and reverse phase HPLC C-18 column. Balterobin showed an apparent molecular weight of 30,000 in non-reduced conditions and displays a specific coagulant activity of 32.8 NIH units/mg over bovine fibrinogen. It also exhibits arginine amidase activity on DL-BAPNA. Like thrombin-like enzymes from other snakes, balterobin possesses valine as N-terminal residue, and is inhibited by PMSF.     

Age-dependent inaccuracy of asthma death certification in Northern England, 1991-1992

OBJECTIVE: To test the usefulness of a commercial DNA hybridization assay for the detection of high-risk (HR) human papillomavirus (HPV) types in archival cervical smears and to compare the sensitivity with that of polymerase chain reaction (PCR) using consensus primers. STUDY DESIGN: Stained material was scraped from archival slides and the pellet volume noted. DNA was extracted using silica/guanidinium isothiocyanate and the quality checked by amplification of the beta-globin gene. HR-HPV DNA was detected using a commercial hybrid capture assay (HCA) and the results compared with an in-house amplification system with consensus primers. RESULTS: Of 156 archival smears stored for 12-13 years, 20 were positive by HCA using an HR probe cocktail. Ninety-eight were also tested by PCR, and 35 were positive. The percentage of HPV-positive samples increased with the increasing size of the pellet. HR-HCA detected more positives in samples with high grade squamous intraepithelial lesion (moderate/severe dyskaryosis). CONCLUSION: Both hybridization by HCA and amplification by PCR could be used to detect genital HPV in archival smears. The general primers PCR detected more positives than HR-HCA but included HPV 6/11. While variation in sample size and prolonged storage may reduce the quality of DNA, the use of archival material for longitudinal studies of HPV presence is potentially worthwhile.     

Biomonitoring of United States Army soldiers serving in Kuwait in 1991

Biomarkers of polycyclic aromatic hydrocarbon (PAH) exposure and genetic biomarkers of potential cancer susceptibility were determined in a group of United States Army soldiers who were deployed to Kuwait and Saudi Arabia in 1991 in the aftermath of the Persian Gulf War. Because hundreds of oil well fires were still burning, there was concern that ground troops stationed in Kuwait might be exposed to high levels of PAHs and other toxicants. The United States Army Environmental Hygiene Agency monitored air and soil for ambient PAHs. In addition, a group of 61 soldiers was involved in the biomonitoring study reported here. These soldiers kept diaries of daily activities and provided blood and urine samples in Germany (June) before deployment to Kuwait, after 8 weeks in Kuwait (August), and 1 month after the return to Germany (October). Here we present data for PAH-DNA adducts measured by immunoassay in blood cell DNA samples obtained at all three sampling times from 22 soldiers and bulky aromatic adducts measured by 32P-postlabeling in blood cell DNA samples from 20 of the same soldiers. Urinary 1-hydroxypyrene-glucuronide levels were determined by synchronous fluorescence spectrometry in a matched set of samples from 33 soldiers. Contrary to expectations, environmental monitoring showed low ambient PAH levels in the areas where these soldiers were working in Kuwait. For both DNA adduct assays, levels were the lowest in Kuwait in August and increased significantly after the soldiers returned to Germany (October). Urinary 1-hydroxypyrene-glucuronide levels were also lowest in Kuwait and highest in Germany, but the differences were not statistically significant. The PAH-exposure biomarker levels were not significantly influenced by polymorphic variations of CYP1A1 (MspI) and glutathione S-transferases M1 and T1. Overall, the data suggest that this group of soldiers was not exposed to elevated levels of PAHs while deployed in Kuwait.     

Uses of nitric oxide in obstetrics and gynecology

A cDNA clone encoding a human ribosomal protein L39 (hRPL39) was isolated through a random cDNA sequencing approach to a cDNA library constructed from a human colon carcinoma cell line of COLO 205. Although levels of hRPL39 mRNA were different in several cell lines including carcinoma cell lines from different tissues, they were shown not to be cell cycle-dependent in a human fibroblast cell line of TIG-1.