Virtual patient simulator for distributed collaborative medical education. (49/443)

Project TOUCH (Telehealth Outreach for Unified Community Health; http://hsc.unm.edu/touch) investigates the feasibility of using advanced technologies to enhance education in an innovative problem-based learning format currently being used in medical school curricula, applying specific clinical case models, and deploying to remote sites/workstations. The University of New Mexico's School of Medicine and the John A. Burns School of Medicine at the University of Hawai'i face similar health care challenges in providing and delivering services and training to remote and rural areas. Recognizing that health care needs are local and require local solutions, both states are committed to improving health care delivery to their unique populations by sharing information and experiences through emerging telehealth technologies by using high-performance computing and communications resources. The purpose of this study is to describe the deployment of a problem-based learning case distributed over the National Computational Science Alliance's Access Grid. Emphasis is placed on the underlying technical components of the TOUCH project, including the virtual reality development tool Flatland, the artificial intelligence-based simulation engine, the Access Grid, high-performance computing platforms, and the software that connects them all. In addition, educational and technical challenges for Project TOUCH are identified.  (+info)

Methodological issues in the surveillance of poisoning, illicit drug overdose, and heroin overdose deaths in new Mexico. (50/443)

New Mexico leads the nation in poisoning mortality, which has increased during the 1990s in New Mexico and the United States. Most of this increase has been due to unintentional deaths from illicit drug overdoses. Medical examiner and/or vital statistics data have been used to track poisoning deaths. In this study, the authors linked medical examiner and vital statistics records on underlying cause of death, coded using the International Classification of Diseases, Ninth Revision, to assess the extent to which these data sources agreed with respect to poisoning deaths. The authors used multiple-cause files, which are files with several causes listed for each death, to further assess poisoning deaths involving more than one drug. Using vital statistics or medical examiner records, 94.7% of poisoning deaths were captured by each source alone. For unintentional illicit drug and heroin overdose deaths, each data source alone captured smaller percentages of deaths. Deaths coded as E858.8 (unintentional poisoning due to other drugs) require linkage with medical examiner or multiple-cause records, because this code identifies a significant percentage of illicit drug overdose deaths but obscures the specific drug(s) involved. Surveillance of poisoning death should include the use of medical examiner records and underlying- and multiple-cause vital statistics records.  (+info)

Lower extremity amputation episodes among persons with diabetes--New Mexico, 2000. (51/443)

Lower extremity amputation (LEA) is one of the most disabling complications of diabetes. Lower extremity problems tend to recur among persons because of underlying complications, including the loss of "protective" sensation. To define the burden of LEA among persons with diabetes in New Mexico, the New Mexico Diabetes Prevention and Control Program (DPCP) analyzed data from the Hospital Inpatient Discharge Database (HIDD) and the Santa Fe Indian Hospital (SFIH) from 2000 by linking hospital discharges to persons to create "episodes" of LEA. This report summarizes the findings of that analysis, which indicated that the age-adjusted rate of LEA by episode was approximately 3.5 times higher for American Indians (AIs) (11.4 per 1,000 persons with diabetes) than for non-Hispanic whites (3.3). To address this disparity, DPCP is collaborating with the Indian Health Service (IHS) to determine the needs for foot-care resources and education in AI communities.  (+info)

Adiposity and sex hormones in postmenopausal breast cancer survivors. (52/443)

PURPOSE: Overweight and obese women with breast cancer have poorer survival compared with thinner women. One possible reason is that breast cancer survivors with higher degrees of adiposity have higher concentrations of tumor-promoting hormones. This study examined the association between adiposity and concentrations of estrogens, androgens, and sex hormone-binding globulin (SHBG) in a population-based sample of postmenopausal women with breast cancer. METHODS: We studied the associations between body mass index (BMI), body fat mass, and percent body fat, measured by dual-energy x-ray absorptiometry scan, waist circumference, and waist-to-hip circumference ratio, with concentrations of estrone, estradiol, testosterone, SHBG, dehydroepiandrosterone sulfate, free estradiol, and free testosterone in 505 postmenopausal women in western Washington and New Mexico with incident stage 0 to IIIA breast cancer. Blood and adiposity measurements were performed between 4 and 12 months after diagnosis. RESULTS: Obese women (BMI > or = 30) had 35% higher concentrations of estrone and 130% higher concentrations of estradiol compared with lighter-weight women (BMI < 22.0; P =.005 and.002, respectively). Similar associations were observed for body fat mass, percent body fat, and waist circumference. Testosterone concentrations also increased with increasing levels of adiposity (P =.0001). Concentrations of free estradiol and free testosterone were two to three times greater in overweight and obese women compared with lighter-weight women (P =.0001). CONCLUSION: These data provide information about potential hormonal explanations for the association between adiposity and breast cancer prognosis. These sex hormones may be useful biomarkers for weight loss intervention studies in women with breast cancer.  (+info)

The Zuni kidney project: a collaborative approach to an epidemic of kidney disease. (53/443)

There is an epidemic of renal disease among the Zuni Indians. In contrast to most other American-Indian communities, the epidemic of renal disease among the Zuni Indians reflects high rates of diabetic and nondiabetic renal disease. Almost every Zuni Indian has a relative with end-stage renal disease. This epidemic offers a unique opportunity to advance our understanding of the risk factors for the susceptibility and/or progression of renal disease. Thus, Zuni Tribal leaders formed a research partnership with the University of New Mexico Health Sciences Center, Indian Health Service, Southwest Foundation for Biomedical Research and Dialysis Clinic Inc., to establish the Zuni Kidney Project (ZKP). The ZKP conducted a population-based, cross-sectional survey of the Zuni Pueblo. Age and gender distributions among survey participants were similar to those of the eligible Zuni population. Among diabetics the prevalence (95% confidence interval) of incipient albuminuria (IA) was 32.3% (25.1, 39.5) in women and 36.1% (24.7, 47.5) in men. The prevalence of IA among nondiabetics was 9.3% (6.9, 11.7) in women and 12.2% (9.7, 14.7) in men. Among diabetics, the prevalence of overt albuminuria (OA) was 17.7% (11.9, 23.5) in women and 20.8% (11.4, 30.2) in men. Among nondiabetics, OA was present in 1.2% (0.3, 2.1) of women and 2.3% (1.1, 3.5) of men. Although IA and OA were each more common among diabetics, the majority of participants with albuminuria were nondiabetics. Hematuria was common among both diabetics and nondiabetics. Among diabetics, the crude prevalence of hematuria was similar among men and women. Among nondiabetics, however, hematuria was more common among women. Diabetes and obesity were more common among women than men. In contrast, hypertension and hypercholesterolemia were more common among men than women. The ZKP is incorporating these preliminary data into planning for the development and implementation of primary and secondary prevention programs.  (+info)

Imported plague--New York City, 2002. (54/443)

On November 1, 2002, a married couple traveled from Santa Fe County, New Mexico, to New York City (NYC), where they both became ill with fever and unilateral inguinal adenopathy; bubonic plague (Yersinia pestis) was diagnosed subsequently. This report summarizes the clinical and public health investigation of these cases and underscores the importance of rapid diagnosis and communication among health-care providers, public health agencies, and the public when patients seek medical attention for an illness that might be caused by an agent of terrorism.  (+info)

Sex differences in the thermoregulation and evaporative water loss of a heterothermic bat, Lasiurus cinereus, during its spring migration. (55/443)

This study quantifies sex differences in thermoregulation and water loss of a small (20-35 g) insectivorous heterothermic mammal, the hoary bat Lasiurus cinereus, during its spring migration. We measured body temperature, metabolic rate and evaporative water loss, and calculated wet thermal conductance, for bats exposed to air temperatures ranging from 0 to 40 degrees C for periods of 2-5 h. Pregnant females maintained normothermic body temperatures (35.7+/-0.7 degrees C; mean +/- S.E.M.) independent of air temperature. In contrast, males became torpid during the majority (68%) of exposures to air temperatures <25 degrees C. The thermal neutral zone (TNZ) ranged between approximately 30 degrees C and 34 degrees C in both sexes and, within the TNZ, females had lower mass-specific metabolic rates (6.1+/-0.2 mW g(-1)) than males (9.0+/-0.9 mW g(-1)). Wet thermal conductance values in torpid bats (0.7+/-0.5 mW g(-1) deg.(-1)) were lower than those of normothermic individuals (1.1+/-0.3 mW g(-1) deg.(-1)). Mass-specific rates of evaporative water loss in males were consistently higher than in females at most air temperatures and rates of water loss in torpid bats were 63+/-6% of normothermic values. These results suggest that male and pregnant female L. cinereus employ different thermoregulatory strategies during their spring migration. Females defend normothermic body temperatures, presumably to expedite embryonic growth, while males use torpor, presumably to minimize energy and water deficits. These variable thermoregulatory strategies may reflect continental differences in the summer distribution of the sexes.  (+info)

Tickborne relapsing fever outbreak after a family gathering--New Mexico, August 2002. (56/443)

On August 2, 2002, the New Mexico Department of Health (NMDOH) and the Indian Health Service (IHS) were notified of a tickborne relapsing fever (TBRF) outbreak after a 1-day family gathering held in late July at a remote, previously uninhabited cabin located in a mountainous region of northern New Mexico (elevation: approximately 8,000 feet). Approximately 40 persons attended the event; at least half slept overnight in the cabin. This report summarizes the investigation of this outbreak, which indicates that prompt diagnosis and collaboration among clinicians and public health authorities can reduce morbidity associated with TBRF. Persons living in areas where TBRF is endemic should avoid sleeping in rodent-infested buildings, rodent-proof susceptible buildings, and consider fumigation of buildings that harbor rodents.  (+info)