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More than 100 botanists have collected vascular plant specimens from the Wind River Range in northwestern Wyoming, U.S.A., and at least seven floristic surveys have been conducted in portions of the range. Until now, however, no comprehensive checklist has been developed for the area. We collected or examined over 28,600 specimens from the Wind Rivers to compile an annotated checklist of 1282 species and varieties, representing nearly 45 percent of the flora of Wyoming. The species richness of the Winds is second only to Yellowstone National Park in western Wyoming. This can be attributed to the presence of a variety of substrates, broad elevation range, and diversity of vegetation types. Ten subregions are recognized within the Wind Rivers that differ in geology, climate, elevation, and floristic diversity. From a conservation perspective, the Wind River Range is significant for having 82 rare plant species and in having three-quarters of its plant taxa present in wilderness areas or other formally protected lands. Más de 100 botánicos han colectado especimenes de plantas vasculares en la Wind River Range en el noroeste de Wyoming, U.S.A., y al menos se han llevado a cabo siete estudios florísticos en partes de la cordillera. Hasta ahora, sin embargo, no se ha desarrollado ningún catálogo global para el área. Hemos colectado o examinado más de 28,600 especimenes de los Wind Rivers para compilar un catálogo anotado de 1282 especies y variedades, que representan cerca del 45 por ciento de la flora de Wyoming. La riqueza de especies de los Winds es la segunda solo después del Yellowstone National Park en el oeste de Wyoming. Esto pude ser atribuido a la presencia de una variedad de substratos, amplio rango de elevación, y diversidad de tipos de vegetación. Se reconocen diez subregiones dentro de los Wind Rivers que difieren en geología, clima, elevación, y diversidad florística. Bajo la perspectiva de la conservación, la Wind River Range es significativa por tener 82 especies de planta raras y por tener tres cuartos de sus taxa vegetales presentes en áreas salvajes u otros espacios protegidos formalmente. [ABSTRACT FROM AUTHOR]

This article investigates the relationship between international trade patterns and the global distribution of coarse grain production responses to market developments in the United States. Our null hypothesis is that world markets are fully integrated, rendering the geographic persistence of bilateral trade flows irrelevant in the global production response to a change in U.S. prices. The alternative hypothesis allows price transmission to vary along with the intensity of competition among countries in specific markets. Using data from 1975 to 2002, we reject the null hypothesis. Our work has direct implications for the analysis of the global land use impacts of biofuel mandates. [ABSTRACT FROM AUTHOR]

Introduction: Hypertension is the leading risk factor for morbidity and mortality throughout the world and is pervasive in United States emergency departments (ED). This study documents the point prevalence of subclinical heart disease in emergency patients with asymptomatic hypertension., Method: This was a prospective observational study of ED patients with asymptomatic hypertension conducted at two urban academic EDs that belong to an eight-hospital healthcare organization in New York. Adult (≥18 years of age) English- or Spanish-speaking patients who had an initial blood pressure (BP) ≥160/100 millimeters of mercury (mmHg) and second BP ≥140/90 mm Hg, and pending discharge, were invited to participate in the study. We excluded patients with congestive heart failure, renal insufficiency, and atrial fibrillation, or who were pregnant, a prisoner, cognitively unable to provide informed consent, or experiencing symptoms of hypertension. We assessed echocardiographic evidence of subclinical heart disease (left ventricular hypertrophy, and diastolic and systolic dysfunction)., Results: A total of 53 patients were included in the study; a majority were young (mean 49.5 years old, [SD 14-52]), self-identified as Black or Other (n = 39; 73.5%), and female (n = 30; 56.6%). Mean initial blood pressure was 172/100 mm Hg, and 24 patients (45.3%) self-reported a history of hypertension. Fifty patients completed an echocardiogram. All (100%) had evidence of subclinical heart disease, with 41 (77.4%) displaying left ventricular hypertrophy and 31 (58.5%) diastolic dysfunction. There was a significant relationship between diastolic dysfunction and female gender [x 2 (1, n = 53) = 3.98; P  = 0.046]; Black or other race [x 2 (3, n = 53) = 9.138; P  = 0.03] and Hispanic or other ethnicity [x 2 (2, n = 53) = 8.03; P  = 0.02]. Less than one third of patients demonstrated systolic dysfunction on echocardiogram, and this was more likely to occur in patients with diabetes mellitus [x 2 (1, n = 51) = 4.84; P  = 0.02]., Conclusion: There is a high probability that Black, Hispanic, and female patients with asymptomatic hypertension are on the continuum for developing overt heart failure. Emergency clinicians should provide individualized care that considers their unique health needs, cultural backgrounds, and social determinants of health., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This project was funded by the Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai, the Center for Nursing Research and Innovation at the Mount Sinai Health System, and the Gordon and Betty Moore Foundation through the Betty Irene Moore Fellowship for Nurse Leaders and Innovators (GBMF9048). There are no other conflicts of interest or sources of funding to declare.

Importance: Magnetic resonance imaging (MRI) and potential MRI-guided biopsy enable enhanced identification of clinically significant prostate cancer. Despite proven efficacy, MRI and potential MRI-guided biopsy remain costly, and there is limited evidence regarding the cost-effectiveness of this approach in general and for different prostate-specific antigen (PSA) strata., Objective: To examine the cost-effectiveness of integrating annual MRI and potential MRI-guided biopsy as part of clinical decision-making for men after being screened for prostate cancer compared with standard biopsy., Design, Setting, and Participants: Using a decision analytic Markov cohort model, an economic evaluation was conducted projecting outcomes over 10 years for a hypothetical cohort of 65-year-old men in the US with 4 different PSA strata (<2.5 ng/mL, 2.5-4.0 ng/mL, 4.1-10.0 ng/mL, >10 ng/mL) identified by screening through Monte Carlo microsimulation with 10 000 trials. Model inputs for probabilities, costs in 2020 US dollars, and quality-adjusted life-years (QALYs) were from the literature and expert consultation. The model was specifically designed to reflect the US health care system, adopting a federal payer perspective (ie, Medicare)., Exposures: Magnetic resonance imaging with potential MRI-guided biopsy and standard biopsy., Main Outcomes and Measures: Incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $100 000 per QALY was estimated. One-way and probabilistic sensitivity analyses were performed., Results: For the 3 PSA strata of 2.5 ng/mL or greater, the MRI and potential MRI-guided biopsy strategy was cost-effective compared with standard biopsy (PSA 2.5-4.0 ng/mL: base-case ICER, $21 131/QALY; PSA 4.1-10.0 ng/mL: base-case ICER, $12 336/QALY; PSA >10.0 ng/mL: base-case ICER, $6000/QALY). Results varied depending on the diagnostic accuracy of MRI and potential MRI-guided biopsy. Results of probabilistic sensitivity analyses showed that the MRI and potential MRI-guided biopsy strategy was cost-effective at the willingness-to-pay threshold of $100 000 per QALY in a range between 76% and 81% of simulations for each of the 3 PSA strata of 2.5 ng/mL or more., Conclusions and Relevance: This economic evaluation of a hypothetical cohort suggests that an annual MRI and potential MRI-guided biopsy was a cost-effective option from a US federal payer perspective compared with standard biopsy for newly eligible male Medicare beneficiaries with a serum PSA level of 2.5 ng/mL or more.

Background: Little is known about the relationship between sleep and obesity in young adults, particularly college students. This study examined the relationship between sleep (i.e., sleep duration and quality) and obesity in a large and diverse binational sample of college students., Methods: Analyses were based on a 40-item paper survey from 2016/2017 to 2017/2018 academic years, with a 72% response rate. The samples were 1578 college students aged 18-25 years from five universities (two in the U.S. and three in South Korea). Weight and height were measured objectively; other measures (e.g., health behaviors) were self-reported. Multinomial logistic regression was used to assess the association between sleep duration and independent variables (race/nationality, gender, and BMI). Poisson regression was used to examine the relationship between sleep quality and independent variables., Results: Overall, blacks had a higher adjusted odds ratio (AOR) of short sleep (< 7 h/night) than whites (AOR = 1.74, P < .01); overweight participants had a higher AOR of short sleep than normal weight participants (AOR = 1.52, P < .01); and obese participants had a higher AORs of both short and long sleep (> 9 h/night) (AOR = 1.67, P < .01; AOR = 1.79, P < .05, respectively). Among men, being black, overweight, and obesity were associated with short sleep (P < .05), whereas only obesity was related to short sleep among women (P < .05). In analyses stratified by race and nationality, overweight and obesity were related to short sleep among blacks only (P < .05). Overall, sleep quality (getting enough sleep to feel rested in the morning in the past 7 days) was worse in blacks and South Koreans than whites (P < .05), worse in women than men (P < .05), and worse in participants with obesity than normal weight participants (P < .05)., Conclusions: Obesity was associated with both short (< 7 h/night) and long sleep duration (> 9 h/night) and poor sleep quality among all participants. In comparison with whites, blacks were more like to have short sleep, and blacks and South Koreans had worse sleep quality. Further investigations using a larger sample of college students in multiple countries may be helpful to identify target populations who are at a greater risk of obesity and sleep problems.

Background: Patients with stable coronary heart disease (CHD) have widely varying prognoses and treatment options. Validated models for risk stratification of patients with CHD are needed. We sought to evaluate traditional and novel risk factors as predictors of secondary cardiovascular (CV) events, and to develop a prediction model that could be used to risk stratify patients with stable CHD., Methods and Results: We used independent derivation (912 participants in the Heart and Soul Study) and validation (2876 participants in the PEACE trial) cohorts of patients with stable CHD to develop a risk prediction model using Cox proportional hazards models. The outcome was CV events, defined as myocardial infarction, stroke, or CV death. The annual rate of CV events was 3.4% in the derivation cohort and 2.2% in the validation cohort. With the exception of smoking, traditional risk factors (including age, sex, body mass index, hypertension, dyslipidemia, and diabetes) did not emerge as the top predictors of secondary CV events. The top 4 predictors of secondary events were the following: N-terminal pro-type brain natriuretic peptide, high-sensitivity cardiac troponin T, urinary albumin:creatinine ratio, and current smoking. The 5-year C-index for this 4-predictor model was 0.73 in the derivation cohort and 0.65 in the validation cohort. As compared with variables in the Framingham secondary events model, the Heart and Soul risk model resulted in net reclassification improvement of 0.47 (95% CI 0.25 to 0.73) in the derivation cohort and 0.18 (95% CI 0.01 to 0.40) in the validation cohort., Conclusions: Novel risk factors are superior to traditional risk factors for predicting 5-year risk of secondary events in patients with stable CHD., (© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)

Context: Vasomotor symptoms (VMS) are common. Whether VMS are associated with fracture incidence or bone mineral density (BMD) levels is unknown., Objective: This study aimed to examine associations of baseline VMS with fracture incidence and BMD., Design: This was a prospective observational study with mean (SD) followup of 8.2 (1.7) years (1993-2005)., Setting: Forty United States clinical centers., Participants: We examined data from Women's Health Initiative Clinical Trial participants (n = 23 573) age 50-79 years not using menopausal hormone therapy, and 4,867 participants of the BMD sub-study., Interventions: None., Main Outcome Measures: We measured baseline VMS, incident adjudicated fractures, and BMD (baseline, annual visits 1, 3, 6, and 9)., Results: After adjustment for baseline age, body mass index, race/ethnicity, smoking, and education, the hazard ratio for hip fracture among women with baseline moderate/severe VMS (vs no VMS) was 1.78 (95% confidence interval [CI], 1.20-2.64; P = .01). There was no association between VMS and vertebral fracture. VMS severity was inversely associated with BMD during followup (P = .004 for femoral neck, P = .045 for lumbar spine). In repeated measures models, compared with women who reported no VMS, women with moderate/severe VMS had 0.015 g/cm(2) lower femoral neck BMD (95% CI, -0.025--0.005) and 0.016 g/cm(2) lower lumbar spine BMD (95% CI, -0.032--0.004)., Conclusions: Women with moderate/severe VMS have lower BMD and increased hip fracture rates. Elucidation of the biological mechanisms underlying these associations may inform the design of preventive strategies for at-risk women prior to occurrence of fracture.

Context: The United States Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture (MOF) is at least 9.3% using the Fracture Risk Assessment Tool. In postmenopausal women age 50-64 years old, it is uncertain how the USPSTF screening strategy compares with the Osteoporosis Self-Assessment Tool and the Simple Calculated Osteoporosis Risk Estimate (SCORE) in discriminating women who will and will not experience MOF., Objective: This study aimed to assess the sensitivity, specificity, and area under the receiver operating characteristic curve of the three strategies for discrimination of incident MOF over 10 years of follow-up among postmenopausal women age 50-64 years., Setting and Design: This was a prospective study conducted between 1993-2008 at 40 US Centers., Participants: We analyzed data from participants of the Women's Health Initiative Observational Study and Clinical Trials, age 50-64 years, not taking osteoporosis medication (n = 62 492)., Main Outcome Measures: The main outcome was 10-year (observed) incidence of MOF., Results: For identifying women with incident MOF, sensitivity of the strategies ranged from 25.8-39.8%, specificity ranged from 60.7-65.8%, and AUC values ranged from 0.52-0.56. The sensitivity of the USPSTF strategy for identifying incident MOF ranged from 4.7% (3.3-6.0) among women age 50-54 years to 37.3% (35.4-39.1) for women age 60-64 years. Adjusting the thresholds to improve sensitivity resulted in decreased specificity., Conclusions: Our findings do not support use of the USPSTF strategy, Osteoporosis Self-Assessment Tool, or SCORE to identify younger postmenopausal women who are at higher risk of fracture. Our findings suggest that fracture prediction in younger postmenopausal women requires assessment of risk factors not included in currently available strategies.

The US Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture is ≥ 9.3%. For identifying screening candidates among women aged 50 to 64 years, it is uncertain how the USPSTF strategy compares with the Osteoporosis Self-Assessment Tool (OST) and the Simple Calculated Osteoporosis Risk Estimate (SCORE). We examined data (1994 to 2012) from 5165 Women's Health Initiative participants aged 50 to 64 years. For the USPSTF (Fracture Risk Assessment Tool [FRAX] major fracture risk ≥ 9.3% calculated without bone mineral density [BMD]), OST (score <2), and SCORE (score >7) strategies, we assessed sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to discriminate between those with and without femoral neck (FN) T-score ≤-2.5. Sensitivity, specificity, and AUC for identifying FN T-score ≤-2.5 were 34.1%, 85.8%, and 0.60 for USPSTF (FRAX); 74.0%, 70.8%, and 0.72 for SCORE; and 79.8%, 66.3%, and 0.73 for OST. The USPSTF strategy identified about one-third of women aged 50 to 64 years with FN T-scores ≤-2.5. Among women aged 50 to 64 years, the USPSTF strategy was modestly better than chance alone and inferior to conventional SCORE and OST strategies in discriminating between women with and without FN T-score ≤-2.5., (© 2014 American Society for Bone and Mineral Research.)

Background: Fibroblast growth factor-23 (FGF-23) is a phosphaturic factor previously associated with left ventricular hypertrophy and systolic dysfunction among individuals with chronic kidney disease. Whether FGF-23 acts directly to induce left ventricular hypertrophy, potentially independent of its klotho coreceptor, remains uncertain. We investigated associations of FGF-23 with cardiac structural abnormalities among individuals with a broad range of kidney function and explored potential biological mechanisms using cardiac magnetic resonance imaging and histology in klotho-null mice, an established model of constitutively elevated FGF-23., Methods and Results: Among 887 participants with coronary artery disease in the Heart and Soul Study, FGF-23 was modestly associated with worse left ventricular ejection fraction (-1.0% per standard deviation increase in lnFGF-23; standard error, 0.4%), but was not associated with the overall prevalence of concentric hypertrophy (odds ratio, 1.5; CI, 0.9 to 2.4) or eccentric hypertrophy (odds ratio, 1.1; CI, 0.9 to 1.3). FGF-23 was only associated with concentric hypertrophy among individuals with diminished kidney function (eGFR <60 mL/min per 1.73 m(2); odds ratio, 2.3; CI, 1.0 to 5.3; P-interaction=0.28). Comparing klotho-null with wild-type mice, null mice did not have greater left ventricular mass (P=0.37) or a lower ejection fraction (P=0.94)., Conclusions: Together, our results suggest that FGF-23 is unlikely to have major effects on cardiovascular structure and function among patients free of substantial chronic kidney disease, and these effects may not be independent of the klotho coreceptor.

Background: Among adults in the United States, asthma prevalence is disproportionately high among African American women; this group also experiences the highest levels of asthma-linked mortality and asthma-related health care utilization. Factors linked to biological sex (e.g., hormonal fluctuations), gender roles (e.g., exposure to certain triggers) and race (e.g., inadequate access to care) all contribute to the excess asthma burden in this group, and also shape the context within which African American women manage their condition. No prior interventions for improving asthma self-management have specifically targeted this vulnerable group of asthma patients. The current study aims to evaluate the efficacy of a culturally- and gender-relevant asthma-management intervention among African American women., Methods/design: A randomized controlled trial will be used to compare a five-session asthma-management intervention with usual care. This intervention is delivered over the telephone by a trained health educator. Intervention content is informed by the principles of self-regulation for disease management, and all program activities and materials are designed to be responsive to the specific needs of African American women. We will recruit 420 female participants who self-identify as African American, and who have seen a clinician for persistent asthma in the last year. Half of these will receive the intervention. The primary outcomes, upon which the target sample size is based, are number of asthma-related emergency department visits and overnight hospitalizations in the last 12 months. We will also assess the effect of the intervention on asthma symptoms and asthma-related quality of life. Data will be collected via telephone survey and medical record review at baseline, and 12 and 24 months from baseline., Discussion: We seek to decrease asthma-related health care utilization and improve asthma-related quality of life in African American women with asthma, by offering them a culturally- and gender-relevant program to enhance asthma management. The results of this study will provide important information about the feasibility and value of this program in helping to address persistent racial and gender disparities in asthma outcomes., Trial Registration: ClinicalTrials.gov: NCT01117805.

Oral bisphosphonates are first-line therapy for the prevention and treatment of osteoporosis in postmenopausal women. Although bisphosphonate treatment has been shown to reduce fractures in randomized, controlled trials, the number of women treated and fractures prevented over the years have not been determined. This study estimated the numbers of women treated and fractures reduced with oral bisphosphonates in the United States from 2001 through 2008. Two medical claims databases for 2001-2008 were combined to determine numbers of women aged 45 years and older filling prescriptions for bisphosphonates by time-dependent medication possession ratios (MPRs): <50%, 50% to 79%, and ≥ 80%. Fracture incidence was compared for each cohort by MPR category relative to the referent cohort with <50% MPR. Fracture rates were extrapolated to the US female population treated with oral bisphosphonates by MPR category over this 8-year period. From 2001 through 2008, 460,584 women in the databases initiated treatment with oral bisphosphonates, with an average follow-up time of 2.4 years. Overall fracture rates declined with improved MPR from 1.52% for the lowest MPR category to 1.18% for the highest MPR category for ages 45 to 64 years and from 5.12% to 3.75% for those aged 65 years or older. Extrapolating to the US population of female bisphosphonate users, we estimate over 27.9 million person-years of bisphosphonate treatment with MPR 50% or greater and 144,670 fractures prevented. Treatment with oral bisphosphonates has prevented a substantial number of fractures. Even more fractures would have been prevented if recognition, treatment, and compliance were improved., (© 2011 American Society for Bone and Mineral Research.)

Two studies were conducted to examine the practical implementation of an integrated health care model in five primary care clinics in the Upstate New York Veterans Affairs (VA) system. The aims of the studies were: (a) to describe the basic clinical elements of the integrated health care service offered by behavioral health providers (BHPs) in the primary care setting, and (b) to evaluate the perceptions of providers and patients regarding integrated health care practices in their primary care clinics. In Study 1, we reviewed 180 electronic medical records of patients who met with a BHP in primary care. In Study 2, we used semistructured interviews and self-report questionnaires to collect information from 46 primary care providers, 12 BHPs, and 140 patients regarding their perceptions of integrated health care in their primary care clinics. Both studies illustrate a useful method for evaluating the practical implementation of integrated health care models., (PsycINFO Database Record (c) 2010 APA, all rights reserved.)

Background: B-type natriuretic peptide (BNP) is predictive of inducible ischemia in patients with coronary heart disease (CHD). Whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) has a comparable strength of association with ischemia is uncertain., Hypothesis: Resting NT-proBNP levels are associated with inducible ischemia in patients with stable CHD., Methods: We performed a cross-sectional study of 901 outpatients with stable CHD. NT-proBNP was measured in all patients prior to exercise treadmill testing and stress echocardiography. In addition, plasma BNP was measured in a subset of 355 participants. Logistic regression was used to examine the association of NT-proBNP and BNP quartiles with inducible ischemia., Results: Inducible ischemia was found in 216 (24%) patients. The proportion with inducible ischemia ranged from 42% (95/225) in the highest quartile of NT-proBNP levels (>410 pg/ml) to 9% (21/226) in the lowest quartile (0-72 pg/ml). The highest quartile had a 7-fold greater odds of inducible ischemia than the lowest quartile (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 4.2-12; P < 0.0001). This association remained robust after adjustment for traditional cardiovascular risk factors, left ventricular ejection fraction, and diastolic dysfunction (OR: 3.6, 95% CI: 1.4-9.1; P = 0.009). In the subgroup with measurements of both NT-proBNP and BNP, both natriuretic peptides were predictive of ischemia. The multivariable-adjusted c-statistics for inducible ischemia were 0.71 for NT-proBNP and 0.62 for BNP (entered as continuous variables)., Conclusions: Resting NT-proBNP levels are independently associated with inducible ischemia in outpatients with stable CHD. Baseline elevations of natriuretic peptide may indicate subclinical inducible ischemia in high risk patients with CHD.

Objective: To review 4 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's ice hockey and to identify potential areas for injury prevention initiatives., Background: The NCAA ISS prospectively collects data on injuries sustained during collegiate participation. Women's NCAA ice hockey began participation in the ISS during the 2000-2001 season. On average, over the 4 years, 15.6% of the eligible schools elected to send their injury data., Main Results: Over the 4 years of study, the rate of injury in games was more than 5 times higher than the injury rate in practices (12.6 versus 2.5 injuries per 1000 athlete-exposures, rate ratio = 5.0, 95% confidence interval = 4.2, 6.1, P < .01). Preseason practice injury rates were almost twice as high as in-season practice rates (4.2 versus 2.3 injuries per 1000 athlete-exposures, rate ratio = 1.8, 95% confidence interval = 1.7, 2.0, P < .01). Concussions were the most common injury in both games (21.6%) and practices (13.2%). The rate of concussions in games appeared to be trending upward over the study period. The greatest number of game injuries (approximately 50%) resulted from player contact, whereas practice injuries were from either contact with another object or noncontact mechanisms., Recommendations: Women's ice hockey is an evolving NCAA sport. Only 4 years of ISS data are available and, therefore, data should be interpreted with caution. Women's ice hockey does not allow for formal body checking; however, approximately 50% of all game injuries were reported to result from contact with another player. Future researchers need to evaluate the effectiveness of the no-checking rule. Additional years of data collection will be required to allow the data to become more stable, and to increase attention to mechanism-of-injury issues. We anticipate that the hypothesized inconsistencies in skill level across and within the various women's teams also will be reduced as more consistently skilled players develop, allowing for more stability in the injury scenario.

Objective: To test for the possible association of past oral contraceptive (OC) use and incident fracture after menopause., Design: A prospective cohort of 93,725 postmenopausal women., Setting: Forty Women's Health Initiative (WHI) clinical centers across the United States., Patient(s): Ethnically diverse 93,725 volunteer postmenopausal women, 50 to 79 years old., Intervention(s): None., Main Outcome Measure(s): The main outcome was self-reported incident first fracture assessed prospectively by annual questionnaire., Result(s): The adjusted relative hazard (HR) for fracture among past OC users was 1.07 (95% CI, 1.01-1.15). Among women without any postmenopausal hormone treatment, past OC use for < or =5 years led to an HR of 1.15 (95% CI, 1.04-1.27) and for past OC use >5 years led to an HR of 1.09 (95% CI, 0.97-1.23) compared with never users., Conclusion(s): This study does not support the idea that past OC use protects against later fracture.

Subspecialty training in endocrinology depends in part on local expertise, with fellows having "hands-on" experience in some areas but only "book knowledge" in others. To provide more uniform training in new technologies, The American College of Endocrinology developed Endocrine University, which provides on-site didactic and interactive sessions on thyroid ultrasound, bone densitometry, and other topics over 6 to 7 days. The inaugural event in 2002 was attended by 137 fellows. A second conference in 2003 had capacity attendance of 143. A third course is scheduled for 2004. Fellows pay a token registration fee; the College provides grants to defray the cost of registration, travel, etc. Financial support comes from the College and industry, with plans for an endowment to sustain the program. Fellows value the educational sessions and also the unique opportunity to meet and visit with their peers. This innovative program can serve as a model for other specialties.

Objective: To determine whether faculty triage (FT) activities can shorten emergency department (ED) length of stay (LOS)., Methods: This was a comparison study measuring the impact of faculty triage vs no faculty triage on ED LOS. It was set in an urban county teaching hospital. Subjects were patients presenting to the registration desk between 9 AM and 9 PM on 16 consecutive Mondays (August 2 to November 15, 1999). On eight Mondays, an additional faculty member was stationed at the triage desk. He or she was asked to expedite care by rapid evaluation orders for diagnostic studies and basic therapeutic interventions, and by moving serious patients to the patient care areas. He or she was not provided with detailed instructions or protocols. The ED LOS, time of registration (TIMEREG), inpatient admission status (ADMIT), x-ray utilization (XRAY), total patients registered each day between 9 AM and 9 PM (TOTREG), and patients who left without being seen (LWBS) were determined using an ED information system. The LOS was analyzed in relation to FT, ADMIT, and XRAY by the Mann-Whitney U test. The LOS was related to TIMEREG and TOTREG by simple linear regression. Stepwise multiple linear regression models to predict LOS were generated using all the variables., Results: Patients without FT (n = 814) had a mean LOS of 445 minutes. Patients with FT (n = 920) had a mean LOS of 363 minutes. Mean difference in LOS was -82 minutes (95% CI = -111 to -53), a reduction of 18%. The LOS was also related to: ADMIT +203 minutes (95% CI = 168 to 238), TOTREG -2.7 min/additional patient registered (95% CI = -1.15 to -4.3), and TIMEREG +0.14 min/min since 9 AM (95% CI = 0.07 to 0.21). The LWBS was reduced by 46% with FT. In multiple regression analysis, ADMIT, FT, TIMEREG, and XRAY were all related to LOS, but the model explained only a small part of variance (adjusted R(2) = 0.093). The faculty cost is estimated to be $11.98/patient., Conclusions: Faculty triage offers a moderate increase in efficiency at this ED, albeit with relatively high cost.

This article addresses important developments in the field of medicine and the law during the last year and highlights some of the significant areas of law affecting health care providers that should be considered. Actions against health care providers may include challenges to peer review immunity, allegations concerning the practice of medicine across state lines without a license, and even accusations of wrongfully assisting a patient to commit suicide. These areas are addressed in turn by this article. Finally, antitrust developments over the last year are briefly addressed as an emerging area of concern for providers forming complex practice networks in today's health care arena.

Automated data processing and electronic data interchange have become necessary and increasingly vital aspects of the processes of admission, registration, billing, and collection. A recent survey of patient accounts managers found they feel they may need to improve their technical skills to meet future challenges.

The profile of the typical senior financial executive in a hospital or corporate healthcare setting has changed little over the past two years. A November 1992 survey of CFOs by HFMA and Zimmerman & Associates, Inc., which updates a similar survey conducted in 1990, showed that the typical healthcare CFO is an extremely busy 41-year-old male with a postgraduate education who has held the position of CFO for six years. Survey findings also reveal that the CFO title is the predominant title for senior financial executives in healthcare facilities. For those receiving incentive compensation, the average compensation in 1992 was 11.7 percent of base salary. Within the context of career advancement, the CFO is most interested in learning more about healthcare reform; declining operating margins was seen as the CFO's most significant career challenge.