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Organizational and professional support structures can provide tools and resources to help academic librarians address the challenges of research and publishing. At the USF Libraries, a Research and Publishing committee was created by the faculty to develop tools and provide professional development support, with the aim of encouraging a community culture of research. The committee's work resulted in a series of workshops, discussion groups, guiding documents, and tools.

This paper describes the software changes made to the data processing and display system for HERMES III accelerator at the Simulation Technology Laboratory (STL) at Sandia National Laboratories, New Mexico. The HERMES III accelerator is a gamma ray simulator producing 100kRad[Si] dose per shot with a full width half max pulse duration of ~25 nanoseconds averaging six shots per day. For each accelerator test approximately 400 probe signals are recorded over approximately 65 digitizers. The original data processing system provided the operator a report summarizing the start of probe signal timings for groups of probes located within the power flow conductors. This timing information is indicative of power flow symmetry allowing the operator to make necessary adjustments prior to the next test. The report also provided data overlays concerning laser trigger light output, x-ray diode currents and x-ray source output. Power flow in the HERMES III accelerator is comprised of many circuit paths and detailed current and voltage information within these paths could provide a more thorough understanding of accelerator operation and performance, however this information was either not quickly available to the operators or the display of the data was not optimum. We expanded our data processing abilities to determine the current and voltage amplitudes throughout the power flow conductors and improved the data display abilities so data plots can be presented in a more organized fashion. We detail our efforts creating a software program capable of processing the ~ 400 probe signals together with an organized method for displaying the dozens of current and voltage probes. This process is implemented immediately after all digitizer data has been collected so the operator is provided timing and power flow information shortly after each accelerator shot.

This paper describes the hardware changes made to the triggering system of the HERMES III accelerator at Sandia National Laboratories, New Mexico. The HERMES III accelerator is a gamma ray simulator producing 100 kRad dose per shot with a full width half max pulse duration of approximately 25 nanoseconds and averaging six shots per day. For each accelerator test, approximately 400 probe signals are recorded over approximately 65 digitizers. The original digitizer trigger system employed numerous independent legacy signal generators resulting in non-referenceable digitizer time bases. We detail our efforts to reference the digitizer time bases together using a modular and scalable approach with commercial-off-the-shelf components. This upgraded trigger system presently measures a maximum digitizer trigger time spread of less than two nanoseconds across the 65+ digitizers. This document details the hardware changes, provides a summary of the accelerator charging process, presents “one-line” trigger system diagrams and summarizes the times of interest for a typical HERMES accelerator shot.

The Hermes III accelerator at Sandia National Laboratories is a 20-cavity multi-stage linear induction voltage accelerator typically producing a 20-MV, 40-ns, 600-kA output pulse. Energy is initially stored in Marx banks that are each discharged into two intermediate store capacitors. Each of these capacitors are then switched with an SF6-insulated high voltage Rimfire gas switch into four parallel pulse forming lines that further condition the discharge pulse and deliver it to the induction cavities arrayed along the axis of the machine. Presently, a single 0.9-J KrF laser operating at 248 nm, the output of which is divided into twenty beams, is used to trigger the 20 rim-fire switches. As part of an upgrade to the accelerator, however, a new solid state laser triggering system is being designed to replace this system and provide additional capabilities for the accelerator. The laser triggering system will be made up of 10 discrete compact flash-lamp pumped, Q-switched Nd:YAG lasers (Tempest 300), each having an output energy of 40 mJ at a wavelength of 266 nm. As each laser will be responsible for triggering only two of the rim-fire switches, it becomes possible to shape the output pulse by varying the times at which the individual lasers fire. Overall reliability for the accelerator's operation with these new lasers will be increased, as well. The general layout of this new laser triggering system design will be presented, along with details pertaining to the triggering of the lasers and the optical beam paths.

Objective – In an environment of shrinking budgets and reduced staffing, this study seeks to identify a comprehensive, integrated assessment strategy to better focus diminished resources within special collections repositories. Methods – This article presents the results of a single case study conducted in the Special and Digital Collections department at a university library. The department created an holistic assessment model, taking into account both public and technical services, to explore inter-related questions affecting both day-to-day operations as well as long-term, strategic priorities. Results – Data from a variety of assessment activities positively impacted the department’s practices, informing decisions made about staff skill sets, training, and scheduling; outreach activities; and prioritizing technical services. The results provide a comprehensive view of both patron and department needs, allowing for a wide variety of improvements and changes in staffing practices, all driven by data rather than anecdotal evidence. Conclusion – Although the data generated for this study is institutionally specific, the methodology is applicable to special collections departments at other institutions. A systemic, holistic approach to assessment in special collections departments enables the implementation of operational efficiencies. It also provides data that allows the department to document its value to university-wide stakeholders.

Librarians have long struggled to find user-friendly mediums to provide meaningful information to patrons using bibliographies, pathfinders, and subject guides with varying degrees of success. Content management systems, such as Springshare's LibGuides, have recently been developed to facilitate the creation of online subject guides. Special collections units also struggle with this issue. This article examines how special collections are presented on the Web, the use of LibGuides for special collections, and how the use of LibGuides is facilitating the goal to provide information in a meaningful way by Special and Digital Collections at the University of South Florida Tampa Library.

The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography (CT) with chest radiography in the screening of older current and former heavy smokers for early detection of lung cancer, which is the leading cause of cancer-related death in the United States. Five-year survival rates approach 70% with surgical resection of stage IA disease; however, more than 75% of individuals have incurable locally advanced or metastatic disease, the latter having a 5-year survival of less than 5%. It is plausible that treatment should be more effective and the likelihood of death decreased if asymptomatic lung cancer is detected through screening early enough in its preclinical phase. For these reasons, there is intense interest and intuitive appeal in lung cancer screening with low-dose CT. The use of survival as the determinant of screening effectiveness is, however, confounded by the well-described biases of lead time, length, and overdiagnosis. Despite previous attempts, no test has been shown to reduce lung cancer mortality, an endpoint that circumvents screening biases and provides a definitive measure of benefit when assessed in a randomized controlled trial that enables comparison of mortality rates between screened individuals and a control group that does not undergo the screening intervention of interest. The NLST is such a trial. The rationale for and design of the NLST are presented.

Declining reference statistics, diminishing human resources, and the desire to be more proactive and embedded in academic departments, prompted the University of South Florida Library to create a taskforce for re-envisioning reference services. The taskforce was charged with examining the staffing patterns at the desk and developing recommendations to give librarians greater flexibility and to better respond to the information-seeking needs of users.These recommendations were based on statistics of desk usage, collected with the newly adapted online tool Desk Tracker, and structured interviews with library administrators. The taskforce was interested in how these stakeholders use quantitative data in decision-making.

This paper summarizes the recent changes to the hardware and software systems associated with the diagnostic digitizer triggers and their data acquisition control program at the Saturn pulsed power facility at Sandia National Laboratories. The main screen room contains approximately 70 digitizing scopes for monitoring 6 voltage or current probes along each of its 36 energy storage and transmission lines. Each module locates probes along its length in an identical fashion so that by comparing the timing of similar probes on each line, a measure of the power flow time symmetry can be obtained. The probes from each line are recorded in scope groupings, each containing 36 channels. In numerous cases, the archived group time bases were not correctly quantified with respect to the other scope groupings. This was problematic when comparing signals from different scope groupings. The source of the errors was found to be how the scope groupings were triggered as well as a software error associated with two models of digitizers. We have implemented changes so that all scope groupings are time tied to a common reference.

The Sandia National Laboratories SPHINX accelerator is used to study the response of electronics to pulsed x-ray and electron environments. The system consists of a Marx generator and an oil-insulated pulse-forming line with self-closing oil switches. SPHINX has a peak load voltage of 2 MV and an adjustable pulse width ranging from 3 to 10 ns. The previous pulsed-power system had reliability and triggering issues with the Marx generator and subsequent undesired variations in voltage output. SPHINX was upgraded to a new Marx-generator system that has solved many of the voltage-output fluctuation and timing issues. The new Marx generator uses recently developed low-inductance 100-kV capacitors and 200-kV spark-gap switches. This paper provides an overview of SPHINX while capturing in detail the design, characterization, and comparative performance of the new Marx generator.

Relatively limited contemporary information is available about the magnitude of, and factors associated with, the metabolic syndrome in adult men and women. The purpose of our observational study was to describe the prevalence and predictors of the metabolic syndrome in a sample of employed adults attending a worksite cardiovascular screening program. The study sample consisted of 871 men and women between the ages of 21 and 77 years from 6 locations of the parent company. These individuals attended an employer-sponsored cardiovascular screening and wellness program during 2003. A standardized questionnaire was administered to all study participants and a number of different coronary risk factors were measured. Approximately 27% of the study sample was classified as having the metabolic syndrome. Men, persons with a history of hypertension, heart disease, or stroke, sedentary individuals, and those with an increased heart rate and higher levels of C-reactive protein were associated with presence of the metabolic syndrome. A relatively similar risk factor profile was noted in persons without a self-reported history of prior cardiovascular disease. The results of our cross-sectional observational study suggest that the prevalence of the metabolic syndrome is considerable. A number of demographic, comorbid, and other factors are associated with this syndrome. Increased attention to the metabolic syndrome, and modification of predisposing factors, remains of considerable public health and clinical importance.

PURPOSE: The statin-prescribing patterns in a large managed care organization and the effectiveness of statin prescriptions in lowering low-density-lipoprotein (LDL) cholesterol levels in patients with coronary artery disease (CAD) or risk-equivalent patients were examined. METHODS: A retrospective review of the records in an integrated medical, pharmacy, and laboratory database was performed. The qualifying period for the study began January 1, 1999, and ended December 31, 2000; the reporting period extended from January 1, 2001, to December 31, 2001. Patients included in this study had a medical claim indicative of a diagnosis of CAD or risk equivalence during the qualifying 18-month period. The data were examined to determine percentages of patients who were tested for circulating LDL cholesterol levels, were prescribed statins, and achieved the LDL cholesterol goal recommended by the National Cholesterol Expert Panel. Physician prescribing patterns were also examined. RESULTS: During the 12-month analysis period of the study, 24% of patients were tested for circulating LDL cholesterol levels, and 39.8% received at least one statin. Of patients whose LDL cholesterol values were documented and who received statins, 44.5% achieved goal LDL cholesterol levels. Of patients who were tested and did not receive statins, 29.8% achieved the LDL cholesterol goal. Cardiologists prescribed statins to CAD patients at a higher rate than other specialists or primary care providers. CONCLUSION: Patients with a diagnosis of CAD or risk equivalence, who would benefit from treatment to reduce circulating LDL cholesterol levels, were significantly undertreated.

There is little information available concerning compliance with pharmacologic therapy for osteoporosis in the usual care setting. We evaluated 176 consecutive, previously untreated women whose physicians initiated treatment for osteoporosis following a bone mineral density (BMD) test obtained as part of routine medical practice. All patients were contacted >/=1 year after the initial BMD test and offered a follow-up BMD. Compliance with therapy was defined as the percent of time that a patient filled a prescription for osteoporosis treatment. Ninety-three (53%) patients received estrogen (ERT), 93 (53%) bisphosphonates, 8 (5%) calcitonin, and 17 (10%) received more than one therapy. Ninety-one of the 176 (52%) agreed to a follow-up BMD at a mean of 590 days after the first study (participants); 85 declined a follow-up BMD (refusers). Participants and refusers were similar for age, treatment patterns, and compliance with therapy. For all patients, compliance for those given bisphosphonate was similar to those given ERT (70.7% (95% CI 63.5-77.9%) versus 69.2% (95% CI 61.7-76.8%). For participants, the change in spine BMD was similar for those treated with bisphosphonate [mean increase 3.53 (+/-2.64)%/year (mean+/-SD)] and those treated with ERT [mean increase 3.00 (+/-2.75)%/year]. For those participants whose compliance with therapy was >/=66%, the mean increase in spine bone density was 3.80 (+/-2.59)%/year compared to 2.11 (+/-2.64)%/year ( p

Introduction : Dementia is a complex and chronic disease and is currently the second leading cause of death in Australia, three in ten people over the age of 85 and almost one in ten people over 65 have dementia. In Northern Sydney, there is projected growth of 23% in the population of people aged 75 years and older between 2011 and 2021, indicating a substantial increase in the number of people with dementia in the region over the next 6 years. There are a wide range of services available in Northern Sydney for people with dementia and their carers; however access and information about support services has been problematic. Information is often fragmented and difficult to find for consumers and Health Care Professionals. A partnership between Northern Sydney Local Health District (NSLHD), Sydney North Health Network, CCNB Ltd and Alzheimer’s Australia NSW was established to improve the journeys of people with dementia in Northern Sydney. Method : People with dementia (3) and many more carers (20) told us their stories, with key themes from these journeys identified. Over 40 health professionals from across sectors were separately engaged in mapping a number of typical journeys as well as an ideal journey. Gaps and issues were identified and prioritised, with a range of solutions then identified and prioritised. A project plan was implemented by the partnership, including strategies to address identified gaps in information, service access, referral pathways and education. Major project outputs include clarification of referral pathways for General Practitioners, a “Memory Problems?” booklet outlining the range of services available for people with dementia and their carers, distribution of the same across health sectors, government and non-government services throughout the region, a dementia hospital discharge follow–up service commissioned by Sydney North Health Network (SNHN), and a number of education events targeting different groups across the region. Other initiatives in progress being led by SNHN are the development of national quality indicators for dementia care in general practice and a localised dementia pathway for health professionals. Results : A number of typical journeys for people with dementia and their carers have been mapped, highlighting the range of complex interactions experienced and many opportunities to enable better journeys. The impact of the resulting initiatives are being evaluated through a range of indicators including the timing of referrals to memory clinics in patient’s journeys, unplanned hospital admissions for people with dementia and provider satisfaction. Results are expected to be available by the time of the conference. The NSW Agency for Clinical Innovation is undertaking evaluation of the partnership and it's benefits as part of a statewide program for integrating care for older people with complex health needs. Conclusions : This partnership has resulted in implementation of a plan which will have a substantially greater impact than if one organisation had undertaken this work alone. The project outputs are practical, sustainable and are expected to improve the journeys of people with dementia and their carers in Northern Sydney.

After spending two weeks in an intensive care unit watching her sister, Barbara Lewis was spurred to improve interactions with hospital staff by writing a bill of rights for families and carers and championing the development of patient and family advisory councils in US hospitals

Objective To assess the positive and negative predictive values of osteoarthritis (OA) diagnoses contained in an administrative database. Methods We identified all members (≥18 years of age) of a Massachusetts health maintenance organization with documentation of at least one health care encounter associated with an OA diagnosis during the period 1994–1996. From this population, we randomly selected 350 subjects. In addition, we randomly selected 250 enrollees (proportionally by the age and sex of the 350 subjects) who did not have a health care encounter associated with an OA diagnosis. Trained nurse reviewers abstracted OA-related clinical, laboratory, and radiologic data from the medical records of both study groups (all but 1 chart was available for review). Pairs of physician reviewers evaluated the abstracted information for both groups of subjects and rated the evidence for the presence of OA according to 3 levels: definite, possible, and unlikely. Results Among the group of patients with an administrative diagnosis of OA, 215 (62%) were rated as having definite OA, 36 (10%) possible OA, and 98 (28%) unlikely OA, according to information contained in the medical record. The positive predictive value of an OA diagnosis was 62%. In those without an administrative OA diagnosis, 44 (18%) were assigned a rating of definite OA. The negative predictive value of the absence of an administrative OA diagnosis was 78%. Conclusion Use of administrative data in epidemiologic and health services research on OA may lead to both case misclassification and underascertainment.

Summary Useful pharmacoeconomic data can be derivedfrom RCTs and observational studies. There is,however, no single pharmacoeconomic study thatwill establish the value of an intervention. Differ-ent audiences bring a variety of perspectives, aswell as definitions of value, to the generation,framing, and interpretation of research questions.Establishing value can result from the synthesis ofdata from a variety of sources, including RCTs,observational studies, and modeling, with appro-priate attention to the weaknesses and limitationsof each kind of data.The most important factors for a researcher toconsider in designing a clinical trial to answerquestions of value are knowing the precise ques-tion(s) that the study is required to answer andknowing the informational needs of the target au-dience. Over the long term, it is recommendedthat effort be directed towards better consensusand a greater degree of standardization of defini-tions and methodologies for assessing health eco-nomic questions through clinical studies.

In her review of Questioning Protocol by Randi Redmond Oster, Barbara Lewis shares how this new and award winning book takes the reader on Randi Oster's harrowing journey of navigating the healthcare system while helping her teenage son’s battle with Crohn’s disease. Seventeen chapters build a chronological story of success, frustration and failure in dealing with modern medicine and a healthcare industry that may appear foreign to the outsider.

Background: The purpose of the present study was to examine physician’s attitudes and practices toward the use of different lipid-lowering management strategies in patients at increased risk for coronary heart disease (CHD). Aims/Methods: An internet-based questionnaire was completed by 78 general internists and family practitioners (mean age = 49 years; 80% male) affiliated with a large primary care health delivery system in Connecticut. Questions were asked about physician knowledge and use of current national guidelines for lipid-lowering therapy and their treatment practices for patients at varying risk for CHD. Results: Most physicians reported they were very knowledgeable about different interventions to lower serum lipids. Most (92%) indicated that they were aware of and followed national guidelines for the treatment of patients with hyperlipidemia the majority of the time. Physicians were likely to initiate lipid-lowering therapy at lower levels of serum LDL cholesterol in patients at high, as compared to those at moderate, risk for coronary disease. Targeted treatment levels were also reported to be considerably lower for patients at higher risk, than for those at moderate risk, for the development of coronary disease. Diabetes, cigarette smoking, and elevated LDL cholesterol levels were reported to be the three most important risk factors for CHD by the physician sample. Gaps in the recommendation of lifestyle changes to patients with hyperlipidemia were observed. Conclusions: Despite adequate physician knowledge, achieving desirable serum lipid levels in primary care patients remains elusive. Provider education is needed to optimize the care of patients with elevated serum lipids treated in the primary care setting.

Background: Relatively limited contemporary information is available about the distribution of, and factors associated with, levels of C-reactive protein (CRP) in adult men and women. The purpose of our descriptive study was to examine the prevalence and predictors of this marker of inflammation in a sample of employed adults attending a worksite cardiovascular screening program. Methods: The study sample consisted of 876 men and women between the ages of 21 and 77 years from 6 locations of the parent company. These individuals attended an employer-sponsored cardiovascular screening and wellness program during 2003. A standardized questionnaire was administered to all study participants, and a number of different coronary risk factors were measured. Results: Approximately 25% of the study sample was classified as having elevated CRP levels (≧3 mg/l). Women, obese individuals, subjects with increasing heart rate and higher levels of serum triglycerides were more likely to have elevated concentrations of CRP than the corresponding comparison groups. Subjects who reported regularly exercising, individuals with a history of heart disease and those with lower total cholesterol levels were less likely to have elevated CRP levels. A relatively similar risk factor profile was noted in individuals without a self-reported history of prior cardiovascular disease. Conclusions: The results of our cross-sectional observational study suggest that the prevalence of elevated CRP levels in the general adult population is considerable. A number of demographic, comorbid and other factors are associated with this inflammatory marker of increased risk of cardiovascular disease, which demands increased attention and modification of potential predisposing factors.

A new laser trigger system (LTS) has been installed on Z that benefits the experimenter with reduced temporal jitter on the X-ray output, the confidence to use command triggers for time sensitive diagnostics and the ability to shape the current pulse at the load. This paper presents work on the pulse shaping aspects of the new LTS. Pulse shaping is possible because the trigger system is based on 36 individual lasers, one per each pulsed power module, instead of a single laser for the entire machine. The firing time of each module can be individually controlled to create an overall waveform that is the linear superposition of all 36 modules. In addition, each module can be set to a long-pulse mode or short-pulse mode for added flexibility. The current waveform has been stretched from /spl sim/100 ns to /spl sim/250 ns. A circuit model has been developed with BERTHA Code, which contains the independent timing feature of the new LTS to predict and design pulse shapes. The ability to pulse-shape directly benefits isentropic compression experiments (ICE) and equation of state measurements (EOS) for the shock physics programs at Sandia National Laboratories. With the new LTS, the maximum isentropic loading applied to Cu samples 750 um thick has been doubled to 3.2 Mb without generating a shockwave. Macroscopically thick sample of Al, 1.5 mm, have been isentropically compressed to 1.7 Mb. Also, shockless Ti flyer-plates have been launched to 21 km.s/sup -1/, remaining in the solid state until impact.

Objective: Family accommodation ofpatients with obsessive-compulsive disorder, i.e., participation in symptoms and modification of personal and family routines, was assessed in relation to family stress, functioning, and attitudes toward the patient. Method: Primary caretakers for 34 patients with obsessive-compulsive disorder were interviewed to assess the nature and frequency ofaccommodating behaviors. The caretakers also completed several measures offamily functioning. Results: Ofthe 34 spouses or parents, 30 (88.2%) reported accommodating the patient. Family accommodation correlated with poor family functioning, rejecting attitudes toward the patient, and several types of family stress. Conclusions: Family accommodation of patients with obsessive-compulsive disorder was associated with global family dysfunction and stress. This study suggests that families’ efforts to accommodate patients may be intended to reduce patient anxiety or anger directed at relatives. (Am J Psychiatry 1995; 152:441-443)

With the introduction of the World Wide Web, the learning environment is changing. Online courses allow learners, once bound by place and time constraints in the traditional classroom, new access to education and collaborative learning. Technology enables this method of delivering education. Selection of technology and software needs to be based on the needs and objectives of the online programs and the students. The instructor needs components that will allow him/her to create active learning experiences in the courses. This investigation evaluated three Course Management Software programs based on each one's ability to accommodate different active learning experiences in online courses.

1. The purpose of this study was to determine the suitability of ratios derived from dual-energy X-ray absorptiometry (DXA) whole body scans to assess regional fat distribution in older men and women by comparing them with the waist-to-hip ratio (WHR) and to evaluate their clinical utility by applying them in a clinical trial involving resistance exercise and recombinant human growth hormone. 2. Sixty-four healthy older adults (39 women and 25 men), aged 65–82 years, served as subjects. The ratios of trunk fat-to-total fat, trunk fat-to-body weight, trunk fat-to-limb fat and trunk fat % were determined by DXA. WHR was assessed on the same day, as was the ratio of subscapular/triceps skinfolds in men. Cardiovascular disease risk factors, functional capacity and serum lipids were also assessed. 3. A moderate relationship (r = 0.36-0.54) between the WHR- and DXA-derived ratios were observed for both men and women. Both DXA and WHR showed similar associations with cardiovascular disease risk factors. However, in men, all DXA ratios were able to detect subtle changes in regional fat distribution resulting from daily administration of recombinant human growth hormone in conjunction with resistance exercise for 10 weeks, whereas the WHR or subscapular/triceps ratios did not. 4. This suggests that DXA-derived ratios may be more sensitive than conventional anthropometric methods in the assessment and categorization of body fat distribution.

Burn prevention lectures instituted in early childhood education is believed to have decreased burn-related injuries in children. Validation of retention of information to verify effectiveness of school lectures is needed. A pretest and posttest were developed to measure the retention of burn prevention methods taught to students. The pretests were administered by the teachers to fourth and fifth graders (n = 500) one day before the prevention lecture. Programs were taught assembly style. The teachers were asked to reissue the posttest within 2 days after the program. The tests were then returned to the community educator. The test included 15 multiple choice questions. Questions addressed escaping a burning building and burn prevention items such as cooking, first aid tips, and other general prevention ideas. Test results showed overall improvement of scores. Additional analysis showed that though test scores improved, there was less improvement in scores of inner-city students. Pretesting and posttesting has provided valuable information regarding student learning. It has also identified target groups and areas where increased efforts of prevention programs must be directed. Language: en

It is widely accepted that physical activity is beneficial to bone. However, the specific relationships of muscle strength to bone mineral density (BMD) are poorly understood. We examined strength and BMD in 59 women aged 18-31 years who ranged in exercise patterns from sedentary to active. Mineral density of the right proximal femur (hip) and spine (L2-4) was evaluated by dual-energy x-ray absorptiometry. BMD at the midradius was measured by single-photon absorptiometry. Dynamic strength (one repetition maximum) was measured for the following muscle groups: back, elbow flexors (biceps), leg extensors (quadriceps), and the hip flexors, extensors, adductors, and abductors. Isometric grip strength was assessed by dynamometry. Mineral density at the hip correlated independently with muscle strength and body weight, but not with age. Specifically, femoral neck BMD was significantly correlated with back strength and weight, whereas trochanter and overall hip mineral density were significantly related to biceps, back, and hip adductor strength. Hip mineral density was not related to strength of the quadriceps groups or to that of the hip flexors, extensors, or abductors. In addition, muscle strength was an independent predictor of lumbar spine and midradius mineral density. In stepwise multiple regression analysis, biceps strength proved the most robust predictor of hip BMD and grip strength best predicted bone density at the lumbar spine and radius. We conclude that muscle strength is an independent predictor of bone mineral density, accounting for 15-20% of the total variance in bone density of young women.(ABSTRACT TRUNCATED AT 250 WORDS)

PCV37 SURVEY OF PHYSICIAN ATTITUDES AND PRACTICES IN LIPID LOWERING MANAGEMENT Lewis BE, Rosen J, Roselli A, Goldberg RJ AstraZeneca, Worcester, MA, USA, ProHealth Physicians, Inc, Bristol, CT, USA, ProHealth Physicians, Farmington, CT, USA, University of Massachusetts Medical School, Worcester, MA, USA OBJECTIVES: While published guidelines for managing hyperlipidemia are well publicized, many patients either are not treated or managed suboptimally. This study examined physicians’ knowledge, attitudes and practices in managing primary care patients with elevated serum lipid levels. METHODS: An online questionnaire was developed, pilot tested, and administered to 98 primary care physicians with patients at varying risk for coronary heart disease (CHD.) The questionnaire was administered during a two week period. Questions assessed physician’s knowledge of current national guidelines for managing patients with hyperlipidemia, use of various lipid lowering therapies, lifestyle interventions to lower serum lipids, use of national guidelines, and treatment practice for patients at varying risk for CHD. Questions used a 5 point Likert scale (with 1 indicating very important and 5 of little to no importance). RESULTS: The questionnaire had an 80% response rate. Most physicians reported following published national cholesterol guidelines all (15%) or most (77%) of the time. Physicians perceived themselves to be very knowledgeable about current published national guidelines for the management of elevated serum cholesterol levels (53%), lifestyle interventions to lower serum lipids (50%), and lipid lowering therapies (49%); they were considerably less knowledgeable (19%) about costs of lipid lowering medications. Major concerns with the use of published national guidelines included lack of patient compliance (moderately to strongly agree) (72%), and lack of time to adequately use guidelines during office visits (22%). CONCLUSIONS: Despite physician guideline awareness, achieving desirable serum lipid levels in the patient population remains an elusive target. Current provider education efforts are not sufficient. As more managed care organizations and group practices implement electronic medical records, the use of evidence based treatment algorithms should result in better management of cardiovascular risk factors, including elevated LDL levels, in general practice populations as well as targeted high risk groups.

The explanations put forth during the nineteenth century to account for Ireland's economic condition may be grouped under three heads. The first was associated with the conceptual framework of the English classical economists and stressed overpopulation and excessive subdivision. A second approach, which might be called the underdeveloped-country explanation, emphasized the need for social overhead capital—drainage, flood control, communications, and education. The third approach argued that defects in the land tenure system were at the root of Ireland's failure to develop a prosperous economy.

Families who have become separated from one of the parents by death or divorce face much stress and adjustment. In addition to carrying the extra burdens of parenting and running a household alone, the single parent may feel isolated from friends and family. Loneliness, depression, and confusion can manifest themselves in various physical and emotional ways. At the beginning of an office visit, the physician should try to ascertain whether any important changes have occurred in the patient's life and should record this information in the patient's chart. Once single parenthood is determined, the importance to the patient and the circumstances of the separation should be obtained. Children in different age-groups often demonstrate specific regressive disorders when a life crisis occurs, and a perceptive physician may spot such behavior and counsel both the parent and the child. Possibly the most effective treatment in such a situation is understanding, reassurance, and listening.