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Background: Lymphocytic esophagitis (LyE) is a recently described clinicopathological condition, but little is known about its features and clinical associations.Aim: The aim of this study was to characterize patients with LyE, compare them to non-LyE controls, and identify risk factors.Methods: We conducted a retrospective study of all patients ≥18 years old who underwent upper endoscopy with esophageal biopsy between January 1, 2000, and June 1, 2012. Archived pathology slides were re-reviewed, and LyE was diagnosed if there was lymphocyte-predominant esophageal inflammation with no eosinophils or granulocytes. Three non-LyE controls groups were also defined: reflux, eosinophilic esophagitis (EoE), and normal. Clinical data were extracted from electronic medical records, and LyE cases were compared to non-LyE controls.Results: Twenty-seven adults were diagnosed with LyE, and the majority were female (63 %). The most common symptom was dysphagia (70 %). Fifty-two percentage had a prior or current diagnosis of reflux. Endoscopic findings included strictures (37 %), erosive esophagitis (33 %), rings (26 %), and hiatal hernia (26 %); 33 % of patients required dilation. After histology re-review, 78 % of LyE patients were found to have more than 20 lymphs/hpf. In comparison with the normal, reflux and EoE controls, patients with LyE tended to be nonwhite (p < 0.01), were more commonly tobacco users (p = 0.02) and less likely to have seasonal allergies (p = 0.02).Conclusion: LyE commonly presents with dysphagia due to esophageal strictures which require dilation. Smoking was associated with LyE, whereas atopy was not. LyE should be considered as a diagnostic possibility in patients with these characteristics undergoing upper endoscopy. [ABSTRACT FROM AUTHOR]

This article argues that the growing use of Indian-American characters in American television programming results from a combination of societal shifts in the United States as well as changes in the international system—specifically, the increasing ethnic diversity in America as well as the rise of non-western nations as important players in a globalized world that has led to a growing global market for American television programs. Further, the portrayal of such characters also ranges from what the British Broadcasting Corporation calls ‘color-blind casting’ (where the race and ethnicity of characters do not determine or limit the roles they portray) to more stereotypical renderings of the Indian-American community. It concludes by suggesting that changes in demography, as well as market forces within the United States and abroad, will probably lead not only to more Indian-Americans on television but also to their portraying roles that fit into the reality of the Indian-American status and experience in American society. [ABSTRACT FROM AUTHOR]

In this study, we collected data from 180 MBA students from the USA, Ireland and India on their individualism/collectivism (IC) orientations and their preferences for human resource management (HRM) practices. Contrary to expectations, the Indian sample tended to he more individualistic than the American or Irish sample. While there were no differences on the preferences for progressive HRM practices across sample, the Americans exhibited a greater preference for paternalistic practices than the Indians and the Irish. Further, the Americans also showed a greater preference for equality in rewards than the Irish and fairness in appraisals/rewards than the Indians. At the individual level, controlling for nationality, age and gender, higher individualism scores on the supremacy of individual goals and self-reliance dimensions were positively related to progressive HRM practices. Higher individualism on supremacy of individual goals was also positively related to procedural fairness in appraisals/rewards and negatively related to paternalistic HRM practices. A higher preference for working alone was negatively related to progressive HRM practices. Further, higher individualism on the supremacy of individual interest dimension was negatively related to progressive HRM practices and positively related to paternalistic HRM practices. Implications are discussed. [ABSTRACT FROM AUTHOR]

Discusses the testing of the nuclear weapons of India and Pakistan. Reaction of Pakistan on the nuclear testing activities conducted by India; Factors that contributed to the decision of India to test its nuclear weapons; Impact of the nuclear tests of Pakistan; Policy of the U.S. on the nuclear weapons testing of India and Pakistan.

Drugs currently used to treat membranous nephropathy vary in their effectiveness among patients and can cause severe side effects. FDA has approved sirolimus for suppressing immune system of patients who have kidney transplant to reduce the risk of organ rejection. The drug does not have any certain side effects that have caused problems for patients treated with other immunosuppressants. To evaluate the safety and efficacy of a new immunosuppressive drug, sirolimus in reducing the proteinuria of patients with idiopathic membranous nephropathy resistant to previous therapy. We prospectively studied ten patients of idiopathic membranous nephropathy, who were resistant to previous therapy with ponticelli regimen (I. V. MP f/b prednisolone and cyclophosphamide every alternate month x 6 months) and of these, five were also non responsive to CsA for six months. All of them screened for the evidence of active infection before starting with sirolimus. All of them had nephrotic range proteinuria at the time of starting the therapy. Sirolimus was started with 3 mg on day 1 followed by 2 mg once a day and adjusted the dosage to achieve the target blood level (4-12 ng/ml) for a period of six months. Oral prednisolone in a dose of 1 mg/kg/day was also given along with sirolimus and tapered off slowly once remission achieved or after 8 weeks of therapy. During treatment, patients were follow up monthly for reduction of proteinuria, GFR and other clinical and laboratory parameters for the safety and effectiveness of the drug. All patients were male, age group of 20 -40 yrs, mean age of onset was 27.2 year, mean duration of illness 36 months, and all of them completed ponticelli regimen, 05 patients (50%) received CsA after they did not respond to ponticelli regimen. 7 patients (70%) received ACEI for 12 months before starting the sirolimus. Eight patients (80%) were reponders [four patients (50%) achieved complete remission (nil proteinuria), and four had partial remission (50% reduction in proteinuria)] and two (20%) were non responders. The mean time to achieve remission was 94±34 days and the mean dose of sirolimus was 2 mg per day. The mean trough levels of sirolimus were 4.7±1.8 ng/ml. The mean 24 hrs proteinuria were significantly lower from baseline of 6.25±1.63 gm/day to 0.825±0.967 gm/day (P= 0.010) and the mean serum albumin levels were increased from baseline 2.67±0.479 gm/dl to 3.28±0.538 gm/dl (P=0.108) after 94±34 days of therapy. The mean GFR values at the end of the study were similar to those prior to the starting of sirolimus 52.5±4.6 ml/mt/1.73 m² vs 49.2±2.3 ml/mt/1.73 m².The mean duration of follow up was 310±188 days. Five patients required statins for control of dyslipidemia on sirolimus therapy. Three patients had cutaneous infection (2 had fungal, 1 had scabies) which responded to antifungal and antiscabies treatment, one had developed diabetes mellitus which was controlled with oral hypoglycemic agent and diarrhea due to entamoeba histolytica. One had urinary tract infection during therapy. None of them relapsed after stopping sirolimus (mean period of 162±112 days). This is the only study so far on the safety and effectiveness of sirolimus in resistant cases of idiopathic membranous nephrotic syndrome. Our results shows that sirolimus is effective in controllong proteinuria without nephrotoxicity and serious adverse events in patients with resistant idiopathic membranous nephropathy. A prospective controlled study on large number of patients needs to be done to compare the safety and efficacy of sirolimus in idiopathic membranous nephropathy cases who are resistant to ponticelli and CsA based immunosupression regimen. [ABSTRACT FROM AUTHOR]

Background: Whether the "July Effect" affects perspectives or has prompted changes in US Internal Medicine residency programs is unknown.Methods: We designed a survey-based study to assess views and efforts aimed at preventing harm in July. A convenience sampling strategy (email listserv and direct messages to program leaders via the Electronic Residency Application Service) was used to disseminate the survey.Results: The response rate was 16% (65/418 programs); however, a total of 262 respondents from all 50 states where residency programs are located were included. Most respondents (n = 201; 77%) indicated that errors occur more frequently in July compared with other months. The most common identified errors included incorrect or delayed orders (n = 183, 70% and n = 167, 64%, respectively), errors in discharge medications (n = 144, 55%), and inadequate information exchange at handoffs (n = 143, 55%). Limited trainee experience (n = 208, 79%), lack of understanding hospital workflow, and difficulty using electronic medical record systems (n = 194; 74% and n = 188; 72%, respectively) were reported as the most common factors contributing to these errors. Programs reported instituting several efforts to prevent harm in July: for interns, additional electronic medical record training (n = 178; 68%) and education on handoffs and discharge processes (n = 176; 67% and n = 108; 41%, respectively) were introduced. Similarly, for senior residents, teaching sessions on how to lead a team (n = 158; 60%) and preferential placement of certain residents on harder rotations (n = 103; 39%) were also reported. Most respondents (n = 140; 53%) also solicited specific "July attendings" using a volunteer system or highest teaching ratings.Conclusion: Residency programs in Internal Medicine appear to have instituted various changes to mitigate harm in July. Further evaluation to understand the impact of these interventions on trainee education and patient safety is necessary. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is a chronic neurodegenerative disease needing effective therapeutics urgently. Sildenafil, one of the approved phosphodiesterase-5 inhibitors, has been implicated as having potential effect in AD., Objective: To investigate the potential therapeutic benefit of sildenafil on AD., Methods: We performed real-world patient data analysis using the MarketScan® Medicare Supplemental and the Clinformatics® databases. We conducted propensity score-stratified analyses after adjusting confounding factors (i.e., sex, age, race, and comorbidities). We used both familial and sporadic AD patient induced pluripotent stem cells (iPSC) derived neurons to evaluate the sildenafil's mechanism-of-action., Results: We showed that sildenafil usage is associated with reduced likelihood of AD across four new drug compactor cohorts, including bumetanide, furosemide, spironolactone, and nifedipine. For instance, sildenafil usage is associated with a 54% reduced incidence of AD in MarketScan® (hazard ratio [HR] = 0.46, 95% CI 0.32- 0.66) and a 30% reduced prevalence of AD in Clinformatics® (HR = 0.70, 95% CI 0.49- 1.00) compared to spironolactone. We found that sildenafil treatment reduced tau hyperphosphorylation (pTau181 and pTau205) in a dose-dependent manner in both familial and sporadic AD patient iPSC-derived neurons. RNA-sequencing data analysis of sildenafil-treated AD patient iPSC-derived neurons reveals that sildenafil specifically target AD related genes and pathobiological pathways, mechanistically supporting the beneficial effect of sildenafil in AD., Conclusions: These real-world patient data validation and mechanistic observations from patient iPSC-derived neurons further suggested that sildenafil is a potential repurposable drug for AD. Yet, randomized clinical trials are warranted to validate the causal treatment effects of sildenafil in AD.

Lower extremity venous insufficiency is a chronic medical condition resulting from primary valvular incompetence or, less commonly, prior deep venous thrombosis or extrinsic venous obstruction. Lower extremity chronic venous disease has a high prevalence with a related socioeconomic burden. In the United States, over 11 million males and 22 million females 40 to 80 years of age have varicose veins, with over 2 million adults having advanced chronic venous disease. The high cost to the health care system is related to the recurrent nature of venous ulcerative disease, with total treatment costs estimated >$2.5 billion per year in the United States, with at least 20,556 individuals with newly diagnosed venous ulcers yearly. Various diagnostic and treatment strategies are in place for lower extremity chronic venous disease and are discussed in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The use of central venous access devices is ubiquitous in both inpatient and outpatient settings, whether for critical care, oncology, hemodialysis, parenteral nutrition, or diagnostic purposes. Radiology has a well-established role in the placement of these devices due to demonstrated benefits of radiologic placement in multiple clinical settings. A wide variety of devices are available for central venous access and optimal device selection is a common clinical challenge. Central venous access devices may be nontunneled, tunneled, or implantable. They may be centrally or peripherally inserted by way of veins in the neck, extremities, or elsewhere. Each device and access site presents specific risks that should be considered in each clinical scenario to minimize the risk of harm. The risk of infection and mechanical injury should be minimized in all patients. In hemodialysis patients, preservation of future access is an additional important consideration. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The clinical learning environment (CLE) encompasses the learner's personal characteristics and experiences, social relationships, organizational culture, and the institution's physical and virtual infrastructure. During the COVID-19 pandemic, all 4 of these parts of the CLE have undergone a massive and rapid disruption. Personal and social communications have been limited to virtual interactions or shifted to unfamiliar clinical spaces because of redeployment. Rapid changes to the organizational culture required prompt adaptations from learners and educators in their complex organizational systems yet caused increased confusion and anxiety among them. A traditional reliance on a physical infrastructure for classical educational practices in the CLE was challenged when all institutions had to undergo a major transition to a virtual learning environment. However, disruptions spurred exciting innovations in the CLE. An entire cohort of physicians and learners underwent swift adjustments in their personal and professional development and identity as they rose to meet the clinical and educational challenges they faced due to COVID-19. Social networks and collaborations were expanded beyond traditional institutional walls and previously held international boundaries within multiple specialties. Specific aspects of the organizational and educational culture, including epidemiology, public health, and medical ethics, were brought to the forefront in health professions education, while the physical learning environment underwent a rapid transition to a virtual learning space. As health professions education continues in the era of COVID-19 and into a new era, educators must take advantage of these dynamic systems to identify additional gaps and implement meaningful change. In this article, health professions educators and learners from multiple institutions and specialties discuss the gaps and weaknesses exposed, opportunities revealed, and strategies developed for optimizing the CLE in the post-COVID-19 world., (Copyright © 2021 by the Association of American Medical Colleges.)

Diverticulosis remains the commonest cause for acute lower gastrointestinal tract bleeding (GIB). Conservative management is initially sufficient for most patients, followed by elective diagnostic tests. However, if acute lower GIB persists, it can be investigated with colonoscopy, CT angiography (CTA), or red blood cell (RBC) scan. Colonoscopy can identify the site and cause of bleeding and provide effective treatment. CTA is a noninvasive diagnostic tool that is better tolerated by patients, can identify actively bleeding site or a potential bleeding lesion in vast majority of patients. RBC scan can identify intermittent bleeding, and with single-photon emission computed tomography, can more accurately localize it to a small segment of bowel. If patients are hemodynamically unstable, CTA and transcatheter arteriography/embolization can be performed. Colonoscopy can also be considered in these patients if rapid bowel preparation is feasible. Transcatheter arteriography has a low rate of major complications; however, targeted transcatheter embolization is only feasible if extravasation is seen, which is more likely in hemodynamically unstable patients. If bleeding site has been previously localized but the intervention by colonoscopy and transcatheter embolization have failed to achieve hemostasis, surgery may be required. Among patients with obscure (nonlocalized) recurrent bleeding, capsule endoscopy and CT enterography can be considered to identify culprit mucosal lesion(s). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment., (Copyright © 2021 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Iliofemoral venous thrombosis carries a high risk for pulmonary embolism, recurrent deep vein thrombosis, and post-thrombotic syndrome complicating 30% to 71% of those affected. The clinical scenarios in which iliofemoral venous thrombosis is managed may be diverse, presenting a challenge to identify optimum therapy tailored to each situation. Goals for management include preventing morbidity from venous occlusive disease, and morbidity and mortality from pulmonary embolism. Anticoagulation remains the standard of care for iliofemoral venous thrombosis, although a role for more aggressive therapies with catheter-based interventions or surgery exists in select circumstances. Results from recent prospective trials have improved patient selection guidelines for more aggressive therapies, and have also demonstrated a lack of efficacy for certain conservative therapies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment., (Copyright © 2020 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

OBJECTIVE. The purpose of this article is to provide an imaging-based guide of the modern genomic classifications and targeted therapies for advanced non-small cell lung cancer (NSCLC) with an emphasis on the relevance of the 2018 American Society of Clinical Oncology molecular testing guidelines for radiologists. CONCLUSION. Knowledge of the radiologic relevance of lung cancer driver mutations and modern targeted agents is essential for imaging interpretation of advanced NSCLC in the modern age of precision medicine.

Venous thromboembolism (VTE)-deep vein thrombosis and pulmonary embolism-is a common cause of morbidity and mortality. The mainstay of VTE prophylaxis and therapy is anticoagulation. In select patients with VTE, inferior vena cava (IVC) filters are used to prevent pulmonary embolism by trapping emboli as they pass from the lower extremity venous system through the IVC. These guidelines review the indications for placement of IVC filters in acute and chronic VTE, as well as the indications for retrieval of implanted IVC filters. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment., (Copyright © 2019 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Objective: We evaluated the transferability of prediction models between trauma care contexts in India and the United States and explored updating methods to adjust such models for new contexts., Study Design and Settings: Using a combination of prospective cohort and registry data from 3,728 patients of Towards Improved Trauma Care Outcomes in India (TITCO) and from 18,756 patients of the US National Trauma Data Bank (NTDB), we derived models in one context and validated them in the other, assessing them for discrimination and calibration using systolic blood pressure, heart rate, and Glasgow coma scale as candidate predictors., Results: Early mortality was 8% in the TITCO and 1-2% in the NTDB samples. Both models discriminated well, but the TITCO model overestimated the risk of mortality in NTDB patients, and the NTDB model underestimated the risk in TITCO patients., Conclusion: Transferability was good in terms of discrimination but poor in terms of calibration. It was possible to improve this miscalibration by updating the models' intercept. This updating method could be used in samples with as few as 25 events., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: Radical cystectomy and urinary diversion may cause chronic metabolic acidosis, leading to long-term bone loss in patients with bladder cancer. However, the risk of fractures after radical cystectomy has not been defined. We assessed whether radical cystectomy and intestinal urinary diversion are associated with increased risk of fracture., Patients and Methods: Population-based study using SEER-Medicare-linked data from 2000 through 2007 for patients with stage 0-III bladder cancer. We evaluated the association between radical cystectomy and risk of fracture at any site, controlling for patient and disease characteristics., Results: The cohort included 50,520 patients, of whom 4,878 had cystectomy and urinary diversion. The incidence of fracture in the cystectomy group was 6.55 fractures per 100 person-years, compared with 6.39 fractures per 100 person-years in those without cystectomy. Cystectomy was associated with a 21% greater risk of fracture (adjusted hazard ratio, 1.21; 95% CI, 1.10 to 1.32) compared with no cystectomy, controlling for patient and disease characteristics. There was no evidence of an interaction between radical cystectomy and age, sex, comorbidity score, or cancer stage., Conclusion: Patients with bladder cancer who have radical cystectomy and urinary diversion are at increased risk of fracture., (© 2014 by American Society of Clinical Oncology.)

Objective: To determine the outcomes of patients with final pathological stage T1N0 disease after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) and to determine whether lymphovascular invasion (LVI) is an independent predictor of prognosis in these patients., Patients and Methods: Records of 958 consecutive patients who underwent RC at three academic centres were reviewed. A total of 101 patients with negative lymph nodes and with final stage (the higher of the pre-RC clinical/transurethral resection [TUR] and post-RC pathological stages) T1 UCB were identified. The median (range) follow-up was 38 (0.4-177) months and the median (range) number of nodes examined was 19 (9-80)., Results: Overall, 12/101 (11.9%) patients experienced cancer recurrence and 7/101 (6.9%) died from their cancer. The 3-year recurrence-free survival probability (SD) was 0.89 (0.04) and 3-year cancer-specific survival probability (SD) was 0.96 (0.02). Six of 101 (6%) patients had LVI, of whom four experienced disease recurrence and three died from bladder cancer. All recurrences and deaths occurred in patients who had either LVI and/or concomitant carcinoma in situ. On multivariable analysis, LVI (hazard ratio [HR] 4.9, P = 0.01) and higher pathological stage (HR 8.5, P = 0.04) predicted cancer recurrence and LVI (HR 6.7, P = 0.01) predicted cancer-specific survival., Conclusions: LVI helps identify patients with final pathological T1N0 UCB who are at significantly increased risk of bladder cancer recurrence and death. These patients should be considered for close monitoring after cystectomy., (© 2012 BJU International.)

Objectives/hypothesis: Head and neck surgeons can be involved in the management of germ cell tumor (GCT) metastatic to the neck from initial diagnosis through postchemotherapy management of residual neck masses. This article reports on 34 consecutive patients with GCT metastatic to the neck., Study Design: Retrospective chart review., Methods: A single-institution retrospective chart review of 34 consecutive patients with GCT metastatic to the neck who underwent postchemotherapy neck surgery between 1991 and 2009 was performed., Results: Seventy-four percent of patients had a neck mass at initial diagnosis, with 50% of patients having a neck mass as the presenting symptom leading to a diagnosis of GCT. Of the 37 neck procedures, positive nodes were found in 22. No significant relationship between preoperative tumor markers and neck pathology (P = .35) was identified. No patients had neck recurrence. No patients had permanent nerve injury or chyle leak. As a secondary end point, survival analysis related to cervical pathology showed that viable tumor in the neck predicted disease-specific survival (P = .01). Five- and 10-year disease-specific survival was 82.3% (median, 52-month follow-up)., Conclusions: Operative management for patients with metastatic GCT to the neck can achieve long-term durable cervical control with limited complications., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Although the 36-Item Short-Form General Health Survey (SF-36) has been utilized to assess quality of life (QoL) in cross-sectional studies, no longitudinal studies have evaluated this instrument in stone formers. Hence, we evaluated the performance of the SF-36 over time in a group of stone formers. From January to May 2007, the SF-36 was administered by independent interviewers to 155 patients with a history of stones, and 96 individuals subsequently completed a second questionnaire at a median interval of 18 months (10.3-28.5 months). Subjects were asked to report changes in stone status, interval procedures, and significant non-stone related changes. Changes in individual and composite scores of SF-36 were compared. Among the 96 patients who completed two SF-36 surveys, 75 patients denied experiencing a stone episode within the month preceding their initial or follow-up SF-36 form. No statistically significant differences in any of the SF-36 domains or the aggregate physical or mental health composite scores over time were noted in these patients. A total of 18 patients reported a stone event within the month preceding completion of the initial questionnaire but no stone event prior to the follow-up survey. No clinically or statistically significant changes in any of the SF-36 domains between the first and follow-up questionnaire were seen among these 18 patients. The results show the stability of the SF-36 over time in patients with no change in their stone status. However, the absence of significant changes in the SF-36 despite a change in stone status suggests that the SF-36 may not be an adequate tool to monitor quality of life over time in stone patients. Validated, disease-specific questionnaires are needed to facilitate comparison of treatment strategies for stone disease.

Objectives: The relationship between anthropometric and metabolic factors and benign prostatic hyperplasia (BPH) is poorly understood. We investigated the associations of BPH with anthropometric and metabolic parameters in this prospective study of Vietnam War veterans., Methods: A total of 1206 participants in the comparison arm of the Air Force Health Study with a median follow-up of 15.6 years were included in this study. The "Ranch Hand" group, occupationally exposed to herbicides, was excluded to eliminate any confounding from exposure to herbicides. BPH was determined by medical record review using the International Classification of Diseases and Related Problems, Ninth Revision. We used Cox proportional hazards regression models for the statistical analysis., Results: The median age for BPH diagnosis was 58.6 years. On multivariate analyses, increasing age (relative risk [RR] 1.14, 95% confidence interval [CI] 1.12 to 1.17), height (RR 1.02, 95% CI 1.004 to 1.03), and fasting blood glucose (RR 1.004, 95% CI 1.001 to 1.007) were associated with increased risk. The effect of age varied with the duration of follow-up. A greater systolic blood pressure (RR 0.992, 95% CI 0.986 to 0.997) was associated with decreased risk of BPH. A dose-response effect was seen for age, height, and systolic blood pressure. No effect was seen for weight, body mass index, change in weight or body mass index, lipids, thyroid hormone status, or the metabolic syndrome., Conclusions: The risk of BPH increased with increasing age, height, and fasting blood glucose levels. The risk was decreased with a greater systolic blood pressure. No relationship was seen between BPH and metabolic syndrome, weight, body mass index, lipid level, or thyroid hormone status.

Objective: Dioxins decrease prostate weight, reduce androgen responsiveness, and inhibit prostate morphogenesis in rats. We assessed the association of dioxins and benign prostatic hyperplasia (BPH) in participants in the National Health and Nutritional Examination Survey 1999-2000., Methods: Forty-two participants were classified as having BPH and 99 were classified as controls. Dioxin exposure was expressed as dioxin toxic equivalents (TEQ). Age, body mass index, waist circumference, race/ethnicity, smoking, physical activity, and education were assessed as potential confounders., Results: After age adjustment, men without BPH had 20.9% higher TEQs (95% confidence interval [CI] = 5.4-38.7%) as compared with men with BPH. On weighted, multivariate, logistic regression analyses, men with higher dioxin levels had lower odds of having BPH (odds ratio = 0.22, 95% CI = 0.08-0.62)., Conclusions: Dioxin exposure in the general population may be associated with decreased odds of BPH. Our study findings need to be confirmed.

Rising employer healthcare costs are driving the need for new cost-saving benefit programs. Consumer-driven health plans have the potential to create savings for employers and better care options for patients. Furthermore, three fundamental forces need to come together for these health plans to become a reality. First, employees need to view healthcare benefits as assets and be provided with the tools to manage those assets. Second, employees must have continuity in the management of their healthcare assets, which includes their medical utilization history. Finally, any savings accumulated in these plans must be employee owned and portable from job to job or available for retirement healthcare needs. Making consumers active participants in the next generation of health plans is a necessity. Making it happen, however, will be a challenge.

Rising healthcare costs have created a crisis situation in employee health benefits. For the first time in a decade, the call for a single-payer healthcare system has been renewed. Although the single-payer system might help expand access to care and reduce administrative costs, the potential costs and bureaucracy make its implementation unrealistic. Consumer-centric health benefit models such as defined contribution and portable HRAs are the first attempts by the private sector to involve consumers in the healthcare decision process. Portable HRAs, which treat health benefits as portable assets to be managed and saved over a lifetime, have the potential to reduce employer costs while improving the quality and continuity of care, with equal access to care for all.