Nevada School Research Articles

Angiotensin Receptor Blocker Use May Decrease the Incidence and Progression of Alzheimer’s Disease and Dementia in Older Men but the Strength of the Evidence Is Questionable

ANGIOTENSIN RECEPTOR BLOCKER USE MAY DECREASE THE INCIDENCE AND PROGRESSION OF ALZHEIMER’S DISEASE AND DEMENTIA IN OLDER MEN BUT THE STRENGTH OF THE EVIDENCE IS QUESTIONABLE Multiple longitudinal studies suggest that elevated blood pressure (BP) in midlife is associated with deterioration of cognitive function later in life, and prospective, randomized, placebo-controlled studies have suggested that treatment of hypertension may reduce the incidence and severity of dementia. Whether certain antihypertensive agents provide additional benefits independent of their BP-lowering ability in reducing the incidence and progression of dementia in general, and Alzheimer’s disease (AD) in particular, has been the subject of considerable debate. A few studies in both humans and animals have suggested that angiotensin receptor blockers (ARBs) may preserve cognitive function independent of and in addition to their effects on BP. The current prospective, observational study analyzed information from the Veteran’s Administration (VA) healthcare system decision support database in a large population with uniform healthcare coverage. It asked whether, as compared to the angiotensin converting enzyme inhibitor (ACEI) lisinopril or other cardiovascular (CV) disease medications, use of ARBs is associated with a decrease in the incidence and progression of dementia and AD. Investigators identified patients who as of October 2002 were 65 years of age or older from a database of over 7.3 million people. Patients were divided into those who did (progression analysis) or did not yet (incidence analysis) have a diagnosis of AD or dementia as of October 2002. In each of these groups, 3 different cohorts were analyzed and compared: (1) those taking ARBs (overall sample size of more than 11,500 patients), (2) those taking the ACEI lisinopril (overall sample size of more than 91,000 patients), and (3) those taking other CV drugs (excluding ARBs, ACEIs, and statins) as defined by VA formulary classification (more than 696,000 patients). Drug use from any of those 3 classes was determined based on a ‘‘drug possession ratio’’ of at least 80% and no exposure to other study drug classes during an index period of 6 months from October 2002. Drug use after entry into the study was in no way restricted by the investigators and was completely at the discretion of the treating physicians. For patients with a known history of dementia or AD at study entry (progression analysis), the primary endpoints evaluated were time to admission to a nursing home and death. For patients without a known history of dementia or AD at study entry (incidence analysis), time to diagnosis of either condition were the primary endpoints. Data on endpoints were collected over a 5-year time span (fiscal year 2002–2006). Since raw BP data were not in the VA decision support database at the time of this study, the investigators determined mean BP for each cohort on the basis of a subsample from the VA health systems vertically integrated service network. To account for potential confounding variables, multiple statistical models including various CV From the Division of General Internal Medicine ⁄ Division of Cardiology, University of Nevada School of Medicine; the Risk Reduction Center, Saint Mary’s Regional Medical Center, Reno, NV; the Primary Care Service Line, Ralph H. Johnson VA Medical Center; and the Division of General Internal Medicine ⁄Geriatrics, Medical University of South Carolina, Charleston, SC Address for correspondence: Michael J. Bloch, MD, Risk Reduction Center, Saint Mary’s Regional Medical Center, 645 North Arlington Street, Suite 460, Reno, NV 89503 E-mail: mbloch@aol.com

A Lower Blood Pressure Goal in Patients Without Diabetes Lessens the Occurrence of Left Ventricular Hypertrophy

A LOWER BLOOD PRESSURE GOAL IN PATIENTS WITHOUT DIABETES LESSENS THE OCCURRENCE OF LEFT VENTRICULAR HYPERTROPHY The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends a blood pressure (BP) goal of <140 ⁄90 mm Hg in most patients with hypertension and a goal of <130 ⁄80 mm Hg in patients with diabetes or chronic kidney disease. A recent scientific statement from the American Heart Association suggested adding patients with known coronary artery disease, carotid disease, peripheral artery disease, an abdominal aortic aneurysm, left ventricular dysfunction, or a calculated 10-year Framingham risk score of at least 10% to the group of patients with a BP goal of <130 ⁄80 mm Hg. These recommendations were made despite a lack of level I clinical trial evidence for benefit of more intensive treatment of BP in those patient populations. These recommendations are largely aimed at reducing the incidence of hard cardiovascular events such as myocardial infarction (MI), stroke, or heart failure. In patients with hypertension, left ventricular hypertrophy (LVH) is a major independent risk factor for stroke, MI, sudden cardiac death, and cardiovascular mortality. Yet, neither JNC 7 nor the American Heart Association (AHA) Scientific Statement specify a more aggressive BP goal in patients with LVH, and prevention of LVH is not emphasized in current guidelines. Whether more aggressive BP lowering would effectively reduce the incidence of LVH was recently tested in the Studio Italiano Sugli Effetti Cardiovascolari del Controllo della Pressione Arteriosa Sistolica (Cardio-Sis) trial. In this open-label, industry-supported trial conducted between February 2005 and February 2007, Italian researchers enrolled 1111 Italian hypertensive nondiabetic patients (93% of those screened). Inclusion criteria included age 55 years or older, a baseline systolic BP of 150 mm Hg, use of antihypertensive therapy for at least 12 weeks, and at least 1 additional risk factor (cigarette smoking, dyslipidemia, family history of premature cardiovascular disease, previous transient ischemic attack or stroke, or established coronary or peripheral artery disease). Patients were excluded if they had a history of diabetes, renal dysfunction, valvular heart disease, liver disease, atrial fibrillation, substance abuse, or a limited life expectancy. Eligible participants entered a run-in phase to make sure that at two visits 7 to 14 days apart their systolic BP on their present antihypertensive regimen was 150 mm Hg. They were then randomized in a 1:1 ratio to receive antihypertensive drug treatment to achieve either usual systolic BP control (<140 mm Hg) (n=553) or tight systolic BP control (130 mm Hg) (n=558). They were followed up every 4 months for 2 years. At baseline and at 1 and 2 years, patients had a 12-lead electrocardiogram (ECG) and laboratory blood tests performed. Treatment was open-label, with all classes of antihypertensive drugs available. Intensification or down-titration of treatment was permitted in order to achieve the specified BP goals. Drug classes were evenly distributed at baseline, except in the usualcontrol group where more patients were taking a diuretic and fewer were taking an angiotensin receptor blocker (ARB). The primary study outFrom the Division of General Internal Medicine ⁄ Division of Cardiology, University of Nevada School of Medicine; the Risk Reduction Center, Saint Mary’s Regional Medical Center, Reno, NV; the Primary Care Service Line, Ralph H. Johnson VA Medical Center, and the Division of General Internal, Medicine ⁄Geriatrics, Medical University of South Carolina, Charleston, SC Address for correspondence: Michael J. Bloch, MD, Risk Reduction Center, Saint Mary’s Regional Medical Center, 645 North Arlington Street, Suite 460, Reno, NV 89503 E-mail: mbloch@aol.com

Prevention of diabetic eye disease: the commonest cause of blindness in individuals younger than 65 years

There has been a considerable advancement in the treatment of diabetes and understanding of the biochemical mechanisms underlying diabetic complications in the last 20 years. However, this advancement has not translated into a consistent reduction in diabetic retinopathy, one of the most frightening complications of diabetes mellitus. It is probable that greater attention to preventive intervention will help reduce the damage load in the next future, and that several drugs for the treatment of more advanced stages of diabetic retinopathy will become available. Competent strategies targeting prevention based on screening programs should be proposed to reduce the burden and to improve the clinical outcome of this devastating diabetes complication.

Heart failure in people younger than 50 years is more common in black than white americans and is closely associated with poorly treated and controlled hypertension: the cardia study

HEART FAILURE IN PEOPLE YOUNGER THAN 50 YEARS IS MORE COMMON IN BLACK THAN WHITE AMERICANS AND IS CLOSELY ASSOCIATED WITH POORLY TREATED AND CONTROLLED HYPERTENSION: THE CARDIA STUDY Heart failure (HF) is a major public health issue that leads to substantial morbidity and mortality in the United States. Age, hypertension, and coronary ischemia are all well-documented risk factors for HF in older adults, but less is known about the incidence, risk factors, and demographics associated with HF in younger people. The Coronary Artery Risk Development in Young Adults (CARDIA) study, a 20-year multicenter longitudinal study of black and white men and women designed to investigate the development of coronary artery disease in young adults, offered an opportunity to explore these relationships. Beginning in 1985–1986, persons 18 to 30 years of age were enrolled from 4 American cities: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. The cohort was well balanced with respect to self-reported race (52% black) and sex (55% women). Multiple clinical measurements, including blood pressure (BP), were obtained at baseline and after 2, 5, 7, 10, 15, and 20 years. BP was measured in standardized fashion, with hypertension defined as a BP of at least 140 ⁄90 mm Hg or use of antihypertensive medications. During both their study examinations and in yearly telephone follow-up, participants were asked about overnight hospitalizations. For each hospitalization, records were obtained and adjudicated for the presence of incident HF, defined as a hospitalization where the final diagnosis of HF was made by a treating physician and HF was treated with at least a diuretic and either digitalis or an afterload-reducing agent. Death was also reported to the study centers every 6 months, and each death was adjudicated to determine whether it was due to HF. In year 5, as part of the examination, participants underwent echocardiography. Systolic function was considered abnormal if the ejection fraction (EF) was either <40% or qualitatively described as abnormal; systolic function was considered borderline if the EF was 40% to 60%. Left ventricular hypertrophy (LVH) was defined as a left ventricular mass index at least 51 g ⁄m. Using multiple statistical tools, the CARDIA investigators compared baseline and subsequent development of risk factors in participants in whom HF did and did not develop. The CARDIA study enrolled 5115 individuals with a mean age of 25 years and a mean baseline BP around 110 ⁄70 mm Hg. The retention rate in the study was exceptionally high, with 87.5% of the original cohort completing the yearly telephone interview at year 20 and 71.8% completing the year 20 in-person examination. During the 20 years of follow-up, incident HF occurred in 27 patients (0.5%), which was more common than the incidence of myocardial infarction. Twenty-six of the 27 patients who developed incident HF were black. The cumulative incidence of HF was 1.1% in black women and 0.9% in black men, compared with 0.08% in white women and 0% in white men. From the Division of General Internal Medicine ⁄ Division of Cardiology, University of Nevada School of Medicine; Risk Reduction Center, Saint Mary’s Regional Medical Center, Reno, NV; Primary Care Service Line, Ralph H. Johnson VA Medical Center; and Division of General Internal Medicine ⁄Geriatrics, Medical University of South Carolina, Charleston, SC Address for correspondence: Michael J. Bloch, MD, Risk Reduction Center, Saint Mary’s Regional Medical Center, 645 North Arlington Street, Suite 460, Reno, NV 89503 E-mail: mbloch@aol.com

Language and Cognitive Development of Children Who Have Williams Syndrome or Duplication of the Williams Syndrome Region

Language and Cognitive Development of Children Who Have Williams Syndrome or Duplication of the Williams Syndrome Region

Potential Molecular Mechanism for c-Src Kinase-mediated Regulation of Intestinal Cell Migration

The ubiquitously expressed Src tyrosine kinases (c-Src, c-Yes, and c-Fyn) regulate intestinal cell growth and differentiation. Src activity is also elevated in the majority of malignant and premalignant tumors of the colon. The development of fibroblasts with the three ubiquitously expressed kinases deleted (SYF cells) has identified the role of Src proteins in the regulation of actin dynamics associated with increased cell migration and invasion. Despite this, unexpectedly nothing is known about the role of the individual Src kinases on intestinal cell cytoskeleton and/or cell migration. We have previously reported that villin, an epithelial cell-specific actin-modifying protein that regulates actin reorganization, cell morphology, cell migration, cell invasion, and apoptosis, is tyrosine-phosphorylated. In this report using the SYF cells reconstituted individually with c-Src, c-Yes, c-Fyn, and wild type or phosphorylation site mutants of villin, we demonstrate for the first time the absolute requirement for c-Src in villin-induced regulation of cell migration. The other major finding of our study is that contrary to previous reports, the nonreceptor tyrosine kinase, Jak3 (Janus kinase 3), does not regulate phosphorylation of villin or villin-induced cell migration and is, in fact, not expressed in intestinal epithelial cells. Further, we identify SHP-2 and PTP-PEST (protein-tyrosine phosphatase proline-, glutamate-, serine-, and threonine-rich sequence) as negative regulators of c-Src kinase and demonstrate a new function for these phosphatases in intestinal cell migration. Together, these data suggest that in colorectal carcinogenesis, elevation of c-Src or down-regulation of SHP-2 and/or PTP-PEST may promote cancer metastases and invasion by regulating villin-induced cell migration and cell invasion.

An Unusual Fetal Ductus Arteriosus Pathway

Received January 22, 2008, from the Children’s Heart Center, Las Vegas, Nevada USA (R.J.A., W.N.E., W.C., R.R.); Division of Cardiology, Department of Pediatrics (R.J.A., W.N.E., W.C., R.R.), and MaternalFetal Medicine Program, Department of Obstetrics and Gynecology (D.R.), University of Nevada School of Medicine, Las Vegas, Nevada USA; Department of Obstetrics and Gynecology, University Medical Center, Las Vegas, Nevada USA (D.R.); and Nevada Perinatal, Las Vegas, Nevada USA (J.M.). Manuscript accepted for publication February 12, 2008. Address correspondence to Ruben J. Acherman, MD, Children’s Heart Center, 3006 S Maryland Pkwy, Suite 690, Las Vegas, NV 89109 USA. E-mail: IAcherman@aol.com uctal tortuosity occurs normally with advancing gestational age.1 Early in gestation, the 2-dimensional echocardiographic high transverse thoracic view shows the ductus arteriosus as a straight channel from the main pulmonary artery to the descending aorta. As gestation progresses, the ductus normally curves to the left away from the aortic arch. We report a fetus that had unusual ductal tortuosity: curving to the right posterior to the ascending aorta and above the right pulmonary artery. We were asked to evaluate this fetus because obstetric sonography suggested a ductus arteriosus abnormality. Initial fetal echocardiography performed at 32 weeks’ gestation showed an unusual ductus arteriosus pathway turning toward the right behind the ascending aorta and above the right pulmonary artery (Figures 1–3). There was no evidence of ductal constriction on follow-up fetal echocardiograms. A healthy neonate was delivered at term. The postnatal echocardiogram showed a ductal anatomy similar to the prenatal findings. Additionally, the ductus arteriosus was aneurysmatic at its aortic end and constricted at its midportion. At 3 days of age, echocardiographic findings were normal without evidence of ductal flow. In summary, we report a previously undescribed fetal ductus arteriosus pathway in a patient that had no evidence of a prenatal or postnatal hemodynamic disturbance.

Cyclic GMP/Protein Kinase G Phosphorylation of Smad3 Blocks Transforming Growth Factor-β–Induced Nuclear Smad Translocation

See related article, pages 185–192 In response to hemodynamic overload, the heart undergoes a complex adaptive remodeling process that involves cardiac myocyte hypertrophy, transformation of fibroblast into myofibroblast, high-level expression of extracellular matrix (ECM) proteins, interstitial fibrosis, and cell death.1 Differentiation of cardiac fibroblasts into myofibroblasts is critical to the production and deposition of collagens and plays a decisive role in myocardial fibrosis and morphological alterations during the progression of adaptive myocardial hypertrophy to decompensation and heart failure.1,2 Among the plethora of identified fibrogenic factors, transforming growth factor (TGF)-β3 plays a fundamental role in hypertrophic and fibrotic remodeling of the heart, where it regulates cardiomyocyte growth, fibroblast activation, and ECM deposition.4,5 The expression of ventricular TGF-β mRNA and protein is increased in numerous models of pathological cardiac hypertrophy and in cardiac cells in response to putative hypertrophic stimuli.6,7 In vitro, TGF-β activates myofibroblast transformation and increases ECM production.7 Blockade of TGF-β signaling is predicted to blunt fibrosis.5 Recent studies from Chen et al8 convincingly demonstrated that disruption of TGF-β signaling by inducible dominant-negative mutation of the TGF-β receptor type II (TβRII) gene significantly reduced the pressure overload–induced myofibroblast transformation and interstitial fibrosis in mouse heart. Thus, there is considerable interest in understanding how signaling by TGF-β receptors is transduced and how the inevitable damage produced could be mitigated. Of the 3 isoforms of TGF-β expressed in mammals,9,10 TGF-β1 is expressed in the adult heart, where it is secreted by cardiomyocytes and myofibroblasts and retained in significant amounts in ECM as a latent cytokine. Recent advances have led to clear description of downstream of TGF-β signal transduction pathways initiated by binding of TGF-β to membrane-bound heteromeric receptor kinases (TβRI and TβRII) that transduce intracellular signals via both Smad and non-Smad pathways …

Small and Smaller: A Comparison of Information Technology in Rural and Frontier Nevada Schools

Most educators, parents, and students seem to agree that computers and information technology should play an increasingly important role in education. As schools continue to add hardware and software, there has been concern about equity. One fear has been that students in rural schools may be at a disadvantage compared to students in urban or suburban school districts. A major problem in interpreting the small, existing body of research comparing the use of information technology in urban and rural schools is the variety of ways that the term rural is defined by researchers. This study developed two matrices (Appendix A and B) and used them to categorize rural districts as either frontier (extremely isolated) or other rural and compared computing resources. The study determined that frontier schools have a higher quantity and quality of information technology resources per student and per classroom while rural schools tend to have faster and higher quality Internet connections.

Confronting Risk About Antidepressants for Children

I first met Dr. Peter Breggin in 1992 when he gave a workshop in Reno, Nevada, on the toxicities of psychotropic medications. The workshop was cosponsored by the Reno V.A. Medical Center and the Department of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine. The events leading up to this workshop suggested that Dr. Breggin was a unique figure in psychiatry. A couple of weeks before the workshop, someone from the American Psychiatric Association contacted the director of the hospital to tell him that it was unwise to allow Dr. Breggin to present his workshop because his views were dangerous and outside of mainstream psychiatry. The director arranged a conference call with the APA representative and the organizers of the workshop. Though I was not in the room, I was later told by someone who was that during the course of the conference call, the director told the caller that the risks of medication treatment were a timely and important topic. He also told the caller that the hospital and the medical school supported academic freedom and would not cancel the workshop. The only concession the director made was to agree to a debate at the end of the workshop on the balance of risk and benefit for psychotropic drugs. Dr. Breggin's workshop went on as scheduled and resulted in the largest turnout of any workshop ever sponsored by the Reno V.A. Medical Center. Over 300 professionals (nurses, psychologists, counselors, and psychiatrists) attended, and many others were turned away at the door because the conference exceeded capacity. Dr. Breggin's presentation was passionate and data-based. The postworkshop debate with a prominent local psychiatrist was spirited and energized the crowd in attendance. The consensus was that Dr. Breggin handily won the debate. What I learned from watching these events unfold was that there was a hunger among professionals for information about the risks of psychotropic medications. Although information was widely available on efficacy, the scientific literature had important gaps on the hazards of such treatment. Dr. Breggin's book Toxic Psychiatry (Breggin, 1991) helped to fill this gap in a way that no publication before it had done. In fact, the Department of Psychiatry and Behavioral Sciences, chairman at the time encouraged the entire faculty to read the book. I remember reading the book cover to cover prior to the Reno workshop and feeling I had been exposed for the first time to an exhaustive accounting of the risks of commonly used psychotropic medications. I realized that it was impossible to conduct a true risk-benefit analysis of any intervention with adequate information only about benefit and inadequate information about risk. I had been trained in a "first do no harm" model of treatment, and this concerned me. I also learned that powerful forces could intervene to try to disrupt the flow of such information if it threatened corporate interests. This experience contributed to a shift in my interests away from benefit alone to the balance of risk and benefit of treatments for depression (e.g., Antonuccio, Burns, & Danton, 2002; Antonuccio, Danton & DeNelsky, 1995; Antonuccio, Danton, DeNelsky, Greenberg, & Gordon, 1999; Antonuccio, Danton, & McClanahan, 2003). I learned the importance of standing up for the data no matter whose ox is gored. I learned to appreciate my colleagues at the Reno V.A. Medical Center and at the Department of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine for their integrity and their support of academic freedom. In addition to finding him a warm and thoughtful individual, I came to respect Dr. Breggin's courage and stamina as a pioneer in the important and politically charged area of psychotropic medication risk. He was willing to answer any questions, and he would not shy away from a debate with anyone on the topic of psychotropic medications. His position was that the risks of these medications almost always outweighed the benefits. …

The Politics of Health as a School-Sponsored Ethic

This article describes the emergence of health policies targeted at the unhealthy school employee by examining how these are manifest in a Nevada school district. The analysis draws on the work of Foucault, specifically his writings on governmentality. The purpose of this critical appraisal is to problematize school-sponsored health policies by suggesting possible ramifications for these kinds of activities. It is salient for educational scholars and practitioners to consider how these policies, advocated in the name of health, work to construct certain ideologies and correspondingly, how these constructions affect the ways in which school work is managed and regulated.

Simulated Case of Massive Hemoptysis

OPEN ACCESSAugust 6, 2007Simulated Case of Massive Hemoptysis Christian Young Christian Young University of Nevada School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.533 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThis simulated case details a frequent and usually benign complaint, a cough, which becomes a very difficult situation, massive hemoptysis requiring intentional mainstem intubation. This resource includes the simulated case narrative along with case debriefing. The case is designed to instruct medical students and residents in the management and stabilization of patients with massive hemoptysis. This simulation is intended to improve understanding and competence in the management of a potentially life-threatening clinical scenario. Educational Objectives By the end of this case, learners will be able to: Review the incidence, epidemiology, and typical presentation of massive hemoptysis.Review the most common causes of hemoptysis.Understand the indications for selective mainstem intubation in the setting of massive hemoptysis. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Hemoptysis Simulator Case.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationYoung C. Simulated Case of Massive Hemoptysis. MedEdPORTAL. 2007;3:533. https://doi.org/10.15766/mep_2374-8265.533 Copyright & Permissions© 2007 Young. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsMassive HemoptysisMainstem Intubation Disclosures None to report. Funding/Support None to report. tabs.loading

Index of Suspicion

Index of Suspicion

Exposure assessment of a mercury spill in a Nevada school—2004

Background. Although mercury is toxic, few studies have measured exposure in children who handled elemental mercury briefly. In 2004, a student spilled approximately 60 milliliters of mercury at a Nevada school. Within 12 hours, all students were removed from the source of exposure. We conducted an exposure assessment at the school. Methods. We administered questionnaires and obtained urine samples from students. Using two-sample t-tests, we compared urine mercury levels from students who self-reported exposure to mercury levels of other students. Results. Two-hundred students participated, including 55/62 (89%) who were decontaminated. The students' geometric mean urine mercury level was 0.36 μg/L (95% confidence interval 0.32–0.40 μg/L). The student who brought the mercury to school was the only one to have an elevated urine mercury level (11.4 μg/L). Conclusion. Despite environmental contamination, mercury exposure may have been minimized because of rapid identification of the elemental mercury spill and decontamination.

Trauma and Addiction: Implications for Helping Professionals

(1) Helping professionals and first responders often experience stressful and traumatic incidents on a daily basis, and sometimes several times per day. (2) Research in addictions suggests an important link between traumatic experiences and the potential for addiction. (3) The idea of self-medicating to cope with stress and trauma is common not only in patients but also in helping professionals and first responders. (4) Treatment of substance-related disorders, trauma disorders, and stress responses share an important common consideration--immediacy.

Discussion

Las Vegas, Nev. Received for publication March 20, 2006. William A. Zamboni, M.D., Department of Surgery, University of Nevada School of Medicine, 2040 W. Charleston Boulevard, Suite 301, Las Vegas, Nev. 89102, [email protected]

Medical nutrition: a comprehensive, school-wide curriculum review

A school-wide nutrition program was established in 1982 and a required medical nutrition course (MNC) was established in 1985 at the University of Nevada School of Medicine. Emphasis was placed on developing an integrated curriculum and on using innovative methods to incorporate nutrition into the existing curriculum. The objective of this review was to establish a baseline and make positive curricular changes to comply with the recommendations of the Liaison Committee on Medical Education for accreditation. The MNC and the nutrition curriculum were evaluated as part of this 3-y comprehensive, school-wide evaluation process. The MNC was invited for review (December 2004) because of its position in the curriculum (first year), special content and methods, and relation to other courses. A review team, which consisted of the Assistant Dean for Medical Education (who chaired the team), a curriculum coordinator, faculty representatives, and a medical student, was appointed. The MNC coordinator prepared a review book that included the requested documentation. The initial 3-h review meeting culminated in a formal evaluation and recommendations. Follow-up meetings at 1 mo and 1 y were scheduled. The review was a positive process that reaffirmed the uniqueness of the nutrition program at the University. It supported the MNC as an important part of the required curriculum. Recommendations included use of the Web, encouragement to identify new opportunities with interested faculty, and a structure to further integrate and align nutrition into existing courses. A positive, proactive review process supports the importance of nutrition in the medical school curriculum and encourages further integration.

WHI response to Ostrzenski and Ostrzenska

Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY; Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Family and Community Medicine, University of Nevada School of Medicine, Reno, NV; Division of Preventive Medicine, University of Alabama at Birmingham, AL; Stanford Center for Research in Disease Prevention, Stanford University, Palo Alto, CA

Peripheral Brain: Rapid Diagnostic Tests for Infectious Diseases Suitable for Office Use

1. Echezona Ezeanolue, MD, MPH* 2. Chinenye Ezeanolue, MD† 3. Barry Dashefsky, MD‡ 1. *Assistant Professor of Pediatrics, Division of Pediatric Infectious Diseases, University of Nevada School of Medicine, Las Vegas, Nev 2. †Departments of Internal Medicine/Pediatrics, Newark Beth Israel Medical Center, Newark, NJ 3. ‡Associate Professor of Pediatrics, Department of Pediatrics, Division of Allergy, Immunology and Pediatric Infectious Diseases, UMDNJ-New Jersey Medical School, Newark, NJ After reading this article, readers should be able to: 1. Describe the generic qualities of a useful rapid diagnostic test. 2. Identify available rapid diagnostic tests for infectious diseases suitable for pediatric office use. 3. Understand the clinical utility and performance specifications of individual rapid diagnostic tests. Comment: This article covers content specifications for board recertification but also includes information pertinent for day-to-day office clinical practice. Several commercial products are listed by name to exemplify test differences, but this list should not be interpreted as an endorsement of the products by either the authors or the American Academy of Pediatrics. # {#article-title-2} 1. Joseph A. Zenel, MD, Associate Editor Rapid, accurate diagnosis of infectious diseases accelerates the initiation of appropriate management and may reduce unnecessary additional diagnostic testing and hospitalizations. Rapid diagnosis also facilitates prompt initiation of infection control policies. Technologic advances have resulted in the development of an array of rapid diagnostic tests suitable for the assessment of patients in the office who are suspected of having an infectious disease. This article discusses only those commercially available licensed rapid diagnostic tests exempted by the Clinical Laboratory Improvement Amendments of 1988, thus certifying that they are sufficiently simple so as to be performed reliably by nonlaboratory personnel in office settings. Rapid diagnostic tests suitable for office use should have the following qualities: Many earlier rapid diagnostic tests used latex or other particle agglutination technology, but most current tests use enzyme immunoassay (EIA) or optical immunoassay (OIA) technologies, which …

John A. McDonald Appointed Dean of the University of Nevada School of Medicine

John A. McDonald Appointed Dean of the University of Nevada School of Medicine