Though prevalent in white postmenopausal women, osteoporosis occurs in all populations and at all ages and has significant physical, psychosocial, and financial consequences. Risks for osteoporosis (reflected by low bone mineral density [BMD]) and for fracture overlap but are not identical. More attention should be paid to skeletal health in persons with conditions associated with secondary osteoporosis. Clinical risk factors have an important but poorly validated role in determining who should have BMD measurement, in assessing fracture risk, and in determining who should be treated. Adequate calcium and vitamin D intake is crucial to develop optimal peak bone mass and to preserve bone mass throughout life. Supplementation with these 2 nutrients may be necessary in persons not achieving recommended dietary intake. Gonadal steroids are important determinants of peak and lifetime bone mass in men, women, and children. Regular exercise, especially resistance and high-impact activities, contributes to development of high peak bone mass and may reduce risk of falls in older persons. Assessment of bone mass, identification of fracture risk, and determination of who should be treated are the optimal goals when evaluating patients for osteoporosis. Fracture prevention is the primary treatment goal for patients with osteoporosis. Several treatments have been shown to reduce the risk of osteoporotic fractures, including those that enhance bone mass and reduce the risk or consequences of falls. Adults with vertebral, rib, hip, or distal forearm fractures should be evaluated for osteoporosis and given appropriate therapy.

Adenocarcinomas of the prostate can be categorized into tumor grades based on the extent to which the cancers histologically resemble normal prostate glands. Because grades are surrogates of intrinsic tumor behavior, characterizing the molecular phenotype of grade is of potential clinical importance. To identify molecular alterations underlying prostate cancer grades, we used microdissection to obtain specific cohorts of cancer cells corresponding to the most common Gleason patterns (patterns 3, 4, and 5) from 29 radical prostatectomy samples. We paired each cancer sample with matched benign lumenal prostate epithelial cells and profiled transcript abundance levels by microarray analysis. We identified an 86-gene model capable of distinguishing low-grade (pattern 3) from high-grade (patterns 4 and 5) cancers. This model performed with 76% accuracy when applied to an independent set of 30 primary prostate carcinomas. Using tissue microarrays comprising >800 prostate samples, we confirmed a significant association between high levels of monoamine oxidase A expression and poorly differentiated cancers by immunohistochemistry. We also confirmed grade-associated levels of defender against death (DAD1) protein and HSD17␤4 transcripts by immunohistochemistry and quantitative RT-PCR, respectively. The altered expression of these genes provides functional insights into grade-associated features of therapy resistance and tissue invasion. Furthermore, in identifying a profile of 86 genes that distinguish high-from low-grade carcinomas, we have generated a set of potential targets for modulating the development and progression of the lethal prostate cancer phenotype.carcinoma ͉ monoamine oxidase A ͉ microarray ͉ expression profile

Current public reports benchmarking nursing homes' performances may require additional technical modifications to avoid compromising the fairness of comparisons.

Background: Presently a median of 37.5% of the U.S. skilled nursing facility (SNF) workforce has been vaccinated for COVID-19. It is essential to understand vaccine hesitancy among SNF workers to inform vaccine campaigns going forward.Objective: To describe the concerns raised among healthcare workers and staff from SNFs during town hall meetings.Design: Sixty-three SNFs from four corporations were invited to send Opinion Leaders, outspoken staff from nursing, nurse aid, dietary, housekeeping or recreational therapy, to attend a 1-h virtual town hall meeting. Meetings used a similar format where the moderator solicited concerns that the attendees themselves had or had heard from others in the facility about the COVID-19 vaccine. Physicians and moderators used personal stories to address concerns and reaffirmed positive emotions.Setting: Twenty-six video town hall meetings with SNF staff.Participants: Healthcare workers and staff, with physicians serving as content experts.Measurement: Questions and comments about the COVID-19 vaccines noted by physicians.Results: One hundred and ninety three staff from 50 facilities participated in 26 meetings between December 30, 2020 and January 15, 2021. Most staff reported getting information about the vaccine from friends or social media.Concerns about how rapidly the vaccines were developed and side effects, including infertility or pregnancy related concerns, were frequently raised. There were no differences in concerns raised by discipline. Questions about returning to prior activities after being vaccinated were common and offered the opportunity to build on positive emotions to reduce vaccine hesitancy.Conclusions: Misinformation about the COVID-19 vaccine was widespread among SNF staff. Sharing positive emotions and stories may be more effective than sharing data when attempting to reduce vaccine hesitancy in SNF staff.

No abstract

Context.-Informal (curbside) consultations are an integral part of medical culture and may be of great value to patients and primary care physicians. However, little is known about physicians' behavior or attitudes toward curbside consultation.Objective.-To describe and compare curbside consultation practices and attitudes among primary care physicians and medical subspecialists.Design.-Survey mailed in June 1997.Participants.-Of 286 primary care physicians and 252 subspecialists practicing in Rhode Island, 213 primary care physicians and 200 subspecialists responded (response rate, 76.8%).Main Outcome Measures.-Self-reported practices of, reasons for, and attitudes about curbside consultation.Results.-Of primary care physicians, 70.4% (150/213) and 87.5% (175/200) of subspecialists reported participating in at least 1 curbside consultation during the previous week. In the previous week, primary care physicians obtained 3.2 curbside consultations, whereas subspecialists received 3.6 requests for curbside consultations. Subspecialties most frequently involved in curbside consultations were cardiology, gastroenterology, and infectious diseases; subspecialties that were requested to provide curbside consultations more often than they were formally consulted were endocrinology, infectious diseases, and rheumatology. Curbside consultations were most often used to select appropriate diagnostic tests and treatment plans and to determine the need for formal consultation. Subspecialists perceived more often than primary care physicians that information communicated in curbside consultations was insufficient (80.2% vs 49.8%; PϽ.001) and that important clinical detail was not described (77.6% vs 43.5%; PϽ.001). More subspecialists than primary care physicians felt that curbside consultations were essential for maintaining good relationships with other physicians (77.2% vs 38.6%; PϽ.001).Conclusions.-Curbside consultation serves important functions in the practice of medicine. Despite the widespread use of curbside consultation, disagreement exists between primary care physicians and subspecialists as to the role of curbside consultation and the quality of the information exchanged.

A multifaceted intervention improved pain-management process and outcome measures in nursing homes.

The Xavantina-Cachimbo Expedition worked during 1967-9 in a 20 km square around a base camp (12° 49' N, 51° 46' W), ca . 260 km north of Xavantina (NE Mato Grosso) and near Xavantina itself. The vegetation is of special interest because the base camp is situated near the junction of the savanna region of Central Brazil and the Amazonian forest. It is a pattern of savanna (cerrado), savanna woodland (cerradão), forest and treeless grassland (campo) with often remarkably abrupt boundaries between the different communities. Until 1967 the area had been very little affected by man. The climate is characterized by high temperature throughout the year, an annual rainfall of about 1200 to 1400 mm, and a more or less rainless dry season from June to September inclusive. During the dry season the cerrado, campo and some forms of cerradao vegetation are subject to fire, but are not burned every year. The forest, except the Deciduous Seasonal forest, is not normally burned. The rocks consist of sandstones overlying shale and mudstones. The sandstone weathers to form widespread dystrophic soils of low nutrient content, whilst the finer textured rocks, exposed in some deeper valleys, produce somewhat richer mesotrophic soils. The woody vegetation types of dystrophic soils are classified into three types of Evergreen Seasonal forest (‘Swampy Gallery' forest,‘Valley' forest and ‘Dry' forest), cerradão and cerrado. The Swampy Gallery forest is found along streams where the water table is close to the surface even in the dry season and is often bordered on one or both sides by strips of campo. In composition it resembles an impoverished Amazonian rain forest. The top-storey is dominated by Qualea ingens and Q. wittrockii , growing sometimes to 40 m, and the undergrowth includes numerous dicotyledons, Scitamineae, grasses and other monocotyledons. At a slightly higher level in stream valleys there is another type of tall forest, Valley forest, in which characteristic trees (all growing to about 40 m) are Apuleia molaris, Copaifera langsdorfii, Hymenaea stilbocarpa and Ormosia sp. (Tento). Much the most extensive type of Evergreen Seasonal forest is the Dry forest which represents the southern fringe of the Amazonian forest and covers a vast area stretching away northwards from the base camp area. This is a mixed community in which the trees seldom grow to more than 20 m. The most abundant species of the upper storey in the area studied are C haetocarpus echinocarpus, Licania blackii, L. kunthiana, Saco glottis guianensis and Xylopia amazonica . The transition from Dry forest to cerrado is sometimes abrupt, but elsewhere there is an ecotone in which Hirtella glandulosa cerradão forms a recognizable nodum, occupying a zone up to 4 km wide. Characteristic species in this are Emmotum nitens, Sclerolobium paniculatum and Vochysia haenkeana , as well as H. glandulosa . The boundary between cerrado and Dry forest appears to be dynamic and there are some indications that the forest has recently invaded the cerrado. The present boundary does not seem to be primarily dependent on climate or burning but shows some relation to soil conditions, though apart from a higher clay content in the latter the cerrado and forest soils are much alike. Cerrado has a lower degree of crown cover than cerradão; it is a type of open savanna with grassy undergrowth and is extremely variable in floristic composition and no clearly defined associations could be recognized. The boundary between cerrado and campo in valleys is sharp and appears to be determined by the height of the water table in the wet season. The mesotrophic soils are occupied by Deciduous Seasonal forest, the only woody community in the area in which the top storey becomes leafless in the dry season. The fioristic composition of this community is very different from that of the other forest types and characteristic top-storey species include Cedrela fissilis, Piptadenia macrocarpa, Platypodium elegans and Sterculia striata , with Acacia polyphylla and Bauhinia cupulata as a second storey. Bamboos and the palm Acrocomia sp. are features of the undergrowth. Floristically this community is similar to forest types found on calcareous rocks in Goiás and Minas Gerais. It is fringed by a characteristic cerradão, termed Magonia pubescens / Callisthene fasciculaia cerradão.