Faculty Bibliography

Ms. [Dorothea Lange]'s territory included all of California, which she covered by automobile. Driving north on Route 101 on a miserable winter's day, she passed a hand-lettered sign reading "Pea-Pickers Camp" near the town of Nipomo. Ms. Lange drove on for 20 miles, or about 32 kilometers, before something pulled her back. On the job for almost a year, she had come to understand the rhythms of migrant life, the periods of physically exhausting labor followed by even longer (unpaid) periods of emotionally draining inactivity. In the Nipomo camp, Ms. Lange met Florence Thompson, 32, the mother of 11 children, five born out of wedlock. The family was in desperate straits, living off stolen vegetables from the fields. Ms. Lange took a half-dozen photos, putting Ms. Thompson and her children in different poses. She took the photos from just outside their tent, even moving a pile of soiled laundry aside, so as not to embarrass the subjects by noting their squalid living conditions. (Though Ms. Gordon doesn't mention it, Ms. Lange may have decided to use only three of the children to avoid the public perception of "Okies" as irresponsible "white trash.") For the key photo, she "made the unusual decision to ask the two youngsters leaning on their mother to turn their faces away from the camera," Ms. Gordon writes. "She was building the drama and impact of the photograph by forcing the viewer to focus entirely on Florence Thompson's beauty and anxiety, and by letting the children's bodies, rather than their faces, express their dependence on their mother."

Aside from the post-9/11 threat of bioterrorism, infectious disease is more of a seasonal annoyance to most Americans than a major threat to their lives. [...] that is. He's intimately familiar with the region, having served as a correspondent in South Asia during the devastating recent tsunami. [...] his grasp of virology, as well as of the ins and outs of the world health bureaucracy, serves him well in explaining why medical practices that appear so obvious to Western experts in containing a deadly epidemic are largely irrelevant to "the backyard chicken farmers, cockfighters, witch doctors, political bosses, and poultry smugglers" who control the terrain where this battle must be fought

Aside from the post-9/11 threat of bioterrorism, infectious disease is more of a seasonal annoyance to most Americans than a major threat. [...] . He's intimately familiar with the region, having served as a correspondent in South Asia during the devastating recent tsunamis. [...] his grasp of virology, as well as of the ins and outs of the world health bureaucracy, serves him well in explaining why medical practices that appear so obvious to Western experts in containing a deadly epidemic are largely irrelevant to "the backyard chicken farmers, cockfighters, witch doctors, political bosses, and poultry smugglers" who control the terrain where this battle must be fought

BACKGROUND: Implantation of devices into the coronary sinus (CS)/great cardiac vein (GCV) to reshape the mitral annulus (MA) is being investigated, despite these structures not being within the same plane and coronary arteries frequently traversing between them. Furthermore, dynamic changes in their relationship have never been studied. We analyzed the CS/GCV dimensions and its relationship with the MA and the coronary arteries. METHODS AND RESULTS: Of 390 consecutive computed tomography angiographies reviewed, 56 met the inclusion criteria. Mean age of the patients was 68.9 + or - 13.1 years (26.8% men). The dimensions of the CS/GCV and the distance between this structure and the MA were measured at 10 different spatial points along the CS/GCV trajectory and at 3 different time points along the cardiac cycle (phases 0%, 40%, and 75% of the RR interval) by using curved multiplanar reconstruction technique. The CS/GCV was larger in phase 40% than in phase 75% and was smallest in phase 0% (P<0.001). The distance between the CS/GCV and the MA was longest in phase 40% and shortest in phase 0% (P=0.013). The diameter of the MA was measured in oblique 2- and 4-chamber reconstructions, being largest in phase 0% and smallest in phase 40% (P=0.019). A coronary artery traversed between the CS/GCV and the MA in 85.7% of the patients. CONCLUSIONS: This study demonstrated dynamic changes in the relationship between the CS/GCV and the MA and also that coronary arteries frequently traverse between both structures. Whether these findings are of clinical relevance for patients undergoing percutaneous mitral annuloplasty needs to be prospectively evaluated.

PURPOSE: We determined the differential diagnosis of concomitant pathological conditions in men with overactive bladder symptoms. MATERIALS AND METHODS: We performed an observational, descriptive study to elucidate the differential diagnosis in men with overactive bladder symptoms using a previously validated overactive bladder symptom questionnaire. All patients provided an extensive history, completed the self-administered questionnaire and a 24-hour voiding diary, and underwent physical examination, 24-hour pad test, uroflowmetry, post-void residual urine measurement, cystoscopy and urodynamics. Selection criteria were developed to assign cases to a category, including idiopathic overactive bladder, benign prostatic enlargement, benign prostatic obstruction, neurogenic bladder, bladder cancer, prostate cancer treatment complications, urethral stricture, bladder stones and bladder diverticulum. RESULTS: Of 122 men who met selection criteria for overactive bladder detrusor overactivity was identified in 99 (79%) on urodynamics. The differential diagnosis was benign prostatic enlargement in 40 men (32%), benign prostatic obstruction in 27 (22%), complications of prostate cancer treatment in 25 (20%), neurogenic bladder in 13 (11%), urethral stricture in 7 (6%), idiopathic overactive bladder in 6 (5%), bladder stone in 2 (2%), bladder cancer in 1 (1%) and bladder diverticulum in 1 (1%). CONCLUSIONS: Overactive bladder is a complex diagnosis with many underlying, contributing urological pathologies. It should be considered a symptom complex and not a syndrome. Knowledge of the differential diagnosis in men with overactive bladder symptoms would hopefully provide clinicians with a diagnostic rubric to more specifically treat such patients with improved success.

AIMS: To determine whether urinary urgency, as defined by the International Continence Society, is an intensification of the normal sensation that occurs when micturition must be delayed once the urge to void is felt (Type 1 urgency) or a discrete, pathologic symptom different from the normal urge (Type 2 urgency). METHODS: Forty-eight consecutive patients who complained of urinary urgency completed two different questionnaires designed to answer the question posed above. The patients were divided into two groups of 24. For the test-retest, group 1 completed questionnaire 1 twice within 3-10 days and group 2 did the same with questionnaire 2. On the second administration of the questionnaire, each subject crossed over and answered the other questionnaire. For the test-retest, since the data set is dichotomous (yes/no), the degree of agreement between the two sets of data was assessed by calculating the kappa coefficient. RESULTS: There were 37 women and 11 men ranging in age from 54 to 87 years. There was no difference in age and sex between the two groups (P = 0.19). There was excellent agreement in the test-retest responses for both questionnaires (kappa = 1.0, P < 0.001). For questionnaire 1, the urge sensation was an intensification of the normal sensation in 33 (68.8%) and it was a different sensation in 15 (31.3%). Similarly, for questionnaire 2, it was an intensification of the normal urge in 34 (70.8%) and different in 14 (29.2%). The differences in patient responses between the two groups were not significant. In the crossover section, only 1 of 48 subjects changed their response, resulting in a very high degree of agreement (kappa = .95, p < .001). Combining the two groups, urgency was perceived as an intensification of the normal urge to void in 33/48 patients (69%), a different sensation in 14/48 (29%) and 1/48 (2%) was not sure. CONCLUSIONS: Urgency is comprised of at least two different sensations. One is an intensification of the normal urge to void and the other is a different sensation. The implications of this distinction are important insofar as they may have different etiologies and respond differently to treatment.