Faculty Bibliography

OBJECTIVES: We explored an innovative strategy for targeted testing and disease management among immigrant communities at risk for tuberculosis. METHODS: Taxi drivers were recruited at an airport holding lot to undergo tuberculin skin testing (Mantoux). After receiving their test results in a location convenient for them, drivers with positive results were referred for evaluation and treatment. We conducted baseline and follow-up assessments. RESULTS: Of 123 drivers who participated, two thirds (82) were at high risk for tuberculosis. Seventy-eight (63%) of the 123 returned for test readings; 62% of these drivers had positive test results. All drivers with positive results received a complete physician evaluation, but 64% of those evaluated were not treated for latent TB infection. Of the untreated drivers, 37.5% were at high risk. Systemic and physician barriers (e.g., lack of knowledge, erroneous beliefs regarding vaccines) affected adherence to evaluation and treatment. CONCLUSIONS: Targeted testing and treatment are important to the control of tuberculosis. The results of this study highlight the need for an aggressive physician educational campaign to identify latent tuberculosis infection and to tailor service delivery to meet the unique needs of foreign-born communities

INTRODUCTION: Colorectal cancer is the second leading cause of cancer death in New York City. In March 2003, the New York City Department of Health and Mental Hygiene recommended colonoscopy every 10 years as the preferred screening test for adults aged 50 years and older in New York City. To screen all eligible adults in New York City would require that approximately 200,000 colonoscopy exams be performed annually. As part of this recommendation, we evaluated current colonoscopy capacity in New York City hospitals. METHODS: We surveyed endoscopy suite nursing or administrative staff at all 66 adult acute care hospitals performing colonoscopy in New York City. Data on colonoscopy procedures performed in 2002 were collected between February and June 2003. RESULTS: All hospitals and two affiliated clinics responded. The number of hospital-based colonoscopy exams performed in 2002 was estimated to be 126,000. Of these, 53,600 (43%) were estimated to be for screening. Hospitals reported their maximum annual capacity to be 195,200, approximately 69,100 more than current practice. Reported barriers to performing more colonoscopy exams included inadequate suite time and space (31%), inadequate staffing (28%), and insufficient patient referrals (24%). CONCLUSION: In 2003, endoscopy suites at New York City hospitals performed approximately one quarter of the estimated citywide need of 200,000 screening colonoscopies. Procedures conducted in outpatient office settings were not assessed. Most endoscopy suites, particularly private hospitals, reported having the capacity to conduct additional procedures. Hospitals and endoscopy suites should prioritize the development of institutional measures to increase the number of persons receiving screening colonoscopy.

OBJECTIVE: We sought to understand the relationship among components of residency education about hormone therapy (HT), knowledge about HT, and provider attitudes toward HT during a time of rapidly changing practice guidelines. METHODS: We surveyed residents in the University of Pittsburgh Internal Medicine residency programs between February to April 2002 (after the release of the Heart Estrogen/Progestin Replacement Study and prior to the release of preliminary Women's Health Initiative data) regarding demographics, educational (didactic and experiential) exposures to HT and menopause management, knowledge about HT, and attitudes toward HT. RESULTS: Sixty-nine of 92 (75%) eligible residents completed the survey; 38% were women. The race and gender of responders did not differ from nonresponders. Residents had significant didactic exposure to HT and menopause management with 80% reporting more than one didactic exposure. Despite this, HT knowledge was low (mean knowledge score 47 +/- 16%) and only 26% of residents felt prepared to counsel patients about HT. We identified four factors related to provider attitudes toward HT: 'persistence' in universally recommending HT, confidence in 'HT benefits,' concern about 'HT cardiac risks,' and concern about 'HT noncardiac risks.' More appropriate attitudes were associated with attending a lecture, having a rotation with a discussion of menopause management (i.e., Women's Health), and a continuity practice including more than 30% women. Pharmaceutical detailing and self-directed study were associated with less appropriate attitudes. Knowledge did not influence attitudes. Strongly held beliefs about the benefits of HT, appropriate or inappropriate, were associated with increasing 'persistence.' CONCLUSIONS: In an area of rapidly changing information, such as the risks and benefits of HT, knowledge is low. Experiential learning appropriately influences attitudes, while pharmaceutical detailing was associated with inappropriate attitudes toward HT risks

Aspergillus fumigatus causes invasive disease in severely immunocompromised hosts but is readily cleared when host innate defenses are intact. Animal models for evaluation of therapeutic strategies to combat invasive aspergillosis that closely mimic human disease are desirable. We determined optimal dosing regimens for neutrophil depletion and evaluated the course of infection following aerosol infection in mice by determining survival, organ fungal burden, and histopathology in mice in which neutropenia was induced by three methods, administration of granulocyte-depleting monoclonal antibody RB6-8C5 (MAb RB6), administration of cyclophosphamide, and administration of both agents. Administration of either individual agent resulted in a requirement for relatively high conidial inocula to achieve 100% mortality in both BALB/c and C57BL/6 mice, although the infection appeared to be somewhat more lethal in C57BL/6 mice. Death following induction of neutropenia with MAb RB6 occurred when a relatively low fungal burden was present in the lung and may have been related to the inflammatory response associated with neutrophil recovery. In contrast, administration of both agents reduced the lethal inoculum in each mouse strain by approximately 1 log(10), and C57BL/6 mice that received both agents had a higher fungal burden and less inflammation in the lung at the time of death than BALB/c mice or mice of either strain that received MAb RB6 alone. Our data suggest that the relationship among fungal burden, inflammation, and death is complex and can be influenced by the immunosuppression regimen, the mouse strain, and the inoculum.

An experimental workstation and surgical tools are presented utilizing electro-magnetic tracking to register real-time laparoscopic ultrasound (LUS) images with static, pre-acquired CT volumes. The registration and image fusion were used to guide tracked needles to target locations in an abdominal phantom. A custom-made sleeve equipped with magnetic sensor coils and attached to the steerable tip of a commercial LUS probe allowed precise localization of the imaging array without line-of-sight restrictions. For registration with CT image space, landmarks in physical space were identified using three different methods: (1) by pointing with a separate, electro-magnetically tracked pointer, (2) by pointing with the tip of the laparoscope, or (3) by imaging and subsequent manual identification of the landmark with LUS. The root-mean square (RMS) registration error using the three methods was 1.5 mm, 1.4 mm, and 1.1 mm, respectively. Overlays of real-time LUS with pre-acquired CT demonstrated the registration quality. Based on these registrations, tracked needles were guided into user-defined target locations. The RMS placement accuracy was 1.8 mm, 1.3 mm, and 1.9 mm, respectively. Accuracy is sufficient for planned clinical trials. (c) 2005 CARS & Elsevier B.V. All rights reserved.

The online population is becoming increasingly diverse. Cancer information websites are a popular destination. However, culturally-appropriate cancer information websites are lacking. METHODS: An Internet behavior and preference study was conducted in Caribbean immigrant women. 60 English-speaking Caribbean immigrant women in New York City participated in website review sessions. RESULTS: Three-quarters of the participants used computers regularly. Over 80% accessed the Internet from home. Over 50% felt confident using the Internet. However, only 6% used the Internet to search for health information. CONCLUSION: A 'cultural digital divide' exists. The Internet should be tailored to immigrants to facilitate web-based cancer education

This article examines whether differences in parental occupational prestige mediate or moderate race differences in four indicators of child development-reading scores, math scores, Behavior problems Index, and health status-using data front the Panel Stud v of Income Dynamics Child Development Supplement. The authors find that although for behavioral problems there is no impact of parental occupational prestige, for reading, math, and health there are significant academic returns to parental occupational prestige, but only for White families. The authors hypothesize that this racially, distinct dynamic may be a result of ongoing discrimination in the labor market, thereby, reducing the association between ability, (job and parenting) and prestige; or it may be a result of the difficulty of Blacks to translate occupational prestige gains into other benefits as a result of discrimination outside the labor market; or finally, it may, be the result of a generational lag between occupational status and parenting practices.