Gastrointestinal carcinoid tumor in a patient with chronic diarrhea.
Explore the source record for details and available documents.
Chronic Disease↗
Biomedical subjects
Stephen Miller
Publications and source records attributed to Stephen Miller.
Supplements and drugs used to enhance athletic performance.
The temptation of using drugs and supplements as shortcuts to improving athletic performance or even to enhance appearance is very seductive to adolescents. This age group is often characterized by a desire for quick results and a lack of concern for future consequences. Preventing the use of drugs to enhance athletic performance is difficult even when we have good medical and scientific evidence to prove a dangerous risk-benefit ratio, such as with AASs. The use of "nutritional supplements" is even more difficult to control. The protection of these substances by the Dietary Supplement Health and Education Act of 1994 removed control of these substances from the FDA. Therefore, release and widespread use of new supplements occurs before significant clinical study of benefit and adverse effects takes place. The distributors' financial interest, the products' promotional claims, and the athletes' and coaches' insatiable desire to win at all costs are a volatile combination. This spawns the production of a huge number of "natural" products, making it even more difficult to assess efficacy, safety, legality, and purity of these substances. Health care professionals need to rely on research when available, stay current on trends in athletes' drug and supplement use, and discuss the individual athlete's concerns when they arise. The preparticipation physical examination can be a good opportunity for discussion. Finally, physicians need to educate athletes, parents, coaches, trainers, and other physicians. A reasonable strength and conditioning program and a well-balanced diet must be presented as a sensible alternative to a riskier, shortcut mindset.
Adolescent↗
Orthopaedic recertification.
This report summarizes a symposium presented at the 2001 Annual Meeting of the American Orthopaedic Association that was designed to assess the current status of recertification by the American Board of Orthopaedic Surgery (ABOS) and to determine how it will change in the near future. Recertification is a process whereby the general public is assured of quality medical care by a competent and knowledgeable physician. As a professional organization, we have an obligation to provide quality care. The nature of the public demand for standards ensuring competence and the history of recertification in orthopaedic surgery are examined. The recertification of commercial airline pilots is reviewed, as it provides a model of an unrelated but highly skilled profession requiring intellectual and technical proficiency. The goals and plans of the American Board of Medical Specialties (ABMS), which encompasses the views of all twenty-four major specialty boards including orthopaedic surgery, are reviewed. Finally, the future plans of the ABOS for recertification are considered.
Certification↗
Volatile organic compounds produced during irradiation of mail.
In 2001, Bacillus anthracis spores were delivered through the United States postal system in a series of bioterrorist acts. Controls proposed for this threat included sanitization with high-energy electrons. Solid phase microextraction was used with gas chromatography/mass spectrometry for field sampling and analysis of volatile compounds apparently produced from polymeric materials such as cellulose and plastics, immediately following processing of mail at a commercial irradiation facility. Solid phase microextraction and direct sampling of air into a cryogenically cooled temperature programmable inlet were used in the laboratory for gas chromatography/mass spectrometry analysis of air in contact with irradiated mail, envelopes only (packaged identically to mail), and air inside irradiated plastic mail packaging bags (with neither mail nor envelopes). Irradiated mail or envelope systems produced hydrocarbons such as propane, butane, pentane, hexane, heptane, methylpentanes, and benzene; and oxygen-containing compounds such as acetaldehyde, acrolein, propionaldehyde, furan, 2-methylfuran, methanol, acetone, 2-butanone, and ethanol. In addition to hydrocarbons, methyl and ethyl nitrate were detected in irradiated bags that contained only air, suggesting reactive nitrogen species formed from air irradiation reacted with hydroxy-containing compounds to give nitro esters. The similarities of volatile compounds in irradiated systems containing paper to those observed by researchers studying cellulose pyrolysis suggests common depolymerization and degradation mechanisms in each case. These similarities should guide additional work to examine irradiated mail for chemical compounds not detectable by methods used here.
Air Pollution, Indoor↗