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OBJECTIVE: To understand the experience of Haida people living with non-insulin-dependent diabetes mellitus (NIDDM), in order to provide a basis for a culturally sensitive community-based approach to managing NIDDM. DESIGN: Qualitative study using grounded theory. SETTING: The villages of Skidegate and Old Massett in Haida Gwaii (Queen Charlotte Islands), British Columbia. PARTICIPANTS: Nine focus groups met at the beginning and six at the end of the project. The focus groups had 8 to 12 members each and roughly the same number of men and women overall. The groups included people with diabetes, family members of people with diabetes, community leaders and elders. FINDINGS: Conceptual findings related to the participants' views on the impact of NIDDM on their lives, their views on what life was like before the effects of NIDDM were felt and their beliefs about the prevention and treatment of NIDDM. Six themes recurred in the discussions: fear; grief and loss; the loss of and desire to regain control; food and eating; physical and personal strength; and traditional ways. CONCLUSIONS: Insights into the illness experience of different cultural groups can inform program development and the creation of culturally sensitive health care interventions.

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OBJECTIVES: To determine whether loss to follow-up can be predicted in patients who present to an emergency sexual assault assessment service and to generate hypotheses regarding the prediction of loss to follow-up on the basis of patient characteristics, assault characteristics and the services provided. DESIGN: Prospective, exploratory study. SETTING: Emergency department functioning as a regional sexual assault centre in a tertiary care hospital. PATIENTS: All 294 women over the age of 16 years who presented to the emergency department with a complaint of sexual assault and consented to be followed up. INTERVENTIONS: Telephone interviews at 24 to 48 hours and 1 month after presentation; face-to-face interviews after 1 week, 3 months and 6 months. MAIN OUTCOME MEASURES: Follow-up status (tracked versus lost to follow-up), State-Trait Anxiety Inventory (STAI-Y), Beck Depression Scale (Beck) and Rape Trauma Symptom Rating Scale (RTSRS). RESULTS: At 24 to 48 hours 136 (46%) of the patients could not be reached. Only 61 (21%) were still tracked at 6 months. Loss to follow-up at 1 month accurately predicted loss to follow-up at 6 months in 209 (98%) of 214 patients. For tracked patients the STAI-Y and Beck scores improved over 6 months. These scores at 1 week did not predict follow-up status at 6 months, but the numbers were small. Subjects with a higher RTSRS score at 24 to 48 hours were most likely to remain tracked throughout the 6 months. CONCLUSIONS: Decisions regarding how vigorously to track patients with a complaint of sexual assault can tentatively be based on the characteristics of the victim and of the assault. We hypothesize that the characteristics predicting loss to follow-up include denial and avoidance behaviour, lack of a telephone number or forwarding address, history of a psychiatric condition, a disability (e.g., deafness), characterization as a "street person," a high degree of violence or injury in the assault, and threat by the assailant. Although a predictive model requires further data, crisis intervention services in an emergency department are essential, given the large number of patients lost to follow-up.

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BACKGROUND: Some family practice residents, by virtue of their behavior, generate discomfort, anger, and ambivalence in their supervising colleagues. These residents are labeled "troublesome." The purpose of this qualitative research was to identify and conceptualize characteristics of troublesome residents. METHODS: We retrospectively reviewed written evaluations of four residents who, out of a total of 111 residents in our program over five years, had been labeled "troublesome." Using the approach of constant comparisons, we identified a conceptual framework that described the troublesome residents. RESULTS: We were able to classify the comments in the residents' written evaluations into three categories. The first category was troublesome residents' discomforting behaviors. These included affronting, avoiding responsibility, and lack of initiative. The second category included ways in which the resident failed to meet faculty and program expectations, often manifest as lack of collaboration and commitment. The third category of comments involved the process of recognizing and dealing with the troublesome resident. This occurred in a three-stage process involving recognition, confrontation, and remediation. CONCLUSIONS: The classification of troublesome residents' performances into conceptual categories may be useful for helping faculty understand and deal with these learners.

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On the basis of 4 patients from our own records we describe the rare syndrome of "Hyperostosis sternocostoclavicularis". The etiology of this disorder is still unclarified. In addition to a swelling that is generally only slightly tender to pressure, the most important symptom is usually a long-standing, intermittent, dull pain in the upper sternum, the claviculae and the adjacent uppermost ribs. Laboratory diagnosis usually shows an accelerated blood sedimentation rate, but other laboratory findings are unremarkable and rheumatological serology gives a negative result. The changes detected by radiography are described, as are the histological findings. Primary or secondary malignant osteomas are also to be taken into account in differential diagnosis. For therapy most authors recommend medicinal treatment with non-steroidal antiphlogistic agents.

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This paper describes an investigation of the comprehensive aerosol correlative measurement experiments conducted between November 1984 and July 1986 for satellite measurement program of the Stratospheric Aerosol and Gas Experiment (SAGE II). The correlative sensors involved in the experiments consist of the NASA Ames Research Center impactor/laser probe, the University of Wyoming dustsonde, and the NASA Langley Research Center airborne 14-inch (36 cm) lidar system. The approach of the analysis is to compare the primary aerosol quantities measured by the ground-based instruments with the calculated ones based on the aerosol size distributions retrieved from the SAGE II aerosol extinction measurements. The analysis shows that the aerosol size distributions derived from the SAGE II observations agree qualitatively with the in situ measurements made by the impactor/laser probe. The SAGE II-derived vertical distributions of the ratio N0.15/N0.25 (where Nr is the cumulative aerosol concentration for particle radii greater than r, in micrometers) and the aerosol backscatter profiles at 0.532- and 0.6943-micrometer lidar wavelengths are shown to agree with the dustsonde and the 14-inch (36-cm) lidar observations, with the differences being within the respective uncertainties of the SAGE II and the other instruments.

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Patients who evoke emotional reactions in the family physician tend to be labelled "difficult". The difficult patient might be one who "yes . . . but" 's every suggestion, or who demands that the physician provide something inappropriate, like drugs or an unjustifiable letter. Whenever such an interaction occurs, the family physician can expect aggravation, frustration and, often, anger, and the results are likely to be unsatisfactory for both doctor and patient. This article describes an approach which will help the doctor to decide what actually to say or do in response to a difficult patient, especially within the time frame of the short office visit.

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Despite the resurgent popularity and known benefits of breast-feeding, most Canadian women do not consider the possibility of continuing breast-feeding when they return to work. This paper examines the reasons why many women make this choice, and what factors are involved in continuing to breast-feed. The long-range goal of our society should be to increase the percentage of mothers who continue to breast-feed their babies until at least six months of age, and to increase the percentage of places of employment where it is possible for an employee to continue to breast-feed after returning to work.

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Polar nephelometer and integrating nephelometer measurements of the volume scattering coefficient for well-documented aerosols were made as a part of the First International Workshop on light absorption by aerosol partioles. These measurements showed a good overall agreement between the two methods, with an average difference between the polar nephelometer and integrating nephelometer data of approximately 10%.

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Aerosol and cloud measurements are simulated for a space shuttle lidar. Expected errors (in signal, transmission, density, and calibration) are calculated algebraically and checked by simulating measurements and retrievals using random number generators. Vertical resolution is 0.1-0.5 km in the troposphere, 0.5-2.0 km above, except 0.25-1.0 km in mesospheric cloud and aerosol layers. Horizontal resolution is 100-2000 km. By day vertical structure is retrieved for tenuous clouds, Saharan aerosols, and boundary layer aerosols (at 0.53 and 1.06 microm) as well as strong volcanic stratospheric aerosols (at 0.53 microm). Quantitative backscatter is retrieved provided that particulate optical depth does not exceed approximately 0.3. By night all these constituents are retrieved plus upper tropospheric and stratospheric aerosols (at 1.06 microm), mesospheric aerosols (at 0.53 microm), and noctilucent clouds (at 1.06 and 0.53 microm). Molecular density is a leading source of error in measuring nonvolcanic stratospheric and upper tropospheric aerosols.

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Results of the first year of data collection by the SAM (Stratospheric Aerosol Measurement) II satellite system are presented. Almost 10,000 profiles of stratospheric aerosol extinction in the Arctic and Antarctic regions are used to construct plots of weekly averaged aerosol extinction versus altitude and time and stratospheric optical depth versus time. Corresponding temperature fields are presented. These data show striking similarities in the aerosol behavior for corresponding seasons. Wintertime polar stratospheric clouds that are strongly correlated with temperature are documented. They are much more prevalent in the Antarctic stratosphere during the cold austral winter and increase the stratospheric optical depths by as much as an order of magnitude for a period of about 2 months. These clouds might represent a sink for stratospheric water vapor and must be considered in the radiative budget for this region and time.

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A study was undertaken to assess the state of hepatitis B virus (HBV) infection in hemodialysis patients. From 97 hemodialysis patients tested, 51 were found to have at least one hepatitis B virus specific marker. 18 were HBsAg carriers, 12 of these carriers have to be regarded as infectious as judged from the presence of HBeAg and/or HBV-specific DNA polymerase activity in the serum. Antinuclear antibodies (ANA) were found in the sera of approximately 20% of the hemodialysis patients with a high prevalence in cases which lacked HBV markers. We conclude from our study that HBsAg-positive hemodialysis patients should be dialyzed in a separate unit and preferably served by personnel which is anti-HBs-positive. The question whether patients in which anti-HBc represents the only HBV marker should be separated is still open and needs further work. The role of non-A/non-B infection is difficult to determine and further studies are needed to elucidate this question.

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A method for calculating light scattering by irregular randomly oriented particles yields results that are in good agreement with experimental data. The method is based on the assumption that surface waves are present in scattering by spherical particles, but they are absent in scattering by irregular particles.

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