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on a background of genetically determined susceptibility that overall accounts for 40 70% of the variation in body weight (Farooqi and O Rahilly, 2006). An obesogenic lifestyle comprises variable combinations of an excessive energy intake and/or decreased energy expenditure, particularly through physical inactivity. The interplay of these factors is discussed in detail in s 7 and 8. The crucial role of lifestyle highlights the importance of a detailed history of food intake and physical activity patterns remembering that obese people frequently underestimate their food intake and over-report their physical activity levels (see 3). Other causes of obesity (Table 15.1) must be borne in mind throughout a consultation with an obese patient. Although unlikely, identifying a primary cause for obesity will often require speci c investigations and treatment that may be curative.

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The VistA Hospital and Radiology Information Systems (HIS/RIS) is used in all VAHE sites. In these systems DICOM and HL7 standards are used for images and text information, respectively. The HIS is internally developed and comprehensive enough to support all clinical services, and it uses a client-server architecture that allows clinical workstation clients to communicate with HIS servers. The database is the vintage Mumps beetree. The database les are all in Mumps, some stored on the hospital side to enable access from anywhere in the facility, and others kept locally. VistARAD is the radiology PACS used for primary image diagnosis. Some VAMCs purchase PACS from vendors; other, smaller centers rely on the VAHE IT department to supporting a homegrown PACS. VistA Imaging is an ePR integrated with images within a multimedia imaging distribution system for clinicians and healthcare providers, which we describe below in Section 22.2.3. Note that the term multimedia is used in VistA when images or data are converted to an image format. The VAHE IT department supports all centers in the integration of the four Vista A components listed above. The connectivity of these four components is shown in Figure 22.2. 22.2.3 The VistA Imaging

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and the average bone age (see the Case Selection Criteria section) and may not be important from a clinical perspective, However, we were able to conclude that the radiologists had a slight tendency, which was statistically signi cant, to overestimate bone age in the Asian and Hispanic populations as a whole. 26.7.3.3 Cross-racial Comparisons The cross-racial differences assessed with analysis of variance among the four races in the four divided age subsets (see Figure 26.16, right column) are presented in the left column of Figure 26.16. Figure 26.16F (upper row) shows that in girls, signi cant mean differences of average reading between races were observed in the third age subset (10 13 years, purple). Radiologists overestimated bone age in Asian girls in comparison with their African-American and Caucasian peers by approximately 0.59 year and 0.70 year, respectively. Similarly radiologists overestimated bone age by 0.58 year in Hispanic

White adipose tissue is a specialized loose connective tissue, in which clusters of individual adipocytes are held together by delicate reticulin bres to form lobules, bounded by brous septa and surrounded by a rich network of capillaries and nerves. Adipocytes comprise only 60 70% of the total cell population. The remaining cell types, comprising the stroma-vascular fraction (SVF), include fat precursor cells, broblasts, immune cells and the endothelial cells and pericytes of the blood vessels (Figure 4.3). The striking multi-cellularity of WAT is re ected in its ability to produce and respond to a wide range of endocrine, metabolic and immune signals, and in the numerous functions that it serves. Some of the secretory products of the adipocyte adipokines are discussed in detail below.

It is assumed that A has a non-zero determinant, so that its inverse exists. Then, the values of C,,,, are computed from equation (3.50). The question of how the symmetrical points (flOlfzO,) along with the corresponding gains of H(floi f2.J , , should be located in the f1 - f2 plane may arise. The following section considers the design algorithm for a 4 x 4 array with L = 4 selected points.

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