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Although historically cisgender women (i.e., women whose sex assigned at birth is consonant with their gender) in the United States have had lower levels of alcohol consumption than cisgender men, [...]

Alcohol consumption, including any alcohol use; patterns of high-risk use, including binge drinking; and alcohol use disorder (AUD) incidence and prevalence, differs substantially over time and by life stage. Variation [...]

INTRODUCTION Patient-centered medical home (PCMH) models include numerous activities. For example, the National Committee for Quality Assurance (NCQA)'s PCMH standards include 100 different expectations. (1) Since PCMH accreditors typically only [...], PURPOSE To identify components of the patient-centered medical home (PCMH) model of care that are associated with lower spending and utilization among Medicare beneficiaries. METHODS Regression analyses of changes in outcomes for Medicare beneficiaries in practices that engaged in particular PCMH activities compared with beneficiaries in practices that did not. We analyzed claims for 302,719 Medicare fee-for-service beneficiaries linked to PCMH surveys completed by 394 practices in the Centers for Medicare & Medicaid Services' 8-state Multi-Payer Advanced Primary Care Practice demonstration. RESULTS Six activities were associated with lower spending or utilization. Use of a registry to identify and remind patients due for preventive services was associated with all 4 of our outcome measures: total spending was $69.77 less per beneficiary per month (PBPM) (P = 0.00); acute-care hospital spending was $36.62 less PBPM (P = 0.00); there were 6.78 fewer hospital admissions per 1,000 beneficiaries per quarter (P1KBPQ) (P = 0.003); and 11.05 fewer emergency department (ED) visits P1KBPQ (P = 0.05). Using a patient registry for pre-visit planning and clinician reminders was associated with $29.31 lower total spending PBPM (P = 0.05). Engaging patients with chronic conditions in goal setting and action planning was associated with 4.62 fewer hospital admissions P1KBPQ (P =0.01) and 11.53 fewer ED visits P1KBPQ (P = 0.00). Monitoring patients during hospital stays was associated with $22.06 lower hospital spending PBPM (P = 0.03). Developing referral protocols with commonly referred-to clinicians was associated with 11.62 fewer ED visits P1KBPQ (P = 0.00). Using quality improvement approaches was associated with 13.47 fewer ED visits P1KBPQ (P= 0.00). CONCLUSIONS Practices seeking to deliver more efficient care may benefit from implementing these 6 activities.

So he called for the birds. The first that came was a little wren. She pecked, and broke her bill, but could not make a hole. Then came the lark, and the robin, and the blue jay, and black bird, and many others that tried, but could do nothing. But as each came and did what it could Tallapus listened and gave it a name. (1), SOMETIME IN THE LATE NINETEENTH CENTURY the Reverend Horace S. Lyman transcribed what he called the story of 'Tallapus and the Cedar Tree' for preservation by the Oregon Historical Society [...]

This Qualitative Interpretive Meta-Synthesis (QIMS) method is used to highlight the sociological concept of colorist privilege, which characteristics of White privilege and colorism intersect to influence biopsychosocial outcomes on the African American population. Colorist privilege is first theoretically defined in this paper, then demonstrated within the synthesized studies to capture the experiences of colorist privilege among 155 African American participants utilizing secondary data. Three themes emerged from the essence of the lived experiences of participants that illustrate the mechanisms through which colorist privilege exists among both inter-racial and intra-racial relationships for African American people. Implications for education, teaching, and research regarding African Americans are discussed., Author(s): Latocia Keyes [sup.1] , Jandel Crutchfield [sup.2] , Betty C. Tonui [sup.3] Author Affiliations: (1) grid.267315.4, 0000 0001 2181 9515, Social Work, University of Texas at Arlington, , 211 [...]

I INTRODUCTION Jurisdiction clauses are contractual provisions which nominate the courts in which the parties agree to litigate in the event of a dispute arising. With the growth in cross-border [...], The Trans-Tasman Proceedings Acts 2010, mirror legislation in New Zealand and Australia, regulate the allocation of jurisdiction in trans-Tasman civil proceedings. The legislation includes provisions dealing with the effects of jurisdiction clauses. This article considers the treatment of jurisdiction clauses under the statutory regime and the common law regime which provides for the effect of jurisdiction clauses that are outside the scope of the legislation, how these regimes differ, and their relative strengths and weaknesses.

INTRODUCTION The rule of law eschews ambiguity. And yet, ambiguity abounds in legislative texts and its resolution consumes considerable interpretive energy. This is not surprising given the limitations of natural [...]

CONTENTS I Introduction II Impact of Accession to the Convention on Australian Law and Practice A Defining 'Exclusive' Jurisdiction Agreements B Jurisdiction Agreements Designating Australian Courts C Jurisdiction Agreements Designating [...], The Joint Standing Committee on Treaties has recommended that Australia accede to the Hague Convention on Choice of Court Agreements. The Convention seeks to ensure uniform treatment of 'exclusive' jurisdiction agreements internationally, and is in force in the European Union, Singapore and Mexico. This article considers the effect that the Convention will have on Australian courts' treatment of exclusive jurisdiction agreements, which will largely be positive, and analyses Australia's proposal for the Convention's implementation. It also identifies shortcomings of the Convention and the proposal for its implementation, and recommends refinements to that proposal. The article concludes by underscoring the problems in the existing law that accession will not redress, some of which could and should be remedied in the legislation which will implement the Convention.

Emerging research suggests that, among trauma therapists, religiousness and spirituality may (a) buffer against compassion fatigue, secondary traumatic stress, and burnout and (b) bolster spiritual growth and compassion satisfaction (Newmeyer [...]

Author(s): Sarah McKetta *, Katherine M. Keyes Introduction Globally, alcohol use is a leading cause of premature death and disability [1,2]. Alcohol consumption is the attributable cause of death to [...], Background Binge and heavy drinking are preventable causes of mortality and morbidity. Alcohol consumption by women who parent is damaging to child health, and it is concerning that women in the United States in their reproductive years have experienced increased drinking over the past decade. Although media attention has focused on the drinking status of women who are child-rearing, it remains unclear whether binge and heavy drinking vary by parenting status and sex. Methods and findings We examined national trends in binge drinking, defined as 5 or more drinks in a single day for men and 4 or more drinks for women, and heavy drinking, defined as 60 or more days with binge episodes in a year. We used survey-weighted logistic regression from the 2006-2018 waves of the cross-sectional National Health Interview Survey (NHIS, N = 239,944 eligible respondents) to study time trends in drinking outcomes by sex, age, and parenting status. Binge drinking increased for both sexes in nearly all age groups, with the largest increase among women ages 30-44 without children (from 21% reporting binge drinking in 2006 to 42% in 2018); the exception was young men (ages 18-29) with children, among whom binge drinking declined. By 2012, the prevalence of binge drinking among young men with children (38.5%) declined to below that of young women without children (39.2%) and stayed lower thereafter. Despite widespread increases in binge drinking, heavy drinking declined or remained stable for all groups except older women (ages 45-55) without children (odds ratio [OR] for heavy drinking each year = 1.06, 95% CI 1.02-1.10) and women ages 30-44, regardless of parenting status. For binge drinking outcomes only, we saw evidence of interaction in drinking trends by parenting status, but this was shown to be confounded by sex and age. Men and women with children reported consistently lower levels of drinking than those without children. Rates of abstention mirrored trends in binge outcomes for both sexes, limiting concerns about invariance. Study limitations include self-reported data and measurement invariance in binge drinking cutoffs across study years. Conclusions This study demonstrated that trends in binge and heavy drinking over time were not differential by parenting status for women; rather, declines and increases over time were mainly attributable to sex and age. Women both with and without children are increasing binge and heavy drinking; men, regardless of parenting status, and women without children consumed more alcohol than women with children. Regardless of impact on child health, increased drinking rates in the past decade are concerning for adult morbidity and mortality: binge drinking has increased among both sexes, and heavy drinking has increased among older women. Men and women of all ages and parenting status should be screened for heavy alcohol use and referred to specialty care as appropriate.

Author(s): Alexander C. Tsai 1,2,3,*, Mathew V. Kiang 4, Michael L. Barnett 2,5,6, Leo Beletsky 7,8,9, Katherine M. Keyes 10, Emma E. McGinty 11, Laramie R. Smith 9, Steffanie A. [...]

Introduction Type 1 diabetes (T1D), one of the most prevalent chronic diseases of childhood that also presents in adults (1, 2), results from destruction of insulin-producing β cells by self-reactive [...], BACKGROUND. Type 1 diabetes (T1D) results from destruction of pancreatic β cells by autoreactive effector T cells. We hypothesized that the immunomodulatory drug alefacept would result in targeted quantitative and qualitative changes in effector T cells and prolonged preservation of endogenous insulin secretion by the remaining β cells in patients with newly diagnosed T1D. METHODS. In a multicenter, randomized, double-blind, placebo-controlled trial, we compared alefacept (two 12-week courses of 15 mg/wk i.m., separated by a 12-week pause) with placebo in patients with recent onset of T1D. Endpoints were assessed at 24 months and included meal-stimulated C-peptide AUC, insulin use, hypoglycemic events, and immunologic responses. RESULTS. A total of 49 patients were enrolled. At 24 months, or 15 months after the last dose of alefacept, both the 4-hour and the 2-hour C-peptide AUCs were significantly greater in the treatment group than in the control group (P = 0.002 and 0.015, respectively). Exogenous insulin requirements were lower (P = 0.002) and rates of major hypoglycemic events were about 50% reduced (P < 0.001) in the alefacept group compared with placebo at 24 months. There was no apparent between-group difference in glycemic control or adverse events. Alefacept treatment depleted [CD4.sup.+] and [CD8.sup.+] central memory T cells (Tcm) and effector memory T cells (Tem) (P < 0.01), preserved Tregs, increased the ratios of Treg to Tem and Tcm (P < 0.01), and increased the percentage of PD-1+[CD4.sup.+] Tem and Tcm (P < 0.01). CONCLUSIONS. In patients with newly diagnosed T1D, two 12-week courses of alefacept preserved C-peptide secretion, reduced insulin use and hypoglycemic events, and induced favorable immunologic profiles at 24 months, well over 1 year after cessation of therapy. TRIAL REGISTRATION. https://clinicaltrials.gov/ NCT00965458. FUNDING. NIH and Astellas.

The central nervous system undergoes constant immune surveillance, but the route that immune cells take to exit the brain has been unclear as it had been thought to lack a classical lymphatic drainage system; here functional lymphatic vessels able to carry both fluid and immune cells from the cerebrospinal fluid are shown to be located in the brain meninges. A lymphatic system for the brain The central nervous system is under constant immune surveillance, but the exit route for immune cells has been unclear as the brain was thought to lack a classical lymphatic drainage system. Jonathan Kipnis and colleagues now show that the brain does indeed possess functional lymphatic vessels, located in the meninges, and that these vessels are able to carry both fluid and immune cells from the cerebrospinal fluid. The presence of a classical lymphatic system in the central nervous system suggests that current thinking on brain tolerance and the immune privilege of the brain should be revisited. Malfunction of the meningeal lymphatic vessels could be a root cause of a variety of neuroimmunological disorders. One of the characteristics of the central nervous system is the lack of a classical lymphatic drainage system. Although it is now accepted that the central nervous system undergoes constant immune surveillance that takes place within the meningeal compartment.sup.1,2,3, the mechanisms governing the entrance and exit of immune cells from the central nervous system remain poorly understood.sup.4,5,6. In searching for T-cell gateways into and out of the meninges, we discovered functional lymphatic vessels lining the dural sinuses. These structures express all of the molecular hallmarks of lymphatic endothelial cells, are able to carry both fluid and immune cells from the cerebrospinal fluid, and are connected to the deep cervical lymph nodes. The unique location of these vessels may have impeded their discovery to date, thereby contributing to the long-held concept of the absence of lymphatic vasculature in the central nervous system. The discovery of the central nervous system lymphatic system may call for a reassessment of basic assumptions in neuroimmunology and sheds new light on the aetiology of neuroinflammatory and neurodegenerative diseases associated with immune system dysfunction., Author(s): Antoine Louveau [sup.1] [sup.2] , Igor Smirnov [sup.1] [sup.2] , Timothy J. Keyes [sup.1] [sup.2] , Jacob D. Eccles [sup.3] [sup.4] [sup.5] , Sherin J. Rouhani [sup.3] [sup.4] [sup.6] [...]

Seeking to identify routes responsible for the recirculation of surveying meningeal immune cells, we investigated the meningeal spaces and the immune cells that occupy those spaces. First, a whole-mount preparation [...], One of the characteristics of the central nervous system is the lack of a classical lymphatic drainage system. Although it is now accepted that the central nervous system undergoes constant immune surveillance that takes place within the meningeal compartment (1-3), the mechanisms governing the entrance and exit of immune cells from the central nervous system remain poorly understood (4-6). In searching for T-cell gateways into and out of the meninges, we discovered functional lymphatic vessels lining the dural sinuses. These structures express all of the molecular hallmarks of lymphatic endothelial cells, are able to carry both fluid and immune cells from the cerebrospinal fluid, and are connected to the deep cervical lymph nodes. The unique location of these vessels may have impeded their discovery to date, thereby contributing to the long-held concept of the absence of lymphatic vasculature in the central nervous system. The discovery of the central nervous system lymphatic system may call for a reassessment of basic assumptions in neuroimmunology and sheds new light on the aetiology of neuroinflammatory and neurodegenerative diseases associated with immune system dysfunction.

Pianist, composer/arranger, and former bandleader Raymond Scott discovered up-and-coming jazz/pop vocalist Gloria Lynne in the late 1950s. (1) Gloria Lynne recorded her debut album Miss Gloria Lynne on the Everest [...]

Ghana has made great progress in meeting most Millennium Development Goals;(1) however, the country's reproductive health indicators continue to lag. Among married women, use of modern contraceptives is low (23%) [...]