Search

In 1976, the Supreme Court of California issued its well‐known Tarasoff Principle. From this principle, other courts found a duty to warn, and some found more than just a duty to warn, a duty to protect. As courts in other states adopted a version of the Tarasoff Principle, they issued a wide variety of third‐party liability rules. In light of the dynamic, everchanging Tarasoff jurisprudence in the United States and recent relevant appellate court opinion in Missouri, a timely updated summary and update of Tarasoff‐related jurisprudence in Missouri is warranted. In the present analysis, we compiled the four appellate court decisions that pertained to the questions of Tarasoff‐like third‐party liability in the State of Missouri: Sherrill v. Wilson (1983), Matt v. Burrell (1995), Bradley v. Ray (1995), and Virgin v. Hopewell (2001). We reviewed all legal measures for clinicians to protect nonpatients in Missouri, not just those that relate to protecting nonpatients from violence as in a Tarasof‐like scenario. Thus, this paper concisely provides a compendium of such options and allows for a meaningful comparison of which legal, protective measures are mandatory and which are permissive, thereby evoking the question of whether measures of protecting nonpatients from a patient's violent acts ought to be mandatory duties or permissive application of professional judgment. [ABSTRACT FROM AUTHOR]

Background and aims Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been implemented widely in medical settings, with little attention focused on how well providers adhere to evidence-based service delivery in everyday practice. The purposes of this paper were to: (1) introduce a flexible, relatively simple methodology, the SBIRT Checklist for Observation in Real-time (SCORe), to assess adherence to evidence-based practice and provide preliminary evidence supporting its criterion validity; and (2) illustrate the feasibility and potential utility of the SCORe by analyzing observations of providers within four large-scale SBIRT programs in the United States. Methods Eighteen potential adherence judges were trained to recognize SBIRT service elements presented in realistic taped portrayals constructed to serve as criterion coding standards. Across the four SBIRT programs, 76 providers were observed performing 388 services in three types of medical settings; emergency departments ( n = 10), hospital out-patient/ambulatory clinics ( n = 16) and hospital in-patient settings ( n = 5). Results Across two exercises, trainees identified 81% of screening and 75% of brief intervention (BI) elements correctly; for the six FRAMES components (Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy), agreement ranged from 69% to 91%. Across programs, 56% of screening, 54% of brief intervention (BI) (81% of FRAMES) and 53% of referral to treatment elements were observed. Programs differed significantly in adherence [screening, P = 0.024; BI, P < 0.001; FRAMES, P < 0.001; referral to treatment (RT), P < 0.001]; medical setting differences were minimal. Conclusions The Screening, Brief Intervention and Referral to Treatment Checklist for Observation in Real-time provides a flexible method for assessing adherence to evidence-based Screening, Brief Intervention and Referral to Treatment service protocols. Preliminary evidence supports the criterion validity, feasibility and potential utility of the Screening, Brief Intervention and Referral to Treatment Checklist for Observation in Real-time protocol. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe coping practices used by older women during preclinical disability. This paper was derived from qualitative data gathered during a larger multimethod longitudinal study. Twelve women (60 to 80 years of age) participated in baseline functional performance measures and then repeated in-depth interviews and participant observations over 18 months. A hermeneutic approach was used to interpret the in-depth interviews, participant observations, and field notes using three interrelated processes of thematic, exemplar, and identification of paradigm cases to identify coping practices. Women coped with functional decline, such as difficulty getting up from the floor, in many different ways. Coping practices were grouped into five themes: resist, adapt, substitute, endure, and eliminate. These findings suggest that nurses need to realize outward appearances may mask the level of effort required for older women to complete daily activities. [ABSTRACT FROM AUTHOR]

The increase in the prevalence of autism spectrum disorders in the last decade has contributed to growth in the field of applied behavior analysis (ABA). This growth has been spurred by consumer demand for access to this evidence-based treatment for those with an autism spectrum disorder. Presently, there are at least 34 states that have laws or regulations in place that mandate insurance coverage for autism spectrum disorders. There are also 14 states that have passed licensure or a similar regulatory mechanism for identifying competent providers of ABA. The following paper documents the process of insuring consumer advocacy and protection in the states of Missouri and Wisconsin through the passage of legislation that established licensure for practitioners of ABA. The evolution of this process in both of these states will be detailed as well as a number of lessons learned that should prove to be helpful as additional states move toward licensure for practitioners of ABA. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Please cite this paper as: August E, Salihu H, Weldeselasse H, Biroscak B, Mbah A, Alio A. Infant mortality and subsequent risk of stillbirth: a retrospective cohort study. BJOG 2011;118:1636-1645. Objective To examine the association between infant mortality in a first pregnancy and risk for stillbirth in a second pregnancy. Design Population-based, retrospective cohort study. Setting Maternally linked cohort data files for the state of Missouri. Population Women who had two singleton pregnancies in Missouri during the period 1989-2005 ( n = 320 350). Methods Women whose first pregnancy resulted in infant death were compared with those whose infant from the first pregnancy survived the first year of life. The Kaplan-Meier product limit estimator was employed to compare probabilities for stillbirth in the second pregnancy between both groups of women. Adjusted hazard ratios (AHRs) and 95% confidence intervals (95% CIs) were generated to assess the association between infant mortality in the first pregnancy and stillbirth in the second pregnancy. Main outcome measures Exposure was defined as infant mortality in the first pregnancy, and the outcome was defined as stillbirth in the second pregnancy. Results Women with prior infant deaths were about three times as likely to experience stillbirth in their subsequent pregnancy (AHR 2.91; 95% CI 2.02-4.18). White women with a previous infant death were nearly twice as likely to experience a subsequent stillbirth, compared with white women with a surviving infant (AHR 1.96; 95% CI 1.13-3.39). Black women with a previous infant death were more than four times as likely to experience subsequent stillbirth, compared with black women with a surviving infant (AHR 4.28; 95% CI 2.61-6.99). Conclusions Previous infant mortality results in an elevated risk for subsequent stillbirth, with the most profound increase observed among black women. Interconception care should consider prior childbearing experiences to avert subsequent fetal loss. [ABSTRACT FROM AUTHOR]

Batina, M. C. & Reese, C. A. 2010: A Holocene pollen record recovered from a guano deposit: Round Spring Cavern, Missouri, USA. Boreas, 10.1111/j.1502-3885.2010.00186.x. ISSN 0300-9483. Bat guano deposits have been the subject of relatively few palynological studies. The studies to date have focused on the most modern samples only, and therefore the full potential of bat guano as an archive for fossil pollen analysis remains unknown. In this paper we report the results of pollen analysis on an 88-cm vertical profile of fossil bat guano from Round Spring Cavern, Missouri. Four AMS radiocarbon dates were in sequence and showed that the guano pile was active between 8155 and approximately 550 cal. yr BP. Pollen is well preserved throughout the profile, with most samples containing less than 10% indeterminable pollen. Wind-pollinated taxa are better represented than insect-pollinated taxa, and pollen concentrations range from 842 to 371 660 grains cm. As expected, the dominant vegetation types represented by the pollen assemblage are oak and pine, in accordance with the region's oak-hickory-pine forest. However, there are discrepancies between the guano pollen record and the results of a lake pollen study conducted in southern Missouri. We propose several possible factors that may be influencing the guano pollen record and provide direction for further investigation into the palaeoecological potential of bat guano. [ABSTRACT FROM AUTHOR]

To accurately predict ecosystem responses induced by climate warming at local-to-global scales, models are in need of more precise knowledge of response during periods of environmental stress such as drought. In this paper, we studied environmental control of canopy-level water use efficiency (WUE) during drought at an eddy flux site in an oak-hickory forest in central Missouri, USA. Two consecutive severe droughts in the summers of 2006 and 2007 afforded coverage of a broad range of environmental conditions. We stratified data to obtain subranges that minimized cross-correlations among putative WUE-controlling factors. Our results showed that WUE was subject to control by atmospheric saturation deficit (ASD), soil water potential (SWP) and the ratio of diffuse to total photosynthetically active radiation ( If/ It). Generally, WUE was found to scale with 1/(ASD)0.5, consistent with predictions from stomatal optimization theory. In contrast, SWP and If/ It were related to WUE in a linear fashion. ASD was better correlated with WUE than either of the other two factors. It was also observed that the relationship between WUE and any single controlling factor was subject to influence of the other two. One such example was an opposite response of WUE to SWP between low and high ASD values, suggesting a breakdown of stomatal optimality under severe environmental stresses and a shift from optimal stomatal regulation to nonstomatal regulation at leaf scale. We have demonstrated that different data handling (stratified vs. nonstratified) or selection (hourly vs. daily) could lead to different conclusions on the relationship between WUE and its controls. For this reason, we recommend modelers to be cautious when applying WUE-response formulas at environmental conditions or at time scales different from those at which they are derived. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Mbah A, Kornosky J, Kristensen S, August E, Alio A, Marty P, Belogolovkin V, Bruder K, Salihu H. Super-obesity and risk for early and late pre-eclampsia. BJOG 2010;117:997–1004. Objective To examine the association between obesity subtypes and risk of early and late pre-eclampsia. Design Population-based retrospective study. Setting State of Missouri maternally linked birth cohort files. Population All singleton live births in the state of Missouri from 1989 to 2005. Methods The body mass index (BMI) was used to classify women as normal weight (BMI = 18.5–24.9 kg/m2), class I obesity (BMI = 30–34.9 kg/m2), class II obesity (BMI = 35–39.9 kg/m2), class III obesity (BMI = 40–49.9 kg/m2) or super-obesity (BMI ≥ 50 kg/m2). Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between obesity and the risk of pre-eclampsia were obtained from logistic regression models with adjustment for intracluster correlation. Results The rate of pre-eclampsia increased with increasing BMI, with super-obese women having the highest incidence (13.4%). Compared with normal weight women, obese women (BMI ≥ 30 kg/m2) had a higher risk for pre-eclampsia (OR = 2.59, 95% CI = 2.87–3.01). This risk remained approximately the same for late-onset pre-eclampsia (pre-eclampsia occurring at 34 weeks or more of gestation) and was slightly reduced for early-onset pre-eclampsia (pre-eclampsia occurring at 34 weeks or less of gestation). Within each BMI category, the risk of pre-eclampsia increased with the rate of weight gain. Compared with normal weight mothers with moderate weight gain, super-obese women with a high rate of weight gain had the greatest risk for pre-eclampsia (OR = 7.52, 95% CI = 2.70–21.0). Conclusion BMI and rate of weight gain are synergistic risk factors that amplify the burden of pre-eclampsia among super-obese women. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to advance the methodology for studying service assessment by comparing self-report and agency-generated methods. This study compares 30-day self-reported service use for homeless individuals (N = 229) randomly recruited from a single urban environment (St Louis, Missouri) with similar data collected from a broad array of service agencies providing homeless, substance abuse and outpatient mental health services across the same environment. Comparisons were made between self-report and agency-based data on shelter use, outpatient mental health service use (case management, psychiatric treatment, group therapy), outpatient substance abuse service use (case management, counselling, group therapy) and drop-in/day treatment use. Consistently low levels of kappa scores (all under 0.4) and correlation coefficients (only shelter use demonstrated significant agreement) were found. Findings demonstrated that the two methods of collecting service data are generally not concordant at the individual level. Certain demographic characteristics (increased age, being male, non-white ethnicity) and diagnoses (cocaine abuse/dependence, mania, schizophrenia) were associated with decreased reliability between the two methods of data collection. The two methods of assessment appeared to capture overlapping but not identical information. Each method of assessment has different utility to researchers and providers wishing to assess service use. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Multi-disciplinary design can be taught in a very general way focusing on methods and procedures that work for any multidisciplinary design project or in a very specific way focusing on a specific multi-disciplinary design project. The general approach teaches students the principles of how to approach any multidisciplinary design project but often lacks meaningful examples of how the principles are applied. Focusing on a specific multidisciplinary design project gives the students a meaningful example of how to apply design principles but they may have difficulty generalizing what they have learned and how it can be applied to other projects. To get a good background in engineering design, engineering students should have educational experiences that are both general and specific. This paper describes a course developed at the University of Missouri-Rolla (UMR) to teach multidisciplinary design by focusing on the design of a solar racing car. The purpose of the course is to teach the aspects of a multidisciplinary design project utilizing a specific example for student comprehension. [ABSTRACT FROM AUTHOR]

The need to better understand landlord involvement in decision-making related to pesticide use and water quality issues is evidenced by several trends. These trends include the increasing documentation of water pollution by farm pesticides. the changing characteristics of farm ownership and operator tenure, and evolutions in resource policy and protection planing. This paper utilizes a theoretical approach to thy sociology of land tenure to interpret results from an investigation of landlord involvement in environmental decision making regarding pesticide selection on rented land. Eight counties with high susceptibility of water contamination by pesticides were selected for study. Structured, in-person interviews were administered to in-county landlords, and a mail survey was used to poll out-of-county landlords. Results indicate that participation is generation low with very little difference between landlords groups. Renters make most of the organizational and operational decisions on rented farmland. Landlord participation is predominantly based on economic, rather than on social or environmental, factors. Furthermore while economic variables are important predictors of participation for both groups gender and social ties to the renter tend to increase local landlord involvement, but not absentee involvement. These results have important implications for both federal programs and further research on land tenure anti environmental stewardship. [ABSTRACT FROM AUTHOR]

The article presents normative data collected on an unselected sample of 9-year old children, for the Missouri Children's Behavior Checklist (MCBC). The checklist can be used in rather large-scale research and evaluation programs because its cost of administration is quite minimal. The norms and validity data presented in this paper can serve as a preliminary guide in the use of the MCBC to identify children who are likely to be in need of professional attention, although they suffer some inadequacies. The first and most serious problem is the disproportionate number of children from professional families in the normative sample.