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1 I INTRODUCTION Over the past decade, many health care systems have embraced the patient-centered medical home (PCMH) to improve care coordination and provide team-based, patient-centered, longitudinal care. (1) Research, [...], Objective: To compare health care system problems or "hassles" experienced by Veterans receiving VA health care only versus those receiving dual care from both VA and non-VA community providers. Data Sources: We collected survey data in 2017-2018 from 2444 randomly selected Veterans with four or more primary care visits in the prior year at one of 12 VA primary care clinics located in four geographically diverse regions of the United States. Study Design: We used baseline surveys from the Coordination Toolkit and Coaching quality improvement project to explore Veterans&apos; experience of hassles (dependent variable), source of health care, self-rated physical and mental health, and sociodemographics. Data Collection: Participants responded to mailed surveys by mail, telephone, or online. Principal Findings: The number of reported hassles ranged from 0 to 16: 79 percent of Veterans reported experiencing one or more hassles. Controlling for sociodemo-graphic characteristics and self-rated physical and mental health, zero-inflated negative binominal regression indicated that dual care users experienced more hassles than VA-only users (adjusted predicted average 5.5 [CI: 5.2, 5.8] vs 4.3 [CI: 4.1,4.6] hassles [P < .0001]). Conclusions: Anticipated increases in Veterans accessing community-based care may require new strategies to help VA primary care teams optimize care coordination for dual care users. KEYWORDS baseline survey, care coordination, patient experience, primary care. Veteran

Betaine has important roles in preimplantation mouse embryos, including as an organic osmolyte that functions in cell volume regulation in the early preimplantation stages and as a donor to the methyl pool in blastocysts. The origin of betaine in oocytes and embryos was largely unknown. Here, we found that betaine was present from the earliest stage of growing oocytes. Neither growing oocytes nor early preantral follicles could take up betaine, but antral follicles were able to transport betaine and supply the enclosed oocyte. Betaine is synthesized by choline dehydrogenase, and female mice lacking Chdhdid not have detectable betaine in their oocytes or early embryos. Supplementing betaine in their drinking water restored betaine in the oocyte only when supplied during the final stages of antral follicle development but not earlier in folliculogenesis. Together with the transport results, this implies that betaine can only be exogenously supplied during the final stages of oocyte growth. Previous work showed that the amount of betaine in the oocyte increases sharply during meiotic maturation due to upregulated activity of choline dehydrogenase within the oocyte. This betaine present in mature eggs was retained after fertilization until the morula stage. There was no apparent role for betaine uptake via the SIT1 (SLC6A20) betaine transporter that is active at the 1- and 2-cell stages. Instead, betaine was apparently retained because its major route of efflux, the volume-sensitive organic osmolyte – anion channel, remained inactive, even though it is expressed and capable of being activated by a cell volume increase.Betaine, which has important roles in preimplantation mouse embryos, is present in growing oocytes, transported into antral follicles, synthesized within oocytes during meiotic maturation, and then retained through the morula stage.Graphical Abstract

This article presents a novel wideband low-noise amplifier (LNA) topology that incorporates noise cancellation in a $g_{m}$ -boosted common gate (CG) LNA by reusing the inverting amplifier used for $g_{m}$ -boosting as a parallel gain stage. A $g_{m}$ -boosted CG stage provides the wideband input matching while the current reuse (CR) inverting amplifier is simultaneously used for boosting $g_{m}$ , improving gain, and canceling noise. Shunt and series inductive peaking techniques are implemented to extend the bandwidth of the LNA. The LNA is fabricated in Taiwan Semiconductor Manufacturing Company (TSMC) 65-nm CMOS process and occupies a die area of 0.263 mm 2. The measurement results indicate the combination of these techniques produces an LNA with a 20-GHz bandwidth, an average gain of 12 dB, an average noise figure (NF) of 3.87 dB, and a 2.53-dBm peak input-referred third-order intercept point (IIP3) while consuming 13.2 mW at 1.2 V, resulting in the highest figure of merit (FoM) among the reported state-of-the-art LNAs.

Objective: Small for gestational age (SGA) preterm infants (PT) are at greatest risk for growth failure. Our objective was to assess the impact of an exclusive human milk diet (HUM) on growth velocities and neonatal morbidities from birth to discharge in a SGA population. Study design: Multicenter, retrospective cohort study, subgroup analysis of SGA PT comparing a cow’s milk diet (CMD) with HUM diet. Results: At birth 420 PT were classified as SGA (197 CMD group, 223 HUM group). Demographics and anthropometric measurements were similar. HUM group PT showed improvement in length Zscore at discharge (p= 0.024) and reduction in necrotizing enterocolitis (NEC) (p= 0.004). Conclusion: SGA PT fed a HUM diet had significantly decreased incidence of NEC, surgical NEC, and late-onset sepsis. Due to concerns about growth in a HUM diet, it is reassuring SGA infants fed the HUM diet had similar growth to CMD diet with trends toward improvement.

ABSTRACTPrecision engineering of the gut microbiome holds promise as an effective therapeutic approach for diseases associated with a disruption in this microbial community. Engrafting a live biotherapeutic product (LBP) in a predictable, controllable manner is key to the consistent success of this approach and has remained a challenge for most LBPs under development. We recently demonstrated high-level engraftment of Bifidobacterium longumsubsp. infantis (B. infantis) in adults when co-dosed with a specific prebiotic, human milk oligosaccharides (HMO). Here, we present a cellular kinetic-pharmacodynamic approach, analogous to pharmacokinetic-pharmacodynamic-based analyses of small molecule- and biologic-based drugs, to establish how HMO controls expansion, abundance, and metabolic output of B. infantisin a human microbiota-based model in gnotobiotic mice. Our data demonstrate that the HMO dose controls steady-state abundance of B. infantisin the microbiome, and that B. infantistogether with HMO impacts gut metabolite levels in a targeted, HMO-dependent manner. We also found that HMO creates a privileged niche for B. infantisexpansion across a 5-log range of bacterial inocula. These results demonstrate remarkable control of both B. infantislevels and the microbiome community metabolic outputs using this synbiotic approach, and pave the way for precision engineering of desirable microbes and metabolites to treat a range of diseases.

Abstract: The effects of post-hydration heating over a broad range of temperatures are evident in many Mighei-like carbonaceous (CM) chondrites as a variety of mineral transitions. To better understand these processes and how a CM chondrite’s starting composition may have affected them, we experimentally heated two meteorites with different degrees of aqueous alteration, Allan Hills 83100 and Murchison, at 25 °C temperature steps from 200 °C to 950 °C and 300 °C to 750 °C, respectively. During heating, synchrotron in situ X-ray diffraction patterns were collected. With the exception of calcite decomposition and its products, most mineral transitions were unaffected by starting composition. Key observations include: (1) partial decomposition of tochilinite at 200 °C, which indicates that tochilinite breakdown might be a two-stage process due to its intergrown layers of brucite/amakinite and mackinawite; (2) the breakdown of serpentine occurring at 300 °C with transitional phases appearing at 525 °C and 575–600 °C, while secondary olivine formed at 600 °C; (3) cronstedtite decomposing faster than lizardite, (4) the formation of secondary enstatite at 750 °C, and (5) calcite decomposition temperature differing significantly between meteorites, occurring at 725 °C and 575 °C in ALH 83100 and Murchison, respectively. The results for calcite are likely controlled by differences in its microstructure and chemical composition, related to the meteorite’s impact history and degree of aqueous alteration. The difference in calcite decomposition temperature also explains the contrasts in the observed breakdown products, with clinopyroxene occurring in both meteorites, and oldhamite only in ALH 83100. Mineral transitions due to post-hydration heating have been characterized with a high resolution XRD method, enabling a better understanding of processes occurring on the parent asteroids of CM chondrites. Graphical Abstract:

This paper presents an ultra-low-power non-uniform sampling scheme using a derivative-based algorithm that can maintain a comparable accuracy to other non-uniform sampling schemes but with less complexity and lower power consumption. In this method, the change in the derivative of the signal above certain threshold values is used to identify high signal activity for retention of the significant points of the signal. The scheme is implemented using simple building blocks that calculate and compare the change in approximate real-time derivative to a tunable threshed value that can be adjusted to obtain the desired Compression Factor (CF) and Post-Reconstruction Signal-to-Noise plus Distortion Ratio (PR-SNDR) for different signal types. Fabricated in TSMC’s $0.13 \mu \text{m}$ CMOS technology and tested with real-world biomedical signals, the proposed Derivative Dependent Sampling (DDS) system consumes a maximum power of 155 nW while achieving a CF of more than 6 for an Electrocardiography (ECG) signal. By adding the proposed DDS block to a data acquisition and processing system, the non-uniform sampling can reduce the power dissipation of the entire system.

Recent developments in digital technologies, including learning analytics are changing educational practices due to the wealth of information available and its utility to inform academic interventions for students. This study investigates the impact of personalised feedback emails on students’ academic performance and student success in large first-year undergraduate chemistry courses. Learning analytics was used to inform and generate feedback emails to students at various timepoints during the semester. The feedback emails to students included an evaluation of their current performance, and advice of support systems and resources to support their learning. We analysed the marks of 6334 students at three timepoints during the semester in addition to their final course grade, and compared academic performance across three years of course offerings (2019–2021). We compared students that did not receive feedback (2019 control groups, n =2391) with students that did receive feedback (2020–2021 experimental groups, n =3943). Our findings suggest that students receiving personalised emails during the semester were more likely to pass their first-year chemistry course. Furthermore, our data showed that sending personalised feedback emails fostered higher student success among a greater number of students within the cohort, as well as students' appraisal of the personalised feedback.

OBJECTIVE--Low vitamin D levels predict the development of diabetes. This double-blind, randomized, control study in subjects with prediabetes and hypovitaminosis D evaluated whether high doses of vitamin D for 1 [...]

OBJECTIVE--The study objective was to evaluate how the use of a pervasive blood glucose monitoring (BGM) technology relates to glycemic control, report of self-care behavior, and emotional response to BGM [...]

OBJECTIVE--To determine whether pharmacological treatment of depression in low-income minorities with diabetes improves A1C and quality of life (QOL). RESEARCH DESIGN AND METHODS--This was a 6-month, randomized, double-blind, placebo-controlled trial. [...]

This paper presents a low-power constant subthreshold transconductance reference circuit that produces a constant transconductance by subtracting the output currents of two independent transconductance references. By taking the difference between the output currents of the two independent transconductance references, process, voltage and temperature variations are reduced by minimizing the effects of channel length modulation and drain-induced barrier lowering without relying on feedback to regulate the drain voltage. The proposed reference, fabricated in TSMC’s 130 nm process and testing with off-chip temperature-insensitive resistors, can provide a constant transconductance over a temperature range of −30 to 120°C, and a supply voltage range of 0.5 to 1.7 V. The experimental result of the proposed transconductance reference shows an average variation of ±0.8% over temperature for the entire operating voltage range and an average variation of ±1.97% over voltage for the entire operating temperature range. Through the subtraction, the proposed circuit also shows less variation across process corners compared to the conventional constant transconductance reference. The proposed constant transconductance reference exhibits the highest power efficiency (transconductance over power consumption) amongst the reported constant transconductance references. At 0.5 V, the proposed transconductance reference produces a transconductance of 21.46 $\mu \text{S}$ , while consuming 1.95 $\mu \text{W}$. [ABSTRACT FROM AUTHOR]

Tobacco use is the leading preventable cause of mortality, accounting for 435,000 deaths in the United States (Mokdad et al. 2004) and 4.8 million deaths due to tobacco worldwide (Ezzati [...], Objective. To evaluate the impact of a locally adapted evidence-based quality improvement (EBQI) approach to implementation of smoking cessation guidelines into routine practice. Data Sources/Study Setting. We used patient questionnaires, practice surveys, and administrative data in Veterans Health Administration (VA) primary care practices across five southwestern states. Study Design. In a group-randomized trial of 18 VA facilities, matched on size and academic affiliation, we evaluated intervention practices' abilities to implement evidence-based smoking cessation care following structured evidence review, local priority setting, quality improvement plan development, practice facilitation, expert feedback, and monitoring. Control practices received mailed guidelines and VA audit-feedback reports as usual care. Data Collection. To represent the population of primary care-based smokers, we randomly sampled and screened 36,445 patients to identify and enroll eligible smokers at baseline (n = 1,941) and follow up at 12 months (n = 1,080). We used computer-assisted telephone interviewing to collect smoking behavior, nicotine dependence, readiness to change, health stares, and patient sociodemographics. We used practice surveys to measure structure and process changes, and administrative data to assess population utilization patterns. Principal Findings. Intervention practices adopted multifaceted EBQI plans, but had difficulty implementing them, ultimately focusing on smoking cessation clinic referral strategies. While attendance rates increased (p < .0001), we found no intervention effect on smoking cessation. Conclusions, EBQI stimulated practices to increase smoking cessation clinic referrals and try other less evidence-based interventions that did not translate into improved quit rates at a population level. Key Words. Smoking cessation, quality of health care, veterans

Background: Adherence to dementia guidelines is poor despite evidence that some guideline recommendations can improve symptoms and delay institutionalization of patients. Objective: To test the effectiveness of a dementia guideline-based disease management program on quality of care and outcomes for patients with dementia. Design: Clinic-level, cluster randomized, controlled trial. Setting: 3 health care organizations collaborating with 3 community agencies in southern California. Participants: 18 primary care clinics and 408 patients with dementia age 65 years or older paired with 408 informal caregivers. Intervention: Disease management program led by care managers and provided to 238 patient-caregiver pairs at 9 intervention clinics for more than 12 months. Measurements: Adherence to 23 guideline recommendations (primary outcome) and receipt of community resources and patient and caregiver health and quality-of-care measures (secondary outcomes). Results: The mean percentage of per-patient guideline recommendations to which care was adherent was significantly higher in the intervention group than in the usual care group (63.9% vs. 32.9%, respectively; adjusted difference, 30.1% [95% CI, 25.2% to 34.9%]; P < 0.001). Participants who received the intervention had higher care quality on 21 of 23 guidelines (P [less than or equal to]0.013 for all), and higher proportions received community agency assistance (P [less than or equal to] 0.03) than those who received usual care. Patient health-related quality of life, overall quality of patient care, caregiving quality, social support, and level of unmet caregiving assistance needs were better for participants in the intervention group than for those in the usual care group (P < 0.05 for all). Caregiver health-related quality of life did not differ between the 2 groups. Limitations: Participants were well-educated, were predominantly white, had a usual source of care, and were not institutionalized. Generalizability to other patients and geographic regions is unknown. Also, costs of a care management program under fee-for-service reimbursement may impede adoption. Conclusions: A dementia guideline-based disease management program led to substantial improvements in quality of care for patients with dementia.

Background: Worldwide efforts are under way to improve the quality of clinical practice. Most quality measurements, however, are poorly validated, expensive, and difficult to compare among sites. Objective: To validate whether vignettes accurately measure the quality of clinical practice by using a comparison with standardized patients (the gold standard method), and to determine whether vignettes are a more or less accurate method than medical record abstraction. Design: Prospective, multisite study. Setting: Outpatient primary care clinics in 2 Veterans Affairs medical centers and 2 large, private medical centers. Participants: 144 of 163 eligible physicians agreed to participate, and, of these, 116 were randomly selected to see standardized patients, to complete vignettes, or both. Measurements: Scores, expressed as the percentage of explicit quality criteria correctly completed, were obtained by using 3 methods. Results: Among all physicians, the quality of clinical practice as measured by the standardized patients was 73% correct (95% CI, 72.1% to 73.4%). By using exactly the same criteria, physicians scored 68% (CI, 67.9% to 68.9%) when measured by the vignettes but only 63% (CI, 62.7% to 64.0%) when assessed by medical record abstraction. These findings were consistent across all diseases and were independent of case complexity or physician training level. Vignettes also accurately measured unnecessary care. Finally, vignettes seem to capture the range in the quality of clinical practice among physicians within a site. Limitations: Despite finding variation in the quality of clinical practice, we did not determine whether poorer quality translated into worse health status for patients. In addition, the quality scores are based on measurements from 1 patient-provider interaction. As with all other scoring criteria, vignette criteria must be regularly updated. Conclusions: Vignettes are a valid tool for measuring the quality of clinical practice. They can be used for diverse clinical settings, diseases, physician types, and situations in which case-mix variation is a concern. They are inexpensive and easy to use. Vignettes are particularly useful for comparing quality among and within sites and may be useful for longitudinal evaluations of interventions intended to change clinical practice.

Background. Increasingly, primary care practices include nurse practitioners (NPs) in their staffing mix to contain costs and expand primary care. To achieve these aims in U.S. Department of Veterans Affairs medical centers (VAMCs), national policy endorsed involvement of NPs as primary care (PC) providers. Objectives. To evaluate the degree to which VAMCs incorporated NPs into PC practices between 1996 and 1999, and to identify the internal and external practice environment features associated with NP use. Study Design. We surveyed 131 PC directors of all VAMCs in 1996 and 1999 to ascertain the staffing and characteristics of the PC practice and parent organization (e.g., academic affiliation, level of physician staffing, use of managed care arrangements), and drew on previously published studies and HRSA State Health Workforce Profiles to characterize each practice&apos;s regional health care environment (e.g., geographic region, state NP practice laws, state managed care penetration). Using multivariate linear regression, we evaluate the contribution of these environmental and organizational factors on the number of NPs/10,000 PC patients in 1999, controlling for the rate of NP use in 1996. Principal Findings. From 1996-1999, NP use increased from 75 percent to 90 percent in VA PC practices. The mean number of NPs per practice increased by about 60 percent (2.0 versus 3.2; p Conclusions. Staffing models in VA PC practices have, in fact, changed, with NPs having a greater presence. However, we found substantial practice-based variations in their use, suggesting that more research is needed to better understand how they have been integrated into practice and what impact their involvement has had on the VA&apos;s ability to achieve its restructuring goals. Key Words. Nurse practitioner, primary care staffing, practice characteristics, environmental characteristics, Health care organizations face ongoing pressures to deliver high-quality care, ensure access to care, and contain costs. Increasingly, primary care practices include nurse practitioners (NPs) in their staffing mix in [...]

Understanding Terror Networks By Marc Sageman. University of Pennsylvania Press. 232 pages. $29.95. Sleeping With the Devil. How Washington Sold Our Soul for Saudi Crude By Robert Baer. Crown. 226 […]

The article offer information the struggle faced by gay activist Tim Mayhew. The author expresses the journey of his move from Seattle from Yakima excommunicated from the Mormon Church, at my instigation and insistence, to be free to be Gay; fiery denunciations of homosexuality, which to them was second only to murder in its seriousness, and rules regulation of the community to obeyed.

Research reveals that mammography screening in women aged 65 and older, with or without mild to moderate levels of comorbidity, decreases the risk of death. However, those with severe or multiple comorbidities mammography screening does not improve the survival rate.

This article examines whether nursing facility residents are referred to emergency departments or admitted to hospitals after a careful consideration of their need for such a care. Data reveal that a structured implicit review of medical records at the time of resident's referral will minimize inappropriate transfers.

Although 2D materials hold great potential for next-generation pressure sensors, recent studies revealed that gases permeate along the membrane-surface interface, necessitating additional sealing procedures. In this work, we demonstrate the use of free-standing complex oxides as self-sealing membranes that allow the reference cavity beneath to be sealed by a simple anneal. To test the hermeticity, we study the gas permeation time constants in nanomechanical resonators made from SrRuO3and SrTiO3membranes suspended over SiO2/Si cavities which show an improvement up to 4 orders of magnitude in the permeation time constant after annealing the devices. Similar devices fabricated on Si3N4/Si do not show such improvements, suggesting that the adhesion increase over SiO2is mediated by oxygen bonds that are formed at the SiO2/complex oxide interface during the self-sealing anneal. Picosecond ultrasonics measurements confirm the improvement in the adhesion by 70% after annealing.

Coupled nanomechanical resonators made of two-dimensional materials are promising for processing information with mechanical modes. However, the challenge for these systems is to control the coupling. Here, we demonstrate strong coupling of motion between two suspended membranes of the magnetic 2D material FePS3. We describe a tunable electromechanical mechanism for control over both the resonance frequency and the coupling strength using a gate voltage electrode under each membrane. We show that the coupling can be utilized for transferring data between drums by amplitude modulation. Finally, we also study the temperature dependence of the coupling and how it is affected by the antiferromagnetic phase transition characteristic of this material. The presented electrical coupling of resonant magnetic 2D membranes holds the promise of transferring mechanical energy over a distance at low electrical power, thus enabling novel data readout and information processing technologies.

[Harada N, Chiu V, Fowler E, et al. Physical therapy to improve functioning of older people in residential care facilities. Phys Ther. 1995; 75.-830- 839.] Key Words: Balance, Elderly, Gait, [...], Background and Purpose. The purpose of this study was to determine the efectiveness of an individualized physical therapy mobility training program on the gait, balance, and functional performance of elderly individuals living in residential care facilities. Subjects. Twenty-seven elderly individuals with impaired balance and difficulty performing at least one functional activity participated in the study. The subjects ranged in age from 71 to 97years (X=87.1, SD=6.7). Methods Balance and gait speed were assessed at baseline and following physical therapy that consisted of exercises to improve specific functional limitations. Outcomes were reassessed 1 month following completion of the physical therapy. Results. Gait and balance outcomes were analyzed using a one-way repeated measures analysis of variance. Improvement was obtained in balance, which was maintained at 1 month follow-up. Gait speed did not improve to a level of statistical significance. Conclusion and Discussion After physical therapy, subjects improved in balance and functional performance. An improvement in gait speed may require a longer duration of treatment.

Hong Kong's fair and efficient legal system is the bedrock of its economic success. The practice of Western law underpins Hong Kong's entire free market by providing a level playing field, due process, protection of property rights and legal contracts. Mr. Lee, the outspoken chairman of the Democratic Party of Hong Kong, warns of the potential harmful impact of Chinese sovereignty in Hong Kong after 1997, particularly through corruption and nepotism., On March 13, 1995, Miami businessman Troy McBride learned the hard way that when a deal goes sour in China, it can go very sour. Mr. McBride traveled to Hefei, [...]

It's a cool and drizzly evening in Munich. A taxi drops me in a well-to-do neighborhood preferred by lawyers and accountants, but I have a different sort of appointment. I [...]

Through rational chemical design, and thanks to the hybrid nature of metal–organic frameworks (MOFs), it is possible to prepare molecule-based 2D magnetic materials stable at ambient conditions. Here, we illustrate the versatility of this approach by changing both the metallic nodes and the ligands in a family of layered MOFs that allows the tuning of their magnetic properties. Specifically, the reaction of benzimidazole-type ligands with different metal centers (MII= Fe, Co, Mn, Zn) in a solvent-free synthesis produces a family of crystalline materials, denoted as MUV-1(M), which order antiferromagnetically with critical temperatures that depend on M. Furthermore, the incorporation of additional substituents in the ligand results in a novel system, denoted as MUV-8, formed by covalently bound magnetic double layers interconnected by van der Waals interactions, a topology that is very rare in the field of 2D materials and unprecedented for 2D magnets. These layered materials are robust enough to be mechanically exfoliated down to a few layers with large lateral dimensions. Finally, the robustness and crystallinity of these layered MOFs allow the fabrication of nanomechanical resonators that can be used to detect─through laser interferometry─the magnetic order in thin layers of these 2D molecule-based antiferromagnets.

ISG15 is an ubiquitin-like modifier that is associated with reduced survival rates in breast cancer patients. The mechanism by which ISG15 achieves this however remains elusive. We demonstrate that modification of Rab GDP-Dissociation Inhibitor Beta (GDI2) by ISG15 (ISGylation) alters endocytic recycling of the EGF receptor (EGFR) in non-interferon stimulated cells using CRISPR-knock out models for ISGylation. By regulating EGFR trafficking, ISGylation enhances EGFR recycling and sustains Akt-signalling. We further show that Akt signalling positively correlates with levels of ISG15 and its E2-ligase in basal breast cancer cohorts, confirming the link between ISGylation and Akt signalling in human tumours. Persistent and enhanced Akt activation explains the more aggressive tumour behaviour observed in human breast cancers. We show that ISGylation can act as a driver of tumour progression rather than merely being a bystander.

Kawasaki syndrome (KS) is an acute febrile (fever-causing) disease that is associated with skin rash, peeling, and swollen lymph nodes. Relatively serious long-term effects are coronary artery disease and aneurysm of the heart wall or arteries. The cause of KS is unknown, but altered immune system function has been implicated. High-dose aspirin therapy has been the accepted treatment, and is effective in reducing fever and inflammation in the acute stage. Intravenously administered gamma globulin (GG), which contains a particular group of antibodies made by the immune system, is effective in decreasing the cardiovascular complications that follow KS when treated with aspirin, but the best dosage and treatment schedule in unknown. Children with KS, aged 9 to 111 months, were put on aspirin therapy, and the effectiveness of two doses and schedules of GG was studied. The first group of 25 children was given a single dose of 1 gram (gm) GG per kilogram (kg) body weight, while the second group of 22 children were given 400 milligrams GG per kg once daily for four days. Alterations in blood levels of several types of immune globulins were observed, the significance of which is unclear. Two patients from the first group developed small coronary artery aneurysms by 21 days after the start of KS, which persisted at least until day 49, but which were not visible by echocardiography at one year. One patient from the second group developed multiple small aneurysms with a similar time course, but after one year, several aneurysms were still visible. Fevers declined more rapidly in the group given 1 gm GG per kg and this led to a decrease in hospitalization by one day, on average. Four children in the first group and three in the second group had mild adverse reactions to treatment with GG. These included flushing, chills, nausea and vomiting, or hypotension. The study indicates that GG given in a single dose of 1 gm per kg is associated with more rapid improvement, but further research on the effects of GG and immune system function in Kawasaki syndrome is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

A review of the clinical uses of immunoglobulins, or antibody molecules, was compiled from articles and reports published from 1982 to 1989. Information about the patients, the clinical situations, the intervention used, and the outcome of the intervention was assessed. There have been few controlled, randomized clinical trials conducted on the use of intravenous immunoglobulin. However, intravenous immunoglobulin is safe and effective in treating patients with the following conditions: primary immune deficiency, where the patients cannot make their own immunoglobulin molecules and are susceptible to infection with various bacteria and viruses; premature infants who have lower levels of immunoglobulins than adults, especially those at risk for group B streptococcus infection; patients, primarily young children, with Kawasaki disease or mucocutaneous lymph node syndrome; patients who have received an organ transplant and are at risk for infection with cytomegalovirus, which causes a pneumonia; patients with idiopathic thrombocytopenic purpura, which is an autoimmune disease that results in low numbers of blood platelets; and some patients with chronic lymphocytic leukemia, who do not have normal levels of immunoglobulins. There is less convincing evidence concerning the value of immunoglobulins to prevent infection in patients with burns, surgery, and trauma. The use of intravenous immunoglobulins may be beneficial in the treatment of other disorders and diseases, such as rheumatoid arthritis, systemic lupus erythematosus, AIDS (acquired immunodeficiency syndrome), multiple myeloma, and lymphomas. However, more research will be necessary to test the efficacy of intravenous immunoglobulins in these disease states. (Consumer Summary produced by Reliance Medical Information, Inc.)

Among the neoconservative thinkers who hold sway in the present administration, one current idee fixe is the dream not merely of eradicating Islamic terrorism but of transforming Islam itself. In […]

Dalcinonacog alfa (DalcA), a next‐generation, recombinant human factor IX (FIX) variant, was developed using a rational design approach for increased procoagulant activity and longer duration of action to be administered subcutaneously (SC) for prophylaxis of hemophilia B bleeding episodes.

The article discusses a grassroots campaign in America to legalize the possession and use of marijuana as of November 2013, focusing on pro-marijuana protests during the 1960s in New York, New York, as well as information about poet Allen Ginsberg's work with the New York chapter of the Committee to Legalize Marijuana. Poet Ed Sanders and medical marijuana laws in states such as Maine and Colorado are mentioned, along with cannabis and then-U.S. President Richard Nixon's views on marijuana.