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Children and adolescents with serious emotional disturbance represent 7–12 percent of all youth in the United States. In 2017, the State of Idaho implemented the Youth Empowerment Service program, which allows youth with serious emotional disturbance who are younger than age eighteen living in households with income up to 300 percent of the federal poverty level to qualify for Medicaid and receive intensive, community-based treatment. A uniquely detailed method was used to assess the need for services: the Child and Adolescent Needs and Strengths tool, a ninety-seven-indicator instrument administered by a clinician. We used these indicators and Idaho’s 2018–22 administrative Medicaid claims data to study the association between children and adolescents’ clinical needs complexity and their actual Medicaid behavioral and mental health service use. Our findings show that there was a substantial proportion of youth who were underusing Medicaid behavioral and mental health care services, and there were virtually no overusers. Our findings have implications for the appropriateness of Medicaid utilization management in behavioral health care and program efforts to maintain families with youth having serious emotional disturbance in the Youth Empowerment Service program.

Decision of when to stop in ultra-massive transfusion resuscitation is not based exclusively on units transfused, but rather the integration of patient and time-specific data, supported through machine learning predictive modeling.

Declines in Cisco Coregonus artedipopulations in some inland lakes have prompted assessments of Cisco occurrence and extirpation risk in relation to various stressors to identify refuge lakes and factors that promote Cisco persistence. However, most previous assessments have focused on presence–absence of Cisco rather than examining how population characteristics, such as relative abundance or growth, might change in relation to lake‐ and landscape‐level environmental factors. Consequently, our specific objectives were to identify important environmental factors explaining variation in Cisco relative abundance and growth and to determine whether population metrics describing size and age distributions were related to relative abundance in Wisconsin inland lakes. Cisco were collected from 48 inland Wisconsin lakes during 2011–2015 using vertical monofilament gill nets and population‐specific relative abundance estimates (catch per unit effort [CPUE]) were quantified as the number of individuals per gill‐net night. Sagittal otoliths were removed from a subsample of Cisco for age estimation and growth was indexed as mean total length (TL; mm) at age 2. Length and age data were used to develop a suite of metrics describing size and age distributions of each population. Random forest models were used to evaluate relationships between 10 biologically relevant predictor variables representing variation in physical, climatic, catchment, and limnological characteristics and Cisco CPUE and growth. Pearson correlations were used to determine whether population characteristics were related to CPUE. Cisco populations exhibited large variation in relative abundance, growth, and size and age distributions. Best‐fit random forest models explained approximately 25% of the variation in Cisco CPUE and 46% of the variation in growth. Growing degree‐days and variables associated with availability, quality, and quantity of suitable oxythermal conditions were identified as important predictors of both Cisco CPUE and growth; CPUE was also identified as an important predictor of growth. Mean TL and mean TL at age 2 were negatively related to Cisco CPUE, whereas mean age, number of age‐classes present, and maximum observed age were positively related to CPUE. Our results suggest that maintenance of suitable oxythermal habitat conditions may be critical to conserving abundant Cisco populations. Our assessment also provides insights on how Cisco populations may respond to environmental and anthropogenic stressors, which could aid ongoing and future conservation and management efforts in Wisconsin and elsewhere. Impact statementCisco populations in inland Wisconsin lakes vary extensively in terms of relative abundance, growth, and size and age composition, and this variation may be indicative of and influenced by a variety of physical, climatic, catchment, and limnological characteristics. Results provide insights on how Cisco populations may respond to environmental and anthropogenic stressors, which could aid conservation and management efforts in Wisconsin and elsewhere. Cisco populations in inland Wisconsin lakes vary extensively in terms of relative abundance, growth, and size and age composition, and this variation may be indicative of and influenced by a variety of physical, climatic, catchment, and limnological characteristics. Results provide insights on how Cisco populations may respond to environmental and anthropogenic stressors, which could aid conservation and management efforts in Wisconsin and elsewhere.

This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0.

Lead halide perovskites such as methylammonium lead iodide are attractive solar cell materials, and others such as cesium lead bromide are expected to be high-performing optoelectronic materials with potential applications including lighting, displays, and quantum information. All of these applications will benefit from having fully controlled electrical conductivity, but it has proven difficult to achieve high hole concentrations in these materials via impurity doping. In this work, possible acceptor dopants for the halide perovskites (including Ag, Na, and Cu) are evaluated using first-principles calculations based on a hybrid functional with spin–orbit coupling. We assess which dopants can act as shallow acceptors on the proper substitutional site, whether other configurations of these impurities cause self-compensation, and whether native defects might ultimately compensate p-type doping attempts. Among the dopants considered, sodium is consistently the most promising acceptor for achieving p-type conductivity in halide perovskites.

Objectives Minimally invasive esophagectomy is a technically challenging procedure that been associated with better outcomes at high-volume tertiary care centers. Louisiana is one of the most impoverished states, and travel to a “destination center” is not an option for many patients. We hypothesize that patients can obtain excellent surgical outcomes following MIE in a comprehensive community cancer center.Methods We identified all patients who underwent totally robotic MIE by a single surgeon at our center from July 2018 to November 2020. All cases were performed using totally robotic Ivor Lewis technique with intrathoracic isoperistaltic esophagogastrostomy. Incidence, demographics, treatment, and outcomes were compared before and after first 10 cases using Student’s t-test.Results We identified 21 patients: 16 male and 5 female. Mean age 65 (49-85). 19 patients underwent MIE for malignancy; 18 of these received neoadjuvant therapy. OR time decreased following the first 10 cases (502 vs. 408 minutes, P= 0.0127). Average lymph node harvest was 14 (4-23 nodes). Positive margin rate was 0%. Mean length of stay trended towards a decrease after the first 10 cases (11 vs. 9 days, P= NS). There were no leaks or strictures. Thirty-day readmission was five patients. Ninety-day mortality was 0%.Conclusion These outcomes rival those of high-volume referral centers and demonstrate that totally robotic MIE can be performed with excellent outcomes in community center. These data call into question the need for all patients to travel to “destination centers” to receive complex oncologic surgery.

The results of several studies have established the validity of the SCOFF questionnaire (a 5-question screening tool for eating disorders), but researchers need to explore further replicability using the US version in the graduate school population. In this study, the authors asked 335 graduate students attending the Northwestern student health clinic on the Chicago campus to complete a written survey anonymously. A total of 305 (91%) patients completed the survey. The sensitivity and specificity for the SCOFF was 53.3% and 93.2%, respectively. This produced a PPV (the proportion who tested positive on the screen and actually had an eating disorder) of 66.7% and an NPV (the proportion of those who tested negative on the screen and actually did not have an eating disorder) of 88.7%. More than 80% of respondents were dissatisfied with their shape and weight, with over one third having a moderate to severe body image disturbance. The SCOFF is an easy instrument to administer that health care providers can use to screen for eating disorders in the primary care setting. Key Words: eating disorder, graduate students, questionnaire, SCOFF, student health, Eating disorders cause enormous suffering for victims and families. They have reached epidemic proportions in America, affecting all segments of the population. (1) Eating disorders are disturbances in eating behavior [...]

Develop your horse's trust with this pressure-release exercise from top clinician John Lyons. YOU USE PRESSURE CUES WITH YOUR horse every day. Tug! Wall this way. Push! Move those hindquarters […]

Documents realeased to The Bulletin from the Defence Intelligence Organisation (DIO) reveal that despite denial by Foreign Minister Alexander Downer, Australia was aware of the violent measures used by Defence Minister Genreal Wiranto and the Indonesian military (TNI), and suggest that Wiranto was using violence to secure a political role in Indonesia.

Issues discussed concern the investigation by the Australian Broadcasting Authority into questionable commercial radio broadcasting deals . At issue is an alleged contract between radio mogul John Laws and advertisers to promote commercials.

Issues discussed concern the controversy over the low pricing of shares of Australian telecommunications provider Telstra, focusing on an estimated public loss of as much as A$16 bil. Topics addressed include the privatization of national industries, and the conflict of interest between the goals of investment companies and the government.

This article examines diplomatic and intelligence cables dealing with Australian policy toward East Timor and Indonesia before the crisis began in East Timor in Aug 1999. Relevant points include the Australian government's argument against the need for peacekeeping forces in East Timor.

This article presents harrowing descriptions of the atrocities perpetrated in East Timor by pro-Indonesian militiamen after most of the populace of the former Portuguese territory voted to become independent of Indonesia. Relevant details include evidence that these so-called militiamen were actually members of the Indonesian armed forces, an account of the East Timorese refugees who fled to Darwin, Australia, and the case for regarding the massacre in East Timor as Australia's most egregious foreign policy blunder.

This article examines classified Australian Defence Department documents and the significant change in defence policy they reveal. The change concerns integration with the US military, the purchase of equipment not suited to Australia's needs, and China as the focal point of Australian defense policy.

This article focuses on Australian radio industry mogul John Laws, who is facing six inquiries and possible criminal proceedings for alleged extortion after discovery of his A$1.2 mil deal with Australia's banks. The moral and ethical aspects of talk radio and advertising are examined.

A civil trial involving prominent lawyer John Marsden and the Channel Seven television station in Sydney, AU, may result in the largest defamation award in Australian history. Channel Seven aired a program identifying Marsden as a pedophile and Marsden sued for defamation. Marsden was president of the New South Wales Law Society and president of the New South Wales Council for Civil Liberties. Some analysts regard Marsden, who is openly gay, as a modern day Oscar Wilde.

Australian Democratic Party leader Meg Lees will have a Senate majority after Jul 1, 1999. She opposes the government of John Howard on economics, health, and other social issues. Although many policymakers emphasized Australia's growing economy, Lees insists the numbers of impoverished Australians are also growing. Lees feels government should not be continually made smaller and weaker.

George Pell, the Archbishop of Melbourne, presides over 1 mil Australians, the country's largest diocese. Before he became archbishop in 1996, the Pope chose Pell to join the Synod of Bishops in Rome. Pell is an outspoken conservative, unshakeable in his beliefs against women priests and homosexuals. The Australian church is experiencing a decrease in vocations and attendance.

American Broadcasting Companies, Inc., Chairman Donald McDonald arrived in Sydney, Australia, in August 1998 to discuss plans for replacing Australia's ABC managing director Brian Johns. Johns resisted the efforts and understood no decision would be made withough his input. A power struggle then began between the two men and within Australia's ABC organization.

Understanding ecological relationships among fishes and their environments are important for informing management policies. We conducted a statewide assessment of cisco (Coregonus artedi) in inland lakes of Wisconsin to better understand the status of this pelagic, coldwater forage fish. We then used long-term (2005–2014), standardized walleye (Sander vitreus) survey data from the Ceded Territory of Wisconsin (CTWI) to test for the influence of cisco (present, extirpated, or never present) and several abiotic factors on walleye growth trajectories described using sex-specific asymptotic lengths (L8), Brody growth coefficients (K), and time in years required to attain common length limits used to manage harvest of walleye in the recreational fishery (381 and 457 mm). Despite being top predators in many north-temperate waters, walleye growth was highly variable among lakes, suggesting that forage base and abiotic factors may be important drivers. Growth characteristics of 160 CTWI walleye populations revealed that females reached greatest L8 in lakes with cisco compared to those where cisco were never present or those lakes where cisco have been extirpated; however, differences were not statistically significant. Male walleye L8 did not differ based on cisco presence. Brody growth coefficients (K) for female walleye were positively correlated with growing degree days and Secchi depth; K for males was positively correlated with Secchi depth. Average time to attain 381 and 457 mm were lowest in lakes where cisco have been extirpated. Our results suggest that cooler water temperatures and lower water clarity may be more important drivers of walleye maximum growth potential in northern Wisconsin lakes than the presence of cisco.

Tolinapant (ASTX660) is a potent, nonpeptidomimetic antagonist of cellular inhibitor of apoptosis proteins 1 and 2 (cIAP1/2) and X-linked IAP, which is currently being evaluated in a phase 2 study in T-cell lymphoma (TCL) patients. Tolinapant has demonstrated evidence of single-agent clinical activity in relapsed/refractory peripheral TCL and cutaneous TCL. To investigate the mechanism of action underlying the single-agent activity observed in the clinic, we have used a comprehensive translational approach integrating in vitro and in vivo models of TCL confirmed by data from human tumor biopsies. Here, we show that tolinapant acts as an efficacious immunomodulatory molecule capable of inducing complete tumor regression in a syngeneic model of TCL exclusively in the presence of an intact immune system. These findings were confirmed in samples from our ongoing clinical study showing that tolinapant treatment can induce changes in gene expression and cytokine profile consistent with immune modulation. Mechanistically, we show that tolinapant can activate both the adaptive and the innate arms of the immune system through the induction of immunogenic forms of cell death. In summary, we describe a novel role for IAP antagonists as immunomodulatory molecules capable of promoting a robust antitumor immune response in TCL.

Objective: This study examined predictors of hospital readmission to determine whether readmissions can serve as a quality indicator for an inpatient psychiatric service. Method: A series of 255 patients consecutively admitted to any of seven psychiatric hospitals in a regional managed care program were followed to determine whether they were readmitted within 6 months of discharge. Case managers assessed patients with the use of a reliable outcome management/decision support system designed for acute psychiatric services. Results: Patients with greater impairment in self-care, more severe symptoms, and more persistent illnesses were more likely to be readmitted than other patients. Suicidal patients were less likely to be re-admitted. There was no evidence to suggest that poor hospital outcome or premature discharge was associated with readmission either within 30 days or within 6 months. Conclusions: Although patients at risk for hospital admission can be identified, it does not appear that the success of the hospital intervention per se influences the likelihood of readmission. Use of readmission rates as quality indicators for hospital care providers is not recommended.

Profit margins of packaging firms were pressured in 1995 from competition, rising costs, and other factors, resulting in some industry consolidation. A major trend toward international expansion is occuring in 1996 via joint ventures, acquisitions and privatization. Also, materials costs are being reduced. Increased demand and lower costs are improving margins for some of these stocks, but investors must be selective.

Stocks in the household products industry are not timely in 1996, due to the defensive traits of the industry's profits in a strong economy. Revenue and earnings have only been mediocre since 1992, also. Mass merchandisers have become larger and more sophisticated in their inventory management, and small manufacturers must change to survive. Further industry consolidation is anticipated, along with internal structural transition.

New order growth has slowed in the homebuilding industry, although new home sales for May 1996 increased 7.5%. However, earnings-per-share will remain favorable through 1996 due to 2nd qtr order backlogs. Earnings for 1997 could be lower if new orders remain sluggish and mortgage rates increase in 1996 and 1997. Stocks with good balance sheets and leading market shares offer the best opportunities for investors in 1996.

New car and truck sales increased during the 2nd qtr of 1996, and 15.4 mil. will be sold by the end of 1996 if the current trend continues. Production capacity may also be increased by the Big Three automakers. About 25% of new cars and trucks are now leased, and this may increase to 50% by the year 2000. Fleet sales are now 25% of the market, as well. Investors need to evaluate these stocks on a weekly basis, as they are not timely for 1996.

Medical supplies sales in the next three to five years are expected to increase through the late 1990s with new product introductions, along with reforms in FDA product review. Lower capital expenditures by hospitals and new outpatient treatment facilities will have an impact on medical supplies sales as well. Industry earnings for 1996 and 1997 are expected to be good, and these stocks should outperform the market.

The replacement auto parts industry performed poorly in 1995. Net income declined, although consolidated sales increased, and manufacturers and distributors had excessive inventory on hand. However, the greater number and the increased age of motor vehicles indicate moderate industry profit growth for the 1990s. There are several above-average investments among these stocks for long-term capital gains.

The number of offshore drilling rigs has decreased to about 575 in 1996 due to lower daily rental rates. Increased drilling activity for petroleum and natural gas in 1996, however, is giving suppliers and offshore drillers greater earnings prospects for the next three to five years. Coiled tubing and 3D seismic are among technologies that are becoming important, also. Investors for the long term will find several good stocks here.

The specialty retail industry performed poorly during the 1990s, with high inventory levels and low consumer spending. Industry prospects are good for 1996 compared to 1995, however, with 2.8% gross domestic product growth in the 1st qtr and 2.5% to 3% growth forecast for the remainder of 1996. The high-end retail segment with affluent customers is expected to outperform th market. Investors must evaluate individual stocks before investing.

The environment for the retail industry is strong in 1996, especially for department stores, compared to 1994 and 1995. The leading department stores are accelerating proprietary brand developments and shifting merchandise offerings, as well as automating internal functions. Results for discount chains, such as Wal-Mart, Kmart, Dollar General, and Family Dollar Stores are more mixed, however. These stocks must be selected on an individual basis.

Canadian banks have performed surprisingly well in the 1990s despite the country's slow economic growth, government cost cutting, high real interest rates and budget deficits. However, growth for 1996 is expected to slow somewhat even though the Canadian banks have shown ingenuity by diversifying income sources. Canadian bank stocks should appeal to investors, especially long-term investors, as they offer high dividends over 4.0% and have a high safety rate.

Rising corn, wheat and grain prices have affected the profitability of some food companies sufficiently to make investment in their securities questionable but have left other food companies unscathed. Hardest hit have been the meat and poultry companies who rely on grains for feeding stock, causing beef prices to drop and the poultry industry unable to cut prices as the consumer demand for beef rises. Surprisingly, ready-to-eat cereal, bread and pasta industries are untouched by the wheat and grain shortage.

Expanding fee-based services, better cost control, and improved quality of assets give the Canadian banking industry good earnings prospects for 1996. There should be a steady decline, both in 1996 and in the future, in the ratio of expense to revenue. Canadian banks are also expanding globally and entering every area of financial services. These stocks are good investments for income, but average for growth in the next six to 12 months.

Poly (lactic acid)/halloysite nanotube (PLA/HNT) nanocomposites have been studied extensively over the past few years owing to the interesting properties of the polymer, PLA, and the nanoclay, HNT, individually and as composites. In this paper, the influence of the screw speed during extrusion was investigated and was found to have a significant impact on the mechanical and thermal performance of the extruded PLA/HNT nanocomposites. To determine the effect of screw speed on PLA/HNT nanocomposites, 5 and 10 wt% of HNTs were blended into the PLA matrix through compounding at screw speeds of 40, 80, and 140 rpm. Virgin PLA was compounded for comparison. The resultant polymer melt was quench cooled onto a calendar system to produce composite films which were assessed for mechanical, thermal, chemical, and surface properties. Results illustrate that in comparison to 40 and 80 rpm, the virgin PLA when compounded at 140 rpm, indicated a significant increase in the mechanical properties. The PLA/HNT 5 wt% nanocomposite compounded at 140 rpm showed significant improvement in the dispersion of HNTs in the PLA matrix which in turn enhanced the mechanical and thermal properties. This can be attributed to the increased melt shear at higher screw speeds.

There was further consolidation in the medical supplies industry in 1995, especially in the interventional cardiology field. Revenues and earnings for the industry have also been strong in 1995. There will be increased demand for medical supplies and services in 1996 with improved living standards and the aging population worldwide, which will benefit profit margins. There are a wide variety of timely stocks in this industry for investor selection.

Fewer discretionary car repairs and a mild 1994-1995 winter has led to a large auto parts inventory in 1995, with lower revenues and earnings for the industry. Results for the 4th qtr of 1995 are also expected to remain low, but a harsher 1995-1996 winter and increased repairs, due to Clean Air Act mandates, will help the industry. These stocks are expected to underperform the market in 1996, but several are worth considering.