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In early 2008, concerned with the yield from its outsourced collections, Centura Health in Denver considered replacing its entire self-pay collection network. But a deeper analysis disclosed that Centura's vendors [...]

COUPLES AND ATTORNEYS OFTEN DO NOT REALIZE THERE ARE UNINTENDED TAX CONSEQUENCES IN DIVORCE SETTLEMENTS. THIS IS WHERE YOU, THE ACCOUNTANT, CAN HELP YOUR CLIENTS. [ILLUSTRATION OMITTED] I have found, [...]

Healthcare organizations have prioritized patient safety and quality improvement efforts to reduce central line-associated bloodstream infections (CLABSIs). Implementation of central venous catheter (CVC) insertion and maintenance bundles have significantly reduced infection rates. Nevertheless, CLABSIs continue to be a significant cause of mortality and morbidity in hospitals, and further efforts are necessary to improve CVC care practices. A hospital-wide committee at a tertiary care pediatric hospital identified gaps in our CVC maintenance practices resulting from CVC contamination events from a patient's body fluids. A lack of published literature on the topic resulted in the need to create an institutional clinical practice guideline (CPG) to develop guidance to mitigate potential CLASBIs from CVC contamination. Utilization of the CVC CPG in all inpatient units and other reduction strategies resulted in a steady decline in our CLABSI rates, particularly in those related to CVC contamination events. Case reports illustrate the effectiveness of the CPG.

INTRODUCTION Perhaps the element of our criminal justice system to which Justice Marshall most committed himself was the death penalty. Throughout his tenure on the Court, Justice Marshall vigorously adhered [...]

Background: While there is substantial evidence that psychological stress enhances risk for coronary artery disease, the mechanisms underlying such an influence remain unclear. We examined the effects of short-term psychological stress on serum lipid levels, hemoconcentration, fibrinogen level, and plasma viscosity. Methods: Forty-four healthy young adults were randomly assigned to perform a distinctly frustrating cognitive task for 20 minutes (stress condition) or to rest quietly for the same period (control condition). Results: Relative to controls, stressed subjects showed significant increases in blood pressure and heart rate; total, low-density, and high-density lipoprotein cholesterol levels; hematocrit; hemoglobin level; and total protein concentration. Stressed subjects also showed significant reductions in plasma volume and increased plasma viscosity and estimated whole-blood viscosity compared with controls. A similar trend in fibrinogen level was not statistically significant. Individual differences in blood pressure and heart rate response to stress correlated highly with changes in total cholesterol levels and hematocrit. Conclusions: Our investigation provides further evidence that exposure to short-term mental stress elicits hemoconcentration with associated increases in serum lipid concentrations, hemostatic factors, and blood viscosity. (Arch Intern Med. 1995;155:615-620)

The federal Obstructing Justice Act is intended to punish individuals that influence or intend to influence judicial proceedings by threat or force, and the Victim and Witness Protection Act defines the federal scheme for protection of witnesses in judicial proceedings. Obstruction of justice is proven by showing actual or attempted interference with a judicial proceeding. The defendant must know of the proceeding and be acting with corrupt intent. Witness tampering is shown by proving the defendant used threats, force, intimidation or deception to knowingly influence a witness.

Monoacylglycerol lipase (MAGL) is the main enzyme responsible for degradation of the endocannabinoid 2-arachidonoylglycerol (2-AG) in the CNS. MAGL catalyzes the conversion of 2-AG to arachidonic acid (AA), a precursor to the proinflammatory eicosannoids such as prostaglandins. Herein we describe highly efficient MAGL inhibitors, identified through a parallel medicinal chemistry approach that highlighted the improved efficiency of azetidine and piperidine-derived carbamates. The discovery and optimization of 3-substituted azetidine carbamate irreversible inhibitors of MAGL were aided by the generation of inhibitor-bound MAGL crystal structures. Compound 6, a highly efficient and selective MAGL inhibitor against recombinant enzyme and in a cellular context, was tested in vivo and shown to elevate central 2-AG levels at a 10 mg/kg dose.

The purpose of a commercial general liability (CGL) policy of insurance is to insure an insured's business, and provide the insured with the broadest spectrum of protection for unexpected personal [...]

YOU CAN IMAGINE my excitement getting an e-mail from the editor of a top magazine telling me how much she liked my query. But my excitement turned to embarrassment after [...]

Purpose. The objectives of this study were to: 1) investigate the infection control practices of practicing dental hygienists, 2) document the attitudes and practices of dental hygienists toward patients with [...]

Göbekli Tepe is the name of a remarkable archaeological site that challenges long held assumptions about the Neolithic Revolution, that is, our first transition from hunters and gatherers into settled farmers. Instead of permanent settlements and agriculture being prerequisite for religion, social specialization, and writing, evidence from Göbekli Tepe suggests that may be backward, and that such psychological changes are what afforded sedentism and agriculture. Three aspects of the site—who built it, its use as a “temple,” and evidence of the earliest known proto-writings—are discussed to illustrate Göbekli Tepe's relevance to psychology. In turn, the social psychological phenomenon of storytelling is used to illustrate psychology's potential relevance to cognitive archeology.

Jose Rizal (1861-1896) is one of the most revered figures in Philippine history. He was a multifaceted intellectual and a political activist, best known for his political writings that inspired the Philippine revolution and ultimately led to his execution by the Spanish colonizers. Rizal was also a physician who trained in ophthalmology under 2 prominent European ophthalmologists, Louis de Wecker and Otto Becker. Arch Ophthalmol. 2001;119:280-284

The current reality of population growth, resource scarcity, and climate change requires resilient agroecosystems to sustain food production and protect the environment. This manuscript reflects a combined effort of speakers at the 2017 C6 Forage and Grazinglands Division Symposium, which was titled “Resiliency in Forage and Grazinglands.” The symposium brought together speakers representing a diverse cross‐section of forage systems across the United States. Each speaker discussed resilience‐related topics from their specific region, including: the importance of diversity and use of complementary forages in grazing systems, how grazing and defoliation affect resilience, the importance of soil fertility and pest management, and development of decision aids to evaluate resilience in grazinglands. Several themes emerged that we propose would help improve the resilience of forage and grazingland systems: (i) identifying moderately diverse, site‐specific mixtures (grasses–legumes) for use in specific regions of the United States, (ii) greater use of complementary forage species such as C3and C4grasses to lengthen the grazing season and provide a buffer against weather variation, (iii) adoption of moderate defoliation intensities to help stabilize forage production and species composition, (iv) more attention to maintaining and improving soil fertility to improve the productivity of desirable forage species and reduce weed pressure, and (v) increase adoption of assessment tools to evaluate the relative “health” and potential resilience of forage‐livestock systems. An integrative management approach that combines many of these elements would help improve the resilience of forage and grazinglands to sustain high productivity under increasingly erratic and extreme weather.

Currently, no standard defines the clinical skills that medical students must demonstrate upon graduation. The Liaison Committee on Medical Education bases its standards on required subject matter and student experiences rather than on observable educational outcomes. The absence of such established outcomes for MD graduates contributes to the gap between program directors’ expectations and new residents’ performance.In response, in 2013, the Association of American Medical Colleges convened a panel of experts from undergraduate and graduate medical education to define the professional activities that every resident should be able to do without direct supervision on day one of residency, regardless of specialty. Using a conceptual framework of entrustable professional activities (EPAs), this Drafting Panel reviewed the literature and sought input from the health professions education community. The result of this process was the publication of 13 core EPAs for entering residency in 2014. Each EPA includes a description, a list of key functions, links to critical competencies and milestones, and narrative descriptions of expected behaviors and clinical vignettes for both novice learners and learners ready for entrustment.The medical education community has already begun to develop the curricula, assessment tools, faculty development resources, and pathways to entrustment for each of the 13 EPAs. Adoption of these core EPAs could significantly narrow the gap between program directors’ expectations and new residents’ performance, enhancing patient safety and increasing residents’, educators’, and patients’ confidence in the care these learners provide in the first months of their residency training.

Cuticular drusen and retinal drusen in general have been linked with kidney disease. The association between cuticular drusen and renal function at a population level has not been previously explored. In this population-based case-control study, the authors did not find cuticular drusen to be associated with decreased kidney function.

Driveline (DL) infection has been a major source of morbidity and mortality following HeartMate II left ventricular assist device (LVAD) implant, despite a significantly lower incidence compared with pulsatile flow devices. The purpose of this study was to compare the incidence of DL infection using two different externalization techniques. Between July 1, 2008, and October 15, 2011, 125 consecutive patients underwent HeartMate II LVAD implant at a single institution. Patients that underwent implant in 2008–2009 (n = 45) had the velour portion of the DL externalized (Velour group) and those that were implanted in 2010–2011 (n = 80) had only the silicone portion externalized (Silicone group). Kaplan–Meier analysis with log-rank test was used to compare actuarial DL infection-free survival and a composite of death and DL infection-free survival. There were 2045 (44.4) DL infections in the Velour group compared with 780 (8.8) in the Silicone group. Driveline infection-free survival was significantly better for the Silicone versusVelour group as was the composite end-point of death and infection-free survival (p< 0.001). Externalization of only the silicone portion of the DL led to a dramatic reduction in infections and significantly improved survival after implant. This represents an opportunity to decrease the incidence of this important cause of morbidity and mortality after LVAD implant.

Several oat processors in the United States and Canada operate under what is referred to as a Purity Protocol for the provision of gluten-free oats. This term is derived from a Health Canada position statement that indicated that pure oats, which they defined as oats that are harvested, transported, stored, processed, and manufactured under good manufacturing practices (GMPs) to minimize the presence of gluten, can safely be consumed by some persons with celiac disease. While proprietary definitions of the appropriate GMPs have been used in industry for many years, no independent definition of the requirements to make a Purity Protocol claim has been published. This paper provides a consensus definition of the Purity Protocol requirements based on input from the four largest Purity Protocol oat processors in North America. This definition provides transparency to gluten-free consumers and allows for auditing of a Purity Protocol claim.

Introduction:Asthma is a chronic inflammatory disease that causes significant morbidity and mortality. Inhaled corticosteroids are the preferred initial treatment for this disorder. Mometasone furoate dry powder is an inhaled corticosteroid that is approved for once-daily treatment of asthma in both adults and children as young as 4 years.Areas covered:The goal of this paper is to review the clinical efficacy and safety of mometasone furoate dry powder inhaler for the treatment of asthma. A literature search using PubMed was done using the terms ‘mometasone furoate’, ‘inhaled corticosteroid’ and ‘asthma’, focusing on articles that highlighted clinical trials and addressed efficacy of the medication.Expert opinion:Mometasone furoate dry powder inhaler has an excellent safety and efficacy profile. For patients with persistent asthma who require treatment with an inhaled corticosteroid, mometasone furoate is an excellent therapeutic choice.

The article offers information on the U.S. Bank Secrecy Act which focuses on anti-money laundering in community banks, consumer lenders, and casinos and mentions topics including the law's compliance requirements, penalties, and enforcement actions.

This paper discusses the various concepts of species and genus and also suggests future usage of these two terms. Cyanobacterial taxonomy must hereafter utilize a polyphasic approach that includes at least some elements of genetics, morphology, cytology, ultrastructure, physiology, biochemistry and ecology - otherwise, descriptions and names, both past and future become nearly meaningless. Using phenotypic characters alone to describe and name taxa is no longer a legitimate pursuit, since it is well known that cyanobacteria of similar morphology and physiology may be quite different genetically, and cyanobacteria of the same genetic makeup may appear quite different under different ecological or physiological conditions, the latter situation often resulting simply from differential gene expression. In genetic terms, species with precise boundaries probably do not exist, but are merely peaks that stand out in never-ending variations in sequences of single or multiple genes or of complete genomes. The central question is whether it will be possible to resolve these species peaks and what is the appropriate level of genetic information to do so (several genes or complete genomes?). One of the main problems with even describing new species or genera in both the traditional or bacteriological sense is that the delineation of new cyanobacteria using genetic and phenotypic criteria is escalating at such an overwhelming rate that the number of cyanobacterial taxonomists who would actually write a formal species (or genus) description would be inadequate to cope with the burgeoning number of strains being characterized and entered into databases. There will be numerous and nevernding revisions, and a new species or genus being described will eventually find itself closely allied to a number of new variants unknown at the time of the formal description. Until there are complete genomes published for hundreds or thousands of cyanobacterial isolates, it may be impossible to determine the boundaries of species or genera, and even then the boundaries may be arbitrary and decided simply by consensus. For now we believe that the current rules of nomenclature (Botanical and Bacteriological) should be used when formal descriptions of very unique taxa are prepared, but that another form of delineating new taxa should now be used for the burgeoning number of strains being discovered. Temporarily, at least, "traditional" and more recent generic names should be used with strain numbers for each clonal isolate or collected specimen, dispensing with species epithets (as in the Pasteur Culture Collection). In some cases the name of the closest morphological equivalent should be given (using cf. from Latin confer = compare) in order to aid future taxonomists. Cyanobacteriologists need to continue to monitor the rapidly increasing genetic and phenotypic information and wait until some logical and pragmatic pattern emerges before attempting to specifically delineate the boundaries of natural species and genera and perhaps, even then, creating new operational taxonomic units that replace the traditional binomials. Polyphasic taxonomy is advancing rapidly, and several examples are presented. The availability of cyanobacteriaspecific primers for genetic identification and the fact that morphological, ecological and physiological information may be obtained without pure cultures, means that new taxa can be both described and labeled quite adequately in a manner already widely in use (e.g. Synechocystis PCC 6803).

Timing of spring fire and glyphosate [N‐(phosphonomethyl)glycine] treatments is critical to control weeds without compromising production of warm‐season grasses. To determine the forage and seed yield response we burned or applied glyphosate to switchgrass (Panicum virgatumL.) and big bluestem (Andropogon gerardiiVitman) in mid‐April, early May, and late May in 1998 and 1999 at Rock Springs, PA. Compared with fire in mid‐April or early May, a late May burn in 1998 reduced July dry matter yields (simulating a hay harvest) by 40 to 48% but did not affect dry matter yields in September (simulating a biomass feedstock harvest) of either grass. In switchgrass, glyphosate applied in late May reduced July yields by 70% and September yields by 30%. In bluestem, late May application of glyphosate reduced July yields by 90% and September yields by 40%. In both grasses, fire in late May reduced yields less than a late May application of glyphosate. Late May glyphosate treatments reduced seed yield compared with the mid‐April date. We conclude that in central Pennsylvania switchgrass or bluestem can be burned through the first week of May (10–15 cm growth) with little effect on hay or biomass yield. Glyphosate should be applied (i) before mid‐ to late April (just before green‐up) if switchgrass or big bluestem is to be harvested as hay in July or for seed in September, or (ii) by the first week of May if the cumulative growth is to be harvested once in autumn.

More than a century since Charles Darwin stated that diverse grasslands produce more herbage than monocultures, scientists still debate the relationship between species diversity and ecosystem function. Postulated benefits of diversity in experimental grasslands include greater and more stable primary production along with more efficient nutrient use. These benefits have been extrapolated to forage and grazing land systems with little supporting objective data. Most information on the potential benefits of increased plant diversity comes from studies of synthesized grasslands that have not included domestic grazing animals. We explore this debate relative to the management of temperate forage and grazing lands. Plant species diversity refers to the number of species (richness) and their relative abundance (evenness) within a defined area. Plant relations influence biodiversity responses through positive (e.g., facilitation, N2fixation, hydraulic lift) and negative interactions (e.g., competitive exclusion, allelopathy). Early 20th century research on complex mixtures of forage species (limited to grasses and legumes) for pasture indicated equivocal results regarding benefits of species‐rich mixtures and typically recommended using the best adapted species in simple grass–legume mixtures. Recent research indicates potential herbage yield benefits from species‐rich mixtures for pastures. Limited animal productivity research on species‐rich mixtures indicates variable responses and much more research is needed. Grazing land productivity is a primary focus for biodiversity benefits because of the direct economic relevance to producers. However, taking a broader view of the multifunctionality of grazing lands to include environmental and aesthetic benefits to humans reveals a great scope for using biodiversity in grazing land management.

The homeless population in the United States is one of great diversity that continues to increase in number. Although data on the oral health status of individuals who are homeless is limited, studies consistently report both the perception and clinical evidence of dental needs among this population as well as a low utilization rate for dental services. This article reviews the oral health needs of people who are homeless as reported in literature, barriers to receiving dental care, and methods used to deliver dental care to this population. Many rehabilitation centers for adults who are homeless consider the establishment and maintenance of a state of good general and oral health as a priority and a key factor in helping homeless adults to return to the workforce and mainstream society.

A comprehensive surveillance system for occupational injuries to adolescents does not exist in Texas, as in most states. Therefore, the magnitude, severity, nature, and source of injuries to working adolescents have not been well described in Texas. The investigators used three data sources to investigate work-related injuries and deaths in Texas: (1) Texas Workers' Compensation Commission (TWCC) claims data from 1991 through April 1996; (2) 1993 TWCC/Bureau of Labor Statistics (BLS) Annual Survey of Occupational Injuries and Illnesses; and (3) work-related fatalities identified from Texas death certificates from 1990–1995. There were 9,027 injuries reported to the TWCC for adolescents 14–17 years of age during slightly more than 5 years. Injuries for which indemnity payments were made (more than 7 days out of work) occurred among 21.7% of the adolescents. Based on BLS data in 1993, of 992 non-fatal injuries involving days away from work, 35% were caused by contact with objects, 27% by bodily reaction, and 24% by falls. Two-thirds of these injuries occurred while working in eating and drinking places and grocery stores. Three-quarters of the 30 deaths from 1990–1995 were accounted for equally by motor vehicle and homicide. In conclusion, a substantial number of adolescents are injured or killed in the workplace each year in Texas. Although improved population-based surveillance is needed, sufficient knowledge exists to begin prevention efforts now. Am. J. Ind. Med. 35:43–50, 1999. © 1999 Wiley-Liss, Inc.

Because of the growing concern of the infectious nature of aerosols produced by air polishers, the Centers for Disease Control and Prevention and the American Dental Association have made recommendations to minimize dental aerosols. In addition, a device was developed in 1997 to reduce the aerosol generated during air polishing.

Cer1p/Lhs1p/Ssi1p is a novel Hsp70-related protein that is important for the translocation of a subset of proteins into the yeast Saccharomyces cerevisiaeendoplasmic reticulum. Cer1p has very limited amino acid identity to the hsp70 chaperone family in the N-terminal ATPase domain but lacks homology to the highly conserved hsp70 peptide binding domain. The role of Cer1p in protein folding and translocation was assessed. Deletion of CER1slowed the folding of reduced pro-carboxypeptidase Y (pro-CPY) approximately twofold in yeast. In wild-type yeast under reducing conditions, pro-CPY can be found in a complex with Cer1p, while partially purified Cer1p is able to bind directly to peptides. Together, this suggests that Cer1p has a chaperoning activity required for proper refolding of denatured pro-CPY which is mediated by direct interaction with the unfolded polypeptide. Cer1p peptide binding and oligomerization could be disrupted by addition of ATP, confirming that Cer1p possesses a functional ATP binding site, much like Kar2p and other members of the hsp70 family. Interestingly, replacing the signal sequence of a CER1-dependent protein with that of a CER1-independent protein did not relieve the requirement of CER1for import. This result suggests that an interaction with the mature portion of the protein also is important for the translocation role of Cer1p. The CER1RNA levels increase at lower temperatures. In addition, the effects of deletion on folding and translocation are more severe at lower temperatures. Therefore, these results suggest that Cer1p provides an additional chaperoning activity in processes known to require Kar2p. However, there appears to be a greater requirement for Cer1p chaperone activity at lower temperatures.

To determine the effects of strength training (ST) on muscle quality (MQ, strength/muscle volume of the trained muscle group), 12 healthy older men (69 ± 3 yr, range 65–75 yr) and 11 healthy older women (68 ± 3 yr, range 65–73 yr) were studied before and after a unilateral leg ST program. After a warm-up set, four sets of heavy-resistance knee extensor ST exercise were performed 3 days/wk for 9 wk on the Keiser K-300 leg extension machine. The men exhibited greater absolute increases in the knee extension one-repetition maximum (1-RM) strength test (75 ± 2 and 94 ± 3 kg before and after training, respectively) and in quadriceps muscle volume measured by magnetic resonance imaging (1,753 ± 44 and 1,955 ± 43 cm3) than the women (42 ± 2 and 55 ± 3 kg for the 1-RM test and 1,125 ± 53 vs. 1,261 ± 65 cm3for quadriceps muscle volume before and after training, respectively, in women; both P< 0.05). However, percent increases were similar for men and women in the 1-RM test (27 and 29% for men and women, respectively), muscle volume (12% for both), and MQ (14 and 16% for men and women, respectively). Significant increases in MQ were observed in both groups in the trained leg (both P< 0.05) and in the 1-RM test for the untrained leg (both P< 0.05), but no significant differences were observed between groups, suggesting neuromuscular adaptations in both gender groups. Thus, although older men appear to have a greater capacity for absolute strength and muscle mass gains than older women in response to ST, the relative contribution of neuromuscular and hypertrophic factors to the increase in strength appears to be similar between genders.

LEAD: GOLDEN INCHES The China Memoir of Grace Service. Edited by John S. Service. Illustrated. 346 pp. Berkeley: University of California Press. $19.95. GOLDEN INCHES The China Memoir of Grace [...]

AbstractObjectives:To evaluate the impact of Occupational Safety and Health Administration (OSHA) regulations on the vaccination of healthcare workers (HCWs), to assess interpretation of these regulations, and to evaluate changes in hospital vaccination policies.Design:Between June 1, 1992, and August 15, 1992, a telephone survey was conducted among 150 hospitals selected randomly from participants in the American Hospital Association 1991 annual survey.Results:Of the 150 hospitals, 96 (64%) provided information on hepatitis B vaccination coverage of their employees. Of the 103,419 employees in these hospitals, 77,302 (75%) were eligible to receive the hepatitis B vaccine, and 38,850 (51%) of these were vaccinated completely (had received 3 doses of vaccine). Following issuance of the final regulations, 73% of hospitals reported greater employee acceptance of hepatitis B vaccine, and hospitals were more likely to offer hepatitis B vaccine to maintenance workers, security personnel, dietary staff, and clerical personnel. Seventy-five hospitals (59%) reported conducting postvaccination serologic testing on all hospital employees, 12 (8%) as a result of OSHA regulations. Twenty-three hospitals (16%) reported administering routine booster doses of hepatitis B vaccine at 3, 5, or 7 years.Conclusions:The new OSHA standard resulted in a greater awareness of risk for HBV infection among HCWs and an increase in the number of HCWs receiving hepatitis B vaccine; however, vaccination coverage remained suboptimal. Postvaccination serologic testing of employees with negligible risk and the routine administration of vaccine booster doses may be diverting resources and preventing comprehensive coverage of high-risk employees.