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Objective Identify preventive medication treatment response trajectories among youth participating in the Childhood and Adolescent Migraine Prevention study. Methods Data were evaluated from 328 youth (ages 8–17). Childhood and Adolescent Migraine Prevention study participants completed headache diaries during a 28-day baseline period and a 168-day active treatment period during which youth took amitriptyline, topiramate, or placebo. Daily headache occurrence trajectories were established across baseline and active treatment periods using longitudinal hierarchical linear modeling. We tested potential treatment group differences. We also compared final models to trajectory findings from a clinical trial of cognitive behavioral therapy plus amitriptyline for youth with chronic migraine to test for reproducibility. Results Daily headache occurrence showed stability across baseline. Active treatment models revealed decreases in headache frequency that were most notable early in the trial period. Baseline and active treatment models did not differ by treatment group and replicated trajectory cognitive behavioral therapy plus amitriptyline trial findings. Conclusions Replicating headache frequency trajectories across clinical trials provides strong evidence that youth can improve quickly. Given no effect for medication, we need to better understand what drives this clinically meaningful improvement. Results also suggest an expected trajectory of treatment response for use in designing and determining endpoints for future clinical trials. Trial Registration. ClinicalTrials.gov Identifier: NCT01581281

Agricultural research oriented towards developmental goals, such as poverty alleviation, better nutrition and environmental sustainability, is challenging for monitoring and evaluation. The causal chains are long, indirect and not well understood. CGIAR, a system of independent agricultural research centres with a mission to agricultural development, has a long history of evaluation and other mechanisms of accountability. The purpose of this article is to analyse the role and utility of independent evaluation in CGIAR over two decades during which the system established a programmatic approach to research and underwent governance changes. The key findings are (i) during the historic period when evaluation of research centres was the primary mechanism of accountability to donors and of improvement of research and management at centres, evaluations were used for their intended purposes and were important for the credibility of CGIAR; (ii) evaluation of programmes in networked systems of institutions revealed challenges related to divided management responsibilities and variance in contribution and performance among partners; (iii) systematic oversight of evaluations and implementation of their recommendations by CGIAR’s highest decision-makers, the donor governance body, has diminished over time thus influencing evaluation effectiveness; and (iv) fragmented, projectized funding has generated parallel accountability mechanisms used by individual donors aside with CGIAR’s centrally designed mechanisms. We conclude that independent evaluation remains a valuable, strategic tool for complementing indicator-based performance management focused on short-term results on one hand and impact assessment of past research on the other hand. It is needed to address qualitative and context-specific aspects of research performance, such as science and research quality and potential for effectiveness.

Objectives: Female family members affect both the likelihood of adolescent pregnancy and the outcome of that pregnancy. We examined the degree to which an older sister’s adolescent reproductive outcomes affect her younger sister’s reproductive behavior, and whether relationships in adolescent pregnancy among sisters born to adolescent mothers differ from those born to nonadolescent mothers. Methods: We followed a birth cohort in Manitoba, Ontario, Canada, to age 20 using linkable administrative databases housed at the Manitoba Centre for Health Policy. The cohort consisted of 12 391 girls born in Manitoba between April 1, 1984, and March 31, 1996, who had 1 older sister. We used logistic regression models to examine the relationships among familial adolescent pregnancy outcomes. Results: Compared with adolescent girls whose older sister did not have an adolescent pregnancy, adolescent girls whose older sister had an adolescent pregnancy were more likely to have a pregnancy (adjusted odds ratio [aOR] = 2.57), regardless of whether that pregnancy was completed (aOR = 2.56) or terminated (aOR = 2.59). Relationships in adolescent pregnancy among sisters were much stronger for those born to nonadolescent mothers (aOR = 3.16 [older sister completed adolescent pregnancy] and 3.18 [older sister terminated adolescent pregnancy]) than to adolescent mothers (aOR = 1.65 [older sister completed adolescent pregnancy] and 1.77 [older sister terminated adolescent pregnancy]). For younger sisters having an adolescent pregnancy, the odds of her completing the pregnancy were reduced if her older sister had terminated an adolescent pregnancy and her mother had not been an adolescent mother (aOR = 0.38). Conclusions: Younger sisters of adolescents who had a pregnancy may benefit from targeted interventions to reduce their likelihood of adolescent pregnancies.

The objective of this study is to examine suicide attempts and completions among mothers who had a child taken into care by child protection services (CPS). These mothers were compared with their biological sisters who did not have a child taken into care and with mothers who received services from CPS but did not have a child taken into care.A retrospective cohort of mothers whose first child was born in Manitoba, Canada, between April 1, 1992, and March 31, 2015, is used. Rates among discordant biological sisters (1872 families) were compared using fixed-effects Poisson regression models, and mothers involved with CPS (children in care [ n = 1872] and received services [ n = 9590]) were compared using a Poisson regression model.Compared with their biological sisters and mothers who received services, the adjusted incidence rate ratio (aIRR) of death by suicide was greater among mothers whose child was taken into care by CPS (aIRR = 4.46 [95% confidence interval (CI), 1.39-14.33] and ARR = 3.45 [95% CI, 1.61-7.40], respectively). Incidence rates of suicide attempts were higher among mothers with a child taken into care compared with their sisters (aIRR = 2.15; 95% CI, 1.40-3.30) and mothers receiving services (aIRR = 2.82; 95% CI, 2.03-3.92).Mothers who had a child taken into care had significantly higher rates of suicide attempts and completions. When children are taken into care, physician and social workers should inquire about maternal suicidal behaviour and provide appropriate mental health.

Objective: The objective was to compare mental illness diagnoses and treatment use among mothers who lost custody of their child through involvement with child protection services and those seen in mothers dealing with the death of a child. Methods: We studied mental health outcomes of a cohort of women whose first child was born in Manitoba, Canada between 1 April 1997 and 31 March 2015. Of these women, 5,792 had a child taken into care, and 1,143 mothers experienced the death of a child (Results: Mothers with a child taken into care had significantly greater ARR of depression (ARR = 1.90; 95% CI, 1.82 to 1.98), anxiety (ARR = 2.51; 95% CI, 2.40 to 2.63), substance use (ARR = 8.54; 95% CI, 7.49 to 9.74), physician visits for mental illness (ARR = 3.01; 95% CI, 2.91 to 3.12), and psychotropic medication use (ARR = 4.95; 95% CI, 4.85 to 5.06) in the years after custody loss compared with mothers who experienced the death of a child. Conclusion: Losing custody of a child to child protection services is associated with significantly worse maternal mental health than experiencing the death of a child. Greater acknowledgement and supportive services should be provided to mothers experiencing the loss of a child through the involvement of child protection services.

Objective: To investigate differences in physician-diagnosed psychiatric disorders between women who gave birth to children with a fetal alcohol spectrum disorder (FASD) diagnosis (study group) compared to women who gave birth to children without FASD (comparison group). Methods: We linked population-level health and social services data to clinical data on FASD diagnoses to identify study group ( n = 702) and comparison group ( n = 2097) women matched 1:3 on date of birth of index child, region of residence, and socioeconomic status. Regression modeling produced relative rates (RRs) for outcomes. Results: Mothers who gave birth to children with FASD had higher adjusted rates of substance use disorder (RR, 12.65; 95% confidence interval [CI], 8.99-17.80), personality disorder (RR, 12.93; 95% CI, 4.88-34.22), and mood and anxiety disorders (RR, 1.75; 95% CI, 1.49-2.07) before the pregnancy of the child. These mothers also had higher adjusted rates of maternal psychological distress during pregnancy (RR, 5.35; 95% CI, 4.58-6.35) and higher rates of postpartum psychological distress (RR, 1.71; 95% CI, 1.53-1.90). These women also had higher adjusted rates for antidepressant prescriptions before, during, and after the pregnancy. Conclusions: A significant psychiatric burden exists for women giving birth to children with FASD. Clinicians should recognise the high rates of psychiatric concerns facing mothers who give birth to children with FASD and should offer treatment and support to these women to improve their health and well-being and prevent further alcohol-exposed pregnancies.

Previous research has shown that there is an overlap between experiences of youth violence and adolescent relationship violence. Yet, little research exists which investigates the sex differences in the associations between specific types of youth violence and relationship violence while controlling for potential confounders. This study addresses this gap in the literature by exploring the associations between experiences of youth violence and receiving and delivering relationship violence in an urban adolescent sample. From 2006 to 2007, 1,454 adolescents aged 13 to 21 years in New York City completed an anonymous survey that included the validated Conflict in Adolescent Relationships Inventory that estimates experiences of relationship violence in the previous year as well as the prevalence of various exposures to youth violence. Bivariate and multivariate analyses assessed the overlap between experiencing other types of youth violence and delivering and receiving physical relationship violence and sexual coercion. Compared with youth in nonviolent relationships, we found a significant association between delivering and receiving relationship physical violence and sexual coercion with participating in a fight, missing school due to fear, being threatened/injured with a weapon, gang membership, and carrying a weapon among both males and females. We also identified the sex differences between these specific associations of youth and relationship violence. Service providers working with adolescents experiencing relationship violence should be aware that they face a higher concurrent risk of experiencing or participating in other forms of youth violence. Likewise, providers working in the area of youth violence intervention and prevention should consider the possibility of concurrent relationship violence. Based on these findings, further research should explore whether interventions targeting relationship violence can also impact participation in youth violence and vice versa.

Cerebral blood volume (CBV) measurement complements conventional magnetic resonance imaging (MRI) to indicate pathologies in the central nervous system (CNS). Dynamic susceptibility contrast (DSC) perfusion imaging is limited by low resolution and distortion. Steady-state (SS) imaging may provide higher resolution CBV maps but was not previously possible in patients. We tested the feasibility of clinical SS-CBV measurement using ferumoxytol, a nanoparticle blood pool contrast agent. SS-CBV measurement was analyzed at various ferumoxytol doses and compared with DSC-CBV using gadoteridol. Ninety nine two-day MRI studies were acquired in 65 patients with CNS pathologies. The SS-CBV maps showed improved contrast to noise ratios, decreased motion artifacts at increasing ferumoxytol doses. Relative CBV (rCBV) values obtained in the thalamus and tumor regions indicated good consistency between the DSC and SS techniques when the higher dose (510 mg) ferumoxytol was used. The SS-CBV maps are feasible using ferumoxytol in a clinical dose of 510 mg, providing higher resolution images with comparable rCBV values to the DSC technique. Physiologic imaging using nanoparticles will be beneficial in visualizing CNS pathologies with high vascularity that may or may not correspond with blood–brain barrier abnormalities.

This article describes two separate studies that were conducted to develop and validate a measure of the prolonged stress activation and anticipatory race-related stress response in African American adults (Prolonged Activation and Anticipatory Race-Related Stress Scale [PARS]). In Study 1, an exploratory factor analytic procedure ( N = 292) resulted in a17-item measure with four underlying factors: (a) Perseverative Cognition, (b) Secondary Appraisal, (c) Anticipatory Race-Related Stress Scale–Psychological, and (d) Anticipatory Race-Related Stress Scale–Physiological. In Study 2 ( N = 227), a confirmatory factor analytic procedure was conducted to evaluate and compare the underlying factor structure for several competing models of the PARS. This procedure supported a four-factor oblique solution as having the best fit to the data. Study 2 also provided evidence for the convergent validity of the PARS in that its factor scores correlated, in the anticipated direction, with scores on measures of related constructs.

The purpose of the study was to assess the impact of an educational intervention on prostate cancer screening behavior and knowledge. Participants were 104 African American men, 45 years and older, who had not been screened for prostate cancer with a prostate-specific antigen and/or digital rectal exam within the past year. All participants received an intervention delivered by trained lay community educators using a prostate cancer educational brochure developed in collaboration with the community, with structured interviews preintervention and 3 months postintervention. The main study outcomes included prostate-specific antigen screening rates during the 3-month interval and knowledge, barriers to screenings, and decisional conflict around screening. Compared with the 46 men who did not get screened, the 58 participants who got screened were more likely to have greater than a high school education, annual household incomes ≥$25,000, and a family history of non–prostate cancer ( p < .05). Average knowledge scores increased, and barriers to screening scores decreased, from preintervention to postintervention only for participants who had been screened ( p < .05). The results of this study demonstrate the feasibility and efficacy of an academic institution collaborating with the African American community to develop a successful prostate cancer educational intervention, an approach that can be expanded to other cancers and other chronic diseases.

In July 2009 we implemented a store-and-forward teledermatology project to provide dermatology care to veterans living in underserved rural areas of the Pacific Northwest region of the US. We also developed an educational programme for rural primary care providers and imaging technicians. Participants were tested and their competencies were assessed at baseline and during a two-year project. Participation in a comprehensive education programme improved the knowledge of dermatology diagnosis and treatment care plans. All of the providers were performing dermatology procedures (e.g. biopsies, excisions, cauteries) after two years and more patients were being seen at their rural clinics than when the teledermatology project began (85% vs 39%). After two years, 71% of the providers and 56% of the imaging technicians had completed surgical training sessions and all passed their competency assessments. The educational component of the teledermatology project created teams of primary care health-care providers and imaging technicians with improved dermatology educational levels and new dermatology skills.

In December 2006, Congress passed the Pandemic and All-Hazards Preparedness Act to improve the nation's public health preparedness and response capabilities. It includes the role of Centers for Public Health Preparedness (CPHPs) to establish a competency-based core curriculum and perform evaluation of impact on newly developed materials. The Heartland Center for Public Health Preparedness (HCPHP) at the Saint Louis University School of Public Health is part of the Centers for Disease Control and Prevention national CPHP network and is engaged with state and regional partners in workforce development, preparedness planning, evaluation, and multi-year exercise and training cycles. This includes development, implementation, and evaluation of the HCPHP Exercise Evaluation Training Program to improve the competence and capacity for exercise evaluation and improvement planning. This program is designed to enhance quality improvement and performance measurement capabilities to identify increase of workforce competence over time (maturity).

Population-specific data on factors that affect intimate partner violence (IPV) are needed on female adolescents and young adults, a cohort at greatest risk of IPV in the United States (Rennison, 2001). Studies have frequently overlooked the role of relationship communication as a gatekeeper to IPV (Ridley & Feldman, 2003). To address this gap, negative binomial regression was conducted with data from a 2004 survey of 618 women aged 15 to 24 seeking care at an urban reproductive health facility. Findings suggest that, within the previous year, verbal aggression by either partner was associated with physical violence by either or both partners, and verbal reasoning was negatively correlated with physical violence. Bidirectional and unidirectional IPV relationships may employ communication strategies differently.

Superparamagnetic iron oxide nanoparticles have diverse diagnostic and potential therapeutic applications in the central nervous system (CNS). They are useful as magnetic resonance imaging (MRI) contrast agents to evaluate: areas of blood–brain barrier (BBB) dysfunction related to tumors and other neuroinflammatory pathologies, the cerebrovasculature using perfusion-weighted MRI sequences, and in vivo cellular tracking in CNS disease or injury. Novel, targeted, nanoparticle synthesis strategies will allow for a rapidly expanding range of applications in patients with brain tumors, cerebral ischemia or stroke, carotid atherosclerosis, multiple sclerosis, traumatic brain injury, and epilepsy. These strategies may ultimately improve disease detection, therapeutic monitoring, and treatment efficacy especially in the context of antiangiogenic chemotherapy and antiinflammatory medications. The purpose of this review is to outline the current status of superparamagnetic iron oxide nanoparticles in the context of biomedical nanotechnology as they apply to diagnostic MRI and potential therapeutic applications in neurooncology and other CNS inflammatory conditions.

The vascular effects of antiangiogenic treatment may pose problems for evaluating brain tumor response based on contrast-enhanced magnetic resonance imaging (MRI). We used serial dynamic contrast-enhanced MRI at 12 T to assess vascular responses to antiangiogenic versus steroid therapy. Athymic rats with intracerebral U87MG human glioma ( n = 17) underwent susceptibility-weighted perfusion MRI with ferumoxytol, a solely intravascular ultrasmall superparamagnetic iron oxide (USPIO) nanoparticle, followed by T1-weighted dynamic gadodiamide-enhanced MRI to measure vascular permeability. Rats were imaged before and after 24, 48, and 72 h of treatment with the antiangiogenic agent bevacizumab or the corticosteroid dexamethasone. Contrast agent extravasation was seen rapidly after gadodiamide, but not with ferumoxytol administration. Bevacizumab significantly decreased the blood volume and decreased permeability in tumors as determined by increased time-to-peak enhancement. A single dose of 45 mg/kg bevacizumab resulted in changes analogous to dexamethasone given in an extremely high dose (12 mg/kg per day), and was significantly more effective than dexamethasone at 2 mg/kg per day. We conclude that dynamic perfusion MRI measurements with ferumoxytol USPIO to assess cerebral blood volume, along with dynamic gadodiamide-enhanced MR to assess vascular permeability, hold promise in more accurately detecting therapeutic responses to antiangiogenic therapy.

This article describes the literature-based, testable, formative Patient-Centered Culturally Sensitive Health Care Model that explains the associations between patient-centered culturally sensitive health care, health-promoting treatment behaviors, and health outcomes and statuses. An intervention program based on the model and its foundational research are also described. In addition, the article summarizes research concerning the ongoing evaluation of the model and the intervention program as well as the development of pilot inventories to assess patient-centered culturally sensitive health care in community-based primary care clinics.

Morphologically, the distinction between undifferentiated embryonal sarcoma of the liver (UESL) and biliary tract rhabdomyosarcoma (RMS) can be uncertain because of some shared pathologic similarities. Patients with UESL have been consistently but erroneously enrolled in Children's Oncology Group (COG) treatment protocols because UESL was equated with RMS, despite the differing primary treatment modalities of these entities. Review of COG pathology files yielded 20 cases of UESL that were compared to 25 cases of biliary tract RMS. Clinicopathologic features including immunohistochemical staining were examined. In the UESL cases, the male:female ratio was 1:1 and the median age was 10.5 years. Histologically, hyaline globules and diffuse anaplasia were consistently present. The cases of RMS had a male:female ratio of 1.8:1 with a median age of 3.4 years and routinely lacked diffuse anaplasia and hyaline globules. Polyclonal desmin and muscle-specific actin were variably immunoreactive in UESL and RMS; however, myogenin and myogenic regulatory protein D1 (MyoD1) were uniformly negative in UESL and routinely positive in the majority of biliary tract RMS. Myogenin, in particular, was highly significant ( P = 0.0003) in distinguishing RMS from UESL. With a median follow-up of 8 months, 11 of 18 patients with UESL were still alive. The estimated 5-year survival for biliary tract RMS was 66%. Establishing the correct diagnosis of these distinct clinical and pathologic entities is important, as surgery alone may be curative in UESL, whereas initial chemotherapy is often recommended for the treatment of biliary tract RMS.

Healy, et al. recently distinguished between recency and “penultimate” effects when contrasting recall performance. They argued that the penultimate effect was significantly different from the typical recency effect, which point was taken as support for distinguishing between primary and secondary memory systems. The current study adapted the Healy, et al. methodology to control for the occurrence of intentional learning strategies. 40 participants were asked to recall the names of 42 U.S. Presidents by their term in office (secondary memory) or in a pseudorandom order (primary memory); the recency and penultimate effects were observed for each condition. With intentional learning controlled for, contrast analyses yielded a pattern of performance similar to that observed by Healy, et al.

OBJECTIVE: To review the evidence for statin secondary prevention of coronary artery disease in patients with near-optimal or optimal low-density lipoprotein cholesterol (LDL-C). DATA SOURCES: A MEDLINE search (1966-October 2003) was conducted using the search terms HMG-CoA reductase inhibitor, statins, coronary disease, post-myocardial infarction, and average cholesterol. DATA SYNTHESIS: Secondary prevention trials enrolling subjects with near-optimal (CONCLUSIONS: Statin secondary prevention of coronary artery disease in patients near goal LDL-C is controversial, but recent trial results show promise.

19 subjects (10 men, 9 women) ages 19 to 30 years ( M = 23.2, SD = 3.3) volunteered to participate in a study to investigate the just-noticeable-difference in movement extent for neck retraction and neck rotation. Testing was carried out with stopped movements, conducted according to the method of constant stimuli, and repeated both with and without vision in a comfortable seated position. Sensitivity was greatest for neck-retraction movements, which had lower just-noticeable-difference than either left or right rotation movements. Having full vision available gave no significant advantage in any direction when discriminating between different extents of midrange head movements.

The use of population-based information systems can help regional health authorities provide integrated healthcare. Administrative data from 1995 through 1997 for Manitoba's rural South Eastman Regional Health Authority and for the rest of Manitoba were used to aid South Eastman's strategic planning process. Three areas of concern were highlighted: the relatively high risk of poor health among residents of the RHA's Southern District, physician maldistribution and inconsistent patterns of service utilization. By improving population access to primary healthcare, regional imbalances are being addressed.

The purpose of a stock compensation program is, typically, to create an incentive for executives to focus on improving stock price as well as to increase stock ownership. Unfortunately, companies have found that compensation is often delivered without an increase in actual share ownership. As a result, guidelines for appropriate levels of executive stock ownership have become popular as a way to force or encourage executives to retain shares from stock compensation programs. Although there are a number of arguments for and against these programs, many of the flaws and criticisms can be addressed through design and administration. This article provides a detailed look at stock ownership program design, including the types of guidelines that can be implemented, how shares can be counted toward meeting goals and approaches to compliance and monitoring. It also discusses other methods of encouraging and forcing ownership.

There are close to 560 different tribes in the United States of America and to be able to understand the complexity of the different tribes and cultures, there is a need to understand that while most tribes have differences they share certain values. These differences do not, for the most part, conflict with some of the values we will discuss later in this article. They are mostly of language and cultural practices, but the basic values remain the same. Even though many of the American Indian tribes have been viewed as having become acculturated, many American Indians have retained ties to their culture through language, spiritual practices, and family. These spiritual values will be discussed in relation to infant care practice.

Cette étude a été menée à partir de données recueillies au Manitoba de 1991 à 1996 afin d'évaluer les effets des réformes de la santé et des progrès technologiques sur les profils d'hospitalisation, la mortalité et les taux de réadmission. La cholécystectomie et la chirurgie herniaire ont servi d'indicateurs en vue de l'évaluation des effets combinés de la nouvelle technologie et des réformes de la santé, tandis que l'appendicectomie et l'hystérectomie ont permis de mesurer les effets des seules réformes de la santé. L'introduction de nouvelles technologies (c.-à-d. la laparoscopie) et les mesures de réforme de la santé (c.-à-d. les séjours moins longs à l'hôpital) n'ont pas eu d'effets défavorables sur le nombre d'interventions, sur la mortalité postchirurgicale ni sur le nombre de réadmissions postchirurgicales.

During the past two decades, fund raising has become increasingly important to nonprofit organizations. Financial pressures have prompted many to use marketing techniques pioneered in the for-profit world. Chief among these is telemarketing. While the response rate for traditional direct mail campaigns is very often between 1% and 3%, some phonathons can deliver a first-time pledge rate that exceeds 20%. Many fundraisers and marketers have come to believe that one-on-one communication is the best way to ask for a donation. Unlike other types of communication, interpersonal communication provides a context in which participants can work collaboratively to produce the message exchanges. Nonetheless, previous work on fundraising communication has focused primarily on the one-way transmission of messages from fundraiser to prospective donors. The dynamic features of interaction between participants have largely been ignored. This paper examines how telefundraisers and prospective donors construct their talk, and explores the effects of three fundraiser actions on pledge rates. Using a 2×2×2 nested design, the field experiment considers the effects of (1) the presence vs. absence of a “how are you” inquiry, (2) the grammatical formulation of the pledge request, and (3) the presence vs. absence of the elicitation of information about a prospect's initial pledge refusal. Results indicate that factors (1) and (3) above have significant effects on pledge rates.

Children with nonambulatory cerebral palsy are frequently found to be osteopenic. We sought factors, in addition to immobility and anticonvulsant therapy, that may contribute to the osteopenia. A retrospective chart review of 19 children with nonambulatory cerebral palsy who received gastrostomy tube feedings of standard commercial formulas was performed. Less than 75% of the Recommended Daily Allowance (RDA) was administered to 95% of the children for calories, 58% for calcium, 68% for phosphorus, and 74% for vitamin D. Five of the 19 chidren sustained fractures without major trauma. This study suggests that inadequate intake of crucial vitamins and minerals may contribute to the severe osteopenia observed in many children with nonambulatory cerebral palsy. The nutritional needs of these children, including those for micronutrients, must be defined and appropriate supplementation given.

Chronic granulomatous disease (CGD), an inherited disorder of phagocytic leukocyte function, is characterized by recurrent infections with catalase-positive organisms. Gastrointestinal (GI) tract involvement, present in the majority of affected individuals, may be present initially and recurrently, mimics other entities such as inflammatory bowel disease, and causes substantive morbidity and mortality. Disorders of motility, ulceration, obstruction, and infection (e.g., abscesses) occur from the mouth to the anus and stereotypically manifest with vomiting, diarrhea, abdominal pain, weight loss, and fever. Careful physical examination, in concert with appropriate diagnostic studies, is necessary to delineate intraabdominal pathologic processes. Abdominal radiographs, ultrasonography, computerized tomography, and endoscopy are useful ancillary diagnostic procedures. Drainage of accessible abscesses, antimicrobial therapy based on organisms cultured from blood and tissue, and interferon gamma may lead to suppression or eradication of infections and resolution of symptoms. Corticosteroids are useful for gastric outlet obstruction and sulfasalazine and cyclosporine for large bowel disease. Gallbladder dysfunction may be ameliorated, as in our pa tient, with administration of cholestyramine.

The purpose of this study was to determine the types of cases residents select for morning report discussion and the educational value of postdischarge follow-up of unknown cases. Between April and December of 1994, at Cardinal Glennon Children's Hospital in St. Louis, Missouri, random, resident, and group-selected patients listed at morning report were followed up throughout hospitalization. Patients were categorized based upon whether or not their morning report and discharge diagnoses were the same or different. Patients discharged without a diagnosis were followed up by chart review at 6 months to determine whether a diagnosis had been made. Data were analyzed by Chi-square analysis with Bonfferoni adjustment factor for multiple comparisons. Residents were more than two times more likely to select cases for discussion in which the diagnosis changed during hospitalization (P

We report a case of Fusarium solani infection in a 2'2-year-old girl with acute lymphoblastic leukemia and severe neutropenia. The infection, initially limited to her sinuses, became disseminated, as evidenced by the development of a characteristic cutaneous lesion on her left leg after a cumulative dose of amphotericin B of 18.3 mg/kg. Amphotericin B lipid complex (ABLC), 5 mg/kg/day, in conjunction with repeated surgical debridement of the sinuses and correction of neutropenia with granulocyte colony stimulating factor (GCSF), led to clinical and mycologic cure.

The United States should continue to maintain its rank in the world as the second largest coal producer and exporter of coal through the forecast period. Coal reserves are adequate -enough to sustain the current level of production well into the future. Growth in coal output is projected for bituminous and sub-bituminous coals to be consumed by the electric utility industry, particuliarly for products with low and medium range sulphur characteristics. The regions which are expected to experience the greatest increases in coal production are the low sulphur bituminous coal region of Central Appalachia, and the sub-bituminous Powder River Basin region. Growth in total electricity generation will occur at a slower rate than GDP as the nation becomes less energy intensive. Utility coal comsumption, coals largest demand sector, occurs throughout the forecast period, although coal's share of the generation market in relation to other fuels is expected to decline slightly to 55 percent. The industrial coal demand sector also is expected to increase, while commercial and residential coal demands remain close to present levels. Prospects for international trade are projected to improve for the U.S. steam coal export market, especially the Asian market, which will be experiencing rapid growth in electricity demand. Prospects would be brighter overall were it not for competition from low cost coal producing countries such as Colombia, Indonesia, China and South Africa, and environmental concerns in Europe. The current rail capacity for coal moving east from the Powder River Basin has been stretched close to the limit recently on some routes. However, as the railroads add track in 1994 and 1995, coal shipments will move more easily. Rail capacity which has traditionally responded to the needs of the coal industry, will be called upon to further increase capacity to handle greater western coal demand from eastern markets. Coal productivity increases which have been a result of

The curled peritoneal dialysis catheter is theoretically less prone to catheter migration and drainage failure. It also allows percutaneous placement, rather than surgical placement exclusively, whenever desired or necessary. Review of 213 curled-catheter placements, 134 (63%) percutaneous and 79 (37%) surgical, over the last 4 years, shows that the probability of continuing catheter function by life-table analysis was 88% at one year, 71% at 2 years, and 61% at three years, with no difference comparing percutaneous to surgical placement. Among the 213 total cases, nearly 50% of all catheters were still functioning at last follow up, and 38 catheters (17.8%) have been lost in total, attributed to infectious complications in 24 cases (tunnel-exit infection alone in 5, peritonitis alone in 11, combined infection in 8), refractory drain failure in 9 cases (early drain failure in 4, late drain failure in 5), recurrent late subcutaneous dialysate leaking in 3 cases, and peri-catheter hernia in 2 cases. Among other complications, the incidence of early drain failure (7.0%), and late drain failure (4.2%), compare favorably to reports describing other devices or other placement methods having comparable size of reported experience. Analyzing our own percutaneous and surgical placements separately, there were no differences in the respective frequencies of early drain failure, late drain failure, late subcutaneous dialysate leaking, outer cuff extrusion, required hernia repair, peritonitis or tunnel-exit infection. Only early external dialysate leaking was more frequent using percutaneous placement methods (21.6% vs. 10.1%; p < 0.05), although no catheters were lost due to early external leaking. In conclusion, the present experience suggests that the curled catheter is both amenable to safe and convenient percutaneous placement methods in the majority of cases, as well as dependable for long-term peritoneal dialysis in a large university program.

This paper Illustrates how religiosity influences behavior in everyday life by investigating the linlcages among religiosity, social class, and alcohol consumption. Reference group theory provides a theoretical basis for understanding these linkages. In their classic essay, "Contributions to a Theory of Reference Group Be- havior," Merton and Rossi (1968) showed how some anomalous empirical findings in "The American Soldier" studies (Stouffer et al. 1949) can be understood more clearly in terms of reference group theory. For example, in groups where there was less real opportunity for promotion, soldiers of similar length of service, education, and rank, perceived a greater likelihood of promotion. Merton and Rossi resolved this paradox by means of reference group theory: They suggested that these men compared themselves to others in the same group, rather than to those in different groups. This article focuses on a different anomaly and resolves it in a similar

We examined and contrasted morning reports at two hospitals, university and community, that have a pediatric residency program. Patient diagnoses assigned at morning report were compared with final diagnoses to assess disease categories discussed and the value of including outpatient follow-up in this educational forum. Data were obtained during morning reports for 6 months by chief residents at university and private community hospitals. Pertinent history, physical examination, and laboratory and radiologic findings were recorded and were assigned a tentative morning report diagnosis based on morning report discussion. Cases were then reviewed at discharge and at 6 months to determine final diagnoses. At the university hospital, 58% of the cases were undiagnosed before presentation at morning report. Of those cases, 23% were assigned a diagnosis at morning report that differed from the final diagnosis. Similarly, at the private community hospital, 28% of cases were undiagnosed before presentation at morning report. Of those cases, 73% were assigned a diagnosis that differed from the final diagnosis. We conclude that the provision of follow-up at morning report is important for maximizing resident education.