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Objective: To examine the effects of common treatments for polycystic ovary syndrome (PCOS) on a panel of hormones (reproductive/metabolic).Design: Secondary analysis of blood from a randomized controlled trial of three 16-week preconception interventions designed to improve PCOS-related abnormalities: continuous oral contraceptive pills (OCPs, N = 34 subjects), intensive lifestyle modification (Lifestyle, N = 31), or a combination of both (Combined, N = 29).Materials and Methods: Post-treatment levels of activin A and B, inhibin B, and follistatin (FST), as well as Insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 2 (IGFBP-2), glucagon, glucagon-like peptide 1 (GLP-1) and 2, and oxyntomodulin were compared to baseline, and the change from baseline in these parameters were correlated with outcomes.Results: Oral contraceptive pill use was associated with a significant suppression in activin A, inhibin A, and anti-mullerian hormone (AMH), but a significant increase in FST. IGF-1, IGFBP-2, glucagon, and GLP-2 levels were significantly decreased. Oxyntomodulin was profoundly suppressed by OCPs (ratio of geometric means: 0.09, 95% confidence interval [CI]: 0.05, 0.18, P < 0.001). None of the analytes were significantly affected by Lifestyle, whereas the effects of Combined were similar to OCPs alone, although attenuated. Oxyntomodulin was significantly positively associated with the change in total ovarian volume (rs = 0.27; 95% CI: 0.03, 0.48; P = 0.03) and insulin sensitivity index (rs = 0.48; 95% CI: 0.27, 0.64; P < 0.001), and it was inversely correlated with change in area under the curve (AUC) glucose [rs = -0.38; 95% CI: -0.57, -0.16; P = 0.001]. None of the hormonal changes were associated with live birth, only Activin A was associated with ovulation (risk ratio per 1 ng/mL increase in change in Activin A: 6.0 [2.2, 16.2]; P < 0.001).Conclusions: In women with PCOS, OCPs (and not Lifestyle) affect a wide variety of reproductive/metabolic hormones, but their treatment response does not correlate with live birth. [ABSTRACT FROM AUTHOR]

Abstract: The pharmaceutical industry spends billions annually on marketing to physicians (over $4.3 billion in 2014). The industry as a whole has a lot of experience in determining what to say to physicians, but it is less confident when it comes to how to say it—sometimes leading to advertising that does not engage, thereby costing sales. In an effort to define a set of rule‐based guidelines for effective pharma branding, the study adapts the primary Jungian archetypes to develop the first collection of archetypal tones of voice for healthcare products. The study here demonstrates, via a series of fuzzy‐set qualitative comparative analyses that well executed ads following an archetype consistently connect with physician audiences, while nonarchetypal healthcare ads demonstrate an inconsistent performance. Such an analysis would traditionally take the form of null hypothesis significance testing (NHST), but NHST provides substantially less insights than algorithm modeling and the use of fuzzy‐set qualitative comparative analysis as this study describes. [ABSTRACT FROM AUTHOR]

The article English history of Second Amendment which protects the right of the people to keep and bear arms. Topics discussed include laws governing laws in the U.S., and in Great Britain; District of Columbia v. Heller court case on the same; and pre-Amendment historical practice of right of the people to keep and bear arms.

What is already known about this subject Obesity is highly prevalent and costly in the US., Obesity often leads to other comorbid conditions, including diabetes and hypertension., Obesity prevention efforts can reduce healthcare costs., What this study adds Obesity combined with other comorbidities significantly increases healthcare costs per patient visit., The combination of obesity and depression exacerbates costs., The most expensive series of chronic conditions in this study included obesity, diabetes, hypertension and depression., Our objectives were to determine payments made by commercial healthcare providers in the US for adults diagnosed with obesity, and those comorbid with any combination of selected chronic conditions. Using a commercial claims and encounters database ( n = 3 562 717), we evaluated an adult study population that had at least one in-patient visit, outpatient visit or emergency department visit, and received a primary or secondary diagnosis of obesity. Persons were categorized by one or more comorbid diagnoses for diabetes mellitus, hypertension, depression or congestive heart failure. We adjusted for age and gender, and calculated the mean total net expenditures (in 2012, $ US) for each combination of comorbid conditions based on individual visits to an in-patient, outpatient or emergency department setting. Among 50 717 claims with diagnosis of obesity, the mean net expenditure for in-patient and outpatient services was $ 1907 per patient per visit. Persons diagnosed with obesity and other comorbidities observed an increase in total net expenditures. Obesity and congestive heart failure observed the highest increase among single comorbidities at $ 5275. For persons with obesity and two other comorbidities, diabetes mellitus and depression was the highest at $ 15 226. The most expensive condition was obesity, diabetes mellitus, hypertension and depression at $ 15 733. Compared with average medical claims, persons diagnosed with obesity and other common chronic conditions experience significant increases in medical costs. These costs are often driven higher by time spent as in-patients. By controlling and reducing the prevalence of obesity, we may see significant decreases in medical expenditures. [ABSTRACT FROM AUTHOR]

Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article offers information on a study of the American birthright citizenship. The article arguments that opposing birthright citizenship is inconsistent in the country with conservative values. It discusses how these conservative arguments use a rhetoric that violates all the conservative canons of interpretation.

Objective To evaluate the interleukin-1 inhibitor rilonacept (Interleukin-1 Trap) for prevention of gout flares occurring in the first few months following initiation of urate-lowering therapy. Methods In this double-blind study, adult patients with hyperuricemia and gout were randomized to receive rilonacept administered subcutaneously once per week (loading dose 320 mg followed by 160 mg weekly) or placebo, and started on allopurinol (300 mg/day, titrated to serum urate <6 mg/dl). At study visits, physical and laboratory assessments were performed and information on any adverse events was ascertained. Results Baseline characteristics were similar between the rilonacept and placebo groups (n = 41 and n = 42, respectively). The mean number of gout flares per patient through week 12 (primary efficacy end point) was markedly lower in the rilonacept group than in the placebo group (0.15 [6 flares] versus 0.79 [33 flares]; P = 0.0011). Fewer flares were observed with rilonacept as early as 4 weeks after initiation of treatment ( P = 0.007). The proportion of patients experiencing a flare during the 12 weeks was lower in the rilonacept group than in the placebo group (14.6% versus 45.2%; P = 0.0037). No rebound in the flare rate was observed for 6 weeks after discontinuation of rilonacept or placebo at week 16. Adverse events were similar between groups, and no deaths or serious infectious adverse events were reported; the most common adverse events were infections (14.6% and 26.2% of rilonacept- and placebo-treated patients, respectively) and musculoskeletal disorders (14.6% and 21.4%, respectively). A higher percentage of rilonacept-treated patients (98%) compared with placebo-treated patients (79%) completed the primary 12-week evaluation period ( P = 0.015). Conclusion The current findings indicate that rilonacept significantly reduces the frequency of gout flares during the initial period of treatment with urate-lowering therapy, with a favorable safety profile. [ABSTRACT FROM AUTHOR]

Shortages of drugs, vaccines, and other biologics are a perennial problem of the U.S. health care system. The objectives of this study were to assess the prevalence of these shortages of drugs, vaccines, and other biologics, and to characterize the products in short supply as reported in the United States by several public agencies and private organizations on June 1, 2011. Reported shortages of pharmaceuticals were obtained from the FDA, the CDC, the American Society of Health-System Pharmacists (ASHP), and the Brigham and Women’s Hospital (BWH). A list of approved drugs and licensed vaccines and other biologic products were obtained from the FDA. The units of analyses were the active ingredient(s) and the route of administration. The study included descriptive analyses of the characteristics of products experiencing shortages and an estimation of the prevalence of shortages as the proportion of non-discontinued FDA-approved products that were listed by the FDA in June 1, 2011. The most frequent characteristics of shortages included: reported by ASHP, referred to a drug approved under the NDA/ANDA system, contained only one active ingredient, was a drug administered by injection, required a prescription, was part of one of six main therapeutic classes, and was marketed by three or less companies. The overall prevalence of drug shortages was estimated at 11.0% of all the FDA-approved and marketed drugs, vaccines, and other biologics. Vaccines had the highest prevalence of shortage. The prevalence varied from 9.9% reported by the ASHP to 4.0% reported by public agencies and to 2.0% reported by BWH. Differences in the reporting of shortages can be attributed to variations in defining shortages and how they were characterized within each reporting organization. The highest prevalence rate was found among active ingredients with injection routes of administration (23.1%). Shortages are prevalent in the U.S. health care system. Several definitions of shortage are currently in use in the United States. Additional research is needed to develop a standard definition for a pharmaceutical shortage and to standardize the criteria used to characterize a pharmaceutical shortage. [ABSTRACT FROM PUBLISHER]

Background: Polycystic ovary syndrome (PCOS) is a familial syndrome, associated with multiple cardiovascular disease (CVD) risk factors. Thus, parents of affected women may have a higher prevalence of CVD events than the general population.Methods: PCOS probands (n = 410) and their participating parents (n = 180 fathers and 211 mothers) were queried for CVD events in themselves and non-participating family members. In order to include the family CVD history of all parents, agreement between the proband and parental reports of CVD events was assessed. Estimated 10-year coronary heart disease (CHD) risk was calculated using the Framingham risk calculator. The National Health and Nutrition Examination Survey (NHANES) 2001-2002 database was used to generate gender, age and body mass index-relevant population parameters of CVD prevalence in the USA population.Results: Ninety-eight percent of the parents' self-reporting of CVD events agreed with the proband's report of parental heart attack history [Kappa = 0.82; 95% CI: (0.69, 0.94)] and 99% with parental stroke history [Kappa = 0.79; 95% CI: (0.62, 0.97)]. Fathers of women with PCOS had a higher prevalence of heart attack and stroke compared with the reference NHANES population (heart attack: 11.1 versus 5.3%, P < 0.0001; stroke: 3.0 versus 1.0%, P = 0.002). Fathers of women with PCOS had an elevated 10-year risk for CHD (11.5 versus 9.9% in NHANES, P = 0.03). No statistically significant increased prevalence of CVD events or 10-year risk was noted in probands or mothers.Conclusions: Fathers, and not mothers, may be disproportionately burdened with CVD in PCOS families. The strengths of this study include the size of our cohort, the consistent phenotyping and the validation of proband's reporting of parental CVD events. [ABSTRACT FROM AUTHOR]

The article discusses the court case Ricci v. DeStefano which leads to several disturbing questions about employment and equal protection in the U.S. It explains the anti-subordination and anti-classification principle and how the case changed the definition of disparate treatment. It also cites the limitations on the scope of the case in aspects of vested rights and race-consciousness and the impossibility of relief used by Ricci that makes the Title VII and Equal Protection Clause unworkable.

Objective:Comparison of the differences between availability of animal-derived surfactant preparations used to treat premature infants is incomplete. The objective of this study was to assess the short-term treatment efficacy of the two most commonly used surfactant preparations in the United States, beractant (100 mg kg-1 initial and subsequent doses) and poractant alfa (200 mg kg-1 initial and 100 mg kg-1 subsequent doses), in very premature, mechanically ventilated infants <30 weeks gestation with respiratory distress syndrome (RDS).Study Design:Inborn infants at two institutions, open label, 1:1, randomized controlled trial. Level of respiratory support for first 72 h of life. Morbidities of prematurity observed during the neonatal intensive care unit hospitalization.Result:We studied 52 infants 24 0/7 to 29 6/7 weeks gestation; 25 received poractant alfa (27.1±1.6 weeks, birth weight of 930±231 g) and 27 received beractant (26.7±1.7 weeks, P=0.343 and birth weight 900±271 g, P=0.668). Respiratory support for the first 72 h of life was lower in the poractant alfa than beractant group for mean airway pressure (MAP, P=0.003) and respiratory index (MAP × FiO2, P=0.032). Infants in the poractant alfa group had a greater number of infants extubated at 48 (13/25 vs 6/27, P=0.027) and 72 h (15/25 vs 8/27, P=0.029) than the beractant group. Although the study was not powered to detect morbidities of prematurity, the prevalence of PDA and air leaks was less in the infants treated with poractant alfa than in those treated with beractant. Rates of bronchopulmonary dysplasia (8/23 vs 11/22, P=0.303) or death (2/15 vs 5/27, P=0.272) were similar in the infants treated with poractant alfa and beractant, respectively.Conclusion:This study suggests significant short-term benefits to the use of the larger initial dose of poractant alfa than beractant in very premature infants with RDS. Further studies involving a larger number of preterm infants are needed to assess long-term effects. [ABSTRACT FROM AUTHOR]

The article reveals that the U.S. Centers for Disease Control and Prevention (CDC) received reports that some laboratory workers in Virginia were infected with the Vaccinia virus (VACV). It discusses the symptoms and stages of infection which the patients undergo and it also presents the safety measures that must be taken to prevent infection. This includes receiving smallpox vaccination as recommended by the Advisory Committee on Immunization Practices (ACIP) for laboratory workers who handle non-highly attenuated VACV strains or other orthopoxviruses.

The article presents an analysis on the different studies of the economic impact of colleges in the U.S. They reveal that the $1.403 billion education-related expenses in the University of Hawaii generates $1.973 billion sales, $1.243 billion employee earnings, $132 million state revenues and 35,800 jobs. The University of Southern California earns over $1.4 billion while Rhode Island has a state revenue of $753 million. However, it is argued that earnings of students who migrate and join the local force after graduation should be excluded in the analysis because they are not part of initial local population.

The article focuses on the increase in the adoption of reverse auction (RA) as a strategy in the procurement of drug development goods and services in the U.S. The major benefit of RAs to drug companies is the establishment of a competitive environment and lower prices. However, RAs may create barriers in clinical trial studies where the success of technology-related services depends on close relationships and open lines of communication to solve development challenges.

PurposeTo determine the molecular pathology and clinical severity of two pedigrees with a history of early retinal detachment and peripheral retinal vascular abnormalities.DesignLongitudinal cohort study.MethodsA longitudinal clinical study and DNA analysis was performed on 49 family members of two pedigrees.ResultsNine individuals were found to be hemizygous for a mutation at codon 112 (Gly112Glu) of the Norrie disease protein (NDP) in one pedigree. Significant phenotypic heterogeneity was found. The proband presented with a unilateral subtotal retinal detachment at the age of 3 years, and subsequently developed a slowly progressive tractional retinal detachment involving the macula in the contralateral eye at the age of 4 years. One individual had only mild peripheral retinal pigmentary changes with normal vision at the age of 79 years. The remaining seven individuals had varying degrees of peripheral retinal vascular abnormalities and anterior segment findings. Seven affected members of a second pedigree affected by a previously reported mutation, Arg74Cys, also demonstrated wide ocular phenotypic variation.ConclusionA novel mutation (Gly112Glu), which represents the most carboxy located, NDP mutation reported, results in significant phenotypic heterogeneity. These data support the contention that the spectrum of ocular disease severity associated with these NDP mutations is broad. Use of terms that characterize this entity by phenotypic appearance, such as familial exudative vitreoretinopathy, do not adequately communicate the potential spectrum of severity of this disorder to affected or carrier family members.Eye (2006) 20, 234–241. doi:10.1038/sj.eye.6701840; published online 18 March 2005 [ABSTRACT FROM AUTHOR]

Numbers of American woodcock (Scolopax minor) males counted on the annual singing ground survey (SGS) have declined over the last 35 years at an average rate of 2.3% per year in the Eastern Region and 1.8% per year in the Central Region. Although hunting was not thought to be a cause of these declines, mortality caused by hunters can be controlled. Furthermore, there has been no research on effects of hunting mortality on woodcock populations at local and regional levels on the breeding grounds. We used radiotelemetry to determine survival rates and causes of mortality for 913 woodcock captured during fall 1997-2000 on 7 areas in Maine, New Hampshire, Pennsylvania, and Vermont, USA. Three of 7 sites were closed to hunting. For all sites and all years combined, 176 woodcock died, and 130 were censored, of which 39 were censored mortalities. Predation was the major (n = 134, 76%) cause of mortality. Mammals accounted for 56% of the predation, raptors accounted for 25%, and 19% was attributed to unknown predators. On hunted sites, 36% of the total mortality (n = 102) was caused by hunting, 63% by predation, and 1 bird starved. Kaplan-Meier survival curves did not differ between hunted and nonhunted sites among years (P = 0.46). Overall, point estimates of survival did not differ (P = 0.217) between hunted (SR = 0.636, SE = 0.04) and nonhunted sites (SR = 0.661, SE = 0.08). We modeled hazard rates from hunting and natural mortality events using program MARK. Akaike's Information Criterion supported using a model with common constant hazards from both hunting and natural causes for groups of sites. Groupings of sites for hazard rates from natural causes were not influenced by whether a site was hunted or not. Models detected no effects of woodcock age and sex (P= 0.52) on survival. Proportional hazards models comparing hunted and nonhunted sites found no effects of age and sex (P= 0.45), interactions of age, sex, capture weight, and bill length (P≥ 0.269). Our data suggest that current hunting regulations are not causing lower survival of woodcock. [ABSTRACT FROM AUTHOR]

Comments on the importance of establishing contract price for pharmaceuticals in the U.S. Occurrence of contract price errors in the billing process for health system pharmaceutical purchases; Determinants of variability in purchasing that can affect pricing; Solutions to mitigate drug pricing errors.

Background: Inappropriate use of antibiotics by individuals worried about biological agent exposures during bioterrorism events is an important public health concern. However, little is documented about the extent to which individuals with self-identified risk of anthrax exposure approached physicians for antimicrobial prophylaxis during the 2001 bioterrorism attacks in the United States. Methods: We conducted a telephone survey of randomly selected members of the Pennsylvania Chapter of the American College of Emergency Physicians to assess patients' request for and emergency physicians' prescription of antimicrobial agents during the 2001 anthrax attacks. Results: Ninety-seven physicians completed the survey. Sixty-four (66%) respondents had received requests from patients for anthrax prophylaxis; 16 (25%) of these physicians prescribed antibiotics to a total of 23 patients. Ten physicians prescribed ciprofloxacin while 8 physicians prescribed doxycycline. Conclusion: During the 2001 bioterrorist attacks, the majority of the emergency physicians we surveyed encountered patients who requested anthrax prophylaxis. Public fears may lead to a high demand for antibiotic prophylaxis during bioterrorism events. Elucidation of the relationship between public health response to outbreaks and outcomes would yield insights to ease burden on frontline clinicians and guide strategies to control inappropriate antibiotic allocation during bioterrorist events. [ABSTRACT FROM AUTHOR]

Focuses on the reorganization of the end-stage renal disease (ESRD) payment system in the U.S. Costs of caring for ESRD patients; Pressure experienced by Medicare program to control costs; Growth in the epidemic of diabetes and associated kidney disease.

Efficient use of natural water resources in agriculture is becoming an important issue in Florida because of the rapid depletion of freshwater resources due to the increasing trend of industrial development and population. Reliable and consistent estimates of evapotranspiration (ET) are a key element of managing water resources efficiently. Since the 1940s numerous grass- and alfalfa-reference evapotranspiration (ET[sub o] and ET[sub r], respectively) equations have been developed and used by researchers and decision makers, resulting in confusion as to which equation to select as the most accurate reference ET estimates. Twenty-one ET[sub o] and ET[sub r] methods were evaluated based on their daily performance in a humid climate. The Food and Agriculture Organization Penman-Monteith (FAO56-PM) equation was used as the basis for comparison for the other methods. Measured and carefully screened daily climate data during a 23-year period (1978–2000) were used for method performance analyses, in which the methods were ranked based on the standard error of estimate (SEE) on a daily basis. In addition, the performance of the four alfalfa-based ET (ET[sub r]) equations and the ratio of alfalfa ET to grass ET (K[sub r] values) were evaluated, which have not been studied before in Florida’s humid climatic conditions. The peak month ET[sub o] estimates by each method were also evaluated. All methods produced significantly different ET[sub o] estimates than the FAO56-PM method. The 1948 Penman method estimates were closest to the FAO56-PM method on a daily basis throughout the year, with the daily SEE averaging 0.11 mm·d-1; thus this method was ranked the second best overall. Although 1963 Penman (with the original wind function) slightly overestimated ET, especially at high ET[sub o] rates, it provided remarkably good estimates as well and ranked as the third best method, with a daily average SEE value of 0.14 mm·d-1. Both methods produced peak month ET[sub o] estimates closest to the FAO56-PM method among all methods evaluated, with daily peak month SEEs averaging 0.07 and 0.09 mm·d-1, respectively. Significant variations were observed in terms of the performance of the various forms of Penman’s equations. For example, the original Penman-Monteith method produced the poorest ET[sub o] estimates among the combination equations, with a daily SEE for all months and peak month averaging 0.50 and 0.35 mm·d-1, respectively and ranked 11th. An average value of 1.18 was used to convert ET[sub r] estimates to ET[sub o] values for alfalfa-reference methods. The K[sub r] value of 1.18 resulted in reasonable estimates of ET[sub o] throughout the year by the Kimberley forms of the Penman equations. Another ET[sub r]-based equation, Jensen-Haise, gave consistently poor estimates. The Stephens-Stewart radiation method was the highest-ranked (10th) noncombination method overall. The temperature-based McCloud method (ranked 19th) produced the poorest ET[sub o] estimates among all methods with a daily SEE for all months and for the peak month averaging 1.93 and 1.22 mm·d-1, respectively. In general, the results obtained from the temperature methods suggest that all of the temperature methods, with the possible exception of the Turc method, can only be applicable for these climatic conditions after they are calibrated or modified locally or regionally. The FAO and Christiansen pan evaporation methods (ranked 17th and 18th, respectively) produced poor ET[sub o] estimates and had the largest amount of point scatter in daily ET[sub o] estimates relative to the FAO56-PM ET[sub o]. Both methods resulted in the highest daily SEE of 1.18 and 1.19 mm·d-1 for all months, after the McCloud method (1.93 mm·d-1), and with the highest SEE of 1.30 and 1.24 mm·d-1 for the peak month of all methods evaluated. The FAO56-PM method uses solar radiation, wind speed, relative humidity, and minimum and maximum air temperature to estimate ET[sub o]. It has been recommended that the FAO56-PM be used for estimating ET[sub o] when all the necessary input parameters are available. However, all these input variables may not be available, or some of them may not be reliable for a given location if the FAO56-PM equation is used, and one may need to choose other temperature, radiation, or pan evaporation methods based on the availability of data for estimating ET[sub o]. The results of this study can be used as a reference tool to provide practical information on which method to select based on the availability of data for reliable and consistent estimates of daily ET[sub o] relative to the FAO56-PM method in a humid climate. [ABSTRACT FROM AUTHOR]

Net radiation (R[sub n]) is a key variable for computing reference evapotranspiration and is a driving force in many other physical and biological processes. The procedures outlined in the Food and Agriculture Organization Irrigation and Drainage Paper No. 56 [FAO56 (reported by Allen et al. in 1998)] for predicting daily R[sub n] have been widely used. However, when the paucity of detailed climatological data in the United States and around the world is considered, it appears that there is a need for methods that can predict daily R[sub n] with fewer input and computation. The objective of this study was to develop two alternative equations to reduce the input and computation intensity of the FAO56-R[sub n] procedures to predict daily R[sub n] and evaluate the performance of these equations in the humid regions of the southeast and two arid regions in the United States. Two equations were developed. The first equation [measured-R[sub s]-based (R[sub s-M])] requires measured maximum and minimum air temperatures (T[sub max] and T[sub min]), measured solar radiation (R[sub s]), and inverse relative distance from Earth to sun (d[sub r]). The second equation [predicted-R[sub s]-based (R[sub s-P])] requires T[sub max],T[sub min], mean relative humidity (RH[sub mean]), and predicted R[sub s]. The performance of both equations was evaluated in different locations including humid and arid, and coastal and inland regions (Gainesville, Fla.; Miami, Fla.; Tampa, Fla.; Tifton, Ga.; Watkinsville, Ga.; Mobile, Ala.; Logan, Utah; and Bushland, Tex.) in the United States. The daily R[sub n] values predicted by the R[sub s-M] equation were in close agreement with those obtained from the FAO56-R[sub n] in all locations and for all years evaluated. In general, the standard error of daily R[sub n] predictions (SEP) were relatively small, ranging from 0.35 to 0.73 MJ m-2 d-1 with coastal regions having lower SEP values. The coefficients of determination were high, ranging from 0.96... [ABSTRACT FROM AUTHOR]

The number of geriatric end-stage renal disease (ESRD) patients in the United States is increasing disproportionately to other age groups on dialysis. Thus there will be more dialysis patients that will require the assistance of nursing homes or extended care facilities. Nursing homes may be beneficial for the geriatric patient in terms of social and physical rehabilitation. Many of these facilities, however, may not take care of or may not have the capacity to adequately care for dialysis patients. Such patients have a higher rate of peritonitis when on peritoneal dialysis (PD) and have higher mortality rates on hemodialysis (HD) or PD compared to similar dialysis patients in the community. Cooperation and communication between the dialysis center and the nursing home, given the complex management issues involved in the care of these patients, are essential. One promising approach to the care of elderly dialysis patients is an integration of nursing home and dialysis unit. Although another approach could be to more fully utilize the services of adult day care centers, this has proven logistically difficult and has not been reported to be successful since it was first suggested more than a decade ago. [ABSTRACT FROM AUTHOR]

Reports on the plans of the U.S. Environmental Protection Agency (EPA) to implement new regulations for the management of atmospheric particulate matter, tropospheric ozone and regional haze. Contribution of forest and agriculture burning to the quality of air; Impact of air quality regulations on wild and agricultural land managers; Discussion of smoke management paradigm.

Presents a diagnostic analysis of the Maricopa-Stanfield Irrigation and Drainage district area in Arizona. Assessment of the performance of agricultural systems; Increase of food production; Occurrence of irrigation development in water-dependent natural environments.

Reports the testing of the Management Improvement Program in the Maricopa-Stanfield Irrigation and Drainage District in Arizona. Improvement of the performance of irrigated agricultural system; Concern of the national government for the need to change irrigated agricultural practices; Identification of opportunities for improvement.

Enumerates the lessons learned from the application of the Management Improvement Program (MIP) to an irrigated agricultural system in Arizona. Identification of the strengths of the MIP methodology; Participation of system stakeholders in management of agricultural systems; Issues affecting the performance of agricultural systems.

Examines the iron deficiency in patients with chronic renal failure (CRF) in the United States. Causes of renal anemia; Benefits of iron therapy; Association of high serum ferritin levels with CRF.

Reprints the letters of Ferdinand and Ernst Boesel, German immigrants to Texas who became involved in the United States Civil War. Journey to America; Initial impressions; Imprisonment; Ferdinand's death.

Focuses on the organization of a dialysis research program at the University of California in Los Angeles. Ability of an investigator to receive the National Institute of Health funding; Establishment of an Office of Clinical Trials; Importance of the support pharmaceutical and device industries to the development of the program.

Discusses the current status and future prospects of Medicare's end-stage renal disease program. Challenges faced by the program; Includes increase in the number and acuity of patients; Availability of trained nephrologists; Policymaking concerning the program.

Describes the effect of the passage of Texas Senate Bill 994 in 1987 limiting professional education courses to no more than 18 semesters based on the context of the chaotic history of teacher education in the state. The historic context of Texas teacher education; Intensions of policymakers who supported the legislation; Lessons learned from the Texas experience; Dealing with economic difficulties and educational reform.

Focuses on the implications of the Federal Trade Commission's failure to order compulsory license to Borden's Real Lemon Trademark in United States to trademark law. Consideration of the decision as violation to consumer culture; Invasion of the enforcement of trademark rights in Lanham Act; Declaration of unfair method of trade by the rule.

Focuses on the tax issues in choosing an entity to hold business operations in the United States. Impact of entities on the tax consequences in the formation of non-US business; Mechanisms of the chosen entity on the tax consequences in business operations; Assessment on the type of ownership of entity chosen.

Focuses on the choice of form in the sale and purchase of foreign businesses in the United States. Taxation of capital gain portion; Sale of assets; Effect of section 338 election on sale of stock.

The article provides an analysis of a study which examines the kinds of options open to decision makers regarding which would be efficient for one party to make in a local crisis, given that party's objectives and its estimates as to the balance of strategic and local military forces and the economic and political environment. It attempts to illustrate the general conditions under which each side can be thought of as representing the leadership of the alliance or the bloc. The objectives of the decision makers of the U.S. and the Soviet Union in relation to the structure of the European crisis of 1961 are discussed.

The purpose of this study is to develop a cost function adequate for assigning highway costs to various classes of vehicles. Costs are defined merely as expenditures of the highway department in the construction and operation of the highway system. The method of analysis is, itself, conceptually very simple. Obviously one would like to identify characteristics of economically significant groupings of vehicles and determine the partial derivative of costs with respect to each and then assign this cost and an appropriate share of the joint costs to each vehicle class. The only methodological problems are determining what these characteristics are and particularly relating them to costs. Where no such relationship can be identified adequately to assign particular costs, those costs must be assigned arbitrarily or not at all. In addition to the primary system construction costs, the costs of both primary and secondary system maintenance will be allocated here. Pavement construction costs of the secondary system are treated as joint costs because, except for some structure cost, none of the secondary system construction costs are considered to be assignable exclusively to heavy vehicles.

The article focuses on the growth of farm tenancy in the U.S. For the past 55 years, the entire period for which we have statistics on land tenure, there has been a continuous and marked decrease in the proportion of operating owners and an accompanying increase in the proportion of tenants. Tenancy has increased from 25 per cent of all farmers in 1880 to 42 per cent in 1935. Because of debt the actual equity of operating owners is far less than these figures indicate. It should be explained that by land ownership in the first statement quoted is meant the equities of farm operators in the land which they operate. The mortgaged part of farms operated by owners as well as the tenant-operated farms are considered as not owned by the farm operator. The Graphic Summary of Farm Tenure ordinarily uses the somewhat less confusing designation, percentage of the value of farm real estate not belonging to the farm operator. As measures of equities, these percentages are roughly correct for 1930.

Background: Who provides health care to resident physicians is not well studied.Objective: To determine whether residency program directors (PDs)provide health care to their own residents and residents' families.Design: An anonymous survey mailed to 1,345 PDs in Emergency Medicine, Family Medicine, Internal Medicine, Medicine-Pediatrics,and Obstetrics-Gynecology in the United States in 2003.Results: Six hundred nineteen PDs (46%) responded. Half had taken care of their own residents for acute conditions. Less commonly, directors had written prescriptions for acute (40%) or chronic needs (15%}or provided ongoing care (22%). Only 3% believed this conflicted with their ability to be effective directors. Responders more likely to provide future care to residents considered this kind of care generally appropriate(P< .001), or appropriate under certain circumstances {P< .001).Most of these spent > 31% of their time seeing patients. There was no difference among types of programs, gender of the director, or the years as director. Twenty-five percent of directors provided care to their residents' families.Conclusions: Substantial numbers of directors provided healthcare to their own residents. Few believed this conflicted with their director role. We believe organizations of PDs should develop positions about this practice. [ABSTRACT FROM AUTHOR]

The article focuses on the impact of the final report of the National Commission on Excellence in Education, published in April 1983, on the state of education in the U.S. One may wonder why this report has been so successful in capturing the attention of the American public. Numerous earlier studies, coming to essentially the same conclusions, had caused but minor ripples in the pool of public awareness. Perhaps the report profited from a military metaphor. The President had expressed a personal interest in the work of the Commission. The report, directed to the Secretary of Education, had the mark of an official document. Or may be the report was a message whose time had come--an epistle serving as a final catalyst to years of nagging discontent. Whatever the cause, this report has had significant impact. It has been noted that after the release of the report, a number of presidential candidates decided that education should be the number one priority in the country. It also has been credited with inspiring a number of progeny in the form of state commissions.

Examines the impact of child-labor legislation on the presence of children in the United States labor force, during the late 19th and early 20th centuries. Age provisions of child-labor legislation; Implications of the legislation.