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Simple Summary: Brain metastases (BMs), the most common type of cerebral tumor, are primarily associated with lung cancer, breast cancer, and melanoma. Patients typically present to the emergency department (ED) with insidious symptoms such as headaches, focal neurological deficits, seizures, and signs of increased intracranial pressure. Key symptomatic treatment in the ED includes corticosteroids to manage peritumoral edema, and carefully selected antiepileptic medications for tumor-related epileptic conditions. After stabilization, the treatment philosophy for BMs should prioritize effective yet minimally toxic options to maximize quality of life. Surgery is recommended for accessible BMs in patients with good performance status. Radiation therapy and systemic treatments, including chemotherapy, targeted therapy, and immunotherapy, are available options for managing disease progression. Given that over half of patients with BMs in the ED are admitted, a better understanding of avoidable hospitalizations is essential to differentiate those who can be safely discharged from those needing observation or hospitalization. Brain metastases (BMs) are the most prevalent type of cerebral tumor, significantly affecting survival. In adults, lung cancer, breast cancer, and melanoma are the primary cancers associated with BMs. Symptoms often result from brain compression, and patients may present to the emergency department (ED) with life-threatening conditions. The goal of treatment of BMs is to maximize survival and quality of life by choosing the least toxic therapy. Surgical resection followed by cavity radiation or definitive stereotactic radiosurgery remains the standard approach, depending on the patient's condition. Conversely, whole brain radiation therapy is becoming more limited to cases with multiple inoperable BMs and is less frequently used for postoperative control. BMs often signal advanced systemic disease, and patients usually present to the ED with poorly controlled symptoms, justifying hospitalization. Over half of patients with BMs in the ED are admitted, making effective ED-based management a challenge. This article reviews the epidemiology, clinical manifestations, and current treatment options of patients with BMs. Additionally, it provides an overview of ED management and highlights the challenges faced in this setting. An improved understanding of the reasons for potentially avoidable hospitalizations in cancer patients with BMs is needed and could help emergency physicians distinguish patients who can be safely discharged from those who require observation or hospitalization. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies looking at the effect of hospital teaching status on septic shock related inhospital mortality are lacking. The aim of this study was to examine the effect of hospital teaching status on mortality in septic shock patients in the United States. METHODS: This was a retrospective observational study, using the Nationwide Emergency Department Sample Database (released in 2018). All patients with septic shock were included. Complex sample logistic regression was performed to assess the impact of hospital teaching status on patient mortality. RESULTS: A total of 388,552 septic shock patients were included in the study. The average age was 66.93 years and 51.7% were males. Most of the patients presented to metropolitan teaching hospitals (68.2%) and 31.8% presented to metropolitan non-teaching hospitals. Septic shock patients presenting to teaching hospitals were found to have a higher percentage of medical comorbidities, were more likely to be intubated and placed on mechanical ventilation (50.5% vs. 46.9%) and had a longer average length of hospital stay (12.47 d vs. 10.20 d). Septic shock patients presenting to teaching hospitals had greater odds of in-hospital mortality compared to those presenting to metropolitan non-teaching hospitals (adjusted odd ratio [OR]=1.295, 95% confidence interval [CI]: 1.256–1.335). CONCLUSION: Septic shock patients presenting to metropolitan teaching hospitals had significantly higher risks of mortality than those presenting to metropolitan non-teaching hospitals. They also had higher rates of intubation and mechanical ventilation as well as longer lengths of hospital stay than those in non-teaching hospitals. [ABSTRACT FROM AUTHOR]

Limited research has examined factors that impact access to postpartum mental healthcare. We investigated the predisposing, enabling, and need factors associated with postpartum consultation for mental health concerns in US mothers with or without depressive symptoms and examined potential disparities in access. We utilized cross-sectional data from the Listening to Mothers II Survey, the second national US survey of women's childbearing experiences. The survey recruited 1573 women, aged 18–45 years, who spoke English and had given birth. Depressive symptoms were measured with the Postpartum Depression Screening Scale (PDSS-SF). The dependent variable was postpartum consultation for mental health concerns. Logistic regression analyses showed that mothers with scores of 14–21 and 22–35 on the PDSS-SF had higher odds of consulting a provider for mental health concerns (OR 3.97; OR 12.91). Latinas had lower odds of seeking mental health consultations than Whites (OR 0.39). Mothers who were employed prenatally full-time or part-time had lower odds of seeking consultations than non-employed mothers (OR 0.62; OR 0.52). Mothers with household incomes of $50,000–$74,999 had higher odds of seeking consultations than those with incomes less than $25,000 (OR 2.20). When regression analyses were restricted to mothers with PDSS-SF scores ≥ 14, findings were similar by race/ethnicity and prenatal employment. Significant depressive symptoms are common in women after giving birth and few sought any form of mental health consultation. Latinas and low-income women are less likely to seek postpartum mental health consultations. Mental health care interventions could be geared towards targeting these at-risk groups.

Perinatal depression (PND) is a major depressive episode during pregnancy or within 4 weeks after childbirth up to a year. Risk factors for PND include stressful life events, history of depression, poor social support, unplanned and unwanted pregnancies, poor relationship quality, current or previous abuse, and low socioeconomic status. This mental disorder has been shown to have negative effects on mothers' quality of life and their intimate relationships, birth outcomes, and breastfeeding likelihood, as well as long-term effects on children's cognitive and emotional development. To date, no nationally representative study has examined whether there are socioeconomic and/or racial/ethnic differences in PND. This study discusses the prevalence and risk factors for PND, as well as its health consequences for mothers and children, the reasons for its underreporting and undertreatment, the evidence for different screening instruments and different treatment options, and the existing supportive policies to address this disorder in the United States. We conclude with outlining next steps in addressing the gaps in the literature on PND. [ABSTRACT FROM AUTHOR]

International medical graduates (IMGs) are medical graduates who have received their degree from international medical schools. IMGs must undertake a 3-step process to apply to the National Residency Matching Program match. First, they must obtain a valid standard certificate from the Educational Commission for Foreign Medical Graduates. Following certification, they must apply for and secure a position in a residency training program. Third, they must obtain a visa that would enable them to commence their training. In this article, we delve thoroughly into these stepladders to provide IMGs with a clear roadmap of the process as well as contacts to key agencies that may provide more comprehensive assistance. [ABSTRACT FROM AUTHOR]

The US offshore wind industry is maturing with several projects in various stages of development. These projects require site wind and environmental data before and during operation. Conventional techniques such as fixed‐bottom meteorological towers present economical and permitting challenges for the US. Floating Light Detection and Ranging (LiDAR) buoys offer significant advantages including reduced costs, less permitting, and reusability. This paper presents the validation of the first floating LiDAR buoy in Northeast US waters. The buoy, named DeepCLiDAR, includes a LiDAR, ecological monitoring sensors, and metocean sensors. A three‐phase LiDAR validation plan was executed, and its results are presented. The objective of the validation plan was to verify the accuracy of measurements made by the LiDAR buoy in wave environments against an unmoving reference wind measurement. Due to a lack of reference met masts, the use of a LiDAR on land as a baseline reference was implemented for validation. Comparison to a reference LiDAR instead of a traditional meteorological tower was a unique approach required in the Northeast US waters due to the absence of a reference fixed‐bottom meteorological tower in the region at the time of this study. The testing included a comparison of wind speed measurements made by the buoy deployed 15 km offshore from the mainland and a land‐based reference LiDAR located on a nearby island. This paper presents the methodology and results of this program, which indicate favorable agreement. This was the first such validation program in the Northeast USA which is now seeing rapid development of offshore wind. [ABSTRACT FROM AUTHOR]

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation. [ABSTRACT FROM AUTHOR]

Abstract: Kidney transplant recipients (KTRs) have greater morbidity and length of stay (LOS) following certain surgical procedures than non‐KTR. Given that appendectomy is one of the most common surgical procedures, we investigated differences in outcomes between 1336 KTR and 2 640 247 non‐KTR postappendectomy at transplant and nontransplant centers in the United States from 2000 to 2011, using NIS data and adjusting for patient‐level and hospital‐level factors. Postoperative complications were identified using ICD‐9 codes. Among KTR, there were no post‐appendectomy in‐hospital deaths, compared to a 0.2% in non‐KTR (P = .5). Overall complications were similar among KTR and non‐KTR (17.0% vs 11.6%; aOR:0.77 1.121.61). LOS and costs were greater for KTR compared to non‐KTR (LOS ratio 1.191.311.45; cost ratio 1.111.171.26). Only 44.8% of KTR had laparoscopic approach compared to 54.5% of non‐KTR, but had similar complication rates (10.6 vs 8.7%, P = .5). When treated at transplant centers, KTR had similar complications (aOR 0.440.791.43), but longer LOS (ratio 1.211.371.55) and greater hospital‐associated costs (ratio 1.191.291.41) than non‐KTR. Conversely, at nontransplant centers, KTR and non‐KTR had similar complications (aOR 0.751.232.0), LOS (ratio 0.840.961.09), and cost (ratio 0.931.011.10). Contrary to other procedures, KTR did not constitute a high‐risk group for patients undergoing appendectomy. [ABSTRACT FROM AUTHOR]

This paper investigates the demand determinants of green power in the U.S. residential sector. The data employed were collected by the National Renewable Energy Laboratory and consist of a cross-section of seven utilities observed over 13 years. A series of tests are performed that resulted in estimating a demand equation using the one-way cross-section random effects model. As expected, we find that demand is highly price inelastic. More interestingly though, is that elasticity with respect to number of customers is 0.52 leading to the conclusion that new subscribers tend to purchase less green power on average than the existing customers. Another compelling finding is that obtaining accreditation will have a 28.5% positive impact on consumption. Knowing that gaining green accreditation is important to the success of programs, utilities may want to seek certification and highlight it in their advertising campaigns. [ABSTRACT FROM AUTHOR]

The weakly regulated independent mortgage companies (IMCs) had a vastly disproportional contribution to the expansion in risky credit during the mortgage boom and to the ensuing foreclosure crisis. We exploit a quasi-experimental setting, created by the inconsistency of state lender regulations between banks and IMCs and their heterogeneity across states, to isolate the impact of regulation on lending standards using county-pairs straddling state borders. We find that weaker state regulation of IMCs is associated with a sharper expansion of IMCs, particularly in risky high-yield loans, which were also of worse quality in the weakly regulated states, based on subsequent delinquency. [ABSTRACT FROM AUTHOR]

Introduction: Racial and ethnic minorities experience greater burden of unintended pregnancy in the U.S. This study examined the factors associated with racial and ethnic disparities in unintended pregnancy among women in the U.S. using the social ecological model.Methods: This study utilized the National Survey of Family Growth data from 2006 to 2010. Data were analyzed in Autumn 2014 and Winter 2015. Decomposition analyses examined which intrapersonal, interpersonal, institutional, community, and public policy factors explained racial and ethnic disparities in unintended pregnancy.Results: Unadjusted analyses found that black and Hispanic women had a greater likelihood of unintended pregnancy compared with white women. Decomposition models explained 51% of the disparity in unintended pregnancy between black and white women and 73% of that between Hispanic and white women. Factors contributing to the disparity between black and white women included age, relationship status, respondent's mother's age at first birth, Federal Poverty Level, and insurance status. Between Hispanic and white women, these factors included age, U.S.-born status, education, and relationship status.Conclusions: Given that the results showed factors at different levels of the social ecological model contribute to racial and ethnic disparities in unintended pregnancy, interventions that aim to reduce these disparities should target at-risk groups of women such as younger, unmarried, lower-income, less-educated, non-U.S. born women and uninsured or publicly insured women. [ABSTRACT FROM AUTHOR]

The article discusses the contributions of scholar and editor Michael R. Matthews to science education in the U.S. Topics discussed include the tradition of history and philosophy of science in science teaching and the formation of the Institute for the History and Philosophy of Science and Technology coming from a subfield of science education. Matthews' editorship of "Science & Education" which served as a venue for exploring concepts and theories is mentioned.

In August 2012, the first social impact bond in the United States was implemented, introducing a revolutionary framework that aligns the incentives of the participants and provides nonprofits with a steady source of long term funding to scale up social projects. In the prevailing social impact bond structure, private investors essentially place a bet with a government agency that the selected nonprofits will accomplish measureable goals through a comprehensive project designed to reduce public costs. If the program fails to reach these goals, the investors lose the bet and their entire financial commitment to the social impact bond. If the program succeeds, the government agency repays the initial investment plus a profit margin to the investors. This Note examines social impact bonds from a nonprofit's perspective and answers the question whether the profit margin that the private investors may achieve would qualify as an impermissible private benefit that would allow the IRS to revoke a participating nonprofit's tax-exempt status. [ABSTRACT FROM AUTHOR]

Background & Aims: We sought to estimate the risk of perioperative mortality or acute liver failure for live liver donors in the United States and avoid selection or ascertainment biases and sample size limitations. Methods: We followed up 4111 live liver donors in the United States between April 1994 and March 2011 for a mean of 7.6 years; deaths were determined from the Social Security Death Master File. Survival data were compared with those from live kidney donors and healthy participants of the National Health and Nutrition Examination Survey (NHANES) III. Results: Seven donors had early deaths (1.7 per 1000; 95% confidence interval [CI], 0.7–3.5); risk of death did not vary with age of the liver recipient (1.7 per 1000 for adults vs 1.6 per 1000 for pediatric recipients; P = .9) or portion of liver donated (2.0 per 1000 for left lateral segment, 2.8 per 1000 for left lobe, and 1.5 per 1000 for right lobe; P = .8). There were 11 catastrophic events (early deaths or acute liver failures; 2.9 per 1000; 95% CI, 1.5–5.1); similarly, risk did not vary with recipient age (3.1 per 1000 adult vs 1.6 per 1000 pediatric; P = .4) or portion of liver donated (2.0 per 1000 for left lateral segment, 2.8 per 1000 for left lobe, and 3.3 per 1000 for right lobe; P = .9). Long-term mortality of live liver donors was comparable to that of live kidney donors and NHANES participants (1.2%, 1.2%, and 1.4% at 11 years, respectively; P = .9). Conclusions: The risk of early death among live liver donors in the United States is 1.7 per 1000 donors. Mortality of live liver donors does not differ from that of healthy, matched individuals over a mean of 7.6 years. [ABSTRACT FROM AUTHOR]

The purpose of the present investigation is to provide an analysis of previous works on the epidemiology of the hepatitis C virus (HCV) infection from six countries throughout Latin America, to forecast the future HCV prevalence trends in Argentina, Brazil, Mexico and Puerto Rico, and to outline deficiencies in available data, highlighting the need for further research. Data references were identified through indexed journals and non-indexed sources. Overall, 1080 articles were reviewed and 150 were selected based on their relevance to this work. When multiple data sources were available for a key assumption, a systematic process using multi-objective decision analysis (MODA) was used to select the most appropriate sources. When data were missing, analogues were used. Data from other countries with similar risk factors and/or population compositions were used as a proxy to help predict the future trends in prevalence. The review indicates that the dominant genotype is type 1. HCV prevalence in the analysed countries ranges from 1 to 2.3%. The Latin American countries have been very proactive in screening their blood supplies, thus minimizing the risk of transmission through transfusion. This suggests that other risk factors are set to play a major role in continued new infections. The number of diagnosed and treated patients is low, thereby increasing the burden of complications such as liver cirrhosis or hepatocellular carcinoma. The HCV prevalence, according to our modelling is steady or increasing and the number of infected individuals will increase. The results herein reported should provide a foundation for informed planning efforts to tackle hepatitis. [ABSTRACT FROM AUTHOR]

Purpose: To report the classification, management, and visual outcomes after laser in situ keratomileusis (LASIK) flap buttonhole caused by a microkeratome cut. Setting: Private practice, Boston, Massachusetts, USA. Methods: This retrospective observational case series comprised 15 patients with an intraoperative LASIK flap buttonhole or near buttonhole. In all cases, the flap was left in place or repositioned without excimer laser treatment. Buttonholes were classified by stage, and a treatment algorithm based on the stage was devised to determine the timing and type of intervention. The uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and complications associated with the laser vision correction surgery were reported. Results: Postoperative follow-up ranged from 1 week to 23 months. All 9 patients who were retreated had a postoperative UCVA of 20/25 or better. No retreated patient lost BSCVA. Before retreatment, the median UCVA was 20/80 (range 20/40−1 to counting fingers), the median BSCVA was 20/20−2 (range 20/15−1 to 20/70), and the spherical equivalent (SE) refractive errors ranged from −1.00 to −6.62 diopters (D). After retreatment, the median UCVA was 20/20−2 (range 20/15−1 to 20/25−1), the median BSCVA was 20/20 (range 20/15 to 20/20−3), and the SE refractive errors ranged from +0.50 to −0.75 D. Complications after laser correction treatment included overcorrection in 3 patients and corneal haze in 2 patients. Conclusions: Classification of buttonholes was helpful in guiding treatment. Good UCVA and BSCVA were achieved by following a simple treatment algorithm based on surface ablation. [Copyright &y& Elsevier]

Management of anthracycline extravasation is problematic and most reports are anecdotal. On September 6, 2007, the U.S. Food and Drug Administration approved Totect™ 500 mg (dexrazoxane hydrochloride for injection) for the treatment of extravasation resulting from i.v. anthracycline chemotherapy. In two studies, a total of 57 evaluable patients experienced extravasation from peripheral vein or central venous access sites with local swelling, pain, or redness. The presence of anthracycline in skin biopsy tissue was confirmed by tissue fluorescence, and treatment with a 3-day schedule of dexrazoxane began within 6 hours of the event. The primary endpoint was a reduction in the need for surgical intervention. Only one patient required surgical repair of the injury site, and late sequelae in the remainder were absent or mild. Also, the sponsor, TopoTarget A/S, Copenhagen, Denmark, performed controlled nonclinical studies in support of dexrazoxane dose and timing for the reduction of tissue injury resulting from anthracycline extravasation. For this uncommon but serious complication of anthracycline therapy, the need for surgical intervention was 1.7% with this regimen. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of the study is to employ the need theory to investigate whether a need for achievement has an effect on persistence behavior among entrepreneurs, and whether a need for achievement and business goals interact to influence such persistence. Design/methodology/approach - A longitudinal study of nascent entrepreneurs was conducted by a field survey in a metropolitan area of a mid-western state in the USA. Logistic regression was used to test the hypotheses. Findings - Need for achievement is found to be positively related to entrepreneurial persistence. Business goals are found to moderate the relationship between need for achievement and persistence. Research limitations/implications - The time span between the two waves of data collection in the longitudinal study might have been too short. Practical implications - This study highlights the importance of matching need for achievement and business goals. For complex tasks, a strong need for achievement should be accompanied with moderate business goals if persistence is to occur. Venture capitalists and government agencies can improve entrepreneurial success by keeping a close eye on the match. Originality/value - Few studies have explored the issue of entrepreneurial persistence. The present study contributes to a better understanding of motivation and other variables that influence entrepreneurial persistence. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates personal and work-related factors associated with the postpartum health of employed women 11 weeks after childbirth in the U.S. The study shows that among the factors with better health outcomes include better preconception health, the absence of prenatal mood problems, more control over work and home activities, and less job stress. This suggests that postpartum women should be evaluated on their fatigue levels and mental and physical symptoms.

We review the regulatory history of the accelerated approval process and summarize the U.S. Food and Drug Administration experience with accelerated approvals in oncology. The accelerated approval regulations, promulgated in 1992, allow approval of drugs for serious or life-threatening diseases on the basis of a surrogate endpoint that is reasonably likely to predict clinical benefit, such as survival or symptom benefit, pending completion of studies designed to confirm clinical benefit, referred to as phase 4 commitments, which are required to be conducted with due diligence. From 1992 to 2004, 22 applications involving anticancer drugs or biologics were approved. Of these 22 applications, accelerated approval was granted to 15 on the basis of findings from studies without an active comparator (i.e., single-arm studies or studies comparing two dose levels) and to the remaining seven on the basis of one or more randomized studies. Of the 22 approved applications, six (i.e., applications for dexrazoxane, irinotecan, capecitabine, docetaxel, imatinib mesylate, and oxaliplatin) have had one or more indications converted to regular approval. This review reports information that was presented at an Oncologic Drugs Advisory Committee meeting held in March 2003; it also presents a discussion of accelerated approval study designs, the study populations evaluated in the accelerated approval and confirmatory settings, and the integration of accelerated approval into a comprehensive drug development plan. [ABSTRACT FROM AUTHOR]

The present study was conducted to evaluate the levels of residual DDT in Lebanese soils. A total of 113 surface soil samples were collected for analysis from three major agricultural regions in the country: Mount Lebanon, Beqa’a valley and the coastal plain. The values of residual DDT in soils ranged between 0 and 1190 ng g−1. The majority of the analyzed soil samples were free or contained very low concentrations of DDE. Only two surface soil samples, which were collected from urban areas with high human activities, contained relatively high concentrations of residual DDT. The levels of residual DDT in all of the analyzed soil samples were within the permissible limits for agricultural soils. [ABSTRACT FROM AUTHOR]

Studies the analogies used by science teachers in the United States. Role of analogy in advancing scientific knowledge; Characteristics of the analogies; Function of analogies in naturalistic instructional settings.