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Purpose: Interstitial cystitis/bladder pain syndrome is a chronic urological condition diagnosed in nearly 8 million females in the United States. Whether urinary microbiota play an etiological role remains controversial. Most studies assessed the microbiota of interstitial cystitis/bladder pain syndrome patients with voided or catheterized urine as a proxy for bladder urothelium; however, urine may not be a true reflection of the bladder microbiota. Bladder biopsy tissue may provide a more accurate, and thus more clinically relevant, picture of bladder microbiota. Materials and Methods: Bladder biopsy tissues were obtained from: (1) 30 females with interstitial cystitis/bladder pain syndrome (18-80 years old) via cystoscopically guided cold-cup biopsy following therapeutic bladder hydrodistention, and (2) 10 non–interstitial cystitis/bladder pain syndrome females undergoing pelvic organ prolapse repair. To detect bacteria, technical duplicates of each RNAlater-preserved biopsy were subjected to 16S rRNA gene sequencing. To visualize bacteria, paraformaldehyde-fixed, paraffin-embedded biopsies were subjected to a combined multiplexed fluorescence in situ hybridization and fluorescence immunohistochemistry assay and confocal microscopy. Results: Bacteria were detected by 16S rRNA gene sequencing in at least 1 technical duplicate of most biopsies. The most abundant genus was Staphylococcus, followed by Lactobacillus; Escherichia was common but not abundant. There was no significant difference between interstitial cystitis/bladder pain syndrome patients and controls (P > .05). Combined fluorescence in situ hybridization and immunohistochemistry reproducibly detected 16S rRNA in epithelial cells and shed cells in the urothelium and lesioned areas and capillary walls in the lamina propria of human bladder biopsy tissue. Conclusions: We conclude that urothelial and urinary microbiota are similar but not identical in adult females. [ABSTRACT FROM AUTHOR]

Amid all the controversy about how to improve America's schools, the importance of strengthening collegial collaboration among teachers has drawn almost unanimous support. However, what schools have instead of collegiality is congeniality. Congeniality is about getting along well, being friendly, warm, and supportive. Schools are full of good people who are cordial to and considerate of one another, who care about each other. Congeniality provides an essential foundation for a faculty's sense of community and its work with students. What it "doesn't" provide is any meaningful attention to that work. By itself, it fosters a culture of niceness and privacy, not a culture of growth. True collegiality requires more than being cordial and caring. It requires a focus on development and performance. It means sharing--deprivatizing--the work of teaching, and it means talking candidly, and being able to disagree constructively, about professional practice. For most educators, none of this comes easily, which surprises and dismays many advocates of improved collegiality, who assume that an appetite and aptitude for collaboration should be the norm in schools. But the fact is that most teachers are not ideally suited to collaborate--and the reasons make sense. They reflect inherent features of teaching itself and of teachers themselves--tendencies that are not only natural, but in key ways crucial to success with students. The forging and sustaining of a truly collegial, collaborative ethos in a faculty means confronting deeply embedded structural and personal challenges. To flourish, collegiality requires a foundation of "shared commitment to appropriate candor in the service of collective growth." This commitment must ultimately be broad and deep--a consensus that, once established, is both regularly renewed and built into the structures of faculty life. As with so much else in education, the building of true collegiality is a journey, an ongoing exploration of teaching and learning. Teachers who embark on this journey have a real chance to learn new ways of looking at themselves and their work and to broaden their view and deepen their craft--and, thus, enrich not only the quality of their teaching and of their students' learning, but of their lives together. (Contains 9 notes.)

Interstitial cystitis/bladder pain syndrome is a chronic pelvic pain condition with no known etiology that affects millions of women and men in the United States. Current management can be aggressive for individuals who are refractory to less invasive options, often resulting in the use of opioid narcotics and/or surgical procedures under general anesthesia, with higher risks and side effects to patients. Pulsed electromagnetic field therapy is a noninvasive therapeutic strategy that is thought to reduce inflammation and pain via alteration of cellular function and microcirculation. This therapy has demonstrated efficacy in management of other chronic pain syndromes including fibromyalgia and chronic low back pain. Herein, we describe a case of pulsed electromagnetic field therapy for management of interstitial cystitis/bladder pain syndrome that resulted in decreases in pelvic pain, burning with bladder filling, and other nonpelvic pain symptoms. This case provides support for a formal clinical trial to evaluate the efficacy of pulsed electromagnetic field therapy for the management of chronic pelvic pain in interstitial cystitis/bladder pain syndrome. [ABSTRACT FROM AUTHOR]

This article analyzes the decision-making processes used by government agencies when trying to decide whether to approve or reject projects that impact the environment. This article examines some of the real-life inputs into the decision, as well as the influences on the decision maker. For example, some academics suggest that decision makers are more influenced by the environmental impact assessment process itself than by the conclusions of the assessment. Three case studies are presented. I provide an overview of each project and the various influences on the respective decision maker. I demonstrate that decision makers tend to elevate social, cultural, and political concerns over the natural environment. I also demonstrate that each decision maker was influenced by a particular social, cultural, or political aspect unique to each situation. I recommend further research in the expanding use of analytical tools and models in environmental decision making. These tools may encourage the decision maker to give more consideration to the results of the environmental impact assessment versus other external influences. Environmental Practice 16: 290–301 (2014) [ABSTRACT FROM AUTHOR]

While the existence of relatively fresh groundwater sequestered within permeable, porous sediments beneath the Atlantic continental shelf of North and South America has been known for some time, these waters have never been assessed as a potential resource. This fresh water was likely emplaced during Pleistocene sea-level low stands when the shelf was exposed to meteoric recharge and by elevated recharge in areas overrun by the Laurentide ice sheet at high latitudes. To test this hypothesis, we present results from a high-resolution paleohydrologic model of groundwater flow, heat and solute transport, ice sheet loading, and sea level fluctuations for the continental shelf from New Jersey to Maine over the last 2 million years. Our analysis suggests that the presence of fresh to brackish water within shallow Miocene sands more than 100 km offshore of New Jersey was facilitated by discharge of submarine springs along Baltimore and Hudson Canyons where these shallow aquifers crop out. Recharge rates four times modern levels were computed for portions of New England's continental shelf that were overrun by the Laurentide ice sheet during the last glacial maximum. We estimate the volume of emplaced Pleistocene continental shelf fresh water (less than 1 ppt) to be 1300 km3 in New England. We also present estimates of continental shelf fresh water resources for the U.S. Atlantic eastern seaboard (104 km3) and passive margins globally (3 × 105 km3). The simulation results support the hypothesis that offshore fresh water is a potentially valuable, albeit nonrenewable resource for coastal megacities faced with growing water shortages. [ABSTRACT FROM AUTHOR]

The U.S. Department of Energy and the National Renewable Energy Laboratory are developing technologies to produce hydrogen from renewable, sustainable sources. A cost goal of $2.00–$3.00 kg-1 of hydrogen has been identified as the range at which delivered hydrogen becomes cost competitive with gasoline for passenger vehicles. Electrolysis of water is a standard commercial technology for producing hydrogen. Using wind and solar resources to produce the electricity for the process creates a renewable system. Biomass-to-hydrogen processes, including gasification, pyrolysis, and fermentation, are less well-developed technologies. These processes offer the possibility of producing hydrogen from energy crops and from biomass materials such as forest residue and municipal sewage. Solar energy can be used to produce hydrogen from water and biomass by several conversion pathways. Concentrated solar energy can generate high temperatures at which thermochemical reactions can be used to split water. Photoelectrochemical water splitting and photobiology are long-term options for producing hydrogen from water using solar energy. All these technologies are in the development stage. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background/Aims:: The burden of comorbidity in the Hepatitis C virus (HCV) infected persons on dialysis is unknown. Methods:: We identified all HCV infected and uninfected subjects in the United States Renal Data System in the years 1997–1998 using ICD-9 codes. Controls were matched on the date of first dialysis. ICD-9 codes and claims data was used to identify medical and psychiatric comorbidities. Results:: We identified 5,737 HCV infected persons and 11,228 HCV uninfected subjects. HCV infected subjects were younger, more likely to be black race and male and more likely to have the following comorbidities: hypertension; hepatitis B; cirrhosis; wasting; anemia; human immunodeficiency virus (HIV) infection; major depression; mild depression; bipolar disorder; schizophrenia; post-traumatic stress disorder; drug use; alcohol use; smoking and less likely to have the following comorbidities: coronary artery disease; stroke; peripheral vascular disease; diabetes; cancer; erythropoietin use. After adjusting for age, gender and race, HCV infected subjects were more likely to have hypertension, hepatitis B, cirrhosis, wasting, anemia and HIV infection and less likely to have coronary artery disease and stroke. Conclusions:: HCV infected persons on dialysis are more likely to have psychiatric comorbidities and substance abuse, as well as certain medical comorbidities. These factors should be considered when developing future intervention strategies. [Copyright &y& Elsevier]

This article focuses on the American system of payment for delivery of healthcare which reflects the national ethos--tremendous variability and inequalities in coverage. Compared with healthcare systems in other technologically developed countries, the American approach places more value on innovation and technology advancement relative to fairness. The manuscript from the Centers for Medicare and Medicaid Services illuminates an approach to harnessing the vast resources of payers to improve their ability to ascertain that their disbursements for healthcare services are providing value.

Studies the occurrence of neuropathy in several nephrectomized patients dialyzed at the University of Minnesota Hospitals and cooperating dialysis units. Methods used; Influence of unphysiology of dialysis on the occurrence of neuropathy; Correlation of mean predialysis toxin concentrations on the occurrence of neuropathy.

Background: Direct-to-consumer advertising (DTCA) of prescription drugs has increased rapidly in the United States during the last decade, yet little is known about its effects on prescribing decisions in primary care. We compared prescribing decisions in a US setting with legal DTCA and a Canadian setting where DTCA of prescription drugs is illegal, but some cross-border exposure occurs. Methods: We recruited primary care physicians working in Sacramento, California, and Vancouver, British Columbia, and their group practice partners to participate in the study. On pre- selected days, patients aged 18 years or more completed a questionnaire before seeing their physician. We asked these patients' physicians to complete a brief questionnaire immediately following the selected patient visit. By pairing individual patient and physician responses, we determined how many patients had been exposed to some form of DTCA, the frequency of patients' requests for prescriptions for advertised medicines and the frequency of prescriptions that were stimulated by the patients' requests. We measured physicians' confidence in treatment choice for each new prescription by asking them whether they would prescribe this drug to a patient with the same condition. Results: Seventy-eight physicians (Sacramento n = 38, Vancouver n = 40) and 1431 adult patients (Sacramento n = 683, Vancouver n = 748), or 61% of patients who consulted participating physicians on pre-set days, participated in the survey. Exposure to DTCA was higher in Sacramento, although 87.4% of Vancouver patients had seen prescription drug advertisements. Of the Sacramento patients, 7.2% requested advertised drugs as opposed to 3.3% in Vancouver (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.2-4.1). Patients with higher self- reported exposure to advertising, conditions that were potentially treatable by advertised drugs, and/or greater reliance on advertising requested more advertised medicines. Physicians fulfilled most requests for DTCA drugs (for 72% of patients in Vancouver and 78% in Sacramento); this difference was not statistically significant. Patients who requested DTCA drugs were much more likely to receive 1 or more new prescriptions (for requested drugs or alternatives) than those who did not request DTCA drugs (OR 16.9, 95% CI 7.5-38.2). Physicians judged 50.0% of new prescriptions for requested DTCA drugs to be only "possible" or "unlikely" choices for other similar patients, as compared with 12.4% of new prescriptions not requested by patients (p < 0.001). Interpretation: Our results suggest that more advertising leads to more requests for advertised medicines, and more prescriptions. If DTCA opens a conversation between patients and physicians, that conversation is highly likely to end with a prescription, often despite physician ambivalence about treatment choice. [ABSTRACT FROM AUTHOR]

This article investigates the relationships among the structure of everyday experience, domain-specific control beliefs, acquisition of science knowledge, and solving of everyday technical problems, in a sample of 531 10-year-olds from Germany and the United States. The theoretical starting point for this study was the assumption that children acquire operative schemata and mental models through daily experiences with technical equipment and toys. The authors assume that these not only transfer to solving technical everyday problems, but also have a positive influence on science learning in elementary schools whenever there is a sufficient overlap between the science curriculum and everyday experiences. Such a positive influence would encourage parents to selectively provide such experiences for their children. In the study, the authors integrated research on information processing and problem solving with motivation theory. The exploratory path model the authors started from is based on an understanding of problem solving as a dynamic interactive process of skill and will. Whether the theoretical assumptions were valid within and across countries was tested by means of structural equation modeling.

Focuses on socio-economic aspects of health care in the United States. Collective financing and collective priorities; Confusion in financial press; Diversion of resources; Expansion of activity in the health sector; Self-perpetuation of a military-industrial complex.

Opinion. Looks at the role of governments and the market in health care reform focusing on the United States. Identification of the economic interests in health care; Similarities of system characteristics; Criticisms leveled at the health care reform; Analyses of the health care market; Results from analyses.

The article focuses on the study that seeks to determine the factors that discourage potential science and mathematics teachers from teaching and to identify the changes necessary to improve their concerns in the U.S. The results of the study revealed that potential teachers avoided teaching due to salary concerns, lack of job security, nature of the job, poor job availability and opposition of family and friends. It was recommended that starting salaries for teachers should be $21,693 and salaries of $32,600 for teachers with bachelor of arts degree and ten years experience in order for the teaching field to become competitive.

Focuses on the insurance services of the Fleet Financial Group Inc. in the United States. Insurance goals for its middle-market customers; Belief in the role of retail banks in insurance product distribution; Effect of changes in the banking and insurance industries.

Inflationary periods in the United States bring with them calls for economic controls. Four times in the past fifty years, the result has been format programs to restrain wages and prices: during World War II, the Korean War, the "guidelines" years of Presidents John F. Kennedy and Lyndon Baines Johnson, and President Richard Milhous Nixon's wage freeze and stabilization rounds. Another alternative, however, involves changing the structure of collective bargaining in order to generate less inflationary settlements. Despite a large number of books and articles on incomes policy, there has been. little formal discussion of the structure of a desirable incomes policy. Japan's macro wage-setting practices, which contain many of the desirable elements listed here, can provide a useful model for the United States. Japan's experience following the first oil shock suggests that inflationary pressures were not perpetrated there through the operation of labor markets: between 1976 and 1982 the average yearly wage increase at large Japanese employers was 7.2 percent, while consumer prices rose at an annual rate of only 5.6 percent.

Examines the proposal for Consumer Bankruptcy Reform in the United States. Availability of chapter seven to debtors without ability to pay; Incorporation of disposable income standard in chapter 13 as a measure of repayment; Extension of chapter 13 repayment plans to five years for accommodation of longer maturities and payment of unsecured debts.

Presents an article on the views regarding the practice of pediatrics and its medical education in the U.S. Importance of improved pediatric care; Possible program of pediatric residency; Preparation of the pediatrician for his role in the community.

Comments on the life and works of author Ernest Hemingway in the U.S. Accusation of Hemingway as an anti-intellectual writer; Evidence to the anti-intellectual behavior of Hemingway; Emotions expressed on the literary works of Hemingway.

The article reports on the difficulty of the United States government in giving economic assistance to the Republic of Korea. The decision of the Korean government to revise the institutional framework for the distribution of aid goods. The Bank of Korea, along with other Korean government offices administered the allocation and sales of aid dollars. The recipients of aid from the United States are required to use the dollars to import the goods specified in the allocation authorization. The sale of dollars in the open market removes the profit base and increase the government revenue. A proposal to revise the allocation program aim to remove the profit opportunities.

Editorial. Comments on the Task Force on Principles for Economic Analysis of Health Care Technology's report titled `Economic Analysis of Health Care Technology.' History of the economic appraisal of health care interventions; Trends in drug purchasing decisions in the United States; Standardization of methodology.

Background: The licensed live, attenuated varicella-zoster virus vaccine prevents herpes zoster in adults older than 50 years. We aimed to determine whether intradermal administration of zoster vaccine could enhance vaccine immunogenicity compared with conventional needle subcutaneous administration.Methods: In this randomised, dose-ranging study, adults aged 50 years or older who had a history of varicella or who had resided in a country with endemic varicella-zoster virus infection for 30 years or more were eligible. Participants received the approved full or a 1/3 dose of zoster vaccine given subcutaneously or one of four intradermal doses (full, 1/3, 1/10, or 1/27 dose) using the MicronJet600 device. The two subcutaneous doses and the four intradermal doses were randomised (1·5:1:1:1:1:1) by computer generated sequence with randomisation stratified by age (50-59 years or 60 years or older). The primary immunogenicity endpoint was the change from baseline in IgG antibody to varicella-zoster virus-specific glycoproteins (gpELISA) measured at 6 weeks. All patients were included in the primary and safety analyses. This study is registered with ClinicalTrials.gov, number NCT01385566.Findings: Between Sept 2, 2011, and Jan 13, 2012, 224 participants were enrolled from three clinics in the USA and 223 were randomly assigned: 52 to receive the full dose subcutaneous zoster vaccine, 34 to receive the 1/3 dose subcutaneous zoster vaccine, 34 to receive the full dose intradermal zoster vaccine, 35 to receive the 1/3 dose intradermal zoster vaccine, 34 to receive the 1/10 dose intradermal zoster vaccine, and 34 to receive the 1/27 dose intradermal zoster vaccine. Full dose zoster vaccine given subcutaneously resulted in a gpELISA geometric mean fold-rise (GMFR) of 1·74 (90% CI 1·48-2·04) at 6 weeks post-vaccination compared with intradermal administration which resulted in a significantly higher gpELISA GMFR of 3·25 (2·68-3·94; p<0·0001), which also remained high at 18 months. An apparent dose-response relation was observed with intradermal administration (1/3 dose subcutaneous GMFR 1·64 [90% CI 1·36-1·99], 1/3 dose intradermal 2·58 (2·13-3·13), 1/10 dose intradermal 2·22 [1·83-2·69], and 1/27 dose intradermal 1·64 [1·35-2·00]). Each partial dose of zoster vaccine given intradermaly had a gpELISA GMFR comparable to that of full dose zoster vaccine given subcutaneously. Transient erythema and induration were more common after intradermal administration (31% erythema for full subcutaneous dose and 77% for intradermal dose).Interpretation: Intradermal zoster vaccine showed a greater increase in varicella-zoster virus gpELISA antibody compared with subcutaneous zoster vaccine at comparable doses. Larger and longer studies of intradermal administration of live, attenuated zoster vaccine are needed to provide convincing evidence of improved cell mediated immunity.Funding: Merck & Co Inc. [ABSTRACT FROM AUTHOR]

To examine the extent to which Canadian residents seek medical care across the border, we collected data about Canadians' use of services from ambulatory care facilities and hospitals located in Michigan, New York State, and Washington State during 1994-1998. We also collected information from several Canadian sources, including the 1996 National Population Health Survey, the provincial Ministries of Health, and the Canadian Life and Health Insurance Association. Results from these sources do not support the widespread perception that Canadian residents seek care extensively in the United States. Indeed, the numbers found are so small as to be barely detectible relative to the use of care by Canadians at home. [ABSTRACT FROM AUTHOR]