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The article focuses on environmental right issues posed by the U.S.-Mexico border wall. Topics discussed include international norms such as right to private property, the rights of indigenous people and the right to non-discrimination violated by the actions of the U.S. government surrounding its border-wall construction, Declaration of the United Nations Conference on the Human Environment, and the International Covenant on Economic, Social and Cultural Rights.

We examined the extent to which a trainee's gender interacts with the gender of the trainer, as well as the gender composition of the classroom, to influence the trainee's knowledge acquisition. Hypotheses based on asymmetrical relational demography arguments were tested with a multilevel model on data collected from 1,515 predominantly Hispanic adult trainees in 115 classrooms taught by a total of 22 different trainers. Results supported an asymmetrical relational demography effect for the relationship between trainee-trainer gender dissimilarity and knowledge acquisition, such that trainer-trainee dissimilarity was related to knowledge acquisition for female trainees, but not for male trainees. No effects on trainee knowledge acquisition were observed for the trainee gender and classroom gender composition interaction. Exploratory analyses suggested that the racial diversity of the classroom was related to the knowledge acquisition of female trainees, but not male trainees. [ABSTRACT FROM AUTHOR]

Washington Gladden was one of the most influential Congregational leaders of the late nineteenth century. His voice was heard in the public square made a difference. Gladden was a classic nineteenth century Protestant liberal whose God was radically immanent. One tragic consequence of classic liberal theology was the loss of the transcendent character of the Church and its ministry. Gladden also made a lasting contribution to Pastoral Theology. His work was visionary but contained a grave weakness. His vision of the Church and its ministry was empty of transcendent character. As a consequence, sociology replaced theology as a base for pastoral ministry, a vision still dominant in American Protestantism. Recapturing the transcendent character of the Church and its ministry will restore pastoral theology and give the Church something unique and powerful to say in a public square no longer interested in hearing the Church echo the prevailing culture. [ABSTRACT FROM AUTHOR]

The author expresses views on issues related to congregationalism. He discusses the impact of congregationalism on the American culture. He cites those who have led the effort in enabling congregational churches to continue to speak in the public square and influence the larger culture, including well-known revivalist and moral crusader Lyman Beecher. He also presents the highlights of the Sixth Congregational Theological Symposium held at Plymouth Church in Brooklyn, New York City from October 30 to November 1, 2008.

The authors discuss the need to introduce stronger laws to protect the teenagers from indoor tanning in the U.S. Topics include the health consequences of health tanning, physician counselling on skin cancer prevention and the consideration of the Federal Drug Administration (FDA) to revise the requirements for tanning beds. The authors believe that the FDA should ban tanning salon below 18 years old.

The authors reflect on the expected decision of the U.S. Food and Drug Administration (FDA) regarding indoor tanning policy in 2010. They say that concerns about indoor tanning arose from the increasing incidence of melanoma and its related mortality in the U.S. They add that skin-cancer screening is not recommended by the U.S. Preventive Services Task Force because its benefit has yet to be validated in large randomized trials. They also believe that regulation of the indoor tanning industry would lead to profound cancer-prevention opportunities.

We describe a patient with a history of allogeneic hematopoietic stem cell transplantation complicated by chronic graft-versus-host disease who developed painful meningo-radiculitis and myositis due to Lyme borreliosis. To our knowledge, this is the first report of such an infection occurring after allogeneic hematopoietic stem cell transplantation in the United States. [ABSTRACT FROM AUTHOR]

Presents a commentary on the use of patch tests in the diagnosis of skin diseases in the United States (U.S.). Ruling of the U.S. Food and Drug Administration (FDA) on the use of patch tests in dermatology; Impact of the ruling on the improvement of dermatological medications; Criticism on the results of the FDA-approved patch tests.

Background: Cutaneous T-cell lymphomas are rare non-Hodgkin lymphomas with substantial morbidity and mortality in advanced disease stages. We compared the efficacy of mogamulizumab, a novel monoclonal antibody directed against C-C chemokine receptor 4, with vorinostat in patients with previously treated cutaneous T-cell lymphoma.Methods: In this open-label, international, phase 3, randomised controlled trial, we recruited patients with relapsed or refractory mycosis fungoides or Sézary syndrome at 61 medical centres in the USA, Denmark, France, Italy, Germany, the Netherlands, Spain, Switzerland, the UK, Japan, and Australia. Eligible patients were aged at least 18 years (in Japan, ≥20 years), had failed (for progression or toxicity as assessed by the principal investigator) at least one previous systemic therapy, and had an Eastern Cooperative Oncology Group performance score of 1 or less and adequate haematological, hepatic, and renal function. Patients were randomly assigned (1:1) using an interactive voice web response system to mogamulizumab (1·0 mg/kg intravenously on a weekly basis for the first 28-day cycle, then on days 1 and 15 of subsequent cycles) or vorinostat (400 mg daily). Stratification was by cutaneous T-cell lymphoma subtype (mycosis fungoides vs Sézary syndrome) and disease stage (IB-II vs III-IV). Since this study was open label, patients and investigators were not masked to treatment assignment. The primary endpoint was progression-free survival by investigator assessment in the intention-to-treat population. Patients who received one or more doses of study drug were included in the safety analyses. This study is ongoing, and enrolment is complete. This trial was registered with ClinicalTrials.gov, number NCT01728805.Findings: Between Dec 12, 2012, and Jan 29, 2016, 372 eligible patients were randomly assigned to receive mogamulizumab (n=186) or vorinostat (n=186), comprising the intention-to-treat population. Two patients randomly assigned to mogamulizumab withdrew consent before receiving study treatment; thus, 370 patients were included in the safety population. Mogamulizumab therapy resulted in superior investigator-assessed progression-free survival compared with vorinostat therapy (median 7·7 months [95% CI 5·7-10·3] in the mogamulizumab group vs 3·1 months [2·9-4·1] in the vorinostat group; hazard ratio 0·53, 95% CI 0·41-0·69; stratified log-rank p<0·0001). Grade 3-4 adverse events of any cause were reported in 75 (41%) of 184 patients in the mogamulizumab group and 76 (41%) of 186 patients in the vorinostat group. The most common serious adverse events of any cause were pyrexia in eight (4%) patients and cellulitis in five (3%) patients in the mogamulizumab group; and cellulitis in six (3%) patients, pulmonary embolism in six (3%) patients, and sepsis in five (3%) patients in the vorinostat group. Two (67%) of three on-treatment deaths with mogamulizumab (due to sepsis and polymyositis) and three (33%) of nine on-treatment deaths with vorinostat (two due to pulmonary embolism and one due to bronchopneumonia) were considered treatment-related.Interpretation: Mogamulizumab significantly prolonged progression-free survival compared with vorinostat, and could provide a new, effective treatment for patients with mycosis fungoides and, importantly, for Sézary syndrome, a subtype that represents a major therapeutic challenge in cutaneous T-cell lymphoma.Funding: Kyowa Kirin. [ABSTRACT FROM AUTHOR]

Objective: Surgical treatment of velopharyngeal insufficiency (VPI) includes a wide array of procedures. The purpose of this study was to develop a classification for VPI procedures and to describe variations in how they are performed. Design/participants/setting/outcomes: We completed an in-depth review of the literature to develop a preliminary schema that encompassed existing VPI procedures. Forty-one cleft surgeons from twelve hospitals across the USA and Canada reviewed the schema and either confirmed that it encompassed all VPI procedures they performed or requested additions. Two surgeons then observed the conduct of the procedures by surgeons at each hospital. Standardized reports were completed with each visit to further explore the literature, refine the schema, and delineate the common and unique aspects of each surgeon's technique., Results: Procedures were divided into three groups: palate-based surgery; pharynx-based surgery; and augmentation. Palate-based operations included straight line mucosal incision with intravelar veloplasty, double-opposing Z-plasty, and palate lengthening with buccal myomucosal flaps. Many surgeons blended maneuvers from these three techniques, so a more descriptive schema was developed classifying the maneuvers employed on the oral mucosa, nasal mucosa, and muscle. Pharynx-based surgery included pharyngeal flap and sphincter pharyngoplasty, with variations in design for each. Augmentation procedures included palate and posterior wall augmentation., Conclusions: A comprehensive schema for VPI procedures was developed incorporating intentional adaptations in technique. There was substantial variation amongst surgeons in how each procedure was performed. The schema may enable more specific evaluations of surgical outcomes and exploration of the mechanisms through which these procedures improve speech., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Importance: Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (AGB) are 2 of the most commonly performed bariatric procedures worldwide. However, few large, multisite studies have directly compared the benefits and harms of these procedures., Objective: To compare the effect of laparoscopic RYGB vs AGB on short- and long-term health outcomes., Design, Setting, and Participants: A retrospective cohort study of 7457 individuals 21 years or older who underwent laparoscopic bariatric surgery from January 1, 2005, through December 31, 2009, with follow-up through December 31, 2010. All individuals were participants in the Scalable Partnering Network, a network of 10 demographically and geographically distributed health care systems in the United States., Main Outcomes and Measures: The primary outcomes were (1) change in body mass index (BMI), (2) a composite end point of 30-day rate of major adverse outcomes (death, venous thromboembolism, subsequent intervention, and failure to discharge from the hospital), (3) subsequent hospitalization, and (4) subsequent intervention., Results: We identified 7457 patients who underwent laparoscopic AGB or RYGB procedures with a median follow-up time of 2.3 years (maximum, 6 years). The mean maximum BMI (calculated as weight in kilograms divided by height in meters squared) loss was 8.0 (95% CI, 7.8-8.3) for AGB patients and 14.8 (95% CI, 14.6-14.9) for RYGB patients (P < .001). In propensity score-adjusted models, the hazard ratio for AGB vs RYGB patients experiencing any 30-day major adverse event was 0.46 (95% CI, 0.27-0.80; P = .006). The hazard ratios comparing AGB vs RYGB patients experiencing subsequent intervention and hospitalization were 3.31 (95% CI, 2.65-4.14; P < .001) and 0.73 (95% CI, 0.61-0.88; P < .001), respectively., Conclusions and Relevance: In this large bariatric cohort from 10 health care systems, we found that RYGB resulted in much greater weight loss than AGB but had a higher risk of short-term complications and long-term subsequent hospitalizations. On the other hand, RYGB patients had a lower risk of long-term subsequent intervention procedures than AGB patients. Bariatric surgery candidates should be well informed of these benefits and risks when they make their decisions about treatment.

In October 2011, California became the first US state to ban indoor tanning for minors under age 18 years. Vermont followed in May 2012. Increasingly, scientific evidence shows that artificial tanning raises the risk of skin cancer, including melanoma, a common cancer in adolescents and young adults and the type most likely to result in death. The World Health Organization, the American Academy of Pediatrics, the American Academy of Dermatology, the American Medical Association, and other organizations strongly recommend legislation to ban minors under age 18 from indoor tanning. Several nations have banned teen tanning. Yet, tanning in salons is still a prevalent practice in the United States, especially among teen girls, where rates for the oldest teens approach 40%. There is no federal legislation to restrict minors from salon tanning. More than 60% of states have some kind of legislation regarding minors' use of tanning salons, but only California and Vermont have passed complete bans of indoor tanning for minors. The Indoor Tanning Association, an industry advocacy group, has vigorously opposed legislative efforts. Pediatricians can play key roles in counseling families and with legislative efforts. In this update, we review the prevalence of salon tanning, association with skin cancer risk, tanning addiction, the roles of the federal and state governments in regulation and legislation, and responses to arguments created by industry to oppose legislation. Preventing exposure to artificial tanning may save lives, including young lives, and is a key cancer prevention opportunity for pediatricians.

The objective of this study was to characterize the rhesus macaque (RM) as a model for inhalational brucellosis in support of the U.S. Food and Drug Administration's (FDA) Animal Rule. The pathophysiology of chronic Brucella melitensis aerosol infection was monitored in two phases that each occurred over an 8-week time period; dose escalation (8 RMs; targeted doses of 5.0E+03, 5.0E+04, or 5.0E+05 CFU/animal or the unchallenged control) and natural history (12 RMs; targeted dose of 2.50E+05 CFU/animal or the unchallenged control). RMs given an aerosol challenge with B. melitensis developed undulating fevers (6/6 phase I; 8/9 phase II), positive enriched blood cultures (5/10; phase II), and bacterial burdens in tissues starting 14 to 21 days postchallenge (6/6 phase I; 10/10 phase II). In addition, 80% (8/10; phase II) of infected RMs seroconverted 14 to 21 days postchallenge. RMs developed elevations in certain liver enzymes and had an increased inflammatory response by 3 weeks postchallenge as shown by increases in C-reactive protein (6/8) and neopterin (4/8), which correlated with the onset of a fever. As early as 14 days postchallenge, positive liver biopsy specimens were detected (2/8), and ultrasound imaging showed the development of splenomegaly. Finally, histopathologic examination found lesions attributed to Brucella infection in the liver, kidney, lung, and/or spleen of all animals. The disease progression observed with the RMs in this study is analogous to human brucellosis pathophysiology. Thus, the results from this study support the use of the RM as an animal model for inhalational brucellosis to evaluate the efficacy of novel vaccines and therapeutics against B. melitensis.

This paper provides the historical, cultural, and clinical context for the relationship between Bruno Bettelheim (1903-1990) and Rudolf Ekstein (1912-2005). Both were Viennese-born and trained intellectuals who received doctorates in the human sciences from the University of Vienna in 1937. Both were deeply identified with lay analysis, emphasizing that for psychoanalysis to perpetuate itself it needed to promote serious and rigorous forms of research. Because Bettelheim was the better known of the two, this introduction focuses on Ekstein's family history, with special emphasis on his experience of loss and trauma and his capacity to recover from personal and educational obstacles. It argues that Ekstein was a representative product of Austro-Marxism in the period between the wars, embracing the ethical brand of democratic socialism and group solidarity that was integral to the theory and practice of Austrian Social Democracy. It discusses Ekstein's training with Moritz Schlick in philosophy and his immersion in the Vienna Circle of logical positivism. From Schlick, Ekstein evolved into a philosophical thinker who learned how to think his own thoughts. Ekstein joined the circle of psychoanalytic pedagogues who clustered around the Vienna Psychoanalytic Society, under the tutelage of Willi Hoffer, August Aichhorn and, above all, Anna Freud. The clinical component of psychoanalysis emanated from his commitment to understanding the inner world of the child. Bettelheim and Ekstein first became aware of each other from reading the analytic literature and finally met in America in the 1950s. They shared a professional interest in conducting research and doing clinical work on severely disturbed children and adolescents, including those with psychotic, borderline and autistic diagnoses. They debated the value of milieu therapy versus psychoanalytically oriented psychotherapy on such children. As their relationship evolved, the two collaborated and began a fascinating correspondence that gradually evolved into an intimate friendship. They both engaged in a polemic with Bernard Rimland, who was massively critical of their clinical work and a hostile critic of psychoanalytic approaches to the treatment of disturbed children. Rimland was an advocate of a neurological approach to mental illness, with an emphasis on biology and psychopharmacology. The 22 letters that constitute the Bettelheim-Ekstein exchange began with clinical concerns, including the varieties of solitude, isolation and countertransference disruptions that may trouble the psychoanalytic researcher and clinician in dealing with primitively disordered children. It moves to other issues, including mutual support during the Rimland Affair. As the two became more friendly, a pattern of good-natured competition and envy appeared. The two engaged in a heated exchange on the question of whether contemporary Vienna remained as anti-Semitic as it had been in their respective youths: Bettelheim, the concentration camp survivor, argued that nothing had changed and that most Austrians remained viscerally anti-Semitic; Ekstein, the Austro-Marxist, contended that one could not blame a generation born after World War II, holding that in his experience many Austrians had examined their consciences and held distinctly different options from their parents or grandparents. Toward the end of their correspondence, we encounter Ekstein's tender sensitivity to Bettelheim's descent into depression as a result of the death of his wife, Trude, leading eventually to recurrent episodes of suicidal ideation and plans for his own suicide. The letters testify to a unique friendship with a somewhat old-world quality.

After selecting five representative European psychoanalytic thinkers, all of whom emigrated to the United States, this essay surveys their earliest perceptions and interpretations of the historical and psychological roots of Fascism, with particular emphasis on anti-Semitism. My samples almost all derive from the period before, during, and immediately after World War II. In examining the writings of Otto Fenichel, Ernst Simmel, Erik Homburger Erikson, Rudolf Loewenstein and Bruno Bettelheim, it discusses the various environmental and psychological dimensions of their understandings of racial prejudice. The paper argues that each thinker attempted to integrate historical, sociological, cultural and clinical factors into their psychodynamic formulations about the individual and group mind of the Fascist anti-Semite. This generation of psychoanalysts explained Fascist anti-Semitism by exploring the mechanisms of projection, the process of massive splitting mechanisms of the group mind, fantasies of delinquent adolescent aggrandizement in Hitler, sado-masochistic and perverse oedipal dynamics, and a macabre identification with the torturers on the part of Jewish inmates in the concentration camps, that obliterated the individual's sense of autonomy and capacity to respond morally. The paper points out the pronounced ambivalence of this generation of Jewish analysts and intellectuals toward their own Jewish backgrounds and sense of themselves as Jews. It also argues that this generation muted its left-wing and socialist political tendencies once they arrived in America, taking a turn against politics. It suggests that some of the features of this Jewish ambivalence can be seen in the exploration of a so-called "Jewish psychology," itself a disguised form of racism, a derivative of projection, which may have had rather negative and authoritarian consequences for the psychoanalytic movement in America.