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Objective: To improve food insecurity interventions, we sought to better understand the hypothesized bidirectional relationship between food insecurity and health care expenditures.Data Source: Nationally representative sample of the civilian noninstitutionalized population of the United States (2016-2017 Medical Expenditure Panel Survey [MEPS]).Study Design: In a retrospective longitudinal cohort, we conducted two sets of analyses: (a) two-part models to examine the association between food insecurity in 2016 and health care expenditures in 2017; and (b) logistic regression models to examine the association between health care expenditures in 2016 and food insecurity in 2017. We adjusted for demographic and socioeconomic variables as well as 2016 health care expenditures and food insecurity.Data Collection: Health care expenditures, food insecurity, and medical condition data from 10 886 adults who were included in 2016-2017 MEPS.Principal Findings: Food insecurity in 2016, compared with being food secure, was associated with both a higher odds of having any health care expenditures in 2017 (OR 1.29, 95% CI: 1.04 to 1.60) and greater total expenditures ($1738.88 greater, 95% CI: $354.10 to $3123.57), which represents approximately 25% greater expenditures. Greater 2016 health care expenditures were associated with slightly higher odds of being food insecure in 2017 (OR 1.007 per $1000 in expenditures, 95% CI: 1.002 to 1.012, P =0.01). Exploratory analyses suggested that poor health status may underlie the relationship between food insecurity and health care expenditures.Conclusions: A bidirectional relationship exists between food insecurity and health care expenditures, but the strength of either direction appears unequal. Higher health care expenditures are associated with a slightly greater risk of being food insecure (adjusted for baseline food insecurity status) but being food insecure is associated with substantially greater subsequent health care expenditures (adjusted for baseline health care expenditures). Interventions to address food insecurity and poor health may be helpful to break this cycle. [ABSTRACT FROM AUTHOR]

Proof beyond a reasonable doubt has been de rigueur in criminal cases almost since the dawn of the republic. It is based on the premise that it is better to let several guilty people go free in order to save one innocent person from wrongful conviction. The jury in a criminal case is not merely an audience. It is the central mechanism without which the wheels of American criminal justice cannot turn--and operates as the final safeguard against a grave error. However, while the Constitution describes the importance, composition, and role of the jury, it does not explicitly use the phrase "proof beyond a reasonable doubt." Though not mentioned in our founding document, proof beyond a reasonable doubt is "an ancient and honored aspect of our criminal justice system." As such, this Article does not question its conceptual wisdom, but rather its jurisprudential implementation. Yet the meaning of "beyond a reasonable doubt" is apparently not selfevident. Jurors constantly ask for definitions of beyond a reasonable doubt. Some jurisdictions allow such a definition. Some require it. Others forbid it entirely under the supposition that its meaning is obvious and requires no definition. Juries are understandably curious and concerned about the meaning of "proof beyond a reasonable doubt." They correctly assert to judges that it is not self-explanatory (despite many judges' erroneous insistence to the contrary). This creates real and significant risk the standard under which defendants are convicted is constitutionally inadequate. When jurors misapprehend how high the burden of proof beyond a reasonable doubt is, they are in danger of convicting the innocent, the gravest kind of mistake that is called "Type I error." When they let a guilty person go free, they commit a less serious kind of mistake called "Type II error." In fact, the theory behind proof beyond a reasonable doubt (letting several guilty people go free in order to save one innocent person) actually contemplates Type II error. The authors posit that many jurors simply don't understand how high a burden of proof beyond a reasonable doubt is supposed to be. They propose redefining proof beyond a reasonable doubt to make it more intelligible to the average juror. They realize the beyond a reasonable doubt standard is veritably sacrosanct in American law, but they don't believe "that's the way it's always been" is a good reason to perpetuate a standard of proof that is unintelligible to the average juror. They suggest changing the burden to a two-step analysis: (1) Did the prosecutor prove each and every element of the crime charged? (2) If so, keeping in mind the extraordinary injustice in the possibility of convicting an innocent person, are you convinced to a moral certainty? The authors are convinced that if American law can somehow let go of its "beyond a reasonable doubt" tradition, the incidence of grievous Type I error will be much lower. [ABSTRACT FROM AUTHOR]

Ten years ago, the Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank)1 attempted to repair the damage done by the financial crisis and hence required the most substantial changes to business operations and periodic reporting2 in the American financial services industry since the Securities Exchange Act of 1934.3 The author had the privilege of commenting on several aspects of the legislation as proposed4 and has continued to discuss the intent, implementation, and modification of Dodd- Frank's provisions and related rulemaking in the decade since 2009.5 This Article centers on Section 953(b)'s reporting burden and how it has affected companies, how it has informed shareholders and non-shareholders, and the degree of public interest in Section 953(b) disclosures. Pay ratios are now headline news because of a controversial provision in the 2010 Dodd-Frank Act, passed in the wake of the financial crisis. It requires publicly traded companies to report their median employee pay ($46,127 in Disney's case) and calculate the CEO pay ratio. Since mandatory reporting began last year, these ratios have captured public attention in ways that the typically technical corporate disclosure documents never do.6 Written in the context of the COVID-19 crisis, during which many CEOs are taking pay cuts or foregoing bonuses, the author has chosen to focus on pre-crisis market conditions, which are better-understood and likely more representative of normal wage dynamics for executives. Executive compensation, and particularly chief executive officer (CEO) compensation, has been an issue receiving substantial political and media attention in recent years7 - a phenomenon not unrelated to Section 953(b)'s intents and contents. For context, from 1978 to 2018, the S&P500 index rose 706.7% while CEO compensation grew 1,007.5%. [ABSTRACT FROM AUTHOR]

The United States is experiencing an opioid crisis imposing enormous fiscal and societal costs and driving the staggering overdose death rate. While prescription opioid analgesics are essential for treating acute pain, cessation of use in individuals with a physical dependence induces an aversive withdrawal syndrome that promotes continued drug use to alleviate/avoid these symptoms. Additionally, repeated bouts of withdrawal often lead to an increased propensity for relapse. Understanding the neurobiology underlying withdrawal is essential for providing novel treatment options to alleviate physiological and affective components accompanying the cessation of opiate use. Here, we administered morphine and precipitated withdrawal with naloxone to investigate behavioral and cellular responses in C57BL/6J male and female mice. Following 3 days of administration, both male and female mice demonstrated sensitized withdrawal symptoms. Since the bed nucleus of the stria terminalis (BNST) plays a role in mediating withdrawal-associated behaviors, we examined plastic changes in inhibitory synaptic transmission within this structure 24 hours following the final precipitated withdrawal. In male mice, morphine withdrawal increased spontaneous GABAergic signaling compared with controls. In contrast, morphine withdrawal decreased spontaneous GABAergic signaling in female mice. Intriguingly, these opposing GABAergic effects were contingent upon activity-dependent dynamics within the ex vivo slice. Our findings suggest that male and female mice exhibit some divergent cellular responses in the BNST following morphine withdrawal, and alterations in BNST inhibitory signaling may contribute to the expression of behaviors following opioid withdrawal. [ABSTRACT FROM AUTHOR]

Death from chronic lung disease is increasing and chronic obstructive pulmonary disease has become the third leading cause of death in the United States in the past decade. Both chronic and acute lung diseases disproportionately affect elderly individuals, making it likely that these diseases will become more frequent and severe as the worldwide population ages. Chronic lung diseases are associated with substantial morbidity, frequently resulting in exercise limiting dyspnea, immobilization, and isolation. Therefore, effective strategies to prevent or treat lung disease are likely to increase healthspan as well as life span. This review summarizes the findings of a joint workshop sponsored by the NIA and NHLBI that brought together investigators focused on aging and lung biology. These investigators encouraged the use of genetic systems and aged animals in the study of lung disease and the development of integrative systems-based platforms that can dynamically incorporate data sets that describe the genomics, transcriptomics, epigenomics, metabolomics, and proteomics of the aging lung in health and disease. Further research was recommended to integrate benchmark biological hallmarks of aging in the lung with the pathobiology of acute and chronic lung diseases with divergent pathologies for which advanced age is the most important risk factor. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including psoriasis, a chronic inflammatory skin condition affecting in the United States population; autoimmune blistering conditions specifically bullous pemphigoid and pemphigus vulgaris, which have significant morbidity and mortality. Early recognition and proper management are crucial.

Polyomaviruses (PyV) are potentially tumorigenic in humans. However, limited data exist on the population seroprevalence of PyVs and individual characteristics that relate to seropositivity. Using multiplex serology, we determined the seroprevalence of 10 human PyVs (BK, JC, KI, WU, MCV, HPyV6, HPyV7, TSV, HPyV9, and HPyV10) among controls from a population-based skin cancer case-control study (n = 460) conducted in New Hampshire between 1993 and 1995. On a subset of participants (n = 194), methylation at CpG dinucleotides across the genome was measured in peripheral blood using the Illumina Infinium HumanMethylation27 BeadChip array (Illumina Inc., San Diego, California), from which lymphocyte subtype proportions were inferred. All participants were seropositive for at least 1 PyV, with seroprevalences ranging from 17.6% (HPyV9) to 99.1% (HPyV10). Seropositivity to JC, MCV, and HPyV7 increased with age. JC and TSV seropositivity were more common among men than among women. Smokers were more likely to be HPyV9-seropositive but MCV-seronegative, and HPyV7 seropositivity was associated with prolonged glucocorticoid use. Based on DNA methylation profiles, differences were observed in CD8-positive T- and B-cell proportions by BK, JC, and HPyV9 seropositivity. Our findings suggest that PyV seropositivity is common in the United States and varies by sociodemographic and biological characteristics, including those related to immune function. [ABSTRACT FROM AUTHOR]

Objective To identify genetic variants that modify bladder cancer prognosis focusing on genes involved in major biological carcinogenesis processes (apoptosis, proliferation, DNA repair, hormone regulation, immune surveillance, and cellular metabolism), as nearly half of patients with bladder cancer experience recurrences reliable predictors of this recurrent phenotype are needed to guide surveillance and treatment. Patients and methods We analysed variant genotypes hypothesised to modify these processes in 563 patients with urothelial-cell carcinoma enrolled in a population-based study of incident bladder cancer conducted in New Hampshire, USA. After diagnosis, patients were followed over time to ascertain recurrence and survival status, making this one of the first population-based studies with detailed prognosis data. Cox proportional hazards regression was used to assess the relationship between single nucleotide polymorphisms ( SNPs) and prognosis endpoints. Results Patients with aldehyde dehydrogenase 2 ( ALDH2) variants had a shorter time to first recurrence (adjusted non-invasive hazard ratio [ HR] 1.90, 95% confidence interval [ CI] 1.29-2.78). There was longer survival among patients with non-invasive tumours associated with DNA repair X-ray repair cross-complementing protein 4 ( XRCC4) heterozygous genotype compared with wild-type (adjusted HR 0.53, 95% CI 0.38-0.74). Time to recurrence was shorter for patients who had a variant allele in vascular cellular adhesion molecule 1 ( VCAM1) and were treated with immunotherapy ( P interaction < 0.001). Conclusions Our analysis suggests candidate prognostic SNPs that could guide personalised bladder cancer surveillance and treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND In the Western world, bladder cancer is the fourth most common cancer in men and the eighth most common in women. Recurrences frequently occur, and continued surveillance is necessary to identify and treat recurrent tumors. Efforts to identify risk factors that are potentially modifiable to reduce the rate of recurrence are needed. METHODS Cigarette smoking behavior and body mass index were investigated at diagnosis for associations with bladder cancer recurrence in a population-based study of 726 patients with bladder cancer in New Hampshire, United States. Patients diagnosed with non-muscle invasive urothelial cell carcinoma were followed to ascertain long-term prognosis. Analysis of time to recurrence was performed using multivariate Cox regression models. RESULTS Smokers experienced shorter time to recurrence (continuing smoker hazard ratio [HR] = 1.51, 95% confidence interval [CI] = 1.08-2.13). Although being overweight (body mass index > 24.9 kg/m2) at diagnosis was not a strong independent factor (HR = 1.33, 95% CI = 0.94-1.89), among continuing smokers, being overweight more than doubled the risk of recurrence compared to smokers of normal weight (HR = 2.67, 95% CI = 1.14-6.28). CONCLUSIONS These observational results suggest that adiposity is a risk factor for bladder cancer recurrence, particularly among tobacco users. Future intervention studies are warranted to evaluate whether both smoking cessation and weight reduction strategies reduce bladder tumor recurrences. Cancer 2014;120:408-414. © 2013 American Cancer Society. [ABSTRACT FROM AUTHOR]

Bladder cancer is the 4th most common cancer among men in the U.S. We analyzed variant genotypes hypothesized to modify major biological processes involved in bladder carcinogenesis, including hormone regulation, apoptosis, DNA repair, immune surveillance, metabolism, proliferation, and telomere maintenance. Logistic regression was used to assess the relationship between genetic variation affecting these processes and susceptibility in 563 genotyped urothelial cell carcinoma cases and 863 controls enrolled in a case-control study of incident bladder cancer conducted in New Hampshire, U.S. We evaluated gene-gene interactions using Multifactor Dimensionality Reduction (MDR) and Statistical Epistasis Network analysis. The 3'UTR flanking variant form of the hormone regulation gene HSD3B2 was associated with increased bladder cancer risk in the New Hampshire population (adjusted OR 1.85 95%CI 1.31-2.62). This finding was successfully replicated in the Texas Bladder Cancer Study with 957 controls, 497 cases (adjusted OR 3.66 95%CI 1.06-12.63). The effect of this prevalent SNP was stronger among males (OR 2.13 95%CI 1.40-3.25) than females (OR 1.56 95%CI 0.83-2.95), (SNPgender interaction P = 0.048). We also identified a SNP-SNP interaction between T-cell activation related genes GATA3 and CD81 (interaction P = 0.0003). The fact that bladder cancer incidence is 3-4 times higher in males suggests the involvement of hormone levels. This biologic process-based analysis suggests candidate susceptibility markers and supports the theory that disrupted hormone regulation plays a role in bladder carcinogenesis. [ABSTRACT FROM AUTHOR]

Two proton-transfer-reaction mass spectrometry systems were deployed at the Bio-hydro-atmosphere interactions of Energy, Aerosols, Carbon, H2O, Organics and Nitrogen-Southern Rocky Mountain 2008 field campaign (BEACHON-SRM08; July to September, 2008) at the Manitou Forest Observatory in a ponderosa pine woodland near Woodland Park, Colorado USA. The two PTR-MS systems simultaneously measured BVOC emissions and ambient distributions of their oxidation products. Here, we present mass spectral analysis in a wide range of masses (m/z 40+ to 210+) to assess our understanding of BVOC emissions and their photochemical processing inside of the forest canopy. The biogenic terpenoids, 2-methyl-3-butene-2-ol (MBO, 50.2%) and several monoterpenes (MT, 33.5%) were identified as the dominant BVOC emissions from a transmission corrected mass spectrum (PTR-MS), averaged over the daytime (11 a.m. to 3 p.m., local time) of three days. To assess contributions of oxidation products of local BVOC, we calculate an oxidation product spectrum with the OH- and ozone-initiated oxidation product distribution mass spectra of two major BVOC emissions at the ecosystem (MBO and β-pinene) that were observed from laboratory oxidation experiments. The majority (∼ 76%) of the total signal in the transmission corrected PTR-MS spectra could be explained by identified compounds. The remainder are attributed to oxidation products of BVOC emitted from nearby ecosystems and transported to the site, and oxidation products of unidentified BVOC emitted from the ponderosa pine ecosystem. [ABSTRACT FROM AUTHOR]

Background: Autism is associated with high rates of genomic aberrations, including chromosomal rearrangements and de novo copy-number variations. These observations are reminiscent of cancer, a disease where genomic rearrangements also play a role. We undertook a correlative epidemiological study to explore the possibility that shared risk factors might exist for autism and specific types of cancer. Methodology/Principal Findings: To determine if significant correlations exist between the prevalence of autism and the incidence of cancer, we obtained and analyzed state-wide data reported by age and gender throughout the United States. Autism data were obtained from the U.S. Department of Education via the Individuals with Disabilities Education Act (IDEA) (2000-2007, reported annually by age group) and cancer incidence data were obtained from the Centers for Disease Control and Prevention (CDC) (1999-2005). IDEA data were further subdivided depending on the method used to diagnose autism (DSM IV or the Code of Federal Regulations, using strict or expanded criteria). Spearman rank correlations were calculated for all possible pairwise combinations of annual autism rates and the incidence of specific cancers. Following this, Bonferroni's correction was applied to significance values. Two independent methods for determining an overall combined p-value based on dependent correlations were obtained for each set of calculations. High correlations were found between autism rates and the incidence of in situ breast cancer (p≤10-10, modified inverse chi square, n = 16) using data from states that adhere strictly to the Code of Federal Regulations for diagnosing autism. By contrast, few significant correlations were observed between autism prevalence and the incidence of 23 other female and 22 male cancers. Conclusions: These findings suggest that there may be an association between autism and specific forms of cancer. [ABSTRACT FROM AUTHOR]

With the release of the landmark report Toxicity Testing in the 21st Century: A Vision and a Strategy, the U.S. National Academy of Sciences, in 2007, precipitated a major change in the way toxicity testing is conducted. It envisions increased efficiency in toxicity testing and decreased animal usage by transitioning from current expensive and lengthy in vivo testing with qualitative endpoints to in vitro toxicity pathway assays on human cells or cell lines using robotic high-throughput screening with mechanistic quantitative parameters. Risk assessment in the exposed human population would focus on avoiding significant perturbations in these toxicity pathways. Computational systems biology models would be implemented to determine the dose-response models of perturbations of pathway function. Extrapolation of in vitro results to in vivo human blood and tissue concentrations would be based on pharmacokinetic models for the given exposure condition. This practice would enhance human relevance of test results, and would cover several test agents, compared to traditional toxicological testing strategies. As all the tools that are necessary to implement the vision are currently available or in an advanced stage of development, the key prerequisites to achieving this paradigm shift are a commitment to change in the scientific community, which could be facilitated by a broad discussion of the vision, and obtaining necessary resources to enhance current knowledge of pathway perturbations and pathway assays in humans and to implement computational systems biology models. Implementation of these strategies would result in a new toxicity testing paradigm firmly based on human biology. [ABSTRACT FROM AUTHOR]

We quantified fine scale sources and sinks of gas phase acetaldehyde in two forested ecosystems in the US. During the daytime, the upper canopy behaved as a net source while at lower heights, reduced emission rates or net uptake were observed. At night, uptake generally predominated thoughout the canopies. Net ecosystem emission rates were inversely related to foliar density which influenced the extinction of light and the acetaldehyde compensation point in the canopy. This is supported by branch level studies revealing much higher compensation points in the light than in the dark for poplar (Populus deltoides) and holly oak (Quercus ilex) implying a higher light/temperature sensitivity for acetaldehyde production relative to consumption. The view of stomata as the major pathway for acetaldehyde exchange is supported by strong linear correlations between branch transpiration rates and acetaldehyde exchange velocities for both species. In addition, natural abundance carbon isotope analysis of gas-phase acetaldehyde during poplar branch fumigation experiments revealed a significant kinetic isotope effect of 5.1±0.3‰ associated with the uptake of acetaldehyde. Similar experiments with dry dead poplar leaves showed no fractionation or uptake of acetaldehyde, confirming that this is only a property of living leaves. We suggest that acetaldehyde belongs to a potentially large list of plant metabolites where stomatal conductance can exert long term control over both emission and uptake rates due to the presence of both source(s) and sink(s) within the leaf which strongly buffer large changes in concentrations in the substomatal airspace due to changes in stomatal conductance. We conclude that the exchange of acetaldehyde between plant canopies and the atmosphere is fundamentally controlled by ambient acetaldehyde concentrations, stomatal conductance, and the acetaldehyde compensation point. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is associated with a twofold increased risk of pancreatic cancer. We conducted a population-based case-control study in six San Francisco Bay area counties from 1994 to 2001 to investigate associations between polymorphisms in genes for two carcinogen-metabolizing enzymes (cytochrome P450 1A1 [CYP1A1] and glutathione S-transferase [GST]), smoking, and adenocarcinoma of the exocrine pancreas.Methods: We used polymerase chain reaction-based methods to analyze blood samples obtained from 309 case subjects and 964 control subjects to determine their genotypes for three CYP1A1 polymorphisms (m1, m2, and m4) and for homozygous deletions of two GST genes, GSTM1 and GSTT1. Control subjects were frequency matched to case subjects by age and sex. All statistical tests were two-sided.Results: None of the genetic polymorphisms themselves affected the risk of pancreatic cancer among Caucasian study participants. However, we observed an interaction between GSTT1-null genotype and cigarette smoking among Caucasians that was more prominent among women than among men. Relative to never smokers with the GSTT1-present genotype, the age-adjusted odds ratios (ORs) of pancreatic cancer for heavy smokers with the GSTT1-null genotype were 5.0 (95% confidence interval [CI] = 1.8 to 14.5) for women and 3.2 (95% CI = 1.3 to 8.1) for men; for heavy smokers with the GSTT1-present genotype they were 2.0 (95% CI = 1.0 to 4.0) for women and 2.1 (95% CI = 1.1 to 3.9) for men. ORs for pancreatic cancer among heavy smokers with both GSTT1-null and GSTM1-null genotypes were similar in magnitude to those among heavy smokers with the GSTT1-null genotype alone. There was no evidence of an interaction between CYP1A1 polymorphisms and smoking.Conclusions: The combination of heavy smoking and a deletion polymorphism in GSTT1 is associated with an increased risk of pancreatic cancer among Caucasians, with the associations possibly stronger in women than in men. [ABSTRACT FROM AUTHOR]

The article presents the author's perspectives on how to stay enthusiastic as law librarian in the U.S. He states that he has been in the law library profession for more than 25 years of service wherein technological advancement and job opportunities have stimulated his job satisfaction because of the learning experiences they provide. He adds that mental challenges, active participation in library meeting associations and communication with colleagues as well as public service could help sustain occupational growth.

Evaluates associations of tibial lead levels with polymorphisms in the vitamin D receptor (VDR) in 504 organolead manufacturing workers in the United States. Genotypes linked to the BsmI polymorphism; Influence of VDR genotypes on calcium kinetics; Impact of the VDR genotype on the accumulation and release of lead from bone.

Presents a study on the nature and extent of changes in the legislature during the members' tenure in the U.S. Nature of the job; Association of variation of perceptions with differences between types of legislatures; Decision making capability of legislatures.

This brief article supplements the preceding critique of the research on state legislatures by describing some of the questions about the legislative process raised by legislators who seek information from the National Conference of State Legislatures. In some areas, such as roles and norms, there are few if any inquiries from legislators. In others, there are questions that not only are pertinent to policymakers but that ought to be interesting to political scientists. [ABSTRACT FROM AUTHOR]

This article focuses on the need of new pistol regulations in the United States. Pistols have been manufactured for many years and they are effective for thousands of occasions, and, with reasonable care, they continue to be usable for many years. To stop the manufacture of pistols, therefore, would not solve the problem because there are plenty of pistols in existence to last the criminal fraternity for hundreds of years to come. Some antipistol reformers say that criminals ought not to be allowed to obtain or possess pistols and it will prevent such crimes of violence as are now perpetrated with the use of pistols. They say that there should be a pistol law to prevent such crimes. But the problem of turning what ought to be into an accomplished fact is frequently a problem which seems to be insoluble. It is also a fact that almost no law is completely effective. The question of the desirability of a law depends in part upon its probable degree of effectiveness. That in turn depends largely upon the extent to which it will receive the voluntary and general acquiescence and obedience of the public.

Head and neck squamous cell carcinomas (HNSCCs) represent clinically and etiologically heterogeneous tumors affecting >40 000 patients per year in the USA. Previous research has identified individual epigenetic alterations and, in some cases, the relationship of these alterations with carcinogen exposure or patient outcomes, suggesting that specific exposures give rise to specific types of molecular alterations in HNSCCs. Here, we describe how different etiologic factors are reflected in the molecular character and clinical outcome of these tumors. In a case series of primary, incident HNSCC (n = 68), we examined the DNA methylation profile of 1413 autosomal CpG loci in 773 genes, in relation to exposures and etiologic factors. The overall pattern of epigenetic alteration could significantly distinguish tumor from normal head and neck epithelial tissues (P P < 0.01), we did not observe an association between these profiles and overall patient survival after adjustment for stage; although methylation of a number of specific loci falling in different cellular pathways was associated with overall patient survival. We found that the etiologic heterogeneity of HNSCC is reflected in specific patterns of molecular epigenetic alterations within the tumors and that the DNA methylation profiles may hold clinical promise worthy of further study. [ABSTRACT FROM AUTHOR]

The Texas Air Quality Study 2000 (TexAQS2000) investigated the photochemical production of ozone and the chemistry of related precursors and reaction products in the vicinity of Houston, TX. The colocation of four instruments for the measurement of volatile organic carbon compounds (VOCs) allowed a unique opportunity for the intercomparison of the different in-situ measuring techniques. The instruments included three gas chromatographs, each with a different type of detector, and a Proton-Transfer- Reaction Mass Spectrometer (PTR-MS) with each system designed to measure a different suite of VOCs. Correlation plots and correlation statistics are presented for species measured by more than one of these instruments. The GC instruments were all in agreement to within 10-20% (slope) with coefficients of variation (r[SUP2]) of ≥0.85. The PTR- MS agreement with other instruments was more dependent on species with some very good agreements (r[SUP2] values of ∼0.95 for some aromatics), but isoprene, acetaldehyde and propene were substantially less highly correlated (0.55

Presents a study on the long-term outcomes of occupational asthma in the United States. Information on asthma as an occupational lung disorder in industrialized countries; Methodology of the study; Results obtained; Conclusion drawn.

Psoriasis is a chronic, inflammatory skin condition with significant effect on quality of life. It affects 3.2% of the United States population. Psoriasis is caused by an interaction between genetic and environmental triggers. Associated conditions include depression, increased cardiovascular risk, hypertension, hyperlipidemia, diabetes, nonalcoholic fatty liver disease, Crohn disease, ulcerative colitis, celiac disease, nonmelanoma skin cancers, and lymphoma. Several clinical variants exist, including chronic plaque, guttate, pustular, inverse, and erythrodermic psoriasis. Lifestyle modification and topical therapies, such as emollients, coal tar, topical corticosteroids, vitamin D analogues, and calcineurin inhibitors, are used for limited disease. More severe psoriasis may require systemic therapy with oral or biologic therapy. Individualized management of psoriasis may involve different combinations of treatments. Counseling patients about associated comorbidities is essential., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Erythema, skin thickening, and scales typify most cases, but other patterns exist. Tx choices may differ, depending on how much body surface area is covered.

Background: Exposure to the herbicide Agent Orange during the Vietnam War was widespread and is associated with numerous adverse health outcomes. A continuing concern of veterans is the possibility that exposure to the dioxin-containing herbicide might induce adverse reproductive outcomes. We sought to assess whether exposure to Agent Orange in Vietnam was associated with changes in DNA methylation in sperm in a subset of Vietnam veterans who participated in the Air Force Health Study (AFHS)., Methods: We studied 37 members of the AFHS chosen to have no, low, medium or high exposure to Agent Orange, based upon serum dioxin levels obtained during a series of examinations. DNA from stored semen was extracted and DNA methylation assessed on the Illumina 450 K platform., Results: Initial epigenome-wide analysis returned no loci that survived control for false discovery. However, the TEAD3 gene had four different CpG sites that showed loss of DNA methylation associated with dioxin exposure. Analysis assessing regional DNA methylation changes revealed 36 gene regions, including the region of the imprinted gene H19 to have altered DNA methylation associated with high exposure compared to the low exposure group. Additional comparison of our data with sperm DNA methylation data from Russian boys exposed to dioxin found an additional 5 loci that were altered in both studies and exhibited a consistent direction of association., Conclusions: Studying a small number of sperm samples from veterans enrolled in the AFHS, we did not find evidence of significant epigenome-wide alterations associated with exposure to Agent Orange. However, additional analysis showed that the H19 gene region is altered in the sperm of Agent Orange-exposed Ranch Hand veterans. Our study also replicated several findings of a prior study of dioxin-exposed Russian boys. These results provide additional candidate loci for further investigation and may have implications for the reproductive health of dioxin-exposed individuals.

Physicians in the United States increasingly care for culturally, linguistically, and educationally diverse immigrants with limited English proficiency. Language barriers contribute significantly to the health disparities experienced by patients with limited English proficiency. Qualified professional interpreters should be used instead of ad hoc interpreters, such as a patient's friend or family member, an untrained bilingual staff member, or a bilingual stranger. Children should not be used as interpreters. Physicians and other health care professionals must be fluent to communicate with patients in another language. Use of electronic translation systems should be avoided. Cultural competence refers to the attitudes, knowledge, and skills needed to work well in cross-cultural situations and effectively provide care to diverse populations. Stereotypes are perpetuated when members of a group are assumed to share cultural values, beliefs, or attitudes. Attempting to memorize a list of what to do and what to avoid when working with any particular group is ineffective. Every patient's culture is multidimensional and dynamic and is not defined by race or language group., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Immigrants and refugees are at risk of infectious diseases (IDs) that are rare in the United States. Screening and treatment before entry into the United States are required for some of these diseases, whereas quarantine is mandated for others. The Centers for Disease Control and Prevention has published specific recommendations for the evaluation and treatment of immigrants and refugees before and after they arrive in the United States. In addition, immigrants and refugees who return to their home countries are at greater risk of IDs than other travelers. Health care professionals are required to report certain IDs to state or local health departments., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Overseas medical screening by panel physicians for conditions that might jeopardize US public health is required for admission to the United States by immigrant visa or refugee status. According to protocols established by the Centers for Disease Control and Prevention, conditions such as active tuberculosis and substance dependence, when detected, prohibit entry to the United States, whereas close medical follow-up after arrival is required for individuals with other conditions. Refugees and asylees should undergo further medical assessment by a US civil surgeon as soon as possible after arrival. Applicants for legal permanent residence in the United States, whether by immigrant visa or adjustment of status, must receive vaccinations comparable to those recommended for citizens. When immigrants and refugees present to a primary care physician, the vaccination process may not be complete, and documentation of the extent to which it is complete might be lacking. Immigrants and refugees may have a variety of unrecognized or untreated musculoskeletal conditions, mental health conditions, infectious diseases, and chronic conditions., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Immigrants leave their homes for unfamiliar destinations in search of better lives for themselves and their families. Many immigrants experience profound loss and emotional distress as they adjust to life in different societies. Despite these challenges, the prevalence of mental health conditions among immigrants is low, whereas children of immigrants have rates equal to those of native populations. The prevalence of mental health conditions is high among refugees, who comprise a specific subgroup of immigrants who have been displaced forcibly and often have experienced severe trauma. Cultural factors, such as stigma and somatization of emotional symptoms, make it less likely that immigrants and refugees from certain groups will ever present to mental health subspecialists. Strong therapeutic relationships, cultural sensitivity, involvement of family members, judicious use of medications, and knowledge of available community resources are important tools that can aid clinicians who treat immigrants and refugees with mental health conditions., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Purpose: Oral and pharyngeal cancer patients diagnosed at an advanced stage experience increased morbidity and mortality relative to those with localized disease. The aim of this study was to assess the impact of dental insurance status and regularity of dental visits on early detection of oral and pharyngeal cancer., Methods: We examined the relationship of dental insurance and frequency of dental visits with stage at diagnosis among 441 oral and pharyngeal cancer cases from a population-based study of head and neck cancer. Ordinal logistic regression models were used to assess the association with stage, and tumor (T) and nodal (N) classification., Results: Never or rarely going to the dentist was associated with being diagnosed at higher stage for oral and pharyngeal cancer (cumulative OR = 2.28, 95 % CI: 1.02-5.10) and oral cancer (cumulative OR = 9.17, 95 % CI: 2.70-31.15) compared to those going to the dentist at least annually. Oral and pharyngeal cancer patients who went to the dentist infrequently (cumulative OR = 1.82, 95 % CI: 1.09-3.05) or rarely/never (cumulative OR = 3.24, 95 % CI: 1.59-6.57) were diagnosed with a higher T classification compared with those who went at least annually., Conclusions: Receipt of regular dental examinations at least annually may reduce the public health burden of oral and pharyngeal cancer by facilitating earlier detection of the disease.

Purpose: Chronic arsenic exposure at levels found in US drinking water has been associated with bladder cancer. While arsenic is a known carcinogen, recent studies suggest that it is useful as a therapeutic agent for leukemia. This study examined the relationship between arsenic exposure and bladder cancer mortality., Methods: We studied 832 cases of bladder cancer diagnosed in New Hampshire from a population-based case-control study. Individual exposure to arsenic was determined in home drinking water using ICP-MS and in toenail samples by instrumental neutron activation analysis., Results: Among the high arsenic exposure group, found using toenail arsenic level or arsenic consumption, cases experienced a de-escalated survival hazard ratio (HR) [high (> or =75 percent) versus low (<25th percentile) toenail arsenic overall survival HR 0.5 (95% CI 0.4-0.8)], controlled for tumor stage, grade, gender, age and treatment regimen. This association was found largely among invasive tumors, in smokers and was not modified by TP53 status. Bladder cancer cause-specific survival showed a similar trend, but did not reach statistical significance [HR 0.5 (95% CI 0.3-1.1)]., Conclusions: Arsenic exposure may be related to the survival of patients with bladder cancer.

Background: Genome-wide association studies have identified three chromosomal regions at 15q25, 5p15, and 6p21 as being associated with the risk of lung cancer. To confirm these associations in independent studies and investigate heterogeneity of these associations within specific subgroups, we conducted a coordinated genotyping study within the International Lung Cancer Consortium based on independent studies that were not included in previous genome-wide association studies., Methods: Genotype data for single-nucleotide polymorphisms at chromosomes 15q25 (rs16969968, rs8034191), 5p15 (rs2736100, rs402710), and 6p21 (rs2256543, rs4324798) from 21 case-control studies for 11 645 lung cancer case patients and 14 954 control subjects, of whom 85% were white and 15% were Asian, were pooled. Associations between the variants and the risk of lung cancer were estimated by logistic regression models. All statistical tests were two-sided., Results: Associations between 15q25 and the risk of lung cancer were replicated in white ever-smokers (rs16969968: odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.21 to 1.32, P(trend) = 2 x 10(-26)), and this association was stronger for those diagnosed at younger ages. There was no association in never-smokers or in Asians between either of the 15q25 variants and the risk of lung cancer. For the chromosome 5p15 region, we confirmed statistically significant associations in whites for both rs2736100 (OR = 1.15, 95% CI = 1.10 to 1.20, P(trend) = 1 x 10(-10)) and rs402710 (OR = 1.14, 95% CI = 1.09 to 1.19, P(trend) = 5 x 10(-8)) and identified similar associations in Asians (rs2736100: OR = 1.23, 95% CI = 1.12 to 1.35, P(trend) = 2 x 10(-5); rs402710: OR = 1.15, 95% CI = 1.04 to 1.27, P(trend) = .007). The associations between the 5p15 variants and lung cancer differed by histology; odds ratios for rs2736100 were highest in adenocarcinoma and for rs402710 were highest in adenocarcinoma and squamous cell carcinomas. This pattern was observed in both ethnic groups. Neither of the two variants on chromosome 6p21 was associated with the risk of lung cancer., Conclusions: In this international genetic association study of lung cancer, previous associations found in white populations were replicated and new associations were identified in Asian populations. Future genetic studies of lung cancer should include detailed stratification by histology.

Background: Autism is associated with high rates of genomic aberrations, including chromosomal rearrangements and de novo copy-number variations. These observations are reminiscent of cancer, a disease where genomic rearrangements also play a role. We undertook a correlative epidemiological study to explore the possibility that shared risk factors might exist for autism and specific types of cancer., Methodology/principal Findings: To determine if significant correlations exist between the prevalence of autism and the incidence of cancer, we obtained and analyzed state-wide data reported by age and gender throughout the United States. Autism data were obtained from the U.S. Department of Education via the Individuals with Disabilities Education Act (IDEA) (2000-2007, reported annually by age group) and cancer incidence data were obtained from the Centers for Disease Control and Prevention (CDC) (1999-2005). IDEA data were further subdivided depending on the method used to diagnose autism (DSM IV or the Code of Federal Regulations, using strict or expanded criteria). Spearman rank correlations were calculated for all possible pairwise combinations of annual autism rates and the incidence of specific cancers. Following this, Bonferroni's correction was applied to significance values. Two independent methods for determining an overall combined p-value based on dependent correlations were obtained for each set of calculations. High correlations were found between autism rates and the incidence of in situ breast cancer (p < or = 10(-10), modified inverse chi square, n = 16) using data from states that adhere strictly to the Code of Federal Regulations for diagnosing autism. By contrast, few significant correlations were observed between autism prevalence and the incidence of 23 other female and 22 male cancers., Conclusions: These findings suggest that there may be an association between autism and specific forms of cancer.

Objective: We evaluated the modifying influence of a delta-aminolevulinic acid dehydratase (ALAD) polymorphism on the relation between lead burden and cognition among older men., Methods: Information on ALAD genotype, lead measurements, potential confounders, and cognitive testing was collected from 982 participants. For each cognitive test and lead biomarker, we fit separate multiple linear regression models, which included an interaction term for ALAD genotype and the lead biomarker and adjusted for potential confounders., Results: With higher levels of tibia lead, ALAD 1-2/2-2 carriers exhibited worse performance on a spatial copying test in comparison with ALAD 1-1 carriers (P interaction = 0.03). However, there was no consistent pattern of an ALAD genotype-lead interaction for the other tests., Conclusions: The results provide some evidence that ALAD genotype may modify the relation between lead and cognition among older men with low lead burden. However, future work in this area is needed to confirm these suggestive findings.

The molecular pathology of bladder cancer has been the subject of considerable interest, and current efforts are targeted toward elucidating the interrelationships between individual somatic gene loss and both etiologic and prognostic factors. Mutation of the TP53 gene has been associated with more invasive bladder cancer, and evidence suggests that TP53 mutation, independent of stage, may be predictive of outcome in this disease. However, there is no consensus in the literature that bladder carcinogen exposure is associated with inactivation of the TP53 gene. Work to date has been primarily hospital based and, as such, subject to possible bias associated with selection of more advanced cases for study. We examined exposure relationships with both TP53 gene mutation and TP53 protein alterations in a population-based study of 330 bladder cancer cases in New Hampshire. Tobacco smoking was not associated with TP53 alterations. We found a higher prevalence of TP53 inactivation (i.e., mutation and nuclear accumulation) among hair dye users (odd ratio [OR] = 4.1; 95% confidence interval [CI] 1.2-14.7), and the majority of these mutations were transversions. Men who had "at risk" occupations were more likely to have mutated TP53 tumors (OR = 2.9; 95% CI 1.1-7.6). There also was a relative absence of TP53 mutation (OR = 0.4; 95% CI 0.0-2.9) and TP53 protein alterations (OR = 0.6; 95% CI 0.3-1.4) in bladder cancers from individuals with higher arsenic exposure. Our data suggest that there is exposure-specific heterogeneity in inactivation of the TP53 pathway in bladder cancers and that integration of the spectrum of pathway alterations in population-based approaches (capturing the full range of exposures to bladder carcinogens) may provide important insights into bladder tumorigenesis., ((c) 2005 Wiley-Liss, Inc.)

Background: Evidence on the association of 5,10 methylentetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms in women with gestational hypertension is inconsistent. It is also unknown whether the fetal genotype is relevant, or whether folic acid supplementation modifies this association., Methods: The study population was composed of U.S. and Canadian white women with nonmalformed infants participating in the Slone Epidemiology Center Birth Defects Study between 1993 and 2000. Women were interviewed within 6 months after delivery regarding multivitamin use in pregnancy and the occurrence of gestational hypertension, among other factors. DNA was extracted from cheek swabs and gene alleles determined by restriction fragment length polymorphism analysis. We compared the prevalence of the 677TT/CT and 1298CC/AC genotypes between cases with gestational hypertension (54 mothers and their 51 offspring) and controls (100 mothers and their 99 offspring). We also estimated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression to control for geographic region and calendar year., Results: The T allele was present in 69% of women with gestational hypertension versus 57% of control women (compared with 677CC, OR = 1.9; 95% CI = 0.9-4.0). The offspring of case and control women had a 677TT/CT genotype prevalence of 68% and 47%, respectively (2.4; 1.1-5.0). Among women supplemented with folic acid during the first 5 months of pregnancy, the ORs for maternal and fetal 677TT/CT genotypes were 0.9 (0.3-2.5) and 2.1 (0.7-6.0), respectively. Neither maternal nor fetal 1298CC/AC genotypes were associated with an increased risk of gestational hypertension., Conclusion: Maternal and fetal MTHFR C677T polymorphism may be associated with a moderately increased risk of gestational hypertension, and there is a suggestion that this association may be diminished among women receiving folate supplementation during pregnancy.

SEMA3B has been implicated as important for neuronal development and as a tumor suppressor in lung cancer. A single nucleotide alteration of this gene leads to the amino acid substitution T415I, and functionally, this variant protein has a reduced ability to act as a tumor suppressor. The prevalence of this variant in populations is unclear and its role in inherited lung cancer susceptibility has not been tested. Utilizing case-control studies of head and neck squamous cell carcinoma in a Caucasian population and of lung cancer in African-American and Latino-American populations, we determined both the prevalence of this polymorphic variant and its association with the case status of these patients. The variant Ile allele occurs at an allele frequency of 0.18 in African-American and 0.39 in Latino-American control subjects but not in Caucasian subjects. In analyses controlling for ethnicity and known lung cancer risk factors, a significant association was observed between case status and possession of the variant allele (OR 0.71, 95% CI 0.51-0.99). In stratified analysis, both Latino-Americans (OR 0.56, 95% CI 0.32-1.01) and African-Americans (OR 0.75, 95% CI 0.50-1.13) also showed a reduced risk of disease associated with the variant Ile allele. Possessing either the heterozygous or homozygous variant genotype confers a >40% reduced relative risk of lung cancer in Latino Americans controlling for other lung cancer risk factors. This study points to the need for further examination of this gene and its variant in lung cancer and other diseases.

The extant nomenclature for congenitally corrected transposition of the great arteries is reviewed for the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. All efforts were made to include all relevant nomenclature categories using synonyms where appropriate. Congenitally corrected transposition of the great arteries is a complex cardiac lesion that is associated with ventricular septal defect, left ventricular outflow tract obstruction, and tricuspid valve abnormalities. Nomenclature for this lesion has been variable and confusing. Herein we attempt to clarify the terminology, with an emphasis on identification of synonymous and nonsynonymous appellations. A comprehensive database set is presented that is based on a hierarchical scheme. Data are entered at various levels of complexity and detail that can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented that will allow for data sharing and would lend itself to basic interpretation of trends. Outcome tables relating diagnoses, procedures, and various risk factors are presented.