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The bullying of nurses by patients, doctors, and employees is common in the healthcare industry. Nurses who are bullied are more likely to experience burnout, and nurses who experience burnout are more likely to intend to quit. However, few studies investigate how leadership can mitigate workplace incivility and nurse bullying as a way to improve nurse retention. A cross‐sectional study was conducted using a sample of 216 nurses recruited from various regions across the United States from different specialties. A moderated mediation model using path analysis was used to examine the relationships between bullying, burnout, and ethical leadership in predicting intentions to stay. Bullying significantly and positively related to burnout (β = 0.22, p = 0.02), and burnout significantly and negatively related to intent to stay (β = −0.18,p = 0.01). Perceived ethical leadership predicted intentions to stay (β = 0.62, p = 0.00), and ethical leadership moderated the effect of bullying on burnout (β = 0.20, p = 0.03). The results of our study also suggest that nurses are less likely to quit when ethical leadership is present, and ethical leadership weakens the effect of bullying on burnout. [ABSTRACT FROM AUTHOR]

Vesicular stomatitis (VS) is a vector‐borne viral disease that causes lesions in livestock, premises, county and state quarantines, and important economic losses. We investigated vector–habitat characteristics for vectors associated with VS in regions of recurrent disease within the western United States (US) that consistently lead to the environment where vector, host, and pathogen populations intersect to enable pathogen transmission. We analyzed the habitats of previously identified insect vectors, including black flies (BFs) (Simulium vittatum complex), biting midges (BMs) (Culicoides variipennis complex, which includes Culicoides sonorensis), and sand flies (SFs) (Lutzomyia shannoni) in six regions of interest (ROIs) containing hotspots of VS ranging from Texas (TX) to Wyoming. This analysis broadened the understanding of (1) how regions of reoccurring VS differ from the broader western US, (2) how geographically separated regions and hotspots are similar across time, and (3) how vector–environment habitat a priori knowledge relates to observed hotspots. Analysis of watershed factors (livestock densities, land‐cover proportions, stream and lake densities, and irrigation methods) indicated a complex system separating areas with high, recurring VS from the broader western US. Although no single characteristic separated the six ROIs from other areas, we found two distinct emerging groups (northern ROI and TX). Hotspots, estimated from monthly VS concentrations, evolved northward throughout the year and most hotspots were closer to flowing water and agricultural land than the broader ROI. All ROIs contained environmental conditions suitable for multiple vectors at some point in the year, but BFs had the highest suitability scores, whereas BM scores were lower and varied annually with higher suitability in summer. SFs had the lowest suitability score in all ROIs, consistent with their low likelihood of being vectors. BM habitat patches were often orders of magnitude smaller than BF patches, and hotspot patches reinforce the likelihood that BF may be the most critical vector in northern ROI, whereas both BM and BF have similar likelihood in southern ROI. Given limited existing vector data, this analysis provides an alternate pathway for using habitat information to associate likely vectors responsible for transmission. Results could support early warning and mitigation efforts to reduce the incidence of VS. [ABSTRACT FROM AUTHOR]

New introductions to invasive mosquitoes, Aedes aegypti and Aedes albopictus, increase the risk for vector-borne diseases such as dengue, chikungunya, and Zika in the United States. Tracking these new introductions is more important than ever. This lesson plan focuses on the collection of mosquito larvae and pupae before the onset of summer with a focus on insect development. Students will observe the immature mosquitoes grow and metamorphose into adults. Novel aspects include collecting larvae and pupae around the home/school, observing the mosquito life cycle by safely rearing them from immature stages (larvae and pupae) to adults, and learning important background information on mosquito biology and pathogens that mosquitoes can transmit. The lesson describes new tools to use with the Invasive Mosquito Project, an international citizen science–based mosquito surveillance program exploring mosquitoes and the pathogens they may transmit to interested community members (including students and teachers) and their companion animals. This project is a stand-alone or follow-up lesson plan to the mosquito egg collection lesson used prior to the onset of winter (see Cohnstaedt et al., 2016). Students are able to participate in a hands-on tutorial to build a sealed emergence chamber to safely raise mosquitoes. Long-term data sets can also be used by teachers and students for further classroom discussions on the risks of mosquito-borne illnesses nationwide. This lesson further focuses on how individuals must play an active role in protecting their communities and pets from illness and increasing awareness of the dangerous pathogens mosquitoes can transmit and the importance of mosquito management. Materials from this lesson plan (available at http://www.citizenscience.us) can be adapted for each classroom but are best-suited for middle school to high school classes, as well as Advanced Placement classes. [ABSTRACT FROM AUTHOR]

Summary: The purpose of this risk assessment (RA) was to qualitatively estimate the risk of emergence of the Japanese encephalitis virus (JEV) in the United States (US). We followed the framework for RA of emerging vector‐borne livestock diseases (de Vos et al. 2011), which consists of a structured questionnaire, whose answers to questions can be delivered in risk categories, descriptive statements, or yes or no type of answers, being supported by the literature. The most likely pathways of introduction of JEV identified were: (a) entry through infected vectors (by aircraft, cargo ships, tires, or wind); (b) import of infected viremic animals; (c) entry of viremic migratory birds; (d) import of infected biological materials; (e) import of infected animal products; (f) entry of infected humans; and (g) import/production of contaminated biological material (e.g., vaccines). From these pathways, the probability of introduction of JEV through infected adult mosquitoes via aircraft was considered very high and via ships/containers was deemed low to moderate. The probability of introduction via other pathways or modes of entry (vector eggs or larvae, hosts, and vaccines) was considered negligible. The probability of transmission of JEV was variable, ranging from low to high (in the presence of both competent vectors and hosts), depending on the area of introduction within the US. Lastly, the probability of establishment of JEV in the continental US was considered negligible. For that reason, we stopped the risk assessment at this point of the framework. This RA provides important information regarding the elements that contribute to the risk associated with the introduction of JEV in the US. This RA also indicates that infected mosquitoes transported in aircraft (and cargo ships) are the most likely pathway of JEV entry and therefore, mitigation strategies should be directed towards this pathway. [ABSTRACT FROM AUTHOR]

The article reports on the pricing of perishable goods, specifically focusing on profit margin, wholesale prices and price changes. The structure of pricing is evaluated with respect to retail margin, percentage margin and the relationship between these price indicators. The article states an important assumption is that businesses shift their margins in an effort to increase profit. The author assumes store owners set prices in an effort to maximize profits. However, the primary challenge facing store owners (price setters) is that they cannot always determine the reaction of customers to price changes. The article uses an example of potato prices in 1953.

Rift Valley fever (RVF) is a zoonotic disease endemic in sub-Saharan Africa with periodic outbreaks in human and animal populations. Mosquitoes are the primary disease vectors; however, Rift Valley fever virus (RVFV) can also spread by direct contact with infected tissues. The transmission cycle is complex, involving humans, livestock, and multiple species of mosquitoes. The epidemiology of RVFV in endemic areas is strongly affected by climatic conditions and environmental variables. In this research, we adapt and use a network-based modeling framework to simulate the transmission of RVFV among hypothetical cattle operations in Kansas, US. Our model considers geo-located livestock populations at the individual level while incorporating the role of mosquito populations and the environment at a coarse resolution. Extensive simulations show the flexibility of our modeling framework when applied to specific scenarios to quantitatively evaluate the efficacy of mosquito control and livestock movement regulations in reducing the extent and intensity of RVF outbreaks in the United States. [ABSTRACT FROM AUTHOR]

Lyme disease has become the most prevalent vector-borne disease in the United States and results in morbidity in humans, especially children. We used historical case distributions to explain vector-borne disease introductions and subsequent geographic expansion in the absence of disease vector data. We used geographic information system analysis of publicly available Connecticut Department of Public Health case data from 1984, 1985, and 1991 to 2012 for the 169 towns in Connecticut to identify the yearly clusters of Lyme disease cases. Our analysis identified the spatial and temporal origins of two separate introductions of Lyme disease into Connecticut and identified the subsequent direction and rate of spread. We defined both epidemic clusters of cases using significant long-term spatial autocorrelation. The incidence-weighted geographic mean analysis indicates a northern trend of geographic expansion for both epidemic clusters. In eastern Connecticut, as the epidemic progressed, the yearly shift in the geographic mean (rate of epidemic expansion) decreased each year until spatial equilibrium was reached in 2007. The equilibrium indicates a transition from epidemic Lyme disease spread to stable endemic transmission, and we associate this with a reduction in incidence. In western Connecticut, the parabolic distribution of the yearly geographic mean indicates that following the establishment of Lyme disease (1988) the epidemic quickly expanded northward and established equilibrium in 2009. [ABSTRACT FROM AUTHOR]

Congenital haemophilia is an inherited bleeding disorder typically diagnosed at birth or shortly thereafter. Haemophilia imposes a significant burden on patients and their caregivers. The aim of the study was to quantify the overall burden of haemophilia on caregivers in the USA using a novel disease-specific questionnaire and the previously validated CarerQol. Targeted literature review and a previous survey conducted by the authors was used to develop an online questionnaire with six burden domains of interest to caregivers (emotional stress, financial, sacrifice, medical management, child's pain and transportation) and several visual analogue scales (VAS). Content validity of the questionnaire was confirmed by three haemophilia caregivers. The study sample consisted of caregivers of children with haemophilia identified via a previously developed optin research database. Descriptive statistics were employed for demographic and clinical characteristics; a generalized linear model (GLM) was used to identify factors influencing caregiver burden. A total of 310 caregivers completed the survey (45.5% response rate). Most of the participating caregivers were mothers of a child with haemophilia (88%), between 35 and 44 years of age (48%), and with a college education or a postgraduate degree (63%). 'Child's pain' was identified as the most burdensome domain to caregivers (median score = 3.50 out of 5), followed by 'emotional stress' (2.67), 'financial' (2.40), 'transportation' (2.33), 'sacrifice' (2.17) and 'medical management' (2.00) domains. Although higher income exhibited a protective effect, episodes of bleeds, current presence of an inhibitor and lower caregiver productivity in the past month negatively affected caregiver burden per GLM results. Training and educational programs should potentially be developed to address caregiver burden. [ABSTRACT FROM AUTHOR]

Current and forward-looking resource constraints within the federal health system and general health market are generating questions of fiscal or economic viability of a number of programs including graduate education. This article establishes a framework for assessing economic value among graduate health-related programs within the Army Medical Department. The findings of this analysis indicated that the programs evaluated in the study generate positive economic value based on a market-based valuation of extrinsic benefits compared to extrinsic costs for conducting graduate education within each of the programs. Suggestions for future research and policy application are also discussed. [ABSTRACT FROM AUTHOR]

The article presents several abstracts on intellectual property (IP) and patent in the U.S. related to planar ultrawideband modular antenna, tunnable antennas, and a system for measuring an antenna radiation pattern.

Abstract: Purpose: The purpose of this survey was to test the feasibility of using proposed quality indicators to assess radiotherapy quality in prostate cancer management based on a 2007 stratified random survey of treating academic and nonacademic US institutions. Methods and Materials: A total of 414 patients with clinically localized prostate cancer treated with external beam radiotherapy (EBRT) or brachytherapy were selected from 45 institutions. Indicators used as specific measurable clinical performance measures to represent surrogates for quality of radiotherapy delivery included established measures such as the use of prescription doses ≥75 Gy for intermediate- and high-risk EBRT patients and androgen-deprivation therapy (ADT) in conjunction with EBRT for patients with high-risk disease, and emerging measures, including daily target localization (image-guidance) to correct for organ motion for EBRT patients. Results: Among the 354 patients treated with EBRT, the beam energy was recorded in 353 patients. One hundred sixty-seven patients (47%) were treated with 6 MV photons, 31 (9%) were treated with 10 MV, 65 (18%) received 15 MV, and the remaining 90 (26%) 16-23 MV. For intermediate- plus high-risk patients (n = 181), 78% were treated to ≥75 Gy. Among favorable-risk patients, 72% were treated to ≥75 Gy. Among high-risk EBRT patients, 60 (87%) were treated with ADT in conjunction with EBRT and 13% (n = 9) with radiotherapy alone. Among low- and intermediate-risk patients, 10% and 42%, respectively, were treated with ADT plus EBRT. For 24% of EBRT patients (85 of 354), weekly electronic portal imaging was obtained as verification films without daily target localization, and the remaining 76% were treated with daily localization of the target using various methods. Conclusions: Adherence to defined quality indicators was observed in a majority of patients. Approximately 90% of high-risk patients were treated with ADT plus EBRT and ≈80% of intermediate- and high-risk patients received prescription doses ≥75 Gy, consistent with the published results of randomized trials. [Copyright &y& Elsevier]

Summary. Inpatient costs comprise >50% of annual healthcare costs for haemophilia patients with inhibitors but no reports exist on inpatient resource use and costs at a US national level. To quantify inpatient resource use and costs for on-demand treatment of bleeds of US haemophilia patients with inhibitors and compare costs and treatment duration between Factor VIII bypassing agents (BAs). Stays with haemophilia A from 2003-2008 were identified from inpatient billing records. Presence of inhibitors was inferred through use of BA; recombinant activated Factor VII and plasma-derived activated prothrombin complex concentrate. Duration and number of infusions of BA, length of stay, use of opioid-containing analgesics and costs were assessed and compared. Among 1322 stays mean BA treatment duration was 4.6 days with 4.9 infusions, 6.1 nights spent in hospital, and 58% administered opioid-containing analgesics. In unadjusted analyses there were significant differences in the above mentioned outcomes by BA use, reflecting underlying differences between the two patient populations. Average inpatient costs were $82 911. In adjusted analyses, African-American race, greater disease severity, hospital region outside the southern US and older age (cost model only) were significant predictors of longer BA treatment duration and higher costs. The economic burden of inpatient on-demand treatment of haemophilia with inhibitors is substantial and is associated with lengthy stays, high costs and inadequate pain relief. Availability of more effective BAs could reduce the need for re-treatment, reducing treatment costs and other medical costs, while improving health related quality of life. [ABSTRACT FROM AUTHOR]

Treatment preferences of haemophilia patients with inhibitors have not been well documented. This study sought to identify treatment attributes that patients/caregivers consider most important in the USA, inasmuch as those preferences may affect patient adherence to treatment plans. A discrete choice experiment was conducted to elicit treatment preferences. Haemophilia patients with inhibitors, or their caregivers on their behalf, completed a written survey that elicited preferences for treatment features and levels synthesized from the medical literature including: risk of viral transmission, rise in inhibitor titre, reduction in thromboembolic events, number of infusions, preparation time, infusion time/volume, time required to stop bleeding/alleviate pain, use of prophylaxis, use of major surgery and medication cost. Relative importance (RI) of preferences was modelled using a multinomial logit function. Most respondents were male (49 of 51, 96.1%); mean age, 20.7 years (SD = 18.8) and 88.5% of patients had haemophilia type A. The three most important patient-identified treatment attributes were as follows: time required to stop bleeding (RI = 19.3), possibility that the level of inhibitor may rise (RI = 14.3) and risk of contracting a virus from the product (RI = 13.5). Haemophilia patients with inhibitors and their caregivers appear to be willing to accept treatments that may be more inconvenient and painful as long as the treatments are effective in quickly controlling bleeds, do not increase inhibitor levels and do not pose a risk for viral contraction. Study findings provide meaningful input to the clinical community from patients and caregivers and support the importance of physicians understanding their patients' treatment preferences. [ABSTRACT FROM AUTHOR]

The article discusses the issue of deaths due to acetaminophen toxicity. It says that acetaminophen toxicity leading to liver failure and death has been a common form of acute liver failure (ALF). In 1990, nearly 50% of ALF cases in the U.S. were due to acetaminophen. A recent advisory from U.S. Food & Drug Administration dictates how much acetaminophen patients should receive each day. It is observed that overdoses are related to misuse of acetaminophen because public is unaware of its risks.

Background. Antimicrobial drugs used in human infection treatment and animal husbandry may select for drug-resistant bacterial pathogens, which are increasingly observed worldwide. We sought to examine the extent to which identical mobile drug resistance elements are shared across common pathogens isolated from human and animal sources. Methods. We compared the distribution of one class of mobile elements--integrons and gene cassettes-- among uropathogenic Escherichia coli isolates, Salmonella enterica serovar Typhimurium isolates from human diarrhea cases, and E. coli and Salmonella isolates from nonhuman sources in the United States. The sequences of the gene cassettes were also compared with those deposited in GenBank. Results. Class 1 integrons were detected in 68 (49%) of 139 uropathogenic E. coli isolates, 16 (72%) of 22 human and animal Salmonella isolates, and 120 (28%) of 436 nonhuman E. coli isolates. The most prevalent cassettes were those encoding aminoglycoside adenyltransferase A (aadA) and dihydrofolate reductase A (dfrA). Sequences of aadA1, dfrA12-orfF-aadA2, and dfrA17-aadA5 gene cassettes from 35 urinary tract infection E. coli isolates and of aadA2 and aadA12 gene cassettes from 7 Salmonella isolates were 100% identical to the corresponding cassette sequences from food animal E. coli isolates and those deposited in GenBank from a wide variety of bacteria isolated from animal hosts from distinct regions of the world. Conclusion. Common community-acquired human drug-resistant infections are caused by bacterial strains that harbor mobile drug resistance determinants of identical sequences that are found in diverse bacterial species from varied animal sources worldwide. [ABSTRACT FROM AUTHOR]

To measure health-related quality of life (HRQL), its determinants, and its association with patient and caregiver productivity among a sample of haemophilia patients with inhibitors in the United States (US). Data on demographical and clinical characteristics, treatment patterns, HRQL (SF-12v2), and productivity outcomes were reported for 53 patients. Mean SF-12v2 domain and mental (MCS) and physical (PCS) component summary scores were assessed and compared with US norms. Regression analyses explored the association of patient and treatment factors with HRQL and productivity. Patients’ mean age was 20.7 years (SD = 18.8), 88.5% were type A, and 39.6% received on-demand therapy as their only mode of treatment. Mean PCS was significantly lower than the US norm (PCS, 39.9, P < 0.01) and mean MCS showed no significant difference (MCS, 49.9, P = ns). On-demand treatment ( B = −0.336, P < 0.05) and number of haemorrhages ( B = −0.366, P < 0.05) were negatively associated with PCS; and PCS was associated with patients’ missed work or school days [incidence rate ratio (IRR) = 0.93, P < 0.001] and perceived impact on daily activities (OR = 0.72, P < 0.05). Younger age (IRR = 0.91, P < 0.01), lower PCS (IRR = 0.94, P < 0.01), more haemorrhages (IRR = 1.05, P < 0.05), and surgery (IRR = 2.74, P < 0.05) were associated with fewer patients’ productive days. Physical functioning among inhibitor patients in the US is compromised and is negatively associated with their daily activities and productivity. These data suggest a positive association of prophylactic and immunotolerance therapy with HRQL, specifically physical impairment. [ABSTRACT FROM AUTHOR]

The article offers information on several antennas patented in the U.S. It includes the high-frequency feed structure antenna apparatus and method of use, composite dipole array and the use of complementary metal oxide semiconductor techniques for antenna system. Other registered products in the U.S. include the composite material with chirped resonant cells, electronically scanned wideband antenna and UWB Antenna with 270 degree coverage and system thereof. It also includes a nanostructured tunable antennas for communication devices.

β-lactam antibiotics are ineffective against Mycobacterium tuberculosis, being rapidly hydrolyzed by the chromosomally encoded blaC gene product. The carbapenem class of β-lactams are very poor substrates for BlaC, allowing us to determine the three-dimensional structure of the covalent BlaC-meropenem covalent complex at 1.8 angstrom resolution. When meropenem was combined with the β-lactamase inhibitor clavulanate, potent activity against laboratory strains of M. tuberculosis was observed [minimum inhibitory concentration (MICmeropenem) less than 1 microgram per milliliter], and sterilization of aerobically grown cultures was observed within 14 days. In addition, this combination exhibited inhibitory activity against anaerobically grown cultures that mimic the "persistent" state and inhibited the growth of 13 extensively drug-resistant strains of M. tuberculosis at the same levels seen for drug-susceptible strains. Meropenem and clavulanate are Food and Drug Administration-approved drugs and could potentially be used to treat patients with currently untreatable disease. [ABSTRACT FROM AUTHOR]

Background: Vancomycin resistant enterococcus (VRE) is a major cause of nosocomial infections in the United States and may be associated with greater morbidity, mortality, and healthcare costs than vancomycin-susceptible enterococcus. Current guidelines for the control of VRE include prudent use of vancomycin. While vancomycin exposure appears to be a risk factor for VRE acquisition in individual patients, the effect of vancomycin usage at the population level is not known. We conducted a systematic review to determine the impact of reducing vancomycin use through prescribing interventions on the prevalence and incidence of VRE colonization and infection in hospitals within the United States. Methods: To identify relevant studies, we searched three electronic databases, and hand searched selected journals. Thirteen studies from 12 articles met our inclusion criteria. Data were extracted and summarized for study setting, design, patient characteristics, types of intervention(s), and outcome measures. The relative risk, 95% confidence interval, and p-value associated with change in VRE acquisition pre- and post-vancomycin prescription interventions were calculated and compared. Heterogeneity in study results was formally explored by stratified analysis. Results: No randomized clinical trials on this topic were found. Each of the 13 included studies used a quasiexperimental design of low hierarchy. Seven of the 13 studies reported statistically significant reductions in VRE acquisition following interventions, three studies reported no significant change, and three studies reported increases in VRE acquisition, one of which reported statistical significance. Results ranged from a reduction of 82.5% to an increase of 475%. Studies of specific wards, which included sicker patients, were more likely to report positive results than studies of an entire hospital including general inpatients (Fisher's exact test 0.029). The type of intervention, endemicity status, type of study design, and the duration of intervention were not found to significantly modify the results. Among the six studies that implemented vancomycin reduction strategies as the sole intervention, two of six (33%) found a significant reduction in VRE colonization and/or infection. In contrast, among studies implementing additional VRE control measures, five of seven (71%) reported a significant reduction. Conclusion: It was not possible to conclusively determine a potential role for vancomycin usage reductions in controlling VRE colonization and infection in hospitals in the United States. The effectiveness of such interventions and their sustainability remains poorly defined because of the heterogeneity and quality of studies. Future research using highquality study designs and implementing vancomycin as the sole intervention are needed to answer this question. [ABSTRACT FROM AUTHOR]

As a result of poverty, discrimination, and immigration and acculturation stress, adolescent Latinas in the United States often struggle with low self-esteem, depression, suicide attempts, and school dropout. Drawing from two studies conducted by the authors, this article discusses factors that are related to the adaptive functioning and sense of well-being of adolescent Latinas, the roles played by mother-daughter mutuality, and the supports offered by after-school programs. [ABSTRACT FROM AUTHOR]

Objectives. We evaluated the association between ecological factors and rates of tuberculosis within California, using pediatric tuberculosis as an indicator of new transmission. Methods. Ecological variables such as racial/ethnic distribution, immigration level, education, employment, poverty, and crowding were obtained from the United States Census for each census tract in California. These data were incorporated into a negative binomial regression model with the rate of pediatric tuberculosis disease in each census tract as an outcome variable. Disease rates were obtained by geocoding reported cases. Subsections of the state (San Francisco and Los Angeles) were examined independently. Results. Census tracts with lower median incomes, more racial/ethnic minorities, and more immigrants had higher rates of pediatric tuberculosis. Other frequently cited risk factors such as overcrowding and unemployment were not associated with increased disease after adjusting for other measures. Risks were comparable across regions, but subtle differences were noted. Conclusions. The techniques used in this work provide a way to examine a disease within its social context. The results confirmed that tuberculosis in California continues to be a disease of poverty and racial/ethnic minorities. [ABSTRACT FROM AUTHOR]

The article provides information on several intellectual property and patented products in the U.S. These include the reconfigurable aperture with an optical backplane developed by Lisa M. Lust and Paul E. Bauhahn and assigned to Honeywell International Inc., effectively balanced dipole microstrip antenna by Allan Tran and assigned to Kyocera Wireless Corp., and electronically steerable passive array antenna by Shuguang Chen and assigned to Paratek Microwave Inc.

Over the past 10 years, various kinds of logistics information systems have been developed to store and process all sorts of data and information to support daily logistics operations. However, the logistics planning or decision-making of logistics activity is still executed manually. In this paper, a real-time knowledge-based system (RKBS) is designed to support logistic service providers in making decisions during the stage of logistics planning and operation by extracting, sharing and storing real-time logistics knowledge. The proposed system, which is suitable for usage in different business processes in a warehouse operating environment, is developed by integrating radio-frequency identification, online analytical processing, case-based reasoning technologies, and a branch-and-bound resource-route-optimizing programming model. Through applying the RKBS in GENCO, a US-based logistics service company, the overall logistics servicing level is enhanced through accurate decision-making and planning of warehouse operations. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The role of hepatitis B virus (HBV) genotypes in the outcome of acute HBV infection is unclear. In this study, we aimed to evaluate the clinical and virological features of patients with hepatitis B-related acute liver failure (HBV-ALF) in the US. Clinical and laboratory features of consecutive patients with HBV-ALF from the US ALF Study Group were analysed. Prevalence of HBV genotypes, precore stop (G1896A) and core promoter dual (T1762A, A1764T) variants among patients with HBV-ALF were compared with a cohort of 530 patients with chronic HBV infection. Thirty-four HBV-ALF patients were studied: mean age 41 years, 56% men, 25 had detectable HBV-DNA. HBV genotypes A, B, C and D were found in 36, 24, 8 and 32% patients, respectively. Precore stop and core promoter dual variants were detected in 32 and 44% of patients, respectively. Twenty-three (68%) patients survived: 14 after liver transplant, nine without transplant. Older age was the only independent factor associated with poor outcome. Compared with patients with chronic HBV infection, patients with ALF were more likely to be non-Asians (88%vs44%,P = 0.005) and to have genotype D (32%vs10%,P < 0.01). A higher prevalence of HBV genotype D persisted even after matching for race and HBeAg status (32%vs16%,P = 0.007). We concluded that HBV genotype D was more frequently found in patients with HBV-ALF than those with chronic HBV infection in the US. Further studies are needed to determine if HBV genotypes play a role in the outcome of acute HBV infection. [ABSTRACT FROM AUTHOR]

The No Child Left Behind Act of 2001 (NCLB) builds on a tradition of gradually increasing federal involvement in the nation's public school systems. NCLB both resembles and differs from earlier federal education laws. Over the past five decades, conservatives in Congress softened their objections to the principle of federal aid to schools and liberals downplayed fears about the unintended consequences of increased federal involvement. The belief in limited federal involvement in education has been replaced by the presumption by many legislators that past federal investments justify imposing high stakes accountability requirements on schools. [ABSTRACT FROM AUTHOR]

From October 1999 through January 2000, an Escherichia coli clonal group (designated ‘CgA’) was isolated from the urine of nearly one-half of all women with urinary tract infections (UTIs) caused by trimethoprim-sulfamethoxazole (TMP-SMZ)–­resistant E. coli in a California community. This study describes the prevalence of pyelonephritis caused by CgA in the same community. E. coli isolates were characterized by enterobacterial repetitive intergenic consensus (ERIC2) polymerase chain reaction (PCR), serogrouping, and pulsed-field gel electrophoresis. Fourteen (11%) of 130 women with UTIs received a diagnosis of pyelonephritis. CgA was associated with 4 (57%) of the 7 pyelonephritis cases caused by TMP-SMZ­resistant E. coli and was associated with none of the cases caused by TMP-SMZ­susceptible E. coli (P<.02). Six (86%) of these TMP-SMZ­resistant E. coli isolates belonged to 2 distinct ERIC2 PCR­defined clonal groups, whereas all of the TMP-SMZ­susceptible E. coli strains had unique fingerprints (P<.001). The prevalence of antimicrobial­resistant pyelonephritis in a community may be affected by a limited number of E. coli clonal groups. [ABSTRACT FROM AUTHOR]

Explains how U.S. patent law determines small-entity status. Definition of small entities; Size standards that are applicable to reduced patent fees programs; Calculation of the number of employees; General principles of affiliation.

Explains the regulation of employee ownership of inventions in the U.S. Expression of ownership rights through contracts or an implied contract; Requirement of employment agreement or other contract obligation; Assignment of ownership to the inventions.

Reports on U.S. Patent and Trademark Office's proposals to speed up the patent process. Hiring of additional examiners; Flexible examination options; Increase patent fees.

Focuses on the use of the theory of planned behavior (TPB) for understanding exercise motivation and behavior in the U.S. Dominance of TPB in social cognitive frameworks; Prediction of incompletely volitional behavior; Concept of perceived behavioral control.

Presents a case of a 50-year-old patient with carotid-cutaneous fistula complications in Stanford, California. Use of neck dissection and radiation therapy for the treatment of tonsillar squamous cell carcinoma; Etiologic factors influencing the patient to bleeding; Association between carotid ligation and high rate of neurologic complications.

Objective: To determine the molecular epidemiology of tuberculosis isolated from patients cared for at eight hospitals scattered throughout New York City. Materials and Methods: Cases of tuberculosis occurring in 1996 and 1997 at collaborating hospitals were identified, and demographic data were extracted from patient charts. All available isolates were analyzed by IS 6110 for genetic relatedness. The molecular fingerprints were compared both to each other and to the larger repository of strains from New York City developed and maintained at the Public Health Research Institute. Results: One hundred and eighty cases were fully characterized. Compared with New York City cases, study patients were more likely to be Asian and less likely to be non-Hispanic blacks. Overall, 97 (54%) of the cases were clustered with respect to other study strains or with respect to the other New York City isolates. Clustered strains were significantly more likely to be from non-Hispanic blacks or patients born in the United States. The largest cluster (n = 17) was the "W" strain previously associated with an outbreak of multidrug-resistant tuberculosis in New York City. In the current study, the majority of W strain isolates were fully drug-susceptible. Conclusions: High rates of genetically related tuberculosis continue to occur among patients in New York City, in spite of improved control of nosocomial outbreaks and dramatic decreases in the overall case rates. The use of molecular techniques to suggest patterns of transmission has become essential in developing and assessing routine tuberculosis control strategies. [ABSTRACT FROM AUTHOR]

Mosquito-borne West Nile virus (WNV) is the causative agent of West Nile disease in humans, horses, and some bird species. Since the initial introduction of WNV to the United States (US), approximately 30,000 horses have been impacted by West Nile neurologic disease and hundreds of additional horses are infected each year. Research describing the drivers of West Nile disease in horses is greatly needed to better anticipate the spatial and temporal extent of disease risk, improve disease surveillance, and alleviate future economic impacts to the equine industry and private horse owners. To help meet this need, we integrated techniques from spatiotemporal epidemiology, eco-phylogenetics, and distributional ecology to assess West Nile disease risk in horses throughout the contiguous US. Our integrated approach considered horse abundance and virus exposure, vector and host distributions, and a variety of extrinsic climatic, socio-economic, and environmental risk factors. Birds are WNV reservoir hosts, and therefore we quantified avian host community dynamics across the continental US to show intra-annual variability in host phylogenetic structure and demonstrate host phylodiversity as a mechanism for virus amplification in time and virus dilution in space. We identified drought as a potential amplifier of virus transmission and demonstrated the importance of accounting for spatial non-stationarity when quantifying interaction between disease risk and meteorological influences such as temperature and precipitation. Our results delineated the timing and location of several areas at high risk of West Nile disease and can be used to prioritize vaccination programs and optimize virus surveillance and monitoring. [ABSTRACT FROM AUTHOR]

Presents information on a study investigating primary care office care visits rates in Iowa. Findings; Conclusions.

The article discusses the fallacy of U.S. militia system by the 1850s, which had been created in 1792 by the act of the Congress. The U.S. Armed Forces were compelled to take assistance from volunteers to fight the Mexican-American War, due to the inadequacy shown by the militia units during the American Revolution and the War of 1812. The system became the sensitive spot of political attack with its degrading cyclical problem and it proved impossible to construct a national system. The political leaders of South Carolina involved the militia in the political system of the state.

Partly in response to the negative social consequences of being unattractive, more and more people every year are turning to medical and dental professionals in the United States for alterations of their facial structures. Using standards for normal and abnormal dentofacial appearance developed in orthodontics, three studies were conducted to determine whether dentofacial irregularities (malocclusions) are "detectable" by the general public and cause a devaluation of an individual's perceived facial esthetics. The following major results were obtained: (a) dentofacial appearance is significantly related to the esthetic judgments of 10-13-yearold children as well as 18-23-year-old college students; (b) the condition which orthodontists treat, dentofacial malocclusion, is a significant, detractor from a person's general facial appearance and attractiveness; (c) subjects' esthetic decisions can be correlated to measurable, classifiable differences in facial morphology. [ABSTRACT FROM AUTHOR]

Presents a time-series regression analysis of Aid to Families with Dependent Children caseload movements in Los Angeles, California during the pre-Reagan and post-Reagan time period. Local demographic change as a main cause of rapid caseload expansion in Los Angeles; Growing number of female heads of households; Extension of restrictive welfare policies.

The article examines the scheduling of planned activities for trainably mentally retarded adolescents in the U.S. A number of classroom activities were schedule in either a predictable or unpredictable order using an ABAB design. The author mentioned the higher rates of disruptions under fixed scheduling were also associated with greater increments in disruptive behavior under random-scheduling conditions.

Discusses the challenges facing labor unions in the United States in the twenty-first century. Need for revitalized labor movements and the development of strategies; Long-term employment relationship with decent wages and benefits; Finding ways to advance the interests of unskilled, peripheral workers.

Focuses on the detection and surveillance of colorectal cancer in the U.S. Detection of early lesions resulting in a mortality rate of 20 percent or less; Importance of increased efforts to be focused not only on primary prevention but also on early detection of malignant lesions.

The article presents a case study of patients with granuloma annulare (GA), dermatofibroma (DF) and keloid/hypertropic scars (SC) treated with targeted broadband ultraviolet B phototherapy in the U.S. Researchers found that the method is beneficial because it promotes degradation of structural components of the dermis through induction of matrix metalloproteinases. Moreover, the method minimizes unnecessary risks like burns and skin cancer.

The article describes a program which aims to train nurses as Family Planning Nurse Practitioners, which is being sponsored by the Obstetrics and Gynecology Department of New Jersey Medical School, Planned Parenthood-World Population and Planned Parenthood-Essex County in the U.S. The main goal of the program is to equip nurse practitioners of skills that will enable them to plan, implement and evaluate several aspects of a family planning services program. Moreover, a family planning nurse practitioner is expected to deliver family planning services to normal patients.