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ABSTRACT We report the result of a new Chandra observation of the black hole X-ray transient H 1705−250 in quiescence. H 1705−250 was barely detected in the new ∼50 ks Chandra observation. With five detected counts, we estimate the source quiescent luminosity to be LX ∼ 9.1 × 1030 erg s−1 in the 0.5-10 keV band (adopting a distance of 8.6 kpc). This value is in line with the quiescent luminosities found among other black hole X-ray binaries with similar orbital periods. By using images taken with the Faulkes Telescope North, we derive a refined position of H 1705−250. We also present the long-term light curve of the optical counterpart from 2006 to 2012, and show evidence for variability in quiescence. [ABSTRACT FROM AUTHOR]

palachicola Bay lies at the mouth of the Apalachicola River, where seasonally variable freshwater inflows and shifting winds have long been thought to contribute to the support of an unusually productive and commercially important oyster fishery. Links between the river and productivity have been shown to lie in salinity-induced reductions in oyster predators and oyster disease as well as organic supplements from an extensive floodplain. Several studies have also indicated that nitrogen (N) and phosphorous (P) carried by the river are important in fertilization of bay primary production. While there is concern that upstream water withdrawals may impact the fishery, the importance of riverine N to oyster diets remains unclear. We measured N and carbon (C) stable isotopes (δN, δC) in macroalgae, surface-water nitrate, and surface sediments, which showed a gradient from enriched riverine δN values to more depleted values in the Gulf of Mexico. In contrast, δC of particulate matter is depleted in the river and enriched offshore. Oyster stable isotope values throughout Apalachicola Bay are more complex, but are dominated by freshwater inputs and reflect the variability and hydrodynamics of the riverine inflows. [ABSTRACT FROM AUTHOR]

The article discusses the history of U.S. federal and state cooperation in the field of wildfire control following the 1911 enactment of the Weeks Act, a U.S. law that allowed the U.S. government to create and conserve national forests and set standards for fire management. The author begins by explaining the fire control measures outlined in the Weeks Act, which largely provided for federal financial assistance for state fire suppression measures. The author argues that the Clarke-McNary Act improved this cooperative framework, as the Weeks Act did not provide adequate funds to the U.S. Forest Service for firefighting. The article concludes with a description of the modern-day National Cohesive Wildland Fire Management Strategy.

Background: Male veterans receiving Veterans Health Administration (VA) care have worse health than men in the general population. Less is known about health status in women veteran VA patients, a rapidly growing population.Objective: To characterize health status of women (vs men) veteran VA patients across age cohorts, and assess gender differences in the effect of social support upon health status.Design and Patients: Data came from the national 1999 Large Health Survey of Veteran Enrollees (response rate 63%) and included 28,048 women and 651,811 men who used VA in the prior 3 years.Measurements: Dimensions of health status from validated Veterans Short Form-36 instrument; social support (married, living arrangement, have someone to take patient to the doctor).Results: In each age stratum (18 to 44, 45 to 64, and > or =65 years), Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were clinically comparable by gender, except that for those aged > or =65, mean MCS was better for women than men (49.3 vs 45.9, P<.001). Patient gender had a clinically insignificant effect upon PCS and MCS after adjusting for age, race/ethnicity, and education. Women had lower levels of social support than men; in patients aged <65, being married or living with someone benefited MCS more in men than in women.Conclusions: Women veteran VA patients have as heavy a burden of physical and mental illness as do men in VA, and are expected to require comparable intensity of health care services. Their ill health occurs in the context of poor social support, and varies by age. [ABSTRACT FROM AUTHOR]

Profiles U.S. Supreme Court Justice Byron R. White. Family background; Educational attainment; His achievements in sports; Career background.

Discusses the problems associated with capital punishment and the justice system being practiced in the U.S. Impact of the delay between sentencing and execution; Background on the capital punishment practice in the country; Deterrence and reform of capital punishment.

Presents several articles that profiles retired Justice Potter Stewart of the U.S. Supreme Court. Discussion on the written opinions on various cases; Background on his career as justice and lawyer; His views on the role as justice.

Focuses on the sequence of areal occupance in a section of Saint Louis, Missouri. Factories in the Cheltenham District; Reputation for the manufacture of various types of clay products; Geographic landscape.

The need for comparative research has been a persistent theme in the literature of community sociology for some time. Although comparative studies are being undertaken with greater frequency, a major problem associated with their design and execution stems from the ambiguity of the concept "community" and an inadequate conceptualization of the dimensions along which these social units vary. One recent approach to this problem has been through the application of factor analysis. Two studies, in particular, serve as our point of departure—Jonassen and Peres' factor analysis of eighty-two variables operating in eighty-eight Ohio counties and Hadden and Borgatta's factor analysis of sixty-five variables operating in all American cities of 25,000 or larger. Both studies contribute much to our knowledge of community structure, but as a framework for comparative analyses they have the following limitations: 1. The Jonassen and Peres study was limited to Ohio counties. Generalizing from their data to a different universe, or units thereof, would be a questionable procedure based on the shaky assumption that Ohio is "typical" or resembles closely the United States or any single state in question. 2. The Hadden and Borgatta study was limited to cities of 25,000 and larger. The use of factors identified in their study to differentiate smaller communities would involve accepting the assumption that smaller units vary along the same dimensions as larger units. 3. Although similar factors were identified in the above two studies, a number of differences were also observed. The differences may be a consequence of the different units studied (counties in one analysis and cities in the other), the different parameters involved (data from all Ohio counties in one study compared with data from all United States cities of 25,000 and larger in the other), or the different variables used in the two studies. (They have only twelve variables in common, and only fourteen others are conceptually similar. [ABSTRACT FROM AUTHOR]

The article describes cases of laboratory-acquired vaccinia virus (VACV) in the U.S. from 2005 to 2007. A laboratory worker experienced a needlestick to a finger while injecting a mice with recombinant VACV. Infection with an orthopoxvirus was confirmed by testing in the Laboratory Response Network laboratory. Another laboratory worker experienced an injury and infection was confirmed by polymerase chain reaction and viral culture. Exposure to VACV can lead to infections and can be associated with a high inoculum.

Focuses on the debate on whether the United States federal courts are becoming large-scale bureaucracies in which the individual judge no longer bears the responsibility for deciding cases and writing opinions. Perceptions of the internal structure of legal institutions; Factors leading to bureaucratic rather than personal decision-making; Proposed reduction of the flow of cases into district courts.

Focuses on the United States Supreme Court facts and misconceptions. Public interest in the operations of the Supreme Court; Role in the system of government; Dissemination of information on argued cases; Justices' preparation of an opinion; Integrity of judicial decisions.

Reflects on the author's experience as practicing lawyer and as an appellate judge in the U.S. Difference between a structured law firm and the supreme court; Similarity between drafting of an opinion and writing of an appellate brief; Activities of a justice; Importance of revising the standards for choosing federal judges.

Background: Caregiver burden (CB) reduces quality of life (QOL) and causes poor health outcomes. Spirituality impacts this relationship., Aims: To determine prevalence of CB and investigate relationships among CB, spirituality, and QOL in older U.S. adult informal caregivers (n = 754)., Methods: This was a cross-sectional, descriptive secondary analysis of data from the 2020 Health and Retirement Study using GLM and SEM., Results: Caregiver mean age was 65.93 (SD=8.37). Caregivers were primarily female (n = 456, 54.0%), White (n = 500, 79.5%), and married (n = 469, 65.3%). Most caregivers had moderate CB (n = 369, 49.8%). Black caregivers who were spiritual (p=.031) and caregivers with a high school diploma/GED who were spiritual (p=.021) had lower CB. Lower CB was correlated with higher QOL (p=< 0.001). SEM depicting an influencing effect of spirituality revealed good model fit (NFI=0.988; IFI=0.993; TLI=0.983; PCFI=0.397, RMSEA=0.043; χ 2 =9.577, p=.048, DF=4) CONCLUSIONS: Fostering spirituality in older adult caregivers could reduce CB and improve QOL., Competing Interests: Declaration of competing interest The authors declare that we have no declarations of interest to submit., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: During the 2022 mpox outbreak, most cases were associated with sexual contact, and many people with mpox sought care from sexual health clinics and programs. The National Network of STD Clinical Prevention Training Centers, in partnership with the Centers for Disease Control and Prevention, conducted a survey of US sexual health clinics and programs to assess knowledge, practices, and experiences around mpox to inform a future public health response., Methods: Between August 31 and September 13, 2022, the National Network of STD Clinical Prevention Training Centers facilitated a web-based survey. Descriptive statistics were generated in R., Results: Among 168 responses by clinicians (n = 131, 78%) and program staff (n = 37, 22%), more than half (51%) reported at least somewhat significant mpox-related clinical disruptions including burdensome paperwork requirements for mpox testing (40%) and tecovirimat use (88%). Long clinic visits (51%) added additional burden, and the median mpox-related visit lasted 1 hour. Few clinicians felt comfortable with advanced pain management, and clinicians felt most uninformed about preexposure (19%) and postexposure (24%) prophylaxis. Of 89 respondents involved in vaccination, 61% reported using equity strategies; however, accounts of these strategies revealed a focus on guideline or risk factor-based screenings instead of equity activities., Conclusions: These findings highlight the substantial impact of the 2022 mpox outbreak on sexual health care in the United States. Critical gaps and barriers were identified that may inform additional mpox training and technical assistance, including challenges with testing, diagnosis, and management as well as a disconnect between programs' stated goal of equity and operationalization of strategies to achieve equity., Competing Interests: Conflict of Interest and Sources of Funding: None declared., (Copyright © 2023 American Sexually Transmitted Diseases Association. All rights reserved.)

The US Food and Drug Administration (FDA) understands that innovative product development is essential to addressing the unmet medical need of non-healing chronic wounds. Barriers to product development for non-healing chronic wounds may involve but are not limited to a dearth of biological models, challenges in drug delivery, challenges in clinical trial execution, and limited commercial viability. This perspective article discusses FDA's renewed focus on non-healing chronic wounds and outlines efforts to address identified barriers to product development for non-healing chronic wounds. In collaboration with key wound healing stakeholders including academia, professional associations, patient groups, reimbursement organizations and industry, FDA intends to help advance product development for non-healing chronic wounds for the ultimate betterment of patients., (Published 2022. This article is a U.S. Government work and is in the public domain in the USA.)

Mississippi ranks as the nation's least-healthy state. There is a shortage of trained preventive medicine (PM) physicians in the state. The Department of Preventive Medicine at The University of Mississippi Medical Center was reinstated in 2015 to address this need. Initial PM residency accreditation was awarded in November of 2017 with subsequent notification of 10-year accreditation status in April of 2020 allowing up to 4 PGY-2 and 4 PGY-3 resident positions per year. The residency experiences provided by the program are varied and unique due to the program being housed in both the School of Medicine and the School of Population Health. Preventive medicine residents have the opportunity to complete the American College of Lifestyle Medicine's Lifestyle Medicine Residency Curriculum. Through our diverse didactic and clinical experiences, we are optimistic that our program will continue to attract, train, and retain PM physicians for our state., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Posttraumatic stress disorder (PTSD) is common in the United States, with a prevalence of nearly 8% in the general population and between 10% and 30% in veterans. Despite how common PTSD is, inpatient providers may not be familiar with its manifestations or feel comfortable taking care of patients who may exhibit symptoms related to it. In our combined experience as VA-based hospital medicine care providers, we have cared for thousands of patients hospitalized for a primary medical condition who also have PTSD as a comorbidity. We have noticed in our practices that we only focus our attention on PTSD if a related problem arises during a patient's hospitalization (eg, confrontations with the care team or high levels of anxiety). We contend that a more proactive approach could lead to better care, but little evidence about best practices exists to inform the interdisciplinary team how to optimally care for hospitalized medical patients with PTSD. In this narrative review, we present a synthesis of existing literature, describe how trauma-informed care could be used to guide the approach to patients with PTSD, and generate ideas for changes that inpatient providers could implement now, such as engaging patients to prevent PTSD exacerbations and promoting better sleep in the hospital.

Objectives: End-of-life communication is crucial because most U.S. hospitals implement cardiopulmonary resuscitation (CPR) in the absence of do-not-resuscitate directives (DNRs). Despite this, there is little DNR utilization data to guide the design of communication-training programs. The objective of this study was to determine DNR utilization patterns and whether their use is increasing., Methods: A retrospective database analysis (2000-2005) of DNR data for 206,437 patients, the entire patient population at Memorial Sloan-Kettering Cancer Center (MSKCC), was performed., Results: The hospital recorded, on average, 4,167 deaths/year. In 2005, 86% of inpatient deaths had a DNR, a 3% increase since 2000 (p < .01). For patients who died outside the institution (e.g., hospice), 52% had a DNR, a 24% increase over 6 years (p < .00001). Adult inpatients signed 53% of DNRs but 34% were signed by surrogates. The median time between signing and death was 0 days, that is, the day of death. Only 5.5% of inpatient deaths had previously signed an outpatient DNR. Here, the median time between signing and death was 30 days., Significance of Results: Although DNR directives are commonly utilized and their use has increased significantly over the past 6 years, most cancer patients/surrogates sign the directives on the day of death. The proximity between signing and death may be a marker of delayed end-of-life palliative care and suboptimal doctor-patient communication. These data underscore the importance of communication-training research tailored to improve end-of-life decision making.

Unlabelled: Support groups are rapidly becoming an important part of the recovery process for many people who stutter, and a growing number of speech-language pathologists (SLPs) are encouraging their clients to participate in support groups. At present, however, little is known about the individuals who join stuttering support groups and the benefits they derive from their participation. This study surveyed members of the National Stuttering Association (NSA) to learn about their experiences in support groups, as well as their experiences in speech therapy. Respondents were 71 people who attended the 1999 NSA conference in Tacoma, WA. The majority of respondents had participated in treatment several times during their lives, using a variety of techniques. Respondents who had participated in fluency-shaping treatments were more likely to report that they had experienced a relapse than those who had participated in stuttering modification or combined treatments. Also, there was a strong positive correlation between respondents' satisfaction with treatment and their judgments of clinicians' competence, suggesting that improved training for SLPs should lead to improved treatment for people who stutter. Results will be used to provide a foundation for further evaluations of the benefits of support group participation for people who stutter., Educational Objectives: The reader will learn (a) that many people who participate in the NSA have had numerous and varied experiences with speech treatment throughout their lives, (b) which aspects of treatment and support group participation are seen as most beneficial for people who participate in the NSA.

Objective: To conduct a multicenter study to validate the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE) II system, APACHE III system, Trauma and Injury Severity Score (TRISS) methodology, and a 24-hour intensive care unit (ICU) point system for prediction of mortality in ICU trauma patient admissions., Methods: The study population consisted of retrospectively identified, consecutive ICU trauma admissions (n = 2,414) from six Level I trauma centers. Probabilities of death were calculated by using logistic regression analysis. The predictive power of each system was evaluated by using decision matrix analysis to compare observed and predicted outcomes with a decision criterion of 0.50 for risk of hospital death. The Youden Index (YI) was used to compare the proportion of patients correctly classified by each system. Measures of model calibration were based on goodness-of-fit testing (Hosmer-Lemeshow statistic less than 15.5) and model discrimination were based on the area under the receiver operating characteristic curve (AUC)., Results: Overall, APACHE II (sensitivity, 38%; specificity, 99%; YI, 37%; H-L statistic, 92.6; AUC, 0.87) and TRISS (sensitivity, 52%; specificity, 94%; YI, 46%; H-L statistic, 228.1; AUC, 0.82) were poor predictors of aggregate mortality, because they did not meet the acceptable thresholds for both model calibration and discrimination. APACHE III (sensitivity, 60%; specificity, 98%; YI, 58%; H-L statistic, 7.0; AUC, 0.89) was comparable to the 24-hour ICU point system (sensitivity, 51%; specificity, 98%; YI, 50%; H-L statistic, 14.7; AUC, 0.89) with both systems showing strong agreement between the observed and predicted outcomes based on acceptable thresholds for both model calibration and discrimination. The APACHE III system significantly improved upon APACHE II for estimating risk of death in ICU trauma patients (p < 0.001). Compared with the overall performance, for the subset of patients with nonoperative head trauma, the percentage correctly classified was decreased to 46% for APACHE II; increased to 71% for APACHE III (p < 0.001 vs. APACHE II); increased to 59% for TRISS; and increased to 62% for 24-hour ICU points. For operative head trauma, the percentage correctly classified was increased to 60% for APACHE II; increased to 61% for APACHE III; decreased to 43% for TRISS (p < 0.004 vs. APACHE III); and increased to 54% for 24-hour ICU points. For patients without head injuries, all of the systems were unreliable and considerably underestimated the risk of death. The percentage of nonoperative and operative patients without head trauma who were correctly classified was decreased, respectively, to 26% and 30% for APACHE II; 33% and 29% for APACHE III; 33% and 19% for TRISS; 20% and 23% for 24-hour ICU points., Conclusion: For the overall estimation of aggregate ICU mortality, the APACHE III system was the most reliable; however, performance was most accurate for subsets of patients with head trauma. The 24-hour ICU point system also demonstrated acceptable overall performance with improved performance for patients with head trauma. Overall, APACHE II and TRISS did not meet acceptable thresholds of performance. When estimating ICU mortality for subsets of patients without head trauma, none of these systems had an acceptable level of performance. Further multicenter studies aimed at developing better outcome prediction models for patients without head injuries are warranted, which would allow trauma care providers to set uniform standards for judging institutional performance.

Background: African American women are seen with more advanced breast cancers, are less likely to be treated with breast-conserving surgery, and generally have poorer prognoses than white women. There are a myriad of potential causes for these phenomena. The purpose of this study was to measure racial differences in the surgical treatment of breast cancer among women with comparable health care access and delivery., Methods: The Breast Cancer Registry of the Department of Surgery at Henry Ford Hospital was accessed for all patients between January 1, 1990, and December 31, 1997 for whom data on race, tumor characteristics, stage, and treatment specifics were available. Socioeconomic information was collected with use of 1990 census block data. Proportions of women who received each treatment were compared for African Americans and whites with use of the relative risk (RR) and 95% confidence intervals (CI). We used multiple logistic regression to obtain estimates of the relative risk, controlling for potential confounding factors., Results: Of the 1699 patients in the database, 1250 had sufficient information for analysis. A total of 8.7% of African American women were diagnosed with late-stage disease (i.e., stage III or IV) compared with 7.9% of whites. Nevertheless, African American women had a lower frequency of stage I disease (30.5% vs 36.2%) and a higher frequency of stage II disease (36.8% vs 31.4%). Overall and adjusted risk estimates for age, tumor stage, marital status, median income, and type of insurance revealed no substantive or statistically significant differences between African American and white patients. The adjusted RR for local excision was 1.39 (95% CI 0.78 to 2.49), for lumpectomy and axillary dissection RR 0.92 (95% CI 0.66 to 1.29), for simple mastectomy RR 0.84 (95% CI 0.41 to 1.72), and for modified radical mastectomy RR 1.00 (95% CI 0.73 to 1.36)., Conclusions: In this setting of equal access to health care, African American women still have higher frequencies of stage II disease, although the frequencies for late-stage disease are similar. Nevertheless, no surgical differences were found in this population, even after the effects of socioeconomic indicators and stage at diagnosis were controlled for Survival differences between African American and white women are unlikely to be explained by differences in treatment.

The Ad Hoc Committee on Acquired Immunodeficiency Syndrome and Hepatitis of The Surgical Infection Society has outlined its policy regarding three deadly blood-borne viral infections. The risk of transmission of these microbes, the role of preoperative testing, the problem of the human immunodeficiency virus-infected surgeon, and conduct in the operating room are discussed.

How can a nursing service convincingly argue for autonomy and accountability without an understanding of the precise meanings of these terms? In this second of two articles exploring the meanings and implications of autonomy and accountability in nursing service, Lewis and Batey arrive at this and other provocative questions. They analyze the concept of accountability and provide selected definitions of the concept by directors of nursing. Their discussion provides insights into the presence or absence of true accountability in nursing organizations and presents issues for further study.

Survey content is necessarily limited by the investigators' foresight and by prior research on their subject of inquiry. Clinical data must supplement statistical data whenever the prior research is insufficient to delineate exactly what problems to expect. The differing perspectives on needs of patients sometimes set up competing demands. This calls for strategies based on a programmatic or population perspective that identifies the commonalities in patients educational needs from the statistical profiles, while at the same time allowing for the development of interventions that provide for as much tailoring of the educational experience based on clinical judgments as possible. By combining the community health education perspective with a clinical perspective, we were able to design interventions that responded to the educational needs of a population of low-income, black hypertensive patients. A needs assessment process that combined these perspectives began with a historical and community assessment of the problem in its most general terms. A second phase focused on the most important behavioral and organizational points for intervention. A third phase required formal assessment of predisposing, enabling, and reinforcing factors that may be determining the priority behaviors of health care organizational problems. Finally, clinical and administrative judgment sharpened and supplemented the educational interventions that were suggested by statistical data from formal surveys. Behavioral sciences theory was applied usefully in all these phases.