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In the next decade Type Ia supernovae (SNe Ia) will be used to test theoriespredicting changes in the Dark Energy equation of state with time. Ultimatelythis requires a dedicated space mission like JDEM. SNe Ia are maturecosmological probes --- their limitations are well characterized, and a path toimprovement is clear. Dominant systematic errors include photometriccalibration, selection effects, reddening, and population-dependentdifferences. Building on past lessons, well-controlled new surveys are poisedto make strides in these areas: the Palomar Transient Factory, Skymapper, LaSilla QUEST, Pan-STARRS, the Dark Energy Survey, LSST, and JDEM. They willobviate historical calibrations and selection biases, and allow comparisons vialarge subsamples. Some systematics follow from our ignorance of SN Iaprogenitors, which there is hope of determining with SN Ia rate studies from0

Funding under Title IV-E has historically not been available to American Indian communities, therefore, tribes have had to develop agreements with states to access these funds for child care services. This study analyzes Title IV-E intergovernmental provisions to help tribes and states strengthen Title IV-E agreements. A nationwide content analysis of existing Title IV-E documents, phone interviews, and focus groups revealed that Title IV-E tribal/state agreements vary widely, with most tribes not receiving full access to state services. These agreements focus on foster care maintenance payments and services. This article includes recommendations to help facilitate tribal access to Title IV-E funding for foster care and adoption services. [ABSTRACT FROM AUTHOR]

In this article we document trends in welfare caseloads and some initial experiences of service providers and welfare recipients on reservations within Arizona under Temporary Assistance for Needy Families (TANF). We document the issues and concerns of state and tribal service providers as they implement the legislation on reservations that are often geographically isolated and which lack infrastructure, jobs, childcare and transportation. We also record experiences of women with children on reservations with the 1996 federal welfare legislation. These families experience similar barriers when trying to move from welfare to work as do their counterparts across the country; however, these barriers are magnified on reservations. The welfare recipients' barriers include: a shortage of employment opportunities on reservations; a lack of transportation and childcare facilities; low levels of education and job experience; and, individual and family problems. Poor families in Indian communities face additional barriers to employment because of their geographic isolation, lack of access to basic necessities (like telephones), as well as stereotypes and discrimination by employers due to ethnicity or personal/family histories. [ABSTRACT FROM AUTHOR]

Renal water reabsorption increases in pregnancy and lactation to expand maternal blood volume to cope with the cardiovascular demands of the developing fetus and new-born baby. Vasopressin (antidiuretic hormone) promotes renal water reabsorption and its secretion is principally stimulated by body fluid osmolality. Hence, lowered osmolality normally decreases vasopressin secretion. However, despite water retention profoundly reducing osmolality in pregnancy and lactation, vasopressin levels are maintained to drive blood volume expansion. Despite its importance for successful reproduction, the cellular mechanisms that maintain vasopressin secretion in the face of decreased osmolality during pregnancy and lactation are unknown. Vasopressin is secreted by neurons that are intrinsically osmosensitive through expression of N-terminal truncated-transient receptor potential vanilloid-1 channel, ΔN-TRPV1, which is mechanically activated by osmotically-induced cell shrinkage to increase vasopressin neuron activity. Vasopressin neurons also express TRPV4 but the role of TRPV4 in vasopressin neuron function is not well characterised. Here, we summarise our novel evidence showing that TRPV4 forms functional channels with ΔN-TRPV1 that have a greater single-channel conductance compared to channels with ΔN-TRPV1 alone. We propose that upregulation of TRPV4 heteromerisation with ΔN-TRPV1 might maintain vasopressin secretion in pregnancy and lactation to expand blood volume for successful reproduction., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Infections with a new corona virus in 2019 lead to the definition of a new disease known as Corona Virus Disease 2019 (COVID-19). The sever cases of COVID-19 and the main cause of death due to virus infection are attributed to respiratory distress. This is associated with the formation of pulmonary oedema that impairs blood oxygenation and hypoxemia as main symptoms of respiratory distress. An important player for the maintenance of a defined liquid environment in lungs needed for normal lung function is the epithelial sodium channel (ENaC). The present article reviews the implications of SARS-CoV-2 infections from the perspective of impaired function of ENaC. The rationale for this perspective is derived from the recognition that viral spike protein and ENaC share a common proteolytic cleavage site. This cleavage site is utilized by the protease furin, that is essential for ENaC activity. Furin cleavage of spike 'activates' the virus protein to enable binding to host cell membrane receptors and initiate cell infection. Based on the importance of proteolytic cleavage for ENaC function and activation of spike, it seems feasible to assume that virus infections are associated with impaired ENaC activity. This is further supported by symptoms of COVID-19 that are reminiscent of impaired ENaC function in the respiratory tract.

Precision medicine research implicates numerous state laws that may affect participants' rights and protections and are not preempted by federal law. The choice of which state's laws apply, and under what circumstances, can have significant impact on research design and oversight. But neither of the traditional approaches to choice of law issues-contractual agreement or determination by a court after a dispute arises-fit the research context well. We hosted a series of workshops with choice of law experts and research law and ethics experts to identify factors that are most crucial to account for in a future choice of law precision medicine research framework. Our workshops focused on precision medicine 'places' and choice of law factors; there was consensus that 'place where the harm occurred' was relevant and best represented by where the participant resides and/or where the research/institution is located. Our experts identified factors that need to be accounted for in a future choice of law framework. They also identified potential approaches, including a federal law or model state law as ways of achieving more uniformity of protections and a comprehensive database of laws, which merit further consideration to provide IRBs and researchers the guidance they require., (© The Author(s) 2022. Published by Oxford University Press on behalf of Duke University School of Law, Harvard Law School, Oxford University Press, and Stanford Law School. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Oxytocin and vasopressin secretion from the posterior pituitary gland are required for normal pregnancy and lactation. Oxytocin secretion is relatively low and constant under basal conditions but becomes pulsatile during birth and lactation to stimulate episodic contraction of the uterus for delivery of the fetus and milk ejection during suckling. Vasopressin secretion is maintained in pregnancy and lactation despite reduced osmolality (the principal stimulus for vasopressin secretion) to increase water retention to cope with the cardiovascular demands of pregnancy and lactation. Oxytocin and vasopressin secretion are determined by the action potential (spike) firing of magnocellular neurosecretory neurons of the hypothalamic supraoptic and paraventricular nuclei. In addition to synaptic input activity, spike firing depends on intrinsic excitability conferred by the suite of channels expressed by the neurons. Therefore, we analysed oxytocin and vasopressin neuron activity in anaesthetised non-pregnant, late-pregnant, and lactating rats to test the hypothesis that intrinsic excitability of oxytocin and vasopressin neurons is increased in late pregnancy and lactation to promote oxytocin and vasopressin secretion required for successful pregnancy and lactation. Hazard analysis of spike firing revealed a higher incidence of post-spike hyperexcitability immediately following each spike in oxytocin neurons, but not in vasopressin neurons, in late pregnancy and lactation, which is expected to facilitate high frequency firing during bursts. Despite lower osmolality in late-pregnant and lactating rats, vasopressin neuron activity was not different between non-pregnant, late-pregnant, and lactating rats, and blockade of osmosensitive ΔN-TRPV1 channels inhibited vasopressin neurons to a similar extent in non-pregnant, late-pregnant, and lactating rats. Furthermore, supraoptic nucleus ΔN-TRPV1 mRNA expression was not different between non-pregnant and late-pregnant rats, suggesting that sustained activity of ΔN-TRPV1 channels might maintain vasopressin neuron activity to increase water retention during pregnancy and lactation.

The interpretation of observations of cooling neutron star crusts in quasipersistent x-ray transients is affected by predictions of the strength of neutrino cooling via crust Urca processes. The strength of crust Urca neutrino cooling depends sensitively on the electron-capture and β-decay ground-state-to-ground-state transition strengths of neutron-rich rare isotopes. Nuclei with a mass number of A=61 are predicted to be among the most abundant in accreted crusts, and the last remaining experimentally undetermined ground-state-to-ground-state transition strength was the β decay of ^{61}V. This Letter reports the first experimental determination of this transition strength, a ground-state branching of 8.1_{-3.1}^{+4.0}%, corresponding to a log ft value of 5.5_{-0.2}^{+0.2}. This result was achieved through the measurement of the β-delayed γ rays using the total absorption spectrometer SuN and the measurement of the β-delayed neutron branch using the neutron long counter system NERO at the National Superconducting Cyclotron Laboratory at Michigan State University. This method helps to mitigate the impact of the pandemonium effect in extremely neutron-rich nuclei on experimental results. The result implies that A=61 nuclei do not provide the strongest cooling in accreted neutron star crusts as expected by some predictions, but that their cooling is still larger compared to most other mass numbers. Only nuclei with mass numbers 31, 33, and 55 are predicted to be cooling more strongly. However, the theoretical predictions for the transition strengths of these nuclei are not consistently accurate enough to draw conclusions on crust cooling. With the experimental approach developed in this work, all relevant transitions are within reach to be studied in the future.

Background: Vasoactive and inotropic support (VIS) may predispose cardiac surgery patients to ischemic gut complications (IGCx). The purpose of this study was to describe the effect of VIS on the manner in which we deliver tube feeds (TFs) and determine its relationship with IGCx in cardiac surgery patients., Methods: We reviewed cardiac surgery patients at a single institution and examined the effect of VIS (none, low, medium, high) on TF administration and evaluated IGCx., Results: Of 3088 cardiac surgery patients, 249 (8%) required TFs, comprising 2151 total TF-days. Increasing VIS was associated with decreased amounts of TF administered per day (P = .001) and an increase in time that TF was held per day (P < .001). High VIS was associated with less intact, more semi-elemental/elemental formula use (P < .001) and increased use of gastric route (P < .001). Of all cardiac surgery patients, 11 of 3125 suffered IGCx (0.4%), with a mortality of 73%. Of the 3 receiving TF, 2 IGCx were focal and consistent with acute embolus, whereas one was diffuse, on high VIS and an intra-aortic balloon pump. Of the 8 IGCx in the patients not receiving TF, 5 were focal, whereas 3 were diffuse and not embolic (P = .21)., Conclusions: Despite 32% of TF-days on moderate to high VIS, non-embolic IGCx were not increased compared with patients not receiving TF. As delivered at this institution, TF in even those requiring moderate to high inotropic and pressor support were not associated with an increase in attributable IGCx., (© 2020 American Society for Parenteral and Enteral Nutrition.)

Researchers now commonly collect biospecimens for genomic analysis together with information from mobile devices and electronic health records. This rich combination of data creates new opportunities for understanding and addressing important health issues, but also intensifies challenges to privacy and confidentiality. Here, we elucidate the "web" of legal protections for precision medicine research by integrating findings from qualitative interviews with structured legal research and applying them to realistic research scenarios involving various privacy threats.

We show that the neutron star in the transient system MXB 1659-29 has a core neutrino luminosity that substantially exceeds that of the modified Urca reactions (i.e., n+n→n+p+e^{-}+ν[over ¯]&#95;{e} and inverse) and is consistent with the direct Urca (n→p+e^{-}+ν[over ¯]&#95;{e} and inverse) reaction occurring in a small fraction of the core. Observations of the thermal relaxation of the neutron star crust following 2.5 yr of accretion allow us to measure the energy deposited into the core during accretion, which is then reradiated as neutrinos, and infer the core temperature. For a nucleonic core, this requires that the nucleons are unpaired and that the proton fraction exceeds a critical value to allow the direct Urca reaction to proceed. The neutron star in MXB 1659-29 is the first with a firmly detected thermal component in its x-ray spectrum that needs a fast neutrino-cooling process. Measurements of the temperature variation of the neutron star core during quiescence would place an upper limit on the core specific heat and serve as a check on the fraction of the neutron star core in which nucleons are unpaired.

The ever-increasing numbers of ethnic minority populations in the USA seeking social services suggest that a "multicultural paradigm shift" is underway and gaining speed. This shift will increasingly demand that prevention programs and interventions be more culturally responsive. Interventions that are not aligned with prospective participants' world views and experiences are only minimally effective. Existing models for conducting culturally grounded program adaptations emphasize identifying distinct levels of cultural influences while preserving core elements of the original intervention. An effective adaptation requires competent language translation as well as trained translations of program concepts and principles that will be meaningful to the targeted group, without compromising program fidelity. This article describes how a university research team and curriculum developers worked with American Indian youth and adults in a large southwestern city using a CBPR process to identify cultural elements that became foundational to the adaptation of a prevention curriculum that is a national model program, with the objective of increasing its applicability for urban native youth.

The temperature in the crust of an accreting neutron star, which comprises its outermost kilometre, is set by heating from nuclear reactions at large densities, neutrino cooling and heat transport from the interior. The heated crust has been thought to affect observable phenomena at shallower depths, such as thermonuclear bursts in the accreted envelope. Here we report that cycles of electron capture and its inverse, β(-) decay, involving neutron-rich nuclei at a typical depth of about 150 metres, cool the outer neutron star crust by emitting neutrinos while also thermally decoupling the surface layers from the deeper crust. This 'Urca' mechanism has been studied in the context of white dwarfs and type Ia supernovae, but hitherto was not considered in neutron stars, because previous models computed the crust reactions using a zero-temperature approximation and assumed that only a single nuclear species was present at any given depth. The thermal decoupling means that X-ray bursts and other surface phenomena are largely independent of the strength of deep crustal heating. The unexpectedly short recurrence times, of the order of years, observed for very energetic thermonuclear superbursts are therefore not an indicator of a hot crust, but may point instead to an unknown local heating mechanism near the neutron star surface.

Dental caries is the most common chronic disease of childhood with approximately 25% of children from low-income families entering kindergarten without ever having seen a dentist ( Larsen, Larsen, Handwerker, Kim, & Rosenthal, 2009 ). Youth, poverty, and race are characteristics of populations susceptible to oral disease (Dye, Xianfen, & Thorton-Evans, 2012). Services delivering oral health care to underserved populations are referred to as dental safety-net clinics. This article explores the impact of the dental safety-net on improving access to oral health care for underserved children in the United States.

This study examined the indigenous identities of urban American Indian youth using measures related to three theoretical dimensions of Markstrom's identity model: identification (tribal and ethnic heritage), connection (reservation ties), and involvement in traditional cultural practices and spirituality. Data came from self-administered questionnaires completed by 142 urban American Indian middle school students in a southwestern metropolitan area with the largest urban American Indian population in the United States. Using both quantitative and qualitative measures, descriptive statistics showed most youth were connected to all three dimensions of indigenous identity. Hierarchical regression analyses showed that youth with the strongest sense of American Indian ethnic identity had native fathers and were heavily involved in traditional cultural practices and spirituality. Although urban American Indians may face challenges in maintaining their tribal identities, the youth in this study appeared strongly moored to their native indigenous heritage. Implications for future research are discussed.

The thermal conductivities of common water models are compared using equilibrium (EMD) and non-equilibrium molecular dynamics (NEMD) simulation. A complete accounting for electrostatic contributions to the heat flux was found to resolve the previously reported differing results of NEMD and EMD Green-Kubo measurements for the extended simple point-charge (SPC/E) model. Accordingly, we demonstrate the influence of long-range electrostatics on the thermal conductivity with a simple coulomb cutoff, Ewald summation, and by an extended particle-particle particle-mesh method. For each water model, the thermal conductivity is computed and decomposed in terms of frequency-dependent thermodynamic and topological contributions. The rigid, three-site SPC, SPC/E, and transferable intermolecular potential (TIP3P-Ew) water models are shown to have similar thermal conductivity values at standard conditions, whereas models that include bond stretching and angle bending have higher thermal conductivities.

This article examines changes in the drug resistance strategies used by urban American Indian (UAI) middle school students during a pilot test of a substance use prevention curriculum designed specifically for UAI youth, Living in 2 Worlds (L2W). L2W teaches four drug resistance strategies (refuse, explain, avoid, leave [R-E-A-L]) in culturally appropriate ways. Data come from 57 UAI students (53% female; mean age = 12.5 years) who participated in L2W during an academic enrichment class for Native youth at two Phoenix schools. Students completed a pre-test questionnaire before the L2W lessons and a post-test 7 months later. Questions assessed the use of R-E-A-L and alternative strategies commonly reported by UAI youth (change the subject, use humor). Tests of mean differences from pre-test to post-test showed significant increases in use of refuse, explain, and leave, and an expanding R-E-A-L repertoire. Use of more passive strategies (avoid, use humor) did not change significantly, except for change the subject, which increased. Changes in the use of strategies did not differ significantly by gender, age, school grades, parental education, or length of urban residence. The L2W curriculum appears effective in teaching culturally relevant communication strategies that expand UAI youths' repertoire of drug resistance skills.

A new three-body method is used to compute the rate of the triple-alpha capture reaction, which is the primary source of 12C in stars. In this Letter, we combine the Faddeev hyperspherical harmonics and the R-matrix method to obtain a full solution to the three-body α+α+α continuum. Particular attention is paid to the long-range effects caused by the pairwise Coulomb interactions. The new rate agrees with the Nuclear Astrophysics Compilation of Reaction rates for temperatures greater than 0.07 GK, but a large enhancement at lower temperature is found (≈10(12) at 0.02 GK). Our results are compared to previous calculations where additional approximations were made. We show that the new rate does not significantly change the evolution of stars around one solar mass. In particular, such stars still undergo a red-giant phase consistent with observations, and no significant differences are found in the final white dwarfs.

Background and Objective: This article explores the aspects of spirituality and religious involvement that may be the protective factors against substance use among urban American Indian (AI) youth., Methods: Data come from AI youth (N = 123) in five urban middle schools in a southwestern metropolis., Results: Ordinary least squares regression analyses indicated that following Christian beliefs and belonging to the Native American Church were associated with lower levels of substance use., Conclusions and Scientific Significance: Following AI traditional spiritual beliefs was associated with antidrug attitudes, norms, and expectancies. Having a sense of belonging to traditions from both AI cultures and Christianity may foster integration of the two worlds in which urban AI youth live.

We present results from time-of-flight nuclear mass measurements at the National Superconducting Cyclotron Laboratory that are relevant for neutron star crust models. The masses of 16 neutron-rich nuclei in the scandium-nickel range were determined simultaneously, with the masses of (61)V, (63)Cr, (66)Mn, and (74)Ni measured for the first time with mass excesses of -30.510(890) MeV, -35.280(650) MeV, -36.900(790) MeV, and -49.210(990) MeV, respectively. With these results the locations of the dominant electron capture heat sources in the outer crust of accreting neutron stars that exhibit super bursts are now experimentally constrained. We find the experimental Q value for the (66)Fe→(66)Mn electron capture to be 2.1 MeV (2.6σ) smaller than predicted, resulting in the transition occurring significantly closer to the neutron star surface., (© 2011 American Physical Society)

Molecular dynamics simulations were used to study the interactions of three theaflavin compounds with lipid bilayers. Experimental studies have linked theaflavins to beneficial health effects, some of which are related to interactions with the cell membrane. The molecular interaction of theaflavins with membranes was explored by simulating the interactions of three theaflavin molecules (theaflavin, theaflavin-3-gallate, and theaflavin-3,3'-digallate) with a mixed bilayer composed of 1-palmitoyl-2-oleoyl phosphatidylcholine (POPC) and 1-palmitoyl-2-oleoyl phosphatidylethanolamine (POPE). The simulations show that the theaflavins evaluated have an affinity for the lipid bilayer surface via hydrogen bonding. The molecular structure of theaflavins influenced their configuration when binding to the bilayer surface, as well as their ability to form hydrogen bonds with the lipid headgroups. The theaflavin-bilayer interactions studied here help to define structure-function relationships of the theaflavins and provide a better understanding of the role of theaflavins in biological processes. The significance of the results are discussed in the context of black tea composition and bioactivity.

This study explored the drug resistance strategies that urban American Indian adolescents consider the best and worst ways to respond to offers of alcohol, cigarettes, and marijuana. Focus group data were collected from 11 female and 9 male American Indian adolescents attending urban middle schools in the southwest. The youth were presented with hypothetical substance offer scenarios and alternative ways of responding, based on real-life narratives of similar youth. They were asked to choose a preferred strategy, one that would work every time, and a rejected strategy, one they would never use. Using eco-developmental theory, patterns in the preferred and rejected strategies were analyzed to identify culturally specific and socially competent ways of resisting substance offers. The youth preferred strategies that included passive, non-verbal strategies like pretending to use the substance, as well as assertive strategies like destroying the substance. The strategies they rejected were mostly socially non-competent ones like accepting the substance or responding angrily. Patterns of preferred and rejected strategies varied depending on whether the offer came from a family member or non-relative. These patterns have suggestive implications for designing more effective prevention programs for the growing yet underserved urban American Indian youth population.

Molecular dynamics simulations were used to study the interactions of four green tea catechin compounds with lipid bilayers. Reported studies have shown that catechins are linked to beneficial health effects, specifically those related to interactions with the cell membrane. To better understand the molecular interaction of catechins with membranes, simulations were carried out of interactions of four catechin molecules [epicatechin (EC), epigallocatechin (EGC), epicatechin gallate (ECG), and epigallocatechin gallate (EGCG)] with a 1-palmitoyl-2-oleoylphosphatidylcholine (POPC) lipid bilayer. The simulations show that catechins possess a strong affinity for the lipid bilayer. Some are absorbed into the bilayer. The molecular structure and aggregated condition of the catechins significantly influences their absorption, as well as their ability to form hydrogen bonds with the lipid headgroups. Insight into these molecular interactions helps to distinguish the structure-function relationship of the catechins with lipid bilayers and provides a foundation for a better understanding of the role of catechins in biological processes.

Molecular dynamics simulations were performed to study the interactions of bioactive catechins (flavonoids) commonly found in green tea with lipid bilayers, as a model for cell membranes. Previously, multiple experimental studies rationalized catechin's anticarcinogenic, antibacterial, and other beneficial effects in terms of physicochemical molecular interactions with the cell membranes. To contribute toward understanding the molecular role of catechins on the structure of cell membranes, we present simulation results for seven green tea catechins in lipid bilayer systems representative of HepG2 cancer cells. Our simulations show that the seven tea catechins evaluated have a strong affinity for the lipid bilayer via hydrogen bonding to the bilayer surface, with some of the smaller catechins able to penetrate underneath the surface. Epigallocatechin-gallate (EGCG) showed the strongest interaction with the lipid bilayer based on the number of hydrogen bonds formed with lipid headgroups. The simulations also provide insight into the functional characteristics of the catechins that distinguish them as effective compounds to potentially alter the lipid bilayer properties. The results on the hydrogen-bonding effects, described here for the first time, may contribute to a better understanding of proposed multiple molecular mechanisms of the action of catechins in microorganisms, cancer cells, and tissues.

An emerging alternative to traditional partner management for sexually transmitted diseases (STDs) is expedited partner therapy (EPT), which involves the delivery of medications or prescriptions to STD patients for their partners without the clinical assessment of the partners. The Centers for Disease Control and Prevention recently recommended EPT nationally in limited circumstances; however, its implementation may raise legal concerns. We analyzed laws relevant to the distribution of medications to persons with whom clinicians have not personally treated or established a relationship. We determined that three fourths of states or territories either expressly permit EPT or do not expressly prohibit the practice. We recommend (1) expressly endorsing EPT through laws, (2) creating exceptions to existing prescription requirements, (3) increasing professional board or association support for EPT, and (4) supporting third-party payments for partners' medications.

Nucleosynthesis, on the surface of accreting neutron stars, produces a range of chemical elements. We perform molecular dynamics simulations of crystallization to see how this complex composition forms new neutron star crust. We find chemical separation, with the liquid ocean phase greatly enriched in low atomic number elements compared to the solid crust. This phase separation should change many crust properties such as the thermal conductivity and shear modulus.

Aim: To evaluate the role of computed tomography (CT) after herniography in the diagnosis and management of primary and recurrent groin hernias not detectable on clinical examination., Material and Methods: Fifty-one patients underwent CT post-herniography over a 6-year period for suspected primary or recurrent inguinal hernia. The herniography and post-herniography CT findings were retrospectively compared with clinical and surgical follow-up. Statistical analysis was performed to assess the role of herniography and CT post-herniography in the primary and recurrent groups., Results: Of the 51 patients investigated for occult inguinal hernia, 19 had previous hernia repair with possible recurrence. The most common symptom at presentation was groin pain or discomfort (84%). Seventy-five percent in the primary group and 84% in the recurrent group had no findings on herniography or CT. Nine percent in the primary group and 16% in the recurrent group had hernias diagnosed by herniography. CT did not enhance the detection of hernia. Sensitivity for herniography and CT herniography in the primary groin hernia group was 75% as against specificity, which was 100 and 90%, respectively. For the recurrent groin hernias, sensitivity was 60% for herniography and 40% for CT herniography and specificity 100% for both., Conclusion: CT performed post-herniography did not provide any benefit over performing herniography alone in the diagnosis of occult primary or recurrent inguinal hernias.

Objective: Cultural and familial ties are crucial for the overall well-being of children. Extant research and permanency planning practices support the reunification of children with their families when possible. In 1978, the Indian Child Welfare Act (ICWA) was enacted to promote cultural and familial preservation for Indian children, but sparse empirical research has examined the implementation and outcomes associated with this landmark legislation. This article examines the relationship between compliance with ICWA in one Southwestern state and the rate of reunification of Indian children with family or tribal members following out-of-home placement., Method: Public child protection records were reviewed for 49 ICWA-eligible children who were placed in alternate care. Data were collected on compliance with placement type, use of qualified expert witnesses, and incorporation of Indian culture and resources. Additionally, 78 state caseworkers and 16 tribal workers were surveyed regarding knowledge and attitudes about three areas of compliance., Results: Case record reviews indicated that the majority (83%) of Indian children were placed according to preferences outlined by ICWA. Almost all cases included a court finding that active efforts were applied to prevent family breakup. While state workers reported limited understanding of many ICWA's requirements, both state and tribal workers reported a high level of state-tribal cooperation in working with Indian families and children., Conclusions: Results of this study point to two major patterns of findings: (1) individual case record reviews suggest compliance with ICWA; and (2) differences exist in knowledge and perceptions of ICWA by state and tribal workers. Furthermore, state child protection systems should follow the American Indian lead in further emphasizing cultural and familial ties for children. Highlighting such ties acknowledges the importance of reunification and cultural and familial preservation to enable children to have a clear sense of tradition and belonging. Evidence indicates that compliance with ICWA promotes better outcomes through reunification.

Effective bioterrorism planning, prevention, and response require information sharing between various entities, ranging from public health authorities and health-care workers to national security and law enforcement officials. While the source of much information exchanged may be nonidentifiable, many entities legitimately need access to personally identifiable health information (or "protected health information" [PHI]) in planning for and responding to a bioterrorism event. The HIPAA Privacy Rule allows for essential exchanges of health data during a public health emergency while protecting against unnecessary disclosures of PHI. In the event of a bioterrorist attack, the Privacy Rule allows covered entities to disclose PHI without individual authorization in the following instances: (1) for treatment by health-care providers, (2) to avert a serious threat to health or safety, (3) to public health authorities for public health purposes, (4) to protect national security, (5) to law enforcement under certain conditions, and (6) for judicial or administrative proceedings. Despite these favorable disclosure provisions, some privacy challenges remain. The flow of PHI may be slowed by misunderstandings of the Privacy Rule's accounting requirement. In addition, in a bioterrorism scenario, nontraditional entities may find themselves acting as health-care providers, triggering Privacy Rule provisions. Finally, the potential for de facto disclosures of individuals' disease or exposure status increases where conspicuous treatment methods, isolation, or quarantine are implemented without additional measures to protect privacy. Understanding the Privacy Rule's impact on bioterrorism planning and response ensures that various entities can conduct their activities with needed information while still protecting individual privacy.

Chronic care facility stay has been shown to be an independent risk factor for venous thromboembolism. Review of the literature, however, reveals a paucity of data addressing the issue of venous thromboembolism in nursing home residents. The purpose of this study was to determine the incidence of venous thromboembolic events among nursing home residents. A retrospective cohort study was derived from data compiled in the State of Kansas Minimum Data Set (MDS) for nursing home residents from July 1, 1997 to July 1, 1998. A total of 18,661 residents (median age, 85 years, 74% female, 95% white) satisfied the study criteria. The outcome measures of the primary endpoint-development of a venous thromboembolic event (VTE)-were obtained from the MDS quarterly health assessments and the Medicare ICD-9 codes. We determined the incidence of VTE among nursing home residents as 1.30 events per 100 person-years of observation.

Objective: To characterize changing patterns of antidepressant use in nursing facilities across the urban-rural continuum during the mid-1990s., Design: Retrospective analysis of antidepressant drug codes and demographic/clinical data from the Minimum Data Set (MDS) 1994 to 1997., Setting: Kansas nursing facilities., Participants: Facility residents aged 65 and older., Measurements: We examined (1) admission use and (2) after-admission use for newer and older antidepressants for each year separately, using a 4-stratum system to classify nursing facility location by county, from urban to most rural. Incidence rate ratios were determined for antidepressant use in each stratum using the urban strata as the reference., Results: Remarkable increases in use of newer antidepressants were seen over time in all strata, but use was highest in the urban area. Modest urban-rural gradient effects attenuated over time and were not consistently seen across analyses and years. Tricyclic antidepressant (TCA) use remained largely unchanged over time and at much lower rates than newer agents. However, TCA use was also modestly higher in urban areas. Differences were clearer for use after admission, in contrast with admission use patterns., Conclusions: Newer antidepressants were rapidly adopted across the urban-rural continuum from 1994 to 1997. Marked increases in both admission and after-admission use of newer antidepressants were seen. Both newer and older antidepressants were used at modestly higher rates in urban areas. Further work is needed to elucidate the patient, prescriber, and facility factors that explain these prescribing patterns.

Objective: To characterize patterns of amitriptyline use across the urban-rural continuum., Design: Retrospective analysis of antidepressant drug codes and demographic and clinical data from the Minimum Data Set (MDS), 1994 to 1997., Setting: Kansas nursing facilities., Participants: Facility residents aged 65 and older., Measures: A four-strata system was used to classify nursing facility location by county, from urban to frontier. We examined admission use and after-admission use of amitriptyline across strata for each year separately. Unadjusted and adjusted odds ratios were determined for each stratum, using the urban stratum as the point of reference., Results: Admission use of amitriptyline occurred in 2.3 to 4% of all admissions, and although such use was highest in the most rural stratum, no clear urban-rural gradient was found. In contrast, amitriptyline use 30 days or more after admission demonstrated modest urban-rural gradients in unadjusted and adjusted analyses. In 1997, when adjusted for demographic factors, odds ratios for amitriptyline use were 2.10 (1.54-2.87), 1.68 (1.33-2.13), and 1.49 (1.17-1.90) for the Frontier, Rural, and Densely Settled Rural categories as compared with the Urban reference group., Conclusions: After admission to Kansas nursing facilities, rural practice patterns for amitriptyline use are less favorable than those in urban areas, and an urban-rural gradient is identified. Further work is needed to identify explanatory patient, facility, and prescriber factors.

Objectives: Depression is a common and treatable condition among nursing facility residents, with low body weight being a frequent concomitant concern. A common prescribing dictum is that older tricyclic antidepressants (TCAs) enhance appetite and may facilitate weight gain, while newer selective serotonin reuptake inhibitors (SSRIs) cause anorexia and resultant weight loss in older adults. Evidence is lacking on whether the small weight changes noted during short-term antidepressant efficacy trials translate into larger weight changes during prolonged treatment periods. Our main objective was to compare weight outcomes at 6 months among users of three different antidepressant groups with a control group of non-antidepressant users. A secondary objective was to determine whether antidepressant selection was associated with weight pattern before drug initiation, to capture possible prescribing bias that would affect study inferences., Design: Retrospective cohort design using the Minimum Data Set--Plus (MDS+)., Setting: Kansas nursing facilities., Participants: 1,157 antidepressant users age 65 and older who started an antidepressant after admission and remained on the same single agent for at least 6 months, and 4,852 persons meeting the same inclusion/exclusion criteria but not receiving an antidepressant., Measurements: Antidepressant use was identified by drug code data and divided into four groups for analysis: TCAs, SSRIs, others, and none. (Amitriptyline and trazodone were excluded because of frequent use for nondepression purposes.) Rates of clinically important loss and gain (assigned for a 10% change from baseline weight or presence of the significant loss or gain markers on the 6-month MDS assessment) and mean weight changes were compared across the four groups. Regression models were used to control for age, gender, baseline weight, confounding comorbidity, and functional variables related to eating. Previous weight patterns (loss, gain, neither, or unknown) before antidepressant initiation were compared across drug groups., Results: Clinically important weight loss and gain occurred at 6 months in 14.8% and 14.4% of the sample, respectively. In unadjusted analyses, an increased likelihood of loss was found for users of SSRIs (Odds Ratio 1.57; CI 1.30, 1.90) and others (OR 1.89; CI 1.18, 3.03), compared with none. In logistic models accounting for potential confounding factors, however, SSRI use showed a modest association with gain (OR 1.31, CI 1.01, 1.70) and a trend toward a similarly modest association with loss (OR 1.28; CI 0.995, 1.64). TCA use was not associated with weight gain. When weight was examined as a continuous variable, all groups demonstrated a broad range of both loss and gain with mean-unadjusted weight changes < 3 pounds. Pairwise comparisons of adjusted differences in weight change at 6 months for SSRIs (mean loss of 1.6 pounds) and TCAs (mean gain of 0.4 pounds) were of marginal importance (P = .046) given the large sample size. No evidence was found for prescribing bias based on prior weight pattern., Conclusions: TCAs do not facilitate weight gain more than other antidepressant groups and SSRIs are not associated disproportionately with weight loss when other important clinical variables are accounted for. Small but statistically significant differences in mean weight changes between groups are largely a reflection of large sample size rather than clinically important differences. Clinicians may wish to reconsider the widely held notions that TCAs facilitate weight gain and that SSRIs place depressed older nursing facility residents at disproportionate risk for weight loss.

Objectives: This study was undertaken to determine the degree to which selected demographic and clinical variables are associated with the use of feeding tubes in older nursing home residents with very severe and irreversible cognitive impairment., Design: Descriptive, cross-sectional, population-based study., Setting: Kansas nursing homes from January 1, 1994, through June 30, 1998., Participants: A total of 4,997 nursing home residents with very severe and irreversible cognitive impairment comprised the study population. Subjects were identified using data in Minimum Data Set (MDS) reports. Those who were included in the study population were over the age of 65, had two consecutive Cognitive Performance Scale scores of 6, were without evidence of significant subsequent improvement, and were not comatose., Measurements: The MDS data on each resident were examined to determine subjects' age, ethnicity, gender, Medicaid eligibility, disease diagnoses, physical functioning, and oral/nutritional status, including feeding tube status. The MDS was also used to determine urban versus rural location of the nursing home. The association between the use of feeding tubes and selected demographic and clinical characteristics was then examined using bivariate and logistic regression tests., Results: Of the 4,997 residents in the study population, 577 (11.6%) had feeding tubes. In multivariate analysis, feeding tube use was found to be associated with swallowing problems (odds ratio (OR) 5.4, 95% confidence interval (CI) 4.3-6.8); urban location of nursing home (OR 2.9, 95% CI 2.3-3.5); non-white race (OR 2.7, 95% CI 1.9-3.6); stroke (OR 2.5, 95% CI 2.0-3.1); and absence of dementia (OR 2.5, 95% CI 2.0-3.1). Feeding tubes were also more weakly associated with age <86 years, male gender, dependency for all activities of daily living, and absence of a living will. Feeding tube use was not found to be associated with chewing problems, Medicaid status, or resuscitation status., Conclusions: Clinical variables including swallowing problems, stroke, and absence of dementia were strongly associated with the use of feeding tubes in this cross-sectional, population-based study. In addition, urban location of nursing home and non-white race were significantly associated with feeding tubes. These findings suggest that feeding tube decisions are strongly influenced by nonclinical factors and invite further investigation.

Objective: To identify factors associated with very long survival among all cancer cases diagnosed at age 19 years or younger registered by the Cancer Data Service at the University of Kansas Medical Center in Kansas City, Kansas, U.S.A. in the 40-year period between 1944 and 1983, with follow-up to 1993., Methods: There were 2720 pediatric patients with 2750 cancers who were studied. Forty-four types of cancer were grouped into 11 diagnostic categories. Diagnosis years spanned four eras: 1944-1953, 1954-1963, 1964-1973, and 1974-1983. Cases were compared using specific characteristics and were divided into short-term and long-term survivors with the division generously set at seven years. The proportions of the long-term survivors were compared by specific characteristics., Results: Among the diagnostic categories, leukemias were the most common (29.8%), followed by CNS tumors (15.2%), and Hodgkin's disease (9.0%). Male to female ratio was 4:3; average age at diagnosis was 8.83 +/- 6.08 years. Long-term survivors totaled 1148 (41.7%). Prognosis was better in cases diagnosed in earlier stages and in later eras. Proportion of long-term survivors increased from 18.7% in era I to 52.6% in era IV. Improvement of survival was statistically significant in most diagnostic categories., Conclusions: This study shows continuing improvement of survival during four consecutive eras for childhood and adolescent cancer. Early diagnosis was associated with better survival. Unstaged cases decreased over time reflecting progress in diagnostic techniques. Many patients died before seven years after diagnosis. Those who survived more than seven years had excellent survival. Pediatricians can expect to participate in the care of these patients long after the original dianosis and treatment.

A new bioelectrical impedance method was developed to determine the erythrocyte sedimentation rate (ESR) by measuring the settling velocity of red blood cells. A sample of blood was collected in a plastic tube with two electrodes, one positioned above the other. Measurements of electrical resistance were made in the upper region of the blood column. As the red blood cells settled towards the bottom of the container, the resistance decreased continuously. The velocity of settling red blood cells was calculated in 45 samples. The values obtained compared favourably with the ESR determined by the standard Westergren method, giving a correlation coefficient of 0.96 and a standard error estimation of 7.0 mmh-1. We conclude that bioelectrical impedance can be used to measure ESR accurately and that this method has important advantages over existing methods.

Advances in radiology over the past 20 years are the product of a technologic imperative that has produced new approaches to the acquisition of medical images and modifications to conventional approaches. The imperative has placed radiology at the leading edge of the computer-technology era of modern medicine and has also produced several big-ticket technologies that have been identified as major contributors to rising health care costs. Consequently, the demands for quantitative data on the impact and cost-effectiveness of the use of these technologies in the clinical arena are increasing. Meeting the growing demand for accountability in radiology requires that the discipline adopt innovative approaches for assessing its technologies and acquire new types of data, including documentation of cost savings accrued by selective use of radiologic technologies and demonstration of the efficiency and cost-effectiveness of triage schemes that lead to more effective decision making. The requirement of quantitative accountability represents a new way of doing business for radiology and a new approach to management for those responsible for business.

The bioelectrical impedance method was used to determine the haematocrit in patient blood samples. The resistance (R) and reactance (X) of a constant volume of blood were measured at a low (50 kHz) and high (1 MHz) frequency. These dual-frequency impedance measurements were then used to determine the intracellular and extracellular (plasma) fluid volume of the blood and thus the haematocrit in 308 blood samples. The values compared favourably with the microhaematocrit determined on the same samples, giving a correlation coefficient of 0.989 and a standard error estimation of 1.41%. Reactance at 1 MHz was a better parameter for predicting haematocrit than resistances. Factors affecting the resistivity of plasma, such as electrolyte and protein concentrations, were the error sources in the impedance technique. Our technique reduced such errors significantly. In conclusion, this electronic method can be used to measure haematocrit accurately and may be more desirable than conventional methods in certain clinical situations.

Objective: The authors sought to determine whether the signs and symptoms of endotoxemia were related to the endotoxin-stimulated increase in circulating phospholipase A2 (PLA2) activity., Background: Because hypotension and pulmonary injury have been associated with elevated PLA2 activity in septic shock and PLA2 levels are reduced with the administration of glucocorticoids, the PLA2 response to endotoxin was investigated in volunteers pretreated with and without hydrocortisone., Methods: Carefully screened human subjects were studied under four conditions: (1) saline, (2) hydrocortisone, (3) endotoxin, and (4) hydrocortisone administration before endotoxin exposure. Pulse rate, blood pressure, temperature, and symptoms of endotoxemia were serially measured. Plasma for tumor necrosis factor concentrations and PLA2 activity was obtained., Results: After lipopolysaccharide, pulse rate and tumor necrosis factor concentrations rose at 1 to 2 hours; temperature increased maximally at 4 hours. PLA2 activity reached peak levels at 24 hours. With hydrocortisone pretreatment, a 50% reduction in the concentrations of tumor necrosis factor and PLA2 occurred. Significant correlations between other variables and PLA2 activity were not observed. The enzyme identified by monoclonal antibody was the secreted nonpancreatic PLA2 (SNP-PLA2)., Conclusions: The results of this study suggest that elevations in circulating SNP-PLA2 activity and systemic events associated with intravenous endotoxin administration are unrelated.

The body's response to infection/inflammation is initiated by the elaboration of cytokines, such as tumor necrosis factor, interleukin 1-beta (IL-1-beta), IL-6, and IL-8. Cytokines, in turn, stimulate the pituitary-adrenal axis, and it has been suggested that the corticosteroids elaborated serve as negative feedback signals to diminish inflammatory events. To test this hypothesis, we administered hydrocortisone shortly before endotoxin administration to normal volunteers. Steroids greatly reduced the clinical response to endotoxin and attenuated the appearance of tumor necrosis factor, IL-6, and IL-8 in the circulation. In contrast, IL-1-receptor antagonist, a competitive antagonist of the IL-1 receptor, was unaffected by steroid administration. These data suggest that IL-1-receptor antagonist may act in synergism with corticosteroids to reduce inflammation. Elevation of concentrations of these two factors, corticosteroids and IL-1-receptor antagonist, in plasma appears to be the mechanism used by the body to overcome the effects of inflammatory cytokines.

Radiofrequency catheter ablation has very quickly generated considerable enthusiasm among electrophysiologists because it offers a less invasive alternative to an open surgical procedure and potentially offers an alternative to lifelong drug therapy. Early literature on RF catheter ablation focused on the technical aspects of the procedure. In contrast, the literature of the past several years is dominated by very favorable reports of large series of patients and the experience of individual institutions. The larger series have focused on the treatment of accessory pathways as opposed to AV nodal reentry pathways. The opinions of the DATTA panelists parallel the literature. The panelists considered the technology to be established in terms of its safety and effectiveness as a curative treatment of accessory pathways, and promising in terms of its safety and between promising and established in terms of its effectiveness as a treatment of AV nodal reentrant tachycardias.