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OBJECTIVE:The authors examined whether factors other than civil commitment criteria influence the involuntary retention of patients who are evaluated for civil commitment in psychiatric emergency services in California general hospitals. METHODS:Logistic regression analysis was used to determine whether admission criteria, institutional constraints, social biases, and procedural justice indicators contributed to the use of coercive retention in the evaluations of 583 patients in the psychiatric emergency services of nine California county general hospitals. RESULTS:Of the 583 patients, 109 (18.7 percent) were retained against their wishes. Clinicians relied primarily on admission criteria in making the decision to retain a patient, which suggests that patients were generally afforded procedural due process during the evaluation in the psychiatric emergency service. Staff workload was a possible factor in violations of due process. CONCLUSIONS:Psychiatric emergency services need additional resources to ensure procedural due process protection for patients who are being evaluated for civil commitment.

Abstract BACKGROUND: Members of the public will soon be taking commercial suborbital spaceflights with significant G x (chest-to-back) acceleration potentially reaching up to 6 G x . Pulmonary physiology is gravity-dependent and is likely to be affected, which may have clinical implications for medically susceptible individuals. METHODS: During 2-min centrifuge exposures ranging up to 6 G x , 11 healthy subjects were studied using advanced respiratory techniques. These sustained exposures were intended to allow characterization of the underlying pulmonary response and did not replicate actual suborbital G profiles. Regional distribution of ventilation in the lungs was determined using electrical impedance tomography. Neural respiratory drive (from diaphragm electromyography) and work of breathing (from transdiaphragmatic pressures) were obtained via nasoesophageal catheters. Arterial blood gases were measured in a subset of subjects. Measurements were conducted while breathing air and breathing 15 oxygen to simulate anticipated cabin pressurization conditions. RESULTS: Acceleration caused hypoxemia that worsened with increasing magnitude and duration of G x . Minimum arterial oxygen saturation at 6 G x was 86 1 breathing air and 79 1 breathing 15 oxygen. With increasing G x the alveolar-arterial (A-a) oxygen gradient widened progressively and the relative distribution of ventilation reversed from posterior to anterior lung regions with substantial gas-trapping anteriorly. Severe breathlessness accompanied large progressive increases in work of breathing and neural respiratory drive. DISCUSSION: Sustained high-G acceleration at magnitudes relevant to suborbital flight profoundly affects respiratory physiology. These effects may become clinically important in the most medically susceptible passengers, in whom the potential role of centrifuge-based preflight evaluation requires further investigation. Pollock RD, Jolley CJ, Abid N, Couper JH, Estrada-Petrocelli L, Hodkinson PD, Leonhardt S, Mago-Elliott S, Menden T, Rafferty G, Richmond G, Robbins PA, Ritchie GAD, Segal MJ, Stevenson AT, Tank HD, Smith TG. Pulmonary effects of sustained periods of high-G acceleration relevant to suborbital spaceflight . Aerosp Med Hum Perform. 2021; 92(7):633641.

An assembly for a commercial Ga(+) liquid metal ion source in combination with an ion transportation and focusing system, a pulse high-voltage quadrupole deflector, and a beam diagnostics system has been constructed in the framework of the iThemba LABS (Cape Town, South Africa)-JINR (Dubna, Russia) collaboration. First, results on Ga(+) ion beam commissioning will be presented. Outlook of further experiments for measurements of charge breeding efficiency in the electron string ion source with the use of external injection of Ga(+) and Au(+) ion beams will be reported as well.

Since the start of managed care, there has been steady deterioration in the ability of physicians, hospitals, payors, and patients to understand reimbursement and the contracts and payment policies that drive it. This lack of transparency has generated administrative costs, confusion, and mistrust. It is therefore essential that physicians, hospitals, and payors have rapid access to accurate information on contractual payment terms. This article summarizes problems with contract-based reimbursement and needed responses by medical practices. It describes an innovative, Internet-based claims and payment verification service, Phynance, which automatically verifies the accuracy of all claims and payments by payor, contract and line item. This service enables practices to know and apply the one, true, contractually obligated allowable. The article details implementation costs and processes and anticipated return on investment. The resulting transparency improves business processes throughout health care, increasing efficiency and lowering costs for physicians, hospitals, payors, employers--and patients.