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The reliance on discretionary spending for American Indian/ Alaska Native health care has produced a system that is insufficient and unreliable and is associated with ongoing health disparities. Moreover, the gap between mandatory spending on a Medicare beneficiary and discretionary spending on an American Indian/Alaska Native beneficiary has grown dramatically, thus compounding the problem. The budget classification for American Indian/Alaska Native health services should be changed, and health care delivery to this population should be designated as mandatory spending. If a correct structure is in place, mandatory spending is more likely to provide adequate funding that keeps pace with changes in costs and need. [ABSTRACT FROM AUTHOR]

Carbon nanodots (CNDs) are a new type of nanomaterial with a size of less than 10 nanometers and excellent biocompatibility, widely used in fields such as biological imaging, transmission, diagnosis, and drug delivery. However, its potential and mechanism to mediate endothelial inflammation have yet to be explored. Here, we report that the uptake of CNDs by EA.hy926 endothelial cells is both time and dose dependent. The concentration of CNDs used in this experiment was found to not affect cell viability. TNF-α is a known biomarker of vascular inflammation. Cells treated with CNDs for 24 h significantly inhibited TNF-α (0.5 ng/mL)-induced expression of intracellular adhesion molecule 1 ( ICAM-1 ) and interleukin 8 ( IL-8 ). ICAM-1 and IL-8 are two key molecules responsible for the activation and the firm adhesion of monocytes to activated endothelial cells for the initiation of atherosclerosis. ROS, such as hydrogen peroxide, play an important role in TNF-α-induced inflammation. Interestingly, we found that CNDs effectively scavenged H 2 O 2 in a dose-dependent manner. CNDs treatment also increased the activity of the antioxidant enzyme NQO1 in EA.hy926 endothelial cells indicating the antioxidant properties of CNDs. These results suggest that the anti-inflammatory effects of CNDs may be due to the direct H 2 O 2 scavenging properties of CNDs and the indirect upregulation of antioxidant enzyme NQO1 activity in endothelial cells. In conclusion, CND can inhibit TNF-α-induced endothelial inflammation, possibly due to its direct scavenging of H 2 O 2 and the indirect upregulation of antioxidant enzyme NQO1 activity in endothelial cells.

In this study, we examined how school policies and strategies (i.e., positive discipline, hardening strategies, and positive behavioral strategies) affect teacher relational factors and teacher reports of victimization and safety. Specifically, we examined the mediational roles of teacher support of student learning, maltreatment of students by teachers, and teachers' differential treatment of students in schools. Using a sample of 6643 pre-K-12th-grade teachers, path analysis results revealed that positive behavior strategies, hardening strategies, and positive discipline were indirectly associated with teacher victimization and sense of safety. Additionally, teachers' perceptions of other teachers maltreating students had the greatest contributions to their sense of safety and victimization by students. Positive discipline was directly and indirectly associated with teacher victimization and safety. Implications and directions for future studies are discussed., (© 2023 The Authors. Journal of Community Psychology published by Wiley Periodicals LLC.)

The COVID-19 pandemic and subsequent school disruptions shined a spotlight on the mental health needs of young people, and the importance of schools and school social workers (SSWs) in attending to those needs. This study sought to understand SSWs' views about mental health and trauma in relation to the pandemic and schools reopening. Data came from written responses to open-ended questions on a national survey of SSWs during June-July 2020 (Kelly et al., 2021; Watson et al., 2022). In the national survey, 450 SSWs responded to open-ended questions, providing 115 single-spaced pages of detailed qualitative comments. A unified conceptual model for a trauma-informed school was created by integrating components suggested within the literature. This conceptual model was then used to generate a theory-based coding schema. Responses mapped well onto the conceptual model. Major themes included recognition of COVID-19 and 2020 social unrest as a unique period and potentially traumatic experience; the need for a trauma-informed school response; the challenges of addressing all facets of safety during the pandemic; and the essentiality and difficulty of maintaining school-based relationships during school closures and remote learning. Results demonstrated that SSWs used and discussed key components of a trauma-informed approach. Respondents offered several recommendations for implementing trauma-informed approaches during and after the pandemic, many of which required collaboration from other school staff. Findings provide empirical support for a unified school model that integrates components of a trauma-informed approach found in the literature. We make recommendations for interpersonal, organizational, and policy adaptations schools can take to become more trauma informed., Competing Interests: Conflict of interestThe authors have no relevant financial or non-financial interests to disclose., (© The Author(s) 2022.)

Despite extensive reports during the COVID-19 pandemic of the academic challenges facing students, and the effects of online learning on academic achievements, we have little information regarding the needs and difficulties of K-12 students and their families from a social work perspective. The present article shares findings from a nationwide survey of 1,275 school social workers (SSWs) reporting on their clients-schools, children, and families-during the spring 2020 COVID-19 school closures. SSWs indicated that the children and families they served had significant unmet basic needs, including for food, healthcare, and housing. Poverty and mental health compounded pandemic difficulties, which were associated with the sociodemographic makeup of schools. Student engagement in social work services during the closures was significantly lower than prepandemic levels, generally due to unmet material needs. Several policy and practice implications arise from these findings, including a need for additional services for students and families, a plan to address structural inequities in our schools and communities, coordinated outreach to reengage missing students, and recognition of the strong work being done by school staff coupled with a need for additional supports and resources to combat persistent inequality., (© 2021 National Association of Social Workers.)

This prospective, multi-centred, randomized trial examined outcomes of 3- and 12-month follow-ups of 159 elderly participants aged more than 75 years with isolated distal radial fractures, treated by anterior locking plate or closed reduction and cast immobilization. The primary outcome was the patient-rated wrist evaluation (PRWE) score. The PRWE score at 12 months was not significantly different between the two groups; however, the radiological outcomes and complications rates were worse in the casting group. Level of evidence: III.

Aneurysmal dilation of arteriovenous fistulae used for haemodialysis is a recognised complication but its clinical significance is a contentious issue. Our aims were to describe aneurysmal fistulae morphologically and clinically.Sixty patients underwent duplex scanning to measure the maximum diameter and skin thickness of their fistula. Haemodialysis function and bleeding risk were assessed clinically.The 75th percentile of maximum diameter was 2.05 cm. In addition to conventional diameter measurement, we describe a novel volume measurement technique which may be of value. No relationship was found between maximum diameter or volume and function, skin thickness or bleeding.Some studies define aneurysm at 2 cm (75th percentile); however, this definition and other arbitrary definitions lack clinical significance. This work suggests that fistula dilation should be considered together with clinical issues when determining the clinical significance of an aneurysm. Our finding that haemodialysis function, skin thickness and bleeding were not associated with diameter needs further study., (© The Author(s) 2014.)

Mediastinal fat necrosis (MFN) or epipericardial fat necrosis, as it is commonly referred to in the literature, is a rare self-limiting cause of chest pain of unclear etiology. MFN affects previously healthy individuals who present with acute pleuritic chest pain. Characteristic computed tomography (CT) findings include a fat attenuation lesion with intrinsic and surrounding increased attenuation stranding. There is often associated thickening of the adjacent pericardium and/or pleural effusions. We present two cases of MFN manifesting as ovoid fat attenuation lesions demarcated by a soft tissue attenuation rim with intrinsic and surrounding soft tissue attenuation stranding and review the clinical and pathologic features of these lesions. Knowledge of the clinical presentation of patients with MFN and familiarity with the characteristic imaging findings of these lesions should allow radiologists to prospectively establish the correct diagnosis and suggest conservative management and follow-up.

Although uncommon, "brain cancer" is one of the most feared diseases that afflict human beings. While still regarded as one of the most deadly forms of primary malignant brain neoplasm, recent advances in the treatment of Glioblastoma Multiforme (GBM) have offered new hope for patients, families and clinicians. In the first part of this two-part evidence-based review, we focused on the multidisciplinary advances that have established the current standard of care practice in the management of GBM. The second part discusses ongoing research efforts, both ongoing clinical trial efforts as well as some of the newer technologies that are forming the promise of the future.

Although uncommon, "brain cancer" is one of the most feared diseases that afflict human beings. While still regarded as one of the most deadly forms of primary brain neoplasm, recent advances in the treatment of glioblastoma (GBM) have offered new hope for patients, families, and clinicians. In the first part of this two-part review, we will focus on the multidisciplinary advances that have established the current treatment approach in the management of GBM. In the second part of this review, ongoing research will be presented including current clinical trials as well as some of the newer technologies that are forming the promise of the future.

The reliance on discretionary spending for American Indian/ Alaska Native health care has produced a system that is insufficient and unreliable and is associated with ongoing health disparities. Moreover, the gap between mandatory spending on a Medicare beneficiary and discretionary spending on an American Indian/Alaska Native beneficiary has grown dramatically, thus compounding the problem. The budget classification for American Indian/Alaska Native health services should be changed, and health care delivery to this population should be designated as mandatory spending. If a correct structure is in place, mandatory spending is more likely to provide adequate funding that keeps pace with changes in costs and need.

Objective: To examine the impact of age on health problems related to traumatic brain injury (TBI)., Design: Case-control study using a survey instrument., Setting: Outpatient setting of a large urban tertiary care hospital., Participants: Young and old community dwellers with histories of TBI and control subjects matched for age., Intervention: Structured interview using the Living Life After TBI assessment tool., Main Outcome Measure: Symptom reporting on 52 potential health problems., Results: Individuals with TBI reported significantly more overall health problems than those without TBI. Younger subjects with TBI reported more problems than their nondisabled, age-matched peers with their patterns of sleep as well as with their metabolic/endocrine, neurologic, and musculoskeletal systems., Conclusions: Older people with TBI were more likely than nondisabled, age-matched peers to report problems with their metabolic/endocrine and neurologic systems. Younger people with TBI were more likely than older people with TBI to report difficulty falling asleep.

The introduction of total intravenous anaesthesia (TIVA) and the use of volatile induction/maintenance anaesthesia (VIMA) has led to the rediscovery of 'single agent' anaesthesia, eliminating the transition phase from induction to maintenance. We compared quality, patient acceptability and cost of TIVA using target control infusion (TCI) with propofol and VIMA with sevoflurane. Forty patients undergoing spinal surgery of 1-3 h were assigned to one of two groups. Group I received propofol-air-oxygen for induction followed by propofol-air-oxygen for maintenance. Group II received 8% sevoflurane-oxygen for induction and sevoflurane-oxygen-nitrous oxide for maintenance. Propofol had a significantly faster mean (SD) induction time (67 (20) s) than sevoflurane (97 (38) s) but was associated with double the incidence of involuntary movements. Although not significant, twice the number of interventions by the anaesthetist were required to maintain an adequate level of anaesthesia in the sevoflurane group. Emergence times, characteristics, postoperative nausea, vomiting and pain were unaffected by the anaesthetic technique. However, a more predictable emergence time was found following sevoflurane. Cardiovascular stability was good and comparable in both groups. The majority of patients found either technique acceptable and would choose the same anaesthetic again. Induction and maintenance was substantially cheaper with sevoflurane (28.06 Pounds) compared with propofol (41.43 Pounds).

Orgaran, a heparinoid, has been used successfully in patients with heparin-induced thrombocytopenia. We report three cases in which Orgaran was combined with the glycoprotein IIbIIa receptor antagonist Reopro during coronary angioplasty. Orgaran was given as a single intravenous bolus of 1500 anti-factor Xa units. No ischemic or hemorrhagic complications occurred during or following the procedure.

A patient is described with antiphospholipid antibodies who died approximately 24 hr after an uncomplicated balloon angioplasty. Since the literature suggests a relationship between the presence of antiphospholipid antibodies and thromboses, we suggest that these antibodies may be a risk factor for abrupt closure after percutaneous transluminal coronary angioplasty.

The burden of pregnancy in patients with severe mitral stenosis continues to present a therapeutic challenge. We present two such cases successfully treated with balloon valvuloplasty using the Inoue balloon. The unique features of this balloon may render it the technique of choice for selected pregnant patients with severe mitral stenosis.

To assess the hemodynamic factors affecting left-to-right shunting following balloon mitral valvuloplasty we studied 10 patients at 3 points during the procedure: pre-septal dilation, post-septal dilation pre-valvuloplasty, and post-valvuloplasty. Hemodynamic parameters were recorded and an oximetry run was obtained at each stage. Mitral valvuloplasty was successful in 8 and unsuccessful in 2 patients. No patient had a significant oxygen step-up at any stage, including the 2 patients with unsuccessful valvuloplasty. Significant left-to-right shunting through the atrial septal puncture in mitral valvuloplasty is infrequent, even before successful balloon valvuloplasty when left atrial pressure is maximally elevated.

The authors present a case in which the diagnosis of prostate cancer metastatic to the skin was made by skin biopsy with immunoperoxidase stains for prostatic specific antigen and prostatic acid phosphatase. These are tests that should be performed when the location of the primary malignancy is not otherwise evident.

The effect of autologous blood perfusion, delivered through an angiographic power injector, on alleviating left ventricular (LV) hemodynamic deterioration during percutaneous transluminal coronary angioplasty (PTCA) was examined. LV systolic and diastolic pressures, LV peak positive and peak negative first derivative of LV pressure (dP/dt), and ST-segment shift were recorded in 9 patients with and without hemoperfusion. Hemoperfusion resulted in an improved LV hemodynamic profile during balloon occlusion, as reflected in LV systolic pressure (127 +/- 14 vs 120 +/- 15 mm Hg, p = 0.01), LV end-diastolic pressure (17 +/- 14 vs 25 +/- 6 mm Hg, p less than 0.001), peak positive (1,237 +/- 240 vs 1,149 +/- 225 mm Hg/s, p less than 0.05) and peak negative (1,666 +/- 357 vs 1,485 +/- 385 mm Hg/s, p = 0.003) dP/dt. Hemoperfusion provides substantial protection for significant LV dysfunction induced by conventional PTCA in 1-vessel angioplasty and is a feasible option to protect against potential cardiovascular collapse in high-risk PTCA.

Four coronary lesions, including a severe left main stenosis, were successfully dilated in a patient with poor left ventricular function; the procedure was supported by percutaneous cardiopulmonary bypass. During left main occlusion there was a loss of phasic systemic arterial pressure, while pulmonary arterial pressure was maintained. The ischemic myocardial depression occurring during left main occlusion was not prevented by percutaneous cardiopulmonary bypass, indicating inadequate myocardial protection.

The effect of intravenous nisoldipine on cardiac performance was examined during pacing-induced ischemia in 14 patients with coronary artery disease. The relative contributions of afterload reduction or prevention of myocardial ischemia were assessed using load-independent global (peak-systolic pressure/end-systolic volume) and regional (peak-systolic pressure/end-systolic radial length) "contractile" indexes. Nisoldipine decreased aortic pressure (predrug, 109 +/- 14 vs postdrug, 88 +/- 13 mm Hg, p less than 0.01) and prevented elevation of left ventricular end-diastolic pressure during rapid atrial pacing (predrug, 7.9 +/- 5.7 vs postdrug, -0.5 +/- 4.9 mm Hg, p less than 0.001). Resting cardiac index (predrug, 3.3 +/- 0.6 vs postdrug, 4.2 +/- 0.7 liters/min/m2, p less than 0.05), and left ventricular ejection fraction (predrug, 68.1 +/- 9.0 vs postdrug, 74.2 +/- 9.4%, p less than 0.05) increased after nisoldipine, which also prevented the deterioration in left ventricular ejection fraction (predrug, -8.1 +/- 7.9 vs postdrug, -1.0 +/- 3.7%, p less than 0.05) and fractional radial shortening (predrug, -8.7 +/- 13.1 vs postdrug, 3.7 +/- 16.4%, p less than 0.01) during rapid atrial pacing. Under these conditions, nisoldipine preserved myocardial function, as determined by global peak-systolic pressure/end-systolic volume (predrug, -0.82 +/- 0.39 vs postdrug, 0.17 +/- 1.54 mm Hg/ml, p less than 0.05) and regional (peak-systolic pressure/end-systolic radial length, predrug, -23.8 +/- 36.1 vs postdrug, 12.7 +/- 36.3 mm Hg/cm, p less than 0.01) "contractile" indexes. Intravenous nisoldipine maintains ventricular performance during rapid atrial pacing via a combination of systemic vasodilation and amelioration of ischemic myocardial dysfunction.

Cryptococcal cellulitis is an uncommon cutaneous manifestation of generalized cryptococcal disease. We describe the only reported incidence with multiple sites of cutaneous involvement. In an immunosuppressed patient an apparent cellulitis, even with multiple sites of involvement, that does not respond to appropriate antibiotics should alert one to the possible diagnosis of cryptococcal cellulitis.

Intravenous fluids were infused into the forearms of 18 volunteers. Baseline hematologic and serum biochemical profiles were obtained from each volunteer prior to starting the IV. After the intravenous fluids had infused for 30 minutes, blood was drawn from the opposite arm, and above and below the IV in the same arm. The intravenous fluids were then stopped, and after waiting two minutes, another blood sample was drawn from the IV needle. The deviation from the baseline value was determined for each analyte by sampling site for each volunteer and the mean deviation was calculated for each analyte from each sample site. Drawing blood from above the infusing IV line resulted in a dilutional effect for most of the analytes. Most analytes were not affected when blood was drawn from the other sites. Serum glucose and phosphorus had mean deviations greater than two standard deviations from the baseline, regardless of where they were drawn. Serum glucose was the only analyte with values higher than the baseline values. We recommend that serum biochemical and hematologic profiles not be drawn above an infusing IV, but should be drawn from the opposite arm or below the IV while it is infusing or out of the IV needle after the intravenous fluids have been stopped for two minutes.

We present the first case of cutaneous mucormycosis reported in a patient who had undergone a heart transplant operation. This appeared to be a localized infection without a predisposing local factor such as a surgical adhesive and without evidence of dissemination. Prompt treatment with intravenous amphotericin B resulted in an apparent cure.

1. A baseline toxicity QSAR model was derived for the 24-h LC50 to the goldfish, Carassius auratus. 2. The QSAR-predicted LC50 values for six epoxide derivatives were 2.8-985 times greater than measured. The excess toxicity of these epoxides and other compounds was ascribed to an electrophile molecular mechanism involving SN2 reaction with sulphydryl and other neucleophile groups present in enzymes and other biological macromolecules. 3. The excess toxicities of allyl alcohol and pentaerythritol triallyl ether were interpreted in terms of proelectrophile mechanisms. For the latter compound, this involves a monooxygenase-mediated free radical proton abstraction to a stable allyl radical. The allyl-free radical can undergo enzymic free radical hydroxylation to afford the corresponding acetal, which on decomposition yields the Michael acceptor electrophile acrolein.