Improving Child Health Care Through Federal Policy: An Emerging Opportunity

Summarizes legislative proposals introduced in 2007 to track primary care outcomes in Medicaid and State Children's Health Insurance Programs (SCHIP) and focus on strengthening primary, preventive, and developmental child health services and research

Credit CARD Act of 2009: The Changes and When They Take Effect

Beginning in August 2009, there will be changes that affect consumer credit card bill¬ings. On May 22, 2009, President Barack Obama signed the Credit Card Accountability, Responsibility and Disclosure Act of 2009 (Credit CARD Act of 2009). The law is designed to protect consumers from some practices by credit card companies

Episode 10 : Burning Platform Part 2—The Arctic and Climate Change

The Arctic is at the forefront of climate change, experiencing rapid environmental shifts that are having very real and meaningful impacts on native populations and landscapes. Join us for part two of our interdisciplinary discussion about how Arctic populations and global economies are responding to these climate change threats and opportunities, as well as how laws and policies are keeping up (or not)

Early Perioperative Fluid Benchmarking to Predict Pancreaticoduodenectomy (PD) Outcomes

Introduction: PD is a complex operation associated with a marked systemic inflammatory response and significant fluid shifts. Establishing a benchmark for ideal perioperative fluid management is critical to optimising PD patient recovery. Methods: In this retrospective study, we evaluated perioperative fluid data for patients undergoing PD. We compared an optimal benchmark group who were discharged home by postoperative day five (≤5day) to a group of patients with an in hospital recovery greater than ten days (≥10day). Results: Seventy-six patients who underwent PD between June 2015 and November 2016 were evaluated. The ≤5day group had a significantly lower intraoperative fluid administration (5.4 vs. 6.6 L, p= 0.012), despite similar operative times (447 mins and 476 mins, respectively). POD1 cumulative fluid balance was lower in the ≤5day group compared to the ≥10day group, 7.8L (97 mL/kg) vs. 9.7L (148 mL/kg) (p= 0.002), respectively. As expected, the postoperative complication rate was reduced in the ≤5day group (5% vs. 95%). Complications included pancreatic fistula (40%), delayed gastric emptying (53%), and intra-abdominal infection (16%). The median weight change from baseline to POD5 was -0.2 Kg for the ≤5day group compared to +2.9 Kg for ≥10day group (p= 0.000006). Conclusions: Patients in the benchmark PD group received less fluid intraoperatively, had a lower cumulative fluid balance by POD1, and were able to return to their preoperative weight by POD5 when compared to ≥10day group. These data offer insights into optimal fluid administration for PD patients

An Iron-Based Ecosystem Model of the Central Equatorial Pacific

The central and eastern equatorial Pacific region is characterized by lower than expected phytoplankton biomass and primary production given the relatively high ambient nitrate concentrations. These unusual conditions have spawned several field programs and laboratory experiments to determine why this high nitrate-low chlorophyll pattern persists in this region. To synthesize the results from these field programs, as well as providing additional evidence in support of the iron hypothesis, we developed a one-dimensional, nine-component ecosystem model of 0 degrees N 140 degrees W. The model components include two phytoplankton size fractions, two zooplankton size fractions, two detrital size fractions, dissolved iron, nitrate, and ammonium. The model was run for 5 years (1990-1994) and was forced using an atmospheric radiative transfer model, an ocean general circulation model (GCM), and in situ data. To our knowledge, this is the first ecosystem model at 0 degrees N 140 degrees W to synthesize the Joint Global Ocean Flux Study Equatorial Pacific Process Study (JGOFS EqPac) data set, as well as to use both in situ and modeled physical data to drive the model. Modeled phytoplankton, zooplankton, and iron all varied on interannual timescales due to El Nino events. Total phytoplankton biomass increased by as much as 40% from early 1992 (El Nino warm) to 1993 (normal). The results also indicate that the biomass increase during a cool period is not constant for each phytoplankton component, but instead the increase is most evident in the netphytoplankton (\u3e10 mu m). Netphytoplankton increase from a low of 0.1% of the total chlorophyll in 1992 to a high of 30% of the total in 1993. Microzooplankton grazing rates fluctuated in response to changes in nanophytoplankton growth rates, whereas mesozooplankton grazing was unrelated to netphytoplankton growth rates. The magnitude and temporal variability of phytoplankton chlorophyll agreed well with in situ data collected during 1992. Modeled primary production was lower than measured during El Nino but agreed with observations during normal conditions. The low primary productivity was probably a result of downwelling produced by the physical model. New production was calculated from total and recycled iron rather than nitrate-based production and was more variable in general and almost 3 times the nitrate-based new production during non-El Nino conditions

Mechanical ventilation modulates Toll-like receptor-3-induced lung inflammation via a MyD88-dependent, TLR4-independent pathway: a controlled animal study

<p>Abstract</p> <p>Background</p> <p>Mechanical ventilation augments lung inflammation resulting from exposure to microbial products. The objective of this study was to test the hypothesis that ventilator-associated immune modulation requires MyD88-dependent signaling. Because MyD88 is a critical adapter protein utilized for pro-inflammatory signaling by all Toll-like receptors (TLRs), with the exception of TLR3, as well as by the IL-1 and IL-18 receptors, MyD88 dependence would implicate generation of an endogenous soluble ligand recognized by one or more of these receptors during mechanical ventilation and would provide an opportunity for a potential future therapeutic intervention.</p> <p>Methods</p> <p>We compared the effect of mechanical ventilation on lung inflammation and permeability between poly(I:C) exposed mice with or without expression of MyD88. Poly(I:C) is a synthetic ligand for TLR3, the only MyD88-independent TLR, allowing isolation of the effect of MyD88 deletion on ventilator-augmentation of lung inflammation. Lung inflammation was assessed by cytokine concentration in lung tissue homogenate and polymorphonuclear cell (PMN) number in bronchoalveolar lavage fluid (BALF). Lung permeability was assessed by total protein, IgM, and intravenously injected FITC-dextran concentrations in BALF.</p> <p>Results</p> <p>We found that MyD88 was required for mechanical ventilation augmentation of TLR3-induced lung inflammation and permeability. Because TLR4 is the most commonly reported receptor for endogenous ligands generated during tissue injury, we performed a second experiment comparing wildtype and TLR4-/- mice. We found that mechanical ventilation increased TLR3-mediated inflammation and permeability independent of TLR4.</p> <p>Conclusion</p> <p>These data support the hypothesis that mechanical ventilation with moderate tidal volumes generates an endogenous ligand(s) recognized by MyD88-dependent receptor(s) other than TLR4, and that this mechanism can contribute to the development of ventilator-associated lung inflammation and injury. Identification of these ligands and/or receptors could lead to new pharmacological treatments for ARDS.</p

A randomised controlled trial of a telephone administered brief HIV risk reduction intervention amongst men who have sex with men prescribed post-exposure prophylaxis for HIV after sexual exposure in the UK: Project PEPSE

Background In western countries, men who have sex with men (MSM) are most affected by HIV and increasingly likely to engage in risky sexual behaviour. MSM who experience a potential sexual exposure to HIV (PEPSE) and receive a preventative regimen of anti-HIV treatment are at particularly high risk of acquiring HIV and could potentially benefit from targeted risk reduction behavioural interventions such as motivational interviewing (MI). Purpose The aim of this trial was to examine the impact of augmented MI (MI plus information provision and behavioural skills building), over and above routine care, on reducing risky sexual behaviour in MSM prescribed PEPSE. Secondary aims of the research were to examine whether the intervention reduced sexually transmitted infections (STI) and further requests for PEP. Methods A parallel-group pragmatic randomised controlled trial was conducted with 175 MSM recruited from five sexual health (SH) clinics in the south east of England. The intervention was two fixed-duration sessions of telephone administered augmented MI. A manual guided the selection of individualised persuasive communication strategies based on underlying change mechanisms specified by the Information, Motivation and Behavioural Skills (IMB) model. Primary outcomes were the number of receptive and active anal intercourse (AI) partners, the use of condoms every time during receptive and active AI and the use of condoms sometimes during receptive and active AI. Results There were no significant impacts on sexual risk behaviour or any of the psychological measures, and no discernible reduction in requests for repeat PEP or rates of STIs within a year. Conclusion Our behavioural intervention of augmented MI did not affect risky sexual behaviour, rates of further PEP and STIs, and psychological factors, in MSM prescribed PEPSE. Trial registration numbers: UKCRN ID:11436; ISRCTN00746242

History of Psychology

Openly licensed anthology focused on the theme of the History of Psychology. Contains: The Mind and the Brain by Alfred Binet; Dream Psychology: Psychoanalysis for Beginners by Sigmund Freud; The Principles of Psychology, Volume 1 (of 2) by William James; The Principles of Psychology, Volume 2 (of 2) by William James; Collected Papers on Analytical Psychology by C. G. Jung; Memoirs of Extraordinary Popular Delusions and the Madness of Crowds by Charles Mackay; The Psychology of Arithmetic by Edward L. Thorndike