Termination of Parental Rights in Washington

Prior to 1978, Washington allowed trial judges broad discretion to decide, on a case by case basis, the necessity of terminating parental rights. The recently adopted Juvenile Court Act in Cases Relating to Dependency of A Child and the Termination of a Parent and Child Relationship represents a legislative attempt to nurture the family unit by severely limiting trial court discretion. The new law provides standards making judicial termination of parental rights difficult in all cases. The Institute of Judicial Administration and the American Bar Association also have jointly proposed standards limiting trial court discretion in termination proceedings. The ABA proposal, however, differs markedly from the Washington legislation. Attempting to limit the duration of foster care placements, the ABA would require the trial judge to order termination in many cases of extended foster care. This comment contrasts the system of broad discretion under the previous Washington law with the two very different systems of limited discretion embodied in the Juvenile Court Act and the ABA proposal

Termination of Parental Rights in Washington

Prior to 1978, Washington allowed trial judges broad discretion to decide, on a case by case basis, the necessity of terminating parental rights. The recently adopted Juvenile Court Act in Cases Relating to Dependency of A Child and the Termination of a Parent and Child Relationship represents a legislative attempt to nurture the family unit by severely limiting trial court discretion. The new law provides standards making judicial termination of parental rights difficult in all cases. The Institute of Judicial Administration and the American Bar Association also have jointly proposed standards limiting trial court discretion in termination proceedings. The ABA proposal, however, differs markedly from the Washington legislation. Attempting to limit the duration of foster care placements, the ABA would require the trial judge to order termination in many cases of extended foster care. This comment contrasts the system of broad discretion under the previous Washington law with the two very different systems of limited discretion embodied in the Juvenile Court Act and the ABA proposal

Proposed reference models for atomic oxygen in the terrestrial atmosphere

A provisional Atomic Oxygen Reference model was derived from average monthly ozone profiles and the MSIS-86 reference model atmosphere. The concentrations are presented in tabular form for the altitude range 40 to 130 km

A rocket tomography measurement of the N+2 3914 A emission rates within an auroral arc

A rocket tomography experiment designed to measure the two-dimensional distribution of the N+2 3914 A volume emission rates within an auroral arc is described. A simple filter photometer on board a sounding rocket, which was launched during the ARIES auroral campaign, was used to measure the 3914 A auroral brightnesses at elevation angles ranging from 0[deg] to 360[deg] in the plane of the rocket trajectory. The measured auroral brightnesses have been tomographically inverted to recover the local 3914 A volume emission rates as a function of both altitude and latitude within the arc. The tomographic inversion procedure, which is based upon a maximum probability algebraic reconstruction approach, is described and the implications of the results for studies of auroral excitation processes are briefly discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29317/1/0000382.pd

Improving patient notification of solid abdominal viscera incidental findings with a standardized protocol

BACKGROUND: The increasing use of computed tomography (CT) scans in the evaluation of trauma patients has led to increased detection of incidental radiologic findings. Incidental findings (IFs) of the abdominal viscera are among the most commonly discovered lesions and can carry a risk of malignancy. Despite this, patient notification regarding these findings is often inadequate. METHODS: We identified patients who underwent abdominopelvic CTs as part of their trauma evaluation during a recent 1-year period (9/2011-8/2012). Patients with IFs of the kidneys, liver, adrenal glands, pancreas and/or ovaries had their charts reviewed for documentation of the lesion in their discharge paperwork or follow-up. A quality improvement project was initiated where patients with abdominal IFs were verbally informed of the finding, it was noted on their discharge summary and/or were referred to specialists for evaluation. Nine months after the implementation of the IF protocol, a second chart review was performed to determine if the rate of patient notification improved. RESULTS: Of 1,117 trauma patients undergoing abdominopelvic CT scans during the 21 month study period, 239 patients (21.4%) had 292 incidental abdominal findings. Renal lesions were the most common (146 patients, 13% of all patients) followed by hepatic (95/8.4%) and adrenal (38/3.4%) lesions. Pancreatic (10/0.9%) and ovarian lesions (3/0.3%) were uncommon. Post-IF protocol implementation patient notification regarding IFs improved by over 80% (32.4% vs. 17.7% pre-protocol, p = 0.02). CONCLUSION: IFs of the solid abdominal organs are common in trauma patients undergoing abdominopelvic CT scan. Patient notification regarding these lesions is often inadequate. A systematic approach to the documentation and evaluation of incidental radiologic findings can significantly improve the rate of patient notification

The Roles of Vertical Advection and Eddy Diffusion in the Equatorial Mesospheric Semi-Annual Oscillation (MSAO)

Observations of the mesospheric semi-annual oscillation (MSAO) in the equatorial region have been reported dating back several decades. Seasonal variations in both species densities and airglow emissions are well documented. The extensive observations available offer an excellent case study for comparison with model simulations. A broad range of MSAO measurements is summarised with emphasis on the 80-100 km region. The objective here is not to address directly the complicated driving forces of the MSAO, but rather to employ a combination of observations and model simulations to estimate the limits of some of the underlying dynamical processes. Photochemical model simulations are included for near-equinox and near-solstice conditions, the two times with notable differences in the observed MSAO parameters. Diurnal tides are incorporated in the model to facilitate comparisons of observations made at different local times. The roles of water vapour as the driver species and ozone as the response species are examined to test for consistency between the model results and observations. The simulations suggest the interactions between vertical eddy diffusion and background vertical advection play a significant role in the MSAO phenomenon. Further, the simulations imply there are rigid limits on vertical advection rates and eddy diffusion rates. For August at the Equator, 90 km altitude, the derived eddy diffusion rate is approximately 1 x 106 cm2 s-1 and the vertical advection is upwards at 0.8 cm s-1. For April the corresponding values are 4 x 105 cm2 s-1 and 0.1 cm s-1. These results from the current 1-D model simulations will need to be verified by a full 3-D simulation. Exactly how vertical advection and eddy diffusion are related to gravity wave momentum as discussed by Dunkerton (1982) three decades ago remains to be addressed

Lecanemab in patients with early Alzheimer\u27s disease: Detailed results on biomarker, cognitive, and clinical effects from the randomized and open-label extension of the phase 2 proof-of-concept study

BACKGROUND: Lecanemab, a humanized IgG1 monoclonal antibody that targets soluble aggregated Aβ species (protofibrils), has demonstrated robust brain fibrillar amyloid reduction and slowing of clinical decline in early AD. The objective of this analysis is to report results from study 201 blinded period (core), the open-label extension (OLE), and gap period (between core and OLE) supporting the effectiveness of lecanemab. METHODS: The lecanemab study 201 core was a double-blind, randomized, placebo-controlled study of 856 patients randomized to one of five dose regimens or placebo. An OLE of study 201 was initiated to allow patients to receive open-label lecanemab 10mg/kg biweekly for up to 24 months, with an intervening off-treatment period (gap period) ranging from 9 to 59 months (mean 24 months). RESULTS: At 12 and 18 months of treatment in the core, lecanemab 10 mg/kg biweekly demonstrated dose-dependent reductions of brain amyloid measured PET and corresponding changes in plasma biomarkers and slowing of cognitive decline. The rates of clinical progression during the gap were similar in lecanemab and placebo subjects, with clinical treatment differences maintained after discontinued dosing over an average of 24 months in the gap period. During the gap, plasma Aβ42/40 ratio and p-tau181 levels began to return towards pre-randomization levels more quickly than amyloid PET. At OLE baseline, treatment differences vs placebo at 18 months in the randomized period were maintained across 3 clinical assessments. In the OLE, lecanemab 10 mg/kg biweekly treatment produced dose-dependent reductions in amyloid PET SUVr, improvements in plasma Aβ42/40 ratio, and reductions in plasma p-tau181. CONCLUSIONS: Lecanemab treatment resulted in significant reduction in amyloid plaques and a slowing of clinical decline. Data indicate that rapid and pronounced amyloid reduction correlates with clinical benefit and potential disease-modifying effects, as well as the potential to use plasma biomarkers to monitor for lecanemab treatment effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT01767311

Discovery and validation of dominantly inherited Alzheimer\u27s disease mutations in populations from Latin America

BACKGROUND: In fewer than 1% of patients, AD is caused by autosomal dominant mutations in either the presenilin 1 (PSEN1), presenilin 2 (PSEN2), or amyloid precursor protein (APP) genes. The full extent of familial AD and frequency of these variants remains understudied in Latin American (LatAm) countries. Due to the rare nature of these variants, determining the pathogenicity of a novel variant in these genes can be challenging. Here, we use a systematic approach to assign the likelihood of pathogenicity in variants from densely affected families in Latin American populations. METHODS: Clinical data was collected from LatAm families at risk for DIAD. Symptomatic family members were identified and assessed by local clinicians and referred for genetic counseling and testing. To determine the likelihood of pathogenicity among variants of unknown significance from LatAm populations, we report pedigree information, frequency in control populations, in silico predictions, and cell-based models of amyloid-beta ratios. RESULTS: We identified five novel variants in the presenilin1 (PSEN1) gene from Brazilian and Mexican families. The mean age at onset in newly identified families was 43.5 years (range 36-54). PSEN1 p.Val103_Ser104delinsGly, p.Lys395Ile, p.Pro264Se, p.Ala275Thr, and p.Ile414Thr variants have not been reported in PubMed, ClinVar, and have not been reported in dominantly inherited AD (DIAD) families. We found that PSEN1 p.Val103_Ser104delinsGly, p.Lys395Ile, p.Pro264Se, and p.Ala275Thr produce Aβ profiles consistent with known AD pathogenic mutations. PSEN1 p.Ile414Thr did not alter Aβ in a manner consistent with a known pathogenic mutation. CONCLUSIONS: Our study provides further insights into the genetics of AD in LatAm. Based on our findings, including clinical presentation, imaging, genetic, segregations studies, and cell-based analysis, we propose that PSEN1 p.Val103_Ser104delinsGly, p.Lys395Ile, p.Pro264Se, and p.Ala275Thr are likely pathogenic variants resulting in DIAD, whereas PSEN1 p.Ile414Thr is likely a risk factor. This report is a step forward to improving the inclusion/engagement of LatAm families in research. Family discovery is of great relevance for the region, as new initiatives are underway to extend clinical trials and observational studies to families living with DIAD