Adoption of Children in Missouri

The purpose of this Article is to investigate the effect of Missouri law on adoption and to determine whether its provisions adequately protect the parties to adoption and whether its degree of clarity properly forestalls litigation

Improving America\u27s Health Care: Authorizing Independent Prescriptive Privileges for Advanced Practice Nurses

Nursing and organized medicine are engaged in a heated and emotional debate over independent prescriptive privileges for advanced practice nurses. Uncontroverted data demonstrates that nurse practitioners provide high quality health care at a reduced cost, while increasing access to health care for under-served populations. It is apparent that advanced practice nurses could improve the delivery of American health care. However, organized medicine is opposed to autonomous advanced nursing practice and lobbies powerfully against it. Currently, the majority of state laws and regulations pertaining to advanced practice nursing do not promote a sound public health policy, do not contemplate liability issues and do not forestall fruitless litigation. Part I of this Article describes the background of expanded nursing practice and regulation. Part II examines the policy considerations of advanced practice nurses (“APNs”) prescribing treatment. Part III reviews applicable liability issues and evaluates varying theories of state regulation. Part IV analyzes the political and statutory obstacles to nurses\u27 prescribing medications. This Article concludes by recommending legislation and regulation authorizing autonomous prescriptive privileges for advanced practice nurse

A National Putative Father Registry, Wells Conference on Adoption Law

This Article will discuss the mechanics of putative father registries, review jurisdictional issues, analyze the policies behind their development, and review relevant case law over the last 5 years

Frozen Pre-Embryo Practice in Missouri

McQueen v. Gadberry was an Eastern District dissolution dispute over frozen pre-implantation embryos formed from McQueen’s eggs and Gadberry’s sperm. The St. Louis County trial court found the pre-embryos to be marital property of a special character and awarded them jointly to each of the former spouses. The appellate court affirmed. McQueen is an important decision because the finding that embryos are marital property was an issue of first impression that affects many Missouri families. Infertility is a common problem, couples frequently utilize assisted reproductive technologies (ART) to form families, and the extra frozen pre-implantation embryos (hereinafter pre-embryos) have fueled increasing legal disputes. Family law, health law, and estate planning attorneys should factor pre-embryo disposition into their repertoires

Tofacitinib in the management of active psoriatic arthritis: patient selection and perspectives.

Tofacitinib is an oral Janus kinase inhibitor approved for the treatment of psoriatic arthritis (PsA). It provides an alternative option for patients who have had an inadequate response and tolerance to other disease modifying antirheumatic drugs (DMARDs). It has demonstrated comparable efficacy to biologics, is effective in the management of treatment resistant disease, and is reported to improve enthesitis, dactylitis, and radiographic progression. Tofacitinib is also associated with an increased risk of serious infections, malignancy, and laboratory abnormalities. There is currently a large armamentarium of therapies for psoriatic arthritis, and choosing among treatments can be challenging. Due to this wide selection, a thorough assessment of psoriatic disease phenotype, patient preference, disease presentation, and comorbidities is critical. This review addresses key considerations in patient selection for the treatment of PsA with tofacitinib

Acrodermatitis continua of Hallopeau: clinical perspectives.

Acrodermatitis continua of Hallopeau (ACH) is a rare, sterile pustular eruption of one or more digits. The condition presents with tender pustules and underlying erythema on the tip of a digit, more frequently arising on a finger than a toe. As far as classification, ACH is considered a localized form of pustular psoriasis. The eruption typically occurs after local trauma or infection, but such a history is not always present and various other etiologies have been described including infectious, neural, inflammatory, and genetic causes. The natural progression of ACH is chronic and progressive, often resulting in irreversible complications such as onychodystrophy that can result in anonychia, as well as osteitis that can result in osteolysis of the distal phalanges. Because of the rarity of ACH, there have been no randomized controlled studies to evaluate therapies, resulting in an absence of standardized treatment guidelines. In clinical practice, a wide variety of treatments have been attempted, with outcomes ranging from recalcitrance to complete resolution. In recent years, the introduction of biologics has provided a new class of therapy that has revolutionized the treatment of ACH. Specifically, rapid and sustained responses have been reported with the use of anti-tumor necrosis factor agents like infliximab, adalimumab, and etanercept; IL-17 inhibitors like secukinumab; IL-12/23 inhibitors like ustekinumab; and IL-1 inhibitors like anakinra. Nevertheless, there remains a considerable need for more research into treatment for the benefit of individual patients with ACH as well as for the clinical knowledge gained by such efforts. The purpose of this review is to provide a comprehensive overview of the key features of ACH as well as a discussion of clinical management strategies for this unique and debilitating condition

Investigating the Justice System Response to Domestic Violence in Missouri

One in four women will experience domestic violence in their lifetimes. Each year, 5.3 million domestic violence assaults occur in the United States alone and domestic violence is the leading cause of injury to women. Yet, despite the prevalence of domestic violence, little empirical research on the justice system\u27s response to it exists. This paper seeks to describe a state funded project that was created to assess and compare responses to domestic violence throughout the state of Missouri. The project lasted for three years and was conducted by an interdisciplinary team of University of Missouri-Columbia (MU) professors and students

Western Immunoblotting in Avian Shell Gland Sample Immunoblotting Methods1

Avian shell gland tissue was subjected to Western blot analysis using anti-human estrogen receptor- α antibody H222. Initial attempts to obtain consistent, high-quality blots were unsuccessful because, as it turned out, excessive lipid in tissue preparations interfered with protein separation. Incremental additions of acetone eventually proved to be the critical step in solubilizing lipids and allowing consistent separation of bands on gels. A detailed description of the methodology is presented

Laboratory Focus on Improving the Culture of Biosafety: Statewide Risk Assessment of Clinical Laboratories That Process Specimens for Microbiologic Analysis

The Wisconsin State Laboratory of Hygiene challenged Wisconsin laboratories to examine their biosafety practices and improve their culture of biosafety. One hundred three clinical and public health laboratories completed a questionnaire-based, microbiology-focused biosafety risk assessment. Greater than 96% of the respondents performed activities related to specimen processing, direct microscopic examination, and rapid nonmolecular testing, while approximately 60% performed culture interpretation. Although they are important to the assessment of risk, data specific to patient occupation, symptoms, and travel history were often unavailable to the laboratory and, therefore, less contributory to a microbiology-focused biosafety risk assessment than information on the specimen source and test requisition. Over 88% of the respondents complied with more than three-quarters of the mitigation control measures listed in the survey. Facility assessment revealed that subsets of laboratories that claim biosafety level 1, 2, or 3 status did not possess all of the biosafety elements considered minimally standard for their respective classifications. Many laboratories reported being able to quickly correct the minor deficiencies identified. Task assessment identified deficiencies that trended higher within the general (not microbiology-specific) laboratory for core activities, such as packaging and shipping, direct microscopic examination, and culture modalities solely involving screens for organism growth. For traditional microbiology departments, opportunities for improvement in the cultivation and management of highly infectious agents, such as acid-fast bacilli and systemic fungi, were revealed. These results derived from a survey of a large cohort of small- and large-scale laboratories suggest the necessity for continued microbiology-based understanding of biosafety practices, vigilance toward biosafety, and enforcement of biosafety practices throughout the laboratory setting

UV Absorption Lines from High-Velocity Gas in the Vela Supernova Remnant: New insights from STIS Echelle Observations of HD72089

The star HD72089 is located behind the Vela supernova remnant and shows a complex array of high and low velocity interstellar absorption features arising from shocked clouds. A spectrum of this star was recorded over the wavelength range 1196.4 to 1397.2 Angstroms at a resolving power lambda/Delta lambda = 110,000 and signal-to-noise ratio of 32 by STIS on the Hubble Space Telescope. We have identified 7 narrow components of C I and have measured their relative populations in excited fine-structure levels. Broader features at heliocentric velocities ranging from -70 to +130 km/s are seen in C II, N I, O I, Si II, S II and Ni II. In the high-velocity components, the unusually low abundances of N I and O I, relative to S II and Si II, suggest that these elements may be preferentially ionized to higher stages by radiation from hot gas immediately behind the shock fronts.Comment: 11 pages, 2 figures, Latex. Submitted for the special HST ERO issue of the Astrophysical Journal Letter