Preparing for the Unexpected: Recognizing a Tortuous Thoracic Aorta During Ultrasound-guided Thoracentesis

Ultrasound-guidance has become the standard of care for bedside thoracentesis. This manuscript describes the importance of utilizing point-of-care-ultrasound (POCUS) and color Doppler in avoiding an unusual, but potentially catastrophic aortic puncture during thoracentesis. The case describes a 70 year-old man who presented with one week of shortness of breath. He was found to have a large left-sided pleural effusion on imaging studies. During a bedside POCUS examination, he was found to have a hyperechoic linear structure in his posterior left hemithorax. Ultrasound application of color Doppler revealed a pulsatile flow, confirming visualization of the aorta. The site of needle insertion for thoracentesis was placed more laterally to avoid aortic puncture. The thoracentesis was performed successfully with removal of about 1000ml of sanguinous fluid. This clinical case demonstrates the importance of considering anatomic variants when performing a thoracentesis. As in this patient’s case, ultrasonography and color Doppler during thoracentesis can be useful in avoiding a potentially life-threatening puncture of the aorta

Three essays on social inequality and the U.S. criminal justice system

This dissertation uses three essays to examine issues related to inequality and the U.S. criminal justice system. In the first essay, I examine links between arrest, residential segregation, and immigration within U.S. metropolitan statistical areas (MSAs). This research addresses two separate, but contemporary fields of research where a) increased crime is associated with highly segregated urban black ghettoes and b) decreased crime is observed among immigrant groups. Data for race and ethnic populations for MSAs are aggregated from 5% integrated public-use micro-samples [IPUMS] of the U.S. Census surveys from 1980-2000; data for arrest rates are taken from FBI Uniform Crime Reports from 1980-2000. Results from fixed effect models find statistically significant results indicating (i) African American social isolation positively correlates with arrest rates and (ii) immigrant groups are differentially correlated with arrest rates based on immigrant race and ethnic classification. In the second essay, I examine the effects of race and history of incarceration on employment among less-skilled men. Recent findings of audit and employer surveys have found that African Americans and ex-offenders are groups who, respectively, are less likely to be hired than whites and non-offenders. Expanding on prior research, I use data from the 1979 National Longitudinal Survey of Youth to test if labor force participation and unemployment are jointly impacted by race and history of incarceration. To control for unobserved invariant characteristics of individuals and interview periods, I utilize fixed effect error terms at the individual level. Results indicate that, relative to whites, African American and Hispanic ex-felons are more likely to experience persisting unemployment and time out of the labor force in years after incarceration. In the third essay, I examine how genetic, individual, familial, and community-level variables possibly mediate a link between father’s incarceration and adult son’s deviance and arrest. Using twin and nationally-representative sub-samples from the National Longitudinal Survey of Adolescent Health, I test how molecular genetic, individual, familial, and community variables from adolescence may mediate this link. In analysis, father’s incarceration is found to be robustly associated with increased delinquency and arrest among adult sons when these effects are estimated

Legacies denied: the intergenerational dimension in crime and punishment

Does having an incarcerated parent adversely affect the outcomes of children? Using the National Longitudinal Study of Adolescent Health (Add Health), I explore if incarceration of a biological father leads to increased probability of criminal behavior and arrest among adult offspring. Analysis suggests that adult children of incarcerated parents are more likely to engage in criminal behavior and face encounters with the criminal justice system. With 2 million individuals serving time in prison or jail in 2000 and the emergence of incarceration as a life-course event among less-educated males and minorities, intergenerational patterns of crime and incarceration may provide new context to the rapidly expanding prison population and the transmission of social disadvantage from parents to children

The Association Between the MAOA 2R Genotype and Delinquency Over Time Among Men: The Interactive Role of Parental Closeness and Parental Incarceration

Using a panel of 6,001 males from the National Longitudinal Study of Adolescent and Adult Health, we examine potential moderation by paternal incarceration and parent-child closeness altering the relationship between the rare 2R MAOA genotype and delinquency. By jointly examining moderation patterns for both the mother and father with the transmission of the MAOA genotype from mother to son, we are able to make inferences about the specific genetic model that best explains these outcomes. In line with prior research, we find a direct relationship between the MAOA 2R genotype and delinquency, independent of parental incarceration and closeness. Examining moderation patterns, we find that delinquency risk for the 2R allele is buffered for males close to their biological or social father, but not their biological mother. We conclude that the 2R delinquency association is not due to passive gene-environment correlation but is best characterized as a social control gene-environment interaction

The VNTR 2 repeat in MAOA and delinquent behavior in adolescence and young adulthood: associations and MAOA promoter activity

Genetic studies of delinquent and criminal behavior are rare in spite of the wide recognition that individuals may differ in their propensity for delinquency and criminality. Using 2524 participants in Add Health in the United States, the present study demonstrates a link between the rare 2 repeat of the 30-bp VNTR in the MAOA gene and much higher levels of self-reported serious and violent delinquency. The evidence is based on a statistical association analysis and a functional analysis of MAOA promoter activity using two human brain-derived cell lines: neuroblastoma SH-SY5Y and human glioblastoma 1242-MG. The association analysis shows that men with a 2R report a level of serious delinquency and violent delinquency in adolescence and young adulthood that were about twice (CI: (0.21, 3.24), P = 0.025; and CI: (0.37, 2.5), P = 0.008 for serious and violent delinquency, respectively) as high as those for participants with the other variants. The results for women are similar, but weaker. In the functional analysis, the 2 repeat exhibits much lower levels of promoter activity than the 3 or 4 repeat

Ultraviolet Spectroscopy of Asteroid (4) Vesta

We report a comprehensive review of the UV-visible spectrum and rotational lightcurve of Vesta combining new observations by Hubble Space Telescope and Swift Gamma-ray Burst Observatory with archival International Ultraviolet Explorer observations. The geometric albedos of Vesta from 220 nm to 953 nm are derived by carefully comparing these observations from various instruments at different times and observing geometries. Vesta has a rotationally averaged geometric albedo of 0.09 at 250 nm, 0.14 at 300 nm, 0.26 at 373 nm, 0.38 at 673 nm, and 0.30 at 950 nm. The linear spectral slope as measured between 240 and 320 nm in the ultraviolet displays a sharp minimum near a sub-Earth longitude of 20^{\circ}, and maximum in the eastern hemisphere. This is consistent with the longitudinal distribution of the spectral slope in the visible wavelength. The photometric uncertainty in the ultraviolet is ~20%, and in the visible wavelengths it is better than 10%. The amplitude of Vesta's rotational lightcurves is ~10% throughout the range of wavelengths we observed, but is smaller at 950 nm (~6%) near the 1-\mum band center. Contrary to earlier reports, we found no evidence for any difference between the phasing of the ultraviolet and visible/near-infrared lightcurves with respect to sub-Earth longitude. Vesta's average spectrum between 220 and 950 nm can well be described by measured reflectance spectra of fine particle howardite-like materials of basaltic achondrite meteorites. Combining this with the in-phase behavior of the ultraviolet, visible, and near-infrared lightcurves, and the spectral slopes with respect to the rotational phase, we conclude that there is no global ultraviolet/visible reversal on Vesta. Consequently, this implies a lack of global space weathering on Vesta, as previously inferred from visible-near-infrared data.Comment: 44 pages, 5 figures, 1 tabl

Gene–environment interactions related to body mass: School policies and social context as environmental moderators

This paper highlights the role of institutional resources and policies, whose origins lie in political processes, in shaping the genetic etiology of body mass among a national sample of adolescents. Using data from Waves I and II of the National Longitudinal Study of Adolescent Health, we decompose the variance of body mass into environmental and genetic components. We then examine the extent to which the genetic influences on body mass are different across the 134 schools in the study. Taking advantage of school differences in both health-related policies and social norms regarding body size, we examine how institutional resources and policies alter the relative impact of genetic influences on body mass. For the entire sample, we estimate a heritability of .82, with the remaining .18 due to unique environmental factors. However, we also show variation about this estimate and provide evidence suggesting that social norms and institutional policies often mask genetic vulnerabilities to increased weight. Empirically, we demonstrate that more-restrictive school policies and policies designed to curb weight gain are also associated with decreases the proportion of variance in body mass that is due to additive genetic influences

The Use of Standardized Patient Simulation for Interprofessional Teaching of Palliative Care Communication Skills

The Use of Standardized Patient Simulation for Interprofessional Teaching of Palliative Care Communication Skills • Children who receive palliative care services are affected by illnesses that are different in nature and number from those that typically affect adult recipients. • Interdisciplinary/Interprofessional teams are the norm: • Special knowledge of pediatric developmental, psychological, social and spiritual dimensions round out the comprehensive palliative care of pediatric patients. • Even symptom management requires unique assessment tools. • http://www2.aap.org/sections/palliative

Intratumoral Delivery of MDNA55, an Interleukin-4 Receptor Targeted Immunotherapy, by MRI-Guided Convective Delivery for the Treatment of Recurrent Glioblastoma

https://digitalcommons.psjhealth.org/other_pubs/1047/thumbnail.jp