Residence Restrictions on Custodial Parents: Sex-Based Discrimination?

Residence restrictions are frequently imposed on the custodial, but not the noncustodial, parent. These restrictions come into play when the custodial parent wishes to move with the child, the noncustodial parent opposes the move, and a court is called upon to resolve the dispute. The court will do so based upon a determination of what it judges to be in the best interests of the child. The best interests inquiry ultimately resolves itself into a question of whether the custodial parent\u27s reasons for making the move are sufficiently substantial to outweigh the noncustodial parent\u27s interest in existing visitation privileges. A custodial parent who violates the residence restrictions may lose custody of the child, forfeit child support, or be subjected to contempt proceedings. This Article will demonstrate that residence restrictions are not consistent with concepts of custody and general rules on change of custody. And, it will show that residence restrictions are sex-based in their application, justification, and effect because they exist to protect only the interests of the noncustodial father. If most custodial parents were men, residence restrictions would cease to exist or would be analyzed differently; the focus would finally be on the real interests at stake for all involved

A Sensor for Oxygen in a Potassium-Sodium Alloy

This project supports a research project to determine the configuration for heat exchanger welds in a space reactor. The reactor is a sodium-potassium (NaK) cooled reactor for use on future missions on the lunar surface or on Mars. Various types of welds in Type 316L stainless steel have been positioned in a furnace which is part of a NaK test loop. The specimens are bathed in circulating NaK at 600 degrees centigrade. Since the oxygen concentration in the NaK is a major factor in corrosion of the weld specimens, it must be carefully monitored and controlled. However, few techniques are available for analysis of oxygen in alkali metals, and perhaps only one is reasonably available for continuous monitoring of oxygen. Electrochemical potential is the method selected to monitor oxygen concentration in the NaK loop, and this research project is to design and fabricate an electrochemical sensor to determine the oxygen concentration in NaK. An existing automotive oxygen sensor was extensively modified for use in the NaK system. It incorporates a reference cell consisting of Bismuth/Bismuth Oxide and molybdenum electrodes. A system for calibration of the sensor at elevated temperatures was developed, and a calibration curve generated for use in the NaK test loop

Exploring the role of inflammation in major depressive disorder: beyond the monoamine hypothesis

Major depressive disorder affects approximately 8.4% of the United States population. The World Health Organization estimates that 280 million adults worldwide are suffering from depression. They have estimated that by 2030 it will be the second most serious condition. Current treatment relies on the monoamine hypothesis, however, one-third of patients with MDD do not respond to monoamine-based antidepressants. For years, it was hypothesized that the primary pathway of MDD involved serotonin as the main neurotransmitter. The monoamine hypothesis, a widely accepted theory, sought to explain the biological basis of MDD as being caused by the depletion of monoamine neurotransmitters, namely norepinephrine and serotonin. This hypothesis regarding monoamines as the pathophysiological basis of MDD led to the design and widespread use of selective serotonin reuptake inhibitors. However, given that only one-third of patients improve with SSRI it is reasonable to infer that the pathway involved is more complex than once hypothesized and there are more neurotransmitters, receptors, and molecules involved. The monoamine hypothesis does not explain why there is a delay in the onset of effect and action of SSRIs. Several studies have demonstrated that chronic stress is a risk factor for the development of MDD. Thus the monoamine hypothesis alone is not enough to fully account for the pathophysiology of MDD highlighting the need for further research involving the pathways of MDD. In this paper, we review the role of inflammation and cytokines on MDD and discuss other pathways involved in the development and persistence of depressive symptoms

Procedural Competency Training during Diagnostic Radiology Residency: Time to Go beyond “See One, Do One, Teach One”!

Objectives: Achieving procedural competency during diagnostic radiology residency can impact the radiologist\u27s future independent practice after graduation, especially in a private practice setting. However, standardized procedure competency training within most radiology residency programs is lacking, and overall procedural skills are still mainly acquired by the traditional “see one, do one, teach one” methodology. We report the development of a simple standardized procedural training protocol that can easily be adopted by residency programs currently lacking any form of structured procedural training. Materials and Methods: An ad hoc resident procedural competency committee was created in our radiology residency program. A procedural certification protocol was developed by the committee which was composed of attending radiologists from the involved divisions and two chief residents. A road map to achieve procedural competency certification status was finalized. The protocol was then implemented through online commercial software. Results: Our procedural certification protocol took effect in September 2014. We reviewed all resident records from September 2014 to December 2016. Eighteen residents of various levels of training participated in our training protocol. About 72% became certified in paracentesis, 11% in thoracentesis, 83% in feeding tube placement, 55% in lumbar puncture/myelogram, and 77% in tunneled catheter removal. Conclusions: Our single-center experience demonstrates that a simple to adopt structured approach to procedural competency training is feasible and effective. Our “certified” radiology residents were deemed capable of performing those procedures under indirect supervision. The following core competencies are addressed in this article: Patient care, Medical knowledge, and Systems-based practice

A closer look to neural pathways and psychopharmacology of obsessive compulsive disorder

The intricate neural pathways involved in obsessive-compulsive disorder (OCD) affect areas of our brain that control executive functioning, organization, and planning. OCD is a chronic condition that can be debilitating, afflicting millions of people worldwide. The lifetime prevalence of OCD in the US is 2.3%. OCD is predominantly characterized by obsessions consisting of intrusive and unwanted thoughts, often with impulses that are strongly associated with anxiety. Compulsions with OCD encompass repetitive behaviors or mental acts to satisfy their afflicted obsessions or impulses. While these factors can be unique to each individual, it has been widely established that the etiology of OCD is complex as it relates to neuronal pathways, psychopharmacology, and brain chemistry involved and warrants further exploration

Robotic bronchoscopy for peripheral pulmonary lesions: A multicenter pilot and feasibility study (BENEFIT)

BACKGROUND: The diagnosis of peripheral pulmonary lesions (PPL) continues to present clinical challenges. Despite extensive experience with guided bronchoscopy, the diagnostic yield has not improved significantly. Robotic-assisted bronchoscopic platforms have been developed potentially to improve the diagnostic yield for PPL. Presently, limited data exist that evaluate the performance of robotic systems in live human subjects. RESEARCH QUESTION: What is the safety and feasibility of robotic-assisted bronchoscopy in patients with PPLs? STUDY DESIGN AND METHODS: This was a prospective, multicenter pilot and feasibility study that used a robotic bronchoscopic system with a mother-daughter configuration in patients with PPL 1 to 5 cm in size. The primary end points were successful lesion localization with the use of radial probe endobronchial ultrasound (R-EBUS) imaging and incidence of procedure related adverse events. Robotic bronchoscopy was performed in patients with the use of direct visualization, electromagnetic navigation, and fluoroscopy. After the use of R-EBUS imaging, transbronchial needle aspiration was performed. Rapid on-site evaluation (ROSE) was used on all cases. Transbronchial needle aspiration alone was sufficient when ROSE was diagnostic; when ROSE was not diagnostic, transbronchial biopsy was performed with the use of the robotic platform, followed by conventional guided bronchoscopic approaches at the discretion of the investigator. RESULTS: Fifty-five patients were enrolled at five centers. One patient withdrew consent, which left 54 patients for data analysis. Median lesion size was 23 mm (interquartile range, 15 to 29 mm). R-EBUS images were available in 53 of 54 cases. Lesion localization was successful in 51 of 53 patients (96.2%). Pneumothorax was reported in two of 54 of the cases (3.7%); tube thoracostomy was required in one of the cases (1.9 %). No additional adverse events occurred. INTERPRETATION: This is the first, prospective, multicenter study of robotic bronchoscopy in patients with PPLs. Successful lesion localization was achieved in 96.2% of cases, with an adverse event rate comparable with conventional bronchoscopic procedures. Additional large prospective studies are warranted to evaluate procedure characteristics, such as diagnostic yield. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT03727425; URL: www.clinicaltrials.gov

Safety and diagnostic performance of pulmonologists performing electromagnetic guided percutaneous lung biopsy (SPiNperc)

Background and objectivePercutaneous lung biopsy for diagnostic sampling of peripheral lung nodules has been widely performed by interventional radiologists under computed tomography (CT) guidance. New technology allows pulmonologists to perform percutaneous lung biopsies using electromagnetic (EM) guided technology. With the adoption of this new technique, the safety, feasibility and diagnostic yield need to be explored. The goal of this study was to determine the safety, feasibility and diagnostic yield of EMâ guided percutaneous lung biopsy performed by pulmonologists.MethodsWe conducted a retrospective, multicentre study of 129 EMâ guided percutaneous lung biopsies that occurred between November 2013 and March 2017. The study consisted of seven academic and three community medical centres.ResultsThe average age of participants was 65.6â years, BMI was 26.3 and 50.4% were females. The majority of lesions were in the right upper lobe (37.2%) and left upper lobe (31.8%). The mean size of the lesions was 27.31â mm and the average distance from the pleura was 13.2â mm. Practitioners averaged two fineâ needle aspirates and five core biopsies per procedure. There were 23 (17.8%) pneumothoraces, of which 16 (12.4%) received smallâ bore chest tube placement. The diagnostic yield of percutaneous lung biopsy was 73.7%. When EMâ guided bronchoscopic sampling was also performed during the same procedural encounter, the overall diagnostic yield increased to 81.1%.ConclusionIn this large multicentred series, the use of EM guidance for percutaneous lung biopsies was safe and feasible, with acceptable diagnostic yield in the hands of pulmonologists. A prospective multicentre trial to validate these findings is currently underway (NCT03338049).Lung cancer screening has led to the discovery of over 1â million pulmonary nodules each year. New technology allows pulmonologists to perform percutaneous lung biopsies using electromagnetic (EM) guided technology. In this retrospective analysis, we demonstrate that EM percutaneous needle biopsy is safe, feasible and provides an acceptable diagnostic yield.See related EditorialPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149341/1/resp13471.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149341/2/resp13471_am.pd

Residence Restrictions on Custodial Parents: Sex-Based Discrimination?

Residence restrictions are frequently imposed on the custodial, but not the noncustodial, parent. These restrictions come into play when the custodial parent wishes to move with the child, the noncustodial parent opposes the move, and a court is called upon to resolve the dispute. The court will do so based upon a determination of what it judges to be in the best interests of the child. The best interests inquiry ultimately resolves itself into a question of whether the custodial parent\u27s reasons for making the move are sufficiently substantial to outweigh the noncustodial parent\u27s interest in existing visitation privileges. A custodial parent who violates the residence restrictions may lose custody of the child, forfeit child support, or be subjected to contempt proceedings. This Article will demonstrate that residence restrictions are not consistent with concepts of custody and general rules on change of custody. And, it will show that residence restrictions are sex-based in their application, justification, and effect because they exist to protect only the interests of the noncustodial father. If most custodial parents were men, residence restrictions would cease to exist or would be analyzed differently; the focus would finally be on the real interests at stake for all involved

Representations of Jews and Judaism in The Dialogue of Timothy and Aquila : Construct or social reality?

The Dialogue of Timothy and Aquila (TA) is an anonymous literary disputation between a Christian and a Jew that is placed in the days of Cyril, Archbishop of Alexandria (412-444 C.E.). Although an earlier form of this text circulated in the third century, the final form of TA emerged in the fifth. This study uses TA to address the problem of assessing information about Jews and Judaism in such polemical, Christian sources. The approach to this project is both historical and literary-critical. The history of relations between Jews and Christians is one set of evidence against which literary accounts of those relations are compared. The principal task is to evaluate evidence that has explicit corroboration in Jewish sources, rabbinic and non-rabbinic; literary and non-literary, as well as evidence that is uncorroborated. The literary critique focuses on the question of precisely how form affects content; how dialogue genre contributes to the portrayals of Judaism it preserves. While the author of the earlier source might have had some first hand acquaintance with Jews, the final form of the text betrays no explicit knowledge of Jews living in a fifth century, Egyptian context. TA does not represent a transcript of an actual disputation but reflects an idealized Christian account of such a disputation. Since the text makes almost no attempt to address contemporary Judaism or issues in relations between Christians and Jews, it could not have been adequate as a Christian disputation manual. Indeed, by importing the earlier form of TA into a later context, the final editor implicitly represents Judaism as frozen in the controversies that engaged Trypho and Justin in the mid-second century. However, as a text concerned with Christian catechesis it is certainly adequate for less sophisticated readers. As such, the Jew, Jews, and Judaism function as heuristic devices in TA and betray no direct interest in the conversion of Jews, unlike what the text superficially presents