Unwarranted Variations in the Quality of Health Care: Can the Law Help Medicine Provide a Remedy/Remedies?

This article reviews the essential findings of studies of variations in quality of care according to three categories of care: effective care, preference-sensitive care, and supply-sensitive care. It argues that malpractice liability and informed consent laws should be based on standards of practice that are appropriate to each category of care. In the case of effective care, the legal standard should be that virtually all of those in need should receive the treatment, whether or not it is currently customary to provide it. In the case of preference-sensitive care, the law should recognize the failure of the doctrine of informed consent to assure that patient preferences are respected in choice of treatment; we suggest that the law adopt a standard of informed patient choice in which patients are invited, not merely to consent to a recommended treatment, but to choose the treatment that best advances their preferences. In the case of supply-sensitive care, we suggest that physicians who seek to adopt more conservative patterns of practice be protected under the “respectable minority” or “two schools of thought” doctrine

Physician Willingness to Withhold Tube Feeding after Cruzan: An Empirical Study

In Cruzan v. Hannon, the Missouri Supreme Court declined to let Nancy Cruzan\u27s father discontinue her tube feedings. The court insisted on clear and convincing evidence of her wishes and was unsatisfied that proof of this kind had been presented in her case.\u27 In addition, it refused to defer to her family or to consider her quality of life. On June 25, 1990, the United States Supreme Court affirmed the Missouri Supreme Court\u27s decision. Since Cruzan, public demand for living wills has exploded

Four Bed Molecular Sieve - Exploration (4BMS-X) Virtual Heater Design and Optimization

A 4BMS-X (Four Bed Molecular Sieve - Exploration) design and heater optimization study for CO2 sorbent beds in proposed exploration system architectures is presented. The primary objectives of the study are to reduce heater power and thermal gradients within the CO2 sorbent beds while minimizing channeling effects. Some of the notable changes from the ISS (International Space Station) CDRA (Carbon Dioxide Removal Assembly) to the proposed exploration system architecture include cylindrical beds, alternate sorbents and an improved heater core. Results from both 2D and 3D sorbent bed thermal models with integrated heaters are presented. The 2D sorbent bed models are used to optimize heater power and fin geometry while the 3D models address end effects in the beds for more realistic thermal gradient and heater power predictions

Considering the Case for Biodiversity Cycles: Reexamining the Evidence for Periodicity in the Fossil Record

Medvedev and Melott (2007) have suggested that periodicity in fossil biodiversity may be induced by cosmic rays which vary as the Solar System oscillates normal to the galactic disk. We re-examine the evidence for a 62 million year (Myr) periodicity in biodiversity throughout the Phanerozoic history of animal life reported by Rohde & Mueller (2005), as well as related questions of periodicity in origination and extinction. We find that the signal is robust against variations in methods of analysis, and is based on fluctuations in the Paleozoic and a substantial part of the Mesozoic. Examination of origination and extinction is somewhat ambiguous, with results depending upon procedure. Origination and extinction intensity as defined by RM may be affected by an artifact at 27 Myr in the duration of stratigraphic intervals. Nevertheless, when a procedure free of this artifact is implemented, the 27 Myr periodicity appears in origination, suggesting that the artifact may ultimately be based on a signal in the data. A 62 Myr feature appears in extinction, when this same procedure is used. We conclude that evidence for a periodicity at 62 Myr is robust, and evidence for periodicity at approximately 27 Myr is also present, albeit more ambiguous.Comment: Minor modifications to reflect final published versio

HSD3B1 genotype identifies glucocorticoid responsiveness in severe asthma

Asthma resistance to glucocorticoid treatment is a major health problem with unclear etiology. Glucocorticoids inhibit adrenal androgen production. However, androgens have potential benefits in asthma. HSD3B1 encodes for 3β-hydroxysteroid dehydrogenase-1 (3β-HSD1), which catalyzes peripheral conversion from adrenal dehydroepiandrosterone (DHEA) to potent androgens and has a germline missense-encoding polymorphism. The adrenal restrictive HSD3B1(1245A) allele limits conversion, whereas the adrenal permissive HSD3B1(1245C) allele increases DHEA metabolism to potent androgens. In the Severe Asthma Research Program (SARP) III cohort, we determined the association between DHEA-sulfate and percentage predicted forced expiratory volume in 1 s (FEV1PP). HSD3B1(1245) genotypes were assessed, and association between adrenal restrictive and adrenal permissive alleles and FEV1PP in patients with (GC) and without (noGC) daily oral glucocorticoid treatment was determined (n = 318). Validation was performed in a second cohort (SARP I&II; n = 184). DHEA-sulfate is associated with FEV1PP and is suppressed with GC treatment. GC patients homozygous for the adrenal restrictive genotype have lower FEV1PP compared with noGC patients (54.3% vs. 75.1%; P < 0.001). In patients with the homozygous adrenal permissive genotype, there was no FEV1PP difference in GC vs. noGC patients (73.4% vs. 78.9%; P = 0.39). Results were independently confirmed: FEV1PP for homozygous adrenal restrictive genotype in GC vs. noGC is 49.8 vs. 63.4 (P < 0.001), and for homozygous adrenal permissive genotype, it is 66.7 vs. 67.7 (P = 0.92). The adrenal restrictive HSD3B1(1245) genotype is associated with GC resistance. This effect appears to be driven by GC suppression of 3β-HSD1 substrate. Our results suggest opportunities for prediction of GC resistance and pharmacologic intervention

UBVRI Light Curves of 44 Type Ia Supernovae

We present UBVRI photometry of 44 type-Ia supernovae (SN Ia) observed from 1997 to 2001 as part of a continuing monitoring campaign at the Fred Lawrence Whipple Observatory of the Harvard-Smithsonian Center for Astrophysics. The data set comprises 2190 observations and is the largest homogeneously observed and reduced sample of SN Ia to date, nearly doubling the number of well-observed, nearby SN Ia with published multicolor CCD light curves. The large sample of U-band photometry is a unique addition, with important connections to SN Ia observed at high redshift. The decline rate of SN Ia U-band light curves correlates well with the decline rate in other bands, as does the U-B color at maximum light. However, the U-band peak magnitudes show an increased dispersion relative to other bands even after accounting for extinction and decline rate, amounting to an additional ~40% intrinsic scatter compared to B-band.Comment: 84 authors, 71 pages, 51 tables, 10 figures. Accepted for publication in the Astronomical Journal. Version with high-res figures and electronic data at http://astron.berkeley.edu/~saurabh/cfa2snIa

Modular Approach to Therapy for Anxiety, Depression, Trauma, or Conduct Problems in outpatient child and adolescent mental health services in New Zealand: study protocol for a randomized controlled trial

Background: Mental health disorders are common and disabling for young people because of the potential to disrupt key developmental tasks. Implementation of evidence-based psychosocial therapies in New Zealand is limited, owing to the inaccessibility, length, and cost of training in these therapies. Furthermore, most therapies address one problem area at a time, although comorbidity and changing clinical needs commonly occur in practice. A more flexible approach is needed. The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) is designed to overcome these challenges; it provides a range of treatment modules addressing different problems, within a single training program. A clinical trial of MATCH-ADTC in the USA showed that MATCH-ADTC outperformed usual care and standard evidence-based treatment on several clinical measures. We aim to replicate these findings and evaluate the impact of providing training and supervision in MATCH-ADTC to: (1) improve clinical outcomes for youth attending mental health services; (2) increase the amount of evidence-based therapy content; (3) increase the efficiency of service delivery. Methods: This is an assessor-blinded multi-site effectiveness randomized controlled trial. Randomization occurs at two levels: (1) clinicians (≥60) are randomized to intervention or usual care; (2) youth participants (7–14 years old) accepted for treatment in child and adolescent mental health services (with a primary disorder that includes anxiety, depression, trauma-related symptoms, or disruptive behavior) are randomly allocated to receive MATCH-ADTC or usual care. Youth participants are recruited from ‘mainstream’, Māori-specific, and Pacific-specific child and adolescent mental health services. We originally planned to recruit 400 youth participants, but this has been revised to 200 participants. Centralized computer randomization ensures allocation concealment. The primary outcome measures are: (i) the difference in trajectory of change of clinical severity between groups (using the parent-rated Brief Problem Monitor); (ii) clinicians’ use of evidence-based treatment procedures during therapy sessions; (iii) total time spent by clinicians delivering therapy. Discussion: If MATCH-ADTC demonstrates effectiveness it could offer a practical efficient method to increase access to evidence-based therapies, and improve outcomes for youth attending secondary care services

1963

Trees for a Beautiful Golf Course by Philip Scott (page 1) The Golf Course\u27s Worst Enemy by Charles Amorim and Hal Haskell (2) Message from the President by James f. Gilligan (2) Turf Management Club News (3) Quotes from 1962 Freshman (4) When I consider How my Night is Spent Leonard Mailloux(5) Protection of a Golf Course by Pay Lucas Jr. (6) Safety - The Superintendents\u27 Responsibility by Gerald Peters (7) Picture - Senior Stockbridge Turf Majors (8) Picture - Freshmen Stockbridge Turf Majors (9) Kansas - In the Transition Zone by Carl Beer (10 Seeds by Don Daigle (11) Picture - Dean F. P. Jeffrey, Dr. W.G. Colby and Director J. R. Beattie (12) Picture - Graduates of Winter School for Turf Managers - 1963 (13) The Effect of Last Year\u27s Weather Upon This Year\u27s Incidence of Turf Insects by John C. Schread (A-1) Labor-Management Relations by Mortimer H. Gavin S.J. (A-4) Massachusetts Labor Laws by Andrew C. SInclair (A-7) Golf Course Budget by John Espey (A-10) Golf Course Budgets by Robert St. Thomas (A-12) Purpose & Method of Budgeting by Leon St. Pierre (A-13) The Committee Chairman, His Duties by Charles Connelly (A-16) Long-range vs. Short-range Planning by George Farber (A-18) The Golf Course Superintendent, His Duties by Sherwood Moore (A-20) The Budget by Leo Kowalski (A-25) Public Relations by Leon St. Pierre (A-26) A Study of WIlt by Harry Meusal (A-28) Specifications for a Method of Putting Green Construction by Alexander Radko (A-33) Management of Kentucky Bluegrass & Grass Mixtures for Turf by F.V. Juska (A-38) What\u27s New in Fertilizers by Geoffrey S. Cornish (A-40) Methylene Ureas by Harvey Stangel (A-42) Plastic Coated Fertilizers by Louis I. Hansen (A-44) The Role of Sewage Sludge by James Latham Jr. (A-49) The Role of Ureaforms in the Turf Fertilizer Industry by Robert T. Miller (A-51) Why Low Phosphorus & Higher Potassium by L. J. Sullivan (A-55) Uptake of Potassium by Evangel Bredakis (A-59) Responsibility of Industry & Community in Land Usage & Plantings by Joseph L. Beasley (A-61) Turf & Other Planting Problems by H. Thurston Handley Jr. (A-65) Weeds & Diseases by Dominic Marini (A-67) General Maintenacne & Equipment by Lewis Hodgkinson (A-68) Fertilizer Problems by William J. Bennett (A-70) Lawn Construction & Insect Problems by herbert C. Fordham (A-71

Fifteen new risk loci for coronary artery disease highlight arterial-wall-specific mechanisms

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Although 58 genomic regions have been associated with CAD thus far, most of the heritability is unexplained, indicating that additional susceptibility loci await identification. An efficient discovery strategy may be larger-scale evaluation of promising associations suggested by genome-wide association studies (GWAS). Hence, we genotyped 56,309 participants using a targeted gene array derived from earlier GWAS results and performed meta-analysis of results with 194,427 participants previously genotyped, totaling 88,192 CAD cases and 162,544 controls. We identified 25 new SNP-CAD associations (P &lt; 5 × 10(-8), in fixed-effects meta-analysis) from 15 genomic regions, including SNPs in or near genes involved in cellular adhesion, leukocyte migration and atherosclerosis (PECAM1, rs1867624), coagulation and inflammation (PROCR, rs867186 (p.Ser219Gly)) and vascular smooth muscle cell differentiation (LMOD1, rs2820315). Correlation of these regions with cell-type-specific gene expression and plasma protein levels sheds light on potential disease mechanisms