Best Outcomes for Indian Children

The Wisconsin Department of Children and Families and the Midwest Child Welfare Implementation Center are collaborating with Wisconsin\u27s tribes and county child welfare agencies to improve outcomes for Indian children by systemically implementing the Wisconsin Indian Child Welfare Act (WICWA).This groundbreaking coUaboration wiU increase practitioners\u27 understanding ofthe requirements of WICWA and the need for those requirements, enhance communication and coordination between all stakeholders responsible for the welfare of Indian children in Wisconsin; it is designed to effect the systemic integration of the philosophical underpinnings of WICWA. In December 2009, Governor James Doyle signed the Wisconsin Indian Child Welfare Act, signaling the end ofa historic collaborative effort to enact the law and marking the beginning ofa new initiative to effectively implement it. Like the work that led to enactment ofthe statute, the work required to effectuate it requires the involvement of stakeholders with very diverse views and interests. However, this group has a common goal to which aU members are committed: to achieve better outcomes for Indian children in Wisconsin. The Midwest Child Welfare Implementation Center, a member of the Training and Technical Assistance network ofthe Children\u27s Bureau, is privileged to assist the 11 tribes, the state of Wisconsin, and its project partners in a four-year implementation project toward the achievement ofthat goal. This article describes the early years ofthat journey and the plan for its current segment, which is in progress

Telehealth by Certified Psychiatric Providers Compared to Emergency Department Healthcare Providers on Psychiatric Patient Outcomes: A Scoping Review

Background: Emergency department visits for mental health disorders have increased over the years due to insufficient mental health resources. The number of ED visits for mental health disorders rose from 1.4 to 2.5 million per year in the US. Therefore, mental health patients being seen by ED physicians are more likely to have longer lengths of stay, an increase in hospital admission, and high recidivism rates. Purpose: In this scoping review, we wanted to determine the role of telehealth on ED mental health patients. outcomes regarding how telehealth can reduce the number of admissions, length of stay in the ED, dispositions of patients with mental illness complaints, the cost-effectiveness of telehealth, and patient and staff satisfaction were reviewed. Method: We collected data using The University of Tennessee Health Science Center (UTHSC) online Library, and we obtained articles using CINAHL Complete, Medline, and PubMed. The eligibility criteria were studies conducted in English, subjects greater than 18 years of age, meet DSM criteria for mental health diagnosis, and no limit on gender, race, and ethnicity. Participants must be able to consent. Result: Data from 11 articles published from 2012 to 2020 was collected. Decreased length of stay, improved patient outcomes, decreased healthcare cost, and reduction in readmission/revisit rates were the most frequently reported findings. Implications for Nursing Practice: Results of this scoping review showed improved patient outcomes and decreased readmission/revisit rates when patients with psychiatric illness were seen by a psychiatric physician via telehealth in the Emergency Department. This practice can be standardized and utilized to yield similar results to the literature review. Additional research is necessary to assist in the development of healthcare resources that will provide patients who suffer from mental illness with the care they deserve

Radiostereometric Analysis of Tantalum vs. Titanium Acetabular Shells in Young THR Patients

Introduction: In the active total hip replacement (THR) population, maintaining acetabular component stability and limiting polyethylene wear are crucial components to preventing premature implant failure. Titanium with Co/Cr/Mo fiber metal coating is among the most common materials used in cementless THR. Trabecular metal, composed of porous tantalum, has a metallic strut design resembling trabecular bone, designed to improve tissue infiltration and limit migration. This study assesses the stability and clinical outcomes of tantalum versus titanium acetabular shells using radiostereometric analysis (RSA) technology. Methods: In this IRB approved, prospective, randomized, blinded study, 46 patients received a primary THR by a single surgeon (DCA). Each patient was randomized to receive a titanium (23) (Trilogy, Zimmer) or tantalum (23) (Modular tantalum shell, Zimmer) uncemented hemispheric cup and either a highly-crosslinked or conventional polyethylene liner. Tantalum RSA markers were implanted around the liner periphery, femur, and periacetabular bone in each patient. RSA examinations, Harris Hip, UCLA, WOMAC, SF-36 scores were obtained at 10 days, 6 months, and annually with the furthest patients evaluated through 5 years. Results: Median translation was greater at all time points for the tantalum mesh cups except for the 3-year follow-up, however due to large standard errors, there was no significant difference between the two designs (p\u3e0.05). These large standard errors were predominantly caused by two outliers, neither of which had clinical evidence of loosening at 5 years follow-up. Mean UCLA, WOMAC, Harris Hip, and SF-36 PCS and MCS scores improved similarly in both groups. Conclusions: In this young THR population, both titanium and tantalum acetabular shells demonstrated excellent stability at five years follow up. Tantalum shells demonstrated slightly greater micromotion, but there was no statistically significant difference in shell migration. Outstanding clinical outcomes with statistically significant improvements in function and pain relief were observed in both groups

Radiostereometric Analysis of Femoral Head Penetration in Cross-Linked Polyethylene in THR Patients

Background: In the young total hip replacement (THR) population limiting polyethylene liner wear is crucial to preventing premature implant failure. Highly cross-linked ultra-high molecular weight polyethylene (HXLPE) liners were designed to improve wear resistance of polyethylene liners. Radiostereometric analysis (RSA) provides highly precise measurements of liner wear. This study utilized RSA to characterize wear of conventional versus HXLPE liners up to five years following THR. Methods: This IRB-approved, prospective, randomized, blinded study, involved 46 patients with a mean age of 58 and BMI of 30. Each patient was double randomized to receive a conventional or HXLPE liner with an uncemented titanium mesh or tantalum trabecular metal cup. Both liners were prepared from compression-molded GUR 1050 resin without calcium stearate, while HXLPE liners undergo further e-beam irradiation and annealing. At the time of surgery, 1mm tantalum RSA markers were implanted around the liner periphery, femur and periacetabular bone. RSA examinations, Harris Hip, UCLA, WOMAC, SF-36 scores were obtained pre-operatively, post-operatively, at six weeks, six months and annually through five years. Results: All patients had statistically significant improvement in Harris Hip, WOMAC and SF-36 PCS scores following THR with no difference between cohorts. On RSA examination, of titanium shells, HXLPE liners revealed significantly lower femoral head penetration at each follow up except six weeks and six months (p Conclusion: In this young THR population RSA shows significantly less femoral head penetration in the HXLPE liners compared to conventional liners. Novel RSA techniques have been developed to determine polyethylene wear in patients

Naturally occurring genetic variants in the oxytocin receptor alter receptor signaling profiles

The hormone oxytocin is commonly administered during childbirth to initiate and strengthen uterine contractions and prevent postpartum hemorrhage. However, patients have wide variation in the oxytocin dose required for a clinical response. To begin to uncover the mechanisms underlying this variability, we screened the 11 most prevalent missense genetic variants in the oxytocin receptor

Viral Networks: Connecting Digital Humanities and Medical History

This volume of original essays explores the power of network thinking and analysis for humanities research. Contributing authors are all scholars whose research focuses on a medical history topic—from the Black Death in fourteenth-century Provence to psychiatric hospitals in twentieth-century Alabama. The chapters take readers through a variety of situations in which scholars must determine if network analysis is right for their research; and, if the answer is yes, what the possibilities are for implementation. Along the way, readers will find practical tips on identifying an appropriate network to analyze, finding the best way to apply network analysis, and choosing the right tools for data visualization. All the chapters in this volume grew out of the 2018 Viral Networks workshop, hosted by the History of Medicine Division of the National Library of Medicine (NIH), funded by the Office of Digital Humanities of the National Endowment for the Humanities, and organized by Virginia Tech

Expression profiling of metalloproteinases and tissue inhibitors of metalloproteinases in normal and degenerate human achilles tendon

To profile the messenger RNA (mRNA) expression for the 23 known genes of matrix metalloproteinases (MMPs), 19 genes of ADAMTS, 4 genes of tissue inhibitors of metalloproteinases (TIMPs), and ADAM genes 8, 10, 12, and 17 in normal, painful, and ruptured Achilles tendons. Tendon samples were obtained from cadavers or from patients undergoing surgical procedures to treat chronic painful tendinopathy or ruptured tendon. Total RNA was extracted and mRNA expression was analyzed by quantitative real-time reverse transcription–polymerase chain reaction, normalized to 18S ribosomal RNA. In comparing expression of all genes, the normal, painful, and ruptured Achilles tendon groups each had a distinct mRNA expression signature. Three mRNA were not detected and 14 showed no significant difference in expression levels between the groups. Statistically significant (P < 0.05) differences in mRNA expression, when adjusted for age, included lower levels of MMPs 3 and 10 and TIMP-3 and higher levels of ADAM-12 and MMP-23 in painful compared with normal tendons, and lower levels of MMPs 3 and 7 and TIMPs 2, 3, and 4 and higher levels of ADAMs 8 and 12, MMPs 1, 9, 19, and 25, and TIMP-1 in ruptured compared with normal tendons. The distinct mRNA profile of each tendon group suggests differences in extracellular proteolytic activity, which would affect the production and remodeling of the tendon extracellular matrix. Some proteolytic activities are implicated in the maintenance of normal tendon, while chronically painful tendons and ruptured tendons are shown to be distinct groups. These data will provide a foundation for further study of the role and activity of many of these enzymes that underlie the pathologic processes in the tendon

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Side-Payments and the Costs of Conflict

Conflict and competition often impose costs on both winners and losers, and conflicting parties may prefer to resolve the dispute before it occurs. The equilibrium of a conflict game with side-payments predicts that with binding offers, proposers make and responders accept side-payments, generating settlements that strongly favor proposers. When side-payments are non-binding, proposers offer nothing and conflicts always arise. Laboratory experiments confirm that binding side-payments reduce conflicts. However, 30 % of responders reject binding offers, and offers are more egalitarian than predicted. Surprisingly, non-binding side-payments also improve efficiency, although less than binding. With binding side-payments, 87 % of efficiency gains come from avoided conflicts. However, with non-binding side-payments, only 39 % of gains come from avoided conflicts and 61 % from reduced conflict expenditures