A Relationship of Trust: Are State ?School Trust Lands? Being Prudently Managed for the Beneficiary?

Every state entering the Union in the United States since 1803 received land grants from the federal government for the support of their public schools. Inherent in this federal grant is the fiduciary duty to prudently and effectively manage trust assets for the beneficiary, their school systems. This paper addresses the question of whether managers of trust lands are meeting their fiduciary responsibilities of ??maximum economic benefit?? for their beneficiaries. Realized market value-based economic returns from grazing lease revenues and capital appreciation for all twenty-three counties in Wyoming are compared with returns that may have been generated from alternative investment policy alternatives. Market values and capital appreciation for school trust lands in Wyoming are estimated from hedonic models formulated from ranch sales data and grazing revenue data.

Implementation of a quality improvement project on smoking cessation reduces smoking in a high risk trauma patient population.

BackgroundCigarette smoking causes about one of every five deaths in the U.S. each year. In 2013 the prevalence of smoking in our institution's trauma population was 26.7 %, well above the national adult average of 18.1 % according to the CDC website. As a quality improvement project we implemented a multimodality smoking cessation program in a high-risk trauma population.MethodsAll smokers with independent mental capacity admitted to our level I trauma center from 6/1/2014 until 3/31/2015 were counseled by a physician on the benefits of smoking cessation. Those who wished to quit smoking were given further counseling by a pulmonary rehabilitation nurse and offered nicotine replacement therapy (e.g. nicotine patch). A planned 30 day or later follow-up was performed to ascertain the primary endpoint of the total number of patients who quit smoking, with a secondary endpoint of reduction in the frequency of smoking, defined as at least a half pack per day reduction from their pre-intervention state.ResultsDuring the 9 month study period, 1066 trauma patients were admitted with 241 (22.6 %) identified as smokers. A total of 31 patients with a mean Injury Severity Score (ISS) of 14.2 (range 1-38), mean age of 47.6 (21-71) and mean years of smoking of 27.1 (2-55), wished to stop smoking. Seven of the 31 patients, (22.5 %, 95 % confidence interval [CI] of 10-41 %) achieved self-reported smoking cessation at or beyond 30 days post discharge. An additional eight patients (25.8 %, 95 % CI 12-45 %) reported significant reduction in smoking.ConclusionsTrauma patients represent a high risk smoking population. The implementation of a smoking cessation program led to a smoking cessation rate of 22.5 % and smoking reduction in 25.8 % of all identified smokers who participated in the program. This is a relatively simple, inexpensive intervention with potentially far reaching and beneficial long-term health implications. A larger, multi-center prospective study appears warranted.Level of evidenceTherapeutic Study, Level V evidence

Exponential Lower Bounds for Polytopes in Combinatorial Optimization

We solve a 20-year old problem posed by Yannakakis and prove that there exists no polynomial-size linear program (LP) whose associated polytope projects to the traveling salesman polytope, even if the LP is not required to be symmetric. Moreover, we prove that this holds also for the cut polytope and the stable set polytope. These results were discovered through a new connection that we make between one-way quantum communication protocols and semidefinite programming reformulations of LPs.Comment: 19 pages, 4 figures. This version of the paper will appear in the Journal of the ACM. The earlier conference version in STOC'12 had the title "Linear vs. Semidefinite Extended Formulations: Exponential Separation and Strong Lower Bounds

The role of bacterial exopolymer and suspended bacteria in the nutrition of the deposit-feeding clam, Macoma balthica

Potential nutritional contributions of bacterial exopolymer and suspended bacteria to the detritus feeding estuarine clam, Macoma balthica, were examined separately in laboratory 14C labelling experiments. Significant removal and assimilation of suspended bacteria by M. balthica was observed within two days, although the low clearance rates suggested planktonic bacteria may not be among its major food sources. Sediment-bound and dissolved bacterial exopolymer did not appear to be directly metabolized by M. balthica, as evidenced by the 1–2 week lag in 14C uptake into clam tissue

Thin Sectioning of Carbonaceous Adsorbent Spheres for Visualization by Light Microscopy and Scanning Electron Microscopy

Three different types of Rohm and Haas carbonaceous adsorbent spheres (XE-340, XE-347 and XE-348) were prepared for light and scanning electron microscopy by embedding in resin and by thin sectioning. Spurr\u27s low viscosity resin, because of its penetrating and wetting ability, contributed to the production of the most uniform and artifact free thin sections. In addition to thin sectioning, gas adsorption surface area measurements were made on batches of each type of sphere. There was an apparent relationship between the surface area measurements of 417.8 m2/g for XE-340, 583.4 m2/g for XE-347 and 752.9 m2/g for XE-348 and the microstructural appearances of the internal morphologies of each type of sphere

Quality of care as an individual concept: Proposition of a three-level concept for clinical practice.

BACKGROUND Quality in health care is a complex framework with many components. The word "quality" is used in different official settings and different contexts (public health, certification, patient safety). On individual and team levels, the perception of quality is heterogenous, and the term is often used beyond the theoretical framework. Therefore, it remains a challenge to describe the perceived quality of care in the clinical setting. The aim of this paper is to present a simple concept that can be used to visually define the perceived quality of care for the individual health care professional. METHODS/CONCEPT An experience-based concept that uses different levels of "quality of care" individually to guide the supervision of health care professionals (residents) and quality goal setting in teams is presented, with the assumption that the ambition of any health care professional is to provide excellence in care. Three perceived levels of quality of care are defined, described, and visualized, namely, a) security, b) comfort, and c) perfection. The "comfort level" defines a sustainable level of care where the optimal balance between good patient care and resource use is achieved. Excellence of care is located between the comfort and the perfection level. The practical application of this proposed concept is described in three settings, namely, 1) the threshold for asking advice from the supervisor (resident physicians), 2) in supervision/coaching discussions between residents and supervisors, and 3) in the analysis of perceived quality of care and goals setting within the team. CONCLUSION A simplified, purpose-built but well-defined concept to visually depict the perception of quality of care by clinicians can be useful in clinical practice, for the supervision of residents and for team dynamics

Diminishing Use of Liver Biopsy among Liver Transplant Recipients for Hepatitis C.

Background and Aims: Hepatitis C virus (HCV) cirrhosis is the leading indication for liver transplantation in the United States and recurrent HCV following liver transplantation is a major cause of allograft loss and mortality. Liver biopsies are commonly used to identify recurrent HCV and determine the need for antiviral therapy. The introduction of direct-acting antiviral agents (DAAs) has changed the management of recurrent HCV infection. This study aimed to describe the role of liver biopsies in liver transplant recipients with HCV after the introduction of DAAs. Methods: A retrospective analysis was performed looking at the rate of liver biopsies post-liver transplantation for HCV. The analysis included 475 adult liver transplants for hepatitis C performed at the University of California, Los Angeles from January 1, 2006 to October 1, 2015. Patients were divided into two eras, pre- and post-introduction of DAAs on December 1, 2013. Results: In the era before the introduction of DAAs, the percentage of patients biopsied was significantly higher compared to the era after the introduction of DAAs (56.1% vs. 26.9%, p < 0.001). Conclusions: The introduction of DAAs has changed the management of liver biopsy following liver transplantation and the management of recurrent HCV. Given that DAAs are well tolerated and have high efficacy, liver biopsies are no longer routinely used to justify the use antiviral therapy following liver transplantation

Journal Club: Glymphatic System in Neurodegenerative Diseases

Neurodegenerative diseases such as Alzheimer\u27s Disease impact a multitude of individuals worldwide. The neural Glymphatic system is a relatively newly discovered cellular transport pathway within the brain that has been implicated in neurodegenerative diseases. This article serves to provide a journal club review of current literature on the Glymphatic system to raise awareness of this system and its potential for future treatment and prevention of neurodegenerative conditions