Mammography facilities serving vulnerable women have longer follow-up times.

ObjectiveTo investigate mammography facilities' follow-up times, population vulnerability, system-based processes, and association with cancer stage at diagnosis.Data sourcesProspectively collected from San Francisco Mammography Registry (SFMR) 2005-2011, California Cancer Registry 2005-2012, SFMR facility survey 2012.Study designWe examined time to biopsy for 17 750 abnormal mammogram results (BI-RADS 4/5), categorizing eight facilities as short or long follow-up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced-stage (≥IIb) cancer diagnosis by facility follow-up group.Data extraction methodsMerged SFMR, Cancer Registry and facility survey data.Principal findingsFacilities (N = 4) with short follow-up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow-up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow-up facilities. The long follow-up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow-up facility was associated with higher adjusted odds of advanced-stage cancer (OR 1.45; 95% CI 1.10-1.91).ConclusionsProviding mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow-up and cancer diagnosis stage

Differences between European birthweight standards: impact on classification of ‘small for gestational age’

We describe a quantitative and comparative review of a selection of European birthweight standards for gestational age for singletons, to enable appropriate choices to be made for clinical and research use. Differences between median values at term across standards in 10 regions and misclassification of ‘small for gestational age’ (SGA), were studied. Sex and parity differences, exclusion criteria, and methods of construction were considered. There was wide variation between countries in exclusion criteria, methods of calculating standards, and median birthweight at term. The lightest standards (e.g. France's medians are 255g lower than Norway's medians) were associated with fewer exclusion criteria. Up to 20% of the population used in the construction of the Scottish standard would be classified as SGA using the Norwegian standard. Substantial misclassification of SGA is possible. Assumptions about variation used in the construction of some standards were not justified. It is not possible to conclude that there are real differences in birthweight standards between European countries. Country-based standards control for some population features but add misclassification due to the differing ways in which standards are derived. Standards should be chosen to reflect clinical or research need. If standards stratified by sex or parity are not available, adjustments should be made. In multinational studies, comparisons should be made between results using both a common standard and country-based standards

The Relative Abundance and Diversity of Parasitoids of the Browntail Moth (Euproctis chrysorrhoea L.) and Factors that Influence Their Population Dynamics

The browntail moth (Euproctis chrysorrhea) is an invasive forest pest that has been present in the Northeast since it was first introduced from Europe in 1897. Originally, its range expanded very rapidly until it reached its peak invasion of 150,000 km2, which included most of New England and parts of Southern Canada and Long Island, NY, in 1915. After this point, its range collapsed until only relic populations remained on islands in the Casco Bay Region of Maine and outer Cape Cod in Massachusetts. In 2016, a large population outbreak occurred that expanded its range into inland Central Maine and appears to be continuing to expand north and east today. Our research aims to assess the relative abundance and diversity of parasitoid natural enemies present within the browntail moth population and the factors that influence browntail moth population dynamics over this outbreak period. We sampled browntail moth in infested areas across mid-coast and central areas of Maine to assess overwintering survival, larval and pupal density, healthy moth emergence, and parasitoid diversity and abundance. We estimated densities using timed 10-minute density counts, while survival and emergence was estimated by rearing out samples. Models to test important factors for both hosts and parasitoids were conducted, where year, distance to coast, age of infestation, habitat, and annual climate variables were tested. Nine parasitoid species were recovered from browntail moth pupation nests, three of which were hyperparasitoids. The highest parasitism occurred from Townsendiellomyia nidicola, a primary parasitoid accounting for 24 percent and Monodontomerus aerus, a hyperparasitoid accounting for 36 percent parasitism across all years. Between 2016 and 2018, hyperparasitoids increased in their proportion and mean percent parasitism while primary parasitoid decreased in these regards. Negative binomial results indicated habitat, year, and total annual precipitation were the most significant factors for the abundance of parasitoids, where distance to coast and age of the infestation were not significant. The mean number of pupation nests per 10-minute density count increased slightly in 2017 (28 ± 6) but decreased in 2018 (20 ± 4). In comparison, the mean rank of MFS winter hibernacula per tree decreased across all years. Browntail moth post-diapausing larvae, late-stage larvae, and pupation nests significant decreased at coastal sites in 2017 while inland sites significantly increased in 2018. Moth survival, however, significantly increased between 2017 and 2018. Negative binomial results indicated that habitat was an important factor across post-diapausing larvae, late-stage larvae, and pupation nests while post-diapausing larvae was the only significant factor for moth abundance. Abundance significantly decreased in 2017 across all browntail moth life stages, likely due to an epizootic outbreak of an entomopathic fungi. This study presents data that indicates a higher incidence of hyperparasitoids that may negatively impact primary parasitism, which could positively impact browntail moth survival. Both parasitoids and hosts were negatively impacted in 2017, likely due to an epizootic outbreak, another factor that may drastically impact population dynamics. The data presented gives new insight to the current population dynamics of browntail moth and their parasitoids

ERISA Preemption of Medical Malpractice Claims in Managed Care: Asserting a New Statutory Interpretation

If Congress wants the American citizens to have access to adequate health care, then Congress must accept its responsibility to define the scope of ERISA preemption and to enact legislation that will ensure every patient has access to that care.\u27 Congress enacted the Employee Retirement Income Security Act of 1974 ( ERISA) to protect employee interests and ensure a uniform body of law for pension and benefit plans. The statute\u27s expansive preemption clause and preclusion of extra-contractual damages have since been used to immunize Managed Care Organizations ( MCOs ) from liability for patients injuries resulting from medical malpractice. Because plaintiffs with preempted claims may receive only the remedies provided for under ERISA-the right or benefit due under the plan-many injured patients have been left with no meaningful remedy. [N]ot a model of legislative drafting, the statute\u27s broad preemption clause provides that state law claims that relate to an ERISA plan are preempted. The ambiguous phrase relate to has been the primary focus of the Supreme Court\u27s attempts to determine the reach of the preemption clause.\u27 Relying primarily on a textual interpretation of the statute, the Court has held that, while ERISA does not preempt run-of-the-mill state-law claims, those plans that have a connection with or reference to \u27 an ERISA plan, without being a tenuous, remote, or peripheral connections, are preempted. The Supreme Court\u27s tortured attempts to give effect to the statutory language have led to doctrinal confusion and chaos in the lower courts.\u27 Little judicial guidance, therefore, currently exists for interpreting ERISA\u27s poorly constructed preemption clause. ERISA is implicated in medical malpractice claims through its regulation of employee welfare plans. An employee welfare benefit plan under ERISA is a plan, fund, or program that an employer establishes or maintains to provide medical, surgical, or hospital care or benefits to participants through the purchase of insurance.\u2

Effective models as instructional designs to build student motivation in learning

Effective Models As Instructional Designs to Build Student Motivation in Learning: A Review of Literature examines some of the research and academic literature related to successful designs/models that educators can use to build motivation in learners. Views of different motivations, extrinsic and intrinsic, as a learner are also discussed. Examples of designs/models are examined that integrate technology. The author concludes by presenting a technology-assisted, literature-based curriculum product that integrates these models to enhance learners\u27 motivation

UNMANNED AIRCRAFT SYSTEMS FOR PRECISION METEOROLOGY: AN ANALYSIS OF GNSS POSITION MEASUREMENT ERROR AND EMBEDDED SENSOR DEVELOPMENT

The overarching objective of this research was to enhance our comprehension of the three-dimensional precision of meteorological measurements obtained using small unmanned aircraft systems (UAS). Two complimentary experiments were conducted to achieve this objective. The first experiment entailed the development and implementation of a system to determine the global navigation satellite system (GNSS) position accuracy on a UAS platform. This system was utilized to assess the static and dynamic accuracy of L1 and L1/L2 GNSS receivers in real-time kinematic (RTK) and non-RTK fix modes. Adjusted two-sample t-tests revealed significant differences in horizontal and vertical error between RTK and non-RTK receivers across the various deployment strategies. The findings indicate that RTK receivers produce more precise measurements with significantly fewer errors compared to non-RTK receivers. However, the practical significance of these differences warrants separate consideration. The study emphasizes the importance of using RTK receivers when conducting meteorological measurements, especially vertical profiles, and suggests the need for further research to differentiate the impact of treatments from the influence of external factors on receiver accuracy. The second experiment involved the development of a set of miniature pressure, temperature, and relative humidity (PTH) probes for UAS integration. An automated calibration/validation routine was devised to calibrate the PTH probes using an environmental chamber. The results of the Tukey-Kramer procedures revealed that fewer calibrated sensors were statistically different from each other compared to uncalibrated sensors, reducing intersensory bias and demonstrating the value of calibrating different sensor models to a common reference. The linear regression offsets showed that calibration was necessary to meet the desired accuracy specification. In most UAS-based applications, the differences between the calibrated PTH probes were expected to be negligible, irrespective of their significance. The outcomes of this research will enhance our ability to quantify minor variations in ambient conditions during coordinated multi-UAS flights. The low-cost GNSS receivers evaluated demonstrated centimeter-level accuracy under RTK mode, which eliminates the need to use barometric pressure sensors to correct for short-term drift in elevation from non-RTK GNSS measurements. The PTH probes demonstrated that research-grade meteorological measurements can be made using embedded sensors through careful design and calibration

ERISA Preemption of Medical Malpractice Claims in Managed Care: Asserting a New Statutory Interpretation

Congress enacted the Employee Retirement Income Security Act of 1974 ( ERISA) to protect employee interests and ensure a uniform body of law for pension and benefit plans. The statute\u27s expansive preemption clause and preclusion of extra-contractual damages have since been used to immunize Managed Care Organizations ( MCOs ) from liability for patients injuries resulting from medical malpractice. Because plaintiffs with preempted claims may receive only the remedies provided for under ERISA-the right or benefit due under the plan-many injured patients have been left with no meaningful remedy. [N]ot a model of legislative drafting, the statute\u27s broad preemption clause provides that state law claims that relate to an ERISA plan are preempted. The ambiguous phrase relate to has been the primary focus of the Supreme Court\u27s attempts to determine the reach of the preemption clause.\u27 Relying primarily on a textual interpretation of the statute, the Court has held that, while ERISA does not preempt run-of-the-mill state-law claims, those plans that have a connection with or reference to \u27 an ERISA plan, without being a tenuous, remote, or peripheral connection, s are preempted. The Supreme Court\u27s tortured attempts to give effect to the statutory language have led to doctrinal confusion and chaos in the lower courts.\u27 Little judicial guidance, therefore, currently exists for interpreting ERISA\u27s poorly constructed preemption clause. ERISA is implicated in medical malpractice claims through its regulation of employee welfare plans. An employee welfare benefit plan under ERISA is a plan, fund, or program that an employer establishes or maintains to provide medical, surgical, or hospital care or benefits to participants through the purchase of insurance.\u27 Employer-provided health insurance, therefore, has been interpreted as an employee benefit within the scope of ERISA. If a state cause of action involving health care provided through an ERISA plan, such as a medical malpractice claim, is deemed to relate to the employee benefit plan, the cause of action is preempted by ERISA under section 514(a)

Effects of methamphetamine on sexual behavior

Methamphetamine (Meth) is a highly addictive psychostimulant associated with enhanced sexual desire, arousal, and sexual pleasure. Moreover, Meth abuse is frequently linked with the practice of sexual risk behavior and increased prevalence of Human Immunodeficiency Virus (HIV). Currently, the neurobiological basis for this drug-sex nexus is unknown. Moreover, there is a lack of studies investigating the effects of Meth on sexual behavior and more importantly, compulsive sex-seeking behavior, under controlled experimental settings in animal models. First, using immuhistochemistry for mating- and Meth-induced neural activation it was demonstrated that Meth administration in male rats activates neurons in brain regions of the limbic system that are involved in the regulation of sexual behavior. Specifically, Meth and mating co-activated neurons in the nucleus accumbens (NAc) core and shell, basolateral amygdala (BLA), anterior cingulate (ACA) and orbitofrontal (OFC) cortices. Second, the effects of acute or chronic administration of Meth on different aspects of sexual behavior were tested including motivation and performance, compulsive behavior, and reward. Results showed that high doses of Meth inhibited sexual motivation and performance. Next, to investigate Meth effects on compulsive sexual behavior a paradigm was established in which visceral illness induced by lithium chloride (LiCl) was paired with sexual reward. A low Meth dose (1mg/kg; s.c.) that does not impair sexual function had long-term effects on compulsive sexual behavior. Specifically, two weeks following the last Meth administration, Meth-pretreated males displayed sex-seeking behavior despite having learned the adverse consequences of mating. This effect was dependent on Meth administration being concurrent with sexual experience. Finally, using a conditioned place preference (CPP) paradigm, it was shown that concurrent Meth and sex experience was required for enhanced CPP for mating with Meth and for Meth alone. In contrast, reward for mating alone was decreased. Together, these findings illustrate that Meth can activate the same neurons as sexual behavior and in turn may alter this natural reward behavior. Moreover, these data indicate that the association between drug use and mating may be required for expression of compulsive sex behavior reported by Meth users and is correlated with increased reward seeking for concurrent Meth exposure and mating