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This introductory chapter traces the history of family law in America, which came of age during the last half of the twentieth century. Earlier, in practice, scholarship, and legal education, it was given little attention or respect. Perhaps the reason for the low status of family law practice, defined narrowly as domestic relations and almost exclusively concerned with divorce, was that it dealt with human conflicts and real people in distress, not legal abstractions. The legislative movement to recodify state family law, particularly divorce law, began mid-century. An important influence on divorce reform was the efforts of the Commissioners on Uniform State Laws. The Commissioners had been working on divorce law for seventy-five years before the Uniform Marriage and Divorce Act was promulgated in 1970. The Act brought clarity in laws on marriage, divorce, and child custody. The chapter then looks at the development of child protection practice and law. Ultimately, the legal landscape of today has been shaped by many factors: the movement for racial equality, children’s rights, women’s rights, gay and lesbian rights, and the social and legal agenda of certain religious groups.

This chapter assesses divorce, both as a termination of a marriage and as the legal, social, and psychological reorganization of that relationship and the parent–child relationship established through the marriage. “Reorganization” is an appropriate descriptor because the divorced couple may have a continuing relationship, albeit altered by post-divorce property and child custody arrangements. Alimony and the assignment of property may continue the adult relationships, but on a level different from marriage. Likewise, the judicial award of a child's custody to one parent or another changes the relationship from what it was during marriage. Ultimately, the petition for divorce not only restricts the personal autonomy of the couple but also limits their relationship with their children at least until they reach majority. The chapter then details the American divorce laws and procedure.

This chapter studies the parent–child relationship through the lens of child protection laws, with emphasis on the issues of state intervention into that relationship. Throughout the history of the laws governing the complex relationship of parent, child, and state, there has been a struggle between parental authority and family privacy, on the one hand, and the state's responsibility of guarding the best interests of the child, on the other. The rhetoric has been that parents have the basic right to raise their children as they see fit, subject to their not overstepping the bounds of reasonableness in all aspects of childrearing. However, parental rights are not unlimited. Historically, the state, the ultimate parent who looks after all the children in society under the parens patriae concept, has a right to subject parents to public scrutiny and legal examination. In the United States, in the main, child protection in the form of child welfare services in the latter part of the twentieth century and the beginning of the twenty-first is basically the responsibility of the states. State social service agencies under the executive branch deliver certain social services themselves but more commonly for reasons of economy contract for foster care and adoption services with private social service agencies, which they monitor. The chapter then looks at the federal government's impact on the child protection systems in the states.

This chapter addresses the establishment of a new parent–child relationship through adoption. It explores the recurring tension between individual autonomy and state regulation in the placement of children for adoption, and how it is reflected in the major developments in adoption in the past half-century. During the twentieth century, adoption was a specialized child welfare service performed by social workers in private and public child welfare agencies. Whether a birth mother relinquished her infant for adoption voluntarily or whether adoption was the final outcome of a child dependency proceeding, the articulated goal, sometimes achieved and sometimes mere rhetoric, was to advance the best interests of the child. These two tracks—voluntary relinquishment and involuntary termination of parental rights—resulting in adoption have given rise to dual systems in the past forty years. Even though the ultimate outcome of adoption for children from either system may be the same in terms of a court establishing the adoptive status, there is a major difference in goals. The goal of the voluntary system may well be to provide a childless couple with an infant so as to continue the adoptive family name. The aim of dependency proceedings resulting in the termination of parental rights is to protect children, and the disposition of adoption is a vehicle for providing a child with a permanent attachment to a family.

This chapter examines the establishment of formal marriage, including same-sex marriage, and the legal issues involved in maintaining that relationship. While in the past the marital relationship was wholly defined by the state, now certain aspects of the relationship can be negotiated by the parties, which may result in a more egalitarian relationship. Also, by including the marriage within the world of contract, one effect is to move the status away from its religious roots and aspects and toward its being a secular relationship. The benefit of treating marriage as a special kind of partnership contract is that it emphasizes the individual nature of the relationship and downplays its community aspects. Indeed, the modern marriage is more like an association, in some situations a business association, of two adults who have preserved their individual rights. The chapter then considers freedom to marry as a fundamental right and looks at how states have limited marriage formation throughout history.

Laser-assisted atom probe tomography (APT) was used to measure the indium mole fraction x of c-plane, MOCVD-grown, GaN/In(x)Ga(1-x)N/GaN test structures and the results were compared with Rutherford backscattering analysis (RBS). Four sample types were examined with (RBS determined) x = 0.030, 0.034, 0.056, and 0.112. The respective In(x)Ga(1-x)N layer thicknesses were 330 nm, 327 nm, 360 nm, and 55 nm. APT data were collected at (fixed) laser pulse energy (PE) selected within the range of (2-1000) fJ. Sample temperatures were = 54 K. PE within (2-50) fJ yielded x values that agreed with RBS (within uncertainty) and were comparatively insensitive to region-of-interest (ROI) geometry and orientation. By contrast, approximate stoichiometry was only found in the GaN portions of the samples provided PE was within (5-20) fJ and the analyses were confined to cylindrical ROIs (of diameters =20 nm) that were coaxial with the specimen tips. m-plane oriented tips were derived from c-axis grown, core-shell, GaN/In(x)Ga(1-x)N nanorod heterostructures. Compositional analysis along [0 0 0 1] (transverse to the long axis of the tip), of these m-plane samples revealed a spatial asymmetry in charge-state ratio (CSR) and a corresponding asymmetry in the resultant tip shape along this direction; no asymmetry in CSR or tip shape was observed for analysis along [-1 2-1 0]. Simulations revealed that the electric field strength at the tip apex was dominated by the presence of a p-type inversion layer, which developed under typical tip-electrode bias conditions for the n-type doping levels considered. Finally, both c-plane and m-plane sample types showed depth-dependent variations in absolute ion counts that depended upon ROI placement., Comment: 45 pages total, which includes 22 figures

SUMMARY During the decade of the 1960s, the epidemiology of a new dengue disease, dengue hemorrhagic fever and dengue shock syndrome (DHF/DSS), was described by collaborative research performed by Thai scientists from many institutions and by workers at the U.S. Army's SEATO Medical Research Laboratory in Bangkok, Thailand. Careful clinical and physiological studies provided the initial description of DSS. DSS cases were caused by each of the four dengue viruses (DENV) and not chikungunya (CHIK) virus or DENV 5 and 6, were associated with a secondary-type dengue antibody response in children over the age of 1 year, were associated with a primary antibody response in infants less than 1 year old whose mothers had neutralizing antibodies to all four DENV, were associated more frequently with secondary DENV 2 infections than those due to DENV 1 and 3, and were more common in females than males over the age of 3 years. Robust laboratory methods for growth and recovery of DENV in tissue cultures were introduced. In addition, life-saving principles of fluid and plasma protein resuscitation of hypovolemia were described. Most epidemiological observations made during the decade of the 1960s have been confirmed in the succeeding 45 years. Much contemporary research on pathogenesis fails to address the two distinct immunological antecedents of DHF/DSS.

This chapter discusses issues of establishing adult relationships, including friendship and informal marriage, and how individuals have attempted to regulate their upcoming marriage by entering into prenuptial agreements. The road to marriage has traditionally consisted of romantic friendship, courtship, engagement, and then formal marriage. It is during the formal or informal engagement period that a couple may think of entering into a prenuptial agreement. However, this behavior pattern has changed dramatically in the past fifty years. There may no longer be defined periods on the road to marriage, and marriage itself may no longer be the final relationship between two people. Whatever the arrangement, the relevant legal questions are the following: What relationships should be labeled “family”; who should be authorized to make such a designation, the state or the parties themselves; and should the state regulate them? At the present time, two kinds of adult relationships that are not formally recognized by the state as marriage are contract cohabitation and domestic partnership or civil union.

Activated protein C resistance (APCR) in the absence of alterations in the factor V gene has been observed during pregnancy, in patients on oral contraceptives, in the presence of antiphospholipid antibodies, and in patients with ischemic stroke. We report a 49-year-old woman with recurrent major venous and arterial thromboses who displayed pronounced APCR, yet no changes in the activated protein C (APC) cleavage sites of factor V. The APCR values determined by four different assays were similar to those obtained in plasma from a homozygote for factor V Q506. Addition of IgG isolated from the patient’s serum to normal plasma lowered the APCR ratio from 2.4 to 1.6. Incubation of patient’s IgG with normal APC resulted in a profound change in the mobility of APC in crossed immunoelectrophoresis. APC was also shown to bind to patient’s IgG immobilized on a protein A agarose column. Factor Va inactivation by APC was inhibited by patient’s IgG, but not by control IgG in the presence or absence of either phospholipids or protein S. These results provide evidence for the existence of an acquired antibody against APC in the patient’s plasma, which gave rise to the APCR phenotype and was probably responsible for the major thrombotic events. We suggest that acquired APCR due to anti-APC antibodies be considered a potential cause for severe venous and arterial thromboses.

Objective. Children with iron poisoning, and mongrel dogs studied under laboratory conditions, were evaluated to explore the safety and effectiveness of the use of desferrioxamine in acute iron intoxication as reported in the 1965 paper.Methodology. Twelve children admitted to a pediatric unit after iron ingestion were subjected to gastric lavage (10) and treatment either with intravenous desferrioxamine (9) or with a combination of intravenous and enteral (gavage) desferrioxamine (3). Serum iron levels before and after therapy, urinary excretion of iron, and symptoms before and after therapy were all measured.Mongrel dogs (23) were fasted overnight and then given toxic doses of ferrous sulfate intraduodenally under general anesthesia. Controls (14) were observed for serum iron, arterial pH, and hematocrit, and mean arterial blood pressures. The 9 dogs treated were given desferrioxamine both intravenously and intraduodenally, whereas the controls were observed without treatment. Four additional dogs were treated with a lethal dose of iron that was first complexed with desferrioxamine and then administered intraduodenally. Another 2 dogs received a slow intravenous infusion of either ferrous or ferric iron, and 2 others were given the same amount of iron, but as a complex with desferrioxamine. Other studies were performed on dogs to evaluate the effect of desferrioxamine on arterial blood pressure and the toxicity of the iron-desferrioxamine complex.Results. Rapid intravenous infusion produced hypotension in two children, one of whom had a seizure. Significant amounts of iron were discovered in the urine of all patients. None had progression of symptoms while in the hospital. One child who was in coma when admitted was noted to be developmentally retarded 5 months later.All 14 control dogs died by 10 hours after duodenal instillation of iron. Three of the dogs treated survived, but these were the three with the lowest pretreatment iron levels. The enteral administration of lethal doses of iron previously complexed with desferrioxamine resulted in the excretion of large amounts of iron in the urine in 4 dogs and in one of three children treated with moderate amounts of iron complexed with desferrioxamine. The children were not affected adversely by this treatment, but the dogs experienced a marked drop in blood pressure and died within a few hours.Conclusions. The use of desferrioxamine results in the rapid excretion of more iron in the urine than would occur without such treatment. The drug produces hypotension when administered rapidly by parenteral infusion. The enteral administration of the drug to poisoned dogs or children does not prevent the absorption of iron; indeed the complex is freely absorbable. The desferrioxamine–iron complex is toxic to the kidneys.COMMENTARY

Objectives: To determine the frequency of inappropriate transport by Emergency Medical Service (EMS). Design: A retrospective study. Subjects: Patients up to 36 months of age with medical complaints transported by EMS to an urban pediatric emergency department (ED). Interventions: None. Measurements: Arbitrary criteria for appropriate use of EMS transport system were developed. The age, triage status, number of previous uses of EMS, health insurance status, time of calls, chief complaint, and clinical management of patients in the ED were determined. The frequency of inappropriate use of EMS was determined and also the percentage of patients up to 36 months of age who used EMS transport system on more than one occasion. Results: Charts of 341 patients were reviewed of which 126 patients (37%) could have been transported by nonemergent vehicles according to our arbitrary criteria. In addition 97 (28%) of these patients had used the EMS transport system on at least one other occasion. Conclusions: EMS is utilized for inappropriate transportation in approximately 37% of our pediatric patients less than 36 months of age with medical complaints. In addition, 28% of these same patients utilized the EMS system on more than one occasion. It would appear that education of care providers in the appropriate use of EMS and use of alternate means of transportation would make the system more efficient and productive.

This book examines the present state of family law in America. The third edition captures recent developments, including the transformation of the institution of marriage from being a relationship between a man and a woman to encompassing same-sex marriage. In this regard, the book includes a full discussion and analysis of Obergefell v. Hodges. Obergefell v. Hodges is the U.S. Supreme Court case that held in a 5-4 decision that the bans on same-sex marriage in Michigan, Kentucky, Ohio, and Tennessee were unconstitutional. The Court held that the right to marry a person of the same sex is protected by the Due Process and Equal Protection Clauses of the Fourteenth Amendment, and therefore may not be denied in any state.

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Perhaps one of the most important changes in family law in the past thirty years has been the inclusion of certain kinds of friendships in the range of relationships from which rights and responsibilities can flow. Domestic partnership laws, a phenomenon of the 1990s, may be seen as a natural development from the judicial recognition of contract cohabitation and the legislative and judicial response to same-sex couples who, unable to meet statutory requirements for marriage, have sought official recognition of their relationships. This essay discusses an aspect of certain kinds of domestic partnership laws-their formal requirements and the extent to which they represent a greater regulation of a relationship than is found in marriage laws.

Over the past 30 years, the legal status of husbands and wives in marriage has undergone major changes with the result that wives are now beginning to have more of an independent legal identity than in the past and, to some extent, more of an equal relationship with their husbands although full equality has not yet been achieved. At the same time, divorce laws and policies have consistently moved toward a view of marriage as an economic partnership and away from the concept of marriage as a status totally regulated by the state and dominated by the husband. This trend has produced significant changes in the statutes, which have, to a certain extent, limited judicial discretion regulating the assignment of marital property and the awarding of alimony upon divorce. These changes have given more consideration to the contribution of wives to the marital enterprise and to the financial needs of children. In addition, recently there has been a movement toward legislating how couples divorce, particularly with regard to their ability—with or without the assistance of counsel—to conclude their divorce with minimal official action. This article explores the trends toward the equality and legal autonomy of husbands and wives in marriage and in the divorce process with particular emphasis on methods of allocating marital property and on new and simplified procedures for divorce.

Length of stay data collected for high-risk newborn infants admitted to a tertiary care children's hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs). We found that the classification system for newborns markedly underestimated the number of days required for the treatment of these infants. The use of the geometric mean instead of the arithmetic mean as the measure of central tendency was a significant contributor to the discrepancy, especially in those sub-groups with bimodal frequency distributions of lengths of stay. Another contributor to the discrepancy was the lack of inborn patients in the children's hospital cohort. The system of prospective payments, as outlined, does not take into account several factors that have a strong influence on length of stay such as birth weight (which requires more than three divisions to serve as an effective predictor), surgery, outborn status, and ventilation. Implementation of the system described in the Federal Register would severely discourage tertiary care referral hospitals from providing neonatal intensive care.

SummaryNo assay of the antithrombotic action of warfarin has been available. Experiments were performed to determine whether Xa inhibitory activity - the reaction rate between activated factor X (Xa) and antithrombin III - could serve this function. 105 warfarin-treated patients demonstrated a significant 18% increase in Xa inhibitory activity compared to 51 controls, p

Specific therapeutic agents for treatment of acute asthma attacks, convulsions, cardiac arrhythmias, anaphylaxis, and poisoning are discussed. Emphasis is placed on care in avoiding overdosage or synergistic effects of drugs.

Protein-heparin complexes, prepared by a water-soluble carbodiimide coupling technique, were used to produce anti-heparin antibodies in rabbits. Antiserums that recognized carbodiimide-treated heparin, but not untreated heparin, were obtained. Carbodiimide-treated heparan sulfate exhibited 10% to 20% cross-reactivity compared with a similarly treated heparin, whereas there was no cross-reactivity with five other carbodiimide-treated mucopolysaccharides. 3H-1-ethyl-3-(3- trimethylammoniumpropyl) carbodiimide iodide was used to demonstrate that carbodiimide forms a stable adduct with heparin and other mucopolysaccharides. Using an antibody fraction that eluted from 1- ethyl-3-(3-trimethylammoniumpropyl) carbodiimide iodide-treated heparin- Sepharose with 2 mol/L KI, it was demonstrated that, for the antibody population studied, the addition of one carbodiimide per heparin molecule resulted in complete epitope expression without loss of anticoagulant activity. The addition of up to eight additional carbodiimide molecules to heparin did not increase the extent of epitope formation, although anticoagulant activity was lost. Except for heparan sulfate, the addition of radiolabeled carbodiimide to other mucopolysaccharides did not result in epitope formation. These data demonstrate that antibodies to an epitope derived from heparin can be formed, that the epitope is fully expressed while anticoagulant activity is present, and that the antibody is specifically directed against an altered portion of the polysaccharide.

One-hundred and fifty-one rabbits, divided into controls and animals treated with varying daily doses of warfarin, were subjected to the stasis assay, and the amount of thrombosis quantitated after intravascular coagulation was initiated either by activated factor X or tissue thromboplastin. Following 8–10 days of warfarin administration, there was a significant dose-dependent decrease in the vitamin-K- dependent coagulation factors paralleled by an increase in the prothrombin time ratio. Whether thrombosis was initiated by activated factor X or tissue thromboplastin, there was, with increasing drug dose, a progressive increase in the inhibition of stasis thrombosis. This significant antithrombotic effect occurred even when the vitamin-K- dependent coagulation activities were at a mean value of 50%.

Patients treated for pneumococcal bacteremia were prospectively evaluated over a 21-month period. Of 2,610 blood cultures obtained, 79 (3%) were positive for Streptococcus pneumoniae. Of these, 37 patients (47%) initially had a focus of infection, and 73 (92%) were reevaluated after the results of the blood culture were known. Two-thirds of these were evaluated within 24 hours of the blood culture being drawn; the remainder were seen between 24 and 72 hours after the initial visit. Twenty-three patients were febrile (greater than 37.4 C) on reevaluation. Six demonstrated persistence of the original disease, nine showed no focus of infection, seven developed a focus of infection, and one developed a second focus of infection. No patients with temperatures less than 37.4 C developed significant disease. A regimen for management of patients with pneumococcemia is given.

The inhibition of activated human Factor X by human plasma protease inhibitors was investigated in both purified and plasma systems. In the former, antithrombin III, alpha 1-proteinase inhibitor, and alpha 2-macroglobulin, at normal plasma concentrations, markedly inhibited activated Factor X. Significant inhibition by alpha 2-antiplasmin, however, was only achieved when present at 40 times its plasma concentration. The relative rates of inhibition of activated Factor X coagulant activity in normal human plasma, antithrombin III-deficient plasma, and alpha 1-proteinase inhibitor-deficient plasma were 1.0, 0.63, and 0.75, respectively. From these relative rates of inhibition and their measured concentrations in the 3 plasmas, it was calculated that antithrombin III, alpha 1-proteinase inhibitor, and alpha 2-macroglobulin contribute 53, 35, and 12%, respectively, to the inhibition of activated Factor X in normal human plasma. Using 125I-labeled activated Factor X and a combination of sodium dodecyl sulfate disc gel electrophoresis and immunoadsorption, it was then demonstrated that antithrombin III accounted for 45-55%, alpha 1-proteinase inhibitor, 35-40%, and alpha 2-macroglobulin, 10-15% of the inhibition of the labeled protease in normal human plasma. The values obtained with the deficient plasmas are consistent with the distribution of activated Factor X-inhibitor complexes in normal human plasma. These data show by two independent techniques, one measuring coagulant activity and the other 125I-labeled activated Factor X-inhibitor complexes, that both antithrombin III and alpha 1-proteinase inhibitor are the major inhibitors of activated Factor X in normal human plasma.

Thromboembolic obstruction to three major components of the circulation--arterial, venous and intravascular foreign surfaces--contributes to premature death and disability in Western society. In many, but not all, of these conditions associated with thromboembolism, heparin and warfarin are the drugs of choice. It is the purpose of this presentation to provide some common ground in the area of anticoagulant prophylaxis that will be of intrinsic value for decision making in cardiac, cerebral and peripheral vascular disease. Only those aspects of the hemostatic mechanism most relevant to the antithrombotic action of heparin and warfarin are discussed. Assays for both drugs as well as some practical guidelines for their use in low, medium and high dose regimens are outlined. Techniques for improving the benefit/risk ratio for each drug are specifically detailed.

The elimination of isoniazid was followed in 2 newborn infants who had received the drug transplacentally, and in 1 of the mothers. The half-time for serum elimination for mother No. 1, babies No. 1 and 2 were calculated as 3.0, 7.8 and 19.8 h, respectively. Near equality existed between maternal and newborn serum isoniazid concentrations. Additional studies are required to determine the acetylation capacity of newborns.

The Committee on Drugs has reviewed the pharmacology of marihuana with special emphasis on effects in man because of the enormous impact of this drug on society. Much of modern day society's reaction to and attitudes about this psychoactive agent does not reflect its pharmacology, and it is only recently that pertinent biologic facts about marihuana have become known. The Committee reports these facts here, in part, to inform the Academy membership of these facts and, in part, to provide a perspective with which to consider the various societal controls (i.e., laws) on the use of marihuana. COMPOSITION Marihuana is a mixture of leaves and flowering tops of the plant Cannabis sativa L. It contains approximately 1% Δ-9-tetrahydrocannabinol (THC), the principal psychoactive substance in marihuana. Street preparations tend to vary in Δ-9-THC content; the range is 0% to 5%. An average marihuana cigarette contains 500 mg of marihuana and, therefore, about 5 mg of Δ-9-THC. Hashish, usually used in Eastern (Asiatic) countries and in North Africa, is the resinous substance of the flowers and leaves of Cannabis sativa L in which Δ-9-THC is found. Hashish contains 5% to 15% Δ-9-THC and is usually smoked as a mixture of the resin and tobacco. Generally, marihuana cigarettes do not contain tobacco, although some street preparations do. USERS In considering adverse effects of marihuana, it is important to appreciate some pertinent epidemiologic facts. It is estimated that 24,000,000 Americans have tried marihuana at least once and that there are 8,300,000 current users in this country.1 Approximately 70% of adults and youth (12 through 17 years) who were found by the National Commission on Marihuana and Drug Abuse1 to use marthuana used it so infrequently as to be considered experimental users.

Significant increases in the number of hours pediatricians devote to counseling families have been documented in the literature, However, approximately half of young pediatricians in practice believe their residency provided insufficient experience in managing psychosocial and developmental disorders. The Behavioral Pediatrics Program is offered in the first year of pediatric training. Based in the Neonatal Unit (inpatient) and the Continuity Care Clinic (outpatient), it emphasizes interviewing parents to help residents gain confidence in ambiguous situations. Data collected at the end of the WSU/CHM program’s first year indicated that residents’ actual experiences in the Neonatal and Continuity Care modules were strongly associated with their rating. The program had impact on resident views of the importance of interviewing and normal development, but resistance to learning psychosocial perspectives was also clear. A number of changes in the program were made after evaluation.

An inverse relationship between Xa inhibitory activity and response to a thrombotic challenge has been demonstrated in human subjects. Because of this relationship a study of thromboembolic effects on 43 postmenopausal ranked the subjects on the basis of Xa inhibitory levels. Group 1 received no estrogen; Group 2 received low-dose Premarin premenopausal controls received low-dose estrogen oral contraceptives. There was no difference in the quantity of antithrombin 3 among the 3 postmenopausal groups. Premarin caused a significant decrease (P < .01) in Xa inhibitory activity. A significant additional decrease in the high-dose group (P < .02) demonstrated that the effect was dose-related. Premarin should be used only if required for medically indicated conditions and then only in the smallest possible dosage.