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Human chromosome 7 has historically received prominent attention in the human genetics community, primarily related to the search for the cystic fibrosis gene and the frequent cytogenetic changes associated with various forms of cancer. Here we present more than 153 million base pairs representing 99.4% of the euchromatic sequence of chromosome 7, the first metacentric chromosome completed so far. The sequence has excellent concordance with previously established physical and genetic maps, and it exhibits an unusual amount of segmentally duplicated sequence (8.2%), with marked differences between the two arms. Our initial analyses have identified 1,150 protein-coding genes, 605 of which have been confirmed by complementary DNA sequences, and an additional 941 pseudogenes. Of genes confirmed by transcript sequences, some are polymorphic for mutations that disrupt the reading frame.

Rapid advancements in information technology and telecommunications (ITT) offer exciting opportunities for neuropsychology. However, guidelines and recommendations for identifying and negotiating ethical challenges have not kept pace with the expansion of ITT. Because many neuropsychologists evaluate and/or treat individuals with cognitive, emotional, and/or physical limitations, neuropsychologists have a responsibility to be aware of the ethical issues associated with ITT use in order to avoid harming those who may be less able to understand or independently manipulate such technology themselves. The purpose of this paper is to raise awareness of potential implications of the interface between ethics and information technology for neuropsychologists. The first steps in this process include defining terms, identifying relevant issues and challenges, and identifying initial mechanisms to address ethical challenges. In addition, strategies for avoiding ethical misconduct related to information technology are discussed and specific recommendations are offered.

Previous studies of patients with severe chronic alcoholism have shown a high prevalence of emotional distress such as anxiety and depression, and neuropsychological impairments such as executive deficits, but few have examined the relationship between these disorders. We addressed this issue in 51 abstinent patients with histories of severe chronic alcoholism utilizing the Minnesota Multiphasic Personality Inventory (MMPI) and the Halstead-Reitan Neuropsychological Test Battery (HRNTB). Applying factor analysis to the MMPI clinical and validity scales, we derived four dimensions accounting for 78% of the available variance. We found that Factor 1, which loaded on most clinical scales of the MMPI, was significantly correlated (p.01) with performance on the Halstead Category Test (HCT), a measure of executive functioning. Further, group analysis with MANOVA using HCT (impaired and nonimpaired) as the independent variable revealed a significant main effect for Factor 1 (p.004), which was maintained and strengthened when age and education were controlled as covariates (p.001). The results suggest a relationship between emotional distress and executive functioning as measured by the HCT, reflecting differing facets of frontal lobe dysfunction common to cognitive and affective domains in patients with severe chronic alcoholism.

The frequency of cognitive impairment associated with traumatic brain injury (TBI) has led to the widespread use of cognitive rehabilitation as a discrete rehabilitative service. This service has become controversial in part because of disagreements regarding its theoretical base and implementation procedures, and in part because of insufficient experimental support.We outline two paradigms for cognitive rehabilitation that are interestingly different, both theoretically and procedurally. These paradigms are defined in relation to the goals of intervention, orientation to assessment, modalities of treatment, organization of treatment, and logistics of service delivery (setting, content, and provider). A rationale for each paradigm is described.We conclude with a call for (a) additional research into the effectiveness of interventions for individuals with cognitive impairment after TBI and (b) clinicians' thoughtful reflection on the foundations of their service.

The role of an expert is to assist the trier of fact in weighing evidence and reaching conclusions. Critical evaluation of opposing experts is an integral part of this process. In more recent times, cross-examination has given way to critical evaluation of opposing experts outside of the courtroom, a tactic we refer to as peer review in this paper. Though neuropsychologists frequently review the work of their colleagues, we are concerned here primarily with commentary that is at best misleading, and occasionally malicious, unethical, and unprofessional. Despite a growing trend to use experts as peer reviewers in the medicolegal arena, expectations concerning ethical and professional conduct of neuropsychologists have been absent. Enforcement of appropriate conduct is further complicated by the ambiguity of existing ethical standards and state statutes, and their limited applicability to all neuropsychologists who provide forensic services. This article provides an overview of ethical and professional issues pertaining to forensic peer review and concludes with recommendations for appropriate professional conduct.

Private health care providers are an important source of modern contraceptives in Sub-Saharan Africa, yet they face many challenges that might be addressed through targeted training.This study measures the impact of a package of trainings and supportive supervision activities targeted to private health care providers in Lagos State, Nigeria, on outcomes including range of contraceptive methods offered, providers' knowledge and quality of counseling, recordkeeping practices, access to credit and revenue. A total of 965 health care facilities were randomly assigned to treatment and control groups. Facilities in the treatment group-but not those in the control group-were offered a training package that included a contraceptive technology update and interventions to improve counseling and clinical skills and business practices. Multivariate regression analysis of data collected through facility and mystery client surveys was used to estimate effects.The training program had a positive effect on the range of contraceptive methods offered, with facilities in the treatment group providing more methods than facilities in the control group. The training program also had a positive impact on the quality of counseling services, especially on the range of contraceptive methods discussed by providers, their interpersonal skills and overall knowledge. Facilities in the treatment group were more likely than facilities in the control group to have good recordkeeping practices and to have obtained loans. No effect was found on revenue generation.Targeted training programs can be effective tools to improve the provision of family planning services through private providers.Contexto: Los proveedores de servicios de salud del sector privado son una fuente importante de anticonceptivos modernos en África subsahariana, sin embargo, enfrentan muchos retos que podrían superarse a través de capacitación dirigida. Métodos: Este estudio mide el impacto de un paquete de capacitaciones y actividades de supervisión asistida, dirigidas a proveedores de servicios de salud del sector privado en el Estado de Lagos, Nigeria. Se enfoca en resultados que incluyen la variedad de métodos anticonceptivos ofrecidos, los conocimientos de los proveedores y la calidad de la consejería, las prácticas de registro, el acceso a crédito y los ingresos. Unas 965 instituciones de salud se asignaron aleatoriamente a grupos de tratamiento y de control. A las instituciones en el grupo de tratamiento—pero no aquellas en el grupo de control—se les ofreció un paquete de capacitación que incluyó una actualización en tecnología anticonceptiva e intervenciones para mejorar las habilidades de consejería y clínicas, así como prácticas de negocios. Se usó análisis de regresión multivariada de datos recolectados a través de encuestas a las instituciones y encuestas de cliente simulado para estimar los efectos. Resultados: El programa de capacitación tuvo un efecto positivo en la variedad de métodos anticonceptivos ofrecidos, lo cual resultó en que las instituciones en el grupo de tratamiento proveyeron más métodos que las instituciones en el grupo de control. El programa de capacitación también tuvo un impacto positivo en la calidad de los servicios de consejería, especialmente en cuanto a la variedad de métodos anticonceptivos sobre los cuales los proveedores informan, sus habilidades interpersonales y sus conocimientos generales. Las instituciones en el grupo de tratamiento tuvieron más probabilidades que las del grupo de control de tener buenas prácticas de registro y de haber obtenido préstamos. No se encontró efecto alguno en la generación de ingresos. Conclusión: Los programas de capacitación dirigida pueden ser herramientas efectivas para mejorar la provisión de servicios de planificación familiar a través de proveedores de servicios del sector privado.Contexte: Les prestataires de soins de santé privés constituent une source importante de contraceptifs modernes en Afrique subsaharienne. Les nombreux défis auxquels ils sont confrontés pourraient vraisemblablement être résolus par un effort de formation ciblée. Méthodes: Cette étude mesure l'impact d'un ensemble de formations et d'activités d'accompagnement destiné à des prestataires de soins de santé privés de l’État de Lagos (Nigeria), sur les résultats relatifs, notamment, à la gamme de méthodes contraceptives proposées, aux connaissances des prestataires et à la qualité du conseil, à la pratique de tenue des dossiers, à l'accès au crédit et au revenu. Au total, 965 établissements de soins de santé ont été affectés aléatoirement à un groupe expérimental ou témoin. Ceux du groupe expérimental—contrairement à ceux du groupe témoin—ont bénéficié d'un ensemble de formations incluant une mise à jour sur la technologie contraceptive et des interventions visant l'amélioration du conseil, des compétences cliniques et des pratiques commerciales. Les effets ont été estimés par analyse de régression multivariée des données collectées dans le cadre d'enquêtes d’établissements et de clientes fictives. Résultats: Le programme de formation a produit un effet positif sur la gamme de méthodes contraceptives proposées, les établissements du groupe expérimental en offrant davantage que ceux du groupe témoin. L'impact est également positif sur la qualité des services de conseil, en particulier concernant la gamme de méthodes contraceptives discutées par les prestataires, leurs compétences interpersonnelles et leurs connaissances générales. Les établissements du groupe expérimental se sont avérés plus susceptibles que ceux du groupe témoin d'adopter de bonnes pratiques de tenue des dossiers et d'avoir obtenu des prêts. Aucun effet n'a été observé sur la génération de revenu.Les programmes de formation ciblée peuvent être des ressources utiles à l'amélioration de la prestation de services de planification familiale à travers les prestataires du secteur privé.

To evaluate the Siebens Domain Management Model (SDMM) for geriatric inpatient rehabilitation (IR) to increase functional independence and dispositions to home.Before and after study.IR facility.During 2010 (preintervention), 429 patients aged ≥75 years who were on average admitted to IR 8.2 days postacute care, and during 2012 (postintervention), 524 patients aged ≥75 years who were on average admitted to IR 5.5 days postacute care. Case-mix group (CMG) comorbidity tier severity, preadmission living setting, and living support were similar in both groups.The SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home.FIM efficiency, length of stay (LOS), and disposition rates to community/home, acute care, and long-term care (LTC) to compare pre-/postintervention facility data and comparison of facility to national CMG-adjusted data from the Uniform Data System for Medical Rehabilitation for both years (2010/2012).Pre-/postintervention group admission FIM scores were similar (t=2.96, P.003), but the preintervention group had on average 2.6 days greater LOS during IR and greater time to onset of IR (8.2 vs 5.5d) from acute care. Preintervention FIM efficiency was 2.1, whereas postintervention FIM efficiency was 2.76, a significant difference (t=4.1, P.0001). There were significantly more discharges to the community in the postintervention group (74.4%) than the preintervention group (58.5%, χ(2)=26.2, P.0001). There were significantly fewer patients discharged to LTC in the postintervention group (χ(2)=30.47, P.0001). The preintervention group did not significantly differ from the 2010 national data, but the postintervention group significantly differed from the 2012 national data for both greater FIM efficiency (t=-5.5, P.0001) and greater discharge to community (χ(2)=34, P.0001). LOS decreased by 2.6 days in the postintervention group compared with the preintervention group, whereas LOS decreased by only 0.6 days nationally from 2010 to 2012, a significant difference with postintervention LOS lower than the national data (t=31.1, P.0001).Use of the SDMM during IR in geriatric patients is associated with increased functional independence and discharges to home/community and reduced institutionalization.

Introduction: HIV testing and counseling is a critical component of the overall response to the HIV epidemic in low and middle income countries. To date, little attention has been paid to the role of private for-profit providers in HIV testing. Methods: We use data from Demographic and Health Surveys and AIDS Indicators Surveys to explore the extent to which this sector provides HIV testing in 18 developing countries. Results: We find that use of the private sector for HIV testing varies significantly by country, with private for-profit providers playing a significant role in some countries and a relatively minor one in others. At the country level, use of private providers for HIV testing is correlated with use of private providers for other health services yet, in many countries, significant differences between use of the private sector for HIV testing and other services exist. Within countries, we find that wealth is strongly associated with use of the private sector for HIV testing in most countries, but the relative socio-economic profile of clients who receive an HIV test from a private provider varies considerably across countries. On the one measure of quality to which we have access, reported adherence to antenatal care testing guidelines, there are no statistically significant differences in performance between public and private for-profit providers in most countries after controlling for wealth. Conclusions: These results suggest that strategies for supervising and engaging private health providers with regard to HIV testing should be country specific and take into account local context.

As providers of medical information and testimony, clinicians have ultimate responsibility for ethical conduct as it relates to this information. The authors offer the following recommendations for enhancing ethical relationships between expert clinicians and the courts. 1. Avoid or resist attorney efforts at enticement into joining the attorney-client team. Such compromises of scientific boundaries and ethical principles exist on a continuum ranging from standard attorney-client advocacy at the beginning of the expert consultation phase (e.g., promotional information at the forefront of retaining an expert, with either provision of selective or incomplete records or less than enthusiastic efforts to produce all records) and extending to completion of evaluation, when requests for changes in reports and documentation might be made. 2. Respect role boundaries and do not mix conflicting roles. Remember that the treating doctor possesses a bond with the patient but does not as a rule obtain complete preinjury and postinjury information in the context of assessing causality and apportionment. In contrast, the expert witness must conduct a thorough and multifaceted case analysis sans the physician-patient relationship in order to facilitate objectivity and allow optimum diagnostic formulations. Finally, the trial consultant's function in this adversarial process is to assist with critically scrutinizing and attacking positions of experts for the opposing side. These roles all represent inherently different interests, and mixing them can only reduce objectivity. 3. Insist on adequate time for thorough record review, evaluation, and report generation. Also insist on sufficient time and preparation for deposition and court appearances. 4. Work at building a reputation for general objectivity, reliance on multiple data sources, reaching opinions only after reviewing complete information from both sides, and completing the evaluation. 5. Spend a good amount of time actually treating the patient population being examined or being offered testimony about. This treatment should be current and should be of a similar frequency to treating practitioner specialists. Be able to discuss relevant research and scientific methodology issues competently and without notes. 6. Arrive at opinions only after reviewing all of the evidence from both sides of the adversarial fence, employing multiple data sources, completing the evaluation, and interpreting data within the full context of comprehensive historical, behavioral observation, and contextual information. Being otherwise favorable to retaining attorney interests suggests endorsement of "opinion prostitute," "scientific perjurer," or "hired gun" status. The only way a practitioner can reduce the likelihood of facing an "opinion prostitute" on the opposing side in future cases is to insist on establishing and maintaining a reputation for scientific objectivity. 7. Balance cases from plaintiff and defense attorneys. Predilection for one side or the other suggests bias and sets up predisposition to nonobjectivity. For example, a preponderance of plaintiff work suggests an overdiagnosis or uncritical sympathy bias, whereas a ratio that favors hiring by the defense suggests an underdiagnosis or skepticism bias. Perhaps Brodsky's suggested cut-off ratio of .8 for favorability findings would represent an initial cutoff for defense versus plaintiff ratio. That is, experts should do at least 20% work for the opposite side of the current case being represented. Further, it might be a reasonable expectation that data on these ratios be collected as an important method for ensuring objective opinions. 8. Ensure against excessive favorability to the side of the retaining attorney or firm. Objectivity demands that scientific opinions not be influenced by the position of the legal advocate. Importantly, Brodsky recommends using a ratio of .8 as a cut-off for detecting excessive bias. That is, practitioners should possess prerequisite objectivity to disagree with the referring attorney at least 20% of the time. We suggest that a more useful cut-off would be .75, where experts are expected to generate findings that do not support the referring attorney's position at least 25% of the time. 9. Never arrive at opinions that are inconsistent with plaintiff records, examination data, test data, behavioral presentation, and so forth, especially when such opinions are favorable to the side of the retaining attorney firm. Instead, use the following recommendations. (ABSTRACT TRUNCATED)

Fingerhut mails up to 120 catalogs per year to each of its 7 million customers. With this dense mail plan and mailing decisions made independently for each catalog, many customers were receiving redundant and unproductive catalogs. To identify and eliminate this excessive operational expense, IBM and Fingerhut together developed an optimization system that selects the most profitable sequence of catalogs, called a mail stream, for each customer. With mail streams, Fingerhut makes better mailing decisions at the customer level, resulting in increased profits. Today, Fingerhut runs this application weekly to find the most profitable mail stream for each customer.

Total factor productivity (TFP) techniques were used to develop measures of productivity performance for public transit systems of varying size and location. This baseline is used to examine the potential contribution of alternative advanced vehicle location (AVL) applications. TFP aggregates outputs on the basis of their revenue contribution and inputs on the basis of their relative importance to total costs to calculate the overall transit firm productivity as a function of these quantities. This approach provides a measure of efficiency contribution and identifies the instruments that can be used to achieve these gains. The results from the study are insightful. AVL was found to be an important factor in both system performance and cost savings. The introduction of AVL had a positive and significant impact on transit firm productivity. Improvements in productivity and better service information can be obtained through use of AVL. In the bus fleet regression, AVL has a negative coefficient, indicating that the use of AVL by a transit firm will result in fewer buses used given the number of vehicle miles and number of passenger trips. Similarly, cost per vehicle mile was found to be lower when the transit firm used AVL. In addition to these cost savings, research indicates that given fleet size and usage AVL will reduce the annual maintenance hours for a firm.

What will our students need to know to work and live productively in tomorrow's society? What can we teach them about how to become life-long learners? How have the Internet and other electronic information sources changed the skills needed to do good research? These are serious questions all schools should be asking.

Noma (cancrum oris) is a disease of poverty and malnutrition, which predominantly affects children younger than 10 years in developing countries. Although the majority of sufferers die of sepsis at the time of the initial infection, or of subsequent starvation due to severe trismus and an inability to eat, a small minority of patients survive and require reconstructive surgery for severe facial scarring and deformity. These patients present significant problems to the anesthesiologist with regard to airway management. We present a series of 26 patients undergoing primary and subsequent reconstructive surgery, with particular focus on airway management. We show that airway management, while challenging, can be performed safely and successfully by using individualized airway plans but may require advanced techniques and equipment. Traditional tests focusing on the anterior/superior airway are helpful in assessing patients with facial deformity due to noma.

We used (+)[ 11 C]dihydrotetrabenazine, a new ligand for the type 2 vesicular monoamine transporter, with positron emission tomography to study striatal monoaminergic presynaptic terminals in 7 male severe chronic alcoholic subjects without Wernicke-Korsakoff disease compared with 7 male normal controls of similar ages. We found reduced specific binding in the caudate nucleus and putamen in the alcoholic group, and the difference reached significance in the putamen. Specific binding was not decreased in the thalamus, which was examined as a reference structure. We also detected deficits in blood-to-brain transfer rate, K 1 , in the same regions of the alcoholic group, with a significant difference in the putamen. K 1 was unchanged in the thalamus. The finding of reduced striatal VMAT2 in severe chronic alcoholic patients suggests that nigrostriatal monoaminergic terminals are reduced, with or without loss of neurons from the substantia nigra. The findings suggest that the damaging effects of severe chronic alcoholism on the central nervous system are more extensive than previously considered.

Patients with severe chronic alcoholism have decreased rates of glucose metabolism in the medial frontal lobe and correlated abnormalities of neuropsychological functioning. The potential influence of family history of alcoholism has not been examined in these patients. In a retrospective study, we used neuropsychological tests and neuroimaging employing [18F]fluorodeoxyglucose with positron emission tomography to study 48 older subjects who had histories of severe, chronic alcohol dependence. These patients were divided into two groups: 27 with a first-degree relative with chronic alcoholism and 21 patients without first-degree relative with chronic alcoholism. No differences were found between groups on either neuropsychological or neuroimaging tests. These results suggest that a family history of alcoholism does not moderate the damaging effects of severe chronic alcoholism on the functioning of the medial frontal lobe.

The rationale for obtaining informed consent from patients contains a number of legal, ethical, and moral arguments that are well entrenched in the medical community but which have been embraced only recently by psychologists. The current Ethical Principles of Psychologists and Code of Conduct (1992) elucidate informed consent guidelines for treatment and research, but do not provide the same degree of clarity concerning informed consent for clinical assessment. The purpose of this paper is to open a dialogue about the use of informed consent in neuropsychological assessment and to provide proposed recommendations for obtaining informed consent from patients receiving neuropsychological evaluations.

Prolonged excessive consumption of alcohol has been associated with a variety of cognitive disorders accompanied by neuropathological and neurochemical abnormalities of the brain, particularly in the frontal lobes. Studies with positron emission tomography (PET) have shown decreased local cerebral metabolic rates for glucose (lCMRglc) in frontal regions, with correlated abnormalities on neuropsychological tests sensitive to executive functioning. This investigation was designed as a pilot study to examine the effects of abstinence and relapse in patients with severe chronic alcoholism studied longitudinally with PET and with neuropsychological evaluation to assess both general and executive functioning. Six patients, including 4 who remained relatively abstinent and 2 who relapsed following their initial evaluation, were studied twice, with inter-evaluation intervals ranging from 10 to 32 months. The patients who remained abstinent or who had minimal alcohol use showed partial recovery of lCMRglc in two of three divisions of the frontal lobes and improvement on neuropsychological tests of general cognitive and executive functioning, whereas the patients who relapsed had further declines in these areas. These results, although based upon a relatively small number of subjects, provide preliminary support for at least partial recovery of metabolic and cognitive functioning in individual patients who abstain from alcohol.

Despite speculation concerning the accuracy of self-reported information, particularly from certain patient populations, many neuropsychologists continue to estimate premorbid intellectual functioning on the basis of self-reported educational attainment. This study examined 116 individuals with diverse diagnoses [i.e., alcoholism, posttraumatic stress disorder (PTSD), schizophrenia or schizoaffective, and dementia] to determine the accuracy of their self-reported high school educational attainment. Results suggest that at least half of all participatts were inaccurate as defined by discrepancies between actual and estimated GPA greater than .5 on a traditional 4-point grading scale. Most patients were inaccurate in the direction of overestimating their educational attainment. Patients diagnosed with alcoholism and PTSD were significantly less accurate in recalling their educational history when compared to a group of normal-control subjects. Several subjects, whose records could not be verified, were found to have not attended high school as they had claimed. These results underscore the potential inaccuracy that exists when estimating premorbid intelligence using self-reported information. © 1997 National Academy of Neuropsychology. Published by Elsevier Science Ltd

Objective The aim of this study was to evaluate a custom angle load reduction rolling walker to determine the relationship between flexion and load reduction on walking performance in patients with lumbar spinal stenosis.The hypothesis was that walking performance in patients with lumbar spinal stenosis would be significantly improved using the Oliver Static Measuring Apparatus device compared with unaided treadmill walking. Design Fifteen patients with symptomatic neurogenic intermittent claudication caused by lumbar spinal stenosis were recruited at a Veterans Affairs Medical Center. This study used a cross-sectional design with two random-order treadmill conditions: (1) spinal flexion and unloading and (2) level walking. Primary outcome measures included initiation time of first symptoms, total walking time, spinal flexion angle, and unloading force. Secondary measures included baseline pain, fatigue, and disability severity. Results The participants' initiation time of symptoms and total walking time were significantly greater with the use of the Oliver Static Measuring Apparatus compared with the unaided walking trial. The participants with increased baseline pain, fatigue, and disability severity had decreased walking performance for the unaided condition but not for the Oliver Static Measuring Apparatus condition. Conclusions The results show that spinal flexion is important for pain reduction in lumbar spinal stenosis. The Oliver Static Measuring Apparatus device used in this study was shown to be effective and immediate in significantly increasing total walking time and prolonging the onset of neurogenic intermittent claudication symptoms while ambulating.

Noma (cancrum oris) is a disease of poverty and malnutrition, which predominantly affects children younger than 10 years in developing countries. Although the majority of sufferers die of sepsis at the time of the initial infection, or of subsequent starvation due to severe trismus and an inability to eat, a small minority of patients survive and require reconstructive surgery for severe facial scarring and deformity. These patients present significant problems to the anesthesiologist with regard to airway management. We present a series of 26 patients undergoing primary and subsequent reconstructive surgery, with particular focus on airway management. We show that airway management, while challenging, can be performed safely and successfully by using individualized airway plans but may require advanced techniques and equipment. Traditional tests focusing on the anterior/superior airway are helpful in assessing patients with facial deformity due to noma.

Disulfiram is an aldehyde dehydrogenase inhibitor that is widely used as an adjunctive agent in the treatment of patients with severe chronic alcoholism. Recent positron emission tomography (PET) studies of local cerebral metabolic rates for glucose (ICMRglc) and benzodiazepine receptor binding in alcoholic patients have shown regional cerebral abnormalities; however, some of the patients were studied while receiving disulfiram, which could influence the biochemical processes under investigation. In a retrospective investigation, we examined the influence of disulfiram administration on the results of PET studies of ICMRglc and benzodiazepine receptor binding and neuropsychological tests of cognition and executive function in patients with severe chronic alcoholism. [18F]Fluorodeoxyglucose was used to measure ICMRglc in 48 male patients, including 11 receiving and 37 not receiving disulfiram in therapeutic doses. [11C]Flumazenil was used to measure benzodiazepine receptor binding in 17 male patients, including 3 receiving and 14 not receiving disulfiram. All patients studied with FMZ were also examined with fluorodeoxyglucose. PET studies of ICMRglc revealed significantly decreased global values in the patients receiving disulfiram compared with those not receiving disulfiram. PET studies of benzodiazepine receptor binding revealed decreased flumazenil influx and distribution volume in patients receiving disulfiram. The neuropsychological tests demonstrated no differences between the two groups of subjects. The findings suggest that disulfiram may influence the results of PET studies of glucose metabolism and benzodiazepine receptor binding.

In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.

This article begins with a brief history of Records Management in the United States of America. It then moves on to consider the question of access and protection to public records in the context of the American county court system, which seems to have missed out on appropriate records management practice, with worrying consequences for historians and others.

Although the concept of outpatient care is not a new one, the growth in ambulatory facilities has revolutionized medical care in the United States. The growth in ambulatory surgery centers, imaging centers, and cancer centers in Florida is explored in detail. With the many changes forthcoming in health care, ambulatory care will play an increasing role in delivering good health care at a reasonable cost.

No abstract is available.

In 2006, the government of India passed a law guaranteeing each and every rural household in the country one hundred days of work at a basic minimum wage. The law, known as the National Rural Employment Guarantee Act (NREGA), in effect created India’s (and probably the world’s) largest anti-poverty program in terms of number of beneficiaries. According to official statistics, 45 million households participated in NREGA in fiscal year 2008-09. An innovative feature of the NREG Act is its provisions for transparency: the act itself stipulates that work records, or “muster rolls”, be made available to the public, and that local “social audits” be conducted on a regular basis (Right to Food, 2007). The state of Andhra Pradesh has taken this call for transparency once step further by making detailed micro-level data on NREGA participation in the state available to the public over the internet. To the author’s knowledge, there are few precedents among major poverty relief programs for this kind of public data dissemination. In this focus note, we highlight some specific lessons that may be learned by looking closely at this data. The lessons presented here are not intended to provide a comprehensive overview of the functioning of NREGA in Andhra Pradesh. For such an overview, readers are recommended to consult Anil Sharma’s excellent review of the program or the articles in the mainstream press by Jean Dreze and his coauthors. Rather, the lessons presented here are meant to complement such overviews by presenting key insights derived from quantitative analysis of the data.

Through randomized control trials, we estimate the impact of three interventions designed to increase awareness and utilization of Rashtriya Swasthya Bima Yojana (RSBY), a government subsidized health insurance program for the poor in India. In the three years since its launch, RSBY has been rolled out to over 80 million individuals yet the program still suers from low levels of usage among policy holders in some areas. The three interventions { health camps held at the panchayat level by public and private hospitals, health camps held at the village level by a local NGO, and an independent audit of the enrolment process by a local NGO { were designed to increase utilization of the scheme by making beneciaries more aware of their rights under the scheme and prompting those who need medical attention to use RSBY to receive treatment. We nd no eects of the health camp interventions on RSBY claims. Our ndings suggest that health camps, as practiced in these two interventions, are not an eective

The purpose of this report is to examine development trends in the Southern Gobi Region (SGR) as they affect livestock and wildlife. It provides an overview of the environment and natural resources of the region, discusses existing relationships and interactions among humans, livestock, large herbivore wildlife, and the natural resources on which they are dependent. It then explores the impact that economic development of the region is likely to have if that development does not consider the needs of the current users. The importance of rangeland and water resources in this region is illustrated by the case study of herder interactions with the Wild Ass or Khulan. This study found that Mongolians in the SGR, especially pastoralists, are interested in wildlife and can be willing cooperators in conservation, especially if they receive some compensation for their efforts. The general conclusion reached by this report is that direct competition for resources is not now the primary issue affecting the relationship between humans, pastoral livestock and large herbivore wildlife; rather it is the lack or loss of a conservation ethic that provides protection for traditional users of natural resources, enforcement of hunting regulations, and prevents illegal sport hunting that is rapidly reducing populations of large wild herbivores in the region. Although economic development of the region will undoubtedly proceed, having in place an effective and functional natural resource management program is critical.

In this report we document the recent rise in equity investment in Indian microfinance and describe the process of obtaining equity financing and working with investors in detail. At the end of the report, we briefly describe two new alternative methods of financing for MFIs – portfolio buyouts and securitisation.

In this report, we present results from the first ever household survey on access to finance in India which includes information on micro-finance, is representative of an entire state’s (Andhra Pradesh) rural population, and for which the data is publicly available.