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This review summarizes the general histologic features of acute and chronic hepatitides and highlights those morphologic findings that may suggest or be diagnostic of a specific agent or etiology. The main epidemiologic, clinical, and pathologic features of the hepatotropic viruses are discussed, with an emphasis on pediatric studies and the differential diagnosis of hepatitis in childhood.

Objective: To evaluate the effectiveness of hospital admissions for indigenous children with malnutrition in a rural/remote Australian centre. Design: Retrospective review of the medical records. Setting: Rural secondary hospital. Subjects: Remote and rural indigenous children aged less than four years managed for malnutrition in Alice Springs Hospital (ASH). Main outcome measure: The primary outcome measure was weight gain during hospitalisation and posthospitalisation. Secondary outcome measures were yield of investigations, diagnoses made, treatments given, social interventions, readmission rate and nosocomial infection. Results: Median age of the 55 children was 15.1 months. Median weight change was 1.5 g day−1prior to hospitalisation, 36.7 g day−1during and 9 g day−1two months following hospitalisation (P

Of the published works by William Stanley Jevons, the marginalist theory of value and distribution in the Theory of Political Economy (1871) is principally remembered by economists today. For Jevons in the early 1870s, however, the reception of the Theory (TPE) had “been of the most discouraging character.” The “recognised professor[s] of the science,” for example, had either ignored or, in the case of J. E. Cairnes, “emphatically repudiated it” (Jevons 1875a, p. 4). In November 1874, buoyed by the publication of the first volume of Leon Walras's Elements of Pure Economics and by correspondence with Walras and other European economists, Jevons presented a defense of the marginalist theory and reply to critics in an address titled “The Progress of the Mathematical Theory of Political Economy.” It was delivered to the Manchester Statistical Society, and was extensively reported in the local newspapers. Jevons used those reports to both publicize and obtain comments on the address before the final version was published in 1875. As some of the papers circulated beyond Manchester, London, readers, for example, could also read or hear of his analysis. In that regard, one component of his argument attracted particular attention.

Suzanne F. Delbanco, PhD MPH, is the first executive director of The Leapfrog Group, founded by the Business Roundtable. The Leapfrog Group's goal is to mobilize employer purchasing power to initiate breakthrough improvements in the safety, quality, and overall value of healthcare for American consumers. The group's growing consortium of more than 155 Fortune 500 companies and other large private and public healthcare purchasers provides health benefits to more than 34 million Americans; these companies spend more than 62 billion dollars on healthcare annually. Dr. Delbanco is a member of the National Committee for Quality Assurance Purchaser Advisory Council and a board member of Bridges to Excellence. Before joining The Leapfrog Group, she was a senior manager at the Pacific Business Group on Health (PBGH), where she worked on the quality team. Prior to joining PBGH, she worked on reproductive health policy and the changing healthcare marketplace initiative at the Henry J. Kaiser Family Foundation. She has also consulted on health insurance coverage in the temporary employment industry and on the first statewide survey in California of MediCal beneficiaries, and worked as a community Liaison for Kaiser Permanente during the establishment of one of California's first County Organized Health Systems. She holds a PhD in public policy from the Goldman School of Public PoLicy and a MPH from the School of Public Health at the University of California, Berkeley.

BACKGROUND: To minimize the bacterial contamination rate in blood collected from donors, a study was designed to evaluate the suitability of a single-use chlorhexidine-alcohol antiseptic for donor arm preparation at all blood collection venues in Australia. STUDY DESIGN AND METHODS: A prospective study of bacterial load on the skin was performed on 616 blood donors’ arms before and after disinfection using a direct swabbing and plating technique. Disinfection was achieved with a swab containing 1 percent chlorhexidine gluconate with 75 percent alcohol, which was applied to the skin in a prescribed method. Feedback from blood donors and staff was obtained using questionnaires. RESULTS: After disinfection, 99 percent of donor arms had bacterial counts of 5 cfu per plate or less, and 99.5 percent had counts of 10 cfu per plate or less, respectively. The mean colony count for all donors after disinfection was 0.39, and the percentage reduction was 99 compared to predisinfection. Sixteen donors (3%) noted transient skin irritation. The majority of staff (64%) preferred not to use the new disinfectant due to the difficulty opening the packaging and an excessive amount of antiseptic solution per pack. CONCLUSION: The bacteriologic study showed that the disinfectant satisfied the requirements of the Australian Red Cross Blood Service for use to prepare blood-donor arms before venesection. An improvement to the packaging was required before it could be acceptable to all staff.

Carolyn M. Clancy, MD, serves as Director of the Agency for Healthcare Research and Quality (AHRQ) in the U.S. Department of Health and Human Services (DHHS). Prior to her appointment as director on February 5, 2003, Dr. Clancy served as AHRQ's acting director (since March 2002) and before that as director of AHRQ's Center for Outcomes and Effectiveness Research (COER). Dr. Clancy is a general internist and health services researcher and a graduate of Boston College and the University of Massachusetts Medical Schools. Following clinical training in internal medicine, Dr. Clancy was a Henry Kaiser Family Foundation Fellow at the University of Pennsylvania. She was also an assistant professor in the Department of Internal Medicine at the Medical College of Virginia in Richmond prior to joining AHRQ in 1990. Her major research interests include women's health, primary care, access to care, and the effect of financial incentives on physicians' decisions. She holds an academic appointment at The George Washington University School of Medicine (Clinical Associate Professor, Department of Medicine) and serves as Senior Associate Editor, Health Services Research. Dr. Clancy is a member of the editorial boards of several journals (American Journal of Public Health; Journal of Evaluation in Clinical Practice; Annals of Family Medicine, and Medical Care Research and Review), has published widely in peer-reviewed journals, and has edited or contributed to seven books.

While the usual caveat on responsibility applies, I would like to thank John Aldrich, Robert Dixon, Ivor Grattan-Guinness, Peter Groenewegen, John King, Harro Maas, Bruce McFarlane, Bert Mosselmans, and participants in a History and Methodology Group seminar, Faculty of Economics and Econometrics,University of Amsterdam, for helpful comments and/or discussion. I am particularly indebted to Philip Mirowski for detailed comments and suggestions.

Penny Hollander Feldman, PhD, is Vice President for Research and Evaluation at the Visiting Nurse Service of New York (VNSNY) and Director of the Center for Home Care Policy and Research. Prior to joining VNSNY, Dr. Feldman served on the faculties of the Kennedy School of Government and the Department of Health Policy and Management at the Harvard School of Public Health. At the Center for Home Care Policy and Research, she directs projects focused on improving the quality, outcomes, and cost-effectiveness of home-based care, supporting informed policymaking by long-term care decision makers, and helping communities promote the health, well-being and independence of people with chronic illness or disability. The translation and implementation of research in both service and policy settings has been an issue of ongoing focus for Dr. Feldman. She also served as a member of the Institute of Medicine Committee on Improving the Quality of Long-Term Care, which issued its report in 2001.

This paper highlights the issues faced by military engineers when restoring civil air facilities following conflict. Based on experiences at Pristina in Kosovo and Kabul in Afghanistan, it covers the various stages of opening runways, from mine clearance and rapid repair for combat operations to more permanent solutions for eventual transfer to civil authorities. At both locations the infrastructure had been destroyed but the differing political environments impacted significantly upon the works undertaken.

The objective of this study was to compare the efficacy and safety of fluticasone propionate (FP) (44 microg)/salmeterol (21 microg) delivered as two inhalations twice daily via a single hydrofluoroalkane (HFA 134a) metered dose inhaler (MDI) (FSC) with that of placebo HFA 134a (PLA), fluticasone propionate 44 microg chlorofluorocarbon (CFC) alone and salmeterol 21 microg CFC alone (S) in patients (n=360) with persistent asthma previously treated with beta2-agonists (short- or long-acting) or inhaled corticosteroids (ICS). After 12 weeks of treatment, patients treated with FSC had a significantly greater increase (p < or = 0.006) in mean FEV1 AUC(bl) compared with PLA, FP, or S. At end point, mean change from baseline in morning predose FEV1 for FSC (0.58 L) was significantly (p < or = 0.004) greater than PLA (0.14 L), FP (0.36 L), and S (0.25 L). Patients treated with FSC also had a significantly higher probability of remaining in the study without being withdrawn due to worsening asthma (2%) compared with those in the PLA (29%) and S (25%) groups (p < 0.001). Finally, treatment with FSC resulted in significantly (p < or = 0.007) greater improvements in morning and evening peak expiratory flow, need for rescue albuterol, and asthma symptom scores compared with FP, S, and PLA. The safety profile of FSC was also similar to FP or S alone. Initial maintenance treatment of the two main components of asthma, inflammation, and smooth muscle dysfunction (e.g., bronchoconstriction), with FSC results in greater overall improvements in asthma control compared with treatment of either individual component alone.

Inductors play a key role in DC-DC converters, but few options exist for implementing on-chip inductors for highly miniaturized, monolithic power converters. Microinductors constructed by standard microelectronic fabrication techniques with magnetic films as the core material have been investigated during the past 20 years with mixed results. A 13-mm/sup 2/ microinductor based on a spiral geometry and having L = 3.2 /spl mu/H and Q = 1.3 at 1 MHz is reported here. Key issues regarding microinductor design and performance are discussed.

Objective: Electroencephalography (EEG) power and coherence changes may be trait markers for alcoholism providing clues to brain mechanisms of vulnerability. However, it is unclear whether alpha power and coherence differences reflect reversible toxic or withdrawal effects of alcohol. Method: The EEGs of 10 non-abstinent and 16 long-term abstinent alcoholics (7.7 ± 5.8 years) and 25 controls were analyzed. Levels of anxiety and depression were assessed by questionnaire. Results: No statistically significant EEG power differences were observed between groups, although the numerical difference between alcoholics and controls was similar to that previously reported. Bilateral, intrahemispheric, posterior coherences were significantly increased in the alpha and beta frequency bands both in long-term abstinent and non-abstinent alcohol-dependent subjects – particularly when depressiveness was included as a covariate. Conclusion: These results suggest that increased EEG-coherence (cortical synchronization) may serve as endophenotype for alcoholism in conjunction with increased depressiveness and point to a possible involvement of GABAergic and/or glutamatergic neurotransmission.

Background H 1 -receptor antagonists differ in their ability to produce peripheral H 1 -blockade. Suppression of histamine-induced flares and wheals is a useful objective test for measuring these differences. Objective To evaluate the relative potency of fexofenadine HCl 180 mg, loratadine 10 mg, and placebo (PBO) in suppressing histamine-induced flares and wheals and compare the onset, duration, and maximum suppression of histamine achieved with each agent. Methods Thirty healthy volunteers were enrolled in this randomized, double-blind, single-dose, crossover study. Flares and wheals induced by skin-prick testing with histamine 1.8 mg/mL were measured before treatment, every 20 minutes during the first hour after dosing, and thereafter hourly between 2 and 12 hours and between 23 and 25 hours postdose. Results Fexofenadine was significantly more effective than loratadine in suppressing the histamine-induced flare response at hours 2 through 7 and 10 through 12 and produced greater flare suppression than did PBO at hours 2 through 25. Onset of flare suppression occurred 2 hours after dosing with fexofenadine and 4 hours after dosing with loratadine. Likewise, fexofenadine was superior to loratadine in suppressing the wheal response from hours 1 through 12 and was more effective than PBO at hours 1 through 12, 24, and 25. Throughout the 25-hour measurement interval, the magnitude of difference in both wheal and flare suppression consistently favored fexofenadine over loratadine. Conclusions In a skin test model of wheal-and-flare suppression, fexofenadine showed rapid distribution into the skin compartment with faster onset of action and greater potency vs loratadine.

The Gene Ontology Consortium (Gene Ontology Consortium 2000) provides a standardized vocabulary for the annotation of gene attributes, which fall into the three general categories of molecular function, biological process, and cellular component. Organism-specific databases such as FlyBase (FlyBase Consortium 2002), Saccharomyces Genome Database (SGD; Cherry et al. 1998), Mouse Genome Database (MGD; Blake et al. 2002), and WormBase (Stein et al. 2001), have codeveloped this vocabulary, and have used it to annotate genes with the attributes that the biomedical literature asserts that they hold. These databases are incomplete because there are genes whose attributes are not yet all known, and because there is literature that has not yet been digested by the database curators. In such cases it is useful to have a prediction of whether a gene has a certain attribute. Such predictions can help to make the databases more complete (and consequently more useful to researchers) by directing curators toward literature that they may have overlooked. Also, predictions that are not presently supported by the literature provide new hypotheses that may be tested experimentally. A variety of approaches for predicting Gene Ontology (GO) attributes have been attempted. Natural language processing was used in Raychaudhuri et al. (2002) to automate the curator's task of extracting gene–attribute associations from literature abstracts. Others have assigned attributes to genes on the basis of microarray data (Hvidsten et al. 2001) or protein folds (Schug et al. 2002). These approaches are especially valuable for assigning attributes to genes with otherwise unknown function. But once some attributes of a gene are known, statistical patterns among the annotations themselves can be useful for predicting additional attributes. In this paper, we model the probabilistic relationships between the GO annotations using two approaches, one based on decision trees and the other based on Bayesian networks. We assess the models using cross-validation on the SGD and FlyBase databases. We also manually assess 100 of those gene–attribute associations that the models indicate are likely to hold but that have not been annotated in the databases.

Older Americans experience chronic disease at rates well above other segments of our society. Rates of health services use are also 2 to 3 times that of younger age groups. The most rapidly growing segments of America's aging population are also its most nutritionally vulnerable-women, minorities, and those 85 years of age and older. The routine incorporation of nutrition screening and intervention into chronic disease management protocols will lower healthcare services usage, decrease healthcare costs, help relieve the burden of human suffering experienced by older Americans with chronic disease, and improve quality of life for our nation's elders.

This paper discusses and reprints two additions to the bibliography of published works by W. Stanley Jevons. The first, concerning Jevons’s sunspot theory of commercial fluctuations, is a signed letter, published by the Athenaeum in February 1879. The second item is a review of the first volume of Henry Dunning Macleod’s Economical Philosophy, published by the Manchester Guardian in June 1873. Unlike the sunspots letter, the review was unsigned. I suggest, however, that it can be attributed to Jevons with a high degree of probability and that it helps explain some puzzling aspects of Jevons’s comments regarding Macleod in his Theory of Political Economy

Objective To describe disease course, histopathology, and outcomes for infants with atypical presentations of alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV) who underwent bilateral lung transplantation. Study design We reviewed clinical history, diagnostic studies, explant histology, genetic sequence results, and post-transplant course for 6 infants with atypical ACDMPV who underwent bilateral lung transplantation at St. Louis Children's Hospital. We compared their histology with infants with classic ACDMPV and compared their outcomes with infants transplanted for other indications. Results In contrast with neonates with classic ACDPMV who present with severe hypoxemia and refractory pulmonary hypertension within hours of birth, none of the infants with atypical ACDMPV presented with progressive neonatal respiratory failure. Three infants had mild neonatal respiratory distress and received nasal cannula oxygen. Three other infants had no respiratory symptoms at birth and presented with hypoxemia and pulmonary hypertension at 2-3 months of age. Bilateral lung transplantation was performed at 4-20 months of age. Unlike in classic ACDMPV, histopathologic findings were not distributed uniformly and were not diffuse. Three subjects had apparent nonmosaic genetic defects involving FOXF1. Two infants had extrapulmonary anomalies (posterior urethral valves, inguinal hernia). Three transplanted children are alive at 5-16 years of age, similar to outcomes for infants transplanted for other indications. Lung explants from infants with atypical ACDMPV demonstrated diagnostic but nonuniform histopathologic findings. Conclusions The 1- and 5-year survival rates for infants with atypical ACDMPV are similar to infants transplanted for other indications. Given the clinical and histopathologic spectra, ACDMPV should be considered in infants with hypoxemia and pulmonary hypertension, even beyond the newborn period.

Background Bronchiolitis is a major health burden in infants globally, particularly among Indigenous populations. It is unknown if 3 weeks of azithromycin improve clinical outcomes beyond the hospitalization period. In an international, double-blind randomized controlled trial, we determined if 3 weeks of azithromycin improved clinical outcomes in Indigenous infants hospitalized with bronchiolitis. Methods Infants aged ≤24 months were enrolled from three centers and randomized to receive three once-weekly doses of either azithromycin (30 mg/kg) or placebo. Nasopharyngeal swabs were collected at baseline and 48 h later. Primary endpoints were hospital length of stay (LOS) and duration of oxygen supplementation monitored every 12 h until judged ready for discharge. Secondary outcomes were: day-21 symptom/signs, respiratory rehospitalizations within 6 months post-discharge and impact upon nasopharyngeal bacteria and virus shedding at 48 h. Results Two hundred nineteen infants were randomized (n = 106 azithromycin, n = 113 placebo). No significant between-group differences were found for LOS (median 54 h for each group, difference = 0 h, 95% CI: −6, 8; p = 0.8), time receiving oxygen (azithromycin = 40 h, placebo = 35 h, group difference = 5 h, 95% CI: −8, 11; p = 0.7), day-21 symptom/signs, or rehospitalization within 6 months (azithromycin n = 31, placebo n = 25 infants, p = 0.2). Azithromycin reduced nasopharyngeal bacterial carriage (between-group difference 0.4 bacteria/child, 95% CI: 0.2, 0.6; p

Background: Australian Aborigines in remote areas have very high rates of kidney disease, which is marked by albuminuria. We describe a "multihit" model of albuminuria in young adults in one remote Aboriginal community. Methods: Urinary albumin/creatinine ratios (ACR) were measured in all subjects who volunteered to participate in a community-wide health screen. Subjects for this study were young adults who had birth weights recorded and whose medical records were inspected for a history of post-streptococcal glomerulonephritis (PSGN). Urine ACR levels were evaluated in the context of birth weights, PSGN history and current BMI. Results: 580 subjects (335 males and 245 females) who were aged 18 - 39 years at time of screening and qualified for inclusion. 26% of subjects had birth weights of < 2.5 kg, and the median birth weight was 2.8 kg. 23% of subjects had a remote history of PSGN, all 3 or more years earlier. Median BMI for the group was 21 kg/m2. Urine ACR levels exceeded the microalbuminuria threshold of 3.4 g/mol in 35.5% of subjects. Birth weight (inversely), remote PSGN, and current BMI were all independent predictors of ACR levels. Median levels of ACR were lowest in those with birth weights ≥2.5 kg, and no history of PSGN, intermediate in those with either birth weights < 2.5 kg or a history of PSGN, and highest in those with both low birth weights and a PSGN history. ACR levels were higher in those with BMIs above the median values, most notably in those with lower birth weights or a PSGN history or both. Interpretation: Much of the great excess of disease in this population is explained by high rates of the early life risk factors, low birth weight and PSGN. Their effects are expressed through amplification of ACR in the context of increasing age, and are further moderated by levels of current body size. Both early life risk factors are potentially modifiable.

Summary With the rapid advances in information technology, the proliferation of information resources and formats, and the increasing complexities of access and evaluation, libraries recognize the necessity for a dynamic information literacy program that will address the needs of all categories of users. University faculty constitute one group of users to which the systemic college library increasingly endeavors to extend and market its services and programs, including its information literacy training workshops. A consideration of this library/classroom faculty relationship in the context of the adult education literature, as well as successful models that have been employed in this effort, provide insight on ways in which the library can successfully accomplish its information literacy training objectives among this group.

BACKGROUND: Placental site trophoblastic tumor is a rare form of gestational trophoblastic disease that commonly presents with vaginal bleeding and amenorrhea after pregnancy. CASE: A women with a normal gestation at 37 weeks presented with a pneumothorax. The patient underwent placement of a chest tube and a subsequent thorascopic pulmonary bullous resection for persistence of the pneumothorax. Histological examination of the specimen revealed a metastatic placental site trophoblastic tumor. CONCLUSION: Gestational trophoblastic disease must be considered in the differential diagnosis of pneumothorax during pregnancy.

There is considerable evidence that the amplitude of the heritable P300 event-related potential (ERP) is reduced in alcoholics and their alcohol-naive children. Low voltage alpha (LVA), a heritable resting electroencephalogram (EEG) trait present in 7-14% of the population, has been shown to be associated with alcoholism and anxiety disorders. A few studies have demonstrated a modest correlation between pre-stimulus alpha power and P300 amplitude. We aimed to test this finding in community volunteers, hypothesizing that LVA would be associated with low P300 amplitude.Digitized resting EEG was recorded at the central parietal site (Pz) from 85 male and 113 female community volunteers (120 unrelated). ERPs were elicited at Pz by auditory and visual oddball paradigms. All participants were interviewed with the Schedule for Affective Disorders, Lifetime Version (SADS-L) and assigned blind-rated psychiatric diagnoses according to the American Psychiatric Association DSM-III-R criteria.LVA participants (including alcoholics and nonalcoholics) had significantly lower auditory and visual P300 amplitudes. Absolute alpha power was modestly correlated with auditory and visual P300 amplitude and was associated with 9.4% and 4.6% of the variance, respectively.The association between LVA and low P300 amplitude, two distinct electrophysiological traits, suggests that, at least in individuals with the LVA trait, some aspects of resting, unstimulated brain activity and activated brain function in the form of attentional response may be fundamentally related.

Lucian L. Leape, MD, is a health policy analyst whose research has focused on error prevention and appropriateness of care. He is currently adjunct professor of health policy at the Harvard School of Public Health. Prior to joining the faculty at Harvard, he was professor of surgery at Tufts University School of Medicine and chief of pediatric surgery at the New England Medical Center. He has been a leading advocate of the nonpunitive systems approach to the prevention of medical error and has led several studies of adverse drug events and their underlying systems failures. In addition, he has directed research into overuse and underuse of cardiovascular procedures. Dr. Leape was a founding director of the National Patient Safety Foundation, the Massachusetts Coalition for the Prevention of Medical Error, and the Harvard Kennedy School Executive Session. He led the Institute for Healthcare Improvement's first Breakthrough Collaborative on Prevention of Adverse Drug Events. He was a member of the Institute of Medicine (IOM) Quality of Health Care in America Committee, which recently released its reports, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century. Recent awards include the Distinguished Service Award of the American Pediatric Surgical Association (1997), the Robert Wood Johnson Investigator Award (1998), the Donabedian Award from the Medical Care Section of the American Public Health Association (1999), the Cheers Award from the Institute for Safe Medication Practices (1999), and the Pinnacle Award from the American Pharmaceutical Association (2001). Dr. Leape is a graduate of Cornell University and Harvard Medical School and trained in surgery at Massachusetts General Hospital and at Boston Children's Hospital.

Recently, I wrote about the workshops and presentations at APEC 2017 that talked about the challenges of magnetics in high-frequency power conversion. Those challenges include losses at high frequency, a lack of good data and models on losses in magnetic materials and devices, and lack of standardization of data from manufacturers. But there were also two other presentations that got me thinking in an entirely different direction: capacitive power conversion. By capacitive power conversion, I generally mean the use of “charge pump” techniques. For example, I am sure many of us have used the charge pump in RS-232 serial line driver ICs to convert +12 Vdc to –12 Vdc. Or maybe we have used a simple charge pump to create a +12 V or +15 Vdc from a +5 Vdc rail to power some small amount of analog circuitry.

Summary Lung alveoli, which are unique to air-breathing organisms, have been challenging to generate from pluripotent stem cells (PSCs) in part because there are limited model systems available to provide the necessary developmental roadmaps for in vitro differentiation. Here we report the generation of alveolar epithelial type 2 cells (AEC2s), the facultative progenitors of lung alveoli, from human PSCs. Using multicolored fluorescent reporter lines, we track and purify human SFTPC+ alveolar progenitors as they emerge from endodermal precursors in response to stimulation of Wnt and FGF signaling. Purified PSC-derived SFTPC+ cells form monolayered epithelial "alveolospheres" in 3D cultures without the need for mesenchymal support, exhibit self-renewal capacity, and display additional AEC2 functional capacities. Footprint-free CRISPR-based gene correction of PSCs derived from patients carrying a homozygous surfactant mutation (SFTPB 121ins2 ) restores surfactant processing in AEC2s. Thus, PSC-derived AEC2s provide a platform for disease modeling and future functional regeneration of the distal lung.

Explores what is meant by "better magnetics" that was discussed and debated at the 2017 IEEE Applied Power Electronics Conference and Exposition (APEC).

The American Gastroenterological Association acknowledges the need for gastroenterologists to participate in and provide value-based care for both cognitive and procedural conditions. Episodes of care are designed to engage specialists in the movement toward fee for value, while facilitating improved outcomes and patient experience and a reduction in unnecessary services and overall costs. The episode of care model puts the patient at the center of all activity related to their particular diagnosis, procedure, or health care event, rather than on a physician's specific services. It encourages and incents communication, collaboration, and coordination across the full continuum of care and creates accountability for the patient's entire experience and outcome. This paper outlines a collaborative approach involving multiple stakeholders for gastrointestinal practices to assess their ability to participate in and implement an episode of care for obesity and understand the essentials of coding and billing for these services.

The Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), utilizing an evidence-informed, consensus-derived process, recommend that a standardized set of diagnostic indicators be used to identify and document pediatric malnutrition (undernutrition) in routine clinical practice. The recommended indicators include z scores for weight-for-height/length, body mass index-for-age, or length/height-for-age or mid-upper arm circumference when a single data point is available. When 2 or more data points are available, indicators may also include weight gain velocity (

RANEY® cobalt, which was first prepared in the 1930s, is known to function effectively as a catalyst for certain chemoselective reductions. However, its utility in chemical synthesis does not seem to have been fully appreciated. This first comprehensive survey of the literature on chemical transformations involving RANEY® cobalt attempts to redress matters by, among other things, highlighting the differences between the performance of this system and its much more well-known but usually less selective congener RANEY® nickel. A reliable method for preparing consistently effective RANEY® cobalt is presented together with a protocol that avoids the need to use it with high pressures of dihydrogen. As such, it is hoped more attention will now be accorded to the title reagent that offers considerable promise as a powerful tool for chemical synthesis, particularly in the assembly of polycyclic frameworks through tandem reductive cyclisation processes.

Understanding the interplay between black-hole accretion and star formation, and how to disentangle the two, is crucial to our understanding of galaxy formation and evolution. To investigate, we use a combination of optical and near-infrared photometry to select a sample of 74 quasars from the VISTA Deep Extragalactic Observations (VIDEO) Survey, over 1 deg$^2$. The depth of VIDEO allows us to study very low accretion rates and/or lower-mass black holes, and 26 per cent of the candidate quasar sample has been spectroscopically confirmed. We use a radio-stacking technique to sample below the nominal flux-density threshold using data from the Very Large Array at 1.4 GHz and find, in agreement with other work, that a power-law fit to the quasar-related radio source counts is inadequate at low flux density. By comparing with a control sample of galaxies (where we match in terms of stellar mass), and by estimating the star formation rate, we suggest that this radio emission is predominantly caused by accretion activity rather than star-formation activity., Comment: 26 pages, 15 figures, replaced with the accepted version, to appear in MNRAS

We appreciate Dr. Kroon and Dr. Taanman’s interest and comments on our manuscript demonstrating the presence of clonally expanded T cells in aneurysmal lesions of patients with aortic abdominal aneurysm (AAA) ([1][1]). The current treatment modalities for AAA involve surgical treatment which

Maternal diabetes is a risk factor for pregnancy complications, including stillbirth and macrosomia. Evolving data suggest that diabetes during pregnancy also has long-term consequences for offspring, putting them at risk for obesity and the metabolic syndrome in childhood. Because nonalcoholic fatty liver disease is known to occur in adults and children with insulin resistance, we hypothesized that altered lipid metabolism in fetuses of diabetic mothers may manifest with hepatic steatosis.We undertook a retrospective autopsy study to compare the presence and degree of hepatic steatosis between stillborns delivered to women with pregestational or gestational diabetes mellitus (gestational age 20-40 weeks; n = 33) and age-matched nondiabetic control stillbirth cases (n = 48), the latter enriched for maternal obesity, macrosomia, and similar cause of demise.Histopathologic hepatic steatosis was significantly more prevalent and severe in the diabetic subjects (26/33, 78.8%) than in the controls (8/48, 16.6%) (P 0.001). Within the diabetic cohort, the severity of steatosis was related directly to gestational age, birth weight, and liver weight, with no correlation of presence or severity of steatosis in the control group to maternal or fetal factors, including maternal body mass index or fetal macrosomia. Although macrosomic stillborns were more common in diabetic women with %hemoglobin A1c6 and body mass index30 kg/m, fetal steatosis was independent of glycemic control, maternal obesity, type of diabetes, ethnicity, or fetal sex in our cohort.This study is the first to our knowledge to demonstrate a specific association between fetal hepatic steatosis and maternal diabetes.

Coding, coverage, and reimbursement for nutrition services are vital to the dietetics profession, particularly to registered dietitian nutritionists (RDNs) who provide clinical care. The objective of this study was to assess RDN understanding and use of the medical nutrition therapy (MNT) procedure codes in the delivery of nutrition services. Its design was an Internet survey of all RDNs listed in the Academy of Nutrition and Dietetics (Academy)/Commission on Dietetics Registration database as of September 2013 who resided in the United States and were not retired. Prior coding and coverage surveys provided a basis for survey development. Parameters assessed included knowledge and use of existing MNT and/or alternative procedure codes, barriers to code use, payer reimbursement patterns, complexity of the patient population served, time spent in the delivery of initial and subsequent care, and practice demographics and management. Results show that a majority of respondents were employed by another and provided outpatient MNT services on a part-time basis. MNT codes were used for the provision of individual services, with minimal use of the MNT codes for group services and subsequent care. The typical patient carries two or more diagnoses. The majority of RDNs uses internal billing departments and support staff in their practices. The payer mix is predominantly Medicare and private/commercial insurance. Managers and manager/providers were more likely than providers to carry malpractice insurance. Results point to the need for further education regarding the full spectrum of Current Procedural Terminology codes available for RDN use and the business side of ambulatory MNT practice, including the need to carry malpractice insurance. This survey is part of continuing Academy efforts to understand the complex web of relationships among clinical practice, coverage, MNT code use, and reimbursement so as to further support nutrition services codes revision and/or expansion.

Background Bronchiolitis obliterans (BO) is the leading cause of mortality beyond the first year after pediatric lung transplant, but the performance of an open lung biopsy is often required for diagnosis. Bronchiolitis obliterans syndrome (BOS) is a clinical diagnosis based on spirometric data that is the accepted standard for staging chronic allograft dysfunction. Methods We determined the sensitivity, specificity, and positive and negative predictive values of BOS for predicting BO in children. A chart review was conducted on 139 open lung biopsies and 43 lung explants performed at our center from 1990 through June 2010 in pediatric recipients of lung transplants. Results were excluded from analysis if insufficient data existed to calculate a stable BOS stage before biopsy/explant. Results The criteria for inclusion in the study were met by 67 open lung biopsies and 31 lung explants. The sensitivity, specificity, positive predictive value, and negative predictive value of BOS for predicting BO were 91.0%, 25.8%, 72.6%, and 57.1%. Conclusions We found that early declines in lung function are sensitive, but not specific, for BO. The low specificity of BOS for identifying BO illustrates the challenge facing clinicians in determining the etiology of pulmonary decline after lung transplant.

Abdominal aortic aneurysm (AAA) is a common disease with often life-threatening consequences. This vascular disorder is responsible for 1–2% of all deaths in men aged 65 years or older. Autoimmunity may be responsible for the pathogenesis of AAA. Although it is well documented that infiltrating T cells are essentially always present in AAA lesions, little is known about their role in the initiation and/or progression of the disease. To determine whether T cells infiltrating AAA lesions contain clonally expanded populations of T cells, we amplified β-chain TCR transcripts by the nonpalindromic adaptor–PCR/Vβ-specific PCR and/or Vβ-specific PCR, followed by cloning and sequencing. We report in this article that aortic abdominal aneurysmal lesions from 8 of 10 patients with AAA contained oligoclonal populations of T cells. Multiple identical copies of β-chain TCR transcripts were identified in these patients. These clonal expansions are statistically significant. These results demonstrate that αβ TCR+ T lymphocytes infiltrating aneurysmal lesions of patients with AAA have undergone proliferation and clonal expansion in vivo at the site of the aneurysmal lesion, in response to unidentified self- or nonself Ags. This evidence supports the hypothesis that AAA is a specific Ag–driven T cell disease.

Particle induced γ-ray emission (PIGE) using the 19 F ( p , α γ)16 O reaction and deuterium induced nuclear reaction analysis (NRA) were used to measure the uptake of fluorine in thin silicon oxide films which varied in thickness and had been nitrided under various conditions and annealing treatments. PIGE results show that 66 – 80 ppm of F was found in samples nitrided with F (as approximately 1% SiF 4) in flowing nitrogen and heated at 1300°C for 1 hour. With NRA, it was not possible to measure these low concentrations because the background signal from silicon overlaps with the F signal. The increase of F in the nitrided specimens from 66 to 80 ppm follows an increase in film thickness from 3 to 53 nm indicating that F is incorporated in the film rather than being located at the surface of the specimen.

A microfabrication process has been developed to prepare thin film solid-state lithium batteries as small as 50 μm × 50 μm. Individual cells operate nominally at 3.9 V with 10 μA h cm−2 for a 0.25 μm thick cathode film. The cells are easily fabricated in series and parallel arrangement to yield batteries with higher voltage and/or capacity. Multiple charge/ discharge cycles are possible, though an apparent reaction of the in situ plated Li film with water or oxygen decreases cycle life several orders of magnitude from expected results. Further optimization of an encapsulating film will likely extend the cell cyclability. These microbattery arrays will be useful for providing on-chip power for low current, high voltage applications for microspacecraft and other miniaturized systems.

Otolith increment data were used to age larval Sardinops sagax from shelf waters between 118°E and 137°E off southern Australia. Maximum and mean growth rates up to an age of 30 days, estimated from a Laird–Gompertz model, were 0.62 and 0.48 mm day–1, respectively. The growth rate of larval S. sagax from southern Australia was less than, or at most comparable to, those estimated from the substantially more productive upwelling systems of southwestern Africa, the central coasts of North and South America, and inshore of the Kuroshio system east of Japan. The lower productivity of the sardine habitat off southern Australia could be expected to manifest as fewer and/or less extensive patches of suitably dense plankton, or lower levels of sufficient food availability, which results in the lower growth rate of larvae. This probably causes higher mortality and, along with slower growth rates of post-recruit stages, may therefore contribute to the low stock size of sardines in southern Australia. Nonetheless, the similarities in growth rates of larvae within a single species over widely separated regions suggest such rates fall between predetermined bounds, limited by starvation at the lower end and an ontogenetic maximum at the other.

Diann B. Uustal, EdD, is the founder and president of an educational consulting firm, Educational Resources in HealthCare, Inc. She is a facilitator of workshops and seminars in clinical ethics, professional caregiving issues, and values education at hospitals, colleges of nursing and medicine, and specialty nursing, medical, and other professional organizations. She also teaches a graduate course in healthcare ethics and is a professor at the University of Rhode Island. She received a bachelor's degree in nursing from the University of Rhode Island and a master's degree in nursing from the University of Massachusetts. She earned her doctorate in education, majoring in ethics and values in healthcare, at the University of Massachusetts. In 1994, Dr. Uustal completed a year's postdoctoral fellowship in clinical bioethics as a Visiting Fellow at the Kennedy Institute of Ethics at Georgetown University. She has authored numerous articles on healthcare values and ethics, professional issues in nursing, and caring for the caregiver. In addition, Dr. Uustal has published four books, most recently, Caring for Yourself--Caring for Others: The Ultimate Balance and Clinical Ethics and Values: Issues and Insights in a Changing Health Care Environment. Dr. Uustal also has co-edited Teacher Burnout, a book published by the National Education Association. She was a major consultant to the award-winning Concept Media film series "Ethics, Values and Health Care" and wrote the script for the film "Values Clarification."

Background: The robust association of alcoholism with reduced P300 event-related potential amplitude has been largely established in severely affected alcoholics and their offspring. Few studies have examined the relationship of increased arousal, anxiety, and P300. In this study, we sought to determine whether P300 group differences could be discerned in well functioning individuals with less severe forms of alcohol use disorders and anxiety disorders. We were particularly interested in looking at the subgroup of alcohol use disorders accompanied by anxiety disorders. This subgroup has previously been found to have diminished α amplitude in the resting EEG. Methods: Male and female community volunteers (99 unrelated index participants and 78 relatives) and 21 unrelated volunteers from an anxiety disorder clinic were interviewed by using the Schedule for Affective Disorders and Schizophrenia, Lifetime version. Blind-rated lifetime psychiatric diagnoses were assigned according to DSM-III-R criteria. Auditory and visual P300 event-related potentials were elicited with an oddball paradigm and were recorded at the midparietal (Pz) site. Results: As expected, auditory P300 amplitudes were significantly reduced in participants with alcohol use disorders and significantly increased in participants with lifetime anxiety disorders. However, more detailed analysis revealed that, in an apparent paradox, auditory P300 amplitudes were lowest in individuals with comorbid alcohol use and anxiety disorders and highest in individuals with anxiety disorders alone. Visual P300 amplitudes followed the same trends but were generally not significant. Conclusions: Even in a sample of largely community-ascertained individuals, auditory P300 amplitude is reduced in alcoholics, particularly those with anxiety disorders, and is highest in nonalcoholics with anxiety disorders.