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Objective: To assess the impact of state laws requiring or encouraging employers to establish "section 125" cafeteria plans that shelter employees' premium contributions from tax.Data Sources: Available descriptive statistics, 65 key-informant interviews, and relevant documents in study states and nationally, 2008-2009.Study Design: Case studies were conducted in Indiana, Massachusetts, and Missouri--three states adopting laws in 2007. Descriptive quantitative information came from insurers, regulators, and surveys of employers. In each state, 15-17 semistructured but open-ended interviews were conducted with insurance agents, insurers, government officials, and third-party administration firms, and 29 informed sources were interviewed from a national perspective or other states. Key informants were selected based on their known or reported experience, in a "snowball" fashion until saturation was reached. Interview notes were coded for systematic analysis. Finally, relevant rulings, brochures, instructions, marketing materials, and other documents were collected and analyzed.Findings: Despite the potential for substantial cost savings, use of section 125 plans to purchase individual insurance remained low in these states after 1 or 2 years. Absent a mandate, few employers were strongly motivated to offer these plans in order to retain an adequate workforce, and uncertainty about federal legality deterred doing so. For smaller employers, benefits to owners did not outweigh administrative complexities. Nevertheless, few downsides were found to states mandating or encouraging these plans. In particular, there is little evidence that many employers dropped group coverage as a result.Conclusions: Section 125 plans remain a limited tool for states to reduce the inequitable tax treatment of individually purchased insurance, but a complete remedy requires reform of federal tax law. [ABSTRACT FROM AUTHOR]

Rationale: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) eradicate gram-negative bacteria (GNB) from the intestinal and respiratory tract in intensive care unit (ICU) patients, but their effect on antibiotic resistance remains controversial. Objectives: We quantified the effects of SDD and SOD on bacterial ecology in 13 ICUs that participated in a study, in which SDD, SOD, or standard care was used during consecutive periods of 6 months (de Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS, van der Hoeven JG, Pickkers P, Bogaers-Hofman D, van der Meer NJ, et al. N Engl J Med 2009;360:20-31). Methods: Point prevalence surveys of rectal and respiratory samples were performed once monthly in all ICU patients (receiving or not receiving SOD/SDD). Effects of SDD on rectal, and of SDD/SOD on respiratory tract, carriage of GNB were determined by comparing results from consecutive point prevalence surveys during intervention (6 mo for SDD and 12 mo for SDD/SOD) with consecutive point prevalence data in the pre- and postintervention periods. Measurements and Main Results: During SDD, average proportions of patients with intestinal colonization with GNB resistant to either ceftazidime, tobramycin, or ciprofloxacin were 5, 7, and 7%, and increased to 15, 13, and 13% postintervention (P < 0.05). During SDD/SOD resistance levels in the respiratory tract were not more than 6% for all three antibiotics but increased gradually (for ceftazidime; P < 0.05 for trend) during intervention and to levels of 10% or more for all three antibiotics postintervention (P < 0.05). Conclusions: SOD and SDD have marked effects on the bacterial ecology in an ICU, with rising ceftazidime resistance prevalence rates in the respiratory tract during intervention and a considerable rebound effect of ceftazidime resistance in the intestinal tract after discontinuation of SDD. [ABSTRACT FROM AUTHOR]

Women in a small coastal village in western India were asked to explain their preference for female sterilization over modern reversible contraceptive methods. Married women aged 19+ years were interviewed in six focus groups (n=60) and individually (n=15) regarding contraceptive methods and their use and side-effects. Women publicly denied contraceptive use but privately acknowledged limited use. They obtained contraceptive information from other village women and believed that modem reversible methods and vasectomy have high physical and social risks, and fertility goals could be achieved without their use. Women felt that reversible contraception is undesirable, socially unacceptable, and usually unnecessary, although the achievement of fertility goals is likely due to the use of female sterilization with abortion as a back-up method. Economic migration of village men may also play a role. Although women with high social capital can effectively disseminate correct knowledge, the impact on the uptake of reversible method is uncertain. [ABSTRACT FROM AUTHOR]

Background: Concern is widespread that the public's and participants' trust in medical research is threatened, but few empirical measures of research trust exist. This project aims to enable more rigorous study of researcher trust by developing and testing appropriate survey measures. Methods: Survey items were developed based on a conceptual model of the primary domains of researcher trust (safety, fidelity, honesty, global trust). Pilot testing was conducted on a regional convenience sample of adults (n = 124). Exploratory factor analyses of the data were performed, and an item selection procedure reduced the number of survey questions. A final set of 12 items was validated, and a 4-item short version of the researcher trust scale was selected and tested in a national web-based survey of asthma and diabetes patients (n = 3623). Further factor analysis and validation were performed on this larger sample. Results: Both the full and short scales have a single-factor structure with acceptable internal reliability (alphas of 0.87 [12 items] and 0.72 [4 items]). Trust in physician researchers and trust in medical researchers generally were found not to be separate constructs. In the national sample, the short scale was positively associated with better health status, prior participation in medical research, and willingness to participate in a hypothetical medical research study, and negatively associated with African-American race and higher education. Conclusions: Trust in medical researchers is a measurable single-factor construct including trust in safety, researcher fidelity, and honesty. This new scale provides an empirical tool for informing the ethics and public policy of medical research. [ABSTRACT FROM AUTHOR]

Strategies for disclosing investigators' financial interests to potential research participants have been adopted by many research institutions. However, little is known about how decisions are made regarding disclosures of financial interests to potential research participants, including what is disclosed and the rationale for making these determinations. We sought to understand the attitudes, beliefs, and practices of institutional review board chairs, conflict of interest committee chairs, and investigators regarding disclosure of financial interests to potential research participants. Several themes emerged, including general attitudes toward conflicts of interest, circumstances in which financial interests should be disclosed, rationales and benefits of disclosure, what should be disclosed, negative effects of and barriers to disclosure, and timing and presentation of disclosure. Respondents cited several rationales for disclosure, including enabling informed decision making, promoting trust in researchers and research institutions, and reducing legal liability. There was general agreement that disclosure should happen early in the consent process. Respondents disagreed about whether to disclose the amounts of particular financial interests. Clarifying the goals of disclosure and understanding how potential research participants use the information will be critical in efforts to ensure the integrity of clinical research and to protect the rights and interests of participants. [ABSTRACT FROM AUTHOR]

Several normal and pathological antigen-driven immune responses are associated with limited TCR usage. CDR3 sequence and to some extent length represent clonal markers which can be used to follow the course of an immune response. We investigated whether differences exist in the CDR3 length distribution in the CD4 versus CD8 populations which might reflect the HLA class restriction of the T cell subpopulation. We showed that the range is similar in both the CD4 and CD8 populations for most BV families. Differences exist between CDR3 length distributions of adult versus cord blood CD4 and CD8 T cells. The percentage expressing CDR3 of 10 amino acids or more across all BV families was significantly lower in the cord blood T cells compared to the adults for both CD4 and CD8 populations. This is likely to reflect either differences in the development of the T cell population such as increased N region length post-partum or may be the result of foreign antigen exposure. To address this issue, samples of TCRBV sequences from cord and adult T cell populations were compared. No significant differences were found in either exonucleolytic removal or N region addition between the adult and cord blood samples suggesting that the population shift is the result of antigen exposure. No spectratype distortions existed for any BV family in the adult or cord blood CD4 populations; however, distortions were seen in CD8 populations from all the adults and much less frequently in the cord blood T cells. We investigated the ability to detect clonality at frequencies that one would expect to find antigen-specific T cells in the peripheral repertoire. It was possible to identify a clone at a frequency of 0.1% in a polyclonal CD4 population. This frequency corresponds to that of some individual clones after antigen driven T cell expansion and establishes parameters within which T cell immune responses may be tracked ex vivo. [ABSTRACT FROM PUBLISHER]

An open prospective study using i.v. methylprednisolone in children with juvenile chronic arthritis (JCA) who had had a systemic exacerbation of disease is described. Eighteen children aged from 3 to 15 yr and 9 months (mean 9.7 yr) were treated. Ten patients (55%) had a loss of all systemic features 1 month after the pulse, and eight (45%) had a reduction in the active joint count. At this time, five of the patients on oral prednisolone had achieved a reduction in dosage. Also at 1 month, a reduction in erythrocyte sedimentation rate was observed in 11 patients (61%) and of C-reactive protein in 11 of 16 (72%). Altogether, 13 patients (72%) had a good response, while a further three (16%) went into remission. Our conclusions are that pulse methylprednisolone provides good short-term benefit in patients with systemic-onset JCA; no serious side-effects were noted. Further long-term studies are warranted. [ABSTRACT FROM PUBLISHER]

This paper presents the corresponding compressive strength of RPC with variable pressure combined with heating rate, heating duration, and starting time of heating. The treatments applied were 8 MPa static pressure on fresh RPC prims and heat curing at 240 °C in an oven. The compressive strength test was conducted at 7-d and 28-d. The images of RPC morphology were captured on the surface of a fractured specimen using Scanning Electron Microscopy in Secondary Electron detector mode to describe pore filing mechanism after treatments. The results show that a heating rate at 50 °C/hr resulted in the highest compressive strength about 40 % more than those at 10 or 100 °C/hr. A heating duration of 48 hours led to the maximum compressive strength. Heat curing applied 2 days after casting resulted in the maximum compressive. Heat curing had a signicant effect on the compresssive strength due to the acceleration of both reactions (hydration and pozzolanic) and the degree of transformation from tobermorite to xonotlite. It is concluded that the optimum condition of treatments is both pressure and heat curing at 2-day after casting with a rate of 50 °C/hr for 48 hours.

When a neutron star accretes hydrogen and helium from the outer layers of its companion star, thermonuclear burning enables the αp-process as a break out mechanism from the hot CNO cycle. Model calculations predict (α, p) reaction rates significantly affect both the light curves and elemental abundances in the burst ashes. The Jet Experiments in Nuclear Structure and Astrophysics (JENSA) gas jet target enables the direct measurement of previously inaccessible (α,p) reactions with radioactive beams provided by the rare isotope re-accelerator ReA3 at the National Superconducting Cyclotron Laboratory (NSCL), USA. JENSA is going to be the main target for the Recoil Separator for Capture Reactions (SECAR) at the Facility for Rare Isotope Beams (FRIB). Commissioning of JENSA and first experiments at Oak Ridge National Laboratory (ORNL) showed a highly localized, pure gas target with a density of ∼1019 atoms per square centimeter. Preliminary results are presented from the first direct cross section measurement of the 34Ar(α, p)37 K reaction at NSCL.

Abstract Background Chronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda. Methods A cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data. Results Overall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37). Conclusions Patients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.