Health Insurance Status as a Predictor of Mode of Colon Cancer Detection but Not Stage at Diagnosis: Implications for Early Detection.

OBJECTIVE: For colon cancer patients, one goal of health insurance is to improve access to screening that leads to early detection, early-stage diagnosis, and polyp removal, all of which results in easier treatment and better outcomes. We examined associations among health insurance status, mode of detection (screen detection vs symptomatic presentation), and stage at diagnosis (early vs late) in a diverse sample of patients recently diagnosed with colon cancer from the Chicago metropolitan area. METHODS: Data came from the Colon Cancer Patterns of Care in Chicago study of racial and socioeconomic disparities in colon cancer screening, diagnosis, and care. We collected data from the medical records of non-Hispanic Black and non-Hispanic White patients aged ≥50 and diagnosed with colon cancer from October 2010 through January 2014 (N = 348). We used logistic regression with marginal standardization to model associations between health insurance status and study outcomes. RESULTS: After adjusting for age, race, sex, and socioeconomic status, being continuously insured 5 years before diagnosis and through diagnosis was associated with a 20 (95% CI, 8-33) percentage-point increase in prevalence of screen detection. Screen detection in turn was associated with a 15 (95% CI, 3-27) percentage-point increase in early-stage diagnosis; however, nearly half (47%; n = 54) of the 114 screen-detected patients were still diagnosed at late stage (stage 3 or 4). Health insurance status was not associated with earlier stage at diagnosis. CONCLUSIONS: For health insurance to effectively shift stage at diagnosis, stronger associations are needed between health insurance and screening-related detection; between screening-related detection and early stage at diagnosis; or both. Findings also highlight the need to better understand factors contributing to late-stage colon cancer diagnosis despite screen detection.

Risk of intra-articular injection with longitudinal ultrasound-guided injection of collateral ligaments of the equine distal interphalangeal joint.

Desmopathy of the collateral ligaments of the distal interphalangeal joint is a common cause of equine foot lameness and carries a poor prognosis with conservative management. Intralesional injections may improve healing, although accuracy of radiographically guided injections is significantly less than when guided by MRI, which requires special needles. Longitudinal ultrasound-guided injection of the distal collateral ligament has not been evaluated objectively. In this prospective, anatomic study, seven equine cadaver limbs (14 collateral ligaments) were injected with methylene blue dye and radiographic contrast medium using ultrasound to guide the needle longitudinally into the collateral ligaments until contacting bone. The insertion site of the needle proximal to the coronary band was measured on the limb and the needles left in place for radiography and CT to evaluate the needle angulation, location of the contrast medium, and whether the contrast entered the distal interphalangeal joint. The limbs were frozen and sectioned with a band saw to identify the location of the dye. Fifty percentage of injections were in or around the collateral ligaments. However, the percentage of "successful" injections, defined as in the collateral ligament but not in the joint, was only 36%. All legs had dye and contrast in the joint after both ligaments had been injected. There were no significant differences between the needle angle and entry site for "successful" and "unsuccessful" injections. Findings from this study indicates that the success rate is low for injecting the distal portions of the distal interphalangeal joint collateral ligaments using ultrasound guidance alone.

How are the domains of women's inclusion, justice, and security associated with maternal and infant mortality across countries? Insights from the Women, Peace, and Security Index.

Women's autonomy and empowerment in their homes, communities, and societies at large have been shown, through many direct and indirect pathways, to be associated with maternal and infant health. A novel global measure-the Women, Peace, and Security (WPS) Index-that bridges insights from gender and development indices with those from peace and security has recently been developed to capture the constructs of women's inclusion, justice, and security, using indicators and targets in the Sustainable Development Goals. This paper adds to the growing literature about the importance of gender inequality to key mortality outcomes for women and children by investigating the associations between nations' WPS Index scores and maternal mortality ratios and infant mortality rates. We use a range of international databases to obtain country-level data from 144 nations on health, demographic, income, and gender equality indicators. The aim is to highlight the role of women's inclusion, justice, and security in explaining national rates of maternal and infant mortality. Fully adjusted Poisson regression models indicate that a one point (0.01) increase on the WPS Index score is associated with a 2.0% reduction in the number of maternal deaths and a 2.3% reduction in the number of infant deaths. For a country such as Sierra Leone, with a maternal mortality ratio of 1360 maternal deaths per 100,000 live births, a one point improvement in the WPS Index would correspond to a maternal mortality ratio of 1,332, or 28 fewer deaths per 100,000 births. These associations are ecological and apply to the average level of mortality at the country level rather than the likelihood or risk faced at the individual level. Although we cannot claim causality for the observed relations in the cross-country regressions, the findings and recurring patterns are both suggestive and encouraging about the potential contributions of women's inclusion, justice, and security to maternal and infant mortality.

Energy digestibility of giant pandas on bamboo-only and on supplemented diets.

Endangered giant pandas (Ailuropoda melanoleuca) are bears (Family Ursidae), within the order Carnivora. They specialize on an herbivorous diet of bamboo yet retain a gastrointestinal tract typical of their carnivorous ancestry. The evolutionary constraints of their digestive tract result in a low extraction efficiency from bamboo (<40% in reported studies). The goal of this study was to determine the energy digestibility of bamboo by giant pandas used in digestibility trials and through subsequent analyses with bomb calorimetry. Seven digestibility trials were conducted (three with bamboo-only diets and four with supplemental diets). Energy digestibilities ranged from 7.5-38.9% for mixed diets and 9.2-34.0% for bamboo-only diets. The bamboo-only trials summarized here represent, to our knowledge, the first empirical data available for energy digestibility on a bamboo diet for giant pandas.

Protein nutrition of southern plains small mammals: immune response to variation in maternal and offspring dietary nitrogen.

Maternal nutrition during pregnancy and postnatal offspring nutrition may influence offspring traits. We investigated the effects of maternal and postweaning offspring dietary nitrogen on immune function and hematology in two species of rodent: the hispid cotton rat (Sigmodon hispidus), a primarily herbivorous rodent, and the fulvous harvest mouse (Reithrodontomys fulvescens), an omnivore. These two species responded differently to the same levels of treatment, with cotton rats primarily influenced by maternal diet and harvest mice by postweaning offspring diet. Cotton rats born to mothers on high-nitrogen diets had lower values of mean corpuscle volume and hemoglobin and greater concentrations of serum immunoglobulins. Spleen size, cell-mediated immune response, and the number of splenocytes and thymic platelets were lower in cotton rats born to mothers on low- and high-nitrogen diets. High-nitrogen offspring diet increased kidney and liver mass in cotton rats. Harvest mice had increased kidney mass on high-nitrogen maternal diets; however, changes in offspring diet after weaning reduced hematological parameters in individuals fed low-nitrogen diets. Body length was also affected, with harvest mice born to mothers fed low- and high-nitrogen diets having shorter lengths. Splenocyte cellular activity was greater in offspring born to mothers on high-nitrogen diets in both species.

Functional characterization and localization of the TcpH conjugation protein from Clostridium perfringens.

In Clostridium perfringens, conjugative plasmids encode important virulence factors, such as toxins and resistance determinants. All of these plasmids carry a conjugation locus that consists of 11 genes: intP and tcpA to tcpJ. Three proteins, TcpA, a potential coupling protein, TcpF, a putative ATPase that is similar to ORF15 from Tn916, and TcpH, which contains VirB6-like domains, are essential for conjugation in the prototype conjugative plasmid pCW3. To analyze the functional domains of TcpH, a putative structural component of the mating-pair formation complex and deletion and site-directed mutants were constructed and analyzed. The results showed that the N-terminal 581 residues and the conserved (242)VQQPW(246) motif were required for conjugative transfer. Bacterial two-hybrid and biochemical studies showed that TcpH interacted with itself and with TcpC. An analysis of the tcpH mutants demonstrated that the region required for these interactions also was localized to the N-terminal 581 residues and that the function of the C-terminal region of TcpH was independent of protein-protein interactions. Finally, immunofluorescence studies showed that TcpH and TcpF were located at both cell poles of donor C. perfringens cells. The results provide evidence that TcpH is located in the cell membrane, where it oligomerizes and interacts with TcpC to form part of the mating-pair formation complex, which is located at the cell poles and is closely associated with TcpF.

TcpA, an FtsK/SpoIIIE homolog, is essential for transfer of the conjugative plasmid pCW3 in Clostridium perfringens.

The conjugative tetracycline resistance plasmid pCW3 is the paradigm conjugative plasmid in the anaerobic gram-positive pathogen Clostridium perfringens. Two closely related FtsK/SpoIIIE homologs, TcpA and TcpB, are encoded on pCW3, which is significant since FtsK domains are found in coupling proteins of gram-negative conjugation systems. To develop an understanding of the mechanism of conjugative transfer in C. perfringens, we determined the role of these proteins in the conjugation process. Mutation and complementation analysis was used to show that the tcpA gene was essential for the conjugative transfer of pCW3 and that the tcpB gene was not required for transfer. Furthermore, complementation of a pCW3DeltatcpA mutant with divergent tcpA homologs provided experimental evidence that all of the known conjugative plasmids from C. perfringens use a similar transfer mechanism. Functional genetic analysis of the TcpA protein established the essential role in conjugative transfer of its Walker A and Walker B ATP-binding motifs and its FtsK-like RAAG motif. It is postulated that TcpA is the essential DNA translocase or coupling protein encoded by pCW3 and as such represents a key component of the unique conjugation process in C. perfringens.

A national survey of tobacco cessation programs for youths.

OBJECTIVES: We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. METHODS: We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. RESULTS: We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was 2000 dollars. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. CONCLUSIONS: There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths' smoking prevalence.

The role of the national practitioner data bank in the credentialing process.

Federal law requires hospitals and permits other entities to seek information from the National Practitioner Data Bank (NPDB) but places no requirements on how that information should be used. Our survey of NPDB users demonstrates that although the NPDB has generated substantial controversy and its information is nominally available from other sources, it still plays an important role in the credentialing process. Most institutions make timely NPDB inquiries that facilitate widespread use of the information in credentialing activities (4-5 individuals or committees). However, in 3% to 7% of cases, a decision was reached before the institution had the NPDB report. Between 5% and 30% of privileging and licensure applications involving an NPDB report were not granted "as requested," suggesting the NPDB data are important to the process. Unfortunately, underreporting was also evident: 60% to 75% of reportable actions were not reported, limiting the information to which health care entities have access.

Nitrogen outputs from fecal and urine deposition of small mammals: implications for nitrogen cycling.

The contribution of small mammals to nitrogen cycling could have repercussions for the producer community in the maintaining or perhaps magnifying of nitrogen availability. Our objective was to model nitrogen outputs (deposition of feces and urine) of small mammals in an old-field ecosystem and estimate the amount of fecal and urinary nitrogen deposited annually. To address this objective, we used models from laboratory studies and combined these with data from field studies to estimate dietary nitrogen and monthly and annual nitrogen outputs from fecal and urine deposition of five rodent species. The models accounted for monthly fluctuations in density and biomass of small-mammal populations. We estimated that the minimal amount of nitrogen deposited by rodents was 1.0 (0.9-1.1) and 2.7 (2.6-2.9) kg Nha(-1) year(-1) from feces and urine, respectively, for a total contribution of 3.7 (3.5-4.0) kg Nha(-1) year(-1). Hispid cotton rats (Sigmodon hispidus) accounted for >75% of the total nitrogen output by small mammals. Our estimates of annual fecal and urinary nitrogen deposited by rodents were comparable to nitrogen deposits by larger herbivores and other nitrogen fluxes in grassland ecosystems and should be considered when assessing the potential effects of herbivory on terrestrial nitrogen cycles.

How useful is the information provided by the National Practitioner Data Bank?

BACKGROUND: The National Practitioner Data Bank (NPDB) serves as a federal information clearinghouse on malpractice payments for and disciplinary sanctions against health care practitioners. Hospitals are required to query the NPDB biannually for practitioners with clinical privileges, and other health care entities with significant peer review are encouraged to query the NPDB. A study was conducted to determine whether health care organizations find the NPDB useful. METHODS: A survey was conducted of 1,038 organizations that queried the NPDB between March 1998 and February 1999; 653 of those respondents also answered questions regarding 1,639 specific matched responses (feedback from the NPDB when the practitioner in question had one or more reports). RESULTS: Overall, the entities rated querying the NPDB as very useful (6.16 on a 7-point scale). More than 21% of matched responses contained new information, and this information altered institutional credentialing decisions in more than 5% of the cases. DISCUSSION: Many of the results from this study are consistent with findings in Office of Inspector General reports. The fact that 5% of credentialing decisions were altered because of NPDB information suggests that practitioner self-report is an inadequate mechanism for soliciting credentialing information. SUMMARY AND CONCLUSIONS: NPDB reports provide accurate and complete information that is useful to providers in their credentialing process.