Born on U.S. Soil: Access to Healthcare for Neonates of Non-Citizens.

INTRODUCTION: The 14th amendment of the United States (US) Constitution guarantees citizenship to infants born in the US. With documentation of citizenship, typically through a birth certificate, neonates gain official identity and the opportunity to qualify for services like healthcare. Most guidance on caring for immigrant children assumes that access to health care is guaranteed for babies born in the US. In practice, some infants born to non-citizen mothers face barriers in obtaining services fundamental to neonatal health. METHODS: We conducted a review of the literature to identify articles on access to care for infants born to non-citizen mothers in the US. Because of the scarcity of relevant peer-reviewed published literature on this topic, the search was broadened to grey literature including news articles, online articles, and legal reviews. Using these aggregated sources, we created a framework for understanding maternal immigration status and barriers to healthcare for neonates born in the US. We discuss risk factors from the public health, historical and ethical perspectives. RESULTS: Barriers exist for some mother-infant dyads in obtaining services such as healthcare, health insurance and supplemental nutrition programs. At-risk dyads include neonates of undocumented immigrants and birth tourists as well as neonates born to women on visas. The impact of these barriers on health-seeking behaviors, access to care, and health outcomes for these neonates is largely unknown. DISCUSSION: The framework for understanding challenges of non-citizen mothers and their infants that we present in this article provides a resource for physicians and public health professionals serving this population. That much of the literature exists outside of healthcare highlights the need for more scholarly work on this problem. Future research will better inform advocacy and public health efforts to protect this vulnerable population of newborn citizens and their mothers.

Monitoring the response of canine hyperadrenocorticism to trilostane treatment by assessment of acute phase protein concentrations.

BACKGROUND: Acute phase proteins (APPS) include haptoglobin (Hp), C-reactive protein (CRP) and serum amyloid A (SAA). Increased Hp concentrations may be induced by endogenous or exogenous glucocorticoids in dogs. OBJECTIVES: To assess whether control of hyperadrenocorticism (HAC) affects the concentrations of Hp, CRP, SAA, alkaline phosphatase (ALKP) and cholesterol, to determine whether these analytes can be used to assess control of HAC following trilostane treatment, and whether a combination of these tests offers a valid method of assessing disease control. METHODS: Hp, CRP, SAA, ALKP and cholesterol were assessed in 11 dogs with spontaneous HAC before and after treatment with trilostane. Adequate control of HAC was defined as post-ACTH cortisol less than 150 nmol/l. RESULTS: Significant reductions in Hp, ALKP, cholesterol and SAA (P<0.05) but not of CRP were found after control of HAC. Only Hp, cholesterol and ALKP were moderately informative (Se & Sp>0.7) of disease control when compared to adrenocorticotropin or corticotropin (ACTH) stimulation test. SAA and CRP were unhelpful (Se & Sp<0.7). The analysis of the combination of the analytes did not improve the correlation with ACTH stimulation test. CLINICAL RELEVANCE: Relying on these analytes does not provide additional information over ACTH stimulation test results when assessing control of HAC treated with trilostane.

Primary care consultations and costs among HIV-positive individuals in UK primary care 1995-2005: a cohort study.

OBJECTIVES: To investigate the role of primary care in the management of HIV and estimate primary care-associated costs at a time of rising prevalence. METHODS: Retrospective cohort study between 1995 and 2005, using data from general practices contributing data to the UK General Practice Research Database. Patterns of consultation and morbidity and associated consultation costs were analysed among all practice-registered patients for whom HIV-positive status was recorded in the general practice record. RESULTS: 348 practices yielded 5504 person-years (py) of follow-up for known HIV-positive patients, who consult in general practice frequently (4.2 consultations/py by men, 5.2 consultations/py by women, in 2005) for a range of conditions. Consultation rates declined in the late 1990s from 5.0 and 7.3 consultations/py in 1995 in men and women, respectively, converging to rates similar to the wider population. Costs of consultation (general practitioner and nurse, combined) reflect these changes, at pound100.27 for male patients and pound117.08 for female patients in 2005. Approximately one in six medications prescribed in primary care for HIV-positive individuals has the potential for major interaction with antiretroviral medications. CONCLUSION: HIV-positive individuals known in general practice now consult on a similar scale to the wider population. Further research should be undertaken to explore how primary care can best contribute to improving the health outcomes of this group with chronic illness. Their substantial use of primary care suggests there may be potential to develop effective integrated care pathways.

A nutrition support team led by general surgeons decreases inappropriate use of total parenteral nutrition on a surgical service.

The purpose of this study was to decrease the number of inappropriate orders for total parenteral nutrition (TPN) in surgical patients. From February 1999 through November 2000 and between July 2001 and June 2002, the surgeon-guided adult nutrition support team (NST) at a university hospital monitored new TPN orders for appropriateness and specific indication. In April 1999, the NST was given authority to discontinue inappropriate TPN orders. Indications, based on the American Society for Parenteral and Enteral Nutrition (ASPEN) standards, included short gut, severe pancreatitis, severe malnutrition/catabolism with inability to enterally feed > or =5 days, inability to enterally feed >50 per cent of nutritional needs > or =9 days, enterocutaneous fistula, intra-abdominal leak, bowel obstruction, chylothorax, ischemic bowel, hemodynamic instability, massive gastrointestinal bleed, and lack of abdominal wall integrity. The number of inappropriate TPN orders declined from 62/194 (32.0%) in the first 11 months of the study to 22/168 (13.1%) in the second 11 months (P < 0.0001). This number further declined to 17/215 (7.9%) in the final 12 months of data collection, but compared to the second 11 months, this decrease was not statistically significant (P = 0.1347). The involvement of a surgical NST was associated with a reduction in inappropriate TPN orders without a change in overall use.

Bounding the risk of crew loss following orbital debris penetration of the International Space Station at assembly stages 1J and 1E.

Orbital debris impacts on the International Space Station occur frequently. To date, none of the impacting particles has been large enough to penetrate manned pressurized volumes. We used the Manned Spacecraft Crew Survivability code to evaluate the risk to crew of penetrations of pressurized modules at two assembly stages: after Flight 1J, when the pressurized elements of Kibo, the Japanese Experiment Module, are present, and after Flight 1E, when the European Columbus Module is present. Our code is a Monte-Carlo simulation of impacts on the Station that considers several potential event types that could lead to crew loss. Among the statistics tabulated by the program is the probability of death of one or more crew members in the event of a penetration, expressed as the risk factor, R. This risk factor is dependent on details of crew operations during both ordinary circumstances and decompression emergencies, as well as on details of internal module configurations. We conducted trade studies considering these procedure and configuration details to determine the bounds on R at the 1J and 1E stages in the assembly sequence. Here we compare the R-factor bounds, and procedures could that reduce R at these stages.

Foundation-level dyslexia: assessment and treatment.

It is supposed that there is an early, foundation stage in beginning reading during which children acquire basic letter-sound knowledge, a capability for alphabetic processing, and a logographic sight vocabulary. An assessment of foundation processes was administered to Scottish children with reading difficulties (n = 51) and to reading-level-matched controls (n = 56). The results suggested that the foundation is normally in place by the time a reading age of about 7 years has been achieved. Foundation-level dyslexia is identifiable in children with reading difficulty whose reading ages fall below this level. Differing patterns of dyslexia were observed, depending on whether the primary effect was on letter-sound learning (literal dyslexia), the acquisition of the alphabetic process (alphabetic dyslexia), or retention of a sight vocabulary (logographic dyslexia). Balanced dyslexia, in which both alphabetic and logographic functions were impaired, was also found. Some implications for assessment and treatment are discussed.

The development of Healthcare Resource Groups--Version 3.

The use of casemix classifications to assist in the analysis of patient-based information is becoming more widespread and routine in the management of the National Health Service (NHS). This paper details the process of modification of and the results of modifications to Healthcare Resource Groups (HRGs), an in-patient classification tailor-made for the English healthcare system. Clinical expertise and extensive statistical analysis of national data were combined to identify areas of HRGs Version 2 where improvement could be made. The ensuing changes were then reviewed by professional associations and the wider NHS before being incorporated into grouping software. Extensive changes were made to the classification, with significant gains in statistical performance. Analysis shows that the revised groupings perform better on English data than other available systems.

Evaluation of three aggression/agitation behaviour rating scales for use on an acute admission and assessment psychogeriatric ward.

BACKGROUND: In recent years many instruments measuring aggressive and agitated behaviours among the elderly in a variety of settings have emerged. Individual instruments have only occasionally been compared with each other. METHOD: Some psychometric properties of three aggression/agitation scales on an acute assessment and admission psychogeriatric ward were examined. The correlation between the Rating Scale for Aggressive Behaviour in the Elderly (RAGE), the Cohen-Mansfield Agitation Inventory (CMAI) and the Brief Agitation Rating Scale (BARS) and their internal consistencies and test-retest and interrater reliabilities were measured. RESULTS: The RAGE was strongly correlated with the CMAI (rho = +0.73) and the BARS (rho = +0.72). The CMAI was strongly correlated with the CMAI (rho = +0.84). The internal consistency, as measured by Cronbach's alpha, was greater than 0.8 on all three scales. The test-retest and interrater reliability correlations were 0.75 or greater for all three scales (except the BARS interrater reliability correlation of 0.6). CONCLUSIONS: All three scales have good psychometric properties for use in acute admission assessment psychogeriatric wards.

Secondary radiation environments in heavy space vehicles and instruments.

Secondary radiations produced by the interactions of primary cosmic rays and trapped protons with spacecraft materials and detectors provides an important, and sometimes dominant, radiation environment for sensitive scientific instruments and biological systems. In this paper the success of a number of calculations in predicting a variety of effects will be examined. The calculation techniques include Monte Carlo transport codes and semi-empirical fragmentation calculations. Observations are based on flights of the Cosmic Radiation Environment and Activation Monitor at a number of inclinations and altitudes on Space Shuttle. The Shuttle experiments included an active cosmic-ray detector as well as metal activation foils and passive detector crystals of sodium iodide which were counted for induced radioactivity soon after return to earth. Results show that cosmic-ray secondaries increase the fluxes of particles of linear energy transfer less than 200 MeV/(gm cm-2), while the activation of the crystals is enhanced by about a factor of three due to secondary neutrons. Detailed spectra of induced radioactivity resulting from spallation products have been obtained. More than a hundred significant radioactive nuclides are included in the calculation and overall close agreement with the observations is obtained.

Assessment of dose and time responses to TRH and thyrotropin in healthy dogs.

Changes in total thyroxine (T4 [TT4]), free T4 (FT4) and total tri-iodothyronine (T3 [TT3]) in serum after the intravenous administration of different doses of thyrotropin (TSH) and thyrotropin-releasing hormone (TRH) were measured in six healthy beagles. Significant (P < 0.05) elevations in serum TT4, FT4 and TT3 were observed at each sampling time (two, four, five, six, seven, eight and 10 hours) after administration of 1, 3 or 5 iu (total dose) TSH and peak mean responses were observed six to eight hours after injection. At six hours after injection the mean TT4, FT4 and TT3 levels were approximately 2.6, 3.9, and 1.5 times basal levels, respectively, and there were no significant differences between the three doses of TSH, Significant (P < 0.05) elevations in serum TT4 and FT4 but not TT3 were observed at each sampling time (two, four, five, six, seven and eight hours) after the administration of TRH. Peak mean responses were observed at four hours after injection at which time TT4 and FT4 levels were approximately 1.7 and 1.9 times basal levels, respectively. No significant differences were observed between the four doses of TRH used (100, 200, 300, and 600 micrograms total dose). Concentrations of TT4, FT4 and TT3 were significantly (P < 0.05) higher following the administration of TSH compared with TRH, and the response to TRH showed greater individual variation.

Public policy and AIDS.

In summary of some of the major issues raised by AIDS (Table 1), social, political, and economic forces all impact on the global outbreak of AIDS. Conversely the epidemiologic and medical realities of this disease have forced a reconsideration of moral and ethical values, prioritization of resource allocation, and pervasion of virtually every aspect of the health care delivery system. Advocates for AIDS funding have set a model for other espousing the significance of diseases ranging from rare disorders to breast cancer. As this issue was written (summer 1993), it was apparent that attention of the media had shifted to numerous other domestic and foreign concerns. Hopefully, when the Clinics next present perinatal AIDS, the pendulum will have swung back and there will be a wider variety of effective therapeutic agents available permitting longer survival of greater quality.

Morphological assessment of neuronal aggregates in the striatum of the rat.

Regional variations in cell-packing density, culminating in the formation of cell clusters, is now a recognized morphological characteristic of the striatum that has been correlated, in some instances, with either regional histochemical variations or the distribution pattern of afferent fiber systems, or both. Within these cluster regions a further level of organization exists, in the form of discrete neuronal aggregates. The light microscopic morphology of these neurons and the nature of their intercellular contacts at the electron microscope level form the focus of this report. The neurons composing such aggregates are characterized by contiguous soma-somatic or soma-dendritic contact with extended regions of junctionlike symmetrical and consistent contacts where the distance between the cytoplasmic membranes of apposing neurons narrows to as close as 7 nm. Coated vesicles close to the contact areas are common. Three-dimensional computer reconstructions of serial 1 micron sections through aggregates in either the caudatoputamen or nucleus accumbens reveal "chains" of contiguous cells that frequently involve as many as 60 neurons. These contiguous cell aggregates are discrete entities within the larger clusters or islands. It is postulated that the cellular aggregates may represent the fundamental level of striatal organization and may be local modules for intrinsic information processing, modifying extrinsic data processed through the biochemical compartmentalization of the striatum imparted by striosomes, neuropeptides, and dopaminergic, thalamic and cortical afferents.

Dietary recall method comparison for hospitalized elderly subjects.

A study was made to compare accuracy of the 24-hour recall, including both number of items recalled and amounts of food eaten, for elderly subjects using three methods: I, unaided oral recall, II, printed questionnaire, and III, interview with actual-size color pictures of foods. Sixty hospitalized patients, age 65 to 94, were interviewed. Factors studied for influence on scores were age, sex, educational level, obesity, place of residence, and food preparer. Results showed no significant difference in scores owing to method used, except that 30 subjects above the median age of 76 scored higher on number of items recalled and amounts of food eaten when using the printed questionnaire. None of the demographic factors studied made a significant difference in scores.

A mouse model of Pasteurella haemolytica infection and its use in assessment of the efficacy of P haemolytica vaccines.

A method for infecting mice with Pasteurella haemolytica is described. Mice were inoculated intraperitoneally with P haemolytica incorporated in gastric mucin, killed at various time intervals thereafter and viable counts of bacteria were performed on liver suspensions. P haemolytica grew at an exponential rate in the livers of normal mice. Mice vaccinated against P haemolytica A1 were protected against homologous challenge and viable counts decreased rapidly in their livers. Mice given trivalent P haemolytica vaccine (types A1, A2 and A6) were protected against challenge with P haemolytica types A1 and A6, but were not protected against challenge with types A2 and A9. These results correlate with findings in sheep.

Behavioral assessment of visual toxicity.

A wide variety of behavioral methods has been employed with animals to assess visual changes induced by drugs or toxicants. The methods range from simple to complex, from broad screening devices to narrowly focused techniques. Their relative advantages for the environmental toxicologist are discussed. Manipulation of stimulus values is an essential ingredient in the identification of specific sensory functions. The percentage of correct choices from a discrete-trial, multiple-choice discrimination procedure is to be preferred to measures of response rate, speed or reaction time when experiments require answers about specific visual functions.