Prenatal and Childhood Smoke Exposure Associations with Cognition, Language, and Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: To assess the relationships of prenatal and childhood smoke exposure with specific neurodevelopmental and behavioral problems during early childhood. STUDY DESIGN: A subsample (n = 386) of mother-child dyads from the Newborn Epigenetic Study (NEST) prebirth cohort participated in the study. Cotinine concentrations were used to objectively measure prenatal and childhood smoke exposure when youth were aged 3-13 years. Multivariable regression models were used to estimate associations of prenatal and childhood cotinine concentrations with performance on the National Institutes of Health (NIH) Toolbox and attention-deficit/hyperactivity disorder and behavioral symptoms, measured using the Behavior Assessment System for Children, 2nd edition (BASC-2). RESULTS: After adjusting for confounders, childhood cotinine concentrations were associated with poorer cognitive performance on tasks measuring cognitive flexibility (B = -1.29; P = .03), episodic memory (B = -0.97; P = .02), receptive language development (B = -0.58; P = .01), and inhibitory control and attention (B = -1.59; P = .006). Although childhood cotinine concentration was associated with higher levels of attention problems (B = 0.83; P = .004) on the BASC-2, after adjustment for confounders, the association is nonsignificant. Although associations for maternal cotinine concentrations were null, an interaction was detected between prenatal and childhood cotinine concentrations on the NIH Toolbox Picture Vocabulary Task (P = .02). CONCLUSIONS: Our findings suggest that childhood tobacco smoke exposure may lead to poorer attention regulation and language acquisition, complex visual processing ability, and attention problems.

Invasive lionfish (Pterois volitans): a potential human health threat for ciguatera fish poisoning in tropical waters.

Invasive Indo-Pacific lionfish (Pterois volitans) have rapidly expanded in the Western Atlantic over the past decade and have had a significant negative impact on reef fish biodiversity, habitat, and community structure, with lionfish out-competing native predators for resources. In an effort to reduce this population explosion, lionfish have been promoted for human consumption in the greater Caribbean region. This study examined whether the geographical expansion of the lionfish into a known ciguatera-endemic region can pose a human health threat for ciguatera fish poisoning (CFP). More than 180 lionfish were collected from waters surrounding the US Virgin Islands throughout 2010 and 2011. Ciguatoxin testing included an in vitro neuroblastoma cytotoxicity assay for composite toxicity assessment of sodium-channel toxins combined with confirmatory liquid chromatography tandem mass spectrometry. A 12% prevalence rate of ciguatoxic lionfish exceeding the FDA guidance level of 0.1 µg/kg C-CTX-1 equivalents was identified in fish from the U.S. Virgin Islands, highlighting a potential consumption risk in this region. This study presents the first evidence that the invasive lionfish, pose a direct human health risk for CFP and highlights the need for awareness and research on this food safety hazard in known endemic areas.

Effects of payment mechanisms on hospital behaviours in Brazil: evidence from a multi-payer and multi-payment system.

A variety of provider payment mechanisms (PPMs) are used in Brazil to direct funds to hospitals. This article examines their effect on hospital efficiency, cost and quality. Public hospitals funded through the traditional line-item public budget are the best least efficient. Those funded through global budgets and other decentralized budget modalities perform on a par with private providers funded mainly by private prepaid health plans. Private hospitals that are dependent on government payments exhibit lower levels of quality. However, the overall effects of PPMs on performance are less than expected for some groups of hospitals. Factors compromising the impact of PPMs on performance are examined.

Desempenho hospitalar no Brasil: em busca da excelência / Hospital Performance in Brazil: The Search for Excellence

O livro retrata a situação da rede hospitalar no país, seja ela pública ou privada, e traz algumas recomendações para melhorar essa gestão. Entre as conclusões apontadas no livro está o fato da baixa governança dos hospitais públicos, com pouca autonomia e responsabilização dos gestores, com mecanismos de financiamento sem relação com os custos e não focados no desempenho.

The elbow and its disorders

Since the first edition of this book, in 1985 I am extremely proud to hear such comments regarding the original and previous efforts such as "the definitive word in elbow surgery". Such statements and confidence is a source of tremendous pride and also motivation to continue to improve. In the spirit of the original goal of providing a source of reliable information that will improve patient care, we continue to be focused on this initial desire to provide clear, concise, current, accurate, relevant and intelligible information that is easily accessible. I have a simple personal requirement for the timing of subsequent editions of this book. This is to wait until I feel as though there has been sufficient additional information to justify another volume. This requirement has been met with this particular effort. Thus, I am very pleased along with my co-authors to have completed the current volume. The overall organization, hope and effort to be a comprehensive reference has been maintained with an increased emphasis on surgical technique which is an ever growing and relevant need of the orthopedic community. We are therefore, specifically pleased to offer video clips in a number of chapters that do complement and enhance the practical and useful learning experience. The exciting advances in elbow arthroscopy are more extensively explored in the currente volume. Innovative opportunities with regard to prosthetic joint replacement are also discussed in the current volume, along with nonprosthetic options such as anconeus arthroplasty. In fact we are pleased to observe considerable enhancement in the majority of chapters. As always I am deeplys appreciative and humbled by those who have contributed material, thoughts, and insights over the years, particularly Doctors O'Driscoll, Steinmann, Sanchez-Sotelo and my other partners at the Mayo Clinic

The protein tyrosine kinase p60c-Src is not implicated in the pathogenesis of the human autosomal recessive form of osteopetrosis: a study of 13 children.

Osteopetrosis has been described in mice generated by homozygous gene disruption of c-src gene encoding for the p60c-Src protein tyrosine kinase (Src-/- mice). The similarities of bone histologic findings in this murine model to those observed in some patients first seen with autosomal recessive osteopetrosis, "malignant" osteopetrosis, led us to investigate the potential role of p60c-Src in the pathogenesis of malignant osteopetrosis in 13 children. In 4 patients a c-src mutation was ruled out by an intragenic microsatellite segregation study. In the other 9 we analyzed p60c-Src expression and function, as well as c-src sequence. The expression was normal in all of the patients tested. In addition, the tyrosine phosphorylation and kinase activity of p60c-Src were also normal in all of the patients. Moreover, in these patients, sequences of the coding region of c-src were identical to the published sequence of the human c-src complementary DNA. These results exclude a role for c-src in the pathogenesis of human malignant osteopetrosis in the 13 patients analyzed.

Gestäo de recursos financeiros / Financial resources management

Discute estratégias de racionalizaçäo e fortalecimento financeiro do setor saúde e de instrumentos de gestäo financeira

Bacteriological Survey of Frozen Mexican-style Foods Produced at Establishments Under Federal Inspection.

During visits to 20 federally inspected establishments producing frozen Mexican-style foods (burritos, taco rolls, and tacos), 477 production line samples and 643 finished product units were collected for bacteriological analyses. The 46 sets of finished product (10 units/set) produced under good manufacturing practices had an aerobic plate count of fewer than 50,000/g (geometric means), all had two or fewer Staphylococcus aureus -positive units, and all were negative for Escherichia coli and salmonellae. In addition, 37 (78%) of these 46 sets had three or fewer coliform-positive units.