Spectroscopic and theoretical studies of UN and UN.

The low-energy electronic states of UN and UN+ have been examined using high-level electronic structure calculations and two-color photoionization techniques. The experimental measurements provided an accurate ionization energy for UN (IE = 50 802 ± 5 cm-1). Spectra for UN+ yielded ro-vibrational constants and established that the ground state has the electronic angular momentum projection Ω = 4. Ab initio calculations were carried out using the spin-orbit state interacting approach with the complete active space second-order perturbation theory method. A series of correlation consistent basis sets were used in conjunction with small-core relativistic pseudopotentials on U to extrapolate to the complete basis set limits. The results for UN correctly obtained an Ω = 3.5 ground state and demonstrated a high density of configurationally related excited states with closely similar ro-vibrational constants. Similar results were obtained for UN+, with reduced complexity owing to the smaller number of outer-shell electrons. The calculated IE for UN was in excellent agreement with the measured value. Improved values for the dissociation energies of UN and UN+, as well as their heats of formation, were obtained using the Feller-Peterson-Dixon composite thermochemistry method, including corrections up through coupled cluster singles, doubles, triples and quadruples. An analysis of the ab initio results from the perspective of the ligand field theory shows that the patterns of electronic states for both UN and UN+ can be understood in terms of the underlying energy level structure of the atomic metal ion.

An auditory oddball (P300) spelling system for brain-computer interfaces.

This study was designed to develop and test an auditory event-related potential (ERP) based spelling system for a brain-computer interface (BCI) and to compare user's performance between the auditory and visual modality. The spelling system, where letters in a matrix were coded with acoustically presented numbers, was tested on a group of healthy volunteers. The results were compared with a visual spelling system. Nine of the 13 participants presented with the auditory ERP spelling system scored above a predefined criterion level control for communication. Compared to the visual spelling system, users' performance was lower and the peak latencies of the auditorily evoked ERPs were delayed. It was concluded that auditorily evoked ERPs from the majority of the users could be reliably classified. High accuracies were achieved in these users, rendering item selection with a BCI based on auditory stimulation feasible for communication.

Client evaluation of a consultation team on crimes against children.

OBJECTIVE: Cases of child abuse filed in court as crimes against children represent a small percentage of the total numbers of children maltreated. However, studying crimes of maltreatment against children is important for individual victims and their families, and for theory and policy in order to assure that these cases are managed as well as possible. Forensic consultation teams can perform several functions related to child abuse crimes: provide multidisciplinary expertise in the evaluation of maltreatment cases, offer a method for allocating resources between cases managed by the criminal justice and child protection systems, and provide important research and teaching opportunities. This study reviews the role played by multidisciplinary team consultations based on the perception of client professionals whose agencies pay for an outside consulting forensic team. METHOD: Professionals referring to a forensic team for consultative assistance were asked to evaluate the service during telephone interviews, responding to both structured and unstructured questions. RESULTS: Responding professionals (N= 18) stated that the team increased their confidence that the approach being taken to a case was correct (94%), that missing expertise was provided (100%), that progress was made in cases that might otherwise not have been made (55%), and that ambiguity was reduced (in 83% of referred cases). Using the team sometimes caused delays. Some delays were unacceptable administrative delays while others were considered necessary to assure completeness of the evaluation. CONCLUSION: The use of the team did not result in resolution of all of the cases referred, but referral to the team consistently provided closure for referring professionals. In one-third of the cases studied, if it had not been for the START consultation the cases would not have proceeded to an appropriate criminal or civil resolution.

Elevation of serum interleukin-6 but not serum-soluble interleukin-2 receptor in children with Crohn's disease.

Previous studies have demonstrated elevated serum levels of interleukin-6 (IL-6) and the soluble interleukin-2 receptor (IL-2R, CD25) in individuals with inflammatory bowel disease (IBD). The aim of our study was to compare serum IL-6 and IL-2R levels to see if one marker better distinguished IBD from other intestinal disorders or better reflected disease activity. Blood samples were obtained from 41 pediatric patients with Crohn's disease, 22 with ulcerative colitis, 19 with other gastrointestinal inflammatory disorders, and 13 with functional abdominal pain. Disease activity and disease location were determined for patients with Crohn's disease and ulcerative colitis. Serum levels of IL-6 and IL-2R were determined by using an enzyme-linked immunosorbent assay. Mean serum levels of IL-6 were significantly elevated (p < 0.05) in patients with Crohn's disease when compared with individuals with ulcerative colitis, other gastrointestinal inflammatory disorders, or functional abdominal pain. By comparison, there was no significant difference in mean serum levels of IL-2R in individuals with Crohn's disease compared with these other groups. Patients with moderate/severe Crohn's disease had elevated mean serum levels of IL-6 and IL-2R when compared with those with mild and inactive disease (p < 0.05); however, neither marker distinguished between inactive and mild disease. IL-6 correlated better with the erythrocyte sedimentation rate (ESR; r = 0.57, p < 0.001) than did IL-2R (r = 0.28, p < 0.01). Our results suggest that elevated IL-6 levels a.e more likely to be seen in patients with Crohn's disease. Although IL-6 may be a better marker for Crohn's disease and active disease than IL-2R, it does not appear to offer any advantage over the ESR.

Cloning of the mgtE Mg2+ transporter from Providencia stuartii and the distribution of mgtE in gram-negative and gram-positive bacteria.

The MM281 strain of Salmonella typhimurium possesses mutations in each of its three Mg2+ transport systems, requires 100 mM Mg2+ for growth, and was used to screen a genomic library from the gram-negative bacterium Providencia stuartii for clones that could restore the ability to grow without Mg2+ supplementation. The clones obtained also conferred sensitivity to Co2+, a phenotype similar to that seen with the S. typhimurium corA Mg2+ transport gene. The sequence of the cloned P. stuartii DNA revealed the presence of a single open reading frame, which was shown to express a protein with a gel molecular mass of 37 kDa in agreement with the deduced size of 34 kDa. Despite a phenotype similar to that of corA and the close phylogenetic relationship between P. stuartii and S. typhimurium, this new putative Mg2+ transporter lacks similarity to the CorA Mg2+ transporter and is instead homologous to MgtE, a newly discovered Mg2+ transport protein from the gram-positive bacterium Bacillus firmus OF4. The distribution of mgtE in bacteria was studied by Southern blot hybridization to PCR amplification products. In contrast to the ubiquity of the corA gene, which encodes the dominant constitutive Mg2+ influx system of bacteria, mgtE has a much more limited phylogenetic distribution.

Legal issues affecting dentistry's role in preventing child abuse and neglect.

Dentists can best help protect children from maltreatment through an understanding of the child protective services process. All dentists are covered under state statutes as mandated reporters of suspected child abuse and neglect. Reporting statutes vary considerably from state to state. All dentists must understand the intricacies of applicable state laws to help identify suspected child maltreatment while protecting themselves from liability.

What have we learned about treating child physical abuse? A literature review of the last decade.

A literature review of articles on treatment of physically abused children and treatment of physically abused parents was undertaken. Only articles that had more than five subjects in the sample, at least 15% of the children in the sample having been physically abused and either pretest, posttest; comparison group; or randomization between different treatments used in the design were selected. Twelve papers meeting these criteria for abusive parents and 13 for treatment of abused children were found. Treatment duration ranged from 4 weeks to 12 months for parents and 4 weeks to 24 months for children. A wide range of treatments were used, the most popular for children being therapeutic daycare, with emphasis on improving developmental skills. While most programs showed some improvement with treatment, many had no, or very short, follow-up to see if improvement was sustained. More emphasis needs to be placed on rigorous evaluation and longer-term follow-up of children in physical abuse treatment programs.

Clinical indicators derived from the patient assessment instrument in the long-stay residents of 69 VA nursing homes.

OBJECTIVES: Previous work has shown that clinical indicators reflecting occurrence of bedsores, behavioral disturbances, and deterioration of activities of daily living (ADLs) can be calculated for the long-stay residents of Veterans Affairs (VA) nursing homes from the standard biannual Patient Assessment Instrument (PAI). The present study aimed to construct national curves for these indicators, against which each facility could in the future compare its own values; and to determine the correlations between the indicator values and selected nursing home characteristics. METHODS: Eight indicators were calculated for the long-stay (more than six months) residents of the 69 VA nursing homes housing 50 or more such patients from the 1992 PAI data. The indicators were: prevalence of bedsores; incidence of bedsores; prevalence of physically aggressive behavior; incidence of aggressive behavior; and frequencies of six-month losses of eating, mobility, transfer, and toileting functions by the initially independent residents. RESULTS: There was a two- to sixfold difference between the most favorable quartile and the least favorable quartile for the eight indicators. Significant correlations across institutions were found between the prevalence and incidence of bedsores, the prevalence and incidence of aggressive behavior, and the frequencies of declines in the four ADLs by the initially independent residents. One or several of the indicators were significantly superior in nursing homes with these characteristics: a smaller size, a slower resident turnover rate, a smaller proportion of residents with nonorganic psychoses, a lower ratio of short-stay to long-stay residents, and a lower ratio of independent to dependent long-stay residents. CONCLUSIONS: These data provide national standards against which each VA nursing home can compare its PAI-derived clinical indicator values. The outcomes measured by these indicators appear to be influenced both by casemix and by environmental factors.

Comparison of postoperative mortality and morbidity in VA and nonfederal hospitals.

We compared postoperative mortality and morbidity rates in the Veterans Health Administration (VA) to those in nonfederal hospitals, using multivariate analysis to adjust for the patient characteristics of age, diagnosis, comorbidity, and severity of illness. We used a total of 544,000 patient discharge records (330,000 nonfederal and 214,000 VA) from 1987 through 1988 and compared 118 surgical procedures or procedure groups composed of 314 individual surgical procedures. We found no significant differences in postoperative mortality rates between the VA and nonfederal hospital systems for 110 of 118 surgical procedures or procedure groups. Endarterectomy, cervical esophagostomy, and esophageal anastomosis or esophagocolostomy showed significantly lower postoperative mortality in the VA hospitals compared to nonfederal hospitals (P = 0.05). VA postoperative mortality rates that were higher than those in nonfederal hospitals and could not be entirely explained by adjusting for patient characteristics were found for suture of ulcer, cholecystostomy, colon surgery, small intestine surgery, and reopening of recent thoracotomy site (P = 0.05). Respiratory, gastrointestinal, and urinary postoperative morbidity were generally lower in the VA hospitals than in nonfederal hospitals (P = 0.05). Infections were generally higher in the VA hospitals than in nonfederal hospitals. Pulmonary embolism, deep venous thrombosis, shock due to surgery or anesthesia, mediastinitis, hemorrhage, cardiac, and central nervous system morbidity showed no significant differences. These data demonstrate that VA postoperative mortality and morbidity in 118 surgical procedures or procedure groups is comparable to those in nonfederal hospitals.

Intussusception and leiomyosarcoma of the gastrointestinal tract in a pediatric patient. Case report and review of the literature.

Intestinal leiomyosarcoma is a rare tumor in infants and children; only 46 cases have been reported in the English literature. Presenting signs and symptoms include abdominal pain and gastrointestinal obstruction and bleeding. We describe a neonate with the unique presentation of ileocecal intussusception accompanying an ileal leiomyosarcoma. In contrast to adult patients, where intussusception is associated with smooth muscle tumors in 30% of cases, leiomyosarcoma and subsequent intussusception is rare in infancy and childhood. The overall prognosis for long-term survival is similar for both pediatric and adult patients with leiomyosarcoma of the intestinal tract, with a five-year survival in reported cases of 53% and 40%, respectively.

Comparison of postoperative mortality in VA and private hospitals.

OBJECTIVE: This study compared unselected VA (Department of Veterans Affairs) and private multi-hospital postoperative mortality rates. In the absence of national standards for postoperative mortality rates and in view of the unique volume and range of surgical procedures studied, the second objective is to help establish national standards through the dissemination of these postoperative mortality norms. SUMMARY BACKGROUND DATA: Public Law 99-166, Section 204, enacted by Congress December 3, 1985, required that the VA compare postoperative mortality and morbidity rates for each type of surgical procedure it performs with the prevailing national standard and analyze any deviation between such rates in terms of patient characteristics. METHODS: The authors compared postoperative mortality in the VA to that in private hospitals, adjusting for the patient characteristics of age, diagnosis, comorbidity, or severity of illness. We used a total of 830,000 patients discharge records (323,000 VA and 507,000 private patients) from 1984 through 1986 among 309 individual surgical procedures within 113 comparison surgical procedures or procedure groups. RESULTS: The authors found no significant differences in postoperative mortality rates between the VA and private hospital systems for 105 of the 113 surgical procedures or procedure groups. VA postoperative mortality rates that were higher than those in private hospitals were found for suture of ulcer, revision of gastric anastomosis, small-to-small intestinal anastomosis, appendectomy, and reclosure of postoperative disruption of abdominal wall (p = 0.05). Vascular bypass surgery, portal systemic venous shunt, and esophageal surgery showed a significantly lower postoperative mortality in the VA as compared with that in private hospitals (p = 0.05). CONCLUSIONS: VA postoperative mortality in 113 surgical procedures or procedure groups is comparable to that in private hospitals.

The pediatrician's documentation of child maltreatment.

Pediatricians are increasingly involved in the assessment of suspected child maltreatment. These assessments are a crucial component of the overall evaluation of the patient and provide the basis for interventions to protect the child. An accurate documentation of the pediatrician's assessment is important to convey the information to professionals in the public agencies involved, including the legal system. However, there may be uncertainty among pediatricians concerning what should be documented in the medical record in cases of child maltreatment. The objectives of this article are to provide a detailed but generic description of the information that should be gathered during the evaluation of children who show signs of any form of child abuse and neglect and to provide clear guidelines for the proper written documentation of child maltreatment.

Convenient numerical procedures for estimating cumulative pregnancy curves.

OBJECTIVE: To develop a simple estimation procedure that will always converge on a solution for a two-parameter model of cumulative pregnancy curves. DESIGN: Utilize raw data from a previous study in which estimation of the two-parameter model did not converge on a solution, and re-estimate the model with the new estimation method. PATIENTS, SETTING, TREATMENT: Infertile women with endometriosis treated as outpatients with laser laparoscopy. MAIN OUTCOME MEASURES: Pregnancy and ability of the new computer program to converge on a solution. RESULTS: The new estimation procedure converged on a solution. Over all stages of endometriosis, the cure rate from laser laparoscopy was 56%, and the monthly probability of pregnancy among those cured was 9.7%. CONCLUSIONS: The new estimation procedure, written for a personal computer, is easy to use and will virtually always converge on a solution for the two-parameter model of cumulative pregnancy after infertility treatment.

Anthropometric predictors of low birth weight outcome in teenage pregnancy.

The highest relative risks of low birth weight are found among births to teenage mothers. An analysis of anthropometrics (weight, mid-arm circumference, and triceps skinfold) among black teenagers attending an adolescent prenatal program was studied. The sample consisted of 100 girls under 17 years. Data were collected from 19 to 35 weeks gestation. Adolescent mothers who delivered low birth weight (LBW) infants demonstrated different patterns of anthropometric changes than teen mothers who delivered normal birth weight (NBW) infants. Mean mid-arm circumference increases in the LBW group (0.05 mm/wk) were significantly less than mean increases in the NBW group (0.80 mm/wk) (p less than 0.05). Arm fat area estimates of the LBW mothers demonstrated weekly depletion (-24.9 mm2/wk), which was significantly less than those of the NBW group, who accumulated fat (+15.3 mm2/wk) (p less than .05). Changes in maternal nutritional status may in part mediate the birthweight outcome in adolescent pregnancy. Anthropometrics may be useful in predicting those teens at highest risk of bearing LBW infants.

PIP: The highest relative risks of low birth weight are found among births to teenage mothers. An analysis of anthropometrics (weight, mid-arm circumference, and triceps skinfold) among black US teenagers attending an adolescent prenatal program was studied. The sample consisted of 100 girls under 17 years. Data were collected from 19 to 35 weeks gestation. Adolescent mothers who delivered low birth weight (LBW) infants demonstrated different patterns of anthropometric changes than teen mothers who delivered normal birth weight (NBW) infants. Mean mid-arm circumference increases in the LBW group (0.05 mm/wk) were significantly less than mean increases in the NBW group (0.80 mm/wk) (p 0.05). Arm fat area estimates of the LBW mothers demonstrated weekly deplection (-24.9 mm squared/wk), which was significantly less than those of the NBW group, who accumulated fat (+15.3 mm squared/wk)(p 0.05). Changes in maternal nutritional status may in part mediate the birthweight outcome in adolescent pregnancy. Anthropometrics may be useful in predicting those teens at highest risk of bearing LBW infants. In conclusion, the LBW phenomenon in young teenagers may be due to an inadequate maternal accumulation of fat stores and/or an excessive mobilization of fat during gestation. Marginal fat reserves and a habitually limited food intake and/or stage of life cycle, despite a weight gain that is apparently compatible with successful adult pregnancy outcome, may diminish a teen mother's ability to sustain the rapid fetal weight gain during the 3rd trimester beyond approximately 35 weeks gestation. Appropriate nutrition and psychosocial and medical intervention may alter the LBW outcome.

The child protective service worker: a profile of needs, attitudes, and utilization of professional resources.

County child protection units throughout the United States were surveyed to (1) profile the attributes of child protection workers, (2) determine their prevailing attitudes and needs, and (3) assess their access to and utilization of professional literature and consultation resources. Responses were received from 301 child protection workers employed in 33 different states. Respondents were generally depressed about their working conditions, the burden of huge caseloads, and unrealistic expectations of them. Job dissatisfaction was especially prevalent among workers who had been in the field for longer periods of time. Many workers had developed attitudes of resignation to their inability to help clients and had a tendency to avoid client contact. Workers reported doing very little professional reading due to the service requirements of their large caseloads and inaccessibility to journals and other meaningful literature pertinent to the field of child abuse and neglect. The availability of consultation in major specialty areas related to the performance of their child protective duties was frequently inadequate to meet their needs. Participation in formal training prior to first case involvement promoted professional reading and worker confidence in the quality of service provided. Worker job satisfaction and self-perceived professional skills were enhanced by membership in professional associations or societies and membership in or use of multidisciplinary teams. These results suggest the need to further develop national and regional resource centers in support of the practice of child protective service (CPS) workers.