Bihar’s malnutrition crisis and potential solutions

The prevalence of underweight children in Bihar is higher than in any country in the world, and the provision of public services to address malnutrition is poor. Based on an assessment of the government’s nutritional support to mothers and children, this column sheds light on the grim public service delivery, likely causes, and ideas to address the problem

Intraperitoneal photodynamic therapy causes a capillary-leak syndrome.

BackgroundIn patients undergoing intraperitoneal (IP) photodynamic therapy (PDT), the combination of aggressive surgical debulking and light therapy causes an apparent systemic capillary-leak syndrome that necessitates significant intensive care unit (ICU) management after surgery.MethodsFrom May 1997 to May 2001, 65 patients underwent surgical debulking and PDT as part of an ongoing phase II trial for disseminated IP cancer. Perioperative data were reviewed retrospectively, and statistical analyses were performed to determine whether any identifiable factors were associated with the need for mechanical ventilation for longer than 1 day and with the occurrence of postoperative complications.ResultsForty-three women and 22 men (mean age, 49 years) were treated. Operative time averaged 9.8 hours, and mean estimated blood loss was 1450 mL. The mean crystalloid requirement for the first 48 hours after surgery was 29.3 L, and 49 patients required blood products. Twenty-four patients were intubated for longer than 24 hours, with a mean of 8.3 days for those intubated longer than 1 day. The median ICU stay was 4 days. Overall, 110 complications developed in 45 (69%) of the 65 patients. Significant complications included 6 patients with acute respiratory distress syndrome, 28 patients with infectious complications, and 4 patients with anastomotic complications. Statistical analyses revealed that surgery-related factors were significantly associated with these complication outcomes.ConclusionsPatients who undergo surgical debulking and IP PDT develop a significant capillary-leak syndrome after surgery that necessitates massive volume resuscitation, careful ICU monitoring, and, frequently, prolonged ventilatory support

Particle Backtracking Improves Breeding Subpopulation Discrimination and Natal-Source Identification in Mixed Populations

We provide a novel method to improve the use of natural tagging approaches for subpopulation discrimination and source-origin identification in aquatic and terrestrial animals with a passive dispersive phase. Our method integrates observed site-referenced biological information on individuals in mixed populations with a particle-tracking model to retrace likely dispersal histories prior to capture (i.e., particle backtracking). To illustrate and test our approach, we focus on western Lake Erie\u27s yellow perch (Perca flavescens) population during 2006-2007, using microsatellite DNA and otolith microchemistry from larvae and juveniles as natural tags. Particle backtracking showed that not all larvae collected near a presumed hatching location may have originated there, owing to passive drift during the larval stage that was influenced by strong river-and wind-driven water circulation. Re-assigning larvae to their most probable hatching site (based on probabilistic dispersal trajectories from the particle backtracking model) improved the use of genetics and otolith microchemistry to discriminate among local breeding subpopulations. This enhancement, in turn, altered (and likely improved) the estimated contributions of each breeding subpopulation to the mixed population of juvenile recruits. Our findings indicate that particle backtracking can complement existing tools used to identify the origin of individuals in mixed populations, especially in flow-dominated systems

Novel neoadjuvant immunotherapy regimen safety and survival in head and neck squamous cell cancer

Background Cellular immune suppression is observed in head and neck squamous cell cancer (HNSCC) and contributes to poor prognosis. Restoration of immune homeostasis may require primary cell‐derived cytokines at physiologic doses. An immunotherapy regimen containing a biologic, with multiple‐active cytokine components, and administered with cytoxan, zinc, and indomethacin was developed to modulate cellular immunity. Methods Study methods were designed to determine the safety and efficacy of a 21‐day neoadjuvant immunotherapy regimen in a phase 2 trial that enrolled 27 therapy‐naïve patients with stage II to IVa HNSCC. Methods included safety, clinical and radiologic tumor response, disease‐free survival (DFS), overall survival (OS), and tumor lymphocytic infiltrate (LI) data collection. Results Acute toxicity was minimal. Patients completed neoadjuvant treatment without surgical delay. By independent radiographic review, 83% had stable disease during treatment. OS was 92%, 73%, and 69% at 12, 24, and 36 months, respectively. Histologic analysis suggested correlation between survival and tumor LI. Conclusion Immunotherapy regimen was tolerated. Survival results are encouraging. © 2011 Wiley Periodicals, Inc. Head Neck, 2011Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88112/1/21660_ftp.pd

Reformulating Outrage: A Critical Analysis of the Problematic Tort of IIED

The intentional infliction of emotional distress ( IIED ), also known as the tort of outrage, is a relatively new cause of action, first appearing in the legal academic literature during the 1930s. Since that time, IIED has gained widespread acceptance and is now recognized in all U.S. jurisdictions, with most courts invoking the definition set forth in the Restatement (Second) of Torts. Despite this general acceptance of the tort, courts routinely assert that IIED is a disfavored cause of action. Courts appear wary of holding defendants liable for plaintiffs\u27 emotional injuries and therefore seek to discourage such claims. In their efforts to cabin the application of IIED while preserving it as a valid cause of action, the Restatement authors and the courts have created a confused tort that means entirely different things to different judges and thus serves disparate functions in the courts of various states. In a minority of jurisdictions, courts express disfavor by limiting IIED claims to instances of outrageous and blatantly wrongful conduct for which the plaintiff has no other viable theory of redress. For example, if a defendant\u27s conduct can support a defamation claim, these courts will not allow the plaintiff to maintain an IIED claim for the same conduct. In effect, these courts define IIED such that it never overlaps with any other tort. Recent formulations of this position characterize IIED as a gap-filler, or a residual tort

Governor Shaw As a Politician

Biography of Leslie Mortier Sha