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Monoclonal antibodies are used to detect serum antigens associated with specific malignancies. These tumor markers are most useful for monitoring response to therapy and detecting early relapse. With the exception of prostate-specific antigen (PSA), tumor markers do not have sufficient sensitivity or specificity for use in screening. Cancer antigen (CA) 27.29 most frequently is used to follow response to therapy in patients with metastatic breast cancer. Carcinoembryonic antigen is used to detect relapse of colorectal cancer, and CA 19-9 may be helpful in establishing the nature of pancreatic masses. CA 125 is useful for evaluating pelvic masses in postmenopausal women, monitoring response to therapy in women with ovarian cancer, and detecting recurrence of this malignancy. Alpha-fetoprotein (AFP), a marker for hepatocellular carcinoma, sometimes is used to screen highly selected populations and to assess hepatic masses in patients at particular risk for developing hepatic malignancy. Testing for the beta subunit of human chorionic gonadotropin (beta-hCG) is an integral part of the diagnosis and management of gestational trophoblastic disease. Combined AFP and beta-hCG testing is an essential adjunct in the evaluation and treatment of nonseminomatous germ cell tumors, and in monitoring the response to therapy. AFP and beta-hCG also may be useful in evaluating potential origins of poorly differentiated metastatic cancer. PSA is used to screen for prostate cancer, detect recurrence of the malignancy, and evaluate specific syndromes of adenocarcinoma of unknown primary.

This study examined the extent to which violent behavior and peer victimization were associated with suicidal ideation, plans, and attempts in a nationally representative sample of 11,113 adolescents who completed the 2005 Youth Risk Behavior Survey. Boys were more likely to be involved in physical fighting and weapon carrying, whereas girls were more likely to report suicidal behavior and feeling unsafe at school. Predictors of suicidal behavior for both male and female adolescents included carrying a weapon, being threatened or injured at school, having property stolen or damaged at school, and getting in a fight. Carrying a weapon and getting in fights in the community, but not in the school, were significantly associated with suicidal behavior for girls. Feeling unsafe in school was predictive of suicidal behavior for girls, but not for boys. Implications for practice, including the importance of coordinating violence and suicide prevention efforts, are discussed.

Herein we describe a case report of a patient with elevated liver enzymes, leukocytosis, anemia and fevers after cholecystectomy surgery done for presumed acute cholecystitis. Numerous post-surgical tests showed no acute surgical complications to account for the laboratory abnormalities. Due to systemic symptoms of joint pain and the chronicity of the symptoms, a liver biopsy was recommended by the gastroenterology service to rule out infectious or auto-immune causes. After the liver biopsy, the patient was diagnosed with intravascular large B-cell lymphoma (IVLBCL), a subset of diffuse large B-cell lymphoma. After a thorough lymphoma evaluation, the IVLBCL was found to be isolated to the liver and treated successfully with chemotherapy. This is only the second case report in the literature of this entity.

The Busang mineral prospect in Kalimantan, Indonesia, was reported to host a large Au resource until 1997 when it was revealed that drill core samples had been deliberately and systematically contaminated (“salted”) with extraneous Au to falsify resource estimates. One month before the fraud was uncovered, Dr. G. Milligan, then professor emeritus of geology, visited the site to collect a suite of core samples for academic study that was deemed representative of the host rocks, alteration, and mineralization of the Busang Southeast Zone. These samples were re-examined here by optical microscopy, electron microprobe (EMPA), whole-rock geochemistry, and fluid inclusion microthermometry to characterize the subsurface geology and hydrothermal mineralization, and to assess reasons why the system is of uneconomic character. The host rocks were variably altered calc-alkaline porphyritic subvolcanic diorites, typical of the lithological units along the mineralized trend in the Kalimantan Gold Belt. Early hydrothermal mineralization with quartz-sulfide (pyrite, chalcopyrite, Cu-sulfosalts) stockwork veinlets associated with pervasive phyllic and propylitic alteration was overprinted by crudely banded quartz-carbonate-sulfide/sulfosalt (pyrite, sphalerite, chalcopyrite, galena, tennantite-tetrahedrite, bournonite-seligmannite) veins. The stockwork veins were associated with up to 140 ppb bulk rock Au, some of which was hosted by Cu-sulfosalts. Microthermometry on quartz-hosted aqueous fluid inclusion assemblages (FIA; n = 13) and single inclusions (non-FIA; n = 20) in quartz-carbonate-sulfide/sulfosalt veins yielded an overall range in homogenization temperatures (Th) between 179 °C and 366 °C and bulk salinities between 1.1 wt.% to 8.6 wt.% NaCl equivalent, with much smaller data ranges for individual FIA (e.g., FIA 3; 239.1 °C to 240.5 °C and 0.5 wt.% to 1.4 wt.% NaCl equivalent). Primary FIA along growth zones in quartz were identified, providing constraints on fluid characteristics at the time of quartz growth. Carbonate-hosted FIA (n = 3) and single inclusions (non-FIA; n = 3) in the same veins yielded Th between 254 °C and 343 °C and bulk salinities of 1.1 wt.% to 11.6 wt.% NaCl equivalent. Likewise, data ranges for individual FIA were much smaller. Many of the geological characteristics of the Busang Southeast Zone were compatible with a telescoped, intermediate-sulfidation epithermal system, having formed from diluted magmatic fluids that precipitated weak base metal mineralization. However, the system was unproductive with respect to Au and Ag, at least within the studied area. Of note, vein textures and fluid inclusion characteristics indicative of boiling or efficient fluid mixing—processes both considered critical for the formation of economic lode gold deposits—were absent in the samples.

This study examined the extent to which violent behavior and peer victimization were associated with suicidal ideation, plans, and attempts in a nationally representative sample of 11,113 adolescents who completed the 2005 Youth Risk Behavior Survey. Boys were more likely to be involved in physical fighting and weapon carrying, whereas girls were more likely to report suicidal behavior and feeling unsafe at school. Predictors of suicidal behavior for both male and female adolescents included carrying a weapon, being threatened or injured at school, having property stolen or damaged at school, and getting in a fight. Carrying a weapon and getting in fights in the community, but not in the school, were significantly associated with suicidal behavior for girls. Feeling unsafe in school was predictive of suicidal behavior for girls, but not for boys. Implications for practice, including the importance of coordinating violence and suicide prevention efforts, are discussed.

Gender-based bullying (GBB) includes threatening behaviors based on gender/gender-role expectations, verbal/physical harassment, unwanted sexual attention and coercion, insults, intimidation, and assaults based on sexual orientation. In this study, 342 teachers completed an online survey to identify which variables predicted their rates of witnessing and intervening in GBB. Individual variables included teacher rates of homophobia and heterosexism. Systems variables included teachers' fear of angry backlash for reporting GBB, the comprehensiveness of districts' safe school policies (SSP), the timeliness of districts' responses to reports of GBB, and the consistency of administrative responses. Also included were the number of district trainings concerning their local SSPs, effective classroom management, LGBT sensitivity, in addition to the frequency of training opportunities in teacher graduate programs addressing these issues. One systems factor, teachers' fear of angry backlash for reporting GBB, predicted teachers' rates of intervention in and witnessing GBB in their classrooms. Descriptive data indicated that most teachers did not report an episode of GBB to their administration at any point in their teaching careers; the few who did report an act of GBB were both more aware of its existence and reported higher rates of intervention, compared to teachers who had never made a report. School districts should attempt to increase the perceived seriousness of GBB by fostering a school climate where teaching staff are comfortable reporting GBB. Given the limited number of training opportunities reported by teachers, in either LGBT sensitivity or classroom management, districts and training programs should attempt to increase teachers' comfort with both intervention in bullying and LGBT affirming practices. Future research should address the factors that promote teachers' awareness of and interventions in GBB. The effects of proposed policy changes should be studied quantitatively; including, for example, the provision of specific protections for all students from GBB; and the consistent documentation of these episodes when they do occur. Research should continue to address whether or not schools that make such policy changes provide measurable quality of life and school climate improvements for all students, as well as the factors that increase the likelihood of achieving a school environment free of GBB.

As a physician, I have read with great interest the heartfelt letters both for and against Measure O. We seem to be losing sight of where these funds came from and the inherent mandate of how they should be spent.

Understanding drivers of river mobility—temporal shifts in river channel positions—is critical for managing fluvial landscapes sustainably and for interpreting past river responses to climate change. However, direct observations linking river mobility and water discharge variability are scarce. Here, we pair multi‐annual measurements of daily water discharge and river mobility, estimated from Landsat, for 48 rivers worldwide. We show that, across climates and planforms, river mobility is correlated with water discharge variability over daily, intra‐annual, and inter‐annual timescales. For similar mean discharge, higher discharge variability is associated with up to an order‐of‐magnitude faster floodplain reworking. A random forest regression model indicates that discharge variability is the primary predictor of river mobility, when compared to mean water discharge, sediment concentration, and channel‐bed slope. Our results suggest that enhanced hydro‐climatic extremes could accelerate future river mobility, and that past changes to discharge variability may explain the fabric of fluvial strata. Plain Language Summary River corridors are fertile landscapes hosting nearly 3 billion people worldwide and supporting agriculture and commerce. However, rivers are not static; they shift their positions over time through a variety of processes. Understanding the controls on river movement is crucial, especially given that climate change and humans are altering water and sediment flows through rivers globally. Here, we compile daily water discharge records and river mobility measurements spanning multiple years for 48 rivers worldwide that cover a wide range of climates and planform shapes. We find that river mobility is correlated with water discharge variability across daily, seasonal, and yearly timescales. Data show that, for similar average water flow rates, rivers with higher discharge variability move faster across their floodplain. A machine learning model suggests that water discharge variability best explains the typical pace of river movement on a multi‐decadal time frame. These results provide, for the first time, widespread evidence that faster river mobility is linked with higher water discharge variability. Our findings can inform how rivers will respond to future climate change‐driven shifts in the distribution of hydro‐climatic extremes. Key Points We paired observations of water discharge and river mobility for 48 rivers spanning varied climate zones and river planforms River mobility was correlated with water discharge variability over daily, intra‐annual, and inter‐annual timescales Higher water discharge variability, for the same mean discharge, is associated with faster river mobility