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2 Methods We conducted a cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS; www.cdc.gov/nchs/ahcd/)—a nationally representative dataset collected by the Center for Disease Control and Prevention of ambulatory care services provided within general and short-stay EDs. Author contributions M.H. provided substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; J.W. drafted the article or revised it critically for important intellectual content; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Declaration of competing interest Micah Hartwell receives funding from the National Institute of Justice and Human Resources Services Agency, which is unrelated to this research.

We test the proposition that the federal bureaucracy exhibits a “bias toward business” during notice and comment rulemaking. We analyze over 30 bureaucratic rules and almost 1,700 comments over the period of 1994 to 2001. We find that business commenters, but not nonbusiness commenters, hold important influence over the content of final rules. We also demonstrate that as the proportion of business commenters increases, so too does the influence of business interests. These findings contrast with previous empirical studies and generally suggest that notice and comment procedures have not succeeded in “democratizing” the agency policymaking process to the extent sometimes suggested in the normative rulemaking literature.

AbstractObjectivesTo determine whether patient reported outcomes improve after single stage versus two stage revision surgery for prosthetic joint infection of the hip, and to determine the cost effectiveness of these procedures.DesignPragmatic, parallel group, open label, randomised controlled trial.SettingHigh volume tertiary referral centres or orthopaedic units in the UK (n=12) and in Sweden (n=3), recruiting from 1 March 2015 to 19 December 2018.Participants140 adults (aged ≥18 years) with a prosthetic joint infection of the hip who required revision (65 randomly assigned to single stage and 75 to two stage revision).InterventionsA computer generated 1:1 randomisation list stratified by hospital was used to allocate participants with prosthetic joint infection of the hip to a single stage or a two stage revision procedure.Main outcome measuresThe primary intention-to-treat outcome was pain, stiffness, and functional limitations 18 months after randomisation, measured by the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) score. Secondary outcomes included surgical complications and joint infection. The economic evaluation (only assessed in UK participants) compared quality adjusted life years and costs between the randomised groups.ResultsThe mean age of participants was 71 years (standard deviation 9) and 51 (36%) were women. WOMAC scores did not differ between groups at 18 months (mean difference 0.13 (95% confidence interval −8.20 to 8.46), P=0.98); however, the single stage procedure was better at three months (11.53 (3.89 to 19.17), P=0.003), but not from six months onwards. Intraoperative events occurred in five (8%) participants in the single stage group and 20 (27%) in the two stage group (P=0.01). At 18 months, nine (14%) participants in the single stage group and eight (11%) in the two stage group had at least one marker of possible ongoing infection (P=0.62). From the perspective of healthcare providers and personal social services, single stage revision was cost effective with an incremental net monetary benefit of £11 167 (95% confidence interval £638 to £21 696) at a £20 000 per quality adjusted life years threshold (£1.0; $1.1; €1.4).ConclusionsAt 18 months, single stage revision compared with two stage revision for prosthetic joint infection of the hip showed no superiority by patient reported outcome. Single stage revision had a better outcome at three months, fewer intraoperative complications, and was cost effective. Patients prefer early restoration of function, therefore, when deciding treatment, surgeons should consider patient preferences and the cost effectiveness of single stage surgery.Trial registrationISRCTN registry ISRCTN10956306.

John Webb was a masterly technical surgeon and pioneer cytologist. In an era when a lump in the breast presaged uncertain frozen section biopsy and mastectomy, Webb mastered fine needle aspiration and accurate diagnosis, saving countless patients from avoidable surgery. His work forms the basis of the routine investigation of suspected breast cancer in modern practice.

Purpose of Review Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. Recent Findings PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine–trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. Summary PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.

Because of their abilities to catalyze generation of toxic free radical species, free concentrations of the redox reactive metals iron and copper are highly regulated. Importantly, desired neurobiological effects of these redox reactive metal cations occur within very narrow ranges of their local concentrations. For example, synaptic release of free copper acts locally to modulate NMDA receptor-mediated neurotransmission. Moreover, within the developing brain, iron is critical to hippocampal maturation and the differentiation of parvalbumin-expressing neurons, whose soma and dendrites are surrounded by perineuronal nets (PNNs). The PNNs are a specialized component of brain extracellular matrix, whose polyanionic character supports the fast-spiking electrophysiological properties of these parvalbumin-expressing GABAergic interneurons. In addition to binding cations and creation of the Donnan equilibrium that support the fast-spiking properties of this subset of interneurons, the complex architecture of PNNs also binds metal cations, which may serve a protective function against oxidative damage, especially of these fast-spiking neurons. Data suggest that pathological disturbance of the population of fast-spiking, parvalbumin-expressing GABAergic inhibitory interneurons occur in at least some clinical presentations, which leads to disruption of the synchronous oscillatory output of assemblies of pyramidal neurons. Increased expression of the GluN2A NMDA receptor subunit on parvalbumin-expressing interneurons is linked to functional maturation of both these neurons and the perineuronal nets that surround them. Disruption of GluN2A expression shows increased susceptibility to oxidative stress, reflected in redox dysregulation and delayed maturation of PNNs. This may be especially relevant to neurodevelopmental disorders, including autism spectrum disorder. Conceivably, binding of metal redox reactive cations by the perineuronal net helps to maintain safe local concentrations, and also serves as a reservoir buffering against second-to-second fluctuations in their concentrations outside of a narrow physiological range.

Opinion statement Patients with hematologic malignancies and their families are among the most distressed of all those with cancer. Despite high palliative care-related needs, the integration of palliative care in hematology is underdeveloped. The evidence is clear that the way forward includes standard-of-care PC integration into routine hematologic malignancy care to improve patient and caregiver outcomes. As the PC needs for patients with blood cancer vary significantly by disease, a disease-specific PC integration strategy is needed, allowing for serious illness care interventions to be individualized to the specific needs of each patient and situation.

A long line of research, beginning with Macaulay's (1963) well-known study of \"Non-Contractual Relations in Business,\" suggests that the formal trappings of domestic law often have effects on private behavior that are, at best, \"indirect, subtle, and ambiguous\" (Macaulay 1984:155). Law and society scholars have spent somewhat less time exploring whether international law's effects on behavior are similarly attenuated. In this article I examine whether foreign investors take the presence of strong formal international legal protections into account when deciding where to invest. I focus on whether the presence of bilateral investment treaties, or BITs, meaningfully influences investment decisions. I present results from a statistical analysis that examines whether the formally strongest BITs—those that guarantee investors access to international arbitration to enforce investors' international legal rights—are associated with greater investment flows. I find no clear link between treaty protections and investment, a finding consistent with past law and society research but in tension with claims common in the BIT literature that the treaties should have dramatic effects on investor behavior.

The American healthcare system faces a crisis in optimizing care for people with serious, life-threatening illnesses. Many Americans lack basic knowledge of how palliative care services could be helpful, and unfortunately many healthcare providers lack sufficient training to meet the expanding palliative-care needs of our aging population. This article presents a framework for the development of population-based palliative-care education.

This paper presents a qualitative analysis of stories of adults who transitioned from being absolutely homeless to becoming housed. Participants’ stories are particularly salient for what they reveal about this transition in the midst of other challenges including substance use, criminalization, and violence, and within a neo-liberal social policy context. Through strategies of narrative analysis, two interconnected processes of becoming housed are discovered: (a) experiencing fateful moments; and (b) perceiving and creating social supports. The main conclusion is that fateful moments in individuals’ lives intersect with the push and pull of instrumental and expressive supports from family, community, and the state to culminate in an exit from absolute homelessness. The implications of these findings for understanding and responding to homelessness are also discussed.