2025 National Conference in Dallas: April 28 – May 1

Conference like this in Dallas is a perfect occasion to give some reminiscences of my 40 years of work as a mathematician, and to muse a little about my mathematical past. It is a rare occasion to be a little sentimental. In this essay, I summarize and expand my birthday talk given at University of Texas at Dallas conference. There, I mostly covered the early years of my mathematical career ending with a detailed description about the smallest volume hyperbolic 3-manifold and the HOMFLYPT polynomial. Thus I seldom venture to the time after 1984 (for example to mention skein modules constructed in April 1987) and only occasionally after 1995 when I settled to work at George Washington University and have had several successful PhD students.

The National Heart, Lung, and Blood Institute of the National Institutes of Health, together with the Longfonds BREATH consortium, convened a working group to review the field of lung regeneration and suggest avenues for future research. The meeting took place on May 22, 2019, at the American Thoracic Society 2019 conference in Dallas, Texas, United States, and brought together investigators studying lung development, adult stem-cell biology, induced pluripotent stem cells, biomaterials, and respiratory disease. The purpose of the working group was 1) to examine the present status of basic science approaches to tackling lung disease and promoting lung regeneration in patients and 2) to determine priorities for future research in the field.

Introduction to Special Issue: Trust in Doubt: Consuming in a Post-Truth World

Five SIGHPC Travel Grants were awarded in early September for the SC18 Conference in Dallas. Two of these students are working on Masters degrees and three on PhDs. The two Masters students are Fabio Banchelli and Benedikt Oehlrich; the three PhD students are Charu Kalra, Ari Rasch, and Shu-Mei Tseng.

Journal Club-Electronic Cigarettes and Vaping as a Harm Reduction Alternative: Really?

1. Bradley R. Wolf, MD, FISHRS (forumeditors{at}ishrs.org) 1. Cincinnati, Ohio, USA </br>![][1]</img> The ISHRS celebrates its 25th anniversary this year. To commemorate this silver jubilee, as well as the first ISHRS conference in Dallas (April 30–May 2, 1993), we will be publishing

This paper addresses several of the challenges facing today's system of higher education, and discusses the implications of these challenges for the athletic training profession. Among the major challenges are cost, accountability, access, and value of a higher education. The paper next focuses on several issues about which athletic training educators should be thinking. They include the importance of a liberal arts education at the undergraduate level, athletic training's role in interprofessional education and practice, and the importance of diversity and inclusive excellence in helping to diversify the health care workforce and reduce health disparities. The paper concludes with a discussion of the evolution of athletic training from physical education to the health care professions and the transition to the professional master's degree as the entry-level degree in athletic training. The contents of this paper are based largely on the keynote address at the 2015 National Athletic Trainers' Association Athletic Training Educators' Conference in Dallas, Texas, February 27–March 1.

A new consensus-based classification of congenital melanocytic nevi (CMN) has recently been proposed. It includes categories for projected adult size (PAS) and location, satellite nevi counts, and morphologic characteristics (color heterogeneity, rugosity, nodularity, and hypertrichosis). The objective of the current study was to test the applicability of the new categorization scheme and to correlate classification outcome with the patient's history of melanoma and neurocutaneous melanocytosis (NCM). Children and adults with CMN attending a patient conference in Dallas, Texas, in 2012 were invited to participate in the study. Anamnestical data were collected using a standardized questionnaire. Two dermatologists performed clinical examinations. Of 45 patients enrolled, 33 had a giant CMN (G1 [>40 cm PAS], n = 13; G2 [>60 cm PAS], n = 20), 12 had an NCM (5 symptomatic, 7 asymptomatic), and 1 had a history of melanoma. CMN size was positively correlated with NCM (p < 0.05). The classification system allowed an easy and detailed phenotypic characterization of each individual CMN. CMN size and morphology were difficult to assess in patients after surgical removal, and the number of satellite nevi at birth or during infancy was not always known. Our report provides practical aids for the application of the newly proposed CMN classification. Prospective evaluation of accurately classified patients in CMN registries will reveal the predictive value of the scheme. The small study sample limits meaningful conclusions regarding the correlation between CMN parameters and the risk of NCM and melanoma.

As I contemplate the state of higher education these days, I frequently find myself thinking that a news item I read or an event I attend somehow marks the end of an era. On my campus, books are being relocated to make way for a coffee bar at the library. A parking garage replaces an old building. A longtime colleague moves on to another job. Change happens, of course. But I confess: when I learned that Sharon Harris would retire from her position as professor of English and director of the Humanities Institute at the University of Connecticut this year, it was quite clear to me that it is indeed the end of an era. Sherry earned her BA and MA degrees in English from Portland State University and her PhD from the University of Washington in 1988. In the twenty-six years since she earned her degree and took her first faculty position at Temple University, she has become a distinguished scholar in nineteenth-century American literature and culture, women's studies, and literature and medicine. Sherry is one of those academics who has truly made a difference in her field and in the lives of countless colleagues and students. For years, I have regarded her as among the most talented scholars in American literature today. Her wide-ranging work in early and nineteenth-century American women writers has been highly significant and broadly influential. Her recent work in literature and medicine has been groundbreaking. She is well known as an outstanding teacher and mentor to young faculty members and graduate students; I can think of dozens of scholars who have benefited from her personal involvement in their work. At conferences, I have watched her introduce herself to young scholars, put them at ease, and inquire about their work--all with her characteristic genuine interest in people and in scholarship. Sherry has also generously undertaken significant administrative service experience at the national and international levels. She was the founder and first president of the Society for the Study of American Women Writers and president and founding executive coordinator of the Society of Early Americanists. She has served on a number of MLA committees and on the editorial boards of American Literature, Early American Literature, and the University of Nebraska Press. She also has a long record of institutional service at the four universities where she has served as a faculty member: Temple University, the University of Nebraska-Lincoln, Texas Christian University, and the University of Connecticut. I first met Sherry in 1992, when we were both participants from different universities at the MLA/FIPSE (Fund for the Improvement of Post-Secondary Education) Curriculum Review Conference in Dallas, Texas. Attended by departmental representatives from about two dozen institutions, this conference was designed to assist departments in undertaking curriculum reviews in primarily undergraduate education. At the time, I was on the faculty at California State University, Los Angeles, and my colleagues and I were asked to work with the group from the University of Nebraska-Lincoln, where Sherry was then a faculty member. I was struck by her sensible and intelligent comments about undergraduate curricula in English departments and the humanities in general. I knew that she was a person I wanted to know. Later, I introduced myself to her after a session in order to ask her some questions about her department and the structure of their English major. Absorbed by the immediate concerns of the conference, I suddenly realized that I had known and admired her work on Rebecca Harding Davis and early American women writers. I was more than a little taken aback to realize that I had just introduced myself to one of my scholarly role models. From that initial meeting in Dallas, we have enjoyed a warm association and a strong friendship--our relationship has been among the most important of my professional career. Over the years, Sherry has steadily amassed a considerable record of research and publication. …

The 2010 ILCOR Pediatric Task Force experts developed 55 questions related to pediatric resuscitation. Topics were selected based on the 2005 Consensus on Science and Treatment Recommendations (CoSTR) document,1,2 emerging science, and newly identified issues. Not every topic reviewed for the 2005 International Consensus on Science was reviewed in the 2010 evidence evaluation process. In general, evidence-based worksheets were assigned to at least 2 authors for each topic. The literature search strategy was first reviewed by a “worksheet expert” for completeness. The expert also approved the final worksheet to ensure that the levels of evidence were correctly assigned according to the established criteria. Worksheet authors were requested to draft CoSTR statements (see Part 3: Evidence Evaluation Process). Each worksheet author or pair of authors presented their topic to the Task Force in person or via a webinar conference, and Task Force members discussed the available science and revised the CoSTR draft accordingly. These draft CoSTR summaries were recirculated to the International Liaison Committee on Resuscitation (ILCOR) Pediatric Task Force for further refinement until consensus was reached. Selected controversial and critical topics were presented at the 2010 ILCOR International Evidence Evaluation conference in Dallas, Texas, for further discussion to obtain additional input and feedback. This document presents the 2010 international consensus on the science, treatment, and knowledge gaps for each pediatric question. The most important changes or points of emphasis in the recommendations for pediatric resuscitation since the publication of the 2005 ILCOR International Consensus on CPR and ECC Science With Treatment Recommendations1,2 are summarized in the following list. The scientific evidence supporting these changes is detailed in this document. Additional evidence shows that healthcare providers do not reliably determine the presence or absence of a pulse in infants or children. New evidence documents the important role of ventilations in CPR for infants and children. However, rescuers who are unable or unwilling to provide ventilations should be encouraged to perform compression-only CPR. To achieve effective chest compressions, rescuers should compress at least one third the anterior-posterior dimension of the chest. This corresponds to approximately 1½ inches (4 cm) in most infants and 2 inches (5 cm) in most children. When shocks are indicated for ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in infants and children, an initial energy dose of 2 to 4 J/kg is reasonable; doses higher than 4 J/kg, especially if delivered with a biphasic defibrillator, may be safe and effective. More data support the safety and effectiveness of cuffed tracheal tubes in infants and young children, and the formula for selecting the appropriately sized cuffed tube was updated. The safety and value of using cricoid pressure during emergency intubation are not clear. Therefore, the application of cricoid pressure should be modified or discontinued if it impedes ventilation or the speed or ease of intubation. Monitoring capnography/capnometry is recommended to confirm proper endotracheal tube position. Monitoring capnography/capnometry may be helpful during CPR to help assess and optimize quality of chest compressions. On the basis of increasing evidence of potential harm from exposure to high-concentration oxygen after cardiac arrest, once spontaneous circulation is restored, inspired oxygen concentration should be titrated to limit the risk of hyperoxemia. Use of a rapid response system in a pediatric inpatient setting may be beneficial to reduce rates of cardiac and respiratory arrest and inhospital mortality. Use of a bundled approach to management of pediatric septic shock is recommended. The young victim of a sudden, unexpected cardiac arrest should have an unrestricted, complete autopsy, if possible, with special attention to the possibility of an underlying condition that predisposes to a fatal arrhythmia. Appropriate preservation and genetic analysis of tissue should be considered; detailed testing may reveal an inherited “channelopathy” that may also be present in surviving family members.

Part 10: Paediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Compassion fatigue is often experienced in health care institutions yet few programs exist to identify and address the needs of employees. This article describes one organization's limited subject size pilot project to support health care providers in achieving a healthy balance in work and life, while offering opportunity for professional and personal maturity. The article acknowledges the need for collaboration between hospital administration and its employees in achieving that balance. The article describes the vital role that chaplains may play in soul care of individuals and institutions when addressing self-care as an ethical and pastoral priority in health care. Lead author Ann Sidney Charlescraft will present a professional development intensive on compassion fatigue and self-care at the Association of Professional Chaplains' 2011 Annual Conference in Dallas, TX.

The Dallas conference on ESRD in 1989 was a landmark meeting. Among the many presentations, the one by Philip Held stimulated a great deal of discussion. On the basis of data from three registries, the US Renal Data System (USRDS), the European Dialysis and Transplant Association (EDTA), and the Japanese Society of Dialysis and Transplantation (JSDT), he showed higher mortality in the United States than in the other two regions. Categories of age and reported cause of ESRD (diabetes versus other) were available in the registries, allowing for descriptions of outcomes by strata of age and diabetes, or adjustment for age and diabetes. The main outcome was 5-yr survival for all patients with ESRD (dialysis and transplantation combined). In virtually each age by diabetes group, a lower percentage of patients survived to 5 years in the US registry than in either the EDTA or the JSDT (1). These results, summarized in Figure 1, were widely quoted for many years. In this article, we (1) explore potential explanations for these international outcomes differences using more recent data, (2) consider trends in therapy during the past 20 years, and (3) describe how study of the associations of practice patterns with outcomes has informed regional differences in survival and can be used to identify opportunities to improve outcomes at the present time.Figure 1: Five-year renal replacement therapy survival by age in the United States versus Europe (1982 through 1987) and the United States versus Japan (1983 through 1987). US data from the Health Care Financing Administration, European data from EDTA, Japanese data from JSDT (1984 through 1988). European and Japanese age group rates and total rates are standardized to the United States.Potential Explanations for Regional Differences in Survival The findings of Held et al. (1) were considered controversial by many because of the concern that they might reflect or imply poorer care of dialysis patients in the United States. In this section, we consider alternative explanations (e.g., various sources of bias) that may in part explain the findings, and we explore the possible role of differences in dialysis treatment delivery that may account for some of the survival differences. Regional Differences in Data Quality The differences in survival could have been due to differences in data completeness and/or event ascertainment, because the USRDS (a mandatory registry) captured all patients and all deaths (supplemented by other sources), whereas the other two registries might have had less complete reporting. The international Dialysis Outcomes and Practice Patterns Study (DOPPS) was begun in 1996 in the United States, in 1999 in Japan, and in 1998 in Europe and was partly motivated to provide insight into the survival differences of hemodialysis (HD) patients by geographic region. The DOPPS provided the opportunity to study case mix, practices, and outcomes using uniform data collection systems and death ascertainment in nationally representative samples from each participating country (2–5). A DOPPS study of mortality risk, with adjustment for very detailed case-mix indicators, allowed Goodkin et al. (6) to confirm the original findings of relatively higher mortality in the United States compared with Japan and Europe. Although these differences were somewhat attenuated with case-mix adjustment, mortality risk remained significantly elevated for the United States compared with Europe and Japan (Figure 2).Figure 2: Survival among HD patients in Japan, Europe, and the United States: Data from DOPPS I (1997 through 2001). *Cox proportional hazards model adjusted for age, male gender, black race, coronary artery disease, congestive heart failure, other cardiac disease, left ventricular hypertrophy, cardiomegaly by x-ray, hypertension, cardiovascular disease, peripheral vascular disease, diabetes, lung disease, dyspnea, smoking, cancer, HIV/AIDS, gastrointestinal bleed, peptic ulcer disease, hepatitis B, hepatitis C, neurologic disorder, psychiatric disease, recurrent cellulitis or gangrene, and vision problems. **P < 0.001.Regional Differences in Patients Who Start Dialysis Registry data highlighting differences in new cases of treated ESRD per population (ESRD incidence) provided a suggestion of regional differences in patients who start dialysis. Among patients with terminal kidney failure, differences in acceptance for ESRD therapy (i.e., whether dialysis is started at all) suggests active decision-making about suitability for dialysis. Even without differences in acceptance for dialysis, key clinical and/or socioeconomic characteristics of patients who reach ESRD may differ (e.g., age-matched patients in the United States might reach ESRD with a substantially greater comorbidity burden). As noted already, the DOPPS provided the opportunity to capture uniform, detailed patient data from patients in each participating country and found significant differences in survival even after detailed adjustment for patient characteristics. The possibility cannot be completely excluded that these differences were due in part to "unmeasured confounders" (e.g., regional differences in patient health status that were unrecognized or unmeasured). Regional Differences in Selection for Transplantation Because the DOPPS is a study of HD patients and does not include patients who have ESRD with a functioning kidney transplant, the markedly longer survival in Japan may be explained in part by the very low transplantation rate there. Higher transplantation rates in the United States and Europe may deplete the dialysis pool of healthier patients, so the higher mortality in these regions than in Japan is likely explained, at least in part, by differences in transplantation rates. However, the original study by Held et al. compared outcomes among all patients with ESRD (dialysis and transplantation). Even though Japan had fewer transplant recipients than the United States, survival was longer there (Figure 1). In addition, because transplantation rates are generally similar for the United States and most European countries in the DOPPS, this explanation does not seem to contribute substantially to the difference in survival between these two regions (7). Regional Mortality Differences in the General Populations Another question was whether large differences in the mortality rate in the respective general populations might contribute to the differences in survival for patients with ESRD. Regional US data have shown that mortality for dialysis patients varies by region and correlates with mortality differences in the general population (8); therefore, one may hypothesize that higher mortality in US dialysis patients is partly explained by higher mortality in the general population. Using data from national ESRD registries and DOPPS, Yoshino et al. (9) correlated national mortality rates among dialysis patients with national mortality data for the general population from the World Health Organization. A strong association was found, suggesting that countries with relatively high mortality rates in the general population also have relatively high mortality rates in the dialysis population. To consider international differences in treating older dialysis populations, this study also adjusted for age, within the limits of the data, and found an even stronger correlation (Figure 3). In sum, a portion of the observed international differences in mortality among dialysis patients may be explained by international differences in overall health status in the population at large. As noted already, data from countries with very low transplantation rates need to be viewed with caution when analyzing results for dialysis populations.Figure 3: Relationship of all-cause mortality rates (per 1000 population) between general population and dialysis population, by country (n = 21). Adjusted for age in the dialysis population and general population. Each dot represents one country. Reprinted from reference 9, with permission.Regional Differences in Dialysis Care: Vascular Access Practice Differences The DOPPS has shown large international variations in vascular access (VA) practice. Differences in patient survival by VA type are widely known. Thus, the question arises whether differences in patient survival between regions is in part explained by differences in VA practice. Pisoni et al. (10) recently addressed this question in analyses of DOPPS I and II data. US HD patients had 36 to 40% higher adjusted mortality risk than HD patients in five European DOPPS countries; however, when these survival models were also adjusted for VA use within each facility, the excess mortality risk was attenuated to 6 to 19% (Figure 4). The elevated mortality among HD patients in the United States versus Japan was also attenuated somewhat by adjusting for differences in facility VA use. By contrast, the survival differences between regions were not substantially attenuated by adjustment for several other facility practices (treatment time, phosphate, calcium, Kt/V, hemoglobin, and albumin). These results suggest that differences in facility VA use may be one of the main factors explaining the higher mortality risk for HD patients in the United States. Recently, Foley and Hakim (11) suggested several other dialysis treatment practices that differ between regions, are modifiable, and may contribute to international differences in patient outcomes.Figure 4: Distributions of percentage of facility patients using a catheter for HD access, by country. DOPPS II (2002 through 2004); n = 320 facilities and 8684 patients. Based on the initial prevalent cross-section in facilities with five or more patients with VA data.Practice Trends in the Past Decade ESRD care has certainly changed since the 1989 Dallas conference. Among numerous examples, anemia care was revolutionized by the introduction of erythropoietin in the year of the conference. This is exemplified by the observation that the fraction of dialysis patients who receive at least one outpatient blood transfusion per 3 months decreased from 14% before 1989 to <4% as early as 1 year after erythropoietin became available in the United States and has remained very low since (7). Another example of a dramatic change is the trend in dialysis dosage as estimated by single-pool Kt/V (spKt/V). Nationally representative samples of HD patients in three special studies of the USRDS and subsequent samples from three phases of DOPPS allowed us to describe the average spKt/V in US HD patients over time. As shown in Figure 5, there has been a consistent increase in the dialysis dosage during the past two decades. These examples of dialysis practice could be correlated with improvement in the case-mix adjusted mortality in the United States (12); however, causality of a relationship with mortality cannot be proved. It is interesting that as the mean Kt/V values increased over time, the fraction of patients with spKt/V values <1.2 decreased, which is a range below that studied in the HEMO Trial.Figure 5: Mortality in the United States versus Europe: Influence of adjustment for facility catheter use. Case-mix adjusted hazard ratio (HR) of mortality for HD patients in the United States versus five European DOPPS I and II countries (n = 24,398), with and without adjustment for differences in facility VA use (case-mix adjusted percentage of facility patients using a catheter and the percentage using a graft referenced to the percentage using a native AVF). All Cox models were adjusted for patient age, gender, black race, number of years with ESRD, body weight, 14 summary comorbid conditions, whether treated in a hospital-based unit, stratified by study phase, and accounted for facility clustering effects. Model 2 was additionally adjusted for facility median treatment time (TT) and percentages of patients with serum phosphorus >5.5 mg/dL and serum calcium >10 mg/dL. Model 3 was additionally adjusted for facility VA. Reprinted from reference 10, with permission.The DOPPS has provided the opportunity to describe trends over the past decade in a wide range of treatments in nationally representative samples of dialysis facilities. Trends in VA, dialysis prescription, laboratory parameters, medication use, and adherence to guidelines have been reported (13–15). Identifying Opportunities to Improve Practices and Outcomes for HD Patients When assessing mortality risk by VA use, the usual approach of correlating use with outcomes among individual patients has the potential to provide biased results. Because patients who undergo dialysis by a catheter tend to be sicker than those who undergo dialysis by a fistula, higher mortality among catheter users may be largely because these patients are sicker than those with an arteriovenous fistula (AVF) or graft. Because we observed in the DOPPS that the type of VA use varies widely from one dialysis facility to another, even in the same country (Figure 6) and when adjusting for differences in case mix between facilities, we were able to study the differences in mortality risk by greater versus lower facility catheter use (specifically, the percentage of patients who used a catheter in each facility) while adjusting for detailed patient characteristics, country, and year (10). This statistical approach of applying the practice (e.g., facility catheter use) to patient survival models is similar to "instrumental variable analysis," a technique widely used in economic studies and now more commonly applied to studies of comparative treatment effectiveness in clinical medicine (16–18). The result provides a mortality risk estimate that is based not on the individual patient's use of a catheter, but on the facility practice of greater versus lesser catheter use. This analytical approach tends to reduce confounding by indication (e.g., as a result of preferential selection of patients with higher mortality risk for catheter use). DOPPS analyses showed that the overall mortality risk was 20% higher for patients who were treated in facilities with 20% greater case-mix adjusted catheter versus AVF use (e.g., 30 versus 10% of patients using a catheter, rather than an AVF). In short, patients in facilities with fewer catheters have longer survival.Figure 6: Change over two decades in mean spKt/V among US HD patients. CMS, Centers for Medicare and Medicaid Services; CMAS, Case Mix Adequacy Study; DMMS, Dialysis Morbidity and Mortality Study.Although randomized trials provide the strongest evidence to guide clinical medicine, few "gold standard" clinical trials (i.e., multicenter, controlled trials of clinical outcomes) have been completed of dialysis patients. In reality, many (or most) treatment decisions must be made under conditions in which supportive clinical trial data cannot be obtained, including situations in which clinical equipoise is questioned, in which treatment choices are complex, or in populations that may not be readily studied or tend not to participate in clinical trials. Most clinical decisions have to be made before availability of clinical trial results even under the best of circumstances. In dialysis patients, for example, it seems unlikely that patients could ever be randomly assigned to a target phosphate level above 6.0 mg/dL; neither could a clinical trial realistically detect differences in outcomes according to a difference in target phosphate levels as small as 0.5 to 1.0 mg/dL. Because clinical trial findings cannot inform numerous treatment decisions made in the dialysis unit, we can ask whether the principles of randomization can be applied to analyses of observational data, which are much more readily available. The answer is, in many circumstances, "Yes." Our analysis of facility catheter use, described already, is one example. When differences in facility practices are large, they are likely not explained (or explained only in part) by differences in patient characteristics and are instead due to differences in provider preferences for one treatment over another. Here, one can consider patients as being "randomized" to a practice by factors, such as proximity to home, which are unrelated to health status. This practice-based analytical approach is particularly successful when the average treatment patterns differ substantially among facilities and when case-mix differences can be adjusted. The results assume that provider opinion or preferences are relevant (i.e., that they influence treatment decisions above and beyond differences in patient characteristics alone). In addition, this approach requires the assumption that other practices are not linked with the practice being studied (i.e., a "good" or "bad" practice effect). Although this assumption cannot be completely verified, in DOPPS analyses we adjust simultaneously for other practices (e.g., percentage of patients who achieve clinical practice guidelines) to lessen this concern. In our experience so far, we have been encouraged that adjustments for several other practices have not meaningfully modified the associations seen for practice-based instrumental variable analyses. Some additional examples of analyses of facility practices and their rationale follow. The first of these is mortality risk by phosphate level. Hyperphosphatemia is associated with elevated mortality, but the utility of this finding for the clinician (i.e., how should this influence practice?) is limited: Patients with very high phosphate levels are often poorly adherent to therapy, and elevated mortality may be due to poor adherence in general rather than hyperphosphatemia itself. Using DOPPS data, Tentori et al. (13) observed large differences between dialysis facilities in the percentage of patients with high serum phosphate levels. Marked variation between facilities was observed within, as well as between, countries. For example, 25% of US facilities had ≤26% patients with phosphate levels >6.0 mg/dL (>1.9 mmol/L), whereas 25% had at least 40% of patients >6.0 mg/dL and 5% had at least 53% of patients >6.0 mg/dL. Because this variation remained large after adjustment for case mix, it is reasonable to suspect that it was largely due to practice differences (e.g., opinion regarding the importance of tighter phosphate control and/or preferences for one therapy over another). Applying the practice-based (instrumental variable) approach, we observed that patients who were treated at dialysis facilities with a higher fraction of patients with phosphate levels >6.0 mg/dL had higher mortality risk. It is interesting that the elevation in cardiovascular mortality risk was particularly pronounced, as shown in Figure 7.Figure 7: Associations of facility distribution of serum phosphorus levels with all-cause and cardiovascular mortality, among patients on HD >180 d in the DOPPS (n = 20,561). Hazard ratios and 95% confidence intervals (whiskers) for all-cause (events n = 5857) and cardiovascular mortality (events n = 1930). Models were stratified by study phase and region and adjusted for facility clustering effect; baseline patient age, gender, race, body mass index, time on ESRD, 13 comorbid conditions, hemoglobin, albumin, normalized protein catabolic rate, spKt/V, previous parathyroidectomy, and vitamin D prescription; and the percentage of patients at a facility within serum calcium and parathyroid hormone categories. For phosphate, 1 mg/dL = 0.323 mmol/L.As another example, Saran et al. (19) found that patients who receive longer treatment time (among patients who receive thrice-weekly dialysis sessions) have longer survival. However, this finding may potentially be biased because patients with shorter life expectancy may receive shorter dialysis sessions. We have therefore applied a practice-based approach, and initial findings indicate that patients who are treated at dialysis facilities that on average provide longer treatment sessions have overall lower mortality risk (20). Again, the patient-based findings are corroborated by these practice-based analyses, providing an additional level of evidence supporting the importance of the association. Conclusions International mortality differences for the United States versus Europe and Japan—as reported 20 years ago—have been confirmed with more recent data from DOPPS, using uniform data collection for death ascertainment and detailed case-mix adjustment. Better outcomes for Japanese dialysis patients may be exaggerated to some extent because selection of healthier patients for transplantation is minimal in Japan. Differences in background mortality in the general population, by country or region, seem to explain, in part, differences in dialysis patient outcomes. Differences in VA practice seem to explain a substantial component of the mortality difference between the United States and elsewhere, thus pointing to an opportunity to improve care and outcomes in the United States. Comparing the US with European DOPPS countries, results both without and with adjustment for VA are relevant in that (1) mortality is confirmed to be higher for similar patients in the United States than in Europe and (2) mortality is nearly equivalent for similar patients in the United States and Europe who undergo dialysis in facilities with similar patterns of VA use. A variety of aspects in dialysis prescription has changed during the past two decades. Two striking examples include the large increase in average dialysis dosage and the major reduction in blood transfusions since the introduction of erythropoietin. The DOPPS has shown that dialysis practices vary substantially from one dialysis facility to another, both within and between countries. These differences allow assessment of outcomes by practice pattern, which can lessen in part confounding by indication that may bias patient-based observational analyses. When evaluating practice preferences, our finding that the differences in practice from one dialysis unit to another are often very large may also be persuasive to clinicians, because this large variation strengthens the argument that differences in outcomes may be due in part to differences in provider preferences. Patients in dialysis facilities with greater catheter use or a greater fraction of patients with hyperphosphatemia have significantly higher mortality. These and other findings provide further strong evidence from observational data that may be relevant to improving dialysis practice, patient survival, and quality of life. Disclosures None. The DOPPS is administered by Arbor Research Collaborative for Health. DOPPS I, II, and III have been supported by research grants from Amgen, Inc., and Kyowa Hakko Kirin Co., Ltd. As of January 2009, the DOPPS is additionally funded by Genzyme Corp. Support is provided without restrictions on publications.

I will attempt to recall, as best as my memory allows, what we learned from the 1989 Dallas Conference on Morbidity and Mortality and Prescription of Dialysis. These thoughts and opinions are my remembrance in the subsequent time period and therefore subject to the limitations of recall. Opinions expressed are my personal beliefs and cannot be verified by hardcore scientific data. Accept the thought process on the basis of recollection and my individual assessment of the issues discussed. It is surprising to me, in retrospect, what has occurred in the past 50 yr. It really is the history of clinical dialysis and kidney transplantation. Many of you may not be familiar with some of the earlier events, so I cover them briefly by decades. It will be difficult for many of us to realize that there were no self-defined nephrologists in the early part of the 1960s but only renal physiologists in some medical schools. The exceptions to this arrangement were led by a few brave pioneers, such as John Merrill in Boston, Belding Scribner in Seattle, and George Schreiner in Washington, DC. These men ignored the scorn of their academic colleagues and actually looked after patients with renal failure. The early effort of these individuals showed that it was possible to have patients recover from acute renal failure or even survive if their condition were chronic. Their results were exciting, capturing the public interests and making the cover of many national magazines, so the Public Health Service, in the mid-1960s, decided to offer 5-yr grants to determine whether chronic dialysis could be applied to the population at large. We obtained one of those grants in 1967 in Dallas. Finally, to close out the decade, a few courageous souls went into private practice as nephrologists, which became a board-certified specialty …

In July 2005 I ran across an ad in Electronic Products [1] for an optical mouse sensor by Agilent Technologies. Like many people, I find using an optical mouse to be superior to the old ball-in-a-cage type mouse (which I first saw demonstrated on the Xerox Star workstation at the National Computer Conference in Dallas, June 1976). Inevitably, I was curious to learn what makes it tick (or "squeak") ... that's my Tinkertoy® mentality at work. I clipped the article, filed it and totally forgot about it until recently.

A View from the Classroom:Film & History Conference Jessica Schoenbaechler Scholars and practitioners poked, prodded, dissected and analyzed issues relating to film and history—from recent boy bands to documentary classics—at the fourth Film & History Biennial Conference in Dallas, Texas, which ran from November 8 to 12. Hosted by Film & History: An Interdisciplinary Journal of Film and Television Studies and sponsored by The Center for the Study of Film and History, the conference drew an international attendance of scholars, students, editors, filmmakers, writers and historians for five days of academic paper presentations, film screenings and question and answer sessions. Noteworthy speakers included Raymond Fielding, Dean Emeritus at Florida State University Film School; filmmakers [End Page 9] Chris Hegedus and DA Pennebaker; and Betsy McLane, former executive director of IDA and co-author, with Jack Ellis, of A New History of Documentary Film. Known for his instruction at UCLA, Temple University, University of Iowa, University of Houston and Florida State University, Professor Fielding has published books on The March of Time and the history of American newsreels, and has served as vice president of Zoetrope Studios, founded by his former student, Francis Ford Coppola. "Despite what poets say, the truth is not necessarily beautiful, nor does it set us free," said Fielding in his introduction to several March of Time newsreels. "Truth tells us who we are, why things fit and why they're not working out the way they're supposed to." According to Fielding, The March of Time, despite being scorned by print journalists, was often the only photographic representation of historic and controversial events from 1936-1951, and had tremendous impact on how people saw the world. The series, which included re-enactments and hidden cameras, was actually banned from Germany, Japan, Russia, Italy and Spain, and was censored in several democratic countries. Fielding highlighted "Inside Nazi Germany" (1935) and segments on Louisiana politician Huey Long; the last public executioner using the guillotine in France; and a humorous piece from 1936 on a Princeton student group, the Veterans of Future Wars, whose mission was to obtain bonus pay upfront for their certain draft into World War II. Pennebacker and Hegedus discussed their 30-year partnership with clips from Dont Look Back (1967), Monterey Pop (1968), The War Room (1993), Startup.com (2001) and Al Franken: God Spoke (2006). Pennebaker fondly recalled the homemade camera rig he first used, which was the size of a small typewriter, held 10 minutes of film, and required constant monitoring for telltale sounds of the end of the roll."We shot 35 hours for The War Room versus 400 hours for Startup.com," said Pennebaker. "You don't have to worry about the roll running out, but then you've got the burden of overabundance. It requires a totally different process of editing." Other screenings included Glen Marcus' The March of the Bonus Army (2006), a documentary about the 1932 march of World War I veterans demanding payment of compensation promised for war service, and Strong Enough to Break (2006), Ashley Greyson's documentary about the band Hanson's three-year struggle with its record label and its decision to start its own label. Allen Mondell and Cynthia Salzman Mondell of Dallas-based Media Projects, Inc. opened the conference with a discussion of the films they have made together over the past 30 years, including Sisters of '77. Also known as The Spirit of Women, the 2004 film received a CINE Golden Eagle and a Telly Award, and aired on PBS' Independent Lens. The filmmakers were introduced by Bart Weiss, director of the Video Association of Dallas. With up to ten different theme-based panel presentations happening at any given time, conference goers often had difficulty deciding which to attend. Topics included individual auteurs, films and film movements; pedagogy, ethics, genres, hybrid forms and the history of film; and issues of the environment, war and minority populations. I attended several of the panel discussions about environmental issues and films, including Hanna Musiol's "Primitive Environments in Robert and Francis Flaherty's Documentaries," in which she pointed out the ways that images of people and the environment are often embedded with the filmmaker...

Free AccessIssues in ADHD in AdultsJ. Russell Ramsay and Anthony L. RostainJ. Russell RamsayDrs. Ramsay and Rostain are with the Adult ADHD Treatment and Research Program at the University of Pennsylvania School of MedicineAddress correspondence to: J. Russell Ramsay, Ph.D., 3535 Market St., 2nd Floor, Philadelphia, PA19104–3309, or e-mail: [email protected]Search for more papers by this author and Anthony L. RostainDrs. Ramsay and Rostain are with the Adult ADHD Treatment and Research Program at the University of Pennsylvania School of MedicineSearch for more papers by this authorPublished Online:December 2006https://doi.org/10.1521/adhd.2006.14.6.5PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutReferencesBarkley R. A., , Cunningham C., , Gordon M., , Faraone S., , Lewandowski L., , & Murphy K. (2006). ADHD symptoms vs. impairment: Revisited. ADHD Report, 14(2), 1–9. Abstract, Google ScholarBarkley R. A., , & Murphy K. R. (2006). Identifying new symptoms for diagnosing ADHD in adulthood. ADHD Report, 14(4), 7–11. Link, Google ScholarBrown, T. E. (1996). Brown attention deficit disorder scales. San Antonio, TX: Psychological Corporation. Google ScholarBrown, T. E. (2005). Attention deficit disorder: The unfocused mind in children and adults. New Haven, CT: Yale University Press. Google ScholarConners, C. K., Erhardt, D., &Sparrow, E. (1999). Conners' adult ADHD rating scales. North Tonawanda, NY: Multi–Health Systems. Google ScholarFaraone, S. V. (2006, May). ADHD “Not otherwise specified”: Conceptual issues. In T. Wilens (Chair), Understanding and managing the transition of ADHD from adolescence to young adulthood: The maturation of the disorder. Industry–supported symposium conducted at the annual meeting of the American Psychiatric Association, Toronto, Canada. Google ScholarFaraone, S. V., & Biederman, J. (2005, October). Adolescent predictors of functional outcome in adult ADHD: A population survey. Poster session presented at the 17th CHADD Annual International Conference in Dallas, Texas. Google ScholarGordon M., , Antshel K., , Faraone S., , Barkley R., , Lewandowski L., , Hudziak J. J., et al.. (2005). Symptoms versus impairment: The case for respecting DSM–IV's criterion D. ADHD Report, 13(4), 1–9. Link, Google ScholarMcGough J. J., , & Barkley R. A. (2004). Diagnostic controversies in adult attention deficit hyperactivity disorder. American Journal of Psychiatry, 161, 1948–1956. Crossref, Google ScholarMilich R., , Balentine A. C., , & Lynam D. R. (2001). ADHD Combined Type and ADHD Predominantly Inattentive Type are distinct and unrelated disorders. Clinical Psychology: Science and Practice, 8, 463–488. Crossref, Google ScholarRamsay J. R., , & Rostain A. L. (2003). A cognitive therapy approach for adult attention–deficit/hyperactivity disorder. Journal of Cognitive Psychotherapy: An International Quarterly, 17, 319–334. Crossref, Google ScholarRamsay J. R., , Brodkin E., , Cohen M. R., , Ekman E., , Listerud J., , & Rostain A. L. (2005). “Better strangers”: Using the relationship in psychotherapy for adult patients with Asperger Syndrome. Psychotherapy: Theory, Research, Practice, Training, 42, 483–493. Crossref, Google ScholarWender, P. H. (1987). The hyperactive child, adolescent and adult: Attention deficit disorder through the lifespan. New York: Oxford University Press. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. The Relationship Between Cognitive Distortions and Adult Attention-Deficit/Hyperactivity Disorder After Accounting for Comorbidities and Personality TraitsOnline publication date: 18 May 2020. Go to citation Crossref Google Scholar2. Development of the Korean Practice Parameter for Adult Attention-Deficit/Hyperactivity DisorderOnline publication date: Go to citation Crossref Google Scholar3. Diagnosis of Attention-Deficit/Hyperactivity Disorder and Its Behavioral, Neurological, and Genetic RootsOnline publication date: Go to citation Crossref Google Scholar4. Assessing College-Level Learning Difficulties and “At Riskness” for Learning Disabilities and ADHDOnline publication date: 20 January 2011. Go to citation Crossref Google Scholar5. A Critical Review of ADHD Diagnostic Criteria: What to Address in the DSM-VOnline publication date: 23 April 2010. Go to citation Crossref Google Scholar6. Adult ADHD ResearchOnline publication date: 10 May 2007. Go to citation Crossref Google Scholar Volume 14Issue 6Dec 2006 Information© The Guilford PressPDF download

President's messageThe H.E.A.T. is on...can you feel it?

The year 2000 saw the publication of two major works on the conservation of wooden heritage resources. The first, by the British wood conservation expert Brian Ridout, entitled Timber Decay in Buildings focuses on the effects of attacks by fungi and insects and on the science and technology of the development of treatments and preventive measures.1 The second, by Norwegian specialists Knut Einar Larsen and Nils Marstein, entitled Conservation of Historic Timber Structures: An Ecological Approach focuses on the development of truly multi-disciplinary approaches to the holistic conservation of historic timber structures.2 Larsen's studies in Japan have enabled this extremely useful work to focus equally on the different conservation philosophies of East and West.3These two excellent studies prompted the author to develop this paper, which reviews the development of appropriate approaches to the conservation problems of wooden structures and outdoor monuments over the last 40 years. It focuses particularly on the sometimes extreme treatments that were developed in the 1960s to treat attacks by wood-destroying fungi and insects, and the residual problems associated with these treatments. The development of more environmentally-friendly conservation treatments and minimalist approaches are also examined. The paper discusses the development of structural conservation media and methods—particularly focussing on the WER (wood-epoxy-reinforcement) and Beta systems and variations on these themes.The examples examined in the paper are all from the author's practice and 40 years of international experience, and include cases from tropical environments, Russia, Canada, Norway, the United Kingdom, and the USA. The paper has been developed from one given by the author at the American Institute for Conservation Conference in Dallas in April 2001.