Growth Failure in International Adoptees Miller, Bradley S.; Johnson, Dana E.; Kang, Judith Eckerle ...
Handbook of Growth and Growth Monitoring in Health and Disease,
2011
Book Chapter
Psychosocial growth failure, represented by significant suppression of height, weight, and head circumference at the time of adoption, is highly prevalent in children who are adopted internationally. ...The effects of institutional deprivation are more profound in children with a higher baseline risk of growth impairment (low birth weight or high risk for prenatal alcohol exposure). Nutritional insufficiency and social deprivation both contribute to the etiology of psychosocial growth failure within institutional care settings. Their relative importance and the consequent clinical presentations relate to the age of the child, with inadequate nutrition contributing more in infancy and early childhood and depression of hypothalamic-pituitary-end organ function, particularly the GH-IGF-1 axis, becoming more important as children age. Both malnutrition and deprivation are associated with suppression of the GH-IGF-1 axis. Children who have experienced institutional care are at an increased risk of medical, developmental, and behavioral problems. Therefore, international adoptees should be carefully evaluated at the time of arrival into their new home country and followed closely as they make the transition to their new home environment. They should be monitored for adequate auxologic and neurocognitive catch-up over time. Children not making appropriate progress should be referred for specialty evaluation. Growth failure at the time of adoption, along with catch-up growth in height and weight, is a risk factor for early and/or more rapid progression through puberty in girls leading to a compromise in final height. There is also reason for concern that children with psychosocial growth failure may be at increased risk of developing metabolic syndrome. Even if growth recovers, persistent abnormalities of the endocrine system or the presence of micronutrient deficiencies during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Infants of low birth weight are particularly vulnerable to the effects of nutritional and social deprivation. This significant impact of psychosocial growth failure on low birth weight infants extends beyond the plight of institutionalized children to the millions of impoverished children worldwide. Psychosocial deprivation within any caregiving environment during early life is as detrimental as malnutrition and must be viewed with as much concern as any severely debilitating childhood disease.
A firm engaged in a cost-plus medical insurance policy can gain better control of expenditures by using a knowledge-based expert system to select a subset of previously paid claims for manual review. ...The selection process focuses on identifying probable errors in claim payments. Knowledge of medical practices and procedures provides the foundation for detecting errors. We obtained the knowledge from a number of health care professionals and encoded it in a rule-based system. The system has been refined over two years and is currently being used by RFE Associates, a health insurance consulting firm, to audit claim payments. A recent audit on behalf of one Fortune 500 retailer resulted in recovery of $377,000 from the plan administrator.
This work describes the techniques used to prepare and analyze a reflectance wavelength standard composed of three rare-earth oxides. A mixture of dysprosium oxide (Dy
2
O
3
), erbium oxide (Er
2
O
3
...), and holmium oxide (Ho
2
O
3
) provides a pressed powder specimen exhibiting a near infrared reflectance spectrum characterized by many discrete absorption minima in the wavelength range 700 to 2000 nm. The object of this activity was to develop a wavelength standard for improving the accuracy of reflectance measurements in the near infrared. The reflectance minima of the rare-earth oxide mixture was analyzed for the effects of varying spectral resolution and temperature. The uncertainties associated with the various parameters affecting the measurements and the determination of the location of the reflectance minima have been analyzed. The overall uncertainty in the location of these reflectance minima is believed not to exceed ± 1 nm.
A gas turbine engine test cell was developed integrating an Allison T63-A-700 helicopter engine with a superflow water brake dynamometer power absorber. Design specifications were set on all systems ...and subsystems necessary to operate the engine. Preliminary and detailed designs of the air, water, fuel, and oil systems were developed producing a construction ready overall design. Performance predictions were made which will be compared to experimental data obtained from system operation. Standard Operating Procedures (SOP) and Emergency Operational Procedures (EOP) were developed for engine and auxiliary equipment operation. Preliminary measurements for the structural response of the engine mounting have been made which set engine operating boundaries. The facility has been built and is ready for operation.
Original contains color plates: All DTIC and NTIS reproductions will be in black and white.
On May 1, 2020, the Office of the National Coordinator for Health Information Technology (ONC) of the Department of Health and Human Services (HHS) published a final rule1 (Final Rule). ...the Final ...Rule defines and relates to three different "Actors" - Healthcare Providers, IT Developers, and HINs/HIEs.13 Third, although ONC was careful to make the Final Rule consistent with HIP A A, the Final Rule overlaps and cross-references technical and important provisions of the HIPAA Privacy Rule. "14 Importantly, for purposes of the information blocking regulations, EHI does not include psychotherapy notes (as defined in HIPAA)15 or information compiled in reasonable anticipation of litigation. ...with respect to EHI, through May 2,2022 EHI includes only those data fields set forth in the United States Core Data for Interoperability (USCDI) standards, which includes, among many other things, discharge summary notes, history & physical notes, progress notes, consultation notes, radiology reports, laboratory reports, pathology reports, and procedure or operative reports.16 To constitute information blocking, Healthcare Providers have to know that a practice is unreasonable and is likely to lead to information blocking. Since publishing the Final Rule, ONC has also hosted several webinars and published Frequently Asked Questions23 that provide further examples of information blocking.
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