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The aim of this meta-analysis was to evaluate whether specific maternal HLA alleles and HLA sharing of couples are associated with the occurrence of recurrent miscarriage (RM). A systematic literature search was performed for studies that evaluated the association between HLA alleles, HLA sharing and RM. RM was defined as three or more consecutive unexplained miscarriages and a control group was included of women with at least one live birth and no miscarriages in their history. Meta-analyses were performed and the pooled odds ratio (OR) was calculated. We included 41 studies. Selection bias was present in 40 studies and information bias in all studies. Meta-analyses showed an increased risk of RM in mothers carrying a HLA-DRB1*4 (OR 1.41, 95% CI 1.05-1.90), HLA-DRB1*15 (OR 1.57, 95% CI 1.15-2.14), or a HLA-E*01:01 allele (OR 1.47, 95% CI 0.20-1.81), and a decreased risk with HLA-DRB1*13 (OR 0.63, 95% CI 0.45-0.89) or HLA-DRB1*14 (OR 0.54, 95% CI 0.31-0.94). Pooling results for HLA ...

This review summarizes the current state-of-the-art regarding the endovascular management of acute ischemic stroke. Beginning with intravenous tissue plasminogen activator, this paper traces the gradual shift of systemic thrombolysis from a competing to complementary treatment modality. Intra-arterial thrombolysis, mechanical thrombectomy with the Merci (Concentric Medical, Mountain View, California) and Penumbra (Penumbra, Inc., Alameda, California) systems, angioplasty, primary intracranial stenting, and emerging stentriever devices are sequentially reviewed. Ultimately, this paper lays the foundation for current endovascular stroke management and considers future areas of progress and research.

Genosensor technology relying on the use of carbon and gold electrodes is reviewed. The key steps of each analytical procedure, namely DNA-probe immobilisation, hybridisation, labelling and electrochemical investigation of the surface, are discussed in detail with separate sections devoted to labelfree and newly emerging magnetic assays. Special emphasis has been given to protocols that have been used with real DNA samples.

Thin films of nanocrystalline cubic AlN were synthesized by vapor–liquid–solid (VLS) route on Si and fused silica substrates at appropriate conditions. The formation of cubic AlN was confirmed by X-ray diffraction studies. We also observed that AuCl3 plays an important role as a catalyst in the synthesis of well crystalline cubic phase of AlN. Energy dispersive analysis of X-rays confirmed

Adaptive thin-film nanocomposite coatings comprised of crystalline ductile phases of gold and molybdenum disulfide, and brittle phases of diamond like carbon (DLC) and ytrria stabilized zirconia (YSZ) have been investigated by specialized microstructurally based finite-element techniques. One of the major objectives is to determine optimal crystalline and amorphous compositions and behavior related to wear and durability over a wide range of thermo-mechanical conditions. The interrelated effects of microstructural characteristics such as grain shapes and sizes, local material behavior due to interfacial stresses and strains, varying amorphous and crystalline compositions, and transfer film adhesion on coating behavior have been studied. The computational predictions, consistent with experimental observations, indicate specific interfacial regions between DLC and ductile metal inclusions are critical regions of stress and strain accumulation that can be precursors to material failure and wear. It is shown by varying the composition, resulting in tradeoffs between lubrication, toughness, and strength, the effects of these critical stresses and strains can be controlled for desired behavior. A mechanistic model to account for experimentally observed transfer film adhesion modes was also developed, and based on these results, it was shown that transfer film bonding has a significant impact on stress and wear behavior.

A simple commercial polyester polymer membrane has been found to exhibit an intense electrochromic effect. Most polymers which undergo electrochromic effects contain either transition metals or extensive conjugated systems. We have found that a simple commercial polyester membrane when coated with gold and polarised to-4 V (vs. Ag) in aprotic organic solvents displays an electrochromic colour change from a colourless to an intense red state.

PURPOSE: Misclassification can produce bias in measures of association. Sensitivity analyses have been suggested to explore the impact of such bias, but do not supply formally justified interval estimates. METHODS: To account for exposure misclassification, recently developed Bayesian approaches were extended to incorporate prior uncertainty and correlation of sensitivity and specificity. Under nondifferential misclassification, a contour plot is used to depict relations among the corrected odds ratio, sensitivity, and specificity. RESULTS: Methods are illustrated by application to a case-control study of cigarette smoking and invasive pneumococcal disease while varying the distributional assumptions about sensitivity and specificity. Results are compared with those of conventional methods, which do not account for misclassification, and a sensitivity analysis, which assumes fixed sensitivity and specificity. CONCLUSION: By using Bayesian methods, investigators can incorporate uncertainty about misclassification into probabilistic inferences.

Background: Chronic paralytic lagophthalmos is a condition that is often conservatively treated with ophthalmic ointments and eye drops, but usually requires definitive surgical correction. Purpose: An effective modification of the gold lid loading technique is described, which we have found to be the simplest and most reliable method for lid reanimation. Material: After empiric evaluations with lead fisherman's weights 'glued' to the eyelid, a custom-made gold lid weight is made by a jeweller on the basis of the tarsal dimensions of the individual patient, and then sutured to the tarsus under local anaesthesia and covered with a fine sheet of temporal galea. Other ancillary procedures (lower lid suspension, lateral tarsal strip, lateral tarsoplasty) are added as required. Methods: Between 1990 and 1996, 27 patients underwent this type of surgery, of whom 24 were re-evaluated after a mean follow-up period of 73.2 months (range 36-96 months), 14 of these for a minimum of 5 years. Results: None of the gold weights was extruded, all 24 patients experienced marked improvement of their dry-eye symptoms and expressed a high degree of satisfaction. Six patients underwent further minor surgery (lateral McLaughlin tarsorrhaphy) in order to improve relative underaction. Two patients had ptosis (less than 2 mm of asymmetry) of the affected side but refused further correction. Conclusion: The use of custom-made gold lid weights and a protective galeal layer is a simple, reliable and successful means for permanently rehabilitating paralysed eyelids.

BACKGROUND: Whether high-ratio resuscitation (HRR) provides patients with survival advantage remains controversial. We hypothesized a direct correlation between HRR infusion rates in the first 180 minutes of resuscitation and survival. STUDY DESIGN: This was a retrospective analysis of massively transfused trauma patients surviving more than 30 minutes and undergoing surgery at a level 1 trauma center. Mean infusion rates (MIR) of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (Plt) were calculated for length of intervention (emergency department [ED] time þ operating room [OR] time). Patients were categorized as HRR (FFP:PRBC > 0.7, and/or Plts: PRBC > 0.7) vs low-ratio resuscitation (LRR). Student's t-tests and chi-square tests were used to compare survivors with nonsurvivors. Cox proportional hazards regression models and Kaplan-Meier curves were generated to evaluate the association between MIR for FFP:PRBC and Plt:PRBC and 180-minute survival. RESULTS: There were 151 patients who met criteria: 121 (80.1%) patients survived 180 minutes (MIR:PRBC 71.9 mL/min, FFP 92.0 mL/min, Plt 3.5 mL/min) vs 30 (19.9%) who did not survive (MIR:PRBC 47.3 mL/min, FFP 33.7 mL/min, Plt 1.1 mL/min), p ¼ 0.43, p < 0.0001 and p < 0.011, respectively. A Cox regression model evaluated PRBC rate, FFP rate, and Plt rate (mL/min) as mortality predictors within 180 minutes to assess if they significantly affected survival (hazard ratios 1.01 [p ¼ 0.054], 0.97 [p < 0.0001], and 0.75 [p ¼ 0.01], respectively). Another model used stepwise Cox regression including PRBC rate, FFP rate, and Plt rate (hazard ratios 1.00 [p ¼ 0.85], 0.97 [p < 0.0001], and 0.88 [p ¼ 0.24], respectively), as well as possible confounding variables. CONCLUSIONS: This is the first study to examine effects of MIRs on survival. Further studies on the effects of narrow time-interval analysis for blood product resuscitation are warranted.

Objective: To investigate whether functional polymorphisms directly (HTR2A and SLC6A4 genes) or indirectly (IL-1 gene complex, APOE and ACE genes) related with serotonergic neurotransmission were associated with suicidal behavior. Subjects and methods: 227 suicide attempters, 686 non-suicidal psychiatric patients, and 420 healthy controls from a homogeneous Spanish Caucasian population were genotyped using standard methods. Results: There were no differences in genotype frequencies between the three groups. The −1438A/G [χ 2 (df)=9.80 (2), uncorrected p=0.007] and IL-1α −889C/T [χ 2 (df)=8.76 (2), uncorrected p= 0.013] genotype frequencies between impulsive and planned suicide attempts trended toward being different (not significant after Bonferroni correction). Suicide attempts were more often impulsive in the presence of −1438G/G or IL-1α −889C/T or C/C genotypes. There was interaction between the polymorphism 5-HTTLPR and age [LRT (df)=6.84 (2), p=0.033] and between the polymorphisms APOE and IL-1RA (86 bp) n [LRT (df)=12.21 (4), p= 0.016] in relation to suicide attempt lethality. Conclusion: These findings further evidence the complexity of the association between genetics and suicidal behavior, the need to study homogenous forms of the behavior and the relevance of impulsive and aggressive traits as endophenotypes for suicidal behavior.

The political districting problem has been studied since the 60's and many different models and techniques have been proposed with the aim of preventing districts' manipulation which may favor some specific political party (gerrymandering). A variety of political districting models and procedures was provided in the Operations Research literature, based on single-or multiple-objective optimization. Starting from the forerunning papers published in the 60's, this article reviews some selected optimization models and algorithms for political districting which gave rise to the main lines of research on this topic in the Operartions Research literature of the last five decades.

In our study, we hypothesized that higher caffeine intake would be associated with lower sleep duration among 13-year-old adolescents. In addition, we aimed to identify food sources of caffeine intake in this sample. Eligible participants were adolescents who were born in 1990 and attended school in Porto, Portugal, in 2003/2004. Self-administered questionnaires were used, and diet was evaluated using a food frequency questionnaire. From the 2160 eligible participants, only 1522 with valid information regarding their diet were included in this study. In our sample, the median intake of caffeine was 23.1 mg/d, with soft drinks being the major source. Ice tea presented the highest median (25th-75th percentiles) contribution (33.1% [14.0-52.1]), followed by cola (21.1% [6.4-37.6]). Regarding cocoa products, chocolate bars presented a median contribution of 5.1% (1.0-14.0), and snacks containing chocolate had a contribution of 3.0% (0.5-7.2). Coffee and tea presented a negligible contribution. Adolescents who reported less sleep duration and those who spent more time watching TV during the weekend had a significantly higher caffeine intake. Overall, boys had higher intakes of caffeine from soft drinks, and private school attendees, those who had parents with more education, who reported less television viewing time and had lower body mass index presented higher intakes of caffeine from chocolate. Considering sleeping more than 9.5 hours as a reference class, for each increase of 10 mg/d in caffeine intake, we found that the odds ratio of sleeping 8.5 hours or less was 1.12 (95% confidence interval, 1.06-1.19). Our results support the hypothesis that caffeine intake was inversely associated with sleep duration in adolescents.

This paper presents a study highlighting the predictive performance of a radial basis function (RBF) network in estimating the grade of an offshore placer gold deposit. In applying the radial basis function network to grade estimation of the deposit, several pertinent issues regarding RBF model construction are addressed in this study. One of the issues is the selection of the RBF network along with its center and width parameters. Selection was done by an evolutionary algorithm that utilizes the concept of cooperative coevolutions of the RBFs and the associated network. Furthermore, the problem of data division, which arose during the creation of the training, calibration and validation of data sets for the RBF model development, was resolved with the help of an integrated approach of data segmentation and genetic algorithms (GA). A simulation study conducted showed that nearly 27% of the time, a bad data division would result if random data divisions were adopted in this study. In addition, the efficacy of the RBF network was tested against a feed-forward network and geostatistical techniques. The outcome of this comparative study indicated that the RBF model performed decisively better than the feed-forward network and the ordinary kriging (OK).

Background: Left ventricular remodeling (LVr) is still common after ST-segment elevation myocardial infarction (STEMI). Early predictors of remodeling are being investigated. The aims of this study were to evaluate the prognostic value of speckle-tracking echocardiography for the prediction of LVr 3 months after primary percutaneous coronary intervention in patients with STEMI and to analyze the relationship between values of peak longitudinal strain of particular LV segments and relative changes of their subvolumes.

Au/Mg(OH)2 catalyst was modified with different amounts of ascorbic acid. After dehydration at 350°C, in various atmospheres, the modified Au/MgO catalysts were characterized and tested in the oxidation of CO. It has been shown for the first time that at high CO pressure supported gold chemisorbs CO and the apparent gold dispersion can be determined. The oxidation of CO was

The differential capacitance of the electrical double layer at glassy carbon, platinum and gold electrodes immersed in various ionic liquids was measured using impedance spectroscopy. We discuss the influence of temperature, the composition of the ionic liquids and the electrode material on the differential capacitance/potential curves. For different systems these curves have various overall shapes, but all include several extremes and a common minimum near the open circuit potential. We attribute this minimum to the potential of zero charge (PZC). Significantly, the differential capacitance generally decreases if the applied potential is large and moving away from the PZC. This is attributed to lattice saturation [A. A. Kornyshev, J. Phys. Chem. B, 2007, 111, 5545] effects which result in a thicker double layer. The differential capacitance of the double layer grows and specific adsorption diminishes with increasing temperature. Specific adsorption of both cations and anions influences the shapes of curves close to the PZC. The general shape of differential capacitance/potential does not depend strongly on the identity of the electrode material.

We have carried out extensive ab initio calculations on the energetics of gold atoms deposited on graphite surfaces, using different geometries and approximations. We consistently find that gold adatoms easily diffuse over this surface with a diffusion barrier of 0.05 eV. The adsorption energy is found to be more difficult to quantify within density functional theory. Combining our calculations with experimental values, we can estimate this adsorption energy to be of order 0.45 eV.

We demonstrate that interferometric lithography provides a fast, simple approach to the production of patterns in self-assembled monolayers (SAMs) with high resolution over square centimeter areas. As a proof of principle, two-beam interference patterns, formed using light from a frequency-doubled argon ion laser (244 nm), were used to pattern methyl-terminated SAMs on gold, facilitating the introduction of hydroxyl-terminated adsorbates and yielding patterns of surface free energy with a pitch of ca. 200 nm. The photopatterning of SAMs on Pd has been demonstrated for the first time, with interferometric exposure yielding patterns of surface free energy with similar features sizes to those obtained on gold. Gold nanostructures were formed by exposing SAMs to UV interference patterns and then immersing the samples in an ethanolic solution of mercaptoethylamine, which etched the metal substrate in exposed areas while unoxidized thiols acted as a resist and protected the metal from dissolution. Macroscopically extended gold nanowires were fabricated using single exposures and arrays of 66 nm gold dots at 180 nm centers were formed using orthogonal exposures in a fast, simple process. Exposure of oligo(ethylene glycol)-terminated SAMs to UV light caused photodegradation of the protein-resistant tail groups in a substrate-independent process. In contrast to many protein patterning methods, which utilize multiple steps to control surface binding, this single step process introduced aldehyde functional groups to the SAM surface at exposures as low as 0.3 J cm -2 , significantly less than the exposure required for oxidation of the thiol headgroup. Although interferometric methods rely upon a continuous gradient of exposure, it was possible to fabricate well-defined protein nanostructures by the introduction of aldheyde groups and removal of protein resistance in nanoscopic regions. Macroscopically extended, nanostructured assemblies of streptavidin were formed. Retention of functionality in the patterned materials was demonstrated by binding of biotinylated proteins.

Population screening studies have identified that up to two thirds of celiac disease (CD) cases are asymptomatic. The aim of this study was to conduct a systematic review of the expected consequences of testing for CD in the following populations: (1) patients with symptoms suggestive of CD, (2) asymptomatic at-risk populations, and (3) general population. Standard systematic review methodology was used. searches were conducted in December 2003. Pooled summary estimates were not calculated. The majority of the included studies were before-after studies, case control, or retrospective cohorts. The quality of evidence for the before-after studies is weaker. The overall strength of the evidence for this issue was fair to good. This area of research is relatively new, and further high-quality studies are required. The consequences of testing for celiac disease in symptomatic individuals appears to have a positive impact on patient-relevant outcomes. The data are less clear for those with silent CD or those with lower grade histologic lesions in small bowel biopsy. The literature suggests that compliance is less than ideal in these individuals, especially if diagnosed when adults. Long-term outcomes have not been extensively studied in those with silent CD. R ecent, large, screening programs have noted a high prevalence of celiac disease (CD) in the general population and, of those who test positive, up to two thirds are asymptomatic. 1 Prior to recommending population screening for CD, the consequences of testing and risk of long-term complications in individuals with clinical silent CD, especially those with low-grade histologic lesions on small bowel biopsy, need to be clarified.

Overall response rate was 77.1% (2,135 of 2,769). Ratings of teamwork differed substantially by operating room caregiver type, with the greatest differences in ratings shown by physicians: surgeons (F[4, 2058] = 41.73, p &lt; 0.001), and anesthesiologists (F[4, 1990] = ...

There is considerable interest in the corrosion control of thin gold plated contact surfaces of consumer electronics products. This originates in the desire to minimize the use of costly gold and other precious metals, like palladium, and their alloys, without sacrificing reliability. When the application is in adverse environments, gold plated contact finishes can enhance the reliability of the electrical contacts. However, the failure mechanisms depend strongly on the operating environment and contact plating and are time dependent processes. Numerous investigations on unloaded gold plated surfaces (unmated and tested at non-operating environmental condition) have been performed to simulate the contact failures induced by corrosion. However, no models have been proposed that account for the effects of loading electrically and mechanically on the corrosion process and selection of gold plating thickness. This article describes the study of loaded electrical contacts with the objective of setting up a comparative model between unloaded and loaded electrical contacts, which will improve the understanding of the influence of contact force and applied voltage on the selection of gold layer thickness and finish material. Contact force will improve the performance of gold finishes in stationary electrical contacts and decrease significantly, the gold plating thickness requirements compared to unloaded situation because of its effect on suppression of surface film growth. Voltage will accelerate the growth of surface film and result in the decrease of contact lifetime. ᭧

Rev Esp Cardiol. 2008;61(2):123-9 123 Introducción y objetivos. Se considera que la capacidad cardiovascular (CCV) es un marcador de salud en todas las edades. La finalidad principal de este estudio fue examinar si las recomendaciones actuales de actividad física (AF) están relacionadas con un mejor CCV en los adolescentes.

Background: Alopecia areata (AA) is considered an autoimmune disease with undetermined pathogenesis. Age at onset predicts distinct outcomes. A nationwide study of the relationship of AA with associated diseases stratified by onset age has rarely been reported.

Background: The protective effect of breast-feeding on the development of childhood asthma remains a matter of controversy. We conducted a systematic review of prospective studies that evaluated the association between exclusive breast-feeding during the first 3 months after birth and asthma. Study design: We searched the 1966-1999 MEDLINE database and reviewed reference lists of relevant articles to identify 12 prospective studies that met pre-stated inclusion criteria. Methodological aspects of the studies, duration and exclusivity of breast-feeding, and outcomes were assessed. Effect estimates were abstracted by the investigators, using a standardized approach. Results: The summary odds ratio (OR) for the protective effect of breastfeeding was 0.70 (95% CI 0.60 to 0.81). The effect estimate was greater in studies of children with a family history of atopy (OR = 0.52) than in studies of a combined population (OR = 0.73).

Surgical site infections are an important complication resulting from surgery. Before the 20th century a significant number of surgeries resulted in death from sepsis. One of the rituals resulting from efforts to reduce infection is the donning of surgical garb. A large body of literature has developed on the efficacy of these specialized garments. The available evidence for the efficacy of each individual garb at reducing surgical site infections will be explored. The relevance of this evidence to the outpatient dermatologic surgery setting will also be discussed.

Recently, Au/Ni/p-type GaN ohmic contacts annealed in an air ambient have been widely investigated. However, to obtain a low specific-contact resistance, the annealing window is limited. In this study, to understand the oxidation function of metallic Ni, the Au/Ni/p-type GaN structure was annealed in an air ambient for 10 min at various temperatures. Using x-ray photoelectron spectroscopy (XPS) analysis, the metallic Ni was oxidized into NiO and NiO1.3 compositions at annealing temperatures of 500°C and 600°C, respectively. However, metallic Ni still existed on the interface of the Ni/p-type GaN annealed at 400°C. The associated barrier heights of 0.42 eV, 0.21 eV, and 0.31 eV were obtained with p-type GaN for the Ni, NiO, and NiO1.3 contacts, respectively. The hole concentrations of p-type NiO and p-type NiO1.3 were 2.6×1016 cm−3 and 2.0×1018 cm−3, respectively. The lower hole concentration of the p-type NiO would lead to reducing the valence-band bending of the p-type GaN, as well as the barrier height for holes crossing from the p-type NiO to the p-type GaN. The formation of NiO was thus an important issue for lowering the specific-contact resistance of the Au/Ni/p-type GaN ohmic contacts annealed in an air ambient.

This paper critiques the approach taken by the Ghanaian Government to address mercury pollution in the artisanal and small-scale gold mining sector. Unmonitored releases of mercury-used in the gold-amalgamation process-have caused numerous environmental complications throughout rural Ghana. Certain policy, technological and educational initiatives taken to address the mounting problem, however, have proved marginally effective at best, having been designed and implemented without careful analysis of mine community dynamics, the organization of activities, operators' needs and local geological conditions. Marked improvements can only be achieved in this area through increased government-initiated dialogue with the now-ostracized illegal galamsey mining community; introducing simple, cost-effective techniques for the reduction of mercury emissions; and effecting government-sponsored participatory training exercises as mediums for communicating information about appropriate technologies and the environment. r

A major challenge for mineral explorers is to efficiently detect mineralisation beneath the weathered cover that extends across the landscape. Determination of the elemental composition of plants (biogeochemical exploration) can aid in the detection of buried ore deposits due to their root penetration through the weathered cover. At the coyote prospect in Western Australia a range of plant species were sampled traversing a buried Au orebody. Here it is shown that the soft spinifex (Triodia pungens) accumulated important pathfinder elements related to the mineralisation, which produced a multi-element surficial expression of the underlying ore deposit. Spinifex grasses are one of the most widespread grasses over the Australian continent and have vertical root systems that can extend for many 10s of metres through sedimentary cover and interact with buried mineral deposits and alteration zones in the underlying substrate. Spinifex biogeochemistry therefore has potential to be a low cost, low environmental impact, sampling medium for mineral exploration programs across large parts of arid Australia. The examination of similar grasses from other semi-arid and arid regions from around the world therefore also warrants further investigation.

Background: Behavioral sleep problems are common in children with attention-deficit/hyperactivity disorder (ADHD), yet their persistence or otherwise is unknown. We examined behavioral sleep problem trajectories, types of sleep problems experienced, and associated risk/protective factors. Methods: Design: Prospective cohort study. Setting: Twenty-one pediatric practices across Victoria, Australia. Participants: A total of 195 children with ADHD (5-13 years). Outcomes: Sleep problem trajectories classified as never, transient, or persistent on the basis of sleep problem severity measured at baseline, 6, and 12 months. Explanatory variables: Types of sleep problems, internalizing and externalizing comorbidities, ADHD symptom severity and medication use, autism spectrum disorder, caregiver mental health, and sociodemographic factors. Analyses: Multinomial logistic regression models.

The selective oxidation of D-glucose to D-gluconic acid was performed at both controlled (7-9.5) and free pH values in an aqueous solution in the presence of a gold on carbon catalyst using dioxygen as the oxidant under mild conditions (323-373 K, pO 2 = 100-300 kPa). No isomerization of glucose to fructose was observed during the reaction, and total selectivity to D-gluconate was obtained. A comparative study of gold and commercial palladium and platinum-derived catalysts highlighted the unique property of supported gold, i.e., it is active at low pH (2.5), whereas at a buffered higher pH (9.5), gold and bismuth-doped platinumpalladium on carbon catalysts show comparable selectivity, though gold has a higher activity. Moreover, upon recycling, gold is more stable toward deactivation, although this also depends on the operative pH. c 2002 Elsevier Science (USA)

Objective-To assess school age cognitive and achievement outcomes after prenatal cocaine exposure, controlling for confounding drug and environmental factors. Study design-At 9 years, 371 children (192 cocaine exposure, CE; 179 non-exposure, NCE) were assessed for IQ and school achievement in a longitudinal, prospective study from birth. An extensive number of confounding variables were controlled, including quality of caregiving environment, polydrug exposure, lead, iron deficiency anemia (IDA), and foster/adoptive care. Results-CE predicted poorer Perceptual Reasoning IQ with a linear relationship of the concentration of the cocaine metabolite, benzoylecgonine, to degree of impairment. Effects were mediated through birth head circumference, indicating a relationship with fetal brain growth. Negative effects of alcohol, lead, and marijuana exposure and positive effects of home environment were additive. Children with CE in foster/adoptive care had better home environments and lower lead levels. School achievement was not affected. Conclusions-There were persistent teratologic effects of CE on specific cognitive functions and additive effects of alcohol, lead, marijuana, IDA, and home environment. Documenting environmental factors in behavioral teratology studies is important because in this sample, CE was associated with better home environments and lower environmental risk for a substantial number of children.