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BackgroundThe opioid epidemic has disproportionately impacted areas in the Appalachian region of the United States. Characterized by persistent Medicaid nonexpansion, higher poverty rates, and health care access challenges, populations residing in these areas of the United States have experienced higher opioid overdose death rates than those in other parts of the country. Jefferson County, Alabama, located in Southern Appalachia, has been especially affected, with overdose rates over 2 times greater than the statewide average (48.8 vs 19.9 overdoses per 10,000 persons). Emergency departments (EDs) have been recognized as a major health care source for persons with opioid use disorder (OUD). A program to initiate medications for OUD in the ED has been shown to be effective in treatment retention. Likewise, continued patient engagement in a recovery or treatment program after ED discharge has been shown to be efficient for long-term treatment success. ObjectiveThis protocol outlines a framework for ED-initiated medications for OUD in a resource-limited region of the United States; the study will be made possible through community partnerships with referral resources for definitive OUD care. MethodsWhen a patient presents to the ED with symptoms of opioid withdrawal, nonfatal opioid overdose, or requesting opioid detoxification, clinicians will consider the diagnosis of OUD using the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) criteria. All patients meeting the diagnostic criteria for moderate to severe OUD will be further engaged and assessed for study eligibility. Recruited subjects will be evaluated for signs and symptoms of withdrawal, treated with buprenorphine-naloxone as appropriate, and given a prescription for take-home induction along with an intranasal naloxone kit. At the time of ED discharge, a peer navigator from a local substance use coordinating center will be engaged to facilitate patient referral to a regional substance abuse coordinating center for longitudinal addiction treatment. ResultsThis project is currently ongoing; it received funding in February 2019 and was approved by the institutional review board of the University of Alabama at Birmingham in June 2019. Data collection began on July 7, 2019, with a projected end date in February 2022. In total, 79 subjects have been enrolled to date. Results will be published in the summer of 2022. ConclusionsED recognition of OUD accompanied by buprenorphine-naloxone induction and referral for subsequent long-term treatment engagement have been shown to be components of an effective strategy for addressing the ongoing opioid crisis. Establishing community and local partnerships, particularly in resource-limited areas, is crucial for the continuity of addiction care and rehabilitation outcomes. International Registered Report Identifier (IRRID)DERR1-10.2196/18734

Math attitudes are related to achievement, yet we do not know how the brain supports changes in math attitudes. 51 children (54.9% female, 45.1% male; 37.3% White, 33.3% Black, 11.8% Latino, 5.9% Asian, 11.8% Other) solved a multiplication task inside the scanner when they were approximately 11 (time 1; T1) and 13 (time 2; T2) years old (i.e., mean age). Results revealed clusters in the left middle to superior temporal gyri at T1 associated with math attitudes at T1 and with their longitudinal improvement. However, changes in attitudes were not associated with brain changes over time. These findings suggest that relying on the storage of arithmetic facts, involved in memory retrieval, explains the development of positive math attitudes.

To examine whether there are common or specific deficits of reading disability (RD) in first (L1) and second languages (L2), Chinese children (9-11 years, N = 76) with or without RD who learn English as an L2 were studied during a visual word rhyming judgment task. Evidence was found for common deficits in L1 and L2 in visuo-orthographic processes in left inferior temporal gyrus and left precuneus, as well as in phonological processes in left dorsal inferior frontal gyrus as children with RD showed less activation than controls in both languages. Furthermore, the visuo-orthographic deficit appears to be a RD effect, whereas the phonological deficit appears to be a reading/performance effect. Some weak evidence for language specific effects was also found.

Attitudes toward math (ATM) predict math achievement. Negative ATM are associated with avoidance of math content, while positive ATM are associated with exerting more effort on math tasks. Recent literature highlights the importance of considering interactions between ATM and math skill in examining relations to achievement. This study investigated, for the first time, the effects of the interaction between math skill and ATM on the neurocognitive basis of arithmetic processing. We examined the effect of this interaction using a single-digit multiplication task in 9- to 12-year-old children. Results showed that higher math skill was correlated with less activation in the left inferior frontal gyrus (IFG), and positive ATM were correlated with less activation in the left IFG. The relation between ATM and the neural basis of multiplication varied depending on math skill. Only among children with lower math skill, positive ATM were associated with greater activation of the left IFG. The results suggest that positive ATM in low-skill children might encourage them to more fully engage the neurocognitive systems underlying controlled effort and retrieval of multiplication facts. Our results highlight the importance of examining the role of both attitudinal and cognitive factors on the neural basis of arithmetic development.

Socioeconomic status (SES) has been shown to influence language skills, with children of lower SES backgrounds performing worse on language assessments compared to their higher SES peers. While there is abundant behavioral research on the effects of SES, whether there are differences in the neural mechanisms used to support language skill is less established. In this study, we examined the relation between maternal education (ME), a component of SES, and neural mechanisms of language. We focused on Kindergarten children, at the beginning of formal reading education, and on a pre-reading skill, phonological awareness--the ability to distinguish or manipulate the sounds of language. We determined ME-related differences in neural activity by examining a skill-matched sample of typically achieving 5-year-old children as they performed a rhyme judgment task. We examined brain lateralization in two language processing regions, the inferior frontal gyrus (IFG) and superior temporal gyrus (STG). In the IFG, lateralization was related to ME but not skill: children with low ME showed bilateral activation compared to children with higher ME who showed leftward lateralization. In the STG, there was a skill by ME interaction on lateralization, such that children with high ME showed a positive relation between rightward lateralization and skill and children with low ME showed a positive relation between leftward lateralization and skill. Thus, we demonstrated ME is related to differences in neural recruitment during language processing, yet this difference in recruitment is not indicative of a deficit in linguistic processing in Kindergarten children.

A common feature within coastal cities is small, urbanized watersheds where the time of concentration is short, leading to vulnerability to flash flooding during coastal storms that can also cause storm surge. While many recent studies have provided evidence of dependency in these two flood drivers for many coastal areas worldwide, few studies have investigated their co-occurrence locally in detail, nor the storm types that are involved. Here we present a bivariate statistical analysis framework with historical rainfall and storm surge and tropical cyclone (TC) and extratropical cyclone (ETC) track data, using New York City (NYC) as a midlatitude demonstration site where these storm types play different roles. In contrast to prior studies that focused on daily or longer durations of rain, we apply hourly data and study simultaneous drivers and lags between them. We quantify characteristics of compound flood drivers including their dependency, magnitude, lag time and joint return periods, separately for TCs, ETCs, non-cyclone associated events, and merged data from all events. We find TCs have markedly different driver characteristics from other storm types and dominate the joint probabilities of the most extreme rain-surge compound events, even though they occur much less frequently. ETCs are the predominant source of more frequent, moderate compound events. The hourly data also reveal subtle but important spatial differences in lag times between the joint flood drivers. For Manhattan and southern shores of NYC during top-ranked TC rain events, rain intensity has a strong negative correlation with lag time to peak surge, promoting pluvial-coastal compound flooding. However, for the Bronx River in northern NYC, fluvial-coastal compounding is favoured due to a 2–6 hour lag from the time of peak rain to peak surge. [ABSTRACT FROM AUTHOR]

Quantum atomic sensors have shown great promise for vacuum metrology. Specifically, the density of gas particles in vacuum can be determined by measuring the collision rate between the particles and an ensemble of sensor atoms. This requires preparing the sensor atoms in a particular quantum state, observing the rate of changes of that state, and using the total collision rate coefficient for state-changing collisions to convert the rate into a corresponding density. The total collision rate coefficient can be known by various methods, including quantum scattering calculations using a computed interaction potential for the collision pair, measurements of the post-collision sensor-atom momentum recoil distribution, or empirical measurements of the collision rate at a known density. Observed discrepancies between the results of these methods call into question their accuracy. To investigate this, we study the ratio of collision rate measurements of co-located sensor atoms, 87Rb and 6Li, exposed to natural abundance versions of H2, He, N2, Ne, Ar, Kr, and Xe gases. This method does not require knowledge of the test gas density and is, therefore, free of the systematic errors inherent in efforts to introduce the test gas at a known density. Our results are systematically different at the level of 3% to 4% from recent theoretical and experiment measurements. This work demonstrates a model-free method for transferring the primacy of one atomic standard to another sensor atom and highlights the utility of sensor-atom cross-calibration experiments to check the validity of direct measurements and theoretical predictions. [ABSTRACT FROM AUTHOR]

Falls and osteoporosis are risk factors for fragility fractures. Bone mineral density (BMD) assessment is associated with better preventative osteoporosis care, but it is underutilized by those at high fracture risk. We created a novel electronic medical record (EMR) alert-driven protocol to screen patients in the Emergency Department (ED) for fracture risk and tested its feasibility and effectiveness in generating and completing referrals for outpatient BMD testing after discharge. The EMR alert was configured in 2 tertiary-care EDs and triggered by the term "fall" in the chief complaint, age (≥65 years for women, ≥70 years for men), and high fall risk (Morse score ≥ 45). The alert electronically notified ED study staff of potentially eligible patients. Participants received osteoporosis screening education and had BMD testing ordered. From November 15, 2020 to December 4, 2021, there were 2,608 EMR alerts among 2,509 patients. We identified 558 patients at high-risk of fracture who were screened for BMD testing referral. Participants were excluded for: serious illness (N  = 141), no documented health insurance to cover BMD testing (N  = 97), prior BMD testing/recent osteoporosis care (N  = 58), research assistant unavailable to enroll (N  = 53), concomitant fracture (N  = 43), bedridden status (N  = 38), chief complaint of fall documented in error (N  = 38), long-term care residence (N  = 34), participation refusal (N  = 32), or hospitalization (N  = 3). Of the 16 participants who had BMD testing ordered, 7 scheduled and 5 completed BMD testing. EMR alerts can help identify subpopulations who may benefit from osteoporosis screening, but there are significant barriers to identifying eligible and willing patients for screening in the ED. In our study targeting an innovative venue for osteoporosis care delivery, only about 1% of patients at high-risk of fracture scheduled BMD testing after an ED visit. Adequate resources during and after an ED visit are needed to ensure that older adults participate in preventative osteoporosis care. [ABSTRACT FROM AUTHOR]