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Community Health Workers (CHWs) have shown value in diabetes care. CHWs are often the individuals who provide behavioral lifestyle intervention to underserved communities and are often the first to assist patients in gaining appropriate access to care. As trusted members of their communities, they have the ability to significantly impact psychosocial and biomedical outcomes, making them important members of the behavioral medicine team. However, lack of recognition of CHWs within multidisciplinary teams (MDTs) gives rise to the issue of the underutilization of their services. Therefore, barriers to including CHWs in MDTs including standardized training and strategies to overcome these are discussed.

The SARS-Cov-2 pandemic changed many contemporary experiences, including how healthcare and exercise programming are delivered. As a result of the pandemic, there was an increase in virtual services and programming and there continues to be a demand for virtual options. The results from Desir et al support the use of virtual visits to successfully change lifestyle factors, specifically nutrition and physical activity. The use of individualized dietary and exercise goals were important to the success of the intervention, and should not be disregarded. As virtual healthcare and exercise continues to evolve, to maximize behavior change, we should also consider how to include the social and community aspects of exercise. Regardless, it is encouraging to see that significant advances are being made in virtual programming and that the needed engagement can occur in a virtual setting.

Pregnancy is a unique time when health care providers have more regular contact with women. Using this time to more fully understand the social influences at play can provide physicians an opportunity to leverage networks to improve health and wellbeing while stemming the exposure to health misinformation. Advocating for supportive social networks or exercise groups/programs can provide additional support and behavioral reinforcement which is needed for sustained behavior change. In this manner, fostering these networks is likely more beneficial to supporting healthy exercise behavior during pregnancy than education alone.

Resolving thermodynamic transport in three-dimensional models of stratified coronal loops is a long-standing challenge that limits progress in solving the coronal heating problem.Since three-dimensional thermal conduction in MHD has been computationally too expensive to resolve the steep temperature gradients in the transition region, two simpler approaches have been adopted: one-dimensional, field-aligned models following the thermal response to imposed forms of heating, and three-dimensional MHD models that produce the forms of Ohmic and viscous heating self-consistently but cannot consider the consequent thermodynamic response.Now, using a novel numerical technique, TRAC, we can resolve energetic transport in the transition region in fully three-dimensional MHD models.In a model of a multi-stranded coronal loop in a curved arcade, we investigate the heating produced in an 'avalanche'-like process.In such, a chain reaction of reconnection-induced local events occurs, with each event disturbing wider plasma and triggering other processes, such as shocks, jets, and turbulence, that generate heating, which we analyse with particular attention to the spatio-temporal distribution of nanoflares.At the same time, we treat the thermodynamic response of the plasma self-consistently, and study the evolving temperature profiles.Avalanches successfully propagate in curved arcades and appear capable of maintaining a hot corona with realistic temperatures and densities in heated loops.One novelty of interest lies in `campfire'-like events, with simultaneous reconnection events at disjoint sites along coronal strands, akin to recent results from Solar Orbiter.

Heterogeneity of response to paediatric obesity interventions is one of the greatest challenges to obesity care. While evaluating school-based interventions by mean changes compared to control is important, it does not provide an understanding of the individual variability in response to intervention. The objective of this study was to comprehensively review school-based interventions that reported study results in terms of response and identify definitions of response used. A scoping review was conducted using a systematic search of five scientific databases from 2009 to 2021. Inclusion criteria included randomized controlled trial design, school-based setting, weight-based outcomes (e.g., BMI, BMI z-score), weight-based outcomes analysed among youth with overweight/obesity, a study conducted in a developed country and publication in English. A total of 26 reports representing 25 unique studies were included. Overall, 19% (5/26) of articles reported response. Response was defined in three ways: maintenance/decrease in BMI z-score, decrease in BMI z-score ≥0.10, and decrease in BMI z-score ≥0.20. Few school-based interventions identified an a priori intervention goal or identified the proportion of participants who responded to the intervention. Without such evaluation participants who do not benefit are likely to be overlooked.

Funding: JR acknowledges the support of the Carnegie Trust for the Universities of Scotland. JR and AWH acknowledge the financial support of STFC through the Consolidated grant, ST/S000402/1, to the University of St Andrews. AWH acknowledges support from ERC Synergy grant ‘The Whole Sun’ (810218). CDJ acknowledges funding from the European Research Council (ERC) under grant agreement No. 647214. A ‘proof of principle’ is presented, whereby the Ohmic and viscous heating determined by a three-dimensional (3D) MHD model of a coronal avalanche are used as the coronal heating input for a series of field-aligned, one-dimensional (1D) hydrodynamic models. Three-dimensional coronal MHD models require large computational resources. For current numerical parameters, it is difficult to model both the magnetic field evolution and the energy transport along field lines for coronal temperatures much hotter than 1MK⁠, because of severe constraints on the time step from parallel thermal conduction. Using the 3D MHD heating derived from a simulation and evaluated on a single field line, the 1D models give coronal temperatures of 1MK and densities 1014--1015m−3 for a coronal loop length of 80Mm⁠. While the temperatures and densities vary smoothly along the field lines, the heating function leads to strong asymmetries in the plasma flows. The magnitudes of the velocities in the 1D model are comparable with those seen in 3D reconnection jets in our earlier work. Advantages and drawbacks of this approach for coronal modelling are discussed. Publisher PDF

INTRODUCTION The objective of this study was to develop and validate a questionnaire to better understand barriers and facilitators to physical activity among low-income, Hispanic youth. METHODS Low-income Hispanic middle and high school students were recruited to participate in this study from a public charter school district in Houston, TX. Questionnaire development and psychometric validation included scale development and question pretesting, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), construct validity, and test-retest reliability of the scales. RESULTS EFA resulted in three subscales for the Barriers to Youth Physical Activity (BYPA) scale: competing interests, environmental interests, and social barriers. CFA suggested that this three-factor model fit data adequately after removing two items that had high loading on all three factors. The BYPA subscales were internally consistent and stable. All three BYPA subscale scores were negatively correlated with self-reported physical activity. EFA for the facilitators to youth physical activity (FYPA) scale resulted in three subscales: enjoyment, family support, and socialization. CFA suggested that this three-factor model fit data adequately after removing one item that had high loading on all three factors. The FYPA subscales were internally consistent and stable. All three FYPA subscale scores were significantly positively correlated with physical activity. CONCLUSIONS The development and validation of the BYPA and FYPA scales resulted in a total of six valid subscales for assessing barriers and facilitators to physical activity among low-income, Hispanic youth. The developed subscales have the potential to assist future efforts in designing physical activity interventions to better address disparities in physical activity levels among this population.

BACKGROUND Moderate-to-vigorous physical activity (MVPA) declines during adolescence, particularly among girls. In this randomized control trial, we examined MVPA in a physical activity intervention compared to physical education (PE) class as usual (TAU), stratified by sex and weight classification. Standardized BMI (zBMI) overtime was also examined. METHODS Hispanic-American middle school students (N = 193) were recruited from a school district in Houston, Texas. Participants were randomized to either a circuit-based physical activity intervention or TAU (PE class as usual). MVPA was assessed using accelerometry at baseline and 6 months. Repeated measures ANCOVA were conducted to examine changes in MVPA, overall and stratified by sex and weight classification. This procedure was repeated for zBMI. RESULTS Participants were 12.10 ± 0.63 years old and 53% were girls. Overall those in intervention increased weekday MVPA more than TAU (F(1,190) = 7.03, p

Objective To develop a childhood obesity prevention program, Food, Feeding and Your Family (FFYF), which encourages eating self-regulation in young children. This article describes the research methods for FFYF. Activities that will be used to guide the development of the program are illustrated in a logic model. Design A randomized control trial will be conducted with participant groups randomized into 1 of 3 conditions: (1) in-class delivery of feeding content and nutrition education, (2) online delivery of feeding content and in-class delivery of nutrition education, and (3) nutrition education only. Assessments will be collected at baseline, program completion, and 6 and 12 months after completion of the program. Setting Study will be conducted through the Expanded Food and Nutrition Education Program in Colorado and Washington State. Participants Parents with 2- to 8-year-old children will be recruited from affiliated community agencies, 540 participants across both states. Interventions FFYF derives content from an empirically validated parental feeding program, Strategies for Effective Eating Development, and will be administered with Eating Smart • Being Active, an evidence-based, nutrition education curriculum. Main Outcome Measures Parents will report on feeding practices, child eating behaviors, feeding styles, and acculturation. Analysis Because of the nested nature of the data, multilevel analyses will be used: time points, within parents, and within groups.

Fear of falling is a critical component in fall prevention approaches; however, it is often overlooked in the majority of fall prevention exercises. Alternative fall prevention approaches that take fear of falling into account are necessary. This article discusses fall prevention activities that are feasible for individuals with limited mobility who have an increased fear of falling. Health care providers should consider the degree to which a patient has a fear of falling and recommend activities that fit most to their patient’s comfort level.

Background: While children have been shown to have increased BMI during the summer compared to the school year, it is not known if this may be due to seasonal variations in height or weight separately.Methods: Trained nurses measured heights (cm) and weights (kg) in a cohort of Kindergarteners (n = 7648) twice per year from the beginning of kindergarten through 5th grade. Variation in height and weight by season (school year vs. summer) was examined using separate mixed-effects models. Season, sex, and BMI trajectory group were tested as fixed effects. Random effects included repeated measurements of time, students nested within a school, intercept, and slope for growth over time. Similar models using BMIz as the outcome examined the interaction of height or weight with season.Results: The rate of height gain was greater during the school year (∼Sept to April) compared to summer (∼April to Sept) (β = -0.05, SE = 0.013, p < 0.0001). The rate of weight gain did not differ seasonally. Height gain was more strongly associated with increased BMIz during summer compared to the school year (β =.02, SE = 0.005, p p < 0.0001) and those who transitioned to a healthier weight status (β = 0.026, SE = 0.008, p = 0.004). We found a similar seasonal effect for the association between weight with BMIz among children who maintained a healthy weight status (β = 0.014, SE = 0.014, p < 0.0001).Conclusion: This study indicates seasonality in children’s height gain, gaining height at a faster rate during the school year compared to the summer, while weight gain remained relatively more consistent throughout the year. Seasonality in height and weight gain had the greatest impact on BMIz among children with a healthy weight status. Future research with more frequent measurements is needed to better understand the seasonal regulation of children’s growth and weight gain.

Health care professionals represent a population at high risk for poor health. Although this may be counterintuitive given their expertise in health, the high stress and long hours of many medical work environments present challenges for health care professionals to engage in healthy lifestyle behaviors. This is extremely problematic for the health and well-being of both health care professionals and the patients they treat. Medical settings are encouraged to implement interventions that intervene at both the enviornmental and personal level to help faciliate behavior change among health care providers.

Carbon prices are used to induce forest managers to adopt longer rotation periods, leading to higher carbon sequestration in the ecosystem and storage in harvested wood products. However, national ...

The use of screen media has significantly increased and several lifestyle consequences have occurred following this change. Screen media exposure is more common among younger age children. Multiple factors may be the reason for this; however, their use is likely reinforced. Parents seek support from screen media devices, which can help calm and occupy their children in a matter of minutes. However, resorting to electronic devices for instant relief is likely to persist due to both negative and positive reinforcement. Reinforcing screen media in this way will make the use of screen devices inextricable for parents and their children. Explaining the issue clearly and coming up with feasible solutions will help minimize the negative health effects of prolonged screen use, the general desirability of screen media devices, and also improve (and increase) healthy screen time habits in children.

From Source to Sink: Past Changes and Model Projections of Carbon Sequestration in the Global Forest Sector

Developing Detailed Shared Socioeconomic Pathway (SSP) Narratives for the Global Forest Sector

This study examines how natural disturbance can adversely affect the carbon sequestration potential of the forest, and the potential contribution that genomics might make towards offsetting these impacts when carbon is priced. A stochastic dynamic programming model of the BC interior, which includes a detailed carbon accounting module, shows that harvests are delayed as carbon prices rise, with less carbon stored in harvested wood products and more in the forest ecosystem, but an increase in the risk of natural disturbance causes the landowner to harvest sooner. As natural disturbance increases in prevalence and severity, this will somewhat offset the lengthening of rotation age that occurs when carbon is priced. With disturbance, the total amount of carbon sequestered falls significantly, but some of this can be recovered through proactive planting of genetically modified (GM) stems that are more productive and less susceptible to disturbance. To make such an investment worthwhile, however, the costs of planting GM stock should not exceed $120–$150/ha. Finally, this study suggests that a modest price of carbon (somewhat less than $25/tCO2) can be an effective incentive to encourage land owners to reduce the rotation age brought about by disturbance, and generate additional carbon offsets.

Carbon stored in harvested wood products (HWPs) can affect national greenhouse gas (GHG) inventories, in which the production and end use of HWPs play a key role. The Intergovernmental Panel on Climate Change (IPCC) provides guidance on HWP carbon accounting, which is sensitive to future developments of socioeconomic factors including population, income, and trade. We estimated the carbon stored within HWPs from 1961 to 2065 for 180 countries following IPCC carbon-accounting guidelines, consistent with Food and Agriculture Organization of the United Nations (FAOSTAT) historical data and plausible futures outlined by the shared socioeconomic pathways. We found that the global HWP pool was a net annual sink of 335 Mt of CO(2) equivalent (CO(2)e)⋅y(−1) in 2015, offsetting substantial amounts of industrial processes within some countries, and as much as 441 Mt of CO(2)e⋅y(−1) by 2030 under certain socioeconomic developments. Furthermore, there is a considerable sequestration gap (71 Mt of CO(2)e⋅y(−1) of unaccounted carbon storage in 2015 and 120 Mt of CO(2)e⋅y(−1) by 2065) under current IPCC Good Practice Guidance, as traded feedstock is ineligible for national GHG inventories. However, even under favorable socioeconomic conditions, and when accounting for the sequestration gap, carbon stored annually in HWPs is

We previously found that a 6-month multidimensional diabetes program, TIME (Telehealth-Supported, Integrated Community Health Workers, Medication-Access) resulted in improved clinical outcomes.To follow TIME participant clinical outcomes for 24 months PARTICIPANTS: Low-income Latino(a)s with type 2 diabetes DESIGN AND INTERVENTION: We collected post-intervention clinical data for five cohorts (n = 101, mean n = 20/cohort) who participated in TIME programs from 2018 to 2020 in Houston, Texas.We gathered HbA1c (primary outcome), weight, body mass index (BMI), and blood pressure data at baseline, 6 months (intervention end), and semiannually thereafter until 24 months after baseline to assess sustainability. We also evaluated participant loss to follow-up until 24 months.Participants decreased HbA1c levels during the intervention (p0.0001) and maintained these improvements at each timepoint from baseline to 24 months (p range:0.0001 to 0.015). Participants reduced blood pressure levels during TIME and maintained these changes at each timepoint from baseline until 18 months (systolic p range0.0001 to 0.0005, diastolic p range:0.0001 to 0.008) but not at 24 months (systolic: p = 0.065; diastolic: p = 0.85). There were no significant weight changes during TIME or post-intervention: weight (p range = 0.07 to 0.77), BMI (p range = 0.11 to 0.71). Attrition rates (loss to follow-up during the post-intervention period) were 5.9% (6 months), 24.8% (12 months), 35.6% (18 months), and 41.8% (24 months).It is possible for vulnerable populations to maintain long-term glycemic and blood pressure improvements using a multiple dimensional intervention. Attrition rates rose over time but show promise given the majority of post-intervention timepoints occurred during the COVID-19 pandemic when low-income populations were most susceptible to suboptimal healthcare access. Future studies are needed to evaluate longitudinal outcomes of diabetes interventions conducted by local clinics rather than research teams.

Medical professionals’ healthy eating and physical activity behaviors are likely to wane as other life events and everyday pressures increase. This is vital because as health behaviors decrease, the likelihood that this topic is addressed with patients also decreases. Increased training to improve health care providers’ knowledge about lifestyle behaviors may be inadequate to actually bring about a healthier lifestyle. The area of personal identity and value formation may shed light on a significant barrier in this area. Developing health care professionals who have values consistent with a healthy diet and physical activity, instead of just being informed about it, would increase the likelihood that healthy behavior changes are discussed with patients. Strategies to encourage value formation around healthy lifestyles among medical professionals are discussed.

Objective: This study examined the differential impact of Hurricane Harvey on adolescent standardized Body Mass Index (zBMI), physical activity, diet, and perceived stress. Methods: Prior to Hurricane Harvey, 175 ethnic minority adolescents were recruited from an independent school district in Houston. Height and weight were directly measured. The School Physical Activity and Nutrition Questionnaire assessed diet and physical activity. Stress was assessed with the Perceived Stress Scale. High hurricane impact was classified as at least 1 affirmative response to house damage, rescue, displacement, or going without food, water, or medicine. Repeated measures such as ANCOVA models were developed to assess differences in zBMI, physical activity, diet, and stress between the hurricane impact groups. Regression models were used to assess stress as a mediator of the hurricane impact and zBMI change relationship. Results: Students who were highly impacted by the hurricane had a greater decrease in zBMI than those less impacted from pre-hurricane to 15 weeks post-hurricane (95% CI 0.02 to 0.25, p Conclusion: The decrease in zBMI among highly impacted students warrants further monitoring. Perceived stress, immediately following the hurricane, impacted student growth months later.

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OBJECTIVE Early response to obesity intervention consistently predicts long-term BMI reductions. However, little is known about how changes in weight at other times in an intervention may impact long-term outcomes. This study examined the relationship between weight-related changes that occurred early and later during an intervention and the association between these changes with overall outcomes. METHODS A secondary analysis of a school-based obesity intervention with replicated efficacy among Hispanic middle school students was conducted (n = 174). Linear regression models were developed in which first and second semester changes in BMI represented as a percentage of the 95th BMI percentile (%BMIp95) were separately used to predict overall %BMIp95 outcomes. First semester changes in %BMIp95 were used to predict subsequent %BMIp95 change (i.e., second semester). RESULTS Changes in %BMIp95 during both the first and second semesters were independently associated with overall changes from baseline (e.g., at 24 months: first semester, β = 0.59, P

Background Research shows that elementary students gain weight over the summer. It is unknown if these findings apply to Hispanic adolescents. We evaluated school and summer standardized body mass index (zBMI) changes in Hispanic middle school students. Methods Hispanic middle school students were randomly assigned to a weight management program (N = 230) or control condition (N = 195). Paired sample t-tests compared zBMI change scores during the school year versus summer when not enrolled in a weight management program (eg, control group). We used 2 × 2 repeated measures analysis of variances to determine program group differences in zBMI scores across school versus summer periods separately for normal and overweight/obese students. Results In the control group, students' zBMI change scores decreased during the school year, but increased during summer for both normal weight and overweight/obese students. Program effects on zBMI indicated school year decreases and summer increases for both normal and overweight/obese students. However, zBMI scores did not differ by program status for normal weight students. Overweight/obese students in the program compared to the control group increased zBMI to a lesser extent over the summer. Conclusion For all students, zBMI increased during the summer. A school-based weight management program protected overweight/obese students against potentially greater summer weight gain.

This article examines how nutritional status is treated throughout the lifecycle. In doing so, the review identifies promising life stages during which intervention may improve nutritional status of future generations. A life course perspective suggests that nutritional changes are most likely to be sustained when they occur during times of developmental transition, such as pregnancy or adolescence. Adolescence is a unique period in which malnutrition in future generations may be addressed because it is the first life stage at which pregnancy becomes feasible and individuals seek independence from parents. A need exists to begin investigating not just how nutrition changes are sustained throughout the lifespan, but how nutritional intervention in one generation impacts the next. This intergenerational approach should be undertaken with cross-discipline collaboration to have the best chance at impacting underlying determinants of malnutrition like poverty and women’s education.

This study explored the consequences for long-term projections and impact analysis of the uncertainty in model parameters and initial conditions. Using the Global Forest Products Model, multiple replications of projections were carried out with parameters or initial condition data sampled randomly from their assumed distribution. The results showed that parameter uncertainty led to uncertainty of the projections increasing steadily with the time horizon, and more rapidly than the uncertainty stemming from initial conditions. Among the parameter uncertainties, those in the supply and demand elasticities tended to dominate the uncertainty in the other parameters describing forest growth, manufacturing activities, and trade inertia. In an application to impact analysis it was found that, due only to the uncertainty of the model parameters, and conditional on other assumptions, an assumed rise in global temperature of 2.8 °C over a century caused the forest stock in 2065 to be 2.4% to 4.0% higher in developed countries, and 2.5% to 3.9% lower in developing countries, with 68% probability, a conservative estimate of the true uncertainty given all the other factors involved in such a prediction.

We would like to acknowledge EPSRC for PhD funding through the Doctoral Training Schemes and the EPSRC National Mass Spectrometry Service Centre, Swansea for mass spectrometric analysis. The bioactive alkaloid natural product perophoramidine and the related family of compounds known as the communesins have inspired the synthesis community for more than a decade. Many of the elegant approaches have required the synthesis of complex intermediates that have not always reacted in the expected manner. In this study we describe a series of cyclic ether-containing precursors that were prepared during our synthetic studies towards these natural products. Attempts to open the cyclic ether ring and trap the resulting stabilised carbocation with a carbon nucleophile ultimately led to the preparation of a diallyl-substituted all carbon quaternary centre. Subsequent attempts to differentiate between the two allyl groups resulted in a relatively clean transformation to an unexpected compound. Extensive structural characterisation, including small molecule X-ray crystallography, showed that a dearomatisation reaction had occurred. Postprint

Food choices and eating behaviors are influenced by a wide variety of factors. However, traditional dietary advice primarily addresses health-related reasons for eating. Lifestyle medicine outcomes may be improved by helping individuals become more aware of why they eat and support individuals to increase their skills in reconciling eating for health and nonhealth purposes. Intuitive eating aims to increase individuals’ awareness of why, what, and how much they eat through mindfulness. This framework and concepts such as flexible restraint can be used to teach individuals skills that may help them improve psychological well-being and manage their weight.

Parents serve as role models and household policy makers for their children's home social environment. Also, parents may influence the home physical environment through the provision of resources to support their children's dietary, activity, and sleep behaviors. Understanding the parental characteristics related to children's home environment may allow for tailoring obesity interventions to families' needs. This study aimed to explore parental qualities (general parenting styles, parent feeding practices, and parental BMI) related to healthy home food, physical activity, media and sleep environment of toddlers. A total of 50 multi-ethnic parents with toddler age children who were enrolled in a randomized pilot study of a wellness program completed the Structure and Control in Parent Feeding (SCPF) questionnaire and Comprehensive General Parenting Questionnaire (CGPQ). Parental BMI was calculated using self-reported weight and height data. The Healthy Home Survey, the Home Food Inventory, the Sleep Environment Questionnaire, and items developed for this study were standardized and summed to create home food, physical activity, screen media, and sleep environment scores; high scores reflected healthier environments. To examine the relationships between parental qualities and the home environment, Pearson's correlation test was performed. Parental BMI and overall healthy home environment were inversely associated (r = -0.306; p = 0.032). Structure in general parenting and parental feeding practice were positively correlated with the overall healthy home environment (r = 0.336; p = 0.026) and healthy home food environment (r = 0.415; p = 0.003), respectively. The coercive control general parenting was inversely related to overall healthy home environment score (r = -0.333; p = 0.022). Based on the findings from this study, parents who provide clear communication, set consistent rules, avoid pressure to control their child's behavior, and have lower BMI tend to live in a home environment that support children's health behaviors.

En nous fondant sur des donnees relatives au differend sur le bois d’oeuvre resineux qui oppose depuis de nombreuses annees le Canada et les Etats-Unis, nous examinons les effets de politiques commerciales protectionnistes sur l’integration des marches nationaux et internationaux. Les avantages de la liberalisation des echanges sont largement reconnus et comprennent une meilleure transmission des prix du marche interieur aux marches etrangers en raison de la reduction des droits de douane et des couts des echanges commerciaux entre les pays. Nous constatons toutefois ces dernieres annees une relance des politiques commerciales protectionnistes ayant pour but de proteger certains groupes a l’echelle nationale, comme les producteurs. De telles politiques pourraient ameliorer la transmission des prix sur les marches interieurs, les consommateurs etant susceptibles de chercher des solutions moins couteuses au pays plutot qu’a l’etranger. Nous analysons ces idees a l’aide d’un modele vectoriel a correction d’erreurs a seuil, bivarie et comportant trois regimes afin d’examiner la transmission spatiale des prix entre les marches canadien et americain et sur les marches interieurs aux Etats-Unis. Pour ce faire, nous introduisons un point de rupture structurel au debut d’une periode de libre-echange donnee comprise dans notre echantillon. Les resultats donnent a penser que l’importation en franchise de droits de douane de bois d’oeuvre resineux canadien reduit considerablement les couts de transaction entre les deux pays. Les prix se transmettent ainsi plus facilement et plus rapidement du marche canadien au marche americain, mais dans le sens oppose, la rapidite de transmission n’est pas statistiquement significative. Sur le marche interieur des Etats-Unis, la vitesse d’ajustement des prix entre les regions etait plus grande avant la periode de libre-echange, ce qui tend a indiquer que les politiques protectionnistes permettent une meilleure integration du marche interieur.

The current climate emergency dictates that immediate action is required to mitigate climate change, which implies that carbon fluxes occurring 20 or more years from now are too late to have any mitigative effect. Economic models discount monetized carbon fluxes, but do not include any discussion of physical carbon fluxes. To respond to a climate emergency, however, future physical carbon fluxes need to be discounted at a high rate to incentivize action today. Using the DICE model, we demonstrate that physical discounting of carbon erodes the effectiveness of afforestation and bioenergy projects that reduce emissions over time. Our analysis indicates that policymakers need to convert concerns about climate urgency into an actual policy variable, namely, a weighting scheme that discounts future physical carbon into a current - value equivalent, thereby removing incentives to delay climate action.

Education is ubiquitous with clinical care. However, not all education supports behavioral change. Education is a broad term that encompasses the process of obtaining general knowledge, personal awareness, and skills training. Although not sufficient, education is a necessary component for behavior change. This article outlines the role of education in behavior change and offers practical suggestions for how clinicians can provide education to their patients to help them change behavior.

A new chapter of an everlasting softwood lumber trade dispute between the U.S. and Canada begins with an imposition of the countervailing duty (CVD) and anti-dumping (AD) tariffs on Canadian softwood lumber supply to the U.S. By using a 20-region global softwood lumber trade model, we examine the regional welfare impacts of CVD and AD tariffs on U.S. imports of Canadian softwood lumber in both countries. We also evaluate the welfare implications of alternative restrictive trade policies relevant to the softwood lumber trade dispute. Simulation results from a mixed complementary problem model calibrated using positive mathematical programming reveal that a 26.75% CVD and AD tariff curtails Canadian lumber shipments to the U.S. by 4.9 million cubic meters (m 3 ), reduces Canada's market share in the U.S. by nearly 5%, and encourages the U.S. domestic lumber industry to produce an additional 2.6 million m 3 . The government tax revenue and the U.S. producers' gain clearly outweigh the loss incurred by U.S. consumers. However, Canadian producers have an economic incentive to voluntarily reduce their share of the U.S. market by voluntarily restricting exports and capturing quota rents. Additionally, the foreign exchange rate has the ability to alter the effects of protectionist policies.

Hispanics are disparately affected by diabetes. Treating socioeconomically disadvantaged Hispanics is challenging due to economic and cultural barriers. Health care providers must understand that cultural beliefs about medicine and disease may have an impact on how diabetes treatment is viewed. Concepts such as susto (fright), coraje (anger), and fatalismo (fatalism) are common cultural beliefs. If these beliefs are not well understood by the health care provider, recommendations for treatment are likely to be discarded. To dismantle cultural barriers between the patient and the health care provider, there are several strategies that a health care provider can implement. For instance, a health care provider must develop trust with the patient. The health care provider could also engage a family member or promotora or promotor (community health worker) in the conversation. Furthermore, if the cultural barriers are significant, the patient may be best served by receiving treatment from someone with a better understanding of his or her background. Thus, a referral may be appropriate.

Purpose The purpose of the study was to evaluate the feasibility of integrating Community Health Workers (CHWs) as part of the team leading diabetes group visits. Methods This was a randomized controlled study that integrated CHWs as part of the team leading diabetes group visits for low-income Hispanic adults (n = 50). Group visits met for 3 hours each month for a 6-month duration. Main measures included baseline and 6-month clinical outcomes (ie, A1C, lipids), concordance with 8 standard of care guidelines (ie, screens for cervical, breast, and colon cancer) from the US Preventive Task Force and American Diabetes Association, and participant acceptability. Results Compared to control participants, the intervention group resulted in significantly better clinical outcomes or guideline concordance for the following areas: target A1C levels, retinal eye exams, diabetes foot exams, mammograms, and urine microalbumin. Significantly more individuals in the control group gained weight, whereas a greater number of participants in the intervention group lost weight. Intervention participants found the group visits highly acceptable. Conclusions Integrating CHWs as part a comprehensive diabetes group visit program is a feasible and effective system-level intervention to improve glycemic control and achieve guideline concordance.

We use a dynamic, global computable general equilibrium (CGE) model to capture the economic impacts of internet adoption, modeled through reduced demand in the newsprint and printing and writing paper (pulp and paper) industries. Global newsprint consumption is estimated to fall dramatically by 2030. We rely on estimates from another study that captures the change in global pulp and paper consumption using the global forest products model (GFPM), based on two scenarios: (i) full per capita internet adoption by 2100 and (ii) more rapid full internet adoption by 2050. We incorporate reductions in pulpwood consumption into a global multiregional dynamic CGE model to estimate economy-wide impacts in Canadian provinces, the United States, and the rest of the world. Results indicated that the year 2050 internet adoption scenario would result in a reduction in cumulative discounted gross domestic product (GDP) by as much as 17% in some regions of Canada, reduce GDP by 5.8% in the United States, and increase GDP by 3.3% in the rest of the world from 2006 to 2030. These findings highlight the costs of internet adoption, leaving net benefit analysis of adoption to future work.

This paper calculates steady state management decisions that, if followed indefinitely, provide an adaptive strategy that maximizes the value from timber and carbon sequestration when risk is present. By including carbon offsets directly in the objective function of a Markov decision process (MDP) model, we find long-term trade-offs exist between economic and ecological outcomes. An economic supply schedule is provided, which shows an exponential increase in the cost of sequestration. Moderate carbon prices effectively sequester additional CO 2 from the atmosphere while having a positive impact on ecological indicators such as size and species diversity. In contrast, high carbon prices promote more of a monoculture in order to maximize expected forest value in the long run from carbon sequestration. This study finds evidence that the optimal adaptive decisions are sensitive to the magnitude of carbon prices, and consequently, so too are ecological outcomes. While some governments acknowledge the influence carbon markets have on the ecological integrity of the forest, fluctuations in carbon prices within a cap-and-trade market likely influence the optimal decision making of the forest manager, and thus, the ecological landscape of the forest itself.

The importance of international trade for the welfare of actors in the forest sector was estimated by comparing the current state of the world with a world in pure autarky with zero imports and exports of roundwood and manufactured wood products. The analysis was done with a comparative statics application of the Global Forest Products Model. The model was first calibrated to replicate observations in the base year 2013, and then solved under autarky conditions. The results showed much variation in the effects of international trade on production, consumption, and prices across countries and sub sectors. Globally international trade did have a positive effect on the economic welfare of the sector. This was due mostly to the positive effect on the surplus of consumers, and to a lesser extent on the increase in value added in forest industries. But value added profited manufacturers in developed countries much more than in developing. Furthermore, while wood producers in developed countries increased their profits with trade, those in developing countries incurred heavy losses that negated any incentive to invest in forest conservation, management and new plantations.

Markov decision process models were extended to reflect some consequences of the risk attitude of forestry decision makers. One approach consisted of maximizing the expected value of a criterion subject to an upper bound on the variance or, symmetrically, minimizing the variance subject to a lower bound on the expected value. The other method used the certainty equivalent criterion, a weighted average of the expected value and variance. The two approaches were applied to data for mixed softwood–hardwood forests in the southern United States with multiple financial and ecological criteria. Compared with risk neutrality or risk seeking, financial risk aversion reduced expected annual financial returns and production and led to shorter cutting cycles that lowered the expected diversity of tree species and size, stand basal area, stored CO2e, and old-growth area.

Increasing physical activity (PA) is a critical issue in improving overall health. Prior attempts by public health campaigns to promote PA through health-focused messaging have faced challenges. As PA and sedentary behaviors are developed during the early childhood period (ages 0 to 5 years), this stage represents a unique opportunity for clinicians to encourage activity at the family level. Clinicians should discuss the holistic benefits of PA, including the development of social skills and relationships, motor skills that could be applicable to sports later in life, and cognitive skills that could translate to academic achievements in school. For PA to occur in children, parents should also be engaged in and model the PA behaviors, increasing the likelihood of young children learning to be physically active.

Health promotion strategies typically include changing the environment, providing supervision to decrease the likelihood an unhealthy behavior will occur, and increasing skills to make decisions supporting health in environments in which such choices are challenging to make. The first two strategies are important in improving the environment to promote healthy decision making. However, the creation of restrictive environments has repeatedly shown to not support disease prevention in the long term. Restrictive environments do not support the development of skills to make healthy choices when restrictions are not in place. This is particularly true for children who are learning to navigate their environment and make health decisions. The creation of adaptive learning environments should be prioritized to help individuals develop the skills needed for long-term health promotion.