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Introduction Health-related behavioral risk factors and obesity are linked to high risk for multiple chronic diseases. We examined the prevalence of these risk factors among American Indians and Alaska Natives (AI/ANs) compared with that of non-Hispanic Whites and across Indian Health Service (IHS) regions. Methods We used 2017 Behavioral Risk Factor Surveillance System data from participants in 50 states and the District of Columbia to assess 4 behavioral risk factors (current cigarette smoking, heavy drinking, binge drinking, and physical inactivity) and obesity. We analyzed disparities in these risk factors between AI/AN and non-Hispanic White participants, nationwide and by IHS region, by conducting log-linear regression analyses while controlling for potential confounders. Results Nationwide, crude prevalence of current smoking, physical inactivity, and obesity were significantly higher among AI/AN than non-Hispanic White participants. After adjustment for sociodemographic characteristics, AI/AN participants were 11% more likely to report current smoking (P < .05) and 23% more likely to report obesity (P < .001) than non-Hispanic White participants. These patterns persisted in most IHS regions with some exceptions. In the Southwest region, AI/AN participants were 39% less likely to report current smoking than non-Hispanic White participants (P < .001). In the Pacific Coast region, compared with non-Hispanic White participants, AI/AN participants were 54% less likely to report heavy drinking (P < .01) but 34% more likely to report physical inactivity (P < .05). Across IHS regions, AI/AN participants residing in Alaska and the Northern Plains regions had the highest prevalence of current smoking and binge drinking, and those in the Southwest and Pacific Coast regions had the lowest prevalence of current smoking. AI/AN participants in the Southwest region had the lowest prevalence of physical inactivity, and those in the Southern Plains region had the highest prevalence of obesity. Conclusions The findings of this study support the importance of public health efforts to address and improve behavioral risk factors related to chronic disease in AI/AN people, both nationwide and among IHS regions, through culturally appropriate interventions.

Background Musculoskeletal (MSK) pain from the five most common presentations to primary care (back, neck, shoulder, knee or multi-site pain), where the majority of patients are managed, is a costly global health challenge. At present, first-line decision-making is based on clinical reasoning and stratified models of care have only been tested in patients with low back pain. We therefore, examined the feasibility of; a) a future definitive cluster randomised controlled trial (RCT), and b) General Practitioners (GPs) providing stratified care at the point-of-consultation for these five most common MSK pain presentations. Methods The design was a pragmatic pilot, two parallel-arm (stratified versus non-stratified care), cluster RCT and the setting was 8 UK GP practices (4 intervention, 4 control) with randomisation (stratified by practice size) and blinding of trial statistician and outcome data-collectors. Participants were adult consulters with MSK pain without indicators of serious pathologies, urgent medical needs, or vulnerabilities. Potential participant records were tagged and individuals sent postal invitations using a GP point-of-consultation electronic medical record (EMR) template. The intervention was supported by the EMR template housing the Keele STarT MSK Tool (to stratify into low, medium and high-risk prognostic subgroups of persistent pain and disability) and recommended matched treatment options. Feasibility outcomes included exploration of recruitment and follow-up rates, selection bias, and GP intervention fidelity. To capture recommended outcomes including pain and function, participants completed an initial questionnaire, brief monthly questionnaire (postal or SMS), and 6-month follow-up questionnaire. An anonymised EMR audit described GP decision-making. Results GPs screened 3063 patients (intervention = 1591, control = 1472), completed the EMR template with 1237 eligible patients (intervention = 513, control = 724) and 524 participants (42%) consented to data collection (intervention = 231, control = 293). Recruitment took 28 weeks (target 12 weeks) with > 90% follow-up retention (target > 75%). We detected no selection bias of concern and no harms identified. GP stratification tool fidelity failed to achieve a-priori success criteria, whilst fidelity to the matched treatments achieved “complete success”. Conclusions A future definitive cluster RCT of stratified care for MSK pain is feasible and is underway, following key amendments including a clinician-completed version of the stratification tool and refinements to recommended matched treatments. Trial registration Name of the registry: ISRCTN. Trial registration number: 15366334. Date of registration: 06/04/2016.

Additional file 1. Summary of participant self-reported measures.

Metal releases have been received by the Grand Lake watershed from the Tri-State Mining District (TSMD) since the mid 1800s. To address data gaps in metal distributions in the Oklahoma portion of the watershed, streambed sediment and floodplain soil was sampled on various streams. The

Metal releases from the Tri-State Mining District (TSMD) that is located in southwestern Missouri, southeastern Kansas, and northeastern Oklahoma, have contaminated floodplain soils within the Neosho and Spring river watersheds of the Grand Lake watershed. Since the Oklahoma portion of the watershed lies within ten tribal jurisdictions, the potential accumulation of metals within plant species that are gathered and consumed by tribal members, as well as the resulting metal exposure risks to tribal human health, was a warranted concern for further investigation. Within this study, a total of 36 plant species that are commonly consumed by tribes were collected from floodplain areas that were previously demonstrated to have elevated soil metal concentrations relative to reference sites. A significant, positive correlation was shown for metal concentrations in plant tissues versus soil (n = 258; Cd: R = 0.72, p = 0.00; Pb: R = 0.52, p = 0.00; and Zn: R = 0.70, p = 0.00). Additionally, a significant difference in metal concentration distributions existed between reference and impacted plant samples (n = 210, p = 0.00 for all metals). These results proved that floodplain soils are a major contamination pathway for metal accumulation within plants, and the source of metal contamination is the result of mining releases from the TSMD. Metal accumulation within plants was found to vary according to specific metal and plant species. The lowest dietary exposure out of all plant organs sampled were associated with fruit, whereas the highest was associated with roots, stem/leaves, and low-lying leafy greens. Metals in plants were compared to weekly dietary intake limits established by the Joint FAO/WHO Expert Committee on Food Additives. Based on specific serving sizes established within this study for tribal children and adults, many plant species had sufficient concentrations to warrant tribal consumption restrictions within the floodplains of Elm Creek, Grand Lake, Lost Creek, Spring River, and Tar Creek. Importantly, these results highlighted the necessity for the issuance of plant consumption advisories for tribal communities in the watershed. A consumption restriction guide on the number of allowable servings of each species per week at specific streams was developed within this study for tribal children and adults. Results also demonstrated that soil metal concentrations do not need to be exceptionally elevated relative to reference sites in order for plants to accumulate sufficient metal concentrations to exceed dietary limits for one serving. Therefore, the exposure risk associated with the consumption of plants cannot be accurately predicted solely from metal concentrations within soils, but must be based on metal concentrations within specific plant tissues on a site-by-site basis. A weekly consumption scenario was created within this study in order to better understand the potential metal dietary exposures to child and adult tribal members who consume multiple servings of multiple plant species per day, as well as benthic invertebrates and fish from the watershed. These findings demonstrated that plants pose a greater consumption exposure risk for tribal members than benthic invertebrates or fish. Therefore, without the consideration of exposure risks associated with the consumption of plants within future human health risk assessments, tribal health risks will be severely underestimated.

This paper examines the influence of combinations of lead, zinc and copper on the hydration of cement and the extent to which these metal ions are able to penetrate the surface of a cement paste in contact with solutions containing them. The overall aim of these experiments was to establish the likely outcome of placing fresh concrete in contact with soil contaminated with these metals. Isothermal conduction calorimetry was used to examine the manner in which combinations of lead, zinc and copper in solution affect the kinetics of cement hydration. Zinc and lead ions have the effect of retarding cement hydration. The influence of copper on hydration is much more complex. Penetration of metal ions into fresh cement pastes is generally dependent on the total mass of metal ions in solution. At depths greater than 7 mm from the cement paste surface it was found that metal concentrations remained very low. The results of geochemical modelling support the Authors' proposed mechanism of large-scale precipitation of metals at the surface layer which severely limits further penetration.

Advancing technology applied to engineering production processes can result in improved output quality. However, customer requirements for improved product quality are progressing at a comparable or faster rate, which can result in increased rework and scrap levels when operating at the limits of the technology available. Competitive advantage is only possible through a better understanding of the process itself. Many processes are perceived by those who design and operate them as bordering on a “black art”, due to a limited knowledge of the complex interactions inherent in the process. With the emphasis on continuous improvement, organisations need to address the intricacies and relationships within these processes in order to overcome the quality problems they are experiencing. A case study of a low‐pressure casting process demonstrates the effectiveness and benefits of using Taguchi techniques and “Design of experiments” to provide enlightenment on the complex interrelationships inherent in this “black art” process.

Chronic diseases (e.g., heart disease, stroke, cancer, and diabetes) are the leading causes of morbidity and mortality in the United States. Engaging in healthy behaviors (e.g., quitting smoking and tobacco use, being more physically active, and eating a nutritious diet) and accessing preventive health-care services (e.g., routine physical checkups, screening for cancer, checking blood pressure, testing blood cholesterol, and receiving recommended vaccinations) can reduce morbidity and mortality from chronic and infectious disease and lower medical costs. Monitoring and evaluating health-risk behaviors and the use of health services is essential to developing intervention programs, promotion strategies, and health policies that address public health at multiple levels, including state, territory, metropolitan and micropolitan statistical area (MMSA), and county.January-December 2010.The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services and practices related to the leading causes of death and disabilities in the United States. This report presents results for 2010 for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the U.S. Virgin Islands, 192 MMSAs, and 302 counties.In 2010, the estimated prevalence of high-risk health behaviors, chronic diseases and conditions, access to health care, and use of preventive health services varied substantially by state and territory, MMSA, and county. In the following summary of results, each set of proportions refers to the range of estimated prevalence for the disease, condition, or behaviors, as reported by survey respondents. Adults reporting good or better health: 67.9%-89.3% for states and territories, 72.2%-92.1% for MMSAs, and 72.8%-95.8% for counties. Adults with health-care coverage: 69.4%-95.7% for states and territories, 45.7%-97.0% for MMSAs, and 45.7%-97.2% for counties. Adults who had a dental visit in the past year: 57.2%-81.7% for states and territories, 47.1%-83.5% for MMSAs, and 47.1%-88.2% for counties. Adults aged ≥65 years having had all their natural teeth extracted (edentulism): 7.4%-36.0% for states and territories, 4.8%-34.8% for MMSAs, and 2.4%-39.3% for counties. A routine physical checkup during the preceding 12 months: 53.8%-80.0% for states and territories, 49.5%-82.6% for MMSAs, and 49.5%-85.3% for counties. Influenza vaccination received during the preceding 12 months among adults aged ≥65 years: 26.9%-73.4% for states and territories, 51.7%-77.1% for MMSAs, and 49.3%-87.8% for counties. Pneumococcal vaccination ever received among adults aged ≥65 years: 24.7%-74.0% for states and territories, 48.6%-79.9% for MMSAs, and 47.6%-83.1% for counties. Sigmoidoscopy or colonoscopy ever received among adults aged ≥50 years: 37.8%-75.7% for states and territories, 37.3%-79.9% for MMSAs, and 37.3%-82.5% for counties. Blood stool test received during the preceding 2 years among adults aged ≥50 years: 8.5%-27.0% for states and territories, 6.7%-51.3% for MMSAs, and 6.8%-57.2% for counties. Women who reported having had a Papanicolaou test during the preceding 3 years: 67.8%-88.9% for states and territories, 63.3%-91.2% for MMSAs, and 63.2%-95.7% for counties. Women aged ≥40 years who had a mammogram during the preceding 2 years: 63.8%-83.6% for states and territories, 60.3%-86.2% for MMSAs, and 59.3%-89.7% for counties. Current cigarette smokers: 5.8%-26.8% for states and territories, 5.8%-28.5% for MMSAs, and 5.9%-29.8% for counties. Binge drinking during the preceding month: 6.6%-21.6% for states and territories, 3.6%-23.0% for MMSAs, and 3.8%-24.0% for counties. Heavy drinking during the preceding month: 2.0%-7.2% for states and territories, 1.0%-10.0% for MMSAs, and 1.0%-14.2% for counties. Adults reporting no leisure-time physical activity: 17.5%-42.3% for states and territories, 13.1%-37.6% for MMSAs, and 8.5%-39.0% for counties. Adults who were overweight: 32.6%-40.7% for states and territories, 28.5%-42.5% for MMSAs, and 27.2%-46.4% for counties. Adults aged ≥20 years who were obese: 22.1%-35.0% for states and territories, 17.1%-42.1% for MMSAs, and 13.3%-42.1% for counties. Adults with current asthma: 5.2%-11.1% for states and territories, 3.4%-14.5% for MMSAs, and 3.3%-14.6% for counties. Adults with diagnosed diabetes: 5.3%-13.2% for states and territories, 4.6%-15.4% for MMSAs, and 2.6%-18.8% for counties. Adults with limited activities because of physical, mental or emotional problems: 10.8%-28.2% for states and territories, 13.5%-38.3% for MMSAs, and 11.7%-32.0% for counties. Adults using special equipment because of any health problem: 2.8%-10.6% for states and territories, 4.5%-15.5% for MMSAs, and 1.3%-15.5% for counties. Adults aged ≥45 years who have had coronary heart disease: 5.3%-16.7% for states and territories, 6.5%-19.6% for MMSAs, and 4.9%-19.6% for counties. Adults aged ≥45 years who have had a stroke: 2.4%-7.1% for states and territories, 2.3%-8.8% for MSMAs, and 1.7%-8.8% for counties.The findings in this report indicate substantial variations in the health-risk behaviors, chronic diseases and conditions, access to health-care services, and the use of the preventive health services among U.S. adults at the state and territory, MMSA, and county levels. Healthy People 2010 (HP 2010) objectives were established to monitor health behaviors, conditions, and the use of preventive health services for the first decade of the 2000s. The findings in this report indicate that many of the HP 2010 objectives were not achieved by 2010. The findings underscore the continued need for surveillance of health-risk behaviors, chronic diseases, and conditions and of the use of preventive health-care services.Local and state health departments and federal agencies use BRFSS data to identify populations at high risk for certain health-risk behaviors, chronic diseases, and conditions and to evaluate the use of preventive health-care services. BRFSS data also are used to direct, implement, monitor, and evaluate public health programs and policies that can lead to a reduction in morbidity and mortality from chronic conditions and corresponding health-risk behaviors.

There is an increasing use of bentonite-cement single phase slurry trench cut-off walls in the U.K. to control lateral migration of leachates/gases from contaminated land sites. The majority of these cut-off walls also have a geomembrane built into them. To address some of the uncertainties related to the long term performance of these cut-off walls, particularly in very aggressive ground conditions, research is being undertaken in the U.K. at the Building Research Establishment (BRE). The work can be broadly divided into three areas: laboratory investigations of physical properties, laboratory assessment of the chemical compatibility of bentonite-cement and in-situ field investigations of existing walls.

This paper outlines an investigation into monitoring the moisture condition of cement-based materials using impedance spectroscopy techniques. Impedance measurements are made over the frequency range 20 Hz-110 MHz, and several parameters identified which could characterise the moisture condition of such materials.

N2-flxing (acetylene-reducing) bacteria were isolated from roots of five species of wild plants in southern New Mexico. Ground cherry (Physalis wrightii) had the highest frequency of roots with N2-fixing bacteria. Acetylene reduction rates of subcultures were comparable with rates exhibited by Azospirillum (300–500 nmol ethylene∙h−1). Three isolates from ground cherry were characterized to the generic level and one to the level of genus and species. Three of these isolates were identified as Enterobacter spp, while the fourth isolate was identified as Azospirillum brasilense. Inoculation of ground cherry with N2-fixing isolates had minimal effects on plant growth, plant nitrogen content, or plant acetylene reduction activity 7 weeks after inoculation. Comparisons between uninoculated and inoculated plants were generally not statistically significant. Significant acetylene reduction activity and high numbers of N2-fixing bacteria occurred only on the roots of plants grown with little or no added nitrogen.

The authors have shown from earlier work that the electrical response of cement paste to an alternating electrical field can be used as a technique for monitoring hydration and phenomena such as setting and hardening. This paper demonstrates an area in which the technique could prove effective, by showing the influence of a range of commercial admixtures on electrical response. It is clearly indicated that admixtures have a definite effect on the response characteristics.

A graduate program designed to train consulting teachers is discussed. Students were instructed in behavior modification techniques and in means of assisting regular classroom teachers with the social and academic behaviors of handicapped children. Three case studies illustrating the types of projects conducted by students are presented.

Aspirin ingestion was followed by hyperventilation, cerebellar signs, and fatal brain stem dysfunction in a patient with sickle cell disease. Autopsy showed a swollen, recently infarcted cerebellum with tonsillar herniation compressing the medulla. We propose that hypocapnea from aspirin-induced hyperventilation caused carotid artery constriction and focal cerebral hypoxia, resulting in cerebellar sickling nad infarction. Hypocapnea should be treated promptly to prevent brain damage in patients with sickle cell disease.

Recently there have appeared several reviews of the neurological complications of infectious mononucleosis. The commonest complication is that of a lymphocytic (serous) meningitis or meningoencephalitis. The rarer complications include neuritis and polyneuritis of the Guillain-Barre type. Silversides and Richardson were able to collect from the literature seven cases of the Guillain-Barre type of polyneuritis with infectious mononucleosis. Subsequent to that review there have appeared case reports by Klovstad and Vinje and Graham, Schwartz, and Chapman. Following is the report of another case, bringing the total number of cases of the Guillain-Barre type of polyneuritis associated with infectious mononucleosis to 10. Of the total, four were fatal. An 18-year-old university student was admitted to the Illinois Neuropsychiatric Institute on Jan. 1, 1951, with a history of many upper respiratory infections since the beginning of the fall term. About Dec. 23, 1950, he noticed that his legs felt somewhat weak and his

SUMMARY Various researchers in the past have shown the suitability of the binormal (also known as the joined half-Gaussian or the two-piece normal) distribution for modelling natural phenomena which exhibit skewness. There is considerable scope for extending the application of this distribution to problems encountered in business and management, particularly in statistical process control using small samples. However, a prerequisite for use in an area such as this is that the consequences of convolution, or adding together independent random variables with known distribution, is predictable. This paper describes an investigation into the convolution of binormal distributions, which verifies their reproductive properties, and derives expressions for the parameters of the resulting distribution. Sampling from the binormal distribution is examined, a theory proposed and the results verified empirically.

This is an anatomical study of veins of the brain stem and the base of the brain. The author has examined fifty brains in which the arteries were injected with a solution of India ink, water, and gelatin. The arteries and veins were dissected under a stereoscopic microscope, and, with a complete injection, he was able to classify the veins and to determine the relative independence of the path of the superficial veins in relationship to the path of the arteries. The most valuable part of this book is the excellent photographs showing in great clarity not only the veins, but also arteries and their relationship with structures of the brain. This small book, which in reality is an atlas, will be of great value to the neuroanatomist, neuroradiologist, and the neurosurgeon who is expert in microsurgery.