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Objective:In the United States, people with intellectual and developmental disabilities (IDD) vote at significantly lower rates than people without disabilities and are underrepresented in the democratic process. This paper examines predictors of voting opportunity among people with IDD receiving state-funded disability services in Virginia. Method:We used secondary data from Virginia’s 2017–2018 and 2018–2019 National Core Indicators In-Person Survey to conduct bivariate and regression analyses on possible predictors of voting opportunity identified from the literature. Results:Factors related to level of intellectual disability were significantly associated with having voting opportunity, as were several factors related to exercising other rights, including participating in the community and in self-advocacy training. Importantly, respondents who had participated in self-advocacy events were more likely to have voting opportunity and people with guardians were less likely to vote or to have had the opportunity. Conclusion:People with legal guardians may be the most likely to be excluded from the democratic process. Social workers and advocates seeking to increase voter turnout should strive to include people with more severe disabilities in self-advocacy events and other efforts to increase voting opportunity among people with IDD.

This multi-site, randomized, double-blind, confirmatory phase 3 study evaluated the efficacy and safety of 3,4-methylenedioxymethamphetamine-assisted therapy (MDMA-AT) versus placebo with identical therapy in participants with moderate to severe post-traumatic stress disorder (PTSD). Changes in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total severity score (primary endpoint) and Sheehan Disability Scale (SDS) functional impairment score (key secondary endpoint) were assessed by blinded independent assessors. Participants were randomized to MDMA-AT (n= 53) or placebo with therapy (n= 51). Overall, 26.9% (28/104) of participants had moderate PTSD, and 73.1% (76/104) of participants had severe PTSD. Participants were ethnoracially diverse: 28 of 104 (26.9%) identified as Hispanic/Latino, and 35 of 104 (33.7%) identified as other than White. Least squares (LS) mean change in CAPS-5 score (95% confidence interval (CI)) was −23.7 (−26.94, −20.44) for MDMA-AT versus −14.8 (−18.28, −11.28) for placebo with therapy (P< 0.001, d= 0.7). LS mean change in SDS score (95% CI) was −3.3 (−4.03, −2.60) for MDMA-AT versus −2.1 (−2.89, −1.33) for placebo with therapy (P= 0.03, d= 0.4). Seven participants had a severe treatment emergent adverse event (TEAE) (MDMA-AT, n= 5 (9.4%); placebo with therapy, n= 2 (3.9%)). There were no deaths or serious TEAEs. These data suggest that MDMA-AT reduced PTSD symptoms and functional impairment in a diverse population with moderate to severe PTSD and was generally well tolerated. ClinicalTrials.gov identifier: NCT04077437.

Compare prevalence of infusion reaction (IR) between infliximab (IFX) and infliximab biosimilar (IFX-abda) at standard and rapid rates and measure the impact on health care cost in children with inflammatory bowel disease (IBD). Records of subjects receiving IFX and IFX-abda were reviewed over a 21-month period. Demographics and IRs were recorded. Cost analysis utilized average wholesale pricing, infusion duration, nursing time, and infusion center throughput. Fifty-six subjects received 498 infusions. Sixteen subjects received both IFX and IFX-abda. Thirteen IRs occurred for an overall prevalence of 2.6%. One outlier subject accounted for 8 of 13 (62%) of IRs. Data were analyzed with and without the outlier. Standard rate infusion of both IFX and IFX-abda was associated with increased risk of IR compared with rapid rate but only reached significance for IFX when calculated with the outlier removed. Risk of IR was not statistically significant between IFX and IFX-abda for both standard and rapid rates. IFX-abda saved an average of $2,611 per infusion. Rapid infusion saved 70 minutes of infusion time, 20 minutes of estimated nursing time per infusion, and decreased infusion center appointment length by as much as 2 hours per infusion. Rapid IFX-abda appears safe without increased IRs and decreases cost.

Objective The use of nicardipine in congenital cardiac surgery has been guarded given the calcium sensitivity of immature myocardium and paucity of clinical data. Reports of nicardipine use have excluded neonates with single ventricles. The goal of this study was to compare the use of nicardipine and sodium nitroprusside for postoperative blood pressure control in young patients recovering from cardiac surgery.Methods All neonates (<30 days) and young infants (31-180 days) who received either sodium nitroprusside or nicardipine as first-line therapy for blood pressure control were retrospectively reviewed. Some patients had multiple index operations and each index operation was counted separately regarding treatment with sodium nitroprusside or nicardipine.Results A total of 59 patients underwent 70 procedures (24 as neonates and 46 as infants). Nicardipine was administered as initial therapy following 33 procedures (n = 28 patients), and sodium nitroprusside was administered as initial therapy following 37 index procedures (n = 31 patients). The duration of treatment was longer (P= .025) when sodium nitroprusside was the initial treatment. Five (15%) patients that received nicardipine required a second blood pressure management agent, and seven (19%) patients that received sodium nitroprusside required a second agent (P= .66). No adverse events related to titratable antihypertensive therapy were recorded in any treatment group. The use of nicardipine resulted in significant medication cost reduction. Based on average wholesale price, patient costs for sodium nitroprusside use were $182,952 ($5,544/pt), while costs for nicardipine were only $24,960 ($780/pt).Conclusions Nicardipine can be safely used as a first-line antihypertensive in infants. The use of nicardipine as initial antihypertensive therapy rather than sodium nitroprusside can lead to a significant reduction in medication costs without jeopardizing clinical outcomes.

AbstractThis study tests an empirically derived model for measuring personal opportunities for people with intellectual and developmental disabilities (IDD) using National Core Indicators In-Person Survey (NCI-IPS) state and national datasets. The four personal opportunities measured, (a) privacy rights, (b) everyday choice, (c) community participation, and (d) expanded friendships, were informed by existing conceptualizations of service as well as NCI-IPS measures. Analyses confirmed the fit of a four-factor model and demonstrated that factors were significantly and positively correlated. To demonstrate the relationships between personal opportunities and personal and environmental characteristics, we estimated a structural equation model that regressed personal opportunities on age, gender, place of residence, and level of intellectual disability. Implications for using personal opportunities for evaluating service quality of IDD systems are discussed.

Risk of relapse within the first months after alcohol use disorder (AUD) interventions is substantial among older adults. For this vulnerable group, little information exists on how this risk is associated with residual DSM‐5 AUD symptoms after treatment. To investigate among older adults who received short‐term treatment for DSM‐5 AUD (1) the prediction of drinking behaviors and quality of life 12 months after treatment initiation by 6‐month DSM‐5 AUD symptoms, AUD severity, and AUD remission, and (2) whether these DSM‐5 AUD indicators provide prognostic information beyond that gained from 6‐month alcohol use (AU) status. The international multicenter RCT “ELDERLY‐Study” enrolled adults aged 60+ with DSM‐5 AUD. We used data from the subsample of 323 German and Danish participants with complete DSM‐5 AUD criterion information 6 months after treatment initiation (61% male; mean age = 65.5 years). AU was assessed with Form 90, DSM‐5 AUD with the M.I.N.I., and quality of life with the WHOQOL‐BREF. Generalized linear models were applied to investigate the associations between 6‐month AUD indicators and 12‐month AU and quality of life. Independent of AU at 6 months, having 1 (vs. no) residual AUD symptom at 6 months predicted a 12‐month “slip,” defined as exceeding a blood alcohol concentration of 0.05% at least once during that time (OR: 3.7, 95% CI: 1.5 to 9.0), heavy episodic drinking, and hazardous use (p< 0.05). AUD remission was associated with a lower risk of a “slip” at 12 months (p< 0.05). Failed reduction/cessation was associated with poorer physical health (Coef.: −0.4, 95% CI −0.7 to −0.1). For older adults, residual AUD symptoms in the first months after short‐term treatment predict problematic AU outcomes during the first 12 months after treatment entry. Thus, residual symptoms should be addressed in this patient population during posttreatment screenings. In older adults treated for DSM‐5 alcohol use disorder (AUD), we found that having at least one residual AUD symptom at the 6 month follow‐up after treatment predicted a 12 month ‘slip’ (exceeding a blood alcohol concentration of 0.05% at least once), heavy episodic drinking, and hazardous use (adjusted for 6 month alcohol use). Few significant associations showed between specific residual symptoms at 6 months and alcohol use at 12 months and between residual symptoms and quality of life at 12 months.

This study assesses a 40‐day 3.25‐km global simulation of the Simple Cloud‐Resolving E3SM Model (SCREAMv0) using high‐resolution ground‐based observations from the Atmospheric Radiation Measurement (ARM) Green Ocean Amazon (GoAmazon) field campaign. SCREAMv0 reasonably captures the diurnal timing of boundary layer clouds yet underestimates the boundary layer cloud fraction and mid‐level congestus. SCREAMv0 well replicates the precipitation diurnal cycle, however it exhibits biases in the precipitation cluster size distribution compared to scanning radar observations. Specifically, SCREAMv0 overproduces clusters smaller than 128 km, and does not form enough large clusters. Such biases suggest an inhibition of convective upscale growth, preventing isolated deep convective clusters from evolving into larger mesoscale systems. This model bias is partially attributed to the misrepresentation of land‐atmosphere coupling. This study highlights the potential use of high‐resolution ground‐based observations to diagnose convective processes in global storm resolving model simulations, identify key model deficiencies, and guide future process‐oriented model sensitivity tests and detailed analyses. This research examines how well a kilometer grid scale global atmospheric model—the Simple Cloud‐Resolving Energy Exascale Earth System Model (SCREAMv0)—performs in simulating clouds and rainfall over the Amazon rainforest region. The model was assessed by comparing to high‐resolution ground‐based observations from the Green Ocean Amazon field campaign supported by the Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) program. The model struggles to produce enough middle‐level clouds. When comparing the simulated rainfall to radar observations, SCREAMv0 showed good performance on the diurnal pattern of rain rate, but tends to form too many small rain clusters while failing to create large ones. A possible contributor to these errors could be the inaccurate depiction of how the earth's surface and the atmosphere interact within the model. Overall, this study shows that using detailed DOE ARM data can help improve our understanding of clouds and rainfall in global storm resolving kilometer grid scale models. Convective processes in a global storm resolving model (SCREAMv0) are evaluated using ground‐based observations over a tropical rainforestSCREAMv0 captures the morning development of shallow convection and the early afternoon precipitation peak but lacks mid‐level congestusSCREAMv0 struggles to form large precipitation clusters greater than 128 km and produces smaller ones more often than observed Convective processes in a global storm resolving model (SCREAMv0) are evaluated using ground‐based observations over a tropical rainforest SCREAMv0 captures the morning development of shallow convection and the early afternoon precipitation peak but lacks mid‐level congestus SCREAMv0 struggles to form large precipitation clusters greater than 128 km and produces smaller ones more often than observed

AbstractA nuanced understanding of disparities impacting racialized people with intellectual and developmental disabilities (IDD) requires scholars employ research methods that make visible the structural factors that influence outcomes. Following the work of Tukufu Zuberi and Eduardo Bonilla-Silva, we explore race-based methodological considerations for disparities research with Black people with IDD. Specifically, we discuss (a) structural racism in research methods, employing disability critical race theory as a framework, (b) the absence of Black voices and Black scholarship, (c) the abstraction and misuse of race as a variable, and (d) mapping race as a point of discussion in the IDD discourse. Implications for research are discussed and recommendations for contextualizing race, ensuring equity in representation and dissemination, and amplifying the voices of Black scholars are provided.

Studies have found that reductions in World Health Organization (WHO) drinking risk levels may be a stable outcome of treatment for alcohol use disorder (AUD) and associated with functional improvements. The aim of this study was to investigate whether posttreatment reductions in WHO drinking risk levels are stable over time among older adults and associated with a decrease in consequences of drinking and AUD symptoms and improved quality of life. Participants. Individuals 60+ years old, suffering from DSM‐5 AUD (n= 693), and seeking outpatient treatment. Measurements. WHO drinking risk levels, prior to treatment and at all follow‐up points up to 1 year after treatment start, were assessed with Form 90. Outcomes at follow‐up included consequences of drinking (Drinker Inventory of Consequences), quality of life (WHOQOL‐BREF), and DSM‐5 AUD symptoms (Mini International Neuropsychiatric Interview). Logistic regression and linear mixed models were used to examine the probability of maintaining risk‐level reductions at follow‐up and the association between risk‐level reductions and outcomes, respectively. Reductions in risk levels were maintained over time (at least 1 level: OR 5.39, 95% CI 3.43, 8.47; at least 2 levels: OR 9.30, 95% CI 6.14, 14.07). Reductions were associated with reduced consequences of drinking and number of AUD symptoms, and minor, but statistically significant, improvements in quality of life. Maintaining reductions in WHO risk levels appears achievable for older adults seeking treatment for AUD. The small reduction of AUD symptoms and improvement of quality of life indicates that these reductions may not be adequate as the only treatment goal. Data on treatment course of 963 60+ year‐old individuals suffering from Alcohol Use Disorder (AUD) in three countries (Denmark, Germany, and the US) showed that reductions in WHO drinking risk levels were stable over a one‐year follow‐up period. Reductions were associated with reduced consequences of drinking and number of DSM‐5 AUD symptoms. Maintaining reductions in WHO risk levels appear to be achievable for older adults with AUD and may be a feasible and stable outcome for treatment.

Post-traumatic stress disorder (PTSD) presents a major public health problem for which currently available treatments are modestly effective. We report the findings of a randomized, double-blind, placebo-controlled, multi-site phase 3 clinical trial (NCT03537014) to test the efficacy and safety of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for the treatment of patients with severe PTSD, including those with common comorbidities such as dissociation, depression, a history of alcohol and substance use disorders, and childhood trauma. After psychiatric medication washout, participants (n= 90) were randomized 1:1 to receive manualized therapy with MDMA or with placebo, combined with three preparatory and nine integrative therapy sessions. PTSD symptoms, measured with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5, the primary endpoint), and functional impairment, measured with the Sheehan Disability Scale (SDS, the secondary endpoint) were assessed at baseline and at 2 months after the last experimental session. Adverse events and suicidality were tracked throughout the study. MDMA was found to induce significant and robust attenuation in CAPS-5 score compared with placebo (P< 0.0001, d= 0.91) and to significantly decrease the SDS total score (P= 0.0116, d= 0.43). The mean change in CAPS-5 scores in participants completing treatment was −24.4 (s.d. 11.6) in the MDMA group and −13.9 (s.d. 11.5) in the placebo group. MDMA did not induce adverse events of abuse potential, suicidality or QT prolongation. These data indicate that, compared with manualized therapy with inactive placebo, MDMA-assisted therapy is highly efficacious in individuals with severe PTSD, and treatment is safe and well-tolerated, even in those with comorbidities. We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation.

AbstractNational policy and litigation have been a catalyst in many states for expanding personal outcomes for people with intellectual and developmental disabilities (IDD) and have served as an impetus for change in state IDD systems. Although several metrics are used to examine personal outcomes, the National Core Indicators (NCI) In-Person Survey (IPS) is one tool that provides an annual depiction of the lives of people who receive Medicaid Home and Community Based IDD waiver services (HCBS). This article examines whether a validated, three-factor (Privacy Rights, Everyday Choice, and Community Participation) measure of Personal Opportunity, derived from NCI items, functions as predicted across non-equivalent, NCI cohorts (N= 2400) from Virginia in 2017, 2018, and 2019. Multiple-groups confirmatory factor analysis (CFA) was employed to examine the invariance and generalizability of the Personal Opportunity constructs. Results indicated that Privacy Rights, Everyday Choice, and Community Participation measured the same concepts even when time and group varied. Significant improvements in Privacy Rights and Community Participation were observed when comparing latent factor means across years. Findings provide stakeholders with a tool for interpreting personal outcomes in the contexts of policy and practice intended to improve inclusion and quality of life for adults with IDD.

We reanalyzed a multisite 26‐week randomized double‐blind placebo‐controlled clinical trial of 600 mg twice‐a‐day Gabapentin Enacarbil Extended‐Release (GE‐XR), a gabapentin prodrug, designed to evaluate safety and efficacy for treating alcohol use disorder. In the original analysis (n= 338), published in 2019, GE‐XR did not differ from placebo. Our aim is to advance precision medicine by identifying likely responders to GE‐XR from the trial data and to determine for likely responders if GE‐XR is causally superior to placebo. The primary outcome measure in the reanalysis is the reduction from baseline of the number of heavy drinking days (ΔHDD). Baseline features including measures of alcohol use, anxiety, depression, mood states, sleep, and impulsivity were used in a random forest (RF) model to predict ΔHDD to treatment with GE‐XR based on those assigned to GE‐XR. The resulting RF model was used to obtain predicted outcomes for those randomized to GE‐XR and counterfactually to those randomized to placebo. Likely responders to GE‐XR were defined as those predicted to have a reduction of 14 days or more. Tests of causal superiority of GE‐XR to placebo were obtained for likely responders and for the whole sample. For likely responders, GE‐XR was causally superior to placebo (p< 0.0033), while for the whole sample, there was no difference. Likely responders exhibited improved outcomes for the related outcomes of percent HDD and drinks per week. Compared with unlikely responders, at baseline likely responders had higher HDDs; lower levels of anxiety, depression, and general mood disturbances; and higher levels of cognitive and motor impulsivity. There are substantial causal benefits of treatment with GE‐XR for a subset of patients predicted to be likely responders. The likely responder statistical paradigm is a promising approach for analyzing randomized clinical trials to advance personalized treatment. Individuals with AUD likely to respond to Gabapentin XR were identified based on predictive baseline clinical features. Their responses were causally superior to a matched group assigned to placebo. At baseline, likely responders had more heavy drinking days, lower levels of depression and anxiety and higher levels of cognitive and motor impulsivity. In the whole sample, there were no between treatment differences. The likely responder statistical paradigm as a valuable approach to analyzing RCTs and for advancing precision medicine.

This study examines marine boundary layer cloud regime transition during a cold air outbreak (CAO) over the Norwegian Sea, simulated by a global storm‐resolving model (GSRM) known as the Simple Cloud‐Resolving Energy Exascale Earth System Model Atmosphere Model (SCREAM). By selecting observational references based on a combination of large‐scale conditions rather than strict time‐matched comparisons, this study finds that SCREAM qualitatively captures the CAO cloud transition, including boundary layer growth, cloud mesoscale structure, and phase partitioning. SCREAM also accurately locates the greatest ice and liquid in the mesoscale updrafts, however, underestimates supercooled liquid water in cumulus clouds. The model evaluation approach adopted by this study takes advantages of the existing computational‐expensive global simulations of GSRM and the available observations to understand model performance and can be applied to assessments of other cloud regimes in different regions. Such practice provides valuable guidance on the future effort to correct and improve biased model behaviors. Cold air outbreaks occur when cold, dry air moves over warmer ocean regions, forming extensive boundary layer clouds. However, current climate models struggle to accurately represent these clouds due to their complex nature. This study examines the performance of the global storm‐resolving model, the Simple Cloud‐Resolving Energy Exascale Earth System Model Atmosphere Model (SCREAM), in simulating marine boundary layer clouds during cold air outbreaks over the Norwegian Sea. This study compares the SCREAM simulated clouds during a cold air outbreak event to observations under similar large‐scale conditions from satellites and ground‐based measurements collected during a field campaign of the Atmospheric Radiation Measurement program. The results indicate that SCREAM successfully simulates three distinct cloud patterns during cold air outbreaks with credible mesoscale structures. Yet, it tends to underestimate supercooled liquid water and consequently, the cloud liquid water fraction, especially in cumulus clouds. The study suggests that using high‐resolution observations under similar large‐scale conditions can effectively evaluate global storm‐resolving models. This approach helps identify areas for improvement without requiring expensive global storm‐resolving model simulation designed for specific cases. The Simple Cloud‐Resolving Energy Exascale Earth System Model Atmosphere Model (SCREAMv0), at a resolution of 3 km, simulated three distinctive cloud regimes in cold air outbreaks with credible mesoscale structuresSCREAMv0 qualitatively captures the transition of the cloud phase partitioning based on high‐resolution observationsObservations selected based on similar large‐scale conditions can be important references for global storm‐resolving model evaluation The Simple Cloud‐Resolving Energy Exascale Earth System Model Atmosphere Model (SCREAMv0), at a resolution of 3 km, simulated three distinctive cloud regimes in cold air outbreaks with credible mesoscale structures SCREAMv0 qualitatively captures the transition of the cloud phase partitioning based on high‐resolution observations Observations selected based on similar large‐scale conditions can be important references for global storm‐resolving model evaluation

Self-direction is an approach to human service delivery within long-term services and supports that aims to provide greater control for individuals with disabilities and their closest supporters. The purpose of this study was to understand the implementation of self-directed supports for individuals with intellectual and developmental disabilities. Researchers interviewed state developmental disabilities administrators in 34 of 42 states that currently operate self-directed service options and used qualitative analysis to arrive at a thematic map of the strengths and challenges currently experienced by state administrators. Common strengths identified by state administrators were increased opportunities for participant self-determination and improved relationships with support staff. Common challenges included restructuring case management relationships, as well as rulemaking and enforcement. Administrators’ suggestions for the future of self-direction focused on increasing program size and streamlining services using technology.

More than 80% of newborn infants experience jaundice as a result of elevated bilirubin during the first few weeks after birth. In most cases, hyperbilirubinemia is physiologic, but persistent and extreme elevations can lead to serious long-term complications, such as kernicterus. To avoid these complications and help clinicians in the successful assessment, evaluation, and treatment of hyperbilirubinemia, the American Academy of Pediatrics updated its clinical practice guideline for neonatal hyperbilirubinemia. This article reviews the guideline and highlights significant updates, such as an elevation in the threshold for phototherapy and exchange transfusion, inclusion of gestational age, and removal of racially based norms.

People with intellectual and developmental disabilities (IDD) were disproportionately affected by the COVID-19 pandemic. Predicting COVID-19 infection has been difficult.

Abstract.Background:The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial “ELDERLY-Study” with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims:To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results:Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion:European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors.

We describe ring‐necked pheasant (Phasianus colchicus) habitat needs, historical U.S. cropland conversion programs (CCPs), research documenting pheasant responses to these programs, and make policy recommendations for programs to more efficiently elicit such responses. Cropland conversion program principles supported in the pheasant literature include establishment of an initial seeding, a multiyear contract structure, prohibition of mowing during the nesting season, promotion of forbs in seedings, provision of large‐block enrollments options, and inclusion of midcontract management. These principles are compatible with the habitat needs of many other grassland bird species. We therefore recommend the Conservation Reserve Program (CRP) and any future CCPs retain these foundational aspects. Initial plantings of higher diversity seed mixes have become prioritized over time, but we note whatever increase in average habitat quality these standards achieved, it was not enough to prevent widespread pheasant declines following more severe statutory limitations on CRP acreage enrollments beginning in 2008, coupled with long‐term declines in other habitat types (e.g., hay, pasture, small grains). When faced with a trade‐off, we thus recommend emphasis of enrolled area over quality, provided enrolled herbaceous tracts provide adequate structure (≥3 dm of 100% visual obstruction) and canopy cover components (>5% forbs and >5% bare ground). Efficiencies may also be gained by altering initial seeding rates, offsetting program costs using grazing income, allowing more discretion in the use of midcontract management, and prioritizing enrollments in focus areas. Individual states, U.S. Department of Agriculture, and bird conservation joint ventures should work cooperatively to share data and perform return‐on‐investment–oriented research at multiple spatial scales concerning the effects of CCPs on pheasants. © 2018 The Wildlife Society. As U.S. policymakers consider a new federal Farm Bill, we reviewed ring‐necked pheasant habitat needs, demography, and responses to past Farm Bill programs to identify potential policy improvements. We concluded that increasing the area enrolled in the Conservation Reserve Program is the most urgent pheasant conservation need, but other changes in program delivery could also yield substantial benefits.

ABSTRACTThe number of interventions available for children with autism spectrum disorder (ASD) has expanded greatly in recent years, although relatively little is known about the factors that influence family caregivers as they make treatment decisions for their children. This study involved a statewide survey of parents of young children with ASD to examine the relative weights of the factors that influenced their treatment decisions. Results suggested that caregivers rely on their own intuition for much decision making, although selected professionals are also influential. Implications for professionals working with children with ASD and their families are discussed.

Congenital diaphragmatic hernias (CDHs) and structural anomalies of the diaphragm are a common class of congenital birth defects that are associated with significant morbidity and mortality due to associated pulmonary hypoplasia, pulmonary hypertension and heart failure. In ∼30% of CDH patients, genomic analyses have identified a range of genetic defects, including chromosomal anomalies, copy number variants and sequence variants. The affected genes identified in CDH patients include transcription factors, such as GATA4, ZFPM2, NR2F2 and WT1, and signaling pathway components, including members of the retinoic acid pathway. Mutations in these genes affect diaphragm development and can have pleiotropic effects on pulmonary and cardiac development. New therapies, including fetal endoscopic tracheal occlusion and prenatal transplacental fetal treatments, aim to normalize lung development and pulmonary vascular tone to prevent and treat lung hypoplasia and pulmonary hypertension, respectively. Studies of the association between particular genetic mutations and clinical outcomes should allow us to better understand the origin of this birth defect and to improve our ability to predict and identify patients most likely to benefit from specialized treatment strategies.

To evaluate the potential of using peripheral monocyte inflammatory response as a biomarker for opioid-associated iatrogenic withdrawal syndrome (IWS) in critically ill children receiving fentanyl infusion during early postsurgical period.

To assess marine boundary layer (MBL) cloud simulations in three versions of the Community Atmosphere Model (CAM), three sets of short‐term global hindcasts are performed and compared to Atmospheric Radiation Measurement Program (ARM) observations on Graciosa Island in the Azores from June 2009 to December 2010. The three versions consist of CAM5.3 with default schemes (CAM5.3), CAM5.3 with Cloud Layers Unified By Binormals (CLUBB‐MG1), and CAM5.3 with CLUBB and updated microphysics scheme (CLUBB‐MG2). Our results show that relative to CAM5.3 default schemes, simulations with CLUBB better represent MBL cloud base height, the height of the major cloud layer, and the daily cloud cover variability. CLUBB also better simulates the relationship of cloud fraction to cloud liquid water path (LWP) most likely due to CLUBB's consistent treatment of these variables through a probability distribution function (PDF) approach. Subcloud evaporation of precipitation is substantially enhanced in simulations with CLUBB‐MG2 and is more realistic based on the limited observational estimate. Despite these improvements, all model versions underestimate MBL cloud cover. CLUBB‐MG2 reduces biases in in‐cloud LWP (clouds are not too bright) but there are still too few of MBL clouds due to an underestimate in the frequency of overcast scenes. Thus, combining CLUBB with MG2 scheme better simulates MBL cloud processes, but because biases remain in MBL cloud cover CLUBB‐MG2 does not improve the simulation of the surface shortwave cloud radiative effect (CRESW). Three versions of CAM short‐term hindcasts are performed and compared to ARM observations from the AzoresCAM5 with CLUBB and MG2 scheme (CLUBB‐MG2) better simulates MBL cloud processesCLUBB‐MG2 does not improve the surface SW CRE mainly due to its MBL cloud cover biases

AbstractSocial inclusion for people with intellectual and developmental disabilities (IDD) is an issue of emerging importance in research, policy, and practice. Though strides have been made to improve community living, inclusive education, and improved employment opportunities for many individuals with IDD, social inclusion has been slower to evolve. A diverse group of stakeholders met at the National Goals 2015 Conference to develop the following set of goals designed to promote better social inclusion in the next 10 years: (a) develop measures for social inclusion, (b) examine how personal and community contexts shape inclusion, (c) embed measures of inclusion in research about other life domains, (d) build capacity for social inclusion, (e) identify best practices for promoting inclusion from the community perspective, and (f) understand life course trajectories that impact inclusion. The goals are discussed in more detail in this article.

Background: Pain management is a frequent problem in the neonatal intensive care unit (NICU). Few studies examining effects of integrative care therapies on pain-related outcomes in neonates have included physiological outcomes or investigated the use of such therapies in a practice-based setting.Objective: The purpose of this practice-based retrospective study was to examine the associations between integrative care therapies, particularly massage and healing touch, and pain-related outcomes among hospitalized infants.Methods: We conducted a retrospective review of a clinical database from a level III NICU regularly delivering integrative care therapies. Paired-samples t-tests were used to examine associations between integrative care therapies and 4 pre-post outcome measures: therapist-rated pain and presentation (ranging from asleep to agitated) and neonates’ heart rate and oxygen saturation.Results: Of 186 patients (Mage=68 days), 58% were male and 67% were Caucasian. Sixty-two percent received both massage and healing touch; the remainder received a single therapy. From pre-post therapy, statistically significant changes were observed in infants’ heart rate (Mpre=156 vs Mpost=140 per minute; P<.001), oxygen saturation (Mpre=95.0% vs.Mpost=97.4%; P<.001), and therapist-reported pain (Mpre=2.8 vs Mpost=0.2; P<.001) and presentation (Mpre=3.2 vs. Mpost=1.0; P<.001).Conclusion: Observed improvements in pain-related outcomes suggest that massage and healing touch may be useful integrative therapies to consider as pain management options in the NICU.

IMPORTANCE: Medical treatment settings such as emergency departments (EDs) present important opportunities to address problematic substance use. Currently, EDs do not typically intervene beyond acute medical stabilization. OBJECTIVE: To contrast the effects of a brief intervention with telephone boosters (BI-B) with those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients. DESIGN, SETTING, AND PARTICIPANTS: Between October 2010 and February 2012, 1285 adult ED patients from 6 US academic hospitals, who scored 3 or greater on the 10-item Drug Abuse Screening Test (indicating moderate to severe problems related to drug use) and who were currently using drugs, were randomized to MSO (n = 431), SAR (n = 427), or BI-B (n = 427). Follow-up assessments were conducted at 3, 6, and 12 months by blinded interviewers. INTERVENTIONS: Following screening, MSO participants received only an informational pamphlet. The SAR participants received assessment plus referral to addiction treatment if indicated, and the BI-B participants received assessment and referral as in SAR, plus a manual-guided counseling session based on motivational interviewing principles and up to 2 “booster” sessions by telephone during the month following the ED visit. MAIN OUTCOMES AND MEASURES: Outcomes evaluated at follow-up visits included self-reported days using the patient-defined primary problem drug, days using any drug, days of heavy drinking, and drug use based on analysis of hair samples. The primary outcome was self-reported days of use of the patient-defined primary problem drug during the 30-day period preceding the 3-month follow-up. RESULTS: Follow-up rates were 89%, 86%, and 81% at 3, 6, and 12 months, respectively. For the primary outcome, estimated differences in number of days of use (95% CI) were as follows: MSO vs BI-B, 0.72 (−0.80 to 2.24), P (adjusted) = .57; SAR vs BI-B, 0.70 (−0.83 to 2.23), P (adjusted) = .57; SAR vs MSO, −0.02 (−1.53 to 1.50), P (adjusted) = .98. There were no significant differences between groups in self-reported days using the primary drug, days using any drug, or heavy drinking days at 3, 6, or 12 months. At the 3-month follow-up, participants in the SAR group had a higher rate of hair samples positive for their primary drug of abuse (265 of 280 [95%]) than did participants in the MSO group (253 of 287 [88%]) or the BI-B group (244 of 275 [89%]). Hair analysis differences between groups at other time points were not significant. CONCLUSIONS AND RELEVANCE: In this sample of drug users seeking emergency medical treatment, a relatively robust brief intervention did not improve substance use outcomes. More work is needed to determine how drug use disorders may be addressed effectively in the ED. TRIAL REGISTRATION: clinicaltrials.gov Identifier:NCT01207791

Immigrant and refugee populations and people with disabilities are known to have inequitable access to a range of health services. Very little study has been undertaken, however, about immigrants who have disabilities and their experience of the American health care system.

Increased horizontal and vertical resolution in global atmospheric models can reduce a significant amount of the biases associated with subtropical marine stratocumulus. The sensitivity of offshore and coastal marine stratocumulus to different horizontal and vertical resolutions has been investigated by using Energy Exascale Earth System Model (E3SM) coupled with the novel Framework for Improvement by Vertical Enhancement which has been demonstrated as a viable tool to improve the representation of marine stratocumulus while saving computational cost. Our study shows that high vertical resolution is the key to improve marine stratocumulus simulations in E3SM. Concurrent horizontal and vertical resolution increases are needed for substantial overall reduction of stubborn marine stratocumulus biases over the coastal region but not necessarily in the offshore area. Most global climate models (GCMs) underestimate low‐level clouds. Increasing vertical or horizontal resolution in GCMs could eliminate potential causes contributing to the problem. In this study, we use a new computational method, known as the Framework for Improvement by Vertical Enhancement, coupled with the Energy Exascale Earth System Model to investigate the sensitivity of offshore and coastal marine stratocumulus to different horizontal and vertical resolutions. Our results show that vertical resolution is more important than the horizontal resolution in simulating realistic marine stratocumulus; however, concurrent horizontal and vertical resolution increases are needed for substantial overall reduction of stubborn marine stratocumulus biases over the coastal region, especially along the coastal region of Peru. Concurrent increases in the horizontal and vertical resolution are essential for major bias reduction in subtropical marine stratocumulusCoastal stratocumulus benefit more from high horizontal resolution, whereas high vertical resolution is more critical for offshore oneA novel framework for running selected physics parameterizations on a higher vertical resolution grid reduces computational cost Concurrent increases in the horizontal and vertical resolution are essential for major bias reduction in subtropical marine stratocumulus Coastal stratocumulus benefit more from high horizontal resolution, whereas high vertical resolution is more critical for offshore one A novel framework for running selected physics parameterizations on a higher vertical resolution grid reduces computational cost

AbstractCognitive control refers to the internal representation, maintenance, and updating of context information in the service of exerting control over thoughts and behavior. Deficits in cognitive control likely contribute to difficulty in maintaining abstinence in individuals with alcohol use disorders (AUD). In this article, we define three cognitive control processes in detail (response inhibition, distractor interference control, and working memory), review the tasks measuring performance in these areas, and summarize the brain networks involved in carrying out these processes. Next, we review evidence of deficits in these processes in AUD, including both metrics of task performance and functional neuroimaging. Finally, we explore the clinical relevance of these deficits by identifying predictors of clinical outcome and markers that appear to change (improve) with treatment. We observe that individuals with AUD experience deficits in some, but not all, metrics of cognitive control. Deficits in cognitive control may predict clinical outcome in AUD, but more work is necessary to replicate findings. It is likely that performance on tasks requiring cognitive control improves with abstinence, and with some psychosocial and medication treatments. Future work should clarify which aspects of cognitive control are most important to target during treatment of AUD.

Recent developments in the study of classic hallucinogens, combined with a re-appraisal of the older literature, have led to a renewal of interest in possible therapeutic applications for these drugs, notably their application in the treatment of addictions. This article will first provide a brief review of the research literature providing direct and indirect support for the possible therapeutic effects of classic hallucinogens such as psilocybin and lysergic acid diethylamide (LSD) in the treatment of addictions. Having provided a rationale for clinical investigation in this area, we discuss design issues in clinical trials using classic hallucinogens, some of which are unique to this class of drug. We then discuss the current status of this field of research and design considerations in future randomized trials.

Self-directed supports are a program or service option in which individuals with Intellectual and Developmental Disabilities (IDD), their families, and their allies directly manage their supports. This study explores the perspectives of county-level administrators in the implementation of one state’s self-directed support option for people with IDD. Perspectives of local-level administrators are important as they have key leadership roles concerning policy, program implementation, and program accountability. As the prevalence of self-directed supports increases, it is important to understand both the successes and challenges faced by local administrators as they implement this service option. A qualitative research methodology was used for this study, following a grounded theory analytic approach. In-depth semi-structured telephone interviews were conducted with county directors of Developmental Disability Services as the primary source of data for this study. Analysis of the semi-structured interviews with the county-level administrators and staff revealed both successes and challenges with the self-directed waiver option. Many county administrators cited changes in professional philosophy, improved quality of life, higher staff quality, and lower costs as major sucof the self-directed waiver option. Challenges of the self-directed waiver option consisted of need for clear policy guidelines, program changes, and monitoring of outcomes. The results of this study illuminate both the successes and chalof self-directed service implementation for individuals with IDD from the perspectives of the local adminwho are responsible for the direct management of programs for individuals with IDD. This research presents important implications for the design, implementation, and modification of future self-directed initiatives.

Background: Adolescence is a period in which cognition and brain undergo dramatic parallel development. Whereas chronic use of alcohol and marijuana is known to cause cognitive impairments in adults, far less is known about the effect of these substances of abuse on adolescent cognition, including possible interactions with developmental processes.

Range-wide declines in northern bobwhite populations (Colinus virginianus) have been attributed to concomitant loss of breeding habitat. Bobwhite management efforts to restore this habitat resource can be informed by empirical studies of associations between breeding success and multi-scale habitat attributes. We compared bobwhite nest success in 2 southern Iowa landscapes as a function of microhabitat and landscape composition. Lake Sugema Fish and Wildlife Area (LSWA) was managed to promote bobwhite recruitment, and Harrisburg Township (HT) was an adjacent landscape dominated by private agricultural production. Survival rate modeling based on telemetry data provided evidence for age-specific daily nest survival rate. Daily survival rates decreased as nest age increased, but the decline was more severe at HT. Nest survival at LSWA (S?=?0.495, SE?=?0.103) was nearly twice that on HT (S?=?0.277, SE?=?0.072). We found no evidence that habitat composition or spatial attributes within 210?m of a nest site significantly influenced nest success. Forb canopy at the nest site had a positive influence on nest success at HT but not at LSWA. We suggest nesting habitat with greater forb canopy cover will increase the opportunity for nesting success in landscapes with limited nesting habitat. © 2010 The Wildlife Society.

The purpose of this study was to explore changes in transaminase values associated with buprenorphine treatment and hepatitis C status among opioid-dependent subjects aged 15 to 21 years.

Background: This study investigated whether subgroups of alcohol‐dependent patients responded differently to naltrexone versus placebo in the NIAAA COMBINE study. In particular, the A versus B and the Early Onset versus Late Onset typologies were examined. Relative to Type A alcoholics, Type B alcoholics are characterized by greater severity, earlier onset, stronger family history, more childhood risk factors (e.g., conduct disorder), and greater frequency of comorbid psychiatric and substance use disorders.

AbstractA large literature exists on population dynamics of ring-necked pheasant (Phasianus colchicus) in North America, but there has not been an attempt to formulate a matrix model nor a sensitivity analysis of the relationships between vital rates and population finite growth rate (?) that can be used to guide management. We summarized demographic data available from a 5-year field study in Iowa, USA, collected in Kossuth County (low composition of perennial habitat) and Palo Alto County (high composition of perennial habitat) into a 2-stage (young and adult) matrix projection model. We estimated ?1(the dominant eigenvalue of the deterministic matrix), the stable age distribution (?), relative reproductive value vector (n¨), other demographic parameters, and ?iid, a bootstrap estimate of growth that includes interannual variation in life history parameters. We analyzed the relative importance of vital rates on population growth rate using sensitivity and elasticity of both matrix elements and lower-level parameters such as winter survival and nest success. We first characterized general life history using averaged data from both areas and all years that yielded ?1= 1.086, and a stable stage distribution of. Minimum success of the initial nesting attempt (H1) that would maintain ? = 1 under average conditions was estimated to be 42%. Changes in ?1were most sensitive to survival of chicks during brood rearing (SB), followed in importance by survival during the subsequent winter (SW), followed by H1. We followed the general analyses with analyses that helped us to focus on the differences in the landscapes of northwest Iowa. ?iidwas =1 in only 9% of simulations of data from Kossuth whereas estimated ?iidwas =1 in 88% of simulations from Palo Alto. Our analyses of the relative importance and interactions between SB, SW, and total recruitment (M, including H1and renesting), if combined with data more specific to a local area, would guide management aimed at affecting multiple life history stages whose relative importance will vary across the landscape.

Abstract: An increasing number of state and national databases are available to assess agricultural and environmental trends in natural resource populations. We use a case study approach to consider methodologies for combining state and national data to assess the impact of agricultural policy on state wildlife populations. The scientific question is to assess the impact of the Conservation Reserve Program on pheasant populations in Iowa, using land cover/use data from the National Resources Inventory and count data from an annual state pheasant population survey. Our approach involves identifying a common spatial polygon for linking summaries from each of two datasets, and then estimating parameters that describe temporal trends in land cover and in pheasant populations over a common time period within each polygon. Estimated pheasant population parameters are regressed on land cover summaries to investigate the impact of the Conservation Reserve Program on pheasant populations in regions of the state. Results reveal that the population response to the Conservation Reserve Program varies by region in relation to the physiography and agricultural use of the region, in ways that were not anticipated by policy developers. Statistical considerations for developing appropriate models for combining data are discussed.

AbstractIn the past several years there has been a dramatic proliferation of drug-related sites on the Internet. This article reviews the information found at selected Internet drug information libraries, and comments on its accuracy and implications. Drug-related sites were found by initially performing an Internet search on “psychoactive drugs” and then exploring links among the sites identified. Sites were chosen on the basis of comprehensiveness of information and positive or tolerant attitude toward drug use. While all classes of drugs are discussed at these sites, the primary foci of interest are synthetic and naturally occurring hallucinogens. Many of the biological materials discussed are legal and readily available. Information surveyed at these sites was largely accurate regarding the effects of various substances and biological sources of psychoactive compounds. Conclusions: Internet drug information libraries contain large amounts of information about a wide variety of drugs, including previously little-known biological sources of hallucinogens. The availability of this information could have significant effects on patterns of drug use.