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In response to increased accountability demands placed on teacher preparation programs across the United States, some programs are using standardized teacher performance assessments, such as edTPA. In our elementary teacher preparation program, a recent state mandate stipulated that teacher candidates had to successfully complete edTPA in order to receive teacher certification. This case study used mixed methods to examine teacher candidates' (N=30) experiences and views while engaging in the assessment. Preparation for edTPA was integrated in specific courses in the program. Data were collected through a survey and individual interviews, with the analysis showing the teacher candidates felt largely ready for and supported during the edTPA completion but did not view the assessment as a fair measure of teaching effectiveness or tend to believe it improved them as neophyte teachers. The findings illuminate concerns about edTPA's use and implications for the program that could be considerations for others using edTPA, including program and curricular refinements. Keywords: elementary teacher preparation, teacher performance assessment, edTPA, Introduction Teacher effectiveness has shifted to the top of education policy agendas (Darling-Hammond, 2017), with more policies and practices directed at the standardization of teacher education. A growing approach is [...]

Smart contracts and their promise of automatic performance capture legal and entrepreneurial imaginations. But the excitement around the technology led to some confusing legal responses. Several legal scholars use chronology to help reduce the confusion and place smart contracts within what is already familiar about computational contracting. According to this line of thinking, blockchain-based smart contracts simply represent the next technological advancement in a long history of computable contracting technologies. However, other scholarly work suggests that such a chronological explanation under-simplifies the nature of the linkages between smart contracts and other forms of code-connected contracts. This Article offers a unified theory of code-connected contracts as a tool for guiding risk allocation and design trade-off discussions when considering whether to use one or more forms of code-connected contracts. Specifically, this Article argues that the many variations of code-connected contracts should be viewed along an axis of state transition complexity. Doing so brings to the forefront the fact that the issues facing smart contracts used to merely automate performance of contractual obligations differ in terms of both magnitude and novelty from algorithmic decision-making tools used by parties to fill gaps in contractual terms and other computational contracting tools. In other words, the state transition complexity theory of code-connected contracts set out in this Article offers an analytical tool for anticipating legal and business risk when using computational contracts. Ultimately, the state transition complexity theory of code-connected contracts demonstrates that getting to the core legal issues presented by code-connected contracting requires an analysis of the details of each specific implementation. As with most legal questions, proper analysis depends on facts and circumstances. Nevertheless, many of the core legal issues will arise because emerging technology, like all technology, is social technology. Thus, the implications of the state transition complexity theory of code-connected contracts are that many of the legal issues are not terribly new, and we should not forget to look to existing jurisprudence and scholarly work in contract law and corollary disciplines., I. INTRODUCTION 982 II. THE MANY VARIATIONS OF CODE-CONNECTED CONTRACTS 984 A. Earlier Forms of Code-Connected Contracts 985 B. Today's Code-Connected Contracts: Smart Contracts 987 C Newer Inquires in Light [...]

Common genetic variants confer substantial risk for chronic lung diseases, including pulmonary fibrosis. Defining the genetic control of gene expression in a cell-type-specific and context-dependent manner is critical for understanding the mechanisms through which genetic variation influences complex traits and disease pathobiology. To this end, we performed single-cell RNA sequencing of lung tissue from 66 individuals with pulmonary fibrosis and 48 unaffected donors. Using a pseudobulk approach, we mapped expression quantitative trait loci (eQTLs) across 38 cell types, observing both shared and cell-type-specific regulatory effects. Furthermore, we identified disease interaction eQTLs and demonstrated that this class of associations is more likely to be cell-type-specific and linked to cellular dysregulation in pulmonary fibrosis. Finally, we connected lung disease risk variants to their regulatory targets in disease-relevant cell types. These results indicate that cellular context determines the impact of genetic variation on gene expression and implicates context-specific eQTLs as key regulators of lung homeostasis and disease.

The microbiological quality of meat is influenced by the conditions of hygiene prevailing during production and handling. Thus, this study aimed to assess the prevalence of Salmonella entericaand its antimicrobial resistance, load of hygiene indicator bacteria including E. coli (ECC), coliforms (CC), total coliform (TCC), Enterobacteriaceae (EB) and aerobic plate count (APC), and meat handler’s food safety knowledge and hygiene practices in butcher shops in two cities, Addis Ababa and Hawassa in Ethiopia, during 2020 and 2021. A total of 360 samples of beef carcasses (n = 120), knives (n = 60), chopping boards (n = 60), weighing balance (n = 60), and personnel’s hands (n = 60) were randomly collected for microbial analysis. Besides, 120 participants were selected to participate in a food safety knowledge and hygiene practices assessment. The S. entericaisolates were identified by agglutination test followed by qPCR targeting invA gene. Phenotypic antimicrobial resistance profiles of S. entericawere determined using disk diffusion assays as described in CLSI. The ECC, CC, TCC, EB, and APC populations were quantified by plating onto petrifilm plates. A structured questionnaire was used to determine food safety knowledge and hygiene practices of participants. Overall prevalence of S. entericawas 16.7% (95% CI, 8.3—26.7) and location seems to have no effect (p = 0.806).Only 20% of the S. entericawere resistant to ampicillin and tetracycline. However, the majority (80%) of S. entericaisolates were susceptible to the panel of 11 antimicrobials tested. The overall mean ± SD (log CFU/cm2) of ECC, CC, TCC, EB, and APC were 4.31 ± 1.15; 4.61 ± 1.33; 4.77 ± 1.32; 4.59 ± 1.38 and 5.87 ± 1.52, respectively. No significant difference (p= 0.123) in E. colicontamination was observed between samples of beef carcasses and chopping boards. The EB contamination showed no significant difference (p> 0.05) among sample sources. The APC contamination levels on beef carcass were significantly higher (p> 0.05) than other sample sources. A total of 56% (95% CI: 46.7 – 65.0) of the participants had poor knowledge and 65% (95% CI: 56.7 – 73.3) had poor hygiene practices towards food safety. This study highlighted the poor hygiene status of butcher facilities with a potential risk of beef safety. Thus, appropriate food safety control strategies and inspection is needed at retail establishments.

Background: Stroke is a significant health issue with devastating consequences among older adults in the United States. However, it can be prevented by improving stroke knowledge and managing risk factors. Many stroke education programs have been shown to be effective. Unfortunately, a minority of older adults, such as older Korean Americans, have not benefited from the programs because of language barriers. Objective: The purpose of this study was to examine the feasibility and preliminary impact of a primary stroke prevention program on stroke knowledge, healthy eating, and physical activity behaviors among Korean Americans. Methods: A randomized controlled pilot trial was conducted. A total of 73 persons were randomly assigned to either an intervention group (n = 37) or a control group (n = 36). The intervention program included in-person lectures and discussions. Sociodemographic data were analyzed using descriptive statistics. Analyses of covariance and logistic regression analysis were used to evaluate the effects of the intervention program. Results: The mean age of participants was 71.49 [+ or -] 6.25 years, and most participants were female (74.0%) and married (65.8%). Upon intervention completion, the intervention group showed greater improvements than the control group in stroke knowledge and intake of sodium and total fats (F = 11.89, P = .001, [[eta].sup.2.sub.p] = 0.151; F = 4.04, P = .048, [[eta].sup.2.sub.p] = 0.057; and F = 4.51, P = .037, [[eta].sup.2.sub.p] = 0.062,respectively). Step counts showed marginal effects (F = 3.27, P = .075, [[eta].sup.2.sub.p] = 0.049). Conclusion: This study demonstrated feasibility and effectiveness of the program to improve stroke knowledge and healthy behaviors in elderly Korean Americans.Keywords: healthy diet, physical activity, primary prevention, stroke, Stroke and cerebrovascular diseases are the leading cause of death among Korean Americans (KAs); it is the third and fifth cause of death in KA women and men, respectively. (1) [...]

Both governments and private entities increasingly turn to distributed ledger technologies (DLT) for more efficient and transparent ways to implement administrative and other processes. When so doing requires grafting legal concepts onto computer code, changes will ripple outward to affect other areas of the law. Treating DLT as a foreign legal system allows comparative law to illuminate five areas of jurisprudential disruption from moving legal processes to DLT-based systems: substantive legal changes, new regulatory actors, legal structure changes, law-lag reduction, and legal culture changes. This article explores such ripple effects in the context of DLT-based corporate share registries in Delaware. The article argues that, in addition to changes to the Delaware General Corporation Law, DLT-based share registries may impact corporate law in other substantive ways, see the rise of new regulator-like entities, and magnify the shift in corporate culture reflected in the unicorn and platform technology company phenomena. CITATION: Carla L. Reyes, Cryptolaw for Distributed Ledger Technologies: A Jurisprudential Framework, 58 JURIMETRICS J. 283-302 (2018)., In July 2017, Delaware Governor John C. Carney Jr. signed into law amendments to the Delaware General Corporation Law that allow corporations to issue shares through blockchain technologies. (1) Meanwhile, [...]

AbstractProfessionalism is defined and described in a variety of ways that differ considerably in details and quantity. While professionalism has become increasingly important, educators’ opinions regarding the types of professionalism vary. The objective of this qualitative study was to evaluate faculty and preceptors’ perspectives regarding veterinary medical students’ professionalism during their clinical rotations. A thematic content analysis was performed to classify 2,014 comments. Five main themes emerged: (a) work ethic and attitude; (b) effective interactions with clients and delivering patient care; (c) effective interactions with health care professionals; (d) punctuality, task completion, and organization; and (e) commitment to improving competency in self and others. The importance of professionalism was stressed by both groups of faculty and preceptors through written comments; however, the magnitude of each theme differed. The results indicate that without understanding professionalism elements, the lack of conceptual clarity and consensus related to expected behaviors and attitudes would make it challenging to assess professionalism appropriately. The themes identified can be used to begin a discussion about expected behavior among faculty, preceptors, and students, therefore prompting a reasonable assessment of professionalism, as well as avoiding unprofessional behavior.

Background:Childhood obesity is a major health concern. Caregivers' feeding practices are modifiable targets of obesity prevention. The study tested two hypotheses: (1) autonomy-promoting feeding practices are associated with lower BMI; and (2) diet mediates the association. We also explored examined whether feeding practices and BMI z-score (BMIz) associations are moderated by child sex, caregiver race, education, family poverty level, and food insecurity.Methods:Cross-sectional study of 437 preschoolers (44.4% girls, 38.2% Black/Other, mean age 48.1 months) and caregivers (90.2% female) from 50 child care centers. Feeding Practices were measured by Comprehensive Feeding Practices Questionnaire, child-size perception by preschooler silhouettes, temperament by the Behavior Rating Inventory of Executive Function, child diet by Young Children Food and Drink Questionnaire, and BMIz by measured weight and height. Latent profile analysis delineated feeding practice patterns. Structure equation modeling assessed the patterns in relationship to BMIz. Mediation and multiple-group analyses were used to assess mechanisms of feeding practice patterns and BMIz association.Results:From the three feeding practice patterns, Controlling, Balancing, and Regulating, Regulating was associated with lower child BMIz (b= −0.09) compared to Controlling. Higher difficult temperament (b= 0.09), higher caregiver BMIz (b= 0.26), and caregiver desire for thinner (b= 0.23) were associated with BMIz (p< 0.05). Evaluations of moderators and mediators were not significant.Conclusions:Comprehensive feeding practices support family factors related to child BMIz. Longitudinal research is needed to examine temporal associations between feeding practices and BMIz, with attention to autonomy-supporting practices, promotion of young children's self-regulation, and caregivers' perceptions of child temperament and size. Trial Registration: NCT03111264.

ABSTRACTThis 5-year mathematics professional development project involves 27 elementary teachers prepared and supported as Elementary Mathematics Specialists (EMSs) in high-need, urban schools. The EMSs are a distinctive population as informal teacher leaders, with a primary responsibility of teaching students. Described here are data collected at the end of Year 1 via a survey of coaching practices, a teacher leader record, and individual and focus group interviews. The findings illuminate the variety of ways they were serving as a more knowledgeable other and practicing agency in this teacher leadership. They were agentic in their teacher leader efforts by navigating constraints through: focusing on incremental changes; developing collegial, trusting relationships with peers; and leaning into the network of teacher support in the project. The findings also provide insights into how their primary and concurrent role as teacher of students provided credibility and understanding with fellow teachers, contributing to affordances in their informal teacher leader capacity.

Natural and man-made disasters lead to hundreds of millions of dollars in economic losses annually worldwide. Veterinarians are most qualified to support local, state, national, and international efforts in emergency management. However, they may lack the knowledge and advanced training to most effectively plan, prepare, and respond. Currently, only two colleges offer training embedded in their core veterinary curriculum. In this study, a survey was conducted to gain an understanding of veterinary practice and practitioner preparedness for natural and man-made disasters in the United States and Canada, with questions assessing pandemic preparedness. The participants graduated from 28 American Veterinary Medical Association (AVMA)–accredited veterinary colleges globally and 2 non-accredited veterinary colleges, represent a diverse set of veterinary practice types, and have an average of 26 years’ practice experience. Overall, 63.5% of veterinary respondents had experienced a natural disaster, while only 9.6% had experienced a man-made disaster. Approximately 66% reported having a practice disaster preparedness plan, while less than 20% of those actively maintained and updated the plan. Furthermore, less than 50% of the practices and practitioners were ready to face the challenges of a global pandemic. Approximately 68% reported using some form of communication to educate clients about family and pet disaster readiness. Many felt that some advanced disaster readiness training would have been helpful in their veterinary curriculum. Our findings indicate that additional training in the veterinary curriculum, as well as continuing education, would help veterinarians and practices be better prepared for natural and man-made disasters.

IMPORTANCE: Other than single-center case studies, little is known about generalized pustular psoriasis (GPP) flares. OBJECTIVE: To assess GPP flares and their treatment, as well as differences between patients with and patients without flares documented in US electronic health records (EHRs). DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adult patients with GPP (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code L40.1) identified in Optum deidentified EHR data between July 1, 2015, and June 30, 2020. The index GPP diagnosis was the first occurrence in the EHR, with no coded history of GPP for at least 6 months prior. Flare episodes were identified using an algorithm based on diagnosis coding, care setting, type of clinician, GPP disease terms, and flare terms and attributes in the EHR. MAIN OUTCOMES AND MEASURES: Flare episodes were characterized by the frequency of occurrence per patient, the care setting in which they were identified, the type of specialist managing the episode, associated symptoms, and the type of treatment before, during, and after the episode. Patients were divided into groups based on whether or not they had a flare episode documented in their EHR. Comparisons were made between the groups based on demographic characteristics, comorbidity burden, health care use, and treatments. RESULTS: Of 1535 patients with GPP (1018 women [66.3%]; mean [SD] age, 53.4 [14.7] years), 271 had 513 flares documented. Compared with patients without flares, patients with flares had a 34% higher mean (SD) Charlson Comorbidity Index score (2.80 [3.11] vs 2.09 [2.52]), were almost 3 times more likely to have inpatient visits (119 of 271 [44%] vs 194 of 1264 [15%]), were more than twice as likely to have emergency department (ED) visits (126 of 271 [47%] vs 299 of 1264 [24%]), and had higher use of almost all treatment classes. Flares were identified in outpatient (271 of 513 [53%]), inpatient (186 of 513 [36%]), and ED (48 of 513 [9%]) settings. The most common treatments during flares were topical corticosteroids (35% of episodes [178 of 513]), opioids (21% [106 of 513]), other oral treatments, (eg, methotrexate, cyclosporine, tacrolimus; 13% [67 of 513]), and oral corticosteroids (11% [54 of 513]). Almost one-fourth of flare episodes (24% [122 of 513]) had no dermatologic treatment 30 days before, during, or 30 days after a flare episode. CONCLUSIONS AND RELEVANCE: This cohort study suggests that there is significant unmet need for the treatment of GPP and its flares, as evidenced by patients seeking treatment in inpatient and ED settings, as well as the lack of advanced treatments.

Motivating at-risk relatives to undergo cascade testing for familial hypercholesterolemia (FH) is critical for diagnosis and lifesaving treatment. As credible sources of information, clinicians can assist in family communication about FH and motivate cascade testing uptake. However, there are no guidelines regarding how clinicians should effectively communicate with probands (the first person diagnosed in the family) and at-risk relatives. Individuals and families with FH can inform our understanding of the most effective communications to promote cascade testing. Guided by the extended parallel process model (EPPM), we analyzed the perspectives of individuals and families with FH for effective messaging clinicians can use to promote cascade testing uptake. We analyzed narrative data from interviews and surveys collected as part of a larger mixed-methods study. The EPPM was used to identify message features recommended by individuals and families with FH that focus on four key constructs (severity, susceptibility, response efficacy, self-efficacy) to promote cascade testing. Participants included 22 individuals from 11 dyadic interviews and 98 survey respondents. Participants described prioritizing multiple messages that address each EPPM construct to alert relatives about their risk. They illustrated strategies clinicians could use within each EPPM construct to communicate to at-risk relatives about the importance of pursuing diagnosis via cascade testing and subsequent treatment for high cholesterol due to FH. Findings provide guidance on effective messaging to motivate cascade testing uptake for FH and demonstrates how the EPPM may guide communication with at-risk relatives about genetic risk and motivate cascade testing broadly.Individuals and families with familial hypercholesterolemia (FH) suggested clinicians use a combination of fear and efficacy messages to motivate at-risk relatives to pursue cascade testing.

Much has been written about information technology governance (ITG) in larger organizations, wherein control of information technology (IT) is addressed with attention to three core elements, namely structures, processes, and relational mechanisms. These elements focus on governing the size of IT investment, the ubiquity of IT functionality to business processes and the demonstrated value from IT investment. For Small-to-Medium Enterprises (SMEs) it is less apparent how IT is or should be governed, how these core elements may contribute to ITG, and how this all contributes to the creation of business value. Through a survey of small SMEs in the Australian tourist accommodation industry regarding their use of and planning for IT investment to deliver business value, this paper delivers new understanding about SME practices related to governing IT. Findings revealed evidence of some sound practices but the opportunity to achieve greater strategic business value beyond the largely operational value already acquired. The paper concludes by proposing a redefined framework of the core elements of structures, processes, and relational mechanisms that is tailored to an SME context. Keywords: Business Value, Business Value Creation, Information Technology Governance (ITG), IT Investment, Small-to-Medium Enterprises (SMEs), INTRODUCTION Studies that report on Information Technology (IT) use and practice typically focus on the experiences of large organizations (Wilkin & Chenhall, 2010). Herein strategic alignment is seen as pivotal [...]

Objective: The authors prospectively examined childhood antecedents of exposure to traumatic events to estimate the risk of posttraumatic stress disorder (PTSD) among those exposed to trauma. Method: Two consecutive cohorts of children entering first grade of a public school system in a large mid-Atlantic city in the mid-1980s were followed into young adulthood (mean age=21). Exposure to traumatic events and PTSD were assessed in 75% of the original cohort (N= 1,698). Childhood assessments, conducted upon entry into the first grade, included standardized measures of reading readiness, teacher ratings of behavioral problems, and child self-reports about depression and anxiety. Family characteristics were assessed by parental report. Results: Young adults who had been rated by their first grade teacher as having aggressive/disruptive behavior problems were more likely to experience traumatic assaultive violence events (e.g., being mugged/threatened with a weapon, badly beaten-up) (relative risk= 2.6) but not PTSD following trauma exposure. Youths with high levels of self-rated depressive and anxious feelings in first grade were more likely to experience PTSD once exposed to trauma (relative risk=1.5). Youths who scored in the highest quartile on a reading test in the first grade were at lower risk for exposure to assaultive violence traumas. Conclusions: Childhood behavioral and depressive/anxious problems may influence the risk for PTSD directly by increasing the vulnerability to the PTSD effects of trauma exposure, and indirectly by increasing the likelihood of exposure to assaultive violence.

ABSTRACT: The diagnosis of urinary tract infection (UTI) can be difficult in elderly patients, who may present with vague complaints or atypical symptoms. Office-based urine testing is less sensitive and [...]

Objective: Using prospective data, the authors assessed the risk of alcohol-related problems among individuals with self-reported sleep disturbances because of worry. Method: As part of the Epidemiologic Catchment Area program, a probability sample of Baltimore residents selected by census tracts and households completed a baseline interview in 1981. Between 1993 and 1996, the original Baltimore cohort was traced. Of the 2,633 survivors, a total of 73% were reinterviewed. After excluding individuals with alcohol-related problems or a current or prior history of alcohol abuse and/or dependence at the time of the 1981 interview, the authors identified a cohort of 1,537 individuals who were at risk for problem drinking at the rime of the follow-up interview, a median of 12.6 years after the baseline interview. Logistic regression was used to assess the association between sleep disturbance because of worry and the risk for incident reports of alcohol problems. Results: Survey respondents with sleep disturbances because of worry at the rime of the baseline interview had a twofold higher risk for developing an alcohol-related problem, relative to those without these sleep disturbances (odds ratio=2.32, 95% confidence interval [CI]=1.31-4.09), with adjustment for selected demographic and clinical variables. Sleep disturbance because of worry predicted the development of alcohol problems among respondents with lifetime anxiety disorders and lifetime dysphoria (odds ratio=3.82, 95% CI=1.56-9.38, and odds ratio=2.71, 95% CI=1.25-5.91, respectively), but not among those without a history of anxiety disorders or dysphoria. Conclusions: Sleep disturbances because of worry may increase risk for alcohol-related problems. Risk is highest for those with sleep disturbance and co-occurring anxiety disorders or dysphoria.

Substance use (SU) or substance use disorder (SUD) prevalence among U.S. nurses has not been assessed foralmost 25 years.

Objectives The Utah Study of Associated Risks of Stillbirth (SOARS) collects data about stillbirths that are not included in medical records or on fetal death certificates. We describe the design, methods, and survey response rate from the first year of SOARS.Methods The Utah Department of Health identified all Utah women who experienced a stillbirth from June 1, 2018, through May 31, 2019, via fetal death certificates and invited them to participate in SOARS. The research team based the study protocol on the Pregnancy Risk Assessment Monitoring System surveillance of women with live births and modified it to be sensitive to women’s recent experience of a stillbirth. We used fetal death certificates to examine survey response rates overall and by maternal characteristics, gestational age of the fetus, and month in which the loss occurred.Results: Of 288 women invited to participate in the study, 167 (58.0%) completed the survey; 149 (89.2%) responded by mail and 18 (10.8%) by telephone. A higher proportion of women who were non-Hispanic White (vs other races/ethnicities), were married (vs unmarried), and had ≥high school education (vs

Nursing practice is highly demanding and has been related to risk of substance use (SU) and SU disorders (SUDs). Despite this, education on registered nurse (RN) SUDs is extremely limited, and this knowledge gap has been related to nurses’ inability to address SU problems among colleagues.

Objective: To study the effect of an educational intervention on the management of hospitalized infants with bronchiolitis. Design: Sequential, prospective cohort study. Setting: A 235-bed children's hospital with nearly all private rooms. Patients: Consecutively admitted, previously healthy children younger than 24 months with symptoms of bronchiolitis. The first cohort was enrolled between January 1 and January 21, 1996; the second cohort between January 29 and February 18, 1996, following a 1-week intervention period; the third (follow-up) cohort between December 1996 and February 1997. Intervention: Educational program and practice guidelines aimed at appropriate utilization of diagnostic tests, decreased antibiotic and bronchodilator use, increased compliance with isolation, decreased length of stay, and maintenance of quality care. Main Outcome Measures: Utilization of respiratory syncytial virus (RSV) enzyme immunoassay, initiation and duration of parenteral antibiotic therapy, number of nebulized bronchodilator treatments, isolation orders, length of stay, and readmission rate. Results: A total of 90 patients were studied preintervention, 63 postintervention, and 90 during the follow-up period. The groups were comparable in demographic and clinical features. No patient had a documented serious bacterial infection; however, almost half in each group received parenteral antibiotics, despite recommendations against this. Immediately postintervention, children with positive RSV test results received antibiotics on fewer days than other children (median 0.6 vs 2.4 days; P =.004), suggesting that physicians stopped treatment with antibiotics once a viral diagnosis was confirmed. This effect did not persist into the follow-up period. Viral testing was reduced and isolation orders increased. Use of bronchodilators was reduced from 91% preintervention to 80% during the follow-up period (P = .046), and the median number of treatments was reduced from 15.0 to 10.0 (P = .005). There was no change in length of stay, which was 2 to 3 days, or in readmission rate, which was 1% to 4%. Conclusions: Educational efforts centered around practice guidelines can improve some aspects of the treatment of patients hospitalized with bronchiolitis. Arch Pediatr Adolesc Med. 1998; 152: 739- 744, Practice guidelines to standardize the care of bronchiolitis may be beneficial. Bronchiolitis is an inflammation of the lung for which there are few effective treatments. Researchers analyzed the use of ineffective treatments for bronchiolitis in groups of children hospitalized before and after an educational intervention using practice guidelines. Almost half the children received antibiotics even after the intervention despite the fact that none had a documented bacterial infection. Bronchodilator use was slightly reduced after the intervention, but there was no change in length of stay or re-admission rates.

The death of a child is always tragic. It is even more so when it was the needless result of a defective product. Unfortunately, many families suffer these tragedies when [...]

Objective: This study compares substance use by medical specialty among resident physicians. Method: The authors estimated the prevalence of substance use of 11 medical specialties from a national sample of 1,754 U.S. resident physicians. Results: Emergency medicine and psychiatry residents showed higher rates of substance use than residents in other specialties. Emergency medicine residents reported more current use of cocaine and marijuana, and psychiatry residents reported more current use of benzodiazepines and marijuana. Contrary to recent concerns, anesthesiology residents did not have high rates of substance use. Family/general practice, internal medicine, and obstetrics/gynecology were not among the higher or lower use groups for most substances. Surgeons had lower rates of substance use except for alcohol. Pediatric and pathology residents were least likely to be substance users. Conclusions: The authors' previous research indicates that residents overall have lower rates of substance use than their age peers in society. Yet resident substance use patterns do differ by specialty. Residents in some specialties are more likely to use specific classes of drugs, to use a greater number of drug classes, and to be daily users of alcohol or cigarettes.

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1540-5885.2009.00693.x Byline: Carla L. Kuesten (1) Abstract: Books reviewed in this issue: Going Lean: How the Best Companies Apply Lean Manufacturing Principles to Shatter Uncertainty, Drive Innovation, and Maximize Profits Ready, Set, Dominate: Implement Toyota's Set-Based Learning for Developing Products and Nobody Can Catch You! Market Rebels: How Activists Make or Break Radical Innovations Author Affiliation: (1)Richland, Michigan

Vegetables in Cambodia are commonly sold in informal markets lacking food safety standards and controls. Current data on microbial contamination of vegetables in Cambodian informal markets are limited. The purpose of this study was to investigate Salmonella entericaand indicator organisms (Escherichia coliand coliforms) on the surface of fresh vegetables sold in informal markets in Cambodia. Samples of loose-leaf lettuce, tomatoes, and cucumbers were collected from 104 vendors at four informal markets in Battambang and Siem Reap provinces during the rainy and dry seasons. Detection methods for S. entericawere adapted from the U.S. Food and Drug Administration's Bacteriological Analytical Manual. Coliform and E. colipopulations were quantified by plating onto E. coli/coliform count plates. S. entericawas most prevalent on lettuce during the dry season (56.5%, 95% confidence interval [CI] [41.0, 70.8]) than during the rainy season (15.4%, 95% CI [7.5, 29.1]), whereas no significant seasonal differences were apparent for tomatoes and cucumbers. Regardless of season, levels of S. entericawere highest on lettuce (5.7 log CFU/g, 95% CI [5.5, 5.9]), relative to cucumbers (4.2 log CFU/g, 95% CI [3.8, 4.6]) and tomatoes (4.3 log CFU/g, 95% CI [4.1, 4.6]). For E. coli,prevalence was higher during the rainy season (34.0%, 95% CI [25.4, 43.8]) than during the dry season (9.1%, 95% CI [4.9, 16.5]), with the highest prevalence estimated on lettuce. Coliform levels on lettuce and tomatoes were greater during the rainy season (6.3 and 5.3 log CFU/g, 95% CI [5.7, 6.8] and [4.7, 5.8], respectively) than during the dry season (5.2 and 3.9 log CFU/g, 95% CI [4.7, 5.7] and [3.4, 4.4], respectively). These results indicate seasonal patterns for microbial prevalence in lettuce and an overall high level of bacterial contamination on raw vegetables sold in Cambodian informal markets.

The COVID-19 pandemic likely exacerbated caregiving challenges for caregivers of parents diagnosed with a blood cancer. Providing care during a public health crisis presents a complex web of uncertainties regarding cancer care, personal health, and COVID-19 risk. Identifying caregivers’ uncertainty experiences during the COVID-19 pandemic can be a first step in learning where to direct resources or alter policies to ensure that they can not only perform their caregiver role but also cope in health-promoting ways. Using uncertainty management theory, this study explored how the pandemic has impacted adult child caregivers’ experiences caring for a parent diagnosed with a blood cancer, as well as their experiences of uncertainty and uncertainty management. As part of a larger study on blood cancer caregivers’ needs, a survey was administered from March 30 to June 1, 2020, to recruit caregivers through the Leukemia and Lymphoma Society. A qualitative and quantitative content analysis was conducted on open-ended responses from 84 caregivers. Caregivers described changes illustrating the complexity of providing care during a pandemic: (a) increased fears and uncertainty-related distress, b) reduced in-person care opportunities, (c) increased isolation, and (d) enhanced family communication. Caregivers with parents diagnosed with acute blood cancers used significantly more uncertainty management strategies and had more sources of uncertainty than caregivers with parents living with chronic blood cancer types. Findings highlight the need for supportive services to help caregivers manage uncertainty and improve their capacity to provide care in an unpredictable global health crisis. Such support may reduce poor psychosocial outcomes.

The COVID-19 pandemic has taken a substantial human, social and economic toll globally, but its impact on Black/African Americans, Latinx, and American Indian/Alaska Native communities in the U.S. is unconscionable. As the U.S. continues to combat the current COVID-19 cycle and prepares for future pandemics, it will be critical to learn from and rectify past and contemporary wrongs. Drawing on experiences in genomic research and intersecting areas in medical ethics, health disparities, and human rights, this article considers three key COVID-19-related issues: research to identify remedies; testing, contact tracing and surveillance; and lingering health needs and disability. It provides a pathway for the future: community engagement to develop culturally-sensitive responses to the myriad genomic/bioethical dilemmas that arise. and the establishment of a Truth and Reconciliation Commission to transition the country from its contemporary state of segregation in healthcare and health outcomes into an equitable and prosperous society for all. [ABSTRACT FROM AUTHOR]

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1540-5885.2008.00302_1.x Byline: Carla L. Kuesten (1) Author Affiliation: (1)Kellogg's Company

This exploratory survey study used quantitative and qualitative analyses to (a) identify challenges communicating with siblings that adult child caregivers of a parent with a blood cancer encounter and (b) examine how these challenges are related to caregivers’ burden, social support, family openness, and clinical communication quality. A total of 95 caregivers with siblings participated in an online survey. We conducted a qualitative content analysis on an open-ended response to understand their challenges and statistical analyses on responses to validated scales to examine associations between the challenges and psychosocial/communication outcomes. Caregivers encountered nine challenges communicating with siblings (lack of agreement and competing obligations). Caregivers’ family openness, social support, and caregiver burden differed based on several challenges. The number of siblings was linked to poorer outcomes (burden). Adult child caregivers face sibling-related challenges, which may inhibit their communication and well-being.

Veterinary practitioners can play a vital role in a community’s preparedness for, response to, and recovery from a foreign animal disease outbreak. This article will examine the steps a practitioner needs to take to become ready to have a role in disaster readiness and response. Resources exist to provide the practitioner with tools needed to transition their normal daily activities to a larger integrated response. The knowledge and skills utilized by practitioners in disaster management will lead to a more effective and efficient response to a foreign animal disease.

T. Canli et al., 2004 use functional MRI to explore the neural interface between personality, mood, and emotional responses. Their finding of a double dissociation in brain response to emotional stimuli based on personality and mood state has significant implications for our understanding of the effects of personality traits and mood states on the neural bases of emotion and cognition.

The lack of hygiene and sanitation practices and insufficient infrastructure in Cambodian informal markets may increase the risk of food contamination, specifically raw vegetables, which in turn may increase the chances of contracting a foodborne disease. The aims of this study in informal markets in Cambodia were (i) to quantify the prevalence of Salmonella entericabased upon differences in season of the year (rainy versus dry), surface types (food contact surfaces versus nonfood contact surfaces), and location of vendors within the market (inside versus outside) and (ii) to characterize S. entericaserotype prevalence. A total of 310 samples were screened for S. entericaprevalence following the U.S. Department of Agriculture guidelines, and results were confirmed by PCR assay. Whole genome sequencing was used to determine the serotype for each isolate in silico using SeqSero 1.0 on draft genomes. A total of 78 samples were confirmed positive for S. enterica. During the dry season, S. entericawas more prevalent on food contact surfaces than on nonfood contact surfaces (estimated probability of detection [confidence interval]: 0.41 [0.25, 0.59] and 0.17 [0.08, 0.32], respectively; P= 0.002), but no differences were apparent in the rainy season. No differences in S. entericaprevalence were found based on location within the market (P= 0.61). Sixteen S. entericaserotypes were detected across multiple surfaces. The most common S. entericaserotypes were Rissen (18 isolates), Hvittingfoss (11), Corvallis (10), Krefeld (8), Weltevreden (6), and Altona (6). Accurate data on the prevalence of S. entericain informal markets are crucial for the development of effective surveillance and implementation of suitable intervention strategies at the domestic level, thus preventing foodborne illness.

Objective: To assess how often maternal transport preceded pregnancy-related deaths and describe contributing factors and recommendations related to maternal transport. Study design: We used Ohio maternal mortality review committee (MMRC) data from 2010 to 2016. We defined two transport types among pregnancy-related deaths: field to hospital and hospital to hospital. We examined deaths determined by the MMRC to be potentially preventable by transfer to a higher level of care and described contributing factors and recommendations. Result: Among 136 pregnancy-related deaths, 56 (41.2%) were transported. Among 15 deaths identified as potentially preventable by transfer to a higher level of care, 5 were transported between hospitals. Contributing factors for 14 deaths included inadequate response by Emergency Medical Services and lack of transport to a higher level of care. Conclusion: Our results suggest opportunities for examining modification and adherence to existing protocols. Improving risk-appropriate maternal care systems is important for preventing pregnancy-related deaths.

The theory-practice gap (TPG) is well known in the environmental realm, referring to disconnects between knowledge generated through scientific research and the needs, expectations, and practices of knowledge users for environmental decision-making and practice. While the presence of the TPG is well established, we have yet to fully implement mechanisms for overcoming its challenges. Thus, our goal is to characterize the TPG and identify practical recommendations for minimizing it. Here, a diverse group of experts in the environmental realm (spanning landscape planning, conservation science, environmental sociology, resource management, political science, and anthropology, among others) present our perspectives on the TPG. More specifically, we share an organized framework for understanding the TPG and suggest recommendations that can help make progress in one or more dimension(s). Conceptual topics discussed are the implications of the gap and its persistence. Organizational/institutional topics include the implications of the overabundance, inaccessibility, and uncertainty of scientific information, and a need for mainstreaming boundary spanning activities. Lastly, cultural topics include differences in culture and epistemologies across knowledge generators and users, shifting cultures through co-production, and changes in educational curricula. Recommendations for minimizing the TPG include conceptually recasting what is considered ‘success,’ institutional reform, enhanced information delivery, leveraging knowledge brokers and boundary organizations, leveraging ‘champions’ in policy, using co-production and/or integrative research, confronting the contemporary ‘fake news’ phenomenon, and rethinking researcher and practitioner training and development. By sharing our framework and recommendations, we provide insight, as well as a starting point for those looking to narrow the TPG and improve knowledge generator-user relationships.