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Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one's practice (multivariable ORs, 1.6e2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. [ABSTRACT FROM AUTHOR]

The article presents an examination into the history of Southwest Arkansas in the aftermath of the U.S. Civil War, describing the process by which slave emancipation was carried out. Introductory comments are given discussing the historiography of the emancipation of slaves in the South generally, noting several areas of controversy. Discussion is then given noting how the events of Southwest Arkansas complicate many research narratives of the time line and agency of emancipation. Conclusions are given suggesting that the emancipation of the institution of slavery was accomplished through both actions of slaves in the later periods of the war as well as Northern administrative intervention.

The article focuses on the collaborative writing skills developed by students who participated in Building Worlds, a writing project included in the elective English course created by an English teacher for grades 9 to 12 students in the U.S. It says that the project allowed students to establish fantasy world and learn how fantasy authors wrote their stories. It relays that Katherine Schultz's study of collaborative writing became instrumental in the creation of the project.

The use of potentially inappropriate medications (PIMs) is considered an important quality indicator for older adults seen in the ambulatory care setting. To evaluate the pattern of potentially inappropriate medication (PIMs) use as specified in the Beers Criteria, for older adults during emergency department (ED) visits in the United States. Using data from the National Hospital Ambulatory Care Survey (NHAMCS) we identified older adults (age 65 or older) discharged home from an ED visit in 2019. We defined PIMs as those with an 'avoid' recommendation under the American Geriatrics Society (AGS) 2019 Beers Criteria in older adults. Logistic regression models were used to assess demographic, clinical, and hospital factors associated with the use of any PIMs upon ED discharge. Overall, 5.9% of visits by older adults discharged from the ED included administration or prescriptions for PIMs. Among those who received any PIMs, 25.5% received benzodiazepines, 42.5 % received anticholinergics, 1.4% received nonbenzodiazepine hypnotics, and 0.5% received barbiturates. A multivariable model showed statistically significant associations for age 65 to 74 (OR 1.91, 95% CI 1.39–2.62 vs. age >=75), dementia (OR 0.45, 95% CI 0.21–0.95), lower immediacy (OR 2.45, 95% CI 1.56–3.84 vs. higher immediacy), and Northeastern rural region (OR 0.34, 95% CI 0.21–0.55 vs. Midwestern rural). We found that younger age and lower immediacy were associated with increased prescriptions of PIMs for older adults seen, while dementia and Northeastern rural region was associated with reduced use of PIMs seen and discharged from EDs in United States. [ABSTRACT FROM AUTHOR]

The article discusses relations between the United States and South Africa in the early 1960s as representative of the intersection of two important developments in world affairs: decolonization and the Cold War. In particular, the heated debate in the United Nations over apartheid, the policy of racial segregation enforced by the white-dominated South African government, is discussed, including the international opposition led by the "African bloc," and U.S. support for South Africa. The efforts of developing countries to refocus international attention on postcolonial issues of universal human rights and opposition to racism, rather than superpower politics, is a particular focus.

To determine whether physician specialty influences transfusion threshold in patients with acute severe traumatic brain injury (TBI). We surveyed transfusion preferences of chiefs of trauma surgery, chairs of neurosurgery, and surgical and neurosurgical ICU directors at all 187 US Level I trauma centers using a scenario-based, multiple-choice instrument administered by mail. We evaluated the hemoglobin value used as a transfusion threshold for patients with severe acute TBI in several scenarios as well as opinions regarding the rationale for transfusion. The response rate was 58% (312/534). Mean time in practice was 17 ± 8 years and 65% were board certified in critical care. Neurosurgeons (NS) used a greater mean hemoglobin threshold for transfusion of TBI patients than trauma surgeons (TS) and non-surgeon intensivists (CC) whether the intracranial pressure was normal (8.3 ± 1.2, 7.5 ± 1.0, and 7.5 ± 0.8 g/dL; NS, TS, and CC, respectively, P < 0.001) or elevated (8.9 ± 1.1, 8.0 ± 1.1, and 8.4 ± 1.1 g/dL; NS, TS, and CC, respectively, P < 0.001). All three groups commonly believed that secondary ischemic injury is an important problem following TBI (74, 66, and 63%, P = 0.32), but fewer NS believed that transfusions have important immunodulatory effects (25, 91, and 83%, P < 0.001). Neurosurgeons prefer more liberal transfusion of TBI patients than TS and CC, suggesting that actual practice may depend largely on which specialist is primarily managing care. The observed clinical equipoise would justify a randomized trial of liberal versus restrictive transfusion strategies in patients with TBI. [ABSTRACT FROM AUTHOR]

The study explores the effects of the Conservation Reserve Program (CRP) on Ring-necked Pheasants (Phasianus colchicus) populations by modeling Breeding Bird Survey (BBS) counts on Ring-necked Pheasants during 1987-2005 along 388 routes in nine American states. It analyzes Ring-necked Pheasant counts as overdispersed Poisson counts in a Bayesian hierarchical model estimated with Markov-chain Monte Carlo methods. It also highlights the advantages of using the methodology to assess the association between the CRP and Ring-necked Pheasants.

Objective: To explore how a single master alarm system affects drivers' responses when compared with multiple, distinct warnings.Background: Advanced driver warning systems are intended to improve safety, yet inappropriate integration may increase the complexity of driving, especially in high workload situations. This study investigated the effects of auditory alarm scheme, reliability, and collision event type on driver performance.Method: Using a 2 x 2 x 4 mixed factorial design, we investigated the impact of two alarm schemes (master vs. individual) and two levels of alarm reliability (high and low) on distracted drivers' performance across four collision event types (frontal collision warnings, left and right lane departure warnings, and warnings for a fast-approaching following vehicle).Results: Participants' reaction times and accuracy rates were significantly affected by the type of collision event and alarm reliability. The use of individual alarms, rather than a single master alarm, did not significantly affect driving performance in terms of reaction time or response accuracy.Conclusion: Even though a master alarm is a relatively uninformative warning, it produced statistically no different reaction times or accuracy results when compared with information-rich auditory icons, some of which were spatially located. In addition, unreliable alarms negatively impacted driver performance, regardless of event type or alarm scheme.Application: These results have important implications for the development and implementation of multiple driver warning systems. [ABSTRACT FROM AUTHOR]

Researchers have suggested golden eagle (Aquila chrysaetos) populations may be declining in portions of their range. However, there are few baseline data describing golden eagle populations across their range in the western United States. We used aerial line transect distance methodology with a double-observer modification to estimate golden eagle population numbers in 4 bird conservation regions of the western United States. We conducted surveys from 16 August to 8 September 2003, after most golden eagles had fledged and before fall migration. The goal of our sampling strategy was to provide ≥80% power (α = 0.1) to detect an annual rate of total population change ≥3% per year over a 20-year period. We observed 172 golden eagles across 148 transects and estimated 27,392 golden eagles (90% CI: 21,352-35,140) occurred in the study area during the late summer and early fall of 2003. Following the surveys, we used Monte Carlo simulation to determine the statistical power to detect trends in the golden eagle populations if yearly surveys were continued over a 20-year monitoring period. The simulation indicated the desired power could be achieved under the current methodology and sample size. The methods utilized in this study can be implemented for other raptor species when population estimates that include nonbreeding members of a population are needed. The results of this study can be utilized by professionals to help manage golden eagle populations and to develop conservation strategies. [ABSTRACT FROM AUTHOR]

The article focuses on the differences between the U.S. and foreign patent law. The article highlights the inconsistences between the patent law of the U.S. and foreign countries in terms of patent priority, grace periods, prior user rights, best mode requirement and publication of pending applications. It also discusses the proposed changes to the patent law under the Patents Reform Act. The effects of these changes on the patent law are also explored.

Past research has suggested that during the calving period, caribou (Rangifer tarandus) in Arctic Alaska generally avoid areas within 1 km of oilfield roads with traffic. However, avoidance is not absolute, and caribou may habituate to infrastructure (e.g., buildings, roads, well pads) and human activity. We conducted road-based surveys of caribou in oilfields on Alaska's Arctic Coastal Plain during the late calving and post-calving periods of June in 2000- 02. We recorded location, composition, and behavior of caribou groups located less than 1 km from active gravel roads and production pads. Caribou groups with calves were on average distributed farther from oilfield infrastructure than were groups without calves, but habituation to oilfield activities, indicated by decreased avoidance, occurred at similar rates for groups with and without calves. During the calving period, sighting rates were greater in areas of low human activity, and calf percentages tended to be greater at night when oilfield activity was reduced. Caribou groups were on average closer to infrastructure during the post-calving periods than during the calving periods in 2000 and 2001, but not in 2002. In 2002, when snow melted early, caribou groups were closer to infrastructure during the calving period than in 2000 and 2001, when snow melted later, emphasizing the importance of examining environmental variables when investigating the dynamic interactions of caribou and oilfields. Overall, caribou appeared to habituate to active oilfield infrastructure after the calving period in 2000, late in the calving period in 2001, and likely before our sampling period in 2002. The timing of annual rehabituation was positively correlated with timing of spring snowmelt. Land and wildlife managers can use information from this study to develop calving period-specific mitigation measures that are more effective and flexible. [ABSTRACT FROM AUTHOR]

Buprenorphine-naloxone is an office-based opioid agonist released in 2003 in the United States for the maintenance of heroin- and other opioid-dependent patients. Concern has been raised that the medication will distract or otherwise inhibit patients from participating in a holistic recovery program or abstinence-based counseling. Using a retrospective chart review, the first thirty opioid-dependent patients induced on buprenorphine maintenance therapy in an inpatient detoxification unit were compared to thirty age- and gender-matched patients who underwent detoxification (with a tramadol taper) and referral to intensive outpatient treatment. The clinical outcomes were a comparison of completion rates for an intensive outpatient program (IOP) and retention in treatment after twelve weeks of aftercare therapy. Patients induced on buprenorphine maintenance over three days had similar relief of withdrawal symptoms to patients detoxified from opioids over five days with tramadol. Patients maintained on buprenorphine had a markedly increased initiation of IOP and remained in outpatient treatment longer than patients who were detoxified (8.5 wks vs. 0.4 wks, p < 0.001). This study indicates that induction and maintenance on buprenorphine may be more effective than detoxification for engaging and retaining patients in abstinence-based comprehensive outpatient addiction treatment. [ABSTRACT FROM AUTHOR]

Purpose. Aggregate Demand Index (ADI) survey results were used to describe the severity of the pharmacist shortage at the national and state levels and by practice site and impact on the U.S. population. Methods. Time-series analysis was used to characterize national and state trends in the ADI from September 1999 through September 2003. The time trends for the distribution of ratings and the demand index by practice site were also examined. Historical data about retail prescriptions filled and related growth rates were compiled and compared. ADI survey results were also compared with data from other surveys. Results. Over time, ADI data demonstrated a continuing national pharmacist shortage, as the ability to fill pharmacist vacancies was rated at least moderately difficult. A very slight downward trend in severity (slope = −0.008) was observed. Other survey series had similar findings. States with the most severe shortage levels tended to have large populations, while those with the lowest levels tended to have smaller populations. More states improved than worsened the severity of their shortage, with 30 states maintaining the same ADI rating. Although there was a high correlation between the retail prescription growth rate and the ADI (r = 0.84), there was a much greater decrease in prescription growth (73%) than ADI levels (6.5%). Conclusion. There was a sustained unmet demand for pharmacists throughout the United States from September 1999 through September 2003. More states moved toward having an adequate supply of pharmacists than toward having a more severe shortage of pharmacists, but the national ADI suggests that the system remains stressed. [ABSTRACT FROM AUTHOR]

Discusses issues and events concerning state and local government laws in the U.S. from 2003 to 2004. Expansion of the authority of the president since the terrorist attacks on September 11, 2001; Impact of the Patriot Act on the rights of criminal suspects; Tasks of the National Energy Policy Development Group formed by President George W. Bush.

The city of Palm Springs gained fame as an exclusive resort in the 1920s. Thereafter, the city elite became consumed with maintaining its reputation. Because public policies in Palm Springs increasingly reflected the interests of local business, real estate, and village elites, social engineering and control over land use became the driving forces behind the city's political economy. Collaborating with local businessmen and attorneys, Palm Springs civic leaders persecuted their lower-income constituents who resided on the local Native American reservation. Attempting to dispossess the Indians of their tribal lands and erase any blighted neighborhoods that might degrade "the city beautiful," Palm Springs officials successfully removed the city's people of color and restructured the race and class configuration of the city. [ABSTRACT FROM AUTHOR]

ABSTRACT. The effects of attitude similarity on voters' preferences were examined. Using secondary analyses, the authors created measures of assumed similarity across 6 issues between voters and U.S. presidential candidates (in 1972). Greater similarity was associated with greater attraction (operationalized in terms of voters' presidential preferences). In 2 independent analyses, perceived similarity resulted in predictive accuracy of 84% to 88%. In a 3rd analysis, the predictive efficiency of each of 6 similarity measures was determined and used to develop a model that accurately predicted voters' actions in a hold-out sample. Findings demonstrate the importance of perceived attitude similarity in determining voter preferences and suggest the utility of earlier similarity-attraction research for the development of models of policy choice behavior. [ABSTRACT FROM AUTHOR]

The role of the World Trade Organization (WTO) in the setting and enforcement of international and domestic environmental policy continues to evolve. This paper reviews the first case that focused clearly on environmental issues that involved WTO mediation: the case of Venezuela's challenge of the legality of United States restrictions on the importation of gasoline based on requirements to reduce health risks under the Clean Air Act. In this case, the WTO deemed the U.S. Environmental Protection Agency's policy as a barrier to free trade and this has important implications for future policies. We explore the underlying issues of the decision and its implications for future cases that focus on environmental risks. [ABSTRACT FROM AUTHOR]

Evaluates the causes of differential skeletal preservation in the human skeletal series of Windover Pond in Florida. Evaluation of relationship between bone preservation and individual age and sex; Relation between the presence of preserved brain material and skeletal preservation; Effects of burial location on bone preservation.

Explores the international implications of a plan proposed by two bounty hunters in the Tacoma, Washington area to charge British thrill seekers to accompany them on manhunts in the U.S. Analysis of the factors that influenced the development of the commercial bail bond system in the U.S.; Contractual relationship between a bail bondsman and a defendant; Scope of the bounty hunter's power; Status of bail bonding in the U.S.

Examines medical malpractice and other professional negligence after the Utah Supreme Court's decision in 'Steiner Corp. v. Johnson & Higgins (Steiner Corp. III).' Adoption of Utah's comparative negligence and liability reform acts; History of the 'Steiner Corp. v. Johnson & Higgins' case; Comparative fault apportionment in medical malpractice cases after 'Steiner Corp. III.'

This study tested the degree to which the Child and Adolescent Functional Assessment Scale (CAFAS; Hodges & Wong, 1996), a mental health assessment tool, predicted recidivism among juvenile offenders. The CAFAS, which is sensitive to rehabilitation treatment effects, was compared with factors insensitive to rehabilitation (e.g., age, ethnicity, sex, and number of prior offenses). Also addressed was the methodological issue of whether to treat recidivism as a continuous or a dichotomous variable. The CAFAS was found to be significantly related to recidivism. The practical application of the results, as well as the value of emphasizing research on dynamic predictors that enable policy makers to target at-risk juveniles, is discussed. [ABSTRACT FROM AUTHOR]

Background: Oropharyngeal squamous cell carcinoma (OPSCC) has now surpassed cervical cancer as the most common site of HPV-related cancer in the United States. HPV-positive OPSCCs behave differently from HPV-negative tumors and often present with early lymph node involvement. The bacterial microbiome of HPV-associated OPSCC may contribute to carcinogenesis, and certain bacteria may influence the spread of cancer from the primary site to regional lymphatics.Objective: To determine the bacterial microbiome in patients with HPV-associated, early tonsil SCC and compare them to benign tonsil specimens.Method: The microbiome of primary tumor specimens and lymph nodes was compared to benign tonsillectomy specimens with pan-pathogen microarray (PathoChip).Results: A total of 114 patients were enrolled in the study. Patients with OPSCC had a microbiome that shifted towards more gram-negative. Numerous signatures of bacterial family and species were associated with the primary tumors and lymph nodes of cancer patients, including the urogenital pathogens Proteus mirabilis and Chlamydia trachomatis, Neisseria gonorrhoeae, Shigella dysenteriae, and Orientia tsutsugamushi.Conclusion: Our results suggest that detection of urogenital pathogens is associated with lymph node metastasis for patients with HPV-positive OPSCCs. Additional studies are necessary to determine the effects of the OPSCC microbiome on disease progression and clinical outcomes. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the author discusses various reports within the journal on topics including religious freedom in America, the First Amendment to the U.S. Constitution's freedom of speech protections, and legal cases involving anti-discrimination laws and the rule of law.

An introduction is presented in which the Editor-in-Chief discusses various reports within the journal on topics including a presumption of constitutionality in statutory interpretation, American federalism, and a judge's role in interpreting the U.S. Constitution.

The article aims to determine the degree of knowledge and attitude of medical students toward the Patient Protection and Affordable Care Act (ACA), in relation to the student' political affiliation, specialty choice, and financial standing. It states that an online survey was e-mailed to all Minnesota medical students asking to specify their level of agreement to ACA through the 5-point Likert scale. Result of the study shows ignorance and indecisiveness but an obligation to implement the ACA.

Past experiments on sand-based putting greens have frequently used randomized complete blocked designs (RCBD), even though these experimental areas are relatively uniform with regard to external variables. Consequently, completely randomized designs (CRD) may have had better precision with which to estimate treatment effects compared with RCBD. The objective of this study was to estimate the relative efficiency (ERE) of a RCBD compared with a CRD when evaluating common parameters on sand-based putting greens. Uniformity trials were conducted in Arkansas and Nebraska on sandbased putting greens established with creeping bentgrass (Agrostis palustris Huds.). Estimated relative efficiency values were calculated for varying blocking schemes when measuring canopy temperature, soil temperature, soil moisture, clipping yield, and macronutrient content in plant tissues. Since canopy temperatures were time dependent, when those measurements were collected by a blocking scheme, the associated RCBD was approximately nine times more efficient than a CRD. For the remaining parameter and blocking scheme combinations, ERE values indicated that the precision between RCBD and CRD was similar. Therefore, it is likely that the precision with which treatment effects are estimated is not compromised from the use of RCBD on sand-based putting green trials. [ABSTRACT FROM AUTHOR]

Summarizes data from the registry about women with smallpox vaccine exposure during pregnancy, reported to the National Smallpox Vaccine in Pregnancy Registry in the U.S. in 2003. Ways to prevent inadvertent exposure of pregnant women to vaccinia virus; Composition of the registry; Manner in which cases of women inadvertently exposed to smallpox vaccine during pregnancy are reported to the registry.

Dog importation data from 2018–2020 were evaluated to ascertain whether the dog importation patterns in the United States changed during the COVID-19 pandemic, specifically with regard to denial of entry. Dog denial of entry reports from January 1, 2018, to December 31, 2020, stored within the Centers for Disease Control and Prevention (CDC) Quarantine Activity Reporting System (QARS), were reviewed. Basic descriptive statistics were used to analyze the data. Reason for denial, country of origin, and month of importation were all examined to determine which countries of origin resulted in the largest number of denials, and whether there was a seasonal change in importations during the COVID-19 pandemic (2020), compared to previous years (2018 and 2019). During 2020, CDC denied entry to 458 dogs. This represents a 52% increase in dogs denied entry compared to the averages in 2018 and 2019. Dogs were primarily denied entry for falsified rabies vaccination certificates (56%). Three countries exported 74% of all dogs denied entry into the United States, suggesting that targeted interventions may be needed for certain countries. Increased attempts to import inadequately vaccinated dogs from countries with canine rabies in 2020 may have been due to the increased demand for domestic pets during the COVID-19 pandemic. Educational messaging should highlight the risk of rabies and the importance of making informed pet purchases from foreign entities to protect pet owners, their families, and the public. [ABSTRACT FROM AUTHOR]

Black Americans bear the greatest burden of HIV, accounting for 43% of new diagnoses. Yet Black Americans also evidence the lowest utilization rates of Pre-Exposure Prophylaxis (PrEP), a highly effective biomedical strategy for preventing HIV infection. Predictors of PrEP acceptance vary; however, little is known about psychological distress, such as post-traumatic stress disorder (PTSD) symptoms, as a predictor. In this cross-sectional study, n = 195 Black Americans, evidencing behaviors found in the research literature to heighten risk for contracting HIV (e.g. sex work, injection drug use) ages 18-29, 55% cisgender women, 39.5% cisgender men, 3% transgender/non-binary, completed audio-computer-assisted self-interviews. Bivariate analyses indicated significant positive associations between PTSD symptoms and PrEP acceptance and self-confidence. In multinomial logistic regression analyses, after controlling for Perceived HIV Risk, participants had a higher likelihood of responding they 'probably would' take PrEP (as opposed to 'definitely would not' take PrEP) if they reported higher levels of PTSD symptoms. Post-hoc analyses revealed a curvilinear relationship between PTSD symptoms and PrEP acceptance with those reporting the highest level of PTSD in the sample having slightly lower PrEP acceptance than those reporting moderately high levels of PTSD. Findings are discussed in the context of the negative impacts of high levels of PTSD and potential positive adaptations subsequent to moderate levels of PTSD that could be relevant to advances in HIV prevention efforts. [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma is the third leading cause of cancer-related death in the United States. As one of the most lethal cancer types, the prognosis for patients diagnosed with pancreatic cancer remains dismal and novel investigations are urgently needed. Evidence for an association of microbes with pancreatic cancer risk, development, treatment response, and post-treatment survivorship is rapidly developing. Herein, we provide an overview on the role of the microbiome as it relates to the natural history of pancreatic cancer, including host immune interactions, alterations in metabolism, direct carcinogenic effect, and its role in treatment response. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the Editor-in-Chief discusses various reports within the journal on topics including American common law, an opioid crisis in the U.S., and the impact of America's Tax Code on religious organizations.

Background The economic burden of cancer in the United States is substantial, and better understanding it is essential in informing health care policy and innovation. Leptomeningeal carcinomatosis (LC) represents a late complication of primary cancer spreading to the leptomeninges. Methods The IBM MarketScan Research databases were queried for adults diagnosed with LC from 2001 to 2015, secondary to 4 primary cancers (breast, lung, gastrointestinal, and melanoma). Health care resource utilization (HCRU) and treatment utilization were quantified at baseline (1-year pre-LC diagnosis) and 30, 90, and 365 days post-LC diagnosis. Results We identified 4961 cases of LC (46.3% breast cancer, 34.8% lung cancer, 13.5% gastrointestinal cancer, and 5.4% melanoma). The median age was 57.0 years, with 69.7% female and 31.1% residing in the South. Insurance status included commercial (71.1%), Medicare (19.8%), and Medicaid (9.1%). Median follow-up was 66.0 days (25th percentile: 24.0, 75th percentile: 186.0) and total cumulative costs were highest for the gastrointestinal subgroup ($167 768) and lowest for the lung cancer subgroup ($145 244). There was considerable variation in the 89.6% of patients who used adjunctive treatments at 1 year, including chemotherapy (64.3%), radiotherapy (57.6%), therapeutic lumbar puncture (31.5%), and Ommaya reservoir (14.5%). The main cost drivers at 1 year were chemotherapy ($62 026), radiation therapy ($37 076), and specialty drugs ($29 330). The prevalence of neurologic impairments was 46.9%, including radiculopathy (15.0%), paresthesia (12.3%), seizure episode/convulsive disorder not otherwise specified (11.0%), and ataxia (8.0%). Conclusions LC is a devastating condition with an overall poor prognosis. We present the largest study of LC in this real-world study, including current treatments, with an emphasis on HCRU. There is considerable variation in the treatment of LC and significant health care costs. [ABSTRACT FROM AUTHOR]

Background The risk of sport-related concussion (SRC) has emerged as a major public health concern. In rare instances, sport-related head injuries can be even more severe, such as subdural hemorrhage, epidural hemorrhage, or malignant cerebral edema. Unlike SRCs, sport-related structural brain injury (SRSBI) is rare, may require neurosurgical intervention, and can lead to permanent neurologic deficit or death. Data characterizing SRSBI are limited, and many have recognized the need to better understand these catastrophic brain injuries. The goal of the current series is to describe, in detail, the presentation, management, and outcomes of examples of these rare injuries. Case Description During the fall of 2015, three high school football players presented with acute subdural hemorrhages following in-game collisions and were treated at our institution within a span of 2 months. For the 2 athletes who required surgical intervention, a previous SRC was sustained within 4 weeks before the catastrophic event. One year after injury, 2 players have returned to school, though with persistent deficits. One patient remains nonverbal and wheelchair bound. None of the athletes has returned to sports. Conclusions Acute subdural hemorrhage resultant from an in-game football collision is rare. The temporal proximity of the reported SRSBIs to recent SRCs emphasizes the importance of return-to-play protocols and raises questions regarding the possibility of second impact syndrome. Although epidemiologic conclusions cannot be drawn from this small sample, these cases provide a unique opportunity to demonstrate the presentation, management, and long-term outcomes of SRSBI in American high school football. [ABSTRACT FROM AUTHOR]

Osteoporosis is a burgeoning public health problem for over 44 million people in the United States. The magnetic resonance imaging-based vertebral bone quality (VBQ) score and cervical VBQ (C-VBQ) score are two novel approaches that use data routinely gathered during preoperative evaluation to assess bone quality. The goal of this study was to investigate the relationship between the VBQ and C-VBQ scores. We performed a retrospective review of chart data for patients who underwent spine surgery for degenerative conditions between 2015 and 2022. Patients eligible for study inclusion had preoperative T1-weighted magnetic resonance imaging of the lumbar and cervical spine available for review. Demographics of each patient were collected. The VBQ score was determined by dividing the median signal intensity (SI) of the L1-L4 vertebral bodies by the SI of the cerebrospinal fluid at L3. The C-VBQ score was calculated by dividing the median SI of the C3-C6 vertebral bodies by the SI of the C2 cerebrospinal fluid space. Pearson's correlation test was utilized to evaluate the association between the scores. We identified 171 patients, with a mean age of 57.44 ± 11.79 years. The interrater reliability of the VBQ and C-VBQ measurements was excellent (intraclass correlation-coefficients were 0.89 and 0.84, respectively). A statistically significant, positive correlation was found between the VBQ score and the C-VBQ score (r = 0.757, P < 0.001). This is the first study, to our knowledge, to assess the degree to which the newly developed C-VBQ score correlates with the VBQ score. We found a strong positive correlation between the scores. [ABSTRACT FROM AUTHOR]

Introduction: Each year, rabies causes approximately 59,000 deaths worldwide, including approximately two deaths in the United States. Before 1960, dogs were a common reservoir of rabies in the United States; however, increasingly, species of wildlife (e.g., bats, raccoons) are the main reservoirs. This report characterizes human rabies deaths, summarizes trends in rabies mortality, and highlights current rabies risks in the United States.Methods: Rabies trends in the United States during 1938-2018 were analyzed using national rabies surveillance data. Data from the Healthcare Cost and Utilization Project for 2006-2014 were used to estimate the number of postexposure prophylaxis (PEP) visits per 100,000 persons during 2017-2018. The Centers for Medicare & Medicaid Services' average sales price data were used to estimate PEP costs.Results: From 1960 to 2018, a total of 125 human rabies cases were reported in the United States; 36 (28%) were attributed to dog bites during international travel. Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats. In 2018, approximately 55,000 persons sought PEP after contact with a potentially rabid animal.Conclusions and Comments: In the United States, wildlife rabies, especially in bats, continues to pose a risk to humans. Travelers also might be exposed to canine rabies in countries where the disease is still present; increased awareness of rabies while traveling abroad is needed. Vaccinating pets, avoiding contact with wildlife, and seeking medical care if one is bitten or scratched by an animal are the most effective ways to prevent rabies. Understanding the need for timely administration of PEP to prevent death is critical. [ABSTRACT FROM AUTHOR]

We examine changes in health insurance coverage and access to and utilization of health care before and after the national implementation of the Patient Protection and Affordable Care Act (ACA) among the U.S. adult immigrant population. Data from the 2011–2016 National Health Interview Survey are used to compare adult respondents in 2011–2013 (before the ACA implementation) and 2014–2016 (after the ACA implementation). Multivariable logistic regression analyses are used to compare changes over time. This study shows that the ACA has closed the coverage gap that previously existed between U.S. citizens and non-citizen immigrants. We find that naturalized citizens, non-citizens with more than 5 years of U.S. residency, and non-citizens with 5 years or less of U.S. residency reduced their probability of being uninsured by 5.81, 9.13, and 8.23%, respectively, in the first 3 years of the ACA. Improvements in other measures of access and utilization were also observed. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) can be complete or incomplete. The level of injury in SCI is defined as the most caudal segment with motor function rated at greater than or equal to 3/5, with pain and temperature preserved. The standard neurological classification of SCI provided by the American Spinal Injury Association (ASIA) assigns grades from ASIA A (complete SCI) through ASIA E (normal sensory/motor), with B, C, and D representing varying degrees of injury between these extremes. The most common causes of SCI include trauma (motor vehicle accidents, sports, violence, falls), degenerative spinal disease, vascular injury (anterior spinal artery syndrome, epidural hematoma), tumor, infection (epidural abscess), and demyelinating processes (). (SDC Figure 1, http://links.lww.com/BRS/B91)(Figure is included in full-text article.). [ABSTRACT FROM AUTHOR]

Reports on two fatal cases related to adenovirus infection in two young adults at a military training base in Illinois. Background on adenoviruses; History of adenoviral vaccines given to young adults in military training; Details of the cases; Conclusions.

OBJECTIVES: To describe the settings of care in which antipsychotics that nursing home (NH) residents received were likely to have been initiated. DESIGN: Cross‐sectional. SETTING: Iowa NHs. PARTICIPANTS: Fee‐for‐service Medicare beneficiaries who had NH stays between January 1, 2011, and December 31, 2014, and had new use of antipsychotics during their NH stays, defined as no antipsychotic use in NHs in the last 6 months. MEASUREMENTS: A linked dataset of Chronic Condition Data Warehouse Medicare claims and Long‐Term Care Minimum Data Set (MDS) 3.0 was used to determine care settings of antipsychotic initiations. RESULTS: Of 7,496 residents with new antipsychotic use in NHs, 4,794 (64.0%, 95% confidence interval (CI) = 62.9–65.0%) initiated them in NHs, 1,392 (18.6%, 95% CI 17.7–19.5%) appeared to have had them initiated in hospitals, and 1,310 (17.5%, 95% CI = 16.6–18.3%) had antipsychotics first dispensed as outpatients. Antipsychotics were commonly prescribed during the early NH stays, and 3,026 (40.4%, 95% CI = 39.3–41.5%) of the entire sample received antipsychotic therapy within the first 7 days after NH admissions. Fifty‐eight percent (n = 4,348) of the study residents initiating antipsychotics had potentially appropriate antipsychotic indications according toMDS records. CONCLUSION: Most residents initiated antipsychotic therapy in NHs, confirming that NH providers are appropriate primary target of interventions to reduce antipsychotic initiation in their residents. However, many antipsychotics were continued from other settings, indicating a need to evaluate the necessity of continued antipsychotic treatment after such transitions of care. J Am Geriatr Soc 66:1082–1088: 2018. [ABSTRACT FROM AUTHOR]

Much attention has been paid to government 'blunders' and 'policy disasters'. National political and administrative systems have been frequently blamed for being disproportionately prone to generating mishaps. However, little systematic evidence exists on the record of failures of policies and major public projects in other political systems. Based on a comparative perspective on blunders in government, this article suggests that constitutional features do not play a prominent role. In order to establish this finding, this article (a) develops theory-driven expectations as to the factors that are said to encourage blunders, (b) devises a systematic framework for the assessment of policy processes and outcomes, and (c) uses fuzzy-set qualitative comparative analysis to identify sets of causal conditions associated with particular outcomes (i.e., blunders). The article applies this novel approach to a set of particular policy domains, finding that constitutional features are not a contributory factor to blunders in contrast to instrument choice, administrative capacity and hyper-excited politics. [ABSTRACT FROM AUTHOR]